Abstract Background Visceral adipose tissue (VAT) is a metabolically active depot that drives systemic and intestinal inflammation via cytokine and adipokine signaling. Unlike subcutaneous (SCT) adipose tissue, VAT has greater immunometabolic activity and is linked to metabolic dysfunction in inflammatory bowel disease (IBD). To date, no studies have evaluated the role of VAT and SCT using ultrasound (US) in pediatric patients with IBD. This study aims to characterize the relationship between BMI, VAT, and SCT and their association IBD disease activity and bowel visualization by US. Methods We conducted a retrospective, single-center, study including 29 pediatric patients (18 years) with IBD who underwent a sonographic examination as standard of care from July to October 2025. VAT was measured using a linear transducer as the distance from the linea alba to the anterior aortic wall. SCT was defined as the distance between the external surface of the rectus abdominis muscle and the dermal interface. Demographic, anthropometric, and disease-related variables were recorded alongside clinical indices and biomarkers. Adequate visualization was defined as the ability to obtain a measurable bowel wall thickness (BWT). Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Owing to the preliminary nature of the dataset, associations between variables were evaluated using univariate linear, logistic, and ordinal logistic regression, with multivariate analyses planned for the final dataset. Results A total of 29 IUS scans were included (median age 15 years 10.9–17.0, 48% female, 76% CD, median BMI 21.2kg/m2 18.3–22.9). Laboratory values within 1 month of IUS were available for a subset of patients (n = 24 CRP, n = 22 ESR, n = 16 FCP). There was a significant association between BMI and SCT thickness (R2 = 0.66, p 0.01), but not with BMI and VAT thickness (R2 = 0.001, p = 0.86). VAT thickness was significantly associated with higher FCP (R2 = 0.31, p = 0.03), higher WBC (R2 = 0.17, p = 0.048, and higher platelet count (R2 = 0.46, p 0.01). Visualization of the terminal ileum and colon were not impacted by patient BMI, SCT, nor VAT thickness. Visualization was adequate for all bowel segments regardless of VAT thickness or SCT excluding the rectum transabdominally which was not assessed. Conclusion In this pediatric IBD cohort, preliminary findings suggest that greater VAT thickness may be associated with increased disease activity and appears independent of BMI, in contrast to SCT. IUS visualization was not influenced by BMI, VAT, or SCT. Data collection is ongoing to further define the role of VAT as assessed by US as a potential marker of disease activity in pediatric IBD. Conflict of interest: Dr. Kellar, Amelia: No conflict of interest Bhuva, Deven: No conflict of interest George, Tessa: No conflict of interest St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda.
Kellar et al. (Thu,) studied this question.
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