Association between body mass index and age of disease onset with clinical outcomes in paediatric-onset Crohn's Disease (CD): a UK nation-wide analyses using the NIHR-IBD BioResource.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
12 Mar 2024
12 Mar 2024
Historique:
received:
28
03
2023
accepted:
27
02
2024
revised:
15
02
2024
medline:
13
3
2024
pubmed:
13
3
2024
entrez:
13
3
2024
Statut:
aheadofprint
Résumé
The evidence on the relationship between adiposity and disease outcomes in paediatric Crohn's disease (CD) is limited and lacks consensus. To investigate the relationship between (a) body mass index (BMI) and clinical CD outcomes (hospitalisation, surgery, disease behaviour, biologic use, extra-intestinal manifestations (EIMs)) and (b) the age of CD onset with clinical outcomes. Clinical outcomes were examined in CD patients diagnosed at age <17 years and enroled in the National Institute for Health Research IBD-UK BioResource at a median age of 24 years. All outcomes and BMI were recorded at the time of enrolment. Participants were categorised into normal (<25 kg/m 848 participants with CD were included (51.8% males) and median age at diagnosis was 14 years. Participants with high BMI experienced a greater frequency of EIMs (P = 0.05) than those with low BMI (1 type of EIM: 18.5% vs. 13.2%, respectively; ≥2 types of EIMs: 7.8% vs. 5.6%, respectively). Age at diagnosis and BMI showed weak correlations with corticosteroid use (ρ = 0.08, P = 0.03 and ρ = -0.09, P = 0.01; respectively). An early diagnosis (<11 years) was associated with higher occurrence of stenosing and penetrating disease behaviour (P = 0.01) and hospitalisations (P < 0.001). A higher BMI and an earlier age of disease onset are associated with worse CD clinical presentation.
Sections du résumé
BACKGROUND
BACKGROUND
The evidence on the relationship between adiposity and disease outcomes in paediatric Crohn's disease (CD) is limited and lacks consensus.
AIM
OBJECTIVE
To investigate the relationship between (a) body mass index (BMI) and clinical CD outcomes (hospitalisation, surgery, disease behaviour, biologic use, extra-intestinal manifestations (EIMs)) and (b) the age of CD onset with clinical outcomes.
DESIGN
METHODS
Clinical outcomes were examined in CD patients diagnosed at age <17 years and enroled in the National Institute for Health Research IBD-UK BioResource at a median age of 24 years. All outcomes and BMI were recorded at the time of enrolment. Participants were categorised into normal (<25 kg/m
RESULTS
RESULTS
848 participants with CD were included (51.8% males) and median age at diagnosis was 14 years. Participants with high BMI experienced a greater frequency of EIMs (P = 0.05) than those with low BMI (1 type of EIM: 18.5% vs. 13.2%, respectively; ≥2 types of EIMs: 7.8% vs. 5.6%, respectively). Age at diagnosis and BMI showed weak correlations with corticosteroid use (ρ = 0.08, P = 0.03 and ρ = -0.09, P = 0.01; respectively). An early diagnosis (<11 years) was associated with higher occurrence of stenosing and penetrating disease behaviour (P = 0.01) and hospitalisations (P < 0.001).
CONCLUSIONS
CONCLUSIONS
A higher BMI and an earlier age of disease onset are associated with worse CD clinical presentation.
Identifiants
pubmed: 38472359
doi: 10.1038/s41430-024-01425-9
pii: 10.1038/s41430-024-01425-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Chang JT. Pathophysiology of inflammatory bowel diseases. N Engl J Med. 2020;383:2652–64.
pubmed: 33382932
doi: 10.1056/NEJMra2002697
Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1–106.
pubmed: 31562236
doi: 10.1136/gutjnl-2019-318484
Cosnes J, Gower–Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–94.e4.
pubmed: 21530745
doi: 10.1053/j.gastro.2011.01.055
Ashton JJ, Peiris D, Green Z, Johnson MJ, Marino LV, Griffiths M, et al. Routine abdominal magnetic resonance imaging can determine psoas muscle area in paediatric Crohn’s disease and correlates with bioelectrical impedance spectroscopy measures of lean mass. Clin Nutr ESPEN. 2021;42:233–8.
pubmed: 33745585
doi: 10.1016/j.clnesp.2021.01.031
Griffiths AM. Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol. 2004;18:509–23.
pubmed: 15157824
doi: 10.1016/j.bpg.2004.01.002
Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017;2:e17.
doi: 10.1097/IJ9.0000000000000017
Rennie K, Jebb S. Prevalence of obesity in Great Britain. Obes Rev. 2005;6:11–2.
pubmed: 15655034
doi: 10.1111/j.1467-789X.2005.00164.x
Conolly A, Neave A. Health Survey for England 2015 Children’s body mass index, overweight and obesity. London: Health and Social Care Information Centre. 2016.
WHO. Obesity and overweight 2021 [Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight .
