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Published in: Digestive Diseases and Sciences 11/2020

01-11-2020 | Crohn's Disease | Original Article

Increased Adiposity and Reduced Lean Body Mass in Patients with Short Bowel Syndrome

Authors: Adeeti J. Chiplunker, Ling Chen, Marc S. Levin, Brad W. Warner, Nicholas O. Davidson, Deborah C. Rubin

Published in: Digestive Diseases and Sciences | Issue 11/2020

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Abstract

Background

Few studies have examined the metabolic consequences of short bowel syndrome (SBS) and its effects on body composition in adults. We hypothesized that body composition of SBS patients is altered compared to a normal age-, race-, and sex-matched population, regardless of parenteral nutrition (PN) dependence.

Aim

To compare the body composition of adult patients with SBS to age-, sex-, and race-matched healthy controls.

Methods

Twenty patients with SBS underwent body composition analysis using the GE Lunar iDXA scanner. Patients were age-, sex-, and race-matched to controls from the National Health and Nutrition Examination Survey (1999–2004). Mean differences in body mass index, fat-free mass, fat mass, percent body fat, visceral adipose tissue mass and volume, and bone mineral density were measured. Statistical analysis was performed using SAS 9.4 software.

Results

Fifty-five percent of subjects had a history of PN use, and 30% were current PN users. Mean percent body fat for SBS patients was 35.1% compared to 30.9% for healthy controls (p = 0.043). Fat-free mass was reduced in SBS (p = 0.007). Patients with reduced bone mass had a trend toward significantly more years of PN exposure compared to those with normal bone mass (p = 0.094), and a trend toward older age (p = 0.075).

