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©The Author(s) 2023.
World J Gastroenterol. Mar 28, 2023; 29(12): 1779-1794
Published online Mar 28, 2023. doi: 10.3748/wjg.v29.i12.1779
Published online Mar 28, 2023. doi: 10.3748/wjg.v29.i12.1779
Table 1 Relationship between obesity and inflammatory bowel disease (obesity as a precursor to the onset of inflammatory bowel disease)
| Ref. | Study design and study population | Key findings |
| Khalili et al[15], 2015 | United States Nurses’ Health Study cohort study: Prospective cohort study of United States women (n = 111498 women); BMI at age 18, baseline, and every 2 yr since baseline was obtained; 2028769 person-years of follow up. CD (n = 153); UC (n = 229) | Obesity at age 18 was an independent risk factor for the development of CD compared to normal BMI (aHR = 2.33, 95%CI: 1.15-4.69). No association between BMI at age 18, baseline BMI, and updated BMI and risk of UC. Higher weight gain was associated with increased risk of CD (Ptrend = 0.04). A greater magnitude of weight gain (from age 18 to age at enrolment) associated with increased risk of developing CD (weight gain > 13.6 kg vs < 2.3 kg, HR = 1.52, 95%CI: 0.87-2.65). No association between weight change (from age 18 to baseline) and risk of UC (Ptrend = 0.17) (weight gain > 13.6 kg vs < 2.3 kg, HR = 0.92, 95%CI: 0.60-1.40) |
| Harpsøe et al[101],2014 | Danish National Birth Cohort study: A large population-based cohort study (n = 75008 women); BMI: Obtained at study baseline (based on prepregnancy body weigh); median 11.4 yr of follow-up. CD (n = 138); UC (n = 394) | An increased risk of developing fetal CD in both underweight (HR = 2.57, 95%CI: 1.30-5.06) and obese women (HR = 1.88, 95%CI: 1.02-3.47) compared with normal-weight women, pointing to a U-shaped association. No association between pregnancy obesity and risk of developing UC (HR = 0.77, 95%CI: 0.48-1.25) |
| Jensen et al[16], 2018 | Copenhagen School Health Records Register cohort study: Cohort from the Copenhagen School Health Records Register (n = 316799); relationship between BMI in the ages of 7 to 13 yr and adult-onset IBD; BMI: Obtained at ages 7 through 13 yr; approximately 10 million person-years of follow-up. CD (n = 1500); UC (n = 2732) | Obesity in early adolescence (at each age from 7 to 13 yr) increased the risk of CD diagnosed before age 30 yr (HR = 1.2, 95%CI: 1.1-1.3) while decreasing the risk of UC (HR = 0.9, 95%CI: 0.9-1.0). No associations between changes in BMI between 7 and 13 yr and later risk of CD or UC |
| Chan et al[17], 2022 | Pooled analysis of 5 prospective cohort studies from the Dietary and Environmental Factors IN-IBD study (n = 601009): BMI: Obtained at study baseline and during follow-up period; 10110018 person-years of follow-up. CD (n = 563); UC (n = 1047) | Obesity was associated with an increased risk of older-onset CD but not UC. The risk of developing CD increased in obese patients compared against those with a normal BMI (aHR = 1.34, 95%CI: 1.05-1.7, I2 = 0%). Each 5 kg/m2 increment in baseline BMI was associated with a 16% increase in risk of CD (aHR = 1.16, 95%CI: 1.05-1.22; I2 = 0%). With each 5 kg/m2 increment in early adulthood BMI (age 18-20 years), there was a 22% increase in risk of CD (pooled aHR = 1.22, 95%CI: 1.05-1.40, I2 = 13.6%). An increase in waist-hip ratio was associated with an increased risk of CD that did not reach statistical significance (pooled aHR across quartiles = 1.08, 95%CI: 0.97-1.19, I2 = 0%). No associations were observed between measures of obesity and risk of UC. For every 5 kg/m2 increase in BMI, the multivariable-adjusted HR was 1.00 (95%CI: 0.90-1.05). For every 5 kg/m2 increase in early adulthood BMI, the multivariable-aHR for UC was 1.05 (95%CI: 0.90-1.22, I2 = 0%) |
| Chan et al[18], 2013 | European Prospective Investigation into Cancer and Nutrition-IBD study (n = 300724): BMI: Obtained at study baseline and during follow-up period. CD (n = 75); UC (n = 177) | No associations with the four higher categories of BMI compared with a normal BMI for UC (Ptrend = 0.36) or CD (Ptrend = 0.83). The lack of associations was consistent when BMI was analyzed as a continuous or binary variable (BMI 18.5 < 25.0 vs ≥ 25 kg/m2). Physical activity and total energy intake, factors that influence BMI, did not show any association with UC (physical activity, Ptrend = 0.79; total energy intake, Ptrend = 0.18) or CD (physical activity, Ptrend = 0.42; total energy, Ptrend = 0.11) |