Khakoo NS, Ioannou S, Khakoo NS, Vedantam S, Pearlman M. Impact of obesity on inflammatory bowel disease. Curr Gastroenterol Rep. 2022;24:1–11.
doi: 10.1007/s11894-022-00840-x
Johnson AM, Loftus EV. Impact of obesity on the management of inflammatory bowel disease. Gastroenterol Hepatol. 2020;16:350.
Long MD, Crandall WV, Leibowitz IH, Duffy L, Del Rosario F, Kim SC, et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis. 2010;17:2162–8.
pubmed: 21910178
doi: 10.1002/ibd.21585
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444:860–7.
pubmed: 17167474
doi: 10.1038/nature05485
Shoelson S, Lee J, Goldfine A. Inflammation and insulin resistance. J Clin Investig. 2006;116:1793–801.
pubmed: 16823477
pmcid: 1483173
doi: 10.1172/JCI29069
Mendall M, Patel P, Ballam L, Strachan D, Northfield T. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. Bmj. 1996;312:1061–5.
pubmed: 8616412
pmcid: 2350910
doi: 10.1136/bmj.312.7038.1061
Poullis A, Foster R, Shetty A, Fagerhol MK, Mendall MA. Bowel inflammation as measured by fecal calprotectin: a link between lifestyle factors and colorectal cancer risk. Cancer Epidemiol Biomark Prev. 2004;13:279–84.
doi: 10.1158/1055-9965.EPI-03-0160
Greenfield JR, Samaras K, Jenkins AB, Kelly PJ, Spector TD, Gallimore JR, et al. Obesity is an important determinant of baseline serum C-reactive protein concentration in monozygotic twins, independent of genetic influences. Circulation. 2004;109:3022–8.
pubmed: 15184288
doi: 10.1161/01.CIR.0000130640.77501.79
Hotamisligil GS, Arner P, Caro JF, Atkinson RL, Spiegelman BM. Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Investig. 1995;95:2409–15.
pubmed: 7738205
pmcid: 295872
doi: 10.1172/JCI117936
Gustafson B, Hammarstedt A, Andersson CX, Smith U. Inflamed adipose tissue: a culprit underlying the metabolic syndrome and atherosclerosis. Arterioscler Thromb Vasc Biol. 2007;27:2276–83.
pubmed: 17823366
doi: 10.1161/ATVBAHA.107.147835
Sutton-Tyrrell K, Newman A, Simonsick EM, Havlik R, Pahor M, Lakatta E, et al. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition. Hypertension. 2001;38:429–33.
pubmed: 11566917
doi: 10.1161/01.HYP.38.3.429
Siegmund B. Mesenteric fat in Crohn’s disease: the hot spot of inflammation? Gut. 2012;61:3–5.
pubmed: 22068165
doi: 10.1136/gutjnl-2011-301354
Blain A, Cattan S, Beaugerie L, Carbonnel F, Gendre J, Cosnes J. Crohn’s disease clinical course and severity in obese patients. Clin Nutr. 2002;21:51–7.
pubmed: 11884013
doi: 10.1054/clnu.2001.0503
Hass DJ, Brensinger CM, Lewis JD, Lichtenstein GR. The impact of increased body mass index on the clinical course of Crohn’s disease. Clin Gastroenterol Hepatol. 2006;4:482–8.
pubmed: 16616354
doi: 10.1016/j.cgh.2005.12.015
Causey MW, Johnson EK, Miller S, Martin M, Maykel J, Steele SR. The impact of obesity on outcomes following major surgery for Crohn’s disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis Colon Rectum. 2011;54:1488–95.
pubmed: 22067176
doi: 10.1097/DCR.0b013e3182342ccb
Nic Suibhne T, Raftery TC, McMahon O, Walsh C, O’Morain C, O’Sullivan M. High prevalence of overweight and obesity in adults with Crohn’s disease: associations with disease and lifestyle factors. J Crohn’s Colitis. 2013;7:e241–e8.
doi: 10.1016/j.crohns.2012.09.009
Flores A, Burstein E, Cipher DJ, Feagins LA. Obesity in inflammatory bowel disease: a marker of less severe disease. Digestive Dis Sci. 2015;60:2436–45.
doi: 10.1007/s10620-015-3629-5
Zwintscher NP, Horton JD, Steele SR. Obesity has minimal impact on clinical outcomes in children with inflammatory bowel disease. J Pediatr Surg. 2014;49:265–8.
pubmed: 24528963
doi: 10.1016/j.jpedsurg.2013.11.033
Yerushalmy-Feler A, Ben-Tov A, Weintraub Y, Amir A, Galai T, Moran-Lev H, et al. High and low body mass index may predict severe disease course in children with inflammatory bowel disease. Scand J Gastroenterol. 2018;53:708–13.
