scholarly journals Hepatic Steatosis, Rather Than Underlying Obesity, Increases the Risk of Infection and Hospitalization for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Adriana Roca-Fernández ◽  
Andrea Dennis ◽  
Rowan Nicholls ◽  
John McGonigle ◽  
Matthew Kelly ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Economic Status ◽  
Liver Fat ◽  
Secondary Outcome ◽  
Proton Density ◽  
Uk Biobank ◽  
Risk Of Infection ◽  
Liver Iron ◽  
Increased Risk

Objective: Obesity is a risk factor for SARS-COV2 infection and is often associated with hepatic steatosis. The aim of this study was to determine if pre-existing hepatic steatosis affects the risk of infection and severity for COVID-19.Design: Prospective cohort study (UK Biobank). Univariate and stepwise multivariate logistic regression analyses were performed on liver phenotypic biomarkers to determine if these variables increased risk of testing positive and being hospitalized for COVID-19; then compared to previously described risk factors associated with COVID-19, including age, ethnicity, gender, obesity, socio-economic status.Setting: UK biobank study.Participants: 502,506 participants (healthy at baseline) in the UK Biobank, of whom 41,791 underwent MRI (aged 50–83) for assessment of liver fat, liver fibro-inflammatory disease, and liver iron. Positive COVID-19 test was determined from UK testing data, starting in March 2020 and censored in January 2021.Primary and Secondary Outcome Measures: Liver fat measured as proton density fat fraction (PDFF%) MRI and body mass index (BMI, Kg/m2) to assess prior to February 2020 using MRI of the liver to assess hepatic steatosis.Results: Within the imaged cohort (n = 41, 791), 4,458 had been tested and 1,043 (2.49% of the imaged population) tested positive for COVID-19. Individuals with fatty liver (≥10%) were at increased risk of testing positive (OR: 1.35, p = 0.007) and those participants with obesity and fatty liver, were at increased risk of hospitalization with a positive test result by 5.14 times (p = 0.0006).Conclusions: UK Biobank data revealed obese individuals with fatty liver disease were at increased risk of infection and hospitalization for COVID-19. Public policy measures and personalized medicine should be considered in order to protect these high-risk individuals.

scholarly journals High Liver Fat Associates with Higher Risk of Developing Symptomatic COVID-19 Infection - Initial UK Biobank Observations

2020 ◽  
Author(s):  
A Roca-Fernández ◽  
A Dennis ◽  
R Nicolls ◽  
J McGonigle ◽  
M Kelly ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Disease ◽  
Fatty Liver ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Liver Fat ◽  
Uk Biobank ◽  
Liver Iron ◽  
Symptomatic Disease ◽  
Increased Risk

ABSTRACTBackgroundA high proportion of COVID-19 patients develop acute liver dysfunction. Early research has suggested that pre-existing fatty liver disease may be a significant risk factor for hospitalisation. Liver fat, in particular, is a modifiable parameter and can be a target for public health policy and individual patient plans. In this study we aimed to assess pre-existing liver disease as a risk factor for developing symptomatic COVID-19.MethodsFrom 502,506 participants from the UK Biobank, 42,146 underwent MRI (aged 45–82), and had measures of liver fat, liver fibroinflammatory disease and liver iron. Patients were censored on May 28th to determine how many had tested for COVID-19 with symptomatic disease. UK testing was restricted to those with symptoms in hospital. COVID-19 symptoms included fever, dry cough, sore throat, diarrhoea and fatigue. Univariate analysis was performed on liver phenotypic biomarkers to determine if these variables increased risk of symptomatic COVID-19, and compared to previously described risk factors associated with severe COVID-19, including to age, ethnicity, gender and obesity,FindingsIncreased liver fat was associated with a higher risk for symptomatic confirmed COVID-19 in this population in univariate analysis(OR:1.85, p = 0.03). In obese participants, only those with concomitant fatty liver(≥10%) were at increased risk(OR:2.96, p = 0.02), with those having normal liver fat (< 5%) showing no increased risk(OR:0.36, p = 0.09).ConclusionsUK Biobank data demonstrated an association between pre-existing liver disease and obesity with severe COVID-19, with higher proportions of liver fat in obese individuals a likely risk factor for symptomatic disease and severity.Public policy measures to protect patients with liver disease who may have almost double the risk of the general population should be considered, especially as dietary and pharmacological strategies to reduce body weight and liver fat already exist.FundingUniversity of Oxford, Innovate UK, UK Biobank. Authors are employees of Perspectum Ltd.

