The Relationship between Body Composition and Physical Activity in
Patients with Crohn’s Disease
Maurizio Marra
1
, Olivia Di Vincenzo
1
, Iolanda Cioffi
1
, Rosa Sammarco
1
, Luca Scalfi
2
and Fabrizio Pasanisi
1
1
Department of Clinical Medicine and Surgery, Federico II University of Naples,
Via S. Pansini 5, 80131, Naples, Italy
2
Department of Public Health, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy
Keywords: Anthropometry, Body Composition, Bioimpedance, Muscular Strength.
Abstract: Crohn’s disease (CD) is a chronic inflammatory gastrointestinal disease associated with malnutrition,
inadequate intake, increased energy expenditure, impaired digestion and absorption, leading to a reduction in
skeletal muscle mass and adipose tissue. The purpose of this study was to evaluate body composition, phase
angle (PhA) and muscular strength in a group of patients with CD. Forty-six male patients, participated in the
study and were divided into two groups: 10 physically active patients (A-, age 29.1±8.9 years; weight 68.5±7.2
kg; height 172±4 cm; BMI 23.2±2.7 kg/m
2
) and 36 sedentary (S-, age 28.9±7.4 years; weight 67.7±8.6 kg;
height 174±6 cm; BMI 22.4±2.5 kg/m
2
). Additionally, 20 healthy control subjects (CONTR, age 30.8±9.2
years; weight 71.4±5.6 kg; height 176±5 cm; BMI 23.1±2.1 kg/m
2
) participated in the study. S- presented
significantly lower FFM values compared to control subjects (p<0.05) but not than A-; whereas no differences
were observed for fat mass values between groups. Whole-body PhA was higher in A- than other groups;
while upper-limbs PhA was lower in S than other groups and lower-limbs PhA was higher in A- than S- but
not compared to controls. Finally, muscular strength resulted statistically lower in S- than C- but not than
A-.
1 INTRODUCTION
Crohn’s disease (CD) is a chronic inflammatory
intestinal disease associated with Protein-Energy
Malnutrition (PEM) (Gassull, 1986; Krok, 2003).
PEM is caused by inadequate intake, improved
energy expenditure due to inflammation and impaired
digestion and absorption (Triantafillidis, 2015).
These conditions lead to decreases in skeletal muscle
and adipose tissue mass. Altered body composition
(BC), such as reduced fat-free mass (FFM), has been
reported in patients with
CD (Bryant, 2013; Molnàr,
2017). Additionally, decreased skeletal muscle mass
has been observed in 60% of patients with CD in
clinical remission (Schneider, 2008; Valentini, 2008).
The relationship between decreased skeletal muscle
mass and prognosis of patients with CD has yet to be
clarified.
Skeletal muscle volume is reported to have a
strong correlation with physical performance, such as
gait speed, as well as with muscle strength, such as
grip strength (Cruz-Jentoft, 2010). Premature and
‘accelerated’ decreases in muscle mass has been
described in subjects affected by chronic
inflammation, malnutrition and immobility, which
are relevant in inflammatory bowel disease as CD
(Sammarco, 2017; Harris-love, 2018; Beenakker,
2010; Beyer, 2012; Jo, 2012; Meng, 2010).
Bioelectrical Impedance Analysis (BIA) is a non-
invasive, reliable and broadly applied method to
evaluate BC and nutritional status in clinical and non-
clinical setting. It is useful in clinical practice
because it allows patients monitoring over time. Raw
BIA parameters (resistance, reactance and phase
angle), are commonly used to evaluate cellular
function and hydration status. In particular, phase
angle (PhA) can be considered an index of the
integrity of the cell membrane. It identifies
extra/intracellular water distribution: a low PhA
being a common finding in severe malnutrition.
Predictive equations can be useful to estimate BC
from BIA parameters: FFM and fat mass (FM).
The purpose of this study was to evaluate BC,
PhA and muscular strength in sedentary and
physically active patients with CD compared with a
control group.
Marra, M., Di Vincenzo, O., Cioffi, I., Sammarco, R., Scalfi, L. and Pasanisi, F.
The Relationship between Body Composition and Physical Activity in Patients with Crohn’s Disease.
DOI: 10.5220/0007967001230125
In Proceedings of the 7th International Conference on Sport Sciences Research and Technology Support (icSPORTS 2019), pages 123-125
ISBN: 978-989-758-383-4
Copyright
c
2019 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
123
2 METHODS
Forty-six male patients with CD, attending the
Clinical Nutritional Unit of the Department of
Clinical Medicine and Surgery, Federico II
University Hospital, Naples, participated in the study.
Patients were divided into two groups according to
leisure time activity: 10 physically active patients (A-
group, age 29.1±8.9 years; weight 68.5±7.2 kg;
height 172±4 cm; BMI 23.2±2.7 kg/m
2
), who carried
out physical activity from 3 to 5 hours a week since
at least 1 year, and 36 sedentary patients (S- group,
age 28.9±7.4 years; weight 67.7±8.6 kg; height 174±6
cm; BMI 22.4±2.5 kg/m
2
). Additionally, 20 healthy
control subjects with similar characteristics (CONTR
group, age 30.8±9.2 years; weight 71.4±5.6 kg;
height 176±5 cm; BMI 23.1±2.1 kg/m
2
), who did not
follow regular exercise regimes, participated in the
study. Subjects were tested in fasting conditions early
in the morning by the same operator, following
standard procedures at Federico II University
Hospital of Naples. Weight was measured to the
nearest 0.1 kg using a platform beam scale and height
to the nearest 0.5 cm using a stadiometer (Seca 709;
Seca, Hamburg, Germany). BMI was then calculated
as weight (kg) / height² (m²).