Table 2 Impact of obesity treatment on inflammatory bowel disease outcomes
| Interventions | Study design | Key finding | Ref. | |
| Lifestyle and dietary interventions | Diet: No data on the effects of overall calorie intake or supervised dietary weight loss on outcomes in IBD patients | Retrospective study: (1) Impact of mediterranean diet on the liver steatosis, clinical disease activity, and QoL in IBD patients (n = 142); (2) 84 UC, 58 CD; and (3) BMI: Collected at study baseline and after 6 mo | Diet-adherent CD and UC improved BMI (UC: -0.42, P = 0.002; CD: -0.48, P = 0.032) and waist circumference (UC: -1.25 cm, P = 0.037; CD: -1.37 cm, P = 0.041). The number of patients affected by liver steatosis of any grade was significantly reduced in both groups after mediterranean diet intervention (UC: 36.9% vs 21.4%, P = 0.0016; CD: 46.6% vs 31.0%, P < 0.001). Mediterranean diet improved QoL in both UC and CD | Chiccoet al[72], 2021 |
| Exercise: (1) Anti-inflammatory effects through a variety of mechanisms, including reducing visceral fat, reducing the secretion of inflammatory adipokines, and reducing stress-induced intestinal barrier dysfunction; and (2) Experts have recommended a prescription of exercise for IBD patients that consists of walking 20-30 min at 60% of maximal heart rate 3 d per week along with resistance training 2-3 times per week for its impact on bone mineral density[102], however this has not been tested prospectively | Prospective study: IBD patients with mild active disease or in remission (n = 32) | IBD patients performed low-intensity walking at an interval of 3 times per week for a duration of 3 mo. IBD patients who exercise have improved sense of well-being and QoL | Ng et al[103], 2007 | |
| 30 patients with moderate-to-mild CD. Randomized to moderate-intensity running 3 × weekly for 10 wk vs usual care | No significant difference in total IBDQ scores, IBDQ social subscores did improve in intervention group (P = 0.023). No disease exacerbation | Klare et al[104], 2015 | ||
| Prospective study: Using the Crohn’s and Colitis Foundation of America Partners Internet-based cohort of IBD patients (n = 1857); 549 UC, 1308 CD | Reduced risk of CD exacerbation (RR = 0.72, 95%CI: 0.55-0.94), reduced risk of UC exacerbation (RR = 0.78, 95%CI: 0.54-1.13), with higher levels of exercise | Jones et al[74], 2015 | ||
| Pharmacologic treatment: BMI of 30 kg/m2 or a BMI of 27 kg/m2 with obesity-related diseases (e.g., hypertension, type 2 diabetes mellitus, and sleep apnea) | Orlistat: (1) By inhibiting gastric and pancreatic lipases, reducing absorption of monoaclglycerides and free fatty acids; and (2) Should be avoided in IBD patients because of the mechanism of action and common side effect | No data on the effect of Orlistat on outcomes in IBD patients | ||
| Liraglutide: Glucagon-like peptide-1 receptor agonist also known as incretin mimetics | Case report: CD patient with type 2 diabetes and active CD | Switching from insulin to liraglutide improved glycemic control and the QoL scores | Kuwata et al[76], 2014 | |
| A nationwide cohort study using Danish registries: Patients with IBD and type 2 diabetes (n = 3751) | A lower risk of adverse clinical events (a composite of the need for oral corticosteroid treatment, need for TNF-α-inhibitor treatment, IBD-related hospitalization, or IBD-related major surgery) amongst patients treated with GLP-1 based therapies compared with treatment with other antidiabetic therapies (adjusted IRR = 0.52, 95%CI: 0.42-0.65) | Villumsen et al[77], 2021 | ||
| Naltrexone/bupropion: Naltrexone and bupropion alone may have anti-inflammatory properties | Uncontrolled studies of IBD patients not in remission (n = 47): Low-dose naltrexone for 12 wk | Low dose naltrexone induced clinical improvement in 74.5%, and remission in 25.5% of patients | Lie et al[78], 2018 | |
| Retrospective study of IBD patients who had received low-dose naltrexone (n = 582) | Initiation of low-dose naltrexone in IBD was followed by reduced dispensing of several drugs considered essential in the treatment of IBD | Raknes et al[79], 2018 | ||