Multi-echo Dixon and breath-hold T2-corrected multi-echo single-voxel MRS for quantifying hepatic iron overload in rabbits

2021 ◽  
pp. 028418512110630
Author(s):  
Fanyu Zhao ◽  
Yidi Chen ◽  
Huiting Zhang ◽  
Chenhui Li ◽  
Liling Long
Keyword(s):  
Iron Overload ◽  
Fatty Liver ◽  
Iron Concentration ◽  
Liver Fat ◽  
Breath Hold ◽  
Proton Density ◽  
Hepatic Iron ◽  
Diagnostic Efficiency ◽  
Liver Iron ◽  
Single Voxel

Background Three-dimensional (3D) multi-echo-Dixon (ME-Dixon) and breath-hold T2-corrected multi-echo single-voxel MR spectroscopy (HISTO) can simultaneously quantify liver fat and liver iron. However, their diagnostic efficacy and application scope for quantitative iron in co-existing fatty liver have not been adequately evaluated. Purpose To evaluate the accuracy of ME-Dixon and HISTO for quantitative analysis of hepatic iron in rabbits with iron deposition and fatty liver using liver–iron concentration (LIC) as a reference standard. Material and Methods ME-Dixon, HISTO, and conventional two-dimensional multi-echo gradient echo (GRE) sequences were performed on 42 rabbits. The following parameters were calculated: R2* from ME-Dixon and GRE; proton density fat fraction (PDFF) from the ME-Dixon, HISTO (normal TE range), and HISTO-H (extended TE range); and R2_water from HISTO and HISTO-H. The LIC and liver–fat concentration (LFC) were measured through chemical analysis, and their relationship with the MRI parameters were assessed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to evaluate the diagnostic efficiency. Results LIC was significantly correlated with R2_HISTO-H, R2*_Dixon, and R2*_GRE ( r = 0.858, 0.910, 0.931, respectively; P < 0.001) and weakly with R2_HISTO ( r = 0.424; P = 0.008). A strong correlation was also observed between the LFC and PDFF obtained from HISTO, HISTO-H, and ME-Dixon ( r = 0.776, 0.811, 0.888, respectively; P < 0.001). ME-Dixon showed the best performance with moderate iron overload (AUC = 0.983). Conclusion 3D ME-Dixon is useful for quantifying the LIC, especially with co-existing fatty liver. Its diagnostic performance is also superior to that of the HISTO sequence.

scholarly journals Quantification of Hepatorenal Index for Computer-Aided Fatty Liver Classification with Self-Organizing Map and Fuzzy Stretching from Ultrasonography

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Kwang Baek Kim ◽  
Chang Won Kim
Keyword(s):  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Learning Algorithm ◽  
Fat Content ◽  
Liver Fat ◽  
Self Organizing Map ◽  
Liver Fat Content ◽  
Computer Aided ◽  
Good Set ◽  
Self Organizing

Accurate measures of liver fat content are essential for investigating hepatic steatosis. For a noninvasive inexpensive ultrasonographic analysis, it is necessary to validate the quantitative assessment of liver fat content so that fully automated reliable computer-aided software can assist medical practitioners without any operator subjectivity. In this study, we attempt to quantify the hepatorenal index difference between the liver and the kidney with respect to the multiple severity status of hepatic steatosis. In order to do this, a series of carefully designed image processing techniques, including fuzzy stretching and edge tracking, are applied to extract regions of interest. Then, an unsupervised neural learning algorithm, the self-organizing map, is designed to establish characteristic clusters from the image, and the distribution of the hepatorenal index values with respect to the different levels of the fatty liver status is experimentally verified to estimate the differences in the distribution of the hepatorenal index. Such findings will be useful in building reliable computer-aided diagnostic software if combined with a good set of other characteristic feature sets and powerful machine learning classifiers in the future.

scholarly journals The association of hepatic steatosis and fibrosis with heart failure and mortality

