title: Impact of Obesity on the Management and Clinical Course of Patients with Inflammatory Bowel Disease.
abstract: BACKGROUND
  Obesity has been linked with a proinflammatory state and the development of inflammatory diseases. Data on the clinical course and treatment of obese patients with inflammatory bowel disease (IBD) are limited. We used an institutional IBD registry to investigate the impact of obesity on IBD severity and treatment.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data for 3 years (2009-2011). Patients with IBD were categorized by body mass index (BMI). IBD-related quality of life, biochemical markers of inflammation, comorbidities, health care utilization, and treatment were characterized. Obesity was defined as a BMI ≥30 (type I: 30-34.9, type II: 35-39.9, and type III ≥40).
  
  
  RESULTS
  Among 1494 patients with IBD, 71.9% were above their ideal BMI and 31.5% were obese. Obesity was more common in ulcerative colitis compared with patients with Crohn's disease (P = 0.04). Obese class II and class III patients were predominantly female. Obesity in IBD was associated with female gender (P < 0.0001), diabetes mellitus (P < 0.001), hypertension (P < 0.001), hyperlipidemia (P < 0.001), poor quality of life (P < 0.0001), and increased rates of C-reactive protein elevation (P = 0.008). In logistic regression analysis, quality of life and C-reactive protein elevation were not independently correlated with obesity. There was no association between increasing BMI and annual prednisone use, emergency department visits, hospitalization, and surgery. Obesity was associated with lower milligrams per kilogram doses of purine analogs and biologics.
  
  
  CONCLUSIONS
  Obesity in IBD is not associated with increased health care utilization and IBD-related surgeries. Optimal regimens for drug dosing in obese patients with IBD have yet to be defined.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Seminerio
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramos-Rivers
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Anwar
authors.initials: A
authors.lastname: Dudekula
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.forename: Jason
authors.initials: J
authors.lastname: Swoger
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.forename: Katherine
authors.initials: K
authors.lastname: Weyant
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dunn
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D003424:Crohn Disease / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D002097:C-Reactive Protein