| Phentermine/topiramate: (1) A highly efficacious oral weight-loss agent, which acts centrally to suppress appetite and increase satiety; and (2) Early experimental data on topiramate suggested that it could significantly reduce colonic tissue damage in animal models of IBD | Large retrospective cohort study using United States administrative claims data (n = 1731): Compared new users of topiramate with users of other anticonvulsant/anti-migraine medications | Topiramate use was not associated with markers of IBD flares including steroid prescriptions (HR = 1.14, 95%CI: 0.74-1.73), initiation of biologic agents (HR = 0.93, 95%CI: 0.39-2.19), abdominal surgery (HR = 1.04, 95%CI: 0.17-6.41), or hospitalization (HR = 0.86, 95%CI: 0.62-1.19) | Crocket et al[83], 2014 | |
| Bariatric endoscopic applications | Intragastric balloon: Weight loss achieved through endoscopic bariatric interventions might achieve the same effect on outcomes in IBD as in other autoimmune diseases, but has not been studied | Case report of UC patient | UC worsened after insertion of an intragastric balloon for the treatment of obesity | Manguso et al[88], 2008 |
| Bariatric surgery: BMI ≥ 40 kg/m2 or 35-39.9 kg/m2 with obesity-related comorbidities and previously failed to achieve adequate weight reduction with non-surgical interventions | Bariatric surgery: (1) Several studies have demonstrated that bariatric surgery is likely feasible, safe, and effective weight loss stratege, that may lead to improved outcomes of IBD patients; and (2) No RCTs or prospective studies were found that compared the different bariatric procedures in patients with IBD | Case-control study of 85 IBD patients, matched to non-IBD patients with BS (n = 85): (1) 20 UC, 64 CD, 1 unclassified IBD; (2) BMI 41.6 ± 5.9 kg/m2; and (3) 3 RYGB/73 SG/12 LAGB | Bariatric surgery is a safe and effective procedure in obese IBD patients: (1) At a mean follow-up of 34 mo, mean weight was 88.6 ± 22.4 kg; (2) Complications: 8 (9%); and (3) No difference was observed between cases and controls for postoperative complications (P = 0.31), proportion of weight loss (P = 0.27), or postoperative deficiencies (P = 0.99) | Reenaers et al[93], 2022 |
| Case-control study of 25 IBD patients who underwent BS, matched to IBD patients who did not undergo BS (n = 47) | IBD patients with weight loss after BS had fewer IBD-related complications compared with matched controls: (1) Median decrease in body mass index after bariatric surgery was 12.2; and (2) Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%, OR = 0.36, 95%CI: 0.08-1.23; 12% vs 28%, OR = 0.2, 95%CI: 0.004-1.79) | Braga Neto et al[95], 2020 | ||
| Retrospective review (n = 20): (1) 13 UC, 7 CD; (2) BMI 50.1 ± 9 kg/m2; and (3) 9 SG/7 RYGB/3 AGB/ 1 AGB to RYGB | BS is safe and mitigate IBD: (1) Weight loss: 14.3 ± 5.7 kg/m2 or 58.9% ± 21.1%; (2) Complications: Early 7 (5 Dr, 1 PE, 1 WI), late 5 (2 Pnt, 2 VH, 1 MU), mortality 1 (unrelated); and (3) IBD status after BS: Remit 9, exacerbate 2, no change 9 | Aminian et al[91], 2016 | ||
| Prospective case-control study (n = 6/101): (1) 1 UC, 5 CD; (2) BMI 40.6 ± 3.74 kg/m2; and (3) 1 Maclean gastroplasty/1 SG + end colostomy/2 SG/2 SG + ileocecal resection | BS is safe and effective and IBD Rx decreasing: (1) Weight loss: 11.45 ± 2.8 kg/m2 or 28.14% ± 6.6%; (2) Complications: Late 1 (1 vomiting/dysphagia); and (3) IBD status after BS: Remit 5, exacerbate 1 | Colombo et al[105], 2015 | ||
| Prospective study (n = 10): (1) 2 UC, 8 CD; (2) BMI 42.6 ± 5.6 kg/m2; and (3) 9 LSG/1 LAGB | BS is effective and safe: (1) Weight loss: 71.4 ± 5.9 EWL%; (2) Complications: Early 1 (1 SLL) late 4 (4 VitD); and (3) IBD status after BS: Remit 2, exacerbate 3, no change 3, improved 1 | Keidar et al[106], 2015 | ||
| Retrospective case-control (n = 4): (1) 4 CD; (2) BMI 45 ± 5.3 (40-51) kg/m2; and (3) 4 LSG | SG is safe in CD: (1) Weight loss: 32.8 ± 4.3 kg/m2 or 60.2% ± 13.7% EWL; (2) Complications: Early 1 (1 SLB); and (3) IBD status after BS: Remit 4 | Ungar et al[107], 2013 | ||
| Retrospective inpatient study (n = 493/15319): (1) 245 UC, 248 CD; (2) BMI 40.6 ± 3.74 kg/m2; and (3) 48% SG, 35% RYGB, 17% LAGB | Complications: 0.4% malnutrition, 0.2% thromboembolism, 12% strictures, 0.6% renal failure; prior-bariatric surgery was associated with decreased IRR for renal failure, under-nutrition, and fistulae formation in morbidly obese IBD patients [(IRR = 0.1; 95%CI: 0.02-0.3; P < 0.001), (IRR = 0.2; 95%CI: 0.05-0.8; P = 0.03), and (IRR = 0.1; 95%CI: 0.2-08; P = 0.03), respectively] | Sharma et al[108], 2018 | ||
- Citation: Kim JH, Oh CM, Yoo JH. Obesity and novel management of inflammatory bowel disease. World J Gastroenterol 2023; 29(12): 1779-1794
- URL: https://www.wjgnet.com/1007-9327/full/v29/i12/1779.htm
- DOI: https://dx.doi.org/10.3748/wjg.v29.i12.1779