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiyun Park ◽  
Gyuri Kim ◽  
Hasung Kim ◽  
Jungkuk Lee ◽  
You-Bin Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Population ◽  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Patient Group ◽  
Cox Regression ◽  
Nonalcoholic Fatty Liver ◽  
Fatty Liver Index ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic disease and independently affects the development of cardiovascular (CV) disease. We investigated whether hepatic steatosis and/or fibrosis are associated with the development of incident heart failure (iHF), hospitalized HF (hHF), mortality, and CV death in both the general population and HF patients. Methods We analyzed 778,739 individuals without HF and 7445 patients with pre-existing HF aged 40 to 80 years who underwent a national health check-up from January 2009 to December 2012. The presence of hepatic steatosis and advanced hepatic fibrosis was determined using cutoff values for fatty liver index (FLI) and BARD score. We evaluated the association of FLI or BARD score with the development of iHF, hHF, mortality and CV death using multivariable-adjusted Cox regression models. Results A total of 28,524 (3.7%) individuals in the general population and 1422 (19.1%) pre-existing HF patients developed iHF and hHF respectively. In the multivariable-adjusted model, participants with an FLI ≥ 60 were at increased risk for iHF (hazard ratio [HR], 95% confidence interval [CI], 1.30, 1.24–1.36), hHF (HR 1.54, 95% CI 1.44–1.66), all-cause mortality (HR 1.62, 95% CI 1.54–1.70), and CV mortality (HR 1.41 95% CI 1.22–1.63) in the general population and hHF (HR 1.26, 95% CI 1.21–1.54) and all-cause mortality (HR 1.54 95% CI 1.24–1.92) in the HF patient group compared with an FLI < 20. Among participants with NAFLD, advanced liver fibrosis was associated with increased risk for iHF, hHF, and all-cause mortality in the general population and all-cause mortality and CV mortality in the HF patient group (all p < 0.05). Conclusion Hepatic steatosis and/or advanced fibrosis as assessed by FLI and BARD score was significantly associated with the risk of HF and mortality.

scholarly journals Effect of Short Term Intensive Lifestyle Intervention on Hepatic Steatosis Indexes in Adults with Obesity and/or Type 2 Diabetes

2019 ◽  
Vol 8 (6) ◽  
pp. 851 ◽  
Author(s):  
Elisa Reginato ◽  
Roberto Pippi ◽  
Cristina Aiello ◽  
Emilia Sbroma Tomaro ◽  
Claudia Ranucci ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Lifestyle Intervention ◽  
Intervention Program ◽  
Liver Fat ◽  
Alcoholic Fatty Liver ◽  
Lifestyle Intervention Program ◽  
Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) has an estimated prevalence of 20–30% in the general population and even higher in individuals with metabolic risk factors. The aim of this study was to evaluate the effect of a lifestyle intervention program on surrogate markers of hepatic steatosis in obesity and/or type 2 diabetes patients, enrolled in the C.U.R.I.A.Mo. (Centro Universitario di Ricerca Interdipartimentale Attività Motoria) trial. Methods: 102 subjects (56 females and 46 males, aged between 23 and 78) with type 2 diabetes, obesity or a BMI of at least 25 kg/m2 with comorbidities, participated in the intensive phase of a multidisciplinary lifestyle intervention program at the Healthy Lifestyle Institute of the University of Perugia (C.U.R.I.A.Mo.). Six indices related to NAFLD (Visceral Adiposity Index, Fatty Liver index, Non-Alcoholic Fatty Liver Disease liver fat score and liver fat equation, hepatic steatosis index and TyG index) were calculated before and after a three-month multidisciplinary lifestyle intervention. Results: The intervention improved the anthropometric and clinical parameters in the total population, the obese and/or diabetics. Data showed a significant weight loss, a reduced waist circumference, triglycerides, and an improvement in Mediterranean diet adherence. Hepatic steatosis indices were significantly reduced in the total population and in different subgroups (males, females, obesity and diabetes).

scholarly journals Noninvasive Quantification of Hepatic Steatosis: Relationship Between Obesity Status and Liver Fat Content

2014 ◽  
Vol 6 (1) ◽  
pp. 16-24 ◽  
Author(s):  
S. C. McLeay ◽  
G. A. Morrish ◽  
T. K. Ponnuswamy ◽  
B. Devanand ◽  
M. Ramanathan ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Liver Volume ◽  
Fat Content ◽  
Liver Fat ◽  
Normal Body Mass Index ◽  
Liver Fat Content ◽  
Total Liver Volume ◽  
Total Liver ◽  
Obese Subjects

