Visceral adiposity predicts post-operative Crohn's disease recurrence

D. Q. Holt, G. T. Moore, B. J. G. Strauss, A. L. Hamilton, P. De Cruz, M. A. Kamm

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Abstract

Background: Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. Aim: To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients. Methods: The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. Results: The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height2 >1.5 times the gender-specific mean experienced endoscopic recurrence at 18 months (compared to 47%) [relative risk 2.1, 95% CI 1.5-3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41% of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046). Conclusions: Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.

Original languageEnglish
Pages (from-to)1255 - 1264
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume45
Issue number9
DOIs
Publication statusPublished - May 2017

Cite this

@article{67bfa625b7c6418abb097e8704e4b537,
title = "Visceral adiposity predicts post-operative Crohn's disease recurrence",
abstract = "Background: Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. Aim: To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients. Methods: The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. Results: The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height2 >1.5 times the gender-specific mean experienced endoscopic recurrence at 18 months (compared to 47{\%}) [relative risk 2.1, 95{\%} CI 1.5-3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41{\%} of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046). Conclusions: Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.",
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Visceral adiposity predicts post-operative Crohn's disease recurrence. / Holt, D. Q.; Moore, G. T.; Strauss, B. J. G.; Hamilton, A. L.; De Cruz, P.; Kamm, M. A.

In: Alimentary Pharmacology and Therapeutics, Vol. 45, No. 9, 05.2017, p. 1255 - 1264.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Visceral adiposity predicts post-operative Crohn's disease recurrence

AU - Holt, D. Q.

AU - Moore, G. T.

AU - Strauss, B. J. G.

AU - Hamilton, A. L.

AU - De Cruz, P.

AU - Kamm, M. A.

PY - 2017/5

Y1 - 2017/5

N2 - Background: Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. Aim: To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients. Methods: The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. Results: The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height2 >1.5 times the gender-specific mean experienced endoscopic recurrence at 18 months (compared to 47%) [relative risk 2.1, 95% CI 1.5-3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41% of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046). Conclusions: Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.

AB - Background: Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. Aim: To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients. Methods: The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. Results: The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height2 >1.5 times the gender-specific mean experienced endoscopic recurrence at 18 months (compared to 47%) [relative risk 2.1, 95% CI 1.5-3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41% of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046). Conclusions: Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.

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DO - 10.1111/apt.14018

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VL - 45

SP - 1255

EP - 1264

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 9

ER -