Department of Gastroenterology & Hepatology, Monash Health, Melbourne, Vic., Australia.
Monash University, Melbourne, Vic., Australia.
Aliment Pharmacol Ther. 2017 May;45(9):1255-1264. doi: 10.1111/apt.14018. Epub 2017 Feb 28.
Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease.
To determine whether body composition is associated with outcome in a prospective study of post-operative Crohn's disease patients.
The POCER study evaluated management strategies for prevention of post-operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross-sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area.
The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height >1.5 times the gender-specific mean experienced endoscopic recurrence at 18 months (compared to 47%) [relative risk 2.1, 95% CI 1.5-3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41% of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046).
Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.
过多的内脏脂肪组织与炎症性肠病患者的预后较差有关。
在一项前瞻性研究中，确定克罗恩病术后患者的身体成分是否与结局相关。
POCER 研究评估了预防术后克罗恩病复发的管理策略；在切除所有肉眼可见的克罗恩病后，招募受试者，并将其随机分为早期内镜检查和可能的治疗升级，或标准护理。主要终点是 18 个月时的内镜复发。对 44 例有横断面腹部影像学检查的患者进行了研究，并使用既定技术进行身体成分分析，以测量内脏脂肪组织面积、皮下脂肪组织面积和骨骼肌面积。
方差最大的身体成分参数是内脏脂肪组织。无论治疗如何，所有内脏脂肪组织/身高大于性别特异性平均值 1.5 倍的患者在 18 个月时都经历了内镜复发（47%）[相对风险 2.1，95%CI 1.5-3.0，P = 0.012]。腰围与内脏脂肪组织面积呈强相关（ρ=0.840，P<0.001）。低骨骼肌很常见（41%的患者），但与内镜复发无关；然而，四肢骨骼肌指数与粪便钙卫蛋白呈负相关（ρ=0.560，P=0.046）。
内脏肥胖是克罗恩病术后内镜复发的独立危险因素。肌肉减少症与炎症生物标志物相关。内脏脂肪组织的测量可能有助于分层术后管理策略的风险。