The aim of this study was to assess and compare fat content within the liver for normal (body mass index (BMI) < 25 kg/m2), overweight (25-30 kg/m2) and obese (≥ 30 kg/m2) subjects using a noninvasive, non-contrast computed tomography (CT) quantification method. Adult subjects aged 18-60 yrs scheduled to undergo CT examination of the abdominal region were recruited for this study, stratified across BMI categories. Liver volume, fat content, and lean liver volume were determined using CT methods. A total of 100 subjects were recruited, including 30 normal weight, 31 overweight, and 39 obese. Total liver volume increased with BMI, with mean values of 1138 ± 277, 1374 ± 331, and 1766 ± 389 cm3 for the normal, overweight, and obese, respectively (P < 0.001), which was due to an increase in both liver fat content and lean liver volume with BMI. Some obese subjects had no or minimal hepatic fat content. The prevalence of mild fatty liver in this study of 100 subjects was overestimated for all BMI categories using a range of qualitative diagnostic measures, with predicted prevalence of fatty liver in obese subjects ranging from 76.9% for liver-to-spleen ratio ≤ 1.1 to 89.7% for liver attenuation index (liver HU - spleen HU) ≤ 40, compared to 66.7% by quantification of fat content. Results show that total liver volume increases with BMI, however, not all obese subjects display fatty infiltration of the liver. CT quantification of liver fat content may be suitable for accurate diagnosis of hepatic steatosis in clinical practice and assessment of donor livers for transplantation.

scholarly journals Surface-Displayed Amuc_1100 From Akkermansia muciniphila on Lactococcus lactis ZHY1 Improves Hepatic Steatosis and Intestinal Health in High-Fat-Fed Zebrafish

2021 ◽  
Vol 8 ◽  
Author(s):  
Feng-Li Zhang ◽  
Ya-Lin Yang ◽  
Zhen Zhang ◽  
Yuan-Yuan Yao ◽  
Rui Xia ◽  
...  
Keyword(s):  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Lactococcus Lactis ◽  
High Fat Diet ◽  
Lipid Synthesis ◽  
Intestinal Barrier ◽  
Liver Fat ◽  
Intestinal Health ◽  
High Fat ◽  
Recombinant Bacteria

Fatty liver and intestinal barrier damage were widespread in most farmed fish, which severely restrict the development of aquaculture. Therefore, there was an urgent need to develop green feed additives to maintain host liver and intestinal health. In this study, a probiotic pili-like protein, Amuc_1100 (AM protein), was anchored to the surface of Lactococcus lactis ZHY1, and the effects of the recombinant bacteria AM-ZHY1 on liver fat accumulation and intestinal health were evaluated. Zebrafish were fed a basal diet, high-fat diet, and high-fat diet with AM-ZHY1 (108 cfu/g) or control bacteria ZHY1 for 4 weeks. Treatment with AM-ZHY1 significantly reduced hepatic steatosis in zebrafish. Quantitative PCR (qPCR) detection showed that the expression of the lipogenesis [peroxisome-proliferator-activated receptors (PPARγ), sterol regulatory element-binding proteins-1c (SREBP-1c), fatty acid synthase (FAS), and acetyl-CoA carboxylase 1 (ACC1)] and lipid transport genes (CD36 and FABP6) in the liver were significantly downregulated (p &lt; 0.05), indicating that AM-ZHY1 could reduce liver fat accumulation by inhibiting lipid synthesis and absorption. Moreover, supplementing AM-ZHY1 to a high-fat diet could significantly reduce serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, indicating that liver injury caused by high-fat diets was improved. The expression of tumor necrosis factor (TNF)-a and interleukin (IL)-6 in the liver decreased significantly (p &lt; 0.05), while IL-1β and IL-10 did not change significantly in the AM-ZHY1 group. Compared to the high-fat diet-fed group, the AM-ZHY1 group, but not the ZHY1 group, significantly increased the expression of intestinal tight junction (TJ) proteins (TJP1a, claudina, claudin7, claudin7b, claudin11a, claudin12, and claudin15a; p &lt; 0.05). Compared to the high-fat diet group, the Proteobacteria and Fusobacteria were significantly reduced and increased in the AM-ZHY1 group, respectively. In conclusion, the recombinant bacteria AM-ZHY1 has the capacity to maintain intestinal health by protecting intestinal integrity and improving intestinal flora structure and improving fatty liver disease by inhibiting lipid synthesis and absorption. This study will lay a foundation for the application of AM protein in improving abnormal fat deposition and restoring the intestinal barrier in fish.