Conclusions

SBS is associated with increased percent body fat and reduced fat-free mass, suggesting that improved dietary and therapeutic interventions are needed to restore normal metabolic indices and avoid risk of metabolic syndrome in SBS patients.
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Literature
1.
go back to reference Billiauws L, Maggiori L, Joly F, Panis Y. Medical and surgical management of short bowel syndrome. J Visc Surg. 2018;155:283–291.CrossRef Billiauws L, Maggiori L, Joly F, Panis Y. Medical and surgical management of short bowel syndrome. J Visc Surg. 2018;155:283–291.CrossRef
2.
go back to reference Boutte HJ, Rubin DC. Short bowel syndrome. In: Bardan E, Shaker R, eds. Gastrointestinal Motility Disorders: A Point-of-Care Clinical Guide. Springer; 2018:343–351. Boutte HJ, Rubin DC. Short bowel syndrome. In: Bardan E, Shaker R, eds. Gastrointestinal Motility Disorders: A Point-of-Care Clinical Guide. Springer; 2018:343–351.
3.
go back to reference Levin MS, Rubin DC. Intestinal adaptation. In: Langnas AN, Goulet O, Quigley EM, Tappenden KA, eds. Intestinal Failure. Oxford: Blackwell Publishing; 2008:45–56.CrossRef Levin MS, Rubin DC. Intestinal adaptation. In: Langnas AN, Goulet O, Quigley EM, Tappenden KA, eds. Intestinal Failure. Oxford: Blackwell Publishing; 2008:45–56.CrossRef
4.
go back to reference Wang Y, Iordanov H, Swietlicki EA, et al. Targeted intestinal overexpression of the immediate early gene tis7 in transgenic mice increases triglyceride absorption and adiposity. J Biol Chem. 2005;280:34764–34775.CrossRef Wang Y, Iordanov H, Swietlicki EA, et al. Targeted intestinal overexpression of the immediate early gene tis7 in transgenic mice increases triglyceride absorption and adiposity. J Biol Chem. 2005;280:34764–34775.CrossRef
5.
go back to reference Tantemsapya N, Meinzner-Derr J, Erwin CR, Warner BW. Body composition and metabolic changes associated with massive intestinal resection in mice. J Pediatr Surg. 2008;43:14–19.CrossRef Tantemsapya N, Meinzner-Derr J, Erwin CR, Warner BW. Body composition and metabolic changes associated with massive intestinal resection in mice. J Pediatr Surg. 2008;43:14–19.CrossRef
6.
go back to reference Barron L, Courtney C, Bao J, et al. Intestinal resection-associated metabolic syndrome. J Pediatr Surg. 2018;53:1142–1147.CrossRef Barron L, Courtney C, Bao J, et al. Intestinal resection-associated metabolic syndrome. J Pediatr Surg. 2018;53:1142–1147.CrossRef
7.
go back to reference Pichler J, Chomtho S, Fewtrell M, Macdonald S, Hill S. Body composition in paediatric intestinal failure patients receiving long-term parenteral nutrition. Arch Dis Child. 2014;99:147–153.CrossRef Pichler J, Chomtho S, Fewtrell M, Macdonald S, Hill S. Body composition in paediatric intestinal failure patients receiving long-term parenteral nutrition. Arch Dis Child. 2014;99:147–153.CrossRef
8.
go back to reference Engelstad HJ, Barron L, Moen J, et al. Remnant small bowel length in pediatric short bowel syndrome and the correlation with intestinal dysbiosis and linear growth. J Am Coll Surg. 2018;227:439–449.CrossRef Engelstad HJ, Barron L, Moen J, et al. Remnant small bowel length in pediatric short bowel syndrome and the correlation with intestinal dysbiosis and linear growth. J Am Coll Surg. 2018;227:439–449.CrossRef
9.
go back to reference Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with short bowel syndrome: an assessment by bioelectric impedance spectroscopy (BIS) and dual-energy absorptiometry (DXA). Eur J Clin Nutr. 2004;58:853–859.CrossRef Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with short bowel syndrome: an assessment by bioelectric impedance spectroscopy (BIS) and dual-energy absorptiometry (DXA). Eur J Clin Nutr. 2004;58:853–859.CrossRef
10.
go back to reference Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with an ileostomy and inflammatory bowel disease: validation of bio-electric impedance spectroscopy (BIS). Eur J Clin Nutr. 2002;56:680–686.CrossRef Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with an ileostomy and inflammatory bowel disease: validation of bio-electric impedance spectroscopy (BIS). Eur J Clin Nutr. 2002;56:680–686.CrossRef
11.
go back to reference Tjellesen L, Staun M, Nielsen PK. Body composition changes measured by dual-energy X-ray absorptiometry in patients receiving home parenteral nutrition. Scand J Gastroenterol. 1997;32:686–690.CrossRef Tjellesen L, Staun M, Nielsen PK. Body composition changes measured by dual-energy X-ray absorptiometry in patients receiving home parenteral nutrition. Scand J Gastroenterol. 1997;32:686–690.CrossRef
12.
