High visceral fat index increases risk for surgery in IBD
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Visceral fat index may indicate a patient’s risk for refractory inflammatory bowel disease and likelihood of surgery, suggesting early surgical referral in these cases, according to a presentation at the Crohn’s and Colitis Congress.
“Patients with a higher [visceral fat index] were profoundly more likely to undergo surgery within 6 and 12 months with the majority of patients needing to undergo surgery within 6 months of starting their anti-TNF,” Phillip Gu, MD, a fellow at UT Southwestern Medical Center, said in his presentation.
Gu and colleagues looked at patients with IBD (n = 181) who started anti-TNF agents between January 1, 2009, and July 31, 2019, at two academic medical centers. They conducted 3D visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes were measured via CT scans.
“One thing to note is 3D measurements have the advantage over 2D measurements because it better accounts for variations in fat distribution and gives a more accurate assessment,” Gu said.
The researchers then calculated visceral fat index (VFI) as a ratio of VAT to SAT and categorized patients by predefined VFI cutoffs of less than 0.33, 0.33 to 0.66 and greater than 0.67. They performed a multivariable logistic regression on corticosteroid-free response and surgery, adjusting for age, sex, IBD diagnosis, disease duration, active tobacco use, baseline albumin and immunomodulator exposure. Higher VFI was seen in white patients, men, older patients and those with diabetes and other cardiometabolic comorbidities.
“IBD patients starting an anti-TNF agent with high VFI are significantly more likely to undergo surgery in the short term,” Gu said.
At 6 months post-anti-TNF initiation, patients with VFI greater than 0.67 were more likely to undergo surgery (aOR = 41.92; 95% CI, 5.09-345.59), while patients with VFI 0.33 to 0.66 had no difference compared with those in the lowest cohort.
Gu showed similar results at 12 months where patients with VFI greater than 0.67 were more likely to undergo surgery (aOR = 15.55; 95% CI, 2.85-80.56) with no difference between the other two cohorts. Gu said there was no major difference between patients with ulcerative colitis and those with Crohn’s.
“Our findings suggest VFI is a potential biomarker that identified IBD patients at risk for medically refractory disease who will likely require surgery in the near future,” Gu said. “If validated by future prospective studies, we speculate patients with high VFI may benefit from starting with higher initial dose anti-TNF, early surgical referral and possibly proactive therapeutic drug monitoring.”
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Gu P. Translating the Latest Basic Research to the Clinic and Featured Abstracts. Presented at: Crohn’s and Colitis Congress (Virtual); January 21-24, 2021.
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