Adams Dawn W, Gurwara Shelly, Silver Heidi J, Horst Sara N, Beaulieu Dawn B, Schwartz David A, Seidner Douglas L
*Department of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee; and †Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Inflamm Bowel Dis. 2017 Jul;23(7):1182-1186. doi: 10.1097/MIB.0000000000001128.
Inflammatory bowel disease (IBD) is associated with altered body composition, such as low muscle mass, which affects clinical outcomes. Body composition changes in overweight patients with IBD are less understood. The study aim was to determine the prevalence of sarcopenic overweight and obese patients in a cohort of patients with IBD starting new anti-tumor necrosis factor-α therapy and examine differences in response.
This is a retrospective review of patients with IBD starting a new anti-tumor necrosis factor-α medication that had computed tomography within 3 months of initiation. L3 vertebral slice was used for segmentation of body composition and identification of sarcopenia. CRP, ESR, Harvey Bradshaw Index, albumin, 25-OH vitamin D, and body mass index at anti-tumor necrosis factor-α initiation and at 6 months were collected. Outcomes included hospitalization, need for surgery, or new biological medication.
Ninety patients were studied. Forty-one of ninety (45%) were sarcopenic; of these, 17 (41.5%) had a normal body mass index and 8 (19.5%) were overweight/obese. More men were sarcopenic (68% versus 32%, P < 0.001). CRP was higher and albumin lower in sarcopenic subjects. Sarcopenia did not predict outcomes in the cohort but was the only significant predictor of need for surgery in overweight and obese subjects (P = 0.002).
Almost half of our cohort was sarcopenic. Most of these patients are normal or overweight and would not be identified as malnourished by traditional measures. Sarcopenia was a predictor of surgery in patients with a body mass index ≥ 25. Identification of sarcopenia has implications for medical nutrition therapy as typically efforts are focused on underweight patients.
炎症性肠病（IBD）与身体成分改变有关，如肌肉量低，这会影响临床结局。IBD超重患者的身体成分变化了解较少。本研究旨在确定开始新的抗肿瘤坏死因子-α治疗的IBD患者队列中肌肉减少性超重和肥胖患者的患病率，并检查反应差异。
这是一项对开始新的抗肿瘤坏死因子-α药物治疗且在开始治疗后3个月内进行计算机断层扫描的IBD患者的回顾性研究。使用L3椎体切片进行身体成分分割和肌肉减少症的识别。收集开始抗肿瘤坏死因子-α治疗时和6个月时的CRP、ESR、哈维·布拉德肖指数、白蛋白、25-羟基维生素D和体重指数。结局包括住院、手术需求或新的生物药物。
研究了90例患者。90例中有41例（45%）存在肌肉减少症；其中，17例（41.5%）体重指数正常，8例（19.5%）超重/肥胖。肌肉减少症患者中男性更多（68%对32%，P<0.001）。肌肉减少症患者的CRP更高，白蛋白更低。肌肉减少症在该队列中不能预测结局，但在超重和肥胖患者中是手术需求的唯一显著预测因素（P = 0.002）。
我们队列中近一半患者存在肌肉减少症。这些患者大多数体重正常或超重，传统方法不会将其识别为营养不良。肌肉减少症是体重指数≥25患者手术的预测因素。肌肉减少症的识别对医学营养治疗有影响，因为通常的努力都集中在体重过轻的患者身上。