go back to reference Skallerup A, Nygaard L, Olesen SS, Kohler M, Vinter-Jensen L, Rasmussen HH. The prevalence of sarcopenia is markedly increased in patients with intestinal failure and associates with several risk factors. Clin Nutr (Edinburgh, Scotland). 2018;37:2029–2035.CrossRef Skallerup A, Nygaard L, Olesen SS, Kohler M, Vinter-Jensen L, Rasmussen HH. The prevalence of sarcopenia is markedly increased in patients with intestinal failure and associates with several risk factors. Clin Nutr (Edinburgh, Scotland). 2018;37:2029–2035.CrossRef
14.
go back to reference Li CY, Ford ES, Zhao GX, Balluz LS, Giles WH. Estimates of body composition with dual-energy X-ray absorptiometry in adults. Am J Clin Nutr. 2009;90:1457–1465.CrossRef Li CY, Ford ES, Zhao GX, Balluz LS, Giles WH. Estimates of body composition with dual-energy X-ray absorptiometry in adults. Am J Clin Nutr. 2009;90:1457–1465.CrossRef
15.
go back to reference Frivolt K, Hetterich H, Schwerd T, et al. Increase of intra-abdominal adipose tissue in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2017;65:633–638.CrossRef Frivolt K, Hetterich H, Schwerd T, et al. Increase of intra-abdominal adipose tissue in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2017;65:633–638.CrossRef
16.
go back to reference Bryant RV, Schultz CG, Ooi S, et al. Visceral adipose tissue is associated with stricturing Crohn’s disease behavior, fecal calprotectin, and quality of life. Inflamm Bowel Dis. 2019;25:592–600.CrossRef Bryant RV, Schultz CG, Ooi S, et al. Visceral adipose tissue is associated with stricturing Crohn’s disease behavior, fecal calprotectin, and quality of life. Inflamm Bowel Dis. 2019;25:592–600.CrossRef
17.
go back to reference Marchix J, Goddard G, Helmrath MA. Host-gut microbiota crosstalk in intestinal adaptation. Cell Mol Gastroenterol Hepatol. 2018;6:149–162.CrossRef Marchix J, Goddard G, Helmrath MA. Host-gut microbiota crosstalk in intestinal adaptation. Cell Mol Gastroenterol Hepatol. 2018;6:149–162.CrossRef
18.
go back to reference Kliewer KL, Ke JY, Lee HY, et al. Short-term food restriction followed by controlled refeeding promotes gorging behavior, enhances fat deposition, and diminishes insulin sensitivity in mice. J Nutr Biochem. 2015;26:721–728.CrossRef Kliewer KL, Ke JY, Lee HY, et al. Short-term food restriction followed by controlled refeeding promotes gorging behavior, enhances fat deposition, and diminishes insulin sensitivity in mice. J Nutr Biochem. 2015;26:721–728.CrossRef
19.
go back to reference Haas V, Kent D, Kohn MR, et al. Incomplete total body protein recovery in adolescent patients with anorexia nervosa. Am J Clin Nutr. 2018;107:303–312.CrossRef Haas V, Kent D, Kohn MR, et al. Incomplete total body protein recovery in adolescent patients with anorexia nervosa. Am J Clin Nutr. 2018;107:303–312.CrossRef
20.
go back to reference El Ghoch M, Calugi S, Lamburghini S, Dalle GR. Anorexia nervosa and body fat distribution: a systematic review. Nutrients. 2014;6:3895–3912.CrossRef El Ghoch M, Calugi S, Lamburghini S, Dalle GR. Anorexia nervosa and body fat distribution: a systematic review. Nutrients. 2014;6:3895–3912.CrossRef
21.
go back to reference Mayer L, Walsh BT, Pierson RN, et al. Body fat redistribution after weight gain in women with anorexia nervosa. Am J Clin Nutr. 2005;81:1286–1291.CrossRef Mayer L, Walsh BT, Pierson RN, et al. Body fat redistribution after weight gain in women with anorexia nervosa. Am J Clin Nutr. 2005;81:1286–1291.CrossRef
22.
go back to reference Dulloo AG, Jacquet J, Girardier L. Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues. Am J Clin Nutr. 1997;65:717–723.CrossRef Dulloo AG, Jacquet J, Girardier L. Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues. Am J Clin Nutr. 1997;65:717–723.CrossRef
23.
go back to reference Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817.
24.
go back to reference Ohkawara K, Tanaka S, Miyachi M, Ishikawa-Takata K, Tabata I. A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials. Int J Obes. 2005;2007:1786–1797. Ohkawara K, Tanaka S, Miyachi M, Ishikawa-Takata K, Tabata I. A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials. Int J Obes. 2005;2007:1786–1797.
25.
go back to reference Verheggen RJ, Maessen MF, Green DJ, Hermus AR, Hopman MT, Thijssen DH. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev. 2016;17:664–690.CrossRef Verheggen RJ, Maessen MF, Green DJ, Hermus AR, Hopman MT, Thijssen DH. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev. 2016;17:664–690.CrossRef
26.
go back to reference Chin SH, Kahathuduwa CN, Binks M. Physical activity and obesity: what we know and what we need to know. Obes Rev. 2016;17:1226–1244.CrossRef Chin SH, Kahathuduwa CN, Binks M. Physical activity and obesity: what we know and what we need to know. Obes Rev. 2016;17:1226–1244.CrossRef
