Velho Sónia, Morão Bárbara, Gouveia Catarina, Agostinho Lisa, Torres Joana, Maio Rui, Baracos Vickie E, Cravo Marília
Dietetics and Nutrition Department, Hospital Beatriz Ângelo, Loures, Portugal.
Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal.
Nutrition. 2023 Apr;108:111959. doi: 10.1016/j.nut.2022.111959. Epub 2022 Dec 31.
OBJECTIVE: We investigated the association between body composition upon diagnosis and complicated phenotypes and time until surgery in patients with Crohn's disease (CD). METHODS: We conducted a retrospective cohort study including patients with CD who had a computed tomography enterography or a magnetic resonance enterography performed ≤6 mo of diagnosis. Skeletal muscle and visceral and subcutaneous adipose tissue cross-sectional areas were determined with computed tomography or magnetic resonance images at the third lumbar vertebral level, processed with the sliceOmatic (TomoVison, Magog, QC, Canada) and ABACS plugin. RESULTS: We included 63 patients: 33 (52%) men, median age 35 y. Disease location (L) and behavior (B) according to the Montreal classification were L1 (ileal disease) = 28 (44%), L2 (colonic disease) = 13 (21%), L3(ileocolonic disease) = 18 (28%), L1 + L4 (ileal and isolated upper disease) = 1 (2%), L3 + L4 (ileocolonic and isolated upper disease) = 3 (5%), B1 (non-stricturing) = 39 (62%), B2 (stricturing) = 11 (17%), and B3 (penetrating)= 13 (21%); 20 (32%) patients had perianal disease. Visceral obesity was present in 12 (19%) patients and was associated with higher age of CD onset (median 60 versus 34 y; P = 0.002) and complicated disease behavior (B2 and B3) (66.7% versus 31.7%; P = 0.021). After adjusting for age and perianal disease, total adipose tissue was associated with a 4% increase in the odds of complicated behavior per 10 cm of total adipose tissue (odds ratio [OR] = 1.004; 95% confidence interval [CI], 1.00-1.008; P = 0.043). Median follow-up time was 3.35 y, during which 15 (24%) of patients underwent abdominal surgery. Visceral obesity was associated with 5.10-times higher risk of abdominal surgery (95% CI, 1.52-17.09; P = 0.008); after adjusting for disease behavior, visceral obesity maintained a near-significant association with a 2.90-times higher risk of surgery (95% CI, 0.83-10.08; P = 0.09). CONCLUSION: Total fat was associated with complicated disease phenotype and visceral obesity, with higher risk of abdominal surgery and shorter time until surgery.
目的：我们研究了克罗恩病（CD）患者诊断时的身体组成与复杂表型以及手术前时间之间的关联。 方法：我们进行了一项回顾性队列研究，纳入诊断后≤6个月内接受计算机断层扫描小肠造影或磁共振小肠造影的CD患者。通过计算机断层扫描或磁共振图像在第三腰椎水平确定骨骼肌、内脏和皮下脂肪组织的横截面积，使用SliceOmatic（TomoVison，加拿大魁北克省马戈格）和ABACS插件进行处理。 结果：我们纳入了63例患者：33例（52%）为男性，中位年龄35岁。根据蒙特利尔分类法，疾病部位（L）和行为（B）分别为：L1（回肠疾病）=28例（44%），L2（结肠疾病）=13例（21%），L3（回结肠疾病）=18例（28%），L1+L4（回肠和孤立的上消化道疾病）=1例（2%），L3+L4（回结肠和孤立的上消化道疾病）=3例（5%），B1（非狭窄性）=39例（62%），B2（狭窄性）=11例（17%），B3（穿透性）=13例（21%）；20例（32%）患者有肛周疾病。12例（19%）患者存在内脏肥胖，其与CD发病年龄较大（中位年龄60岁对34岁；P=0.002）和复杂疾病行为（B2和B3）相关（66.7%对31.7%；P=0.021）。在调整年龄和肛周疾病后，每10cm总脂肪组织，总脂肪组织与复杂行为的几率增加4%相关（优势比[OR]=1.004；95%置信区间[CI]，1.00-1.008；P=0.043）。中位随访时间为3.35年，在此期间15例（24%）患者接受了腹部手术。内脏肥胖与腹部手术风险高5.10倍相关（95%CI，1.52-17.09；P=0.
Int J Colorectal Dis. 2021-11
Zotero 插件