Intestinal Research

Original Articles

Exploring the link between celiac disease and obesity: a potential role of gut microbiome: Sunaina Addanki, Anastasia Mashukova, Arkene Levy; Received April 3, 2024 Accepted August 22, 2024 Published online November 8, 2024; DOI: https://doi.org/10.5217/ir.2024.00049 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
In today’s age, celiac disease (CD) is no longer solely characterized by chronic diarrhea in a malnourished child. Obesity is gradually being acknowledged as part of CD’s clinical course. Both conditions have been linked to alterations of gut microbiome. Given the difficulty of strict gluten-free diet adherence, there is a need for less restrictive adjunctive therapies. We aimed to investigate the prevalence of obesity in patients diagnosed with CD with the goal of developing new therapeutic approaches.
Methods
Baseline data from the National Institute of Health’s All of Us Research Program, was used to evaluate the relationship between CD and obesity. A retrospective cohort study was conducted where groups of individuals with CD and without CD were matched by age range and health surveys. Statistical analysis with odds ratios (OR) with 95% confidence intervals (CI) were reported.
Results
The prevalence of obesity was 32.6% in the CD group compared to 18.4% in the control group (OR, 2.111; 95% CI, 1.914–2.328; P< 0.0001). Women accounted for a greater population of patients with CD and obesity. The largest percentage of patients with CD and obesity were older than 65 years. The highest percentage of individuals in both the experimental and control groups were white, followed by African Americans.
Conclusions
Our data shows a significant association between CD and increased prevalence of obesity. These results warrant further investigation into microbial changes and dietary exposures that affect the pathogenesis of both diseases.

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IBD

A nationwide analysis on the influence of obesity in inflammatory bowel disease hospitalizations: Dushyant Singh Dahiya, Asim Kichloo, Farah Wani, Jagmeet Singh, Dhanshree Solanki, Hafeez Shaka; Intest Res 2022;20(3):342-349. Published online May 21, 2021; DOI: https://doi.org/10.5217/ir.2021.00046

Abstract PDF PubReader ePub

Background/Aims
Proinflammatory cytokines released from adipocytes can influence the development, progression, and treatment of inflammatory bowel disease (IBD), and may be associated with worse clinical outcomes.
Methods
For 2016–2018, we analyzed data from the Nationwide Inpatient Sample to identify adult (≥18 years) hospitalizations with a primary discharge diagnosis of IBD. The study sample was divided based on the presence or absence of obesity. The primary outcomes included inpatient mortality, while the secondary outcomes consisted of system-based complications and disease implications on the United States healthcare system.
Results
We identified 282,005 hospitalizations of IBD from 2016 to 2018. Of these hospitalizations, 26,465 (9.4%) had a secondary diagnosis of obesity while 255,540 (90.6%) served as controls. IBD hospitalizations with obesity had a higher mean age (47.9 years vs. 45.2 years, P<0.001), middle age (range, 40–65 years) predominance (37.7% vs. 28.9%, P<0.001), female predominance (64.1% vs. 52.5%, P<0.001) and higher proportion of patients with comorbidities compared to the non-obese cohort. White predominance was observed in both subgroups. No difference in the odds of inpatient mortality was noted between the 2 subgroups; however, IBD hospitalizations with obesity had higher mean total hospital charge ($50,126 vs. $45,001, P<0.001), longer length of stay (5.5 days vs. 4.9 days, P<0.001) and higher proportion of complications compared to the non-obese cohort.
Conclusions
Obese IBD hospitalizations had higher length of stay, total hospital charge, and complications compared to the non-obese cohort.

