Pediatrics

48 - Serum Adipokines and Increased Abdominal Visceral Adipose Tissue at Diagnosis Predict Need for Biologic Therapy in Pediatric Inflammatory Bowel Disease

Tuesday, October 9
2:35 PM - 2:45 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: Pediatrics
Jacob A. Kurowski, MD1, Rishi Gupta, MD2, Iulia Barbur3, Sarah Worley, MS1, Erick M. Remer, MD1, Tracey Bonfield, PhD3, Jean-Paul Achkar, MD, FACG1, Claudio Fiocchi, MD1, Satish E. Viswanath, MS, PhD3, Marsha Kay, MD1
1Cleveland Clinic, Cleveland, OH; 2University of Maryland Medical Center, Baltimore, MD; 3Case Western Reserve University, Cleveland, OH

Award: Pediatric GI Award

Introduction: Adipokines are thought to play a role in the inflammatory response derived from abdominal visceral adipose tissue (VAT). Pediatric patients with inflammatory bowel disease (IBD) have higher VAT volumes than healthy controls. We sought to evaluate the correlations between the abnormal VAT volumes in pediatric IBD with serum adipokines and their 12-month disease-related outcomes.

Methods: Pediatric patients with suspected IBD were prospectively enrolled at time of initial colonoscopy. Clinical, laboratory, endoscopic, and anthropometric data were obtained at enrollment and 6- and 12-month follow up for patients with IBD.  Analysis included adipokines and cytokines. Abdominal MRI and CT sequencing was analyzed for VAT volumes if obtained within 3 months of diagnosis. Statistical analysis was performed with a p value of ≤0.05 determining statistical significance.

Results: A total of 108 patients were recruited, 66 healthy controls (HCs) and 42 with newly diagnosed-IBD, 83% with Crohn’s disease (Table 1). HCs had higher body mass index (BMI)-for-age percentiles than patients with IBD. Imaging was obtained on 44 patients and the ratio of VAT to total abdominal fat mass was higher in patients with IBD versus HCs (26.8% vs 22.6%, p=0.21). Patients with IBD had significantly higher baseline levels of resistin, PAI-1, HGF, and IL-6 at diagnosis compared to HCs. Resistin levels also correlated with VAT volumes (rho=0.48; p=0.027). Patients who required biologic therapy by 12 months following diagnosis had significantly higher baseline levels of resistin (27.3 ng/mL vs 13.8 ng/mL, p=0.04) and VAT volumes (822 cm3 vs 585cm3, p=0.05) compared to patients with IBD not on biologics. Additionally, patients on biologic therapy by 12 months also had a significant reduction in resistin, IL-6, PAI-1, and HGF along with an increase in leptin and BMI-for-age Z –score  compared to patients not on a biologic at follow-up (Table 2).

Discussion: Newly-diagnosed patients with IBD have a significantly higher level of resistin than age and BMI-matched HCs which correlates with higher VAT volumes. Additionally, IBD patients with higher VAT volumes and higher resistin levels at diagnosis were more likely to require biologic therapy by 12 months.  Patients on biologic therapy had significant improvement in adipokines compared to patients not on biologics. Resistin and VAT volume at diagnosis may be a surrogate marker to predict the need for early biologic therapy and to assess response to therapy.


Disclosures:
Jacob Kurowski indicated no relevant financial relationships.
Rishi Gupta indicated no relevant financial relationships.
Iulia Barbur indicated no relevant financial relationships.
Sarah Worley indicated no relevant financial relationships.
Erick Remer indicated no relevant financial relationships.
Tracey Bonfield indicated no relevant financial relationships.
Jean-Paul Achkar indicated no relevant financial relationships.
Claudio Fiocchi indicated no relevant financial relationships.
Satish Viswanath indicated no relevant financial relationships.
Marsha Kay indicated no relevant financial relationships.

Jacob A. Kurowski

Clinical Assistant Professor of Pediatrics
Cleveland Clinic
Cleveland, Ohio

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