Altered body composition is an important characteristic of malnutrition that may better reflect the clinical course. This study aimed to evaluate the prognostic role of sarcopenia by computed tomography (CT) on colectomy in acute severe ulcerative colitis (ASUC) during index hospitalization and follow-up.
254 ASUC patients undergoing CT scans at admission were retrospectively included. Sarcopenia was assessed by the skeletal muscle index (SMI) with CT scans at L3, and patients with an SMI below the lowest sex-specific quartile were diagnosed with sarcopenia. Body mass index (BMI) < 18.5 kg/m2 was defined as clinical malnutrition. Univariate and multivariate analyses were performed to determine the association between sarcopenia and colectomy.
The prevalence of sarcopenia in ASUC was 50.0%, and malnutrition was 25.2%. Among sarcopenic patients, 36.2% was malnutrition, 51.2% had normal BMI, 11.8% was overweight, and 0.8% was obese. During index hospitalization, 66.9% patients needed rescue therapy with 52.4% received medical rescue therapy and 14.6% received colectomy. During follow-up, 33.2% patients needed colectomy. Significantly more sarcopenic patients required colectomy (22.0% vs 7.1%, p = 0.001) and rescue therapy (81.9% vs 52.0%, p < 0.001) during index hospitalization and colectomy during follow-up (44.4% vs 23.7%, p = 0.001) than non-sarcopenic patients. However, BMI < 18.5 kg/m2 was not related to the clinical course. In multivariate analyses, sarcopenia remained an independent risk factor for rescue therapy and colectomy during index hospitalization and colectomy during follow-up.
Sarcopenia rather than BMI was associated with clinical outcomes in ASUC and played an important role in predicting the need for colectomy.
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The datasets generated during and/or analyzed during the current study are available from the first author or corresponding author on reasonable request.
Mak WY, Zhao M, Ng SC, Burisch J. The epidemiology of inflammatory bowel disease: East meets West. J Gastroenterol Hepatol. 2020;35:380–9.
Casanova MJ, Chaparro M, Molina B, Merino O, Batanero R, Duenas-Sadornil C, et al. Prevalence of malnutrition and nutritional characteristics of patients with inflammatory bowel disease. J Crohns Colitis. 2017;11:1430–9.
Chang JT. Pathophysiology of inflammatory bowel diseases. N Engl J Med. 2020;383:2652–64.
Fiorindi C, Cuffaro F, Piemonte G, Cricchio M, Addasi R, Dragoni G. et al. Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD. Clin Nutr. 2021;40:928–35.
Ray JJ, Esen E, McIntyre S, Kirat HT, Grieco M, Remzi F. Association of malnutrition with postoperative outcomes after ileal pouch-anal anastomosis. J Gastrointest Surg. 2020. https://doi.org/10.1007/s11605-020-04861-7.
Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38:1–9.
Fiorindi C, Luceri C, Dragoni G, Piemonte G, Scaringi S, Staderini F. et al. GLIM criteria for malnutrition in surgical IBD patients: a pilot study. Nutrients. 2020;12:2222.
Cushing KC, Kordbacheh H, Gee MS, Kambadakone A, Ananthakrishnan AN. Sarcopenia is a novel predictor of the need for rescue therapy in hospitalized ulcerative colitis patients. J Crohns Colitis. 2018;12:1036–41.
Grillot J, D’Engremont C, Parmentier AL, Lakkis Z, Piton G, Cazaux D, et al. Sarcopenia and visceral obesity assessed by computed tomography are associated with adverse outcomes in patients with Crohn’s disease. Clin Nutr. 2020;39:3024–30.
Zhang S, Tan S, Jiang Y, Xi Q, Meng Q, Zhuang Q, et al. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: a prospective cohort study. Clin Nutr. 2019;38:2881–8.
Binay Safer V, Tasci I, Safer U. Crohn’s disease, visceral obesity and sarcopenia. Clin Nutr. 2020;39:2315–6.
Feuerstein JD, Isaacs KL, Schneider Y, Siddique SM, Falck-Ytter Y, Singh S, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158:1450–61.
Laharie D, Bourreille A, Branche J, Allez M, Bouhnik Y, Filippi J, et al. Ciclosporin versus infliximab in patients with severe ulcerative colitis refractory to intravenous steroids: a parallel, open-label randomised controlled trial. Lancet. 2012;380:1909–15.
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:601.
Eros A, Soos A, Hegyi P, Szakacs Z, Benke M, Szucs A, et al. Sarcopenia as an independent predictor of the surgical outcomes of patients with inflammatory bowel disease: a meta-analysis. Surg Today. 2020;50:1138–50.
Saul D, Kosinsky RL. Dextran sodium sulfate-induced colitis as a model for sarcopenia in mice. Inflamm Bowel Dis. 2020;26:56–65.
Bamba S, Inatomi O, Takahashi K, Morita Y, Imai T, Ohno M, et al. Assessment of body composition from CT images at the level of the third lumbar vertebra in inflammatory bowel disease. Inflamm Bowel Dis. 2020. https://doi.org/10.1093/ibd/izaa306.
Whaley KG, Rosen MJ. Contemporary medical management of acute severe ulcerative colitis. Inflamm Bowel Dis. 2019;25:56–66.
Guerra RS, Fonseca I, Sousa AS, Jesus A, Pichel F, Amaral TF. ESPEN diagnostic criteria for malnutrition—a validation study in hospitalized patients. Clin Nutr 2017;36:1326–32.
