Sarcopenia Per Revised Definition, Combining Myopenia and Muscle Strength, in Patients with Ulcerative Colitis and Its Relationship with Disease Activity

Background Ulcerative Colitis (UC) with reduced muscle mass is associated with the failure of corticosteroids & poor surgical outcomes. We aimed to identify the frequency of sarcopenia as per the revised European consensus definition in UC and its relationship with disease activity. Methods Baseline disease variables and biochemical parameters of consecutive UC patients were recorded. Complete Mayo’s Score was used to assess disease activity. Grip strength was assessed with a Jamar hand dynamometer, muscle mass with appendicular skeletal muscle index using a DEXA scan, and physical performance with a 4-meter walk test. The values were compared with population-derived normal values. Probable sarcopenia was defined as a reduction in grip strength. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed (<0.8 m/s) in the presence of sarcopenia. Acute severe colitis (ASUC) was defined as per Truelove-Witts criteria. Prevalence of sarcopenia and severe sarcopenia was noted with respect to disease activity. Multivariate analysis was done to predict the factors associated with sarcopenia. Results 114 patients (median age: 34.5 [26-48] years; 54.4% males) were included. As per Mayo’s score, 32 (28%), 46(40.4%), and 36 (31.6%) had UC in remission, mild-moderately active, and severe disease, respectively. Prevalence of probable sarcopenia, sarcopenia, and severe sarcopenia was 43(37.7%), 25(21.9%), and 14(12.2%), respectively. There was a significantly higher prevalence of sarcopenia in patients with active disease (2 in remission, 6 in mild-moderately active, and 17 in severe, p<0.001). Among patients with severe sarcopenia, 13 had severe UC, while 1 had mild-moderately active UC. Mayo’s score of >8 was 84% sensitive and 63% specific in predicting the presence of sarcopenia (AUROC:0.773). Higher Mayo score and Lower BMI were independent predictors of sarcopenia on multivariate analysis. Thirty-seven patients were admitted with ASUC, out of which 16(43.2%) had sarcopenia. The response to iv steroids was similar between patients with and without sarcopenia. Conclusions Prevalence of sarcopenia and severe sarcopenia correlate with the disease activity. Sarcopenia did not influence short-term outcomes in ASUC.