Body composition & risk for post-op recurrence of CD

Feb 20, 2018 - E-Mentoring in IBD | Volume 11 • 2018

Issue 04

Clinical Question

Does body composition alter the risk for post-operative recurrence of Crohn’s disease (CD)?

Editor’s Bottom Line

CD patients with excessive visceral adipose tissue (e.g., large waists vs. height) could be more closely monitored post-operatively as they are at higher risk for recurrence.

Reference

Holt DQ, Moore GT, Strauss BJ, et al. Visceral adiposity predicts post-operative Crohn’s disease recurrence. Aliment Pharmacol Ther. 2017 May;45(9):1255–64. https://www.ncbi.nlm.nih.gov/pubmed/28244124

Synopsis

Patients enrolled in POCER, a randomized controlled trial where patients were allocated 2:1 post-operatively to either undergo colonoscopy at 6 months or receive standard care. Enrolled patients who had undergone body composition imaging within 12 months prior to surgery were eligible for the current substudy. Body scans taken at the L3 and L4-5 levels were analysed using SliceOmatic 4.3 by an experienced user blinded to the study. Estimates of appendicular skeletal muscle indices, total body fat mass, fat-free mass, and waist circumference were made. Patients underwent colonoscopy again at 18 months.

Regardless of study group allocation (active or control), patients with visceral adipose tissue/height that was greater than 1.5 times the gender-specific mean were more likely to develop endoscopic recurrence of CD at 18 months, with relative risk (RR) 2.1 (P=0.012). Waist circumference was associated with visceral adipose tissue area while low skeletal muscle mass was not.

Details

Study Design: Prospective RCT, sub-study of POCER
Funding: Crohn’s and Colitis Australia
Allocation: Previously described (POCER)
Setting: Australia
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.