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The effect of body weight on the severity and clinical course of ulcerative colitis

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Abstract

Purpose

Obesity is a risk factor for inflammatory diseases such as nonalcoholic steatohepatitis, pancreatitis, and Crohn’s disease. The effect of being overweight or obese on the severity and clinical course of ulcerative colitis (UC) was assessed in a retrospective analysis of data from 2000–2006.

Methods

Two hundred and two consecutive UC patients were categorized according to body mass index (BMI). Patient and disease characteristics were compared between BMI categories using chi-square or Kruskal-Wallis tests. The percentage of patients with active UC, complications, steroid therapy, or immunosuppressive therapy was calculated for each group, and matched pair analyses were performed.

Results

Ten patients (5 %) were underweight, 111 (55 %) were normal weight, 54 (26.7 %) were overweight, and 27 (13.4 %) were obese. Pancolitis was inversely related to weight. BMI was also inversely correlated to disease severity, with a significantly smaller proportion of years with chronic active disease among overweight subjects versus normal-weight subjects (17.6 versus 23.9 %, p = 0.05). More overweight than normal-weight patients had no chronic active disease in any year (66 versus 49 %, p = 0.06), and the proportion of years with disease complications was higher in normal weight than in overweight subjects (1.8 versus 0.4 %, p = 0.08). Disease activity during 2000–2006 was higher for underweight versus normal-weight patients, and only 20 % of underweight subjects had no hospital admission compared to 80 % of normal-weight patients (p = 0.07).

Conclusions

This first study to explore the influence of obesity on UC showed that high BMI had rather a favorable effect on the prognosis, whereas low BMI pointed to a more severe course of the disease.

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References

  1. Hotamisligil GS (2006) Inflammation and metabolic disorders. Nature 444:860–867

    Article  CAS  PubMed  Google Scholar 

  2. John BJ, Irukulla S, Abulafi AM, Kumar D, Mendall MA (2006) Systematic review: adipose tissue, obesity and gastrointestinal diseases. Aliment Pharmacol Ther 23:1511–1523

    Article  CAS  PubMed  Google Scholar 

  3. Maury E, Brichard SM (2010) Adipokine dysregulation, adipose tissue inflammation and metabolic syndrome. Mol Cell Endocrinol 314:1–16

    Article  CAS  PubMed  Google Scholar 

  4. Trayhurn P, Wood IS (2004) Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 92:347–355

    Article  CAS  PubMed  Google Scholar 

  5. Bondini S, Younossi ZM (2006) Non-alcoholic fatty liver disease and hepatitis C infection. Minerva Gastroenterol Dietol 52:135–143

    CAS  PubMed  Google Scholar 

  6. Evans AC, Papachristou GI, Whitcomb DC (2010) Obesity and the risk of severe acute pancreatitis. Minerva Gastroenterol Dietol 56:169–179

    CAS  PubMed  Google Scholar 

  7. Schäffler A, Schölmerich J, Büchler C (2005) Mechanisms of disease: adipocytokines and visceral adipose tissue—emerging role in nonalcoholic fatty liver disease. Nat Clin Pract Gastroenterol Hepatol 2:273–280

    Article  PubMed  Google Scholar 

  8. Van der Poorten D, George J (2008) Disease-specific mechanisms of fibrosis: hepatitis C virus and nonalcoholic steatohepatitis. Clin Liver Dis 12:805–824

    Article  PubMed  Google Scholar 

  9. Rosemar A, Angerås U, Rosengren A (2008) Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum 51:450–455

    Article  PubMed  Google Scholar 

  10. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL (2009) Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 136:115–122

    Article  PubMed Central  PubMed  Google Scholar 

  11. Karmiris K, Koutroubakis IE, Xidakis C, Polychronaki M, Voudouri T, Kouroumalis EA (2006) Circulating levels of leptin, adiponectin, resistin, and ghrelin in inflammatory bowel disease. Inflamm Bowel Dis 12:100–105

    Article  PubMed  Google Scholar 

  12. Konrad A, Lehrke M, Schachinger V et al (2007) Resistin is an inflammatory marker of inflammatory bowel disease in humans. Eur J Gastroenterol Hepatol 19:1070–1074

    Article  CAS  PubMed  Google Scholar 

  13. Matarese G, Mantzoros C, La Cava A (2007) Leptin and adipocytokines: bridging the gap between immunity and atherosclerosis. Curr Pharm Des 13:3676–3680

    Article  CAS  PubMed  Google Scholar 

  14. Valentini L, Wirth EK, Schweizer U et al (2009) Circulating adipokines and the protective effects of hyperinsulinemia in inflammatory bowel disease. Nutrition 25:172–181

    Article  CAS  PubMed  Google Scholar 

  15. Sennello JA, Fayad R, Pini M, Gove ME, Fantuzzi G (2006) Transplantation of wild-type white adipose tissue normalizes metabolic, immune and inflammatory alterations in leptin-deficient ob/ob mice. Cytokine 36:261–266

