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Visceral Fat Is Associated With Mucosal Healing of Infliximab Treatment in Crohn’s Disease

Shen, Weisong, Ph.D.; Cao, Lei, M.D.; Li, Yi, Ph.D.; Cai, Xingchen, M.D.; Ge, Yuanyuan, Ph.D.; Zhu, Weiming, Ph.D.

Diseases of the Colon & Rectum: June 2018 - Volume 61 - Issue 6 - p 706–712
doi: 10.1097/DCR.0000000000001074
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: Visceral fat is the pathogenesis of Crohn’s disease and is associated with disease status.

OBJECTIVE: This study aimed to evaluate the effect of the visceral fat on mucosal healing in patients with Crohn’s disease after infliximab induction therapy

DESIGN: This was a retrospective study.

SETTINGS: The study was conducted in a tertiary referral hospital.

PATIENTS: Between 2011 and 2017, 97 patients with Crohn’s disease with the presence of ulcers underwent infliximab therapy.

MAIN OUTCOME MEASURES: We studied them retrospectively. Mucosal healing was the end point. Patients composed 2 groups: mucosal healing and no mucosal healing. Univariate, multivariate, and receiver operating characteristic curve analyses determined the predictive value of the visceral fat area.

RESULTS: Univariate analysis showed a statistically significant difference in the smoking history between the groups. Mucosal healing rates after infliximab were lower among active smokers (p = 0.022). Healed patients had significantly less visceral fat area before therapy (47.76 ± 4.94 vs 75.88 ± 5.55; p = 0.000) and a lower mesenteric fat index (0.52 ± 0.04 vs 0.89 ± 0.07; p = 0.000). There was no significant difference in the subcutaneous fat area (87.39 ± 5.01 vs 93.31 ± 6.95; p = 0.500). Multivariate analysis showed that only visceral fat area (OR = 0.978 (95% CI, 0.964–0.992); p = 0.002) and smoking history (OR = 0.305 (95% CI, 0.089–0.996); p = 0.041) were independent factors for mucosal healing. Receiver operating characteristic curve analysis showed predictive cutoff values of 61.5 cm2 and 0.62 for visceral fat area and mesenteric fat index.

LIMITATIONS: This was a retrospective study.

CONCLUSIONS: There was an association between increased visceral fat area and attenuated mucosal healing after infliximab therapy in biologically naive patients with Crohn’s disease, indicating a need for earlier increased infliximab doses among patients with increased visceral fat. See Video Abstract at

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

Funding/Support: This work was supported in part by funding from the National Natural Science Foundation of China (81570500 and 81670471).

Financial Disclosure: None reported.

Weisong Shen, Lei Cao, and Yi Li contributed equally to this work.

Correspondence: Weiming Zhu, Ph.D., Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons