Effects Of Surgical Treatment On Visceral/subcutaneous Fat Distribution In Patients With Crohn’s Disease

Background:Mesenteric fat plays an important role in the pathogenesis of Crohn’s disease (CD), and a higher ratio of visceral fat area (VFA) to subcutaneous fat area (SFA) is related to complicated disease status. Surgery is an effective treatment option for patients with CD, and the aims of this study are to assess the effects of surgery on abdominal fat distribution in patients with CD.Methods:Data were obtained from the patient with CD between July2011and January2014in SRRSH. The SFA and VFA were measured in34patients with CD, one week before and3months after surgery, The mesenteric fat index (MFI), defined as the ratio of VFA to SFA, was calculated. The correlations between MFI and CD activity index、 C-reactive protein level、albumin、hemoglobin and body mass index (BMI) were also evaluated. At the same time, we selected20patients with gallbladder stones, and measured the preoperative SFA, VFA and MFI of the umbilical level, and compared the differences of fat and fat distribution between patients with gallbladder stones and patients with Crohn disease.Results:Before surgery, compared with the patients with gallstone, the VFA in Crohn’s disease patients has no significant difference (33.98±23.77cm vs35.88±26.69cm, P=0.850), but the SFA was significantly lower (54.49±42.84cm2vs65.78±44.36cm2, P=0.012), and the patients’s MFI was significantly higher than the gallstone patients’(0.74±0.50vs0.56±0.32, P=0.005). Both VFA (33.98±23.77cm2vs45.32±30.24cm2, P=0.03) and SFA (54.49±42.84cm2vs88.35±44.27cm2, P <0.001) were significantly decreased in patients after surgery, and MFI was significantly decreased (0.74±0.50vs0.52±0.36, P=0.025). The CDAI (289.65±61.30vs117.96±63.85, P<0.001), CRP(49.33±41.07mg/L vs5.92±6.67mg/L, P<0.001), ESR (28.66±21.92mm/h vs13.56±12.39mm/h, P<0.001) and ALB (34.48±6.44g/L vs39.02±10.96g/L, P<0.001) were significantly decreased in patients after surgery,but the BMI and the HB showed no significantly change after surgery. MFI was significantly correlated with CD activity index (r=0.494, P=0.027) and C-reactive protein (r=0.530,P=0.013) in patients with active CD before surgery, although no positive correlations were observed in patients after surgery.Conclusions:Surgery can significantly decrease the patient’s CDAI, CRP, ESR. Surgery is associated with a significant decrease in MFI in patients with CD, and MFI is significantly correlated with CD activity index and C-reactive protein in active CD. We believe that besides the direct resection of bowel disease, surgery can also change the distribution of fat, thus to relieve Crohn’s disease.