Visceral fat area is associated with a high risk for early postoperative recurrence in Crohn's disease

Li, Y.; Zhu, Weiming; Gong, Jianfeng; Zhang, Weiyi; Gu, Lili; Guo, Zhen; Cao, Lei; Shen, Bo; Li, N.; Li, J.

doi:10.1111/codi.12798

Cited by 104 publications

(78 citation statements)

References 24 publications

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“…19 Interestingly, a number of recent studies have also demonstrated an association between visceral adiposity and post-operative morbidity and disease recurrence in CD. 20,21 Because these prior studies have small sample sizes and limited information on other key risk factors, our analysis which benefited from nearly 500 well-characterized CD patients and carefully adjusted for important confounders significantly extends these prior findings. Moreover, to our knowledge this is the first study evaluating the interaction between visceral adiposity and genetic predisposition on risk of CD complications.…”

Section: Discussionmentioning

confidence: 55%

“…17 A number of prior studies have evaluated the impact of VAT on disease incidence and progression, however these studies have been limited by their sample size and lack of detailed information on important confounders such as smoking. 16,18–21 In addition, prior studies have not accounted for the potential influence of genetic variants on the association between VAT and CD progression. The importance of genetics in disease progression has been highlighted by twin studies demonstrating similar disease phenotypes across identical twins as well as a recent study demonstrating the association between genetic variants and disease phenotypes in CD.…”

Section: Introductionmentioning

confidence: 99%

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Visceral Adiposity, Genetic Susceptibility, and Risk of Complications Among Individuals with Crohnʼs Disease

Sloot

Joshi

Bellavance

et al. 2017

Inflammatory Bowel Diseases

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Introduction Adipose tissue in mesenteric fat plays a key role in systemic and luminal inflammation. However, little is known about the role of visceral adipose tissue (VAT) and its interaction with genetic predisposition in Crohn’s disease (CD) progression. Methods Our study population included CD patients enrolled in Prospective Registry in Inflammatory Bowel Disease Study at Massachusetts General Hospital (PRISM). VAT volume was measured from CT scans using Aquarius 3D. We used logistic regression models to estimate the multivariable-adjusted odds ratio (MV-adjusted OR) and 95% confidence interval (CI). We tested for effect modification by genetic predisposition using the log-likelihood ratio test. Results Among 482 CD patients with available data on VAT, 174 developed penetrating disease, 132 developed stricturing disease, 147 developed perianal disease, and 252 required surgery. Compared to individuals in the lowest quartile of VAT volume, the MV-adjusted OR of surgery among individuals in the highest quartile was 2.02 (95% CI, 1.09 – 3.76; Ptrend = 0.006). Similarly, the risk of penetrating disease appeared to increase with greater VAT volume (Ptrend = 0.022) but not stricturing or perianal disease (all Ptrend > 0.23). The associations between VAT volume and CD complications were not modified by genetic predisposition (all Pinteraction > 0.12). Conclusions Visceral adiposity as measured by VAT volume may be associated with a significant increase in risk of penetrating disease and surgery in CD. Our data suggest that visceral adiposity as measured by VAT may negatively impact long-term progression of CD regardless of genetic predisposition.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Visceral Adiposity, Genetic Susceptibility, and Risk of Complications Among Individuals with Crohnʼs Disease

Sloot

Joshi

Bellavance

et al. 2017

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

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“…In quiescent CD, mesenteric hypertrophy does not seem to be a risk factor for disease relapse. 180 However, our recent study demonstrated that increased MAT was associated with increased risk for postoperative recurrence 196 and postoperative complications in patients with CD after ileocolonic resection. 197 The investigation of molecular mechanisms of adipose tissue remodeling will have clinical implications in the current and future treatment of CD.…”

