Obesity in Inflammatory Bowel Disease: Gains in Adiposity despite High Prevalence of Myopenia and Osteopenia

Abstract

Background: Rising rates of obesity have been reported in patients with inflammatory bowel disease (IBD); however, prospective data is lacking. The aim of this study is to prospectively evaluate body composition in adults with IBD over 24 months. Methods: Whole body dual energy X-ray absorptiometry (DXA) data was performed at 0 months, 12 months, and 24 months. Bone mineral density (BMD), fat mass index (FMI (kg)/height (m2)), appendicular skeletal muscle index (ASMI (kg)/height (m2)), visceral adipose tissue and the visceral adipose height index (VHI, VAT area (cm3)/height (m2)), and clinical and anthropometric assessments were performed at each time point. Multivariable linear mixed effects regression analyses were performed. Results: Initially, 154 participants were assessed at baseline (70% Crohn’s disease, 55% male, median age 31 years), of whom 129 underwent repeated DXA at 12 months, and 110 underwent repeated DXA at 24 months. Amongst those undergoing repeated DXA, their body mass index (BMI) significantly increased over time, such that by 24 months, 62% of patients were overweight or obese (annual change BMI β = 0.43, 95%CI = [0.18, 0.67], p = 0.0006). Gains in BMI related to increases in both FMI and VHI (β = 0.33, 95%CI = [0.14, 0.53], p = 0.0007; β = 0.08, 95%CI = [0.02, 0.13], p = 0.001; respectively), whereas ASMI decreased (β = −0.07, 95%CI = [−0.12, −0.01], p = 0.01) with a concordant rise in rates of myopenia (OR = 3.1 95%CI = [1.2, 7.7]; p = 0.01). Rates of osteopenia and osteoporosis were high (37%), but remained unchanged over time (p = 0.23). Conclusion: Increasing rates of obesity in patients with IBD coincide with decreases in lean muscle mass over time, while high rates of osteopenia remain stable. These previously undocumented issues warrant attention in routine care to prevent avoidable morbidity.

Mechanisms Underlying Bone Loss Associated with Gut Inflammation

“…Those mice displayed significant trabecular bone loss with increased TNF-α in bone and colon, which is negatively correlated with OB activity, leading to decreased bone formation rate, but few effects on cortical bone. Interestingly, low dose DSS treatment induces a redistribution of fat storage from subcutaneous to visceral sites, which is reported to be more proinflammatory and consistent with disease pathologies (e.g., Creeping fat accumulation) found in CD patients [146][147][148]. Studies from Harris et al reported a transition in bone composition occurred following active IBD phases [93].…”

Role of Human Body Composition Analysis and Malnutrition Risk Questionnaire in the Assessment of Nutritional Status of Patients With Initially Diagnosed Crohn's Disease

“…In the population with normal BMI, the muscular mass reduction may be still present due to the proportional imbalance of the body components. Bryant et al (31) found that the obesity in obese patients with CD increased with the muscular mass reduction. In clinically treated patients with CD, an elevated BMI does not necessarily mean an improvement of disease condition, and body composition analysis should be done to avoid BMI increase due to water content increase (edema), body fat elevation, and muscular mass reduction.…”

Role of Obesity, Mesenteric Adipose Tissue, and Adipokines in Inflammatory Bowel Diseases

“…In many patients with IBD and particularly with CD, the body composition, reflected by as proportions of bone, fat, and lean body mass may be abnormal. Sarcopenia, defined as depletion of muscle mass and impaired muscle function [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82], is an important feature in this disease [70][71][72]81]. Depletion of lean body mass and loss of muscle strength associated with lower QoL and higher mortality and morbidity commonly occurs as part of the aging process [65,77].…”