Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
Department of Radiology, Tallaght University Hospital, Dublin, Ireland.
Inflamm Bowel Dis. 2024 Sep 3;30(9):1517-1528. doi: 10.1093/ibd/izad225.
Obesity, sarcopenia, and myosteatosis in inflammatory bowel disease may confer negative outcomes, but their prevalence and impact among patients with Crohn's disease (CD) have not been systematically studied. The aim of this study was to assess nutritional status and body composition among patients undergoing resectional surgery for CD and determine impact on operative outcomes.
Consecutive patients with CD undergoing resection from 2000 to 2018 were studied. Total, subcutaneous, and visceral fat areas and lean tissue area (LTA) and intramuscular adipose tissue (IMAT) were determined preoperatively by computed tomography at L3 using SliceOmatic (Tomovision, Canada). Univariable and multivariable linear, logistic, and Cox proportional hazards regression were performed.
One hundred twenty-four consecutive patients were studied (ileocolonic disease 53%, n = 62, biologic therapy 34.4% n = 43). Mean fat mass was 22.7 kg, with visceral obesity evident in 23.9% (n = 27). Increased fat stores were associated with reduced risk of emergency presentation but increased corticosteroid use (β 9.09, standard error 3.49; P = .011). Mean LBM was 9.9 kg. Sarcopenia and myosteatosis were associated with impaired baseline nutritional markers. Myosteatosis markers IMAT (P = .002) and muscle attenuation (P = .0003) were associated with increased grade of complication. On multivariable analysis, IMAT was independently associated with increased postoperative morbidity (odds ratio [OR], 1.08; 95% confidence interval (CI), 1.01-1.16; P = .037) and comprehensive complications index (P = .029). Measures of adiposity were not associated with overall morbidity; however, increased visceral fat area independently predicted venous thromboembolism (OR, 1.02; 95% CI, 1.00-1.05; P = .028), and TFA was associated with increased wound infection (OR, 1.00; 95% CI, 1.00-1.01; P = .042) on multivariable analysis.
Myosteatosis is associated with nutritional impairment and predicts increased overall postoperative morbidity following resection for CD. Despite its association with specific increased postoperative risks, increased adiposity does not increase overall morbidity, reflecting preservation of nutritional status and relatively more quiescent disease phenotype. Impaired muscle mass and function represent an appealing target for patient optimization to improve outcomes in the surgical management of CD.
炎症性肠病中的肥胖症、肌少症和肌内脂肪变性可能带来负面结果，但尚未系统研究克罗恩病（CD）患者中这些病症的流行情况及其影响。本研究旨在评估接受 CD 切除术患者的营养状况和身体成分，并确定其对手术结果的影响。
研究人员连续纳入 2000 年至 2018 年间接受切除术的 CD 患者。使用 SliceOmatic（加拿大的 Tomovision）在 L3 处通过计算机断层扫描（CT）检测总脂肪、皮下脂肪和内脏脂肪区、瘦组织区（LTA）和肌内脂肪（IMAT）。采用单变量和多变量线性、逻辑和 Cox 比例风险回归进行分析。
研究共纳入 124 例连续患者（回肠结肠疾病 53%，n=62；生物治疗 34.4%，n=43）。平均脂肪量为 22.7kg，23.9%（n=27）存在内脏肥胖。脂肪储存增加与急诊就诊风险降低相关，但与皮质类固醇使用增加相关（β 9.09，标准误差 3.49；P=0.011）。平均 LBM 为 9.9kg。肌少症和肌内脂肪变性与基线营养标志物受损相关。肌内脂肪变性标志物 IMAT（P=0.002）和肌肉衰减（P=0.0003）与并发症严重程度增加相关。多变量分析显示，IMAT 与术后并发症发病率增加独立相关（比值比[OR]，1.08；95%置信区间[CI]，1.01-1.16；P=0.037）和综合并发症指数（P=0.029）。体脂测量值与总发病率无关；然而，内脏脂肪区增加独立预测静脉血栓栓塞（OR，1.02；95%CI，1.00-1.05；P=0.028），TFA 与切口感染增加相关（OR，1.00；95%CI，1.00-1.01；P=0.042）。
肌内脂肪变性与营养受损相关，并预测 CD 切除术患者的整体术后发病率增加。尽管其与特定的术后风险增加相关，但脂肪增加不会增加总发病率，这反映了营养状况的保持和相对更静止的疾病表型。肌肉质量和功能受损是患者优化的一个有吸引力的目标，以改善 CD 手术管理的结果。
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