Article Review: High Prevalence of Overweight and Obesity in Adults With Crohn’s Disease: Associations with Disease And Lifestyle Factors

Suibhne et al. (2013) prefaced their study by noting that overweight and obesity have reached epidemic proportions, presenting a serious public health problem. Weight loss was traditionally recognized as a feature of Crohn’s disease (CD), but overweight has recently surfaced as a problem associated with CD. The study was designed to determine and compare the prevalence of overweight and obesity in the two groups and discern disease-specific and generic factors linked with body mass index (BMI) in the individuals with CD.

Using a prospective case-control research design, Suibhne et al. (2013) compared data from 100 outpatients with CD to a matched (age, gender, socioeconomic status) control group of 100 healthy adults. In addition to calculating BMI, Suibhne et al. (2013) used two techniques for assessing body fat to calculate adiposity. The participants were evaluated on a number of lifestyle and disease factors including smoking status, physical activity, need for CD related surgery and use of corticosteroids within the past year, and inflammatory disease markers using the Crohn’s disease activity index (CDAI), in which values below 150 indicate remission. Blood samples were also taken, assessing white blood cell count and C-reactive protein (CRP), which is associated with obesity.

Suibhne et al. (2013) used highly rigorous research methodology. Analysis of variance (ANOVA) was used for comparisons and backward stepwise multiple linear regression analysis was utilized to assess the association between BMI and disease-related and lifestyle factors. The results showed a high prevalence of overweight/obesity in both groups, although lower (albeit insignificantly) in the participants with CD (40%) compared to the control group (52%). In contrast to the traditional association of CD with underweight and low BMI, only two CD patients were underweight. Overweight and obese CD patients tended to be older and more sedentary compared to those with a healthy weight and those maintaining a healthy lifestyle, but they also showed lower disease activity and white blood cell counts, implying more stable CD. Roughly two-thirds (67%) of the CD patients were in remission (CDAI values <150) and 15% had CDAI values of 150-199. None of the patients had very severe disease (CDAI 450 or higher). BMI had no significant link with either surgery or corticosteroid use.

Overall, the results showed a marked trend away from the traditional association of CD with underweight. Of particular significance, higher BMI was associated with more stable CD. The pattern that emerged was that BMI was positively linked with older age and lower physical activity and inversely linked with CDAI and white blood cell count.

Additionally, Suibhne et al. (2013) observed a connection between higher BMI and higher CRP, which is recognized as a marker for obesity in the general population and also emerged as a marker for CD. The researchers conducted a highly detailed study, assessing the participants on numerous factors and using multiple modes of analysis. The study was driven by the escalation of poor diets and obesity in Western societies, and in particular, by prior research suggesting that high BMI is associated with indicators of more serious CD. The very rigorous research design adds weight to the validity of the findings.

Suibhne et al. (2013) did an excellent job of presenting their case for ongoing research into the effects of overweight and obesity on the trajectory of CD. In particular, they are concerned with the long-range implications of high BMI on CRP and inflammation in adults with CD. Their study serves as a springboard for future research.

Reference

Suibhne, T. N., Raftery, T. C., McMahons, O., Walsh, C., Morain, C., & O’Sullivan, M. (2013). High prevalence of overweight and obesity in adults with Crohn’s disease: Associations with disease and lifestyle factors. Journal of Crohn’s and Colitis, 7, e241-e248. Retrieved from http://dx.doi.org/10.1016/j.crohns.2012.09.00