Abstract
The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD) remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera’s prognostic nutritional index (O-PNI) and the controlling nutritional status (CONUT) index. The L3 skeletal muscle index (SMI), which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3) vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn’s disease (CD) and 48% with ulcerative colitis (UC)). In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015) and disease type (CD or UC) (P = 0.007) were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003) and a stratified analysis of CD patients (P = 0.001) using the Kaplan–Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.
Highlights
Inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD), are chronic gastrointestinal diseases that are associated with protein-energy malnutrition (PEM) [1, 2]
We enrolled IBD patients who were admitted to our hospital for disease exacerbation, and we demonstrated that a low skeletal muscle index (SMI) was a strong predictor of intestinal resection in CD patients
Previous reports have shown that altered body composition or decreased skeletal muscle volume was frequently observed in IBD patients [7,8,9]
Summary
Inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn’s disease (CD), are chronic gastrointestinal diseases that are associated with protein-energy malnutrition (PEM) [1, 2]. PEM is caused by low dietary intake, enhanced energy expenditure due to inflammation, impaired digestion and absorption, and protein leakage from ulcerative lesions [2,3,4,5,6]; it leads to decreases in skeletal muscle and adipose tissue volumes. Sarcopenia and CD composition, such as reduced fat-free mass, has been reported in IBD patients [7, 8]. Decreased skeletal muscle volume has been observed in 60% of CD patients in clinical remission [9]. There are several reports concerning altered body composition and clinical outcomes of IBD. The relationship between reductions in skeletal muscle volume and prognoses of IBD patients has yet to be elucidated.
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