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Peyrin-Biroulet L, Gonzalez F, Dubuquoy L et al (2012) Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn’s disease. Gut 61:78–85

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. WHO (1998) Obesity: preventing and managing the global epidemic: report of a WHO consultation. WHO, Geneva

    Google Scholar 

  18. Blain A, Cattan S, Beaugerie L, Carbonnel F, Gendre JP, Cosnes J (2002) Crohn’s disease clinical course and severity in obese patients. Clin Nutr 21:51–57

    Article  CAS  PubMed  Google Scholar 

  19. Hass DJ, Brensinger CM, Lewis JD, Lichtenstein GR (2006) The impact of increased body mass index on the clinical course of Crohn’s disease. Clin Gastroenterol Hepatol 4:482–488

    Article  PubMed  Google Scholar 

  20. Hemmelmann C, Brose S, Vens M, Hebebrand J, Ziegler A (2010) [Percentiles of body mass index of 18–80-year-old German adults based on data from the Second National Nutrition Survey] [Article in German]. Dtsch Med Wochenschr 135:848–852

    Article  CAS  PubMed  Google Scholar 

  21. Statistisches Bundesamt: Gesundheitswesen – Mikrozensus 2009 – Fragen zur Gesundheit – Rauchgewohnheiten der Bevölkerung 2009. http://www-ec.destatis.de/csp/shop/sfg/bpm.html

  22. Steed H, Walsh S, Reynolds N (2009) A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts 2:370–372

    Article  PubMed  Google Scholar 

  23. Peppercorn MA (2008) Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults. http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-prognosis-of-ulcerative-colitis-in-adults. Accessed Feb 2012

  24. Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G (1998) Metabolic features of inflammatory bowel disease in a remission phase of the disease. J Intern Med 243:339–347

    Article  CAS  PubMed  Google Scholar 

  25. Ferguson A, Sedgwick DM (1994) Juvenile onset inflammatory bowel disease: height and body mass index in adult life. BMJ 308:1259–1263

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Vagianos K, Bector S, McConnell J, Bernstein CN (2007) Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 31:311–319

    Article  CAS  PubMed  Google Scholar 

  27. Jahnsen J, Falch JA, Mowinckel P, Aadland E (2003) Body composition in patients with inflammatory bowel disease: a population-based study. Am J Gastroenterol 98:1556–1562

    Article  PubMed  Google Scholar 

  28. Klein S, Meyers S, O’Sullivan P, Barton D, Leleiko N, Janowitz HD (1988) The metabolic impact of active ulcerative colitis. Energy expenditure and nitrogen balance. J Clin Gastroenterol 10:34–40

    Article  CAS  PubMed  Google Scholar 

  29. Ripoli J, Miszputen SJ, Ambrogini O Jr, de Carvalho L (2010) Nutritional follow-up of patients with ulcerative colitis during periods of intestinal inflammatory activity and remission. Arq Gastroenterol 47:49–55

    Article  PubMed  Google Scholar 

  30. Silk DBA, Payne-James J (1989) Inflammatory bowel disease: nutritional implications and treatment. Proc Nutr Soc 48:355–361

    Article  CAS  PubMed  Google Scholar 

  31. Peyrin-Biroulet L, Chamaillard M, Gonzalez F et al (2007) Mesenteric fat in Crohn’s disease: a pathogenetic hallmark or an innocent bystander? Gut 56:577–583

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Sartor RB (2006) Mechanisms of disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol 3:390–407

    Article  CAS  PubMed  Google Scholar 

  33. Holtmann MH, Krummenauer F, Claas C et al (2010) Significant differences between Crohn’s disease and ulcerative colitis regarding the impact of body mass index and initial disease activity on responsiveness to azathioprine: results from a European multicenter study in 1,176 patients. Dig Dis Sci 55:1066–1078

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

Author contributions

Data collection and presentation were part of Denia Stabroth-Akil thesis. Ludger Leifeld, Roland Pfützer, and Julia Morgenstern contributed to the patient documentation, discussion of the project and the data, and preparation the manuscript, and Wolfgang Kruis contributed to the initiation of the project and the preparation of the manuscript and was the mentor of the thesis of D. S-A.

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Authors and Affiliations

  1. Department of Internal Medicine Gastroenterology, Evangelisches Krankenhaus Kalk, Teaching hospital of the University of Cologne, Buchforststrasse 2, 51103, Cologne, Germany

    Denia Stabroth-Akil, Ludger Leifeld, Roland Pfützer, Julia Morgenstern & Wolfgang Kruis

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  1. Denia Stabroth-Akil
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  2. Ludger Leifeld
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  3. Roland Pfützer
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  4. Julia Morgenstern
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  5. Wolfgang Kruis
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Correspondence to Wolfgang Kruis.

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Stabroth-Akil, D., Leifeld, L., Pfützer, R. et al. The effect of body weight on the severity and clinical course of ulcerative colitis. Int J Colorectal Dis 30, 237–242 (2015). https://doi.org/10.1007/s00384-014-2051-3

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  • DOI: https://doi.org/10.1007/s00384-014-2051-3

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