P660 Body composition and health-related quality of life in adult Crohn’s Disease during clinical remission: The INTICO2 cohort study

Abstract

Abstract Background A reduction in the absolute or relative mass of lean tissue or muscle mass in the context of disease and/or malnutrition are well-described features associated with poor prognosis. Conversely, excessive adiposity may lead to metabolic disease, increased inflammation and has been linked to adverse CD outcomes. Bioelectrical impedance analysis (BIA) allows estimation of fat-mass index (FMi kg/m2) and fat-free mass index (FFMi kg/m2) which can be expressed standardised as Z scores using device-specific age and gender reference ranges. Here we report the body composition and relationship between BMI, elevated FMi and reduced FFMi Z scores and patient reported outcome measures in an adult cohort in CD clinical remission. Methods 194 adult CD outpatients in clinical and biochemical remission were recruited from a single tertiary IBD service (Harvey Bradshaw Index <5 and calprotectin <250µg) as part of the INTICO2 observational study. 55 had undergone previous intestinal resection, 81 were on biological therapy, 67 immunomodulator and 33 both. Subjects needed to be in intestinal continuity and not currently receiving either exclusive or partial EN or IV nutrition. Body composition was assessed using BIA (seca mBCA 515) and expressed as FMi and FFMi Z scores. Health and disease-related quality of life was assessed using Short Form 36 (SF36) and the fatigue-specific PROM FACIT-F. Results The Median BMI of the cohort was 26.1 (18.0-48.9) Kg/m2. One subject was underweight (≤18.5) by BMI, 37% of patients (71/194) were overweight (BMI ≥25), of which 47 (24% of cohort) were obese (BMI≥30). 16/97 of men and 11/97 of women were below the 5th centile (SDS score <-2) for age and sex matched values for FFMi, respectively. Of the 27 individuals with reduced lean mass, 20 had a normal BMI (20-25), 2 were overweight (25-30). 14/97 and 21/97 of women were above the 95th centile for FMI Z-scores (SDS score >2), all had BMI over 30. Excessive fatigue was present among the population affecting 25% (49/194). FMiz was correlated to excessive fatigue among women (r- 0.236 p<0.05), but there was no relationship to FFMiZ among either sex. Conclusion While weight loss is a recognised presentation of CD, this characterisation of a large outpatient adult cohort in remission found the commonest BMI-defined malnutritional states to be overweight or obese. In the population of individuals with predominantly normal or elevated BMI, sarcopenia was common, masked by excessive adiposity and may not have been appreciated without BIA assessment of body composition. Body composition analysis estimates of excessive age and sex matched adiposity was correlated to excessive fatigue, which was common in the population.