Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2020; 26(47): 7528-7537
Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7528
Prevalence and associated factors of obesity in inflammatory bowel disease: A case-control study
Giuseppe Losurdo, Rosa Federica La Fortezza, Andrea Iannone, Antonella Contaldo, Michele Barone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi
Giuseppe Losurdo, Rosa Federica La Fortezza, Andrea Iannone, Antonella Contaldo, Michele Barone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
Author contributions: Iannone A, Di Leo A and Principi M planned the study; Losurdo G, La Fortezza RF, Iannone A, Contaldo A and Barone M collected data; Ierardi, Barone M and Principi M supervised the study; Losurdo G performed statistical analysis; Losurdo G and Ierardi E wrote the manuscript; all authors read and approved the final version.
Institutional review board statement: The study was approved by the independent Ethics Committee of the Policlinico di Bari (protocol No. 4862) and was performed according to the Helsinki declaration 1975 statements.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Losurdo, MD, Academic Fellow, Doctor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. giuseppelos@alice.it
Received: September 30, 2020
Peer-review started: September 30, 2020
First decision: November 13, 2020
Revised: November 18, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 21, 2020
Processing time: 79 Days and 19.2 Hours
Abstract
BACKGROUND

In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. Obesity, moreover, has been directly correlated with a more severe clinical course and loss of response to treatment.

AIM

To assess the prevalence and associated factors of obesity in IBD.

METHODS

We collected data about IBD disease pattern and activity, drugs and laboratory investigations in our center. Anthropometric measures were retrieved and obesity defined as a body mass index (BMI) > 30. Then, we compared characteristics of obese vs non obese patients, and Chi-squared test and Student’s t test were used for discrete and continuous variables, respectively, at univariate analysis. For multivariate analysis, we used binomial logistic regression and estimated odd ratios (OR) and 95% confidence intervals (CI) to ascertain factors associated with obesity.

RESULTS

We enrolled 807 patients with IBD, either ulcerative colitis (UC) or Crohn’s disease (CD). Four hundred seventy-four patients were male (58.7%); the average age was 46.2 ± 13.2 years; 438 (54.2%) patients had CD and 369 (45.8%) UC. We enrolled 378 controls, who were comparable to IBD group for age, sex, BMI, obesity, diabetes and abdominal circumference, while more smokers and more subjects with hypertension were observed among controls. The prevalence of obesity was 6.9% in IBD and 7.9% in controls (not statistically different; P = 0.38). In the comparison of obese IBD patients and obese controls, we did not find any difference regarding diabetes and hypertension prevalence, nor in sex or smoking habits. Obese IBD patients were younger than obese controls (51.2  ± 14.9 years vs 60.7 ± 12.1 years, P = 0.03). At univariate analysis, obese IBD were older than normal weight ones (51.2 ± 14.9 vs 44.5 ± 15.8, P = 0.002). IBD onset age was earlier in obese population (44.8 ± 13.6 vs 35.6 ± 15.6, P = 0.004). We did not detect any difference in disease extension. Obese subjects had consumed more frequently long course of systemic steroids (66.6% vs 12.5%, P = 0.02) as well as antibiotics such as metronidazole or ciprofloxacin (71.4% vs 54.7%, P = 0.05). No difference about other drugs (biologics, mesalazine or thiopurines) was observed. Disease activity was similar between obese and non obese subjects both for UC and CD. Obese IBD patients suffered more frequently from arterial hypertension, type 2 diabetes, non-alcoholic fatty liver disease. Regarding laboratory investigations, obese IBD patients had higher levels of triglyceridemia, fasting blood glucose, gamma-glutamyl-transpeptidase. On multivariate analysis, however, the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference (OR = 16.3, 95%CI: 1.03-250, P = 0.04).

CONCLUSION

Obese IBD patients seem to have features similar to general obese population, and there is no disease-specific factor (disease activity, extension or therapy) that may foster obesity in IBD.

Keywords: Inflammatory bowel disease; Obesity; Body mass index; Antibiotics; Risk factor; Corticosteroids

Core Tip: Obesity in inflammatory bowel disease (IBD) may be correlated with a more severe clinical course and loss of response to treatment. We did not find any peculiar difference between obese IBD patients and controls. On the other hand, it is possible that some drugs, such as steroids or antibiotics may contribute to the development of obesity in IBD, despite our results suggest that a more complex interaction of several factors could be more likely.