BIA was performed at 50 kHz using Human Im
Plus II (DS Medica-Milan) at room temperature (22–
25 °C) after 20 min in the supine position; all subjects
were in a fasted state (12 h) and voided prior to
measurement.
Each subject was evaluated on the non-dominant
side of the body using disposable electrodes. Two
injecting electrodes were placed on the hand and foot
(mid-dorsum of hand/foot just proximal to the
metacarpal/metatarsal phalangeal joint line) and two
sensing electrodes were placed on the wrist and ankle
(mid-dorsum of wrist/ankle centred on a line joining
the bony prominences of radius and ulna/the medial
and lateral malleoli).
The measured BIA variables were R and PhA,
which were determined at 50 kHz (Human Im Plus II,
DS Medica S.r.l., Milan, Italy). For segmental BIA
analysis, the length of each segment was measured,
and the electrodes were properly positioned to
measure PhA values of upper and lower limbs. This
evaluation was conducted according to the Organ
method (Organ, 1985). FFM and FM were estimated
using the prediction equation developed by Kushner.
Hand grip Strength (HGS), was measured at baseline
with a hand dynamometer (Jamar Lafayette
Hydraulic Hand Dynamometer, USA), always by the
same operator (MM).
For each upper limb, three measurements were
made at a distance of one minute from each other. The
resulting value was then transcribed, with an
approximation to 0.1 kg. For statistical analysis, the
mean value (the arithmetic mean of the three recorded
values) was considered for the non-dominant limb.
Statistical Analysis.
Results are expressed as mean ± standard deviation.
The statistical analysis (SPSS. 19.0 vers., Chicago,
USA) has been performed using one-way analysis of
variance (ANOVA with post-hoc Tukey test). Simple
linear correlation was used to assess the association
between variables. Chi-square (χ
2
) test was used for
evaluation of prevalence in different groups.
Statistical significance was pre-determined as
p<0.05.
3 RESULTS
Age and anthropometric measurements did not show
significant differences among the three groups (Table
1).
Table 1: Anthropometric characteristics, body composition
and phase angle of participants.
Active
Crohn’s
Patients
(n =10)
Mean ± SD
Sedentary
Crohn’s
Patients
(n =36)
Mean ± SD
Control
Group
(n =20)
Mean ±
SD
Age years 29.1±8.96 28.9±7.37 30.8±9.18
Weigh
t
kg 68.5±7.22 67.7±8.64 71.4±5.61
Heigh
t
cm 172±4 174±6 176±5
BMI kg/
m
2
23.2±2.7 22.4±2.5 23.1±2.1
FM kg 12.3±5.9 12.7±6.4 12.5±3.2
FM % 17.5±7.5 18.2±7.9 17.4±3.9
FFM kg 56.2±4.1 55.0±6.2 58.9±4.7*
PhA
W/B
degrees
8.03±0.72# 6.71±0.71 7.26±0.72
PhA
U/L
degrees
6.32±0.75 5.11±0.59^ 5.83±1.24
PhA
L/L
degrees
9.31±0.76 7.94±1.14° 8.45±1.11
HGS kg 39.2±4.9 35.0±6.8 39.2±2.9*
DS=standard deviation; BMI=body mass index;
FM=fat mass; FFM=fat-free mass;
NS=not significant; PhA=phase angle; W/B=whole-body;
U/L= upper-limbs; L/L=lower-limbs; HGS= hand grip strength;
*=C vs. S; #=A vs. all; ^=S vs. all; °=A vs. S;
Regarding BC, S- group presented significantly
lower FFM values compared to controls (p<0.05) but
not than A-. No statistically differences were obser-
icSPORTS 2019 - 7th International Conference on Sport Sciences Research and Technology Support
124
ved for FM values between groups.
Whole-body PhA resulted higher in A- than other
groups (Table 1). Upper-limbs PhA was significantly
higher in both A- and controls than S- while, lower-
limbs PhA was significantly higher in A- than S- but
not compared to controls. HGS test resulted
statistically lower in S- than controls but not than A-.
Moreover, patients in clinical remission were about
80% for A-group and about 40% for S- group (test χ
2
:
p=0.001).
4 DISCUSSION
Our data shows that BC variables, like FFM and FM,
were similar between A- and S- patients with CD.
Conversely, PhA, as qualitative parameter, was
higher in A- than S- and control subjects. In addition,
muscular strength, evaluated with HGS, was higher in
A- than S- but similar to control group. These results
suggest that practising leisure time physical activity,
as 3 to 5 hours per week, might be helpful in keeping
and promoting health status of CD patients.
Finally, higher PhA, an index of integrity of the
cell membrane, is associated with a more active
lifestyle in patients with CD.
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