Citations

Citations to this article as recorded by

Recomendaciones sobre el manejo de la obesidad grave en pacientes con enfermedad inflamatoria intestinal del Grupo Español de Trabajo en Enfermedad Inflamatoria Intestinal (GETECCU), Sociedad Española de Obesidad (SEEDO), Asociación Española de Cirugía (A
Eugeni Domènech, Andreea Ciudin, José María Balibrea, Eduard Espinet-Coll, Fiorella Cañete, Lilliam Flores, Manuel Ferrer-Márquez, Román Turró, Alejandro Hernández-Camba, Yamile Zabana, Ana Gutiérrez, José María Balibrea, Manuel Barreiro-de Acosta, Javier
Gastroenterología y Hepatología.2024; 47(8): 906. CrossRef
The Rising Epidemic of Obesity in Patients with Inflammatory Bowel Disease
Jellyana Peraza, Erin Abbott, Mark Shneyderman, Asher Kornbluth, Maitreyi Raman, Stephanie Gold
Current Treatment Options in Gastroenterology.2024; 22(3): 134. CrossRef
Recommendations on the management of severe obesity in patients with inflammatory bowel disease of the Spanish Group on Crohn’s Disease and Ulcerative Colitis (GETECCU), Spanish Society of Obesity (SEEDO), Spanish Association of Surgery (AEC) and Spanish
Eugeni Domènech, Andreea Ciudin, José María Balibrea, Eduard Espinet-Coll, Fiorella Cañete, Lilliam Flores, Manuel Ferrer-Márquez, Román Turró, Alejandro Hernández-Camba, Yamile Zabana, Ana Gutiérrez, José María Balibrea, Manuel Barreiro-de Acosta, Javier
Gastroenterología y Hepatología (English Edition).2024; 47(8): 906. CrossRef
Body Mass Index Profile of Adult Patients with Inflammatory Bowel Disease in a Multicenter Study in Northeastern Brazil
Jones Lima, Carlos Brito, Lívia Celani, Marcelo Vicente Araújo, Maurilio Lucena, Graciana Vasconcelos, Gustavo Lima, Fernando Nóbrega, George Diniz, Norma Lucena-Silva, Regiane Maio, Valéria Martinelli
Clinical and Experimental Gastroenterology.2023; Volume 16: 213. CrossRef
Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study
Seung Yong Shin, Soo Jung Park, Young Kim, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-Ho Ki
Intestinal Research.2022; 20(3): 350. CrossRef

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Miscellaneous

Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver: Ashish Agarwal, Alka Singh, Wajiha Mehtab, Vipin Gupta, Ashish Chauhan, Mahendra Singh Rajput, Namrata Singh, Vineet Ahuja, Govind K. Makharia; Intest Res 2021;19(1):106-114. Published online April 22, 2020; DOI: https://doi.org/10.5217/ir.2019.00136

Abstract PDF PubReader ePub

Background/Aims
Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease.
Methods
Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan.
Results
In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively.
Conclusions
Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.

Citations

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Sunaina Addanki, Anastasia Mashukova, Arkene Levy
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Miscellaneous

Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence: Youn I Choi, Hyun Sun Woo, Jun-Won Chung, Young Sup Shim, Kwang An Kwon, Kyoung Oh Kim, Yoon Jae Kim, Dong Kyun Park; Intest Res 2019;17(4):554-560. Published online October 14, 2019; DOI: https://doi.org/10.5217/ir.2018.00148

Abstract PDF PubReader ePub

Background/Aims
There is limited data to compare the clinical characteristics and recurrence rates between left-sided primary epiploic appendagitis (PEA) versus left-sided acute colonic diverticulitis (ACD), and right-sided PEA versus right-sided ACD, respectively.
Methods
We retrospectively reviewed the medical records and radiologic images of the patients who presented with left-sided or right-sided acute abdominal pain and had computer tomography performed at the time of presentation showing radiological signs of PEA or ACD between January 2004 and December 2014. We compared the clinical characteristics of left PEA versus left ACD and right PEA versus right ACD, respectively.
Results
Fifty-six patients (left:right = 27:29) and 308 patients (left:right = 24:284) were diagnosed with symptomatic PEA and ACD, respectively. Left-sided PEA were statistically significantly younger (50.2 ± 15.4 years vs. 62.1 ± 15.8 years, P= 0.009), more obese (body mass index [BMI]: 26.3 ± 2.9 kg/m2 vs. 22.3 ± 3.1 kg/m2 , P< 0.001), and had more tendencies with normal or mildly elevated high-sensitivity C-reactive protein (hsCRP) (1.2 ± 1.3 mg/dL vs. 8.4 ± 7.9 mg/dL, P< 0.001) than patients with left-sided ACD. The discriminative function of age, BMI and CRP between left-sided PEA versus left-sided ACD was 0.71 (cutoff: age ≤ 59 years, sensitivity of 66.7%, specificity of 77.8%), 0.83 (cutoff: BMI > 24.5 kg/m2 , sensitivity of 80.0%, specificity of 80.0%) and 0.80 (cutoff: CRP < 1.8 mg/dL, sensitivity of 72.2%, specificity of 85.7%).
Conclusions
If patients with left lower quadrant abdominal pain are less than 60 years, obese (BMI > 24.5 kg/m2 ) with or without normal to mild elevated CRP levels (CRP < 1.8 mg/dL), it might be necessary for clinicians to suspect the diagnosis of PEA rather than ACD.