Cima RR. Timing and indications for colectomy in chronic ulcerative colitis: Surgical consideration. Dig Dis. 2010;28:501–7.
Tiu SPT, Hajirawala LN, Leonardi C, Davis KG, Orangio GR, Barton JS. Delayed surgery does not increase risk in urgent colectomy for ulcerative colitis. Am Surg. 2020:3134820971576.
Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: Current management. J Crohns Colitis. 2017;11:769–84.
Zhang T, Cao L, Cao T, Yang J, Gong J, Zhu W, et al. Prevalence of sarcopenia and its impact on postoperative outcome in patients with Crohn’s Disease undergoing bowel resection. J Parenter Enter Nutr. 2017;41:592–600.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.
Thiberge C, Charpentier C, Gillibert A, Modzelewski R, Dacher JN, Savoye G, et al. Lower subcutaneous or visceral adiposity assessed by abdominal computed tomography could predict adverse outcome in patients With Crohn’s disease. J Crohns Colitis. 2018;12:1429–37.
Houttu N, Kalliomaki M, Gronlund MM, Niinikoski H, Nermes M, Laitinen K. Body composition in children with chronic inflammatory diseases: a systematic review. Clin Nutr. 2020;39:2647–62.
Galata C, Hodapp J, Weiss C, Karampinis I, Vassilev G, Reissfelder C, et al. Skeletal muscle mass index predicts postoperative complications in intestinal surgery for Crohn’s disease. J Parenter Enter Nutr. 2020;44:714–21.
Fujikawa H, Araki T, Okita Y, Kondo S, Kawamura M, Hiro J, et al. Impact of sarcopenia on surgical site infection after restorative proctocolectomy for ulcerative colitis. Surg Today. 2017;47:92–8.
Dedhia PH, White Y, Dillman JR, Adler J, Jarboe MD, Teitelbaum DH, et al. Reduced paraspinous muscle area is associated with post-colectomy complications in children with ulcerative colitis. J Pediatr Surg 2018;53:477–82.
Zhang T, Ding C, Xie T, Yang J, Dai X, Lv T, et al. Skeletal muscle depletion correlates with disease activity in ulcerative colitis and is reversed after colectomy. Clin Nutr. 2017;36:1586–92.
van Langenberg DR, Della Gatta P, Hill B, Zacharewicz E, Gibson PR, Russell AP. Delving into disability in Crohn’s disease: dysregulation of molecular pathways may explain skeletal muscle loss in Crohn’s disease. J Crohns Colitis. 2014;8:626–34.
de Sire R, Rizzatti G, Ingravalle F, Pizzoferrato M, Petito V, Lopetuso L, et al. Skeletal muscle-gut axis: emerging mechanisms of sarcopenia for intestinal and extra intestinal diseases. Minerva Gastroenterol Dieto.l 2018;64:351–62.
Subramaniam K, Fallon K, Ruut T, Lane D, McKay R, Shadbolt B, et al. Infliximab reverses inflammatory muscle wasting (sarcopenia) in Crohn’s disease. Aliment Pharm Ther. 2015;41:419–28.
Singh S, Dulai PS, Zarrinpar A, Ramamoorthy S, Sandborn WJ. Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes. Nat Rev Gastroenterol Hepatol. 2017;14:110–21.
Sun X, Xu J, Chen X, Zhang W, Chen W, Zhu C, et al. Sarcopenia in patients with normal body mass index is an independent predictor for postoperative complication and long-term survival in gastric cancer. Clin Transl Sci. 2020. https://doi.org/10.1111/cts.12940.
Adams DW, Gurwara S, Silver HJ, Horst SN, Beaulieu DB, Schwartz DA, et al. Sarcopenia is common in overweight patients with inflammatory bowel disease and may predict need for surgery. Inflamm Bowel Dis. 2017;23:1182–6.
Cederholm T, Krznaric Z, Pirlich M. Diagnosis of malnutrition in patients with gastrointestinal diseases: recent observations from a global leadership initiative on malnutrition perspective. Curr Opin Clin Nutr Metab Care. 2020;23:361–6.
Holt DQ, Moore GT, Strauss BJ, Hamilton AL, De Cruz P, Kamm MA. Visceral adiposity predicts post-operative Crohn’s disease recurrence. Aliment Pharm Ther. 2017;45:1255–64.
Lim Z, Welman CJ, Raymond W, Thin L. The effect of adiposity on anti-tumor necrosis factor-alpha levels and loss of response in Crohn’s disease patients. Clin Transl Gastroenterol. 2020;11:e00233.
Cravo ML, Velho S, Torres J, Costa Santos MP, Palmela C, Cruz R, et al. Lower skeletal muscle attenuation and high visceral fat index are associated with complicated disease in patients with Crohn’s disease: an exploratory study. Clin Nutr Espen. 2017;21:79–85.
Ha CWY, Martin A, Sepich-Poore GD, Shi B, Wang Y, Gouin K. et al. Translocation of viable gut microbiota to mesenteric adipose drives formation of creeping fat in humans. Cell. 2020;183:666–83e17.
The authors gratefully acknowledge all of the investigators for their contributions to the trial, as well as Bin Chen, who provided medical writing assistance.
This work was supported by National Natural Science Foundation of China (grant number 81800474).
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The authors declare no competing interest.
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Ge, X., Xia, J., Wu, Y. et al. Sarcopenia assessed by computed tomography is associated with colectomy in patients with acute severe ulcerative colitis. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-021-00953-y