scholarly journals Hepatic Steatosis in Patients With Single Ventricle and a Fontan Circulation

2021 ◽  
Author(s):  
David A. Katz ◽  
Daniel Peck ◽  
Adam M. Lubert ◽  
Mathias Possner ◽  
Faizeen Zafar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Liver Disease ◽  
Magnetic Resonance ◽  
Hepatic Steatosis ◽  
Fontan Procedure ◽  
Subcutaneous Fat ◽  
Fontan Circulation ◽  
Liver Fat ◽  
Proton Density ◽  
Resonance Imaging

Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. This study examined the prevalence and associations of hepatic steatosis in patients with a Fontan circulation. Methods and Results This was a single‐center retrospective study of 95 patients with a Fontan circulation with liver magnetic resonance imaging performed between 2012 and 2019. The average age at magnetic resonance imaging was 21.5±8.5 years. The percent liver fat signal was determined using magnetic resonance chemical shift‐encoded proton density fat fraction imaging. Hepatic steatosis was defined as liver fat ≥5% and was present in 10.5% of the cohort. The presence of hepatic steatosis was associated with higher body mass index (29±4 versus 24±6 kg/m 2 , P =0.006), a higher frequency of obesity (50% versus 12%, P =0.015), lower high‐density lipoprotein cholesterol (35±9 versus 43±14 mg/dL, P =0.050), and greater subcutaneous fat thickness (2.6±0.7 versus 1.8±1.0 cm, P =0.043). There was no association between hepatic steatosis and cardiovascular imaging or hemodynamic variables from cardiac catheterization. Conclusions Risk factors for hepatic steatosis in patients with Fontan circulation include obesity and dyslipidemia, similar to what is seen in the general population. Fontan hemodynamics were not associated with hepatic steatosis.

scholarly journals Metabolic Syndrome (MetS) as a Predictor of Fatty Liver in HIV Infected Adults from the Miami Adult Studies on HIV (MASH) Cohort (FS12-06-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Colby Teeman ◽  
Yongjun Huang ◽  
Qingyun Liu ◽  
Jacqueline Hernandez ◽  
Javier Tamargo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Disease ◽  
Fatty Liver ◽  
Liver Steatosis ◽  
Liver Fat ◽  
Proton Density ◽  
People Living With Hiv ◽  
Serum Triglycerides ◽  
Significant Difference ◽  
Stage 1

Abstract Objectives One of the major comorbidities among people living with HIV (PLWH) is liver disease. MetS is common in this population and may also play a role in the development of liver disease. In order to better understand the mechanisms of liver disease in PLWH, it is important to investigate the relationship between components of MetS and the risk of fatty liver, an early precursor to liver disease. The objective of this study was to determine if the 5 criteria used to diagnose MetS contribute to liver steatosis. Methods Crossectional analyses of data from the MASH cohort were analyzed. Waist circumference (WC) and blood pressure (BP) were measured by a research nurse. Serum triglycerides (TRG), glucose (GLU), and HDL were determined in fasting by LabCorp. Liver fat % was estimated with proton density fat fraction using Magnetic Resonance Elastography conducted on a 3T Siemens MAGNETOM Prisma MRI. Liver fat >5% was defined as stage 1 steatosis. Components of MetS were taken from the NCEP ATP III definition of MetS. Spearman correlations and logistic regression were used for analyses. Results A total of 324 PLWH aged 53.5 ± 7.5 years were included. Liver fat% was correlated with WC (r = 0.394, P < 0.001), TRG (r = 0.332, P < 0.001), GLU (r = 0.358, P < 0.001), and systolic BP (r = 0.183, P = 0.011), inversely correlated with HDL (r = −0.236, P = 0.001), and trended toward significance with diastolic BP (r = 0.133, P = 0.065). Participants with stage 1 steatosis had a larger WC (41.02in ± 5.3 vs 36.95 ± 5.5, P = 0.001), higher TRG (210.3 mg/dL ± 173.9 vs 121.3 ± 67.9, P = 0.002), and higher GLU (126.1 mg/dL ± 77.7 vs 93.92 ± 50.8, P = 0.001) than those without steatosis. No significant difference was found for HDL cholesterol, SBP, or DBP. A logistic regression model that included all 5 MetS criteria and was controlled for age, gender, and alcohol AUDIT score >8 found that WC (OR 1.11, 95% CI 1.01–1.23, P = 0.030), TRG (OR 1.01, 95% CI 1.00–1.01, P = 0.040), and GLU (OR 1.01, 95% CI 1.00–1.03, P = 0.033) are significant predictors of stage 1 steatosis. Conclusions WC, TRG, and GLU, three of the 5 criteria for diagnosing MetS were significant predictors of stage 1 steatosis in PLWH. Future studies investigating the risk of liver disease progression in PLWH need to account for these confounding factors as they explore HIV specific mechanisms for liver disease. Funding Sources National Institutes on Drug Abuse #5UO1DA040381.

