The Relationship between Body Composition and Physical Activity in

Patients with Crohn’s Disease

Maurizio Marra

, Olivia Di Vincenzo

, Iolanda Cioffi

, Rosa Sammarco

, Luca Scalfi

and Fabrizio Pasanisi

Department of Clinical Medicine and Surgery, Federico II University of Naples,

Via S. Pansini 5, 80131, Naples, Italy

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

) 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

). 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

) 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

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

), 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

). 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

), 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

) 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 ±

Age years 29.1±8.96 28.9±7.37 30.8±9.18

Weigh

kg 68.5±7.22 67.7±8.64 71.4±5.61

Heigh

cm 172±4 174±6 176±5

BMI kg/

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

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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