Citations

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Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases
Ayman El‐Menyar, Syed G. A. Naqvi, Omer Al‐Yahri, Abdelaziz MA Abusal, Abdulwahhab Al‐Shaikhli, Sadia Sajid, Husham Abdelrahman, Ahmad G. Kloub, Muhamed Ibnas, Rifat Latifi, Yasser M. R. Toble, Hassan Al‐Thani
World Journal of Surgery.2024; 48(6): 1363. CrossRef
Epiploic Adipose Tissue (EPAT) in Obese Individuals Promotes Colonic Tumorigenesis: A Novel Model for EPAT-Dependent Colorectal Cancer Progression
Rida Iftikhar, Patricia Snarski, Angelle N. King, Jenisha Ghimire, Emmanuelle Ruiz, Frank Lau, Suzana D. Savkovic
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Recurrencia en pacientes con apendagitis epiploica: un reporte de caso
Mía Alejandra Gómez Corrales, Fabian Andrés Chávez Ecos, Jackeline Alexandra Espinoza Utani, Carlos Alberto Dávila Hernández
Revista colombiana de Gastroenterología.2023; 38(1): 94. CrossRef

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Colorectal neoplasia

Association of visceral adiposity and insulin resistance with colorectal adenoma and colorectal cancer: In Sub Jung, Cheol Min Shin, Sung Jae Park, Young Soo Park, Hyuk Yoon, Hyun Jin Jo, Nayoung Kim, Dong Ho Lee; Intest Res 2019;17(3):404-412. Published online November 12, 2018; DOI: https://doi.org/10.5217/ir.2018.00072

Abstract PDF PubReader ePub

Background/Aims
To examine whether visceral adiposity serves as a risk factor for colorectal cancer (CRC) and colorectal adenomas.
Methods
Two hundred healthy subjects, 200 patients with colorectal adenoma, and 151 patients with CRC (46 with early-stage and 105 with advanced-stage cancers) were enrolled at a tertiary referral hospital. All subjects underwent colonoscopy, and had laboratory data, and computed tomography (CT) scan available for abdominal fat measurement. An abdominal CT scan taken 1 to 4 years (mean interval, 20.6 months) before the diagnosis of CRC was also available in the 42 CRC patients.
Results
The mean areas of visceral adipose tissue (VAT) areas in the control, adenoma, early- and advanced-stage CRC groups were 94.6, 116.8, 110.4, and 99.7 cm2 , respectively (P<0.001). The risk of adenoma positively correlated with VAT area and the visceral-to-total fat ratio (P for trend <0.01), but the risk of CRC did not (P>0.05). The risk of both adenoma and CRC positively correlated with fasting plasma glucose levels (P for trend <0.05). In patients with early-stage cancer (n=17), VAT area decreased when the CT scan at diagnosis was compared with that taken before the diagnosis of CRC, but superficial adipose tissue area did not, so visceral-to-total fat ratio significantly decreased (46.6% vs. 50.7%, respectively, P=0.018)
Conclusions
VAT area is related to the risk of colorectal adenoma. However, VAT decreases from the early stages of CRC. Impaired fasting glucose has a role in colorectal carcinogenesis.

Citations

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