Original articleSarcopenia and visceral obesity assessed by computed tomography are associated with adverse outcomes in patients with Crohn's disease
Introduction
Crohn's disease (CD) is a chronic progressive and disabling inflammatory bowel disease (IBD) which may lead to hospitalizations, surgery and impact quality of life. CD is well known to be associated with malnutrition [[1], [2], [3], [4]], lower body mass index (BMI) [5] and lower lean body mass [6,7]. Indeed, 75% of hospitalized CD patients are malnourished and 1/3 has a low BMI [8]. There are multiple causes: limited food intake, malabsorption, increased nutrients losses and potentially treatment adverse events. Current data indicate that IBD patients, particularly CD patients, have alterations in their body composition (lean and fatty mass) that the simple BMI assessment may fail to detect [[9], [10], [11]]. Also, growing evidence suggests that altered body composition in IBD is associated with more severe phenotypes [12] and may negatively impact on the clinical course of the disease, response to treatments, and quality of life [8,[13], [14], [15]], although some discordant results have been reported regarding surgery indications and outcomes [16].
While the deuterium oxide dilution method, or to a lesser extent a proxy by the whole-body dual-energy X-ray absorptiometry (DXA), would be the best measures of body composition, these techniques are neither routinely accessible nor feasible in clinical practice. Recently, the development of an accessible method to assess body composition, using a third lumbar (L3) computed tomography (CT) slice, has demonstrated its reliability and prognostic ability in other diseases such as cancer and obesity [[17], [18], [19], [20], [21], [22]]. This tool has extended nutritional assessment possibilities in routine clinical care, and can be applied to CD patients [23]. CT can differentiate body tissues (adipose, muscular, skeletal), water and air, based on tissue specific attenuation values, and easily provides a body composition analysis, including quantification of abdominal circumference, abdominal adipose tissues (AT) (subcutaneous, visceral, and intermuscular), and skeletal muscle (SM) [24].
The aims of this study were to assess the body composition of hospitalized CD patients by a L3 single CT slice and to investigate the association between body composition and adverse outcomes during the follow-up of this cohort of patients.
Section snippets
Study population
From our cohort of patients with a confirmed diagnosis of CD and follow-up at Besançon University Hospital, those aged 18–65 years who had an abdominal CT scan and were hospitalized in the Gastroenterology unit between the 1st of January 2010 and the 15th of June 2016, were retrospectively enrolled for this study. Only hospitalized CD patients were included, as they fulfilled the criteria to have both CT scan examination and full conventional nutritional assessment in the same time period and
Demographic and disease characteristics
Among our CD cohort patients, a total of 175 patients had an abdominal CT during the inclusion period, among them 105 were hospitalized and 88 were meeting all inclusion criteria (Supplementary Fig. 1). Follow-up data were subsequently available for 85 patients.
The baseline characteristics of the 88 patients are shown in Table 1. Overall, median age was 35.4 ± 12.4 years, half were men (44 patients), half were current smokers (44 patients), and the mean HBI was 7.4 ± 4.4. Regarding disease
Discussion
In this observational cohort of hospitalized CD patients, we demonstrated that the evaluation of the body composition using a single CT slice was a suitable tool to assess their nutritional status, and was predictive of adverse events in the course of the disease: abscesses, digestive surgery and hospitalization, whereas BMI and/or serum albumin levels were not. We also found that both sarcopenia and visceral obesity were independently associated with surgery during the follow-up. This study
Authors’ contributions
Guarantor of the article: Lucine Vuitton, MD, PhD.
JG was involved in the design of the study, the conception of the case report form (CRF), patients’ recruitment, data collection and drafting of the manuscript. LV supervised the study design and drafting. LV, SB and GP contributed to data interpretation and manuscript preparation. JG and ALP contributed to statistical analysis and interpretation of data. CDE, SK, CG, DC, MdB recruited patients and recorded clinical data. All authors contributed
Funding source
None.
Conflicts of interest
J Grillot has received lecture fees from Baxter, Pfizer and MSD.
S Koch has received lecture fees from Abbvie, Mayoli, MSD, FujiFilm.
C Gay has received lecture fees from Abbvie, MSD and Takeda.
L Vuitton has received lecture fees from Abbvie, Ferring, MSD, Pfizer, Janssen and Takeda, consulting fees from Abbvie, Ferring and Gilead and research grants from MSD, Pfizer and Takeda.
CDE, ALP, DC, GP, MdB, ZL and SB declare no conflict of interest.
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