Section: Mesenteric Fat In the Disease Course Of CDmentioning

confidence: 91%

The Role of the Mesentery in Crohnʼs Disease

Zhu

Zuo

et al. 2016

Inflammatory Bowel Diseases

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Crohn's disease (CD) is a complex gastrointestinal disorder involving multiple levels of cross talk between the immunological, neural, vascular, and endocrine systems. The current dominant theory in CD is based on the unidirectional axis of dysbiosis-innate immunity-adaptive immunity-mesentery-body system. Emerging clinical evidence strongly suggests that the axis be bidirectional. The morphologic and/or functional abnormalities in the mesenteric structures likely contribute to the disease progression of CD, to a less extent the disease initiation. In addition to adipocytes, mesentery contains nerves, blood vessels, lymphatics, stromal cells, and fibroblasts. By the secretion of adipokines that have endocrine functions, the mesenteric fat tissue exerts its activity in immunomodulation mainly through response to afferent signals, neuropeptides, and functional cytokines. Mesenteric nerves are involved in the pathogenesis and prognosis of CD mainly through neuropeptides. In addition to angiogenesis observed in CD, lymphatic obstruction, remodeling, and impaired contraction maybe a cause and consequence of CD. Lymphangiogenesis and angiogenesis play a concomitant role in the progress of chronic intestinal inflammation. Finally, the interaction between neuropeptides, adipokines, and vascular and lymphatic endothelia leads to adipose tissue remodeling, which makes the mesentery an active participator, not a bystander, in the disease initiation and precipitation CD. The identification of the role of mesentery, including the structure and function of mesenteric nerves, vessels, lymphatics, and fat, in the intestinal inflammation in CD has important implications in understanding its pathogenesis and clinical management.

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“…In a retrospective cohort study of 114 paediatric patients with IBD (101 with Crohn’s disease), high VAT volume was associated with increased risk of penetrating or stricturing Crohn’s disease complications (OR 1.7, 95% CI 1.1–2.9), Crohn’s-disease-related hospitalization (OR, 1.9, 95% CI 1.2–3.4), shorter time interval to surgery (HR 1.4, 95% CI 1.0–2.0) and moderate–severe disease activity scores (OR 1.8, 95% CI 1.1–3.1), after adjusting for age and BMI 24 . High visceral fat area has also been associated with increased risk of recurrence of Crohn’s disease after surgical resection (endoscopic recurrence: HR 8.6, 95% CI 1.6–47.1; clinical recurrence: HR 2.6, 95% CI 1.0–6.7) 80 . Likewise, the metabolic consequences of obesity, in particular of visceral adiposity, have also been associated with IBD-related disease severity.…”

Section: Effect Of Obesity On Ibd Coursementioning

confidence: 99%

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Singh

Dulai

Zarrinpar

et al. 2016

Nat Rev Gastroenterol Hepatol

307

285

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Incidence of IBD is rising in parallel with overweight and obesity. Contrary to conventional belief, about 15–40% of patients with IBD are obese, which might contribute to the development of IBD. Findings from cross-sectional and retrospective cohort studies are conflicting on the effect of obesity on natural history and course of IBD. Most studies are limited by small sample size, low event rates, non-validated assessment of disease activity and lack robust longitudinal follow-up and have incomplete adjustment for confounding factors. The effect of obesity on the efficacy of IBD-related therapy remains to be studied, though data from other autoimmune diseases suggests that obesity results in suboptimal response to therapy, potentially by promoting rapid clearance of biologic agents leading to low trough concentrations. These data provide a rationale for using weight loss interventions as adjunctive therapy in patients with IBD who are obese. Obesity also makes colorectal surgery technically challenging and might increase the risk of perioperative complications. In this Review, we highlight the existing literature on the epidemiology of obesity in IBD, discuss its plausible role in disease pathogenesis and effect on disease course and treatment response, and identify high-priority areas of future research.

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Visceral fat area is associated with a high risk for early postoperative recurrence in Crohn's disease

Abstract: A high VFA value is associated with postoperative recurrence of Crohn's disease and has clinical implications with respect to optimizing prophylaxis for each individual. However, further studies are needed to confirm the predictive role of this biomarker in a different data set.

Cited by 104 publications

References 24 publications

Visceral Adiposity, Genetic Susceptibility, and Risk of Complications Among Individuals with Crohnʼs Disease

Visceral Adiposity, Genetic Susceptibility, and Risk of Complications Among Individuals with Crohnʼs Disease

The Role of the Mesentery in Crohnʼs Disease

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

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