Diagnosis of sarcopenic obesity in patients with inflammatory bowel disease

Abstract

Background: Body composition (BC) analysis is emerging as a highly clinically relevant physiological marker in inflammatory bowel disease (IBD), yet the most commonly used measurements in the UK remain weight and body mass index (BMI).1 Over-representation of fat mass (FM) may mask deficits in skeletal muscle mass, leading to a failure to recognise sarcopenia. Sarcopenia is associated with adverse outcomes in IBD such as disease flares, hospitalisations and need for surgery however the prevalence of sarcopenic obesity (SO) in IBD is unknown.2,3 Aims: Our primary aim was to evaluate the application of ESPEN and EASO diagnostic criteria for SO in clinical practice and its prevalence within our IBD patient cohort.4 Our secondary aim was to identify if any differences in BC measurements between IBD phenotype or ethnicity exist. Method(s): This was a cross-sectional study conducted in a tertiary IBD centre over a 6-month period (2023-2024). Consecutive patients attending IBD outpatient appointments were screened for SO using BMI defined by ethnicity cut-offs. Patients who screened positive were further assessed with anthropometry and bioelectrical impedance analysis (BIA). Data were collected on: ethnicity, IBD phenotype, weight, height, BMI, waist circumference (WC), handgrip strength (HGS), mid-upper arm circumference (MUAC), calf circumference (CC), FM and skeletal muscle mass adjusted by weight (SMM/W). A diagnosis of SO was confirmed if a patient had altered skeletal muscle function (reduced HGS) and altered BC (increased % FM plus reduced SMM/W). Result(s): A total of 273 patients were assessed (152 males, 121 females; 162 Crohn's disease, 97 ulcerative colitis, 14 IBD-unclassified; 123 Caucasian, 116 Asian, 22 Black, 12 Mixed ethnicity). Eighty patients (29.3%) had predictive SO, with 40 (50%) proceeding to full assessment. Nine patients (22.5%) had evidence of altered skeletal muscle function with reduced HGS and 21 patients (52.5%) had evidence of altered BC with increased % FM. However, zero patients had SMM/W lower than the defined cut-off value and therefore no patients fulfilled the ESPEN and EASO diagnostic criteria for SO. There were no statistically significant differences in WC, MUAC, CC, HGS, FM or SMM/W between IBD phenotype or ethnicity. Conclusion(s): Whilst 29.3% of patients with IBD had BMI predictive of SO, and a significant proportion had evidence of reduced muscle function and altered BC, no patients fulfilled the diagnostic criteria. The clinical utility of ESPEN and EASO diagnostic criteria within the IBD population remains unclear and larger studies are therefore warranted. References 1. Lomer MCE, Gourgey R, Whelan K. Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn's disease. J Hum Nutr Diet 2014; 27: 28-35. 2. Pedersen M, Cromwell J, Nau P. Sarcopenia is a predictor of surgical morbidity in inflammatory bowel disease. Inflamm Bowel Dis 2017; 23: 1867-1872. 3. Bamba S, Sasaki M, Takaoka A. Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease. PLoS One 2017; 12: e0180036. 4. Donini LM, Busetto L, Bischoff SC. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Obesity facts. 2022; 15: 321-35. Copyright © 2025