pubmed: 29688090
doi: 10.1080/00365521.2018.1464595
Chandrakumar A, Wang A, Grover K, El-Matary W. Obesity is more common in children newly diagnosed with ulcerative colitis as compared to those with Crohn disease. J Pediatr Gastroenterol Nutr. 2019;70:593–7.
doi: 10.1097/MPG.0000000000002639
Yerushalmy-Feler A, Galai T, Moran-Lev H, Ben-Tov A, Dali-Levy M, Weintraub Y, et al. BMI in the lower and upper quartiles at diagnosis and at 1-year follow-up is significantly associated with higher risk of disease exacerbation in pediatric inflammatory bowel disease. Eur J Pediatr. 2020;180:21–9.
pubmed: 32500205
doi: 10.1007/s00431-020-03697-2
Jain A, Bricker J, Kappelman MD, Dotson JL. Overweight and obese status is not associated with disease activity for children and adolescents with newly diagnosed inflammatory bowel disease. Am J Gastroenterol. 2022;117:1146–53.
pubmed: 35470288
doi: 10.14309/ajg.0000000000001803
Rodin I, Chan J, Meleady L, Hii C, Lawrence S, Jacobson K. High body mass index is not associated with increased treatment failure in infliximab treated pediatric patients with inflammatory bowel disease. JGH Open. 2019;4:446–53.
pubmed: 32514452
pmcid: 7273726
doi: 10.1002/jgh3.12277
Group WMGRS, de Onis M. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr. 2006;95:76–85.
doi: 10.1111/j.1651-2227.2006.tb02378.x
Parkes M. IBD BioResource: an open-access platform of 25 000 patients to accelerate research in Crohn’s and Colitis. Gut. 2019;68:1537–40.
pubmed: 31270165
doi: 10.1136/gutjnl-2019-318835
Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5A–36A.
pubmed: 16151544
doi: 10.1155/2005/269076
Von Graffenried T, Schoepfer AM, Rossel J-B, Greuter T, Safroneeva E, Godat S, et al. Impact of overweight and obesity on disease outcome in the pediatric swiss inflammatory bowel disease cohort. JPGN Rep. 2022;3:e193.
doi: 10.1097/PG9.0000000000000193
Greuter T, Porchet F, Braga-Neto MB, Rossel J-B, Biedermann L, Schreiner P, et al. Impact of obesity on disease activity and disease outcome in inflammatory bowel disease: results from the Swiss inflammatory bowel disease cohort. U Eur Gastroenterol J. 2020;8:1196–207.
doi: 10.1177/2050640620954556
Singla MB, Eickhoff C, Betteridge J. Extraintestinal manifestations are common in obese patients with Crohn’s disease. Inflamm Bowel Dis. 2017;23:1637–42.
pubmed: 28691941
doi: 10.1097/MIB.0000000000001187
Pringle PL, Stewart KO, Peloquin JM, Sturgeon HC, Nguyen D, Sauk J, et al. Body mass index, genetic susceptibility, and risk of complications among individuals with Crohn’s disease. Inflamm Bowel Dis. 2015;21:2304–10.
pubmed: 26181430
Wardle RA, Thapaliya G, Nowak A, Radford S, Dalton M, Finlayson G, et al. An examination of appetite and disordered eating in active Crohn’s disease. J Crohn’s Colitis. 2018;12:819–25.
doi: 10.1093/ecco-jcc/jjy041
Curtis JR, Westfall AO, Allison J, Bijlsma JW, Freeman A, George V. et al.Population‐based assessment of adverse events associated with long‐term glucocorticoid use.Arthritis Care Res. 2006;55:420–6.
doi: 10.1002/art.21984
Wung PK, Anderson T, Fontaine KR, Hoffman GS, Specks U, Merkel PA, et al. Effects of glucocorticoids on weight change during the treatment of Wegener’s granulomatosis. Arthritis Care Res. 2008;59:746–53.
doi: 10.1002/art.23561
Blackwell J, Selinger C, Raine T, Parkes G, Smith MA, Pollok R. Steroid use and misuse: a key performance indicator in the management of IBD. Frontline Gastroenterol. 2021;12:207–13.
pubmed: 33907617
doi: 10.1136/flgastro-2019-101288
Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571–607.
pubmed: 21464096
doi: 10.1136/gut.2010.224154
Roda G, Chien NS, Kotze PG, Argollo M, Panaccione R, Spinelli A, et al. Crohn’s disease. Nat Rev Dis Prim. 2020;6:1–19.
Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21:1982–92.
pubmed: 26154136
doi: 10.1097/MIB.0000000000000392
Vernier–Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology. 2008;135:1106–13.
pubmed: 18692056
doi: 10.1053/j.gastro.2008.06.079
Polito J 2nd, Childs B, Mellits ED, Tokayer AZ, Harris ML, Bayless T. Crohn’s disease: influence of age at diagnosis on site and clinical type of disease. Gastroenterology. 1996;111:580–6.
pubmed: 8780560
doi: 10.1053/gast.1996.v111.pm8780560