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

Abstract

Purpose While the prevalence of obesity in inflammatory bowel disease (IBD) patients is rapidly increasing, it is unclear whether obesity affects surgical outcomes in this population. This meta-analysis aims to assess the impact of obesity/overweight on patients undergoing surgery for IBD. Methods Databases (PubMed, Web of Science, Cochrane Library, and Springer) were searched through September 2021. The meta-analysis included patients with surgically treated IBD to investigate the impact of obesity/overweight on this population. Primary outcomes included overall complications, infectious complications, noninfectious complications, and conversion to laparotomy. Results Fifteen studies totaling 12,622 IBD patients were enrolled. Compared with nonobese (including overweight) patients, obese IBD patients have increased the risk in terms of overall complications (OR = 1.45, p < 0.001), infectious complications (OR = 1.48, p = 0.003) (especially wound complications), as well as conversion to laparotomy (OR = 1.90, p < 0.001). Among the noninfectious complications, only the incidence of visceral injury (OR = 2.36, p = 0.05) had significantly increased. Compared with non-overweight patients, the risk of developing wound complications (OR = 1.65, p = 0.01) and sepsis (OR = 1.73, p = 0.007) were increased in overweight patients, but the rates of overall complications (OR = 1.04, p = 0.81), infectious complications (OR = 1.31, p = 0.07), and conversion to laparotomy (OR = 1.33, p = 0.08) associated with body mass index (BMI) were not significantly different. Conclusion Obesity is a risk factor for surgical complications in IBD patients, mainly reflected in infectious complications. Moreover, obese patients seem to have a more common chance of developing surgical complications than overweight patients.

UEG position paper: Obesity and digestive health

“…Patrizia Burra 1 Marianna Arvanitakis 2,3 Jorge Amil Dias 4 Michael Bretthauer 5,6 Ana Dugic 7,8 Daniel Hartmann 9 Patrick Michl 10 Thomas Seufferlein 11 Joana Torres 12,13 Hans Törnblom 14 Monique E. van Leerdam 15 Shira Zelber-Sagi 16,17…”

“…Obesity and inflammatory bowel disease Twenty percent of paediatric 7 and 40% of adult 8 patients with IBD are overweight or obese A western‐type diet is thought to contribute to obesity and IBD 9 Obesity and/or visceral adiposity may increase the risk for developing surgical complications, hospitalisation and post‐operative recurrence in patients with IBD 10 , 11 , 12 , 13 , 14 …”

“…Obesity and/or visceral adiposity may increase the risk for developing surgical complications, hospitalisation and post‐operative recurrence in patients with IBD 10 , 11 , 12 , 13 , 14 …”

“…-Twenty percent of paediatric 7 and 40% of adult 8 patients with IBD are overweight or obese -A western-type diet is thought to contribute to obesity and IBD 9 -Obesity and/or visceral adiposity may increase the risk for developing surgical complications, hospitalisation and post-operative recurrence in patients with IBD [10][11][12][13][14] Obesity and liver disease -NAFLD is common in people who are obese or morbidly obese (prevalence of 70%-95%) 15 -NAFLD is a leading cause of liver-related mortality in Europe, predicted to become the leading cause of end-stage liver disease unless urgent action is taken 16,17 Obesity and digestive cancers -Obesity is an established risk factor for multiple types of cancer, 18 including pancreatic, 19,20 liver, 21,22 and colorectal 23 cancer -In 2019, 4.6% of all cancer deaths were attributable to obesity 24…”

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

“…Obesity has turned out to be an increasing global burden in recent decades and, together with the still rising number of new IBD cases in developing countries, it should be perceived as a risk factor for IBD. The observations from clinical research aiming to determine the actual role of obesity in the premorbid period of IBD are quite ambiguous [ 20 , 21 , 22 , 23 ]. One of the large cohort studies suggested that obesity present in the early stage of adolescence was positively associated with an early diagnosis of CD, before the age of 30, but inversely correlated with a future diagnosis of UC at any age [ 10 ].…”