P101 SARCOPENIA IS ASSOCIATED WITH INCREASED RISK OF INFECTION IN IBD PATIENTS OLDER THAN 50 YEARS STARTING BIOLOGIC MEDICATIONS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S3-S3
Author(s):  
James Campbell ◽  
Levi Teigen ◽  
Ghislaine Feussom ◽  
Kathleen Price ◽  
Rebecca Cogswell ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Response ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Response To Therapy ◽  
Secondary Outcome ◽  
Risk Of Infection ◽  
Skeletal Muscle Index ◽  
Increased Risk ◽  
One Year

Abstract Background The relationship between sarcopenia and clinical outcomes outside of the post-operative setting has not been well-studied in IBD patients. We aimed to characterize the prevalence of sarcopenia and its association with adverse events and clinical response in IBD patients starting on new biologic medications. Methods We identified a retrospective cohort of adult (≥18 years old) IBD patients at the University of Minnesota with an abdominal CT or MRI within 6 months prior to or one month after starting a new biologic medication. Baseline demographics, disease severity (based on Physician’s Global Assessment from GI encounters), laboratory values and clinical outcomes for one year after the start of medications were obtained from chart review. The primary endpoint was incidence of adverse events (defined as infection, need for surgery, or hospitalization) within one year after medication start. The secondary outcome was clinical response as assessed based on clinical, endoscopic, and radiographic follow-up. Skeletal muscle index (SMI) measures were obtained from CT/MRI images at the L3 vertebral level. Published cut-offs (SMI of 38.5 cm2/m2 for women and 52.4 cm2/m2 for men) were used to determine the presence of sarcopenia. Associations between sarcopenia and outcomes were analyzed using logistic regression and age stratification was performed. Results Ninety-four patients (74 CD, 20 UC, 47% male, mean age 38 years) were included in the analysis. The majority of patients had moderate disease severity or worse (83%) at the time of medication start, and 75% were started on anti-TNF medications. Overall prevalence of sarcopenia was 57% (57% CD, 60% UC). In the entire cohort, sarcopenia was not associated with increased rates of adverse events (OR = 0.516, 95% CI 0.217–1.225; p= 0.1334). However, in patients ≥ 50 years of age (n=23), those with sarcopenia had higher risk of infection at 1 year compared to those without sarcopenia (85% vs. 20%; OR = 21.99, 95% CI 3.086–262.515; p = 0.0051). The majority of infections were those that required antibiotics or antivirals, but not hospitalization. Examples included sinusitis, upper respiratory infections, periodontitis, urinary tract infection, herpes simplex, and two cases of C. difficile. Furthermore, when controlling for disease duration and concomitant steroid use, the association between sarcopenia and infection remained significant. In this age subgroup, there was no association between sarcopenia and clinical response to therapy. Conclusions In our cohort, sarcopenia was present in the majority of adult IBD patients starting new biologic medications. In patients ≥ 50 years old, sarcopenia was associated with an increased risk of infections. Further work is needed to validate these findings and to understand which patients may benefit from sarcopenia assessment prior to biologic start.

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