社论:肥胖和溃疡性结肠炎高级治疗的结果——脂肪的问题:作者的答复。

IF 6.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Aakash Desai, Priya Sehgal
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引用次数: 0

摘要

我们对Kuzhiyanjal等人的社论表示赞赏。随着肥胖在IBD患者中越来越普遍,其临床意义也越来越重要。肥胖与更严重的IBD表型相关,其特征是疾病活动性增加和治疗反应欠佳。我们认为这种关系主要是由内脏脂肪驱动的,内脏脂肪是指沉积在内脏周围的激素和代谢活性脂肪。与皮下脂肪相比,内脏脂肪可能是肥胖和IBD患者不良结局背后的关键因素。内脏脂肪可以促进由脂肪细胞衍生的细胞因子如瘦素、tnf - α和IL-6[3]介导的促炎状态。在一项前瞻性研究中,内脏肥胖与无皮质类固醇和内窥镜缓解率下降有关。内脏脂肪也与克罗恩病和溃疡性结肠炎患者IBD发作间隔时间缩短有关。此外,内脏脂肪与接受抗tnf -α治疗的患者手术风险增加、克罗恩病的狭窄以及回肠结肠切除术后的术后死亡率相关[6,7]。我们探讨了肥胖(BMI≥30 kg/m2)对溃疡性结肠炎结局的影响;BMI升高与2年内使用皮质类固醇、改变高级治疗或结肠切除术的综合结果相关,包括抗肿瘤坏死因子(tnf)、vedolizumab、ustekinumab和Janus激酶抑制剂(JAKi)[8]。考虑到数据库研究的局限性,BMI是唯一可能衡量肥胖的指标。与先前的研究一致,我们假设BMI可以作为内脏脂肪的替代指标,因为内脏脂肪增加的患者可能表现出更高的BMI。BMI在常规临床实践中也很方便。然而,它仍然是一个不完美的测量,它与IBD不良结局的关联是不一致的。例如,在一项多中心队列研究中,IBD患者开始接受新的生物治疗,BMI与住院、IBD相关手术或严重感染bb0无关。此外,在四项临床试验(ACCENT-1、SONIC、ACT-1和- 2)的汇总分析中,BMI与克罗恩病或溃疡性结肠炎的临床缓解、临床反应或粘膜愈合之间没有显著关联。我们同意Kuzhiyanjal等人的观点,即未来研究肥胖与IBD疾病活动之间关系的真正影响应该同时利用BMI和内脏脂肪。建立这两个暴露变量与疾病活动性结果之间的关系是谨慎的——最好是内窥镜和组织学。此外,研究应前瞻性地进行,并有能力调整协变量,如吸烟、类固醇使用、造口术的存在和基线疾病活动。我们期待未来的前瞻性研究能够更清楚地阐明内脏脂肪、BMI和IBD预后之间的关系。阿卡什·德赛:写作-原稿,写作-审查和编辑,调查,概念化。Priya Sehgal:写作-原稿,写作-审查和编辑,调查,概念化。作者声明无利益冲突。这篇文章链接到Desai等人的论文。要查看这些文章,请访问https://doi.org/10.1111/apt.18513和https://doi.org/10.1111/apt.70097。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Editorial: Obesity and Outcomes on Advanced Therapy in Ulcerative Colitis—The Fat of the Matter: Authors' Reply

We appreciate the editorial by Kuzhiyanjal et al. [1] As obesity becomes increasingly prevalent among individuals with IBD, its clinical implications continue to gain relevance [2]. Obesity has been associated with a more severe phenotype of IBD, characterised by increased disease activity and suboptimal treatment response. We propose that this relationship is primarily driven by visceral adiposity, which refers to the hormonally and metabolically active fat deposited around the viscera. Visceral, as opposed to subcutaneous, adiposity may be the key player behind adverse outcomes in patients with obesity and IBD. Visceral fat can promote a pro-inflammatory state mediated by adipocyte-derived cytokines such as leptin, TNF-alpha, and IL-6 [3]. In a prospective study, visceral adiposity was associated with decreased rates of corticosteroid-free and endoscopic remission [4]. Visceral adiposity has also been associated with decreased time between IBD flares in both Crohn's disease and ulcerative colitis [5]. Furthermore, visceral adiposity has been associated with increased risk of surgery among patients on anti-TNF-α therapy, stricturing in Crohn's disease, and post-operative mortality following ileocolonic resection [6, 7].

We explored the impact of obesity (BMI ≥ 30 kg/m2) on outcomes in ulcerative colitis; elevated BMI was associated with the composite outcome of corticosteroid use, change in advanced therapy, or colectomy within 2 years across several different advanced therapies including anti-TNF agents, vedolizumab, ustekinumab and Janus kinase inhibitors (JAKi) [8]. Given the confines of a database study, BMI was the only possible measure of obesity. In keeping with prior studies, we hypothesized that BMI may serve as a surrogate measure for visceral adiposity, as patients with increased visceral fat probably exhibit higher BMI. BMI is also convenient in routine clinical practice. However, it remains an imperfect measure, and its association with adverse IBD outcomes is inconsistent. For instance, in a multi-centre cohort study, of patients with IBD starting a new biologic therapy, BMI was not associated with hospitalisation, IBD-related surgery, or serious infection [9]. Additionally, in a pooled analysis of four clinical trials (ACCENT-1, SONIC, ACT-1, and −2), there was no significant association between BMI and clinical remission, clinical response, or mucosal healing in Crohn's disease or ulcerative colitis [10].

We agree with Kuzhiyanjal et al. in that future studies examining the true impact of the relationship between obesity and IBD disease activity should utilise both BMI and visceral adiposity. It would be prudent to establish a relationship between these two exposure variables and the outcomes of disease activity—ideally endoscopic and histologic. Furthermore, studies should be carried out prospectively with the ability to adjust for co-variables such as smoking, steroid use, presence of ostomy and baseline disease activity.

We look forward to future prospective studies to elucidate more clearly the relationship between visceral adiposity, BMI and outcomes in IBD.

Aakash Desai: writing – original draft, writing – review and editing, investigation, conceptualization. Priya Sehgal: writing – original draft, writing – review and editing, investigation, conceptualization.

The authors declare no conflicts of interest.

This article is linked to Desai et al papers. To view these articles, visit https://doi.org/10.1111/apt.18513 and https://doi.org/10.1111/apt.70097.

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来源期刊
CiteScore
15.60
自引率
7.90%
发文量
527
审稿时长
3-6 weeks
期刊介绍: Alimentary Pharmacology & Therapeutics is a global pharmacology journal focused on the impact of drugs on the human gastrointestinal and hepato-biliary systems. It covers a diverse range of topics, often with immediate clinical relevance to its readership.
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