Preop body composition & postop outcomes in CD

September 15, 2025

Issue 18

Clinical Question

How does body composition impact outcomes after ileal resection in patients with CD?

Editor’s Bottom Line

Myosteatosis on imaging predicts adverse postoperative outcomes in patients with CD undergoing ileal resection.

Reference

Bak MTJ, Demers K, van Ruler O, et al. Preoperative Body Composition Parameters Are Associated With Postoperative Outcomes in Patients With Crohn’s Disease. Clin Gastroenterol Hepatol. Epub ahead of print July 28, 2025. https://www.cghjournal.org/article/S1542-3565(25)00636-6/fulltext

Synopsis

This prospective multicenter Dutch study investigated the association between preoperative (preop) body composition parameters and postoperative (postop) outcomes in 227 patients with Crohn’s disease (CD) undergoing ileocolic (re-)resection (ICR).

The patients were treated at eight academic and seven nonacademic Dutch hospitals and were at least 16 years of age. All had preop abdominal imaging within 12 months of ICR, with researchers measuring cross-sectional surface area normalized for body height (index) and lipid content in skeletal muscle mass (SM) as well as subcutaneous and visceral adipose tissue using computed tomography (CT) or magnetic resonance imaging (MRI) at the L3 vertebral level.

The primary outcome was postop complications within 30 days of surgery. Secondary outcomes included moderate-to-severe complications, infectious complications and endoscopic recurrence at six months.

Patients were a median 35 years of age at surgery (interquartile range, 25.9–50.6 years) and 40.5% were male. Preop imaging was with CT in 44.1% of patients and MRI in 55.9%. The median interval between imaging and surgery was 2.3 months.

Analysis showed that high lipid content in skeletal muscle mass was linked with higher overall rates of postop complications (adjusted odds ratio [aOR]: 3.09; 95% Confidence Interval [CI], 1.36–7.00), moderate-to-severe complications (aOR: 2.66; 95% CI, 1.24–5.68), and infectious complications (aOR: 2.44; 95% CI, 1.10–5.40).

Conversely, low preop subcutaneous adipose tissue was protective against postop complications (aOR: 0.38; 95% CI, 0.16–0.88). Low lipid content in visceral adipose tissue was associated with more postop infectious complications (aOR: 4.31; 95% CI, 1.11–16.71), while high lipid content in visceral adipose tissue was protective against endoscopic postop recurrence (aOR: 0.26; 95% CI, 0.07–0.99).

Both low (aOR: 4.46; 95% CI, 1.09–19.57) and high skeletal muscle mass index were associated with endoscopic recurrence (aOR: 2.45; 95% CI, 1.06–5.65).

No association was found between preop BMI and any postop outcomes in univariable or multivariable analyses. Other significant predictors included active smoking, which increased risk of overall complications (aOR: 2.89; 95% CI, 1.34–6.21) and endoscopic recurrence (aOR: 5.27; 95% CI, 2.22–12.53).

Details

Study Design: Prospective multicenter cohort
Funding: No funding
Allocation: Not stated
Setting: Multicenter
Level of Evidence: 2b