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P537 The effect of anti TNF induction therapy on body composition parameters in inflammatory bowel disease

A.A. Csontos*1, A. Molnar2, I. Kovacs3, Z. Piri1, B. Katona1, K. Mullner1, P. Miheller1

1Semmelweis University, 2nd Dept. Med., Budapest, Hungary, 2Hungarian Crohn and Colitis Association, Hungarian Crohn and Colitis Association, Budapest, Hungary, 3Hungarian Dietetic Association, Hungarian Dietetic Association, Budapest, Hungary

Background

Nutritional status and particularly sarcopenia may influence disease outcome in chronic disorders. Our aim was to assess the changes in body composition during the initiation phase of anti-TNF-alpha therapy in inflammatory bowel disease (IBD).

Methods

40 IBD outpatients (33 Crohn's disease [CD], 7 ulcerative colitis [UC]) were included into our study. 24 patients received adalimumab (ADA: 160/80mg at weeks 0/2, then 40mg every other week) and 16 patients were treated with infliximab (IFX 5 mg/kg at week 0, 2, 6 and then in every 8 weeks). Bioelectrical impedance analysis (BIA) was performed and body composition was measured by the InBody 720 body analyzer right before starting biological therapy. The measurement was repeated 3 months later. Body composition indexes were derived from the computed values (fat-free mass index [FFMI], skeletal muscle index [SMI] and body fat mass index [BFMI]) of BIA.

Results

According to our findings baseline BMI and muscle parameters increased significantly during the observed period (BMI: 23.81 ± 7.19 kg/m2 vs. 24.52 ± 7.34kg/m2, p<0.001; FFMI: 17.64 ± 3.00 kg/m2 vs. 18.14 ± 3.08 kg/m2, p<0.001; SMI: 9.81 ± 1.83 kg/m2 vs. 10.05 ± 1.90 kg/m2; p=0.003; body cell mass: 34.04 ± 7.97 vs. 35.11 ± 8.24; p<0.001 at week 0 vs. week 12, resp). However no significant changes were detected in body fat parameters (BFMI: 6.21 ± 5.20 kg/m2 vs. 6.44 ± 5.27 kg/m2; Body Fat Percent: 23.24 ± 11.34 vs. 23.56 ± 11.71; Visceral Fat Area: 109.01 ± 68.57 vs. 107.11 ± 73.58; resp.). There was no significant difference between the effects of ADA vs. IFX treatment on body composition parameters (deltaFFMI: 0.55 ± 0.82 vs. 0.43 ± 0.69; deltaSMI:0.51 ± 07.78 vs. 0.11 ± 0.42; deltaBFMI: 0.23 ± 0.85 vs. 0.21 ± 1.01; resp.). Greater improvement was observed regarding muscle parameters in CD than UC patients (deltaFFMI: 0.61 ± 0.74 vs. -0.04 ± 0.69, p=0.038; deltaSMI: 0.34 ± 0.44 vs. -0.24 ± 0.33, p=0.002). There was no significant difference in the extent of changes in body composition parameters whether the patients were on corticosteroids (n=15) or not (n=25) at week 0 (deltaFFMI:0.44 ± 0.84 vs 0.59 ± 0.72; deltaSMI:0.17 ± 0.48 vs 0.31 ± 0.47; deltaBFMI:0.366 ± 1.12 vs. 0.09 ± 0.71 on and without steroid, resp.)

Conclusion

Comparing baseline and week 12 data we observed significant improvement in BMI and in body composition muscle parameters. Risk of sarcopenia defined by FFMI and SMI decreased during the anti-TNF induction therapy, while fat parameters have not changed significantly. Our findings suggest that induction anti-TNF therapy has beneficial effect on nutritional status and body composition regardless leaving the steroid therapy. We observed no difference between IFX and ADA treatment in the effect on body composition.