Obesity in inflammatory bowel disease: A review of its role in the pathogenesis, natural history, and treatment of IBD

Abstract

In contrast to previous perceptions that inflammatory bowel disease (IBD) patients are generally malnourished and underweight, there is mounting evidence to suggest that rates of obesity in IBD now mirror that of the general population. IBD is an immune-mediated condition that appears to develop in individuals who have not only a genetic predisposition to immune dysregulation but also likely exposure to various environmental factors which further potentiate this risk. With the surge in obesity alongside the rising incidence of IBD, particularly in developing nations, the role that obesity may play, not only in the pathogenesis but also in the natural history of disease has become a topic of growing interest. Currently available data exploring obesity's impact on the natural history of IBD are largely conflicting, potentially limited by the use of body mass index as a surrogate measure of obesity at varying time points throughout the disease course. While there are pharmacokinetic data to suggest possible detrimental effects that obesity may have on the response to medical therapy, results in this realm are also inconsistent. Moreover, not only is it unclear whether weight loss improves IBD outcomes, little is known about the safety and efficacy of available weight-loss strategies in this population. For these reasons, it becomes increasingly important to further understand the nature of any interaction between obesity and IBD.

Systematic review and meta-analysis: association between obesity/overweight and surgical complications in IBD

“…Current pharmacological treatment for IBD mainly includes 5-aminosalicylate, corticosteroids, anti-TNF (tumor necrosis factor) drugs (infliximab (IFX), adalimumab (ADA)), antiintegrin preparation (vedolizumab (VDZ)) [49][50][51][52][53], all of which may reduce the occurrence of infectious complications to some extent. Since the pharmacokinetics of the medications in obese patients are not the same as that in the normal, the efficacy of these drugs may be altered in obese patients.…”

“…In our study, among noninfectious complications, obese IBD patients had an increased risk of visceral injury. Many problems such as obesity-induced changes in abdominal contour and increased abdominal wall thickness pose a greater challenge to the patient's surgery [49]. Bleeding, complicated surgery, and prolonged surgery are more common conditions [16,22], which can subsequently lead to visceral injury.…”

Overweight and abdominal fat are associated with normal bone mineral density in patients with ulcerative colitis

“…The role of obesity in patients with IBD is still uncertain, although initially it is believed that the greater inflammatory potential of adipose tissue could have a negative impact on the evolution of the disease in these patients[ 32 , 33 ]. The effect of body weight on bone mass can be attributed to the mechanical compression of weight on the skeleton, and in response, it increases bone mass to accommodate greater load[ 34 ].…”

Impact of Obesity on the Course of Management of Inflammatory Bowel Disease—A Review

“…The presence of creeping fat (abdominal fat migrating to the wall of the inflamed small intestine) in CD patients has been proven to create a specific environment for cytokines in comparison to splanchnic or subcutaneous storage of fat. As a result, a hypothesis was proposed that the overexpression of various proinflammatory molecules in the course of IBD might provoke the underlying disease-specific inflammation [ 50 ]. Figure 1 presents the general relationships between obesity, adipokines, and IBD.…”