P2171 - Impact of Obesity and Metabolic Syndrome on Extraintestinal Manifestations of IBD

Katie Hsia, MD¹, Jennifer Youn, MD¹, Surya Khadilkar, MD¹, Tanya Zeina, MD¹, Puja Rai, MD², Akash Rastogi, MD, MBA¹, Sureya Hussani, MS¹, Samara Spence, BA³, Pranay Adavelly, ¹, Jason Yanes, BS¹, Jacob Kotlier, ⁴, Sonia Friedman, MD⁴, Alexander N.. Levy, MD^5
1Tufts Medical Center, Boston, MA; ²Tufts Medical Center, Cambridge, MA; ³Tufts University School of Medicine, Cambridge, MA; ⁴Tufts University School of Medicine, Boston, MA; ⁵Yale Digestive Diseases, New Haven, CT

Introduction: The extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) have been seen at higher rates in patients with obesity. Adipose tissue has been demonstrated to promote proinflammatory states. Metabolic syndrome, a clinical condition of central obesity, dyslipidemia, hypertension, and impaired glucose metabolism, share features of immune dysregulation seen in IBD. We suspect that the systemic proinflammatory state of metabolic syndrome would lead to more EIM in patients with metabolic syndrome.

Methods: Clinical data was extracted for patients with IBD seen from 1996-2022 at a tertiary medical center. Data collected includes BMI, metabolic syndrome, diabetes, hypertension, hyperlipidemia, and EIM. Obesity was defined as BMI >= 30 kg/m2. Relative risk with confidence intervals of 95% and Pearson’s Chi Squared with alpha 0.05 were calculated using Excel and EpiR.

Results: There were 1418 patients with an average age of 45.6 years +/- 18.2 years and 49% were male. There were 724 (51%) patients with Crohn’s Disease (CD) and 675 (48%) patients with Ulcerative Colitis (UC).



EIM were found in 320 patients (23% of the sample). EIM were more common in patients with CD than UC (57% v 41%, p=0.01). The most common EIM was peripheral joint disease, which involved 180 patients (56% of patients with EIM).



EIM were more common in IBD patients with obesity than in IBD patients who were not obese. Obese patients had higher rates of primary sclerosing cholangitis (PSC) (RR 1.95, CI 1.15-3.3, p=0.019), peripheral joint disease (RR 1.57, CI 1.19-2.07, p=0.002), hidradenitis suppurativa (RR 7.06, CI 1.92-25.94, p=0.002), and psoriasis (RR 1.9, CI 1.08-3.34, p=0.036) than non-obese patients. The prevalence of PSC was significantly increased in all comorbidities measured, including metabolic syndrome (RR 2.18, CI 1.23-3.85, p=0.011), obesity, diabetes (RR 2.61, CI 1.38-4.95, p=0.006), hypertension (RR 2.07, CI 1.22-3.52, p=0.01), and hyperlipidemia (RR 2.23, CI 1.29-3.86, p=0.005). Autoimmune hepatitis was significantly elevated in IBD patients with diabetes (RR 9.98, CI 1.42-70.23, p=0.048).

Discussion: Patients with obesity have a greater risk of total EIM, including peripheral joint disease and skin manifestations. Patients with obesity, metabolic syndrome, diabetes, hypertension, and hyperlipidemia all have a greater relative risk of PSC. Future research can explore how the metabolic activity of obesity, specifically visceral adiposity, impacts the risk for extra intestinal manifestations.


Disclosures:


Katie Hsia, MD¹, Jennifer Youn, MD¹, Surya Khadilkar, MD¹, Tanya Zeina, MD¹, Puja Rai, MD², Akash Rastogi, MD, MBA¹, Sureya Hussani, MS¹, Samara Spence, BA³, Pranay Adavelly, ¹, Jason Yanes, BS¹, Jacob Kotlier, ⁴, Sonia Friedman, MD⁴, Alexander N.. Levy, MD⁵. P2171 - Impact of Obesity and Metabolic Syndrome on Extraintestinal Manifestations of IBD, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.