27.
go back to reference Shook RP. Obesity and energy balance: what is the role of physical activity? Expert Rev Endocrinol Metab. 2016;11:511–520.CrossRef Shook RP. Obesity and energy balance: what is the role of physical activity? Expert Rev Endocrinol Metab. 2016;11:511–520.CrossRef
28.
go back to reference Kalaitzakis E, Carlsson E, Josefsson A, Bosaeus I. Quality of life in short-bowel syndrome: impact of fatigue and gastrointestinal symptoms. Scand J Gastroenterol. 2008;43:1057–1065.CrossRef Kalaitzakis E, Carlsson E, Josefsson A, Bosaeus I. Quality of life in short-bowel syndrome: impact of fatigue and gastrointestinal symptoms. Scand J Gastroenterol. 2008;43:1057–1065.CrossRef
29.
go back to reference Royall D, Greenberg GR, Allard JP, Baker JP, Harrison JE, Jeejeebhoy KN. Critical assessment of body-composition measurements in malnourished subjects with Crohn’s disease: the role of bioelectric impedance analysis. Am J Clin Nutr. 1994;59:325–330.CrossRef Royall D, Greenberg GR, Allard JP, Baker JP, Harrison JE, Jeejeebhoy KN. Critical assessment of body-composition measurements in malnourished subjects with Crohn’s disease: the role of bioelectric impedance analysis. Am J Clin Nutr. 1994;59:325–330.CrossRef
30.
go back to reference Tjellesen L, Nielsen PK, Staun M. Body composition by dual-energy X-ray absorptiometry in patients with Crohn’s disease. Scand J Gastroenterol. 1998;33:956–960.CrossRef Tjellesen L, Nielsen PK, Staun M. Body composition by dual-energy X-ray absorptiometry in patients with Crohn’s disease. Scand J Gastroenterol. 1998;33:956–960.CrossRef
31.
go back to reference Frank AP, de Souza Santos R, Palmer BF, Clegg DJ. Determinants of body fat distribution in humans may provide insight about obesity-related health risks. J Lipid Res. 2018;60:1710–1719.CrossRef Frank AP, de Souza Santos R, Palmer BF, Clegg DJ. Determinants of body fat distribution in humans may provide insight about obesity-related health risks. J Lipid Res. 2018;60:1710–1719.CrossRef
32.
go back to reference Zong G, Zhang Z, Yang Q, Wu H, Hu FB, Sun Q. Total and regional adiposity measured by dual-energy X-ray absorptiometry and mortality in NHANES 1999–2006. Obesity (Silver Spring). 2016;24:2414–2421.CrossRef Zong G, Zhang Z, Yang Q, Wu H, Hu FB, Sun Q. Total and regional adiposity measured by dual-energy X-ray absorptiometry and mortality in NHANES 1999–2006. Obesity (Silver Spring). 2016;24:2414–2421.CrossRef
33.
go back to reference Barreira TV, Staiano AE, Harrington DM, et al. Anthropometric correlates of total body fat, abdominal adiposity, and cardiovascular disease risk factors in a biracial sample of men and women. Mayo Clin Proc. 2012;87:452–460.CrossRef Barreira TV, Staiano AE, Harrington DM, et al. Anthropometric correlates of total body fat, abdominal adiposity, and cardiovascular disease risk factors in a biracial sample of men and women. Mayo Clin Proc. 2012;87:452–460.CrossRef
34.
go back to reference Bi X, Seabolt L, Shibao C, et al. DXA-measured visceral adipose tissue predicts impaired glucose tolerance and metabolic syndrome in obese Caucasian and African–American women. Eur J Clin Nutr. 2015;69:329–336.CrossRef Bi X, Seabolt L, Shibao C, et al. DXA-measured visceral adipose tissue predicts impaired glucose tolerance and metabolic syndrome in obese Caucasian and African–American women. Eur J Clin Nutr. 2015;69:329–336.CrossRef
35.
go back to reference Rothney MP, Catapano AL, Xia J, et al. Abdominal visceral fat measurement using dual-energy X-ray: association with cardiometabolic risk factors. Obesity (Silver Spring). 2013;21:1798–1802.CrossRef Rothney MP, Catapano AL, Xia J, et al. Abdominal visceral fat measurement using dual-energy X-ray: association with cardiometabolic risk factors. Obesity (Silver Spring). 2013;21:1798–1802.CrossRef
36.
go back to reference Jeppesen PB, Mortensen PB. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut. 1998;43:478–483.CrossRef Jeppesen PB, Mortensen PB. The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection. Gut. 1998;43:478–483.CrossRef
37.
go back to reference Pironi L, Joly F, Forbes A, et al. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut. 2011;60:17–25.CrossRef Pironi L, Joly F, Forbes A, et al. Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut. 2011;60:17–25.CrossRef
Metadata
Title
Increased Adiposity and Reduced Lean Body Mass in Patients with Short Bowel Syndrome
Authors
Adeeti J. Chiplunker
Ling Chen
Marc S. Levin
Brad W. Warner
Nicholas O. Davidson
Deborah C. Rubin
Publication date
01-11-2020
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 11/2020
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-019-06032-4

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