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A RETROSPECTIVE ANALYSIS OF FAT COMPOSITION IN A COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Ciaran McHale 1, Khalid Gehani 1, Margaret Walshe 1, Subhasish Sengupta 1, Aidan Quinn 1, John Keohane 1

Affiliations

1 Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland

Summary

AI Generated

A retrospective CT study of 201 IBD patients found visceral obesity in 32% of patients, with ulcerative colitis patients showing higher visceral-to-subcutaneous fat ratios than Crohn's disease patients, and thiopurine monotherapy associated with lower visceral fat.

Patients with ulcerative colitis had 5.2% higher VAT:SAT ratio compared to Crohn's disease patients (p=0.036).
Thiopurine monotherapy was associated with 5.6% lower VAT:SAT compared to patients not on thiopurines (p=0.038), while combination therapy (thiopurine plus biologic) showed 9.02% higher VAT:SAT than thiopurine alone (p=0.058).
No significant difference in fat composition or waist circumference was found between IBD patients and age-gender matched controls.
Waist circumference showed strong correlation with visceral adipose tissue (r=0.809), and age was significantly associated with multiple surgeries (p=0.001).
The study analyzed CT scans at the L3 level in 122 Crohn's disease and 79 ulcerative colitis patients, with visceral obesity defined as VAT:SAT ratio of 40%.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The role of adipose tissue in IBD is yet to be fully elucidated. Adipose tissue is distributed into two main compartments ; Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Previous studies suggest that VAT may be a predictor of disease progression particularly in Crohn’s disease (CD)(1). VAT:SAT ratio, and not BMI, has been associated with a structuring CD phenotype, faecal calprotectin and quality of life (2). In previous studies, visceral obesity has been defined as a VAT area of 100cm² as well as VAT:SAT 40% (3-4). We sought to investigate the difference in fat composition of patients with IBD using computed tomography (CT).

Aims & Methods

Patients with IBD were selected randomly from an IBD database in our centre. Age and gender matched controls were selected for comparison.
Using TeraRecon software, we retrospectively analyzed CT results to obtain the following parameters; VAT Area (cm²), SAT Area (cm²), VAT:SAT Ratio (VAT/VAT+SAT - %) and Waist Circumference (WC) (cm). Measurements were taken at the level of the umbilicus (L3). Data was also collected retrospectively from outpatient clinic letters, previous biopsy reports and endoscopy reports. Statistical analysis was preformed using Minitab.

Results

A random sample of 480 patients were identified. 279 of these patients were excluded, leaving 201 patients which were analysed.
The majority of this cohort were female (n=102). The mean age was 43. 122 patients had CD and 79 patients had Ulcerative colitis (UC). At the time of imaging, 95 patients were on biologics with a further 29 patients progressing onto biologics later in their treatment. Visceral obesity (40% VAT:SAT) was found in 31.8% of patients. 46.8% of patients had VAT 100cm². Male gender accounted for 17.27% more VAT:SAT in comparison to female gender (p =0.000). VAT showed a strong correlation with WC (r =0.809).
No significant difference was found in fat composition or WC between a sample of patients with IBD and their controls.
Patients with UC had 5.2% more VAT:SAT compared to patients with CD (p=0.036). Males had a 17.3% higher VAT:SAT (p=0.000). There was no significant differences noted between those on biologics vs. non-biologic treatments. However, those taking thiopurines (6-Mercaptopurine (6-MP)/Azathioprine) had 5.6% lower VAT:SAT compared to those not (p=0.038). Combination therapy (thiopurine + Biologic) had 9.02% more VAT:SAT than those on thiopurine monotherapy (p=0.058).
Binary logistic regression models were used to identify factors associated with markers of disease severity (surgery, multiple surgeries and multiple biologic use). Age was found to be a significant associated factor with multiple surgeries (coeff 0.0641) (p=0.001).

Conclusion

Visceral obesity was found in at least 30% of patients in this IBD cohort. This was in comparison to 44%of the age-gender matched control group.
We report no significant difference in body fat composition or WC in age and gender matched controls and a random sample of patients with IBD. Rising obesity levels in the community may account for this. However, in this cohort, patients with UC had a higher % VAT:SAT compared to those with CD. Regarding treatment, thiopurine monotherapy was associated with lower %VAT:SAT. This may suggest that combination therapy may be required in those with higher %VAT:SAT to treat a more aggressive disease course.
Age is a known risk factor for a more severe disease course in IBD. This was in keeping with our model.
Of note, WC showed a strong correlation with VAT. This may be a more acceptable alternative for monitoring VAT rather than CT imaging.

References

Tsai, Y.-W. et al. (2020) “Adipokine-modulated immunological homeostasis shapes the pathophysiology of inflammatory bowel disease,” International Journal of Molecular Sciences, 21(24), p. 9564. Available at:https://doi.org/10.3390/ijms21249564.
Bryant, R.V. et al. (2018) “Visceral adipose tissue is associated with stricturing crohn’s disease behavior, fecal calprotectin, and quality of life,” Inflammatory Bowel Diseases, 25(3), pp. 592–600. Available at: https://doi.org/10.1093/ibd/izy278.
Kong, M. et al. (2022) “Assessing visceral obesity and abdominal adipose tissue distribution in healthy populations based on computed tomography: A large multicenter cross-sectional study,” Frontiers in Nutrition, 9. Available at: https://doi.org/10.3389/fnut.2022.871697.
Matsuzawa, Y. et al. (1995) “Visceral fat accumulation and cardiovascular disease,” Obesity Research, 3(S5). Available at: https://doi.org/10.1002/j.1550-8528.1995.tb00481.x.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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