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Nutrition in acute and chronic diseases

Combination of sarcopenia and high visceral fat predict poor outcomes in patients with Crohn’s disease

European Journal of Clinical Nutrition volume 75, pages 1491–1498 (2021)Cite this article

Subjects

Abstract

Background

Sarcopenia and visceral fat independently predict poor outcomes in Crohn’s disease (CD). However, combined influence of these parameters on outcomes is unknown, and was investigated in the present study.

Methods

This retrospective study evaluated skeletal muscle index (SMI-cross-sectional area of five skeletal muscles normalized for height), visceral and subcutaneous fat area and their ratio (VF/SC) on single-slice computed tomography (CT) images at L3 vertebrae in CD patients (CT done: January 2012-December 2015, patients followed till December 2019). Sarcopenia was defined as SMI < 36.5 cm2/m2 and 30.2 cm2/m2 for males and females, respectively. Disease severity, behavior, and long-term outcomes (surgery and disease course) were compared with respect to sarcopenia and VF/SC ratio.

Results

Forty-four patients [age at onset: 34.4 ± 14.1 years, median disease duration: 48 (24–95) months, follow-up duration: 32 (12–53.5) months, males: 63.6%] were included. Prevalence of sarcopenia was 43%, more in females, but independent of age, disease severity, behavior and location. More patients with sarcopenia underwent surgery (31.6% vs 4%, p = 0.01). VF/SC was significantly higher in patients who underwent surgery (1.76 + 1.31 vs 0.9 + 0.41, p = 0.002), and a cutoff of 0.88 could predict surgery with sensitivity and specificity of 71% and 65% respectively. On survival analysis, probability of remaining free of surgery was lower in patients with sarcopenia (59.6% vs 94.1% p = 0.01) and those with VF/SC > 0.88 (66.1% vs 91.1%, p = 0.1), and still lower in those with both sarcopenia and VF/SC > 0.88 than those with either or none (38% vs 82% vs 100%, p = 0.01).

Conclusions

Combination of sarcopenia and high visceral fat predict worse outcomes in CD than either.

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Fig. 1: Representative CT images.
Fig. 2: Diagnostic accuracy of VF/SC ratio to predict surgery.
Fig. 3: Influence of sarcopenia and visceral fat on outcomes in Crohn’s disease.

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Funding

The work was supported by the ICMR Center for Advanced Research and Excellence in Intestinal Diseases.

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Authors and Affiliations

  1. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Gurasis Boparai, Saurabh Kedia, Pabitra Sahu, Sudheer Kumar Vuyyuru, Bhaskar Kante, Davesh P. Yadav, Venigalla Pratap Mouli, Govind Makharia & Vineet Ahuja

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India

    Devasenathipathy Kandasamy, Raju Sharma & Kumble Seetharama Madhusudhan

  3. Department of Gastro-intestinal Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India

    Nihar Ranjan Dash, Sujoy Pal, Peush Sahni & Rajesh Panwar

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  1. Gurasis Boparai
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Correspondence to Vineet Ahuja.

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Ethical clearance was obtained from the institute review board (IRB number: IECPG-213/10.5.2018).

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Boparai, G., Kedia, S., Kandasamy, D. et al. Combination of sarcopenia and high visceral fat predict poor outcomes in patients with Crohn’s disease. Eur J Clin Nutr 75, 1491–1498 (2021). https://doi.org/10.1038/s41430-021-00857-x

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