2929 Correlation of Body Mass Index (BMI) and C-Reactive Protein (CRP) With Inflammatory Bowel Disease Progression in an Urban, Afro-Caribbean Population

Abstract

INTRODUCTION: Inflammatory Bowel Disease (IBD) is associated with changes in body composition of patients. Recent studies have shown that the prevalence of obesity is rising in patients with IBD, where 15-40% of adults are obese and 20-40% are considered overweight. One prospective study analyzed body composition in IBD patients overtime and noted that despite an overall increase in adiposity, the total muscle mass was decreased. Low lean muscle mass has an association with poor response to therapy, surgical outcomes and the quality of life in IBD patients. Low C-reactive protein (CRP) levels after initiation of anti-TNF therapy have been associated with mucosal healing on surveillance colonoscopies and clinical disease remission. The aim of this study is to analyze the association between BMI and CRP with progression of IBD, using anti- TNF use as a surrogate marker for disease severity. METHODS: Medical records at Kings County Medical Center in Brooklyn, New York were queried for patients with the ICD 9 and 10 code diagnoses for Crohn's disease (CD) and Ulcerative Colitis (UC) from 2015 to 2018. Biographical, laboratory and endoscopic data, including BMI and CRP, was collected and analyzed. RESULTS: 148 patients with IBD were analyzed from 2015-2018; where 57.2% had UC and 42.8% had CD. Mean age of patients was 47.4 years, and 53.4% of patients were females. The average BMI prior to initiation of therapy was 27.6 kg/m2. The average years diagnosed with IBD was 11.1 years. Of the total patients, 37 were on biologic therapy. In the BMI group, the odds ratio was 0.905 indicating that patients with a lower BMI had more severe disease. The P value was 0.068, not significant but trended towards significance. In the CRP group, the odds Ratio was 1.020, which signified that patients with higher CRP values had more severe disease, with a P value of 0.046. CONCLUSION: The results of our small retrospective study suggest that a lower BMI and higher CRP are independent predictors of severe disease. Our study demonstrated that severe IBD, as measured by anti-TNF use, is associated with high CRP levels. We believe that low BMI and high CRP measurements may be used in conjunction with endoscopic findings and clinical presentation to escalate therapy early preventing worsening of disease. Further studies can be done to also incorporate endoscopic scoring system on surveillance colonoscopies to confirm the correlation between lower BMI and higher CRP with severity of disease.