title: Impact of abdominal visceral adipose tissue on disease outcome in pediatric Crohn's disease.
abstract: BACKGROUND
  Increased abdominal visceral adipose tissue (VAT) is associated with systemic inflammation. The influence of VAT on pediatric inflammatory bowel disease (IBD) has not been studied. The objective of this study was to investigate the differences in VAT between pediatric patients with IBD and age-matched controls and identify associations between VAT and Crohn's disease (CD) outcomes.
  
  
  METHODS
  Single-center retrospective cohort study of 114 pediatric patients with IBD (101 CD and 13 ulcerative colitis) who had abdominal computed tomography at diagnosis. VAT volumes were measured from computed tomography images. A control group of 78 age-matched patients without IBD who had abdominal computed tomography was selected for comparison.
  
  
  RESULTS
  Median VAT was 634 cm (interquartile range, 411-1041) in the IBD group and 659 cm (interquartile range, 394-1015) in the controls. IBD group had 33% higher VAT than controls (95% confidence interval [CI], 11-58) P = 0.002 after adjusting for body mass index and age. In patients with CD, higher VAT was associated with fistulizing or fibrostenotic disease (odds ratio [OR], 1.7; 95% CI, 1.1-2.9; P = 0.03), CD hospitalizations (OR, 1.9; 95% CI, 1.2-3.4; P = 0.01), moderate or severe disease activity scores (OR, 1.8; 95% CI, 1.1-3.1; P = 0.02), and shorter intervals from diagnosis to surgery (hazard ratio, 1.4; 95% CI, 1.0-2.0; P = 0.05) after adjusting for body mass index and age.
  
  
  CONCLUSIONS
  At diagnosis, pediatric patients with IBD have higher adjusted VAT volumes than age- and body mass index-matched controls. Higher VAT volumes in pediatric patients with CD predicted more hospitalizations, increased likelihood of complicated disease, shorter interval from diagnosis to surgery, and higher disease activity scores at diagnosis.
authors.affiliation: Departments of *Pediatric Gastroenterology, and †Pathobiology, Cleveland Clinic, Cleveland, Ohio; ‡Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio; §Department of Radiology, Children's Hospital and Research Center of Oakland, Oakland, California; and ‖Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Victor
authors.initials: V
authors.lastname: Uko
authors.forename: Eugene
authors.initials: E
authors.lastname: Vortia
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Achkar
authors.forename: Pinar
authors.initials: P
authors.lastname: Karakas
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiocchi
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.forename: Marsha H
authors.initials: MH
authors.lastname: Kay
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000209:etiology* / Q000473:pathology; D003424:Crohn Disease / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050152:Intra-Abdominal Fat / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies