Jiakai Luo,1,* Gengfeng Li,1,* Wen Hu,2 Keren Shen,3 Xiaoxu Huang,4 Xiaoying Wang,1 Dingting Xu,1 Yan Ma,1 Minfang Lv,1 Shuyan Li,1 Yan Chen,1 Qiao Yu1 

1Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China; 3Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Department of Nutrition, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yan Chen, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, People’s Republic of China, Tel +86 13757118653, Email chenyan72_72@zju.edu.cn Qiao Yu, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, People’s Republic of China, Tel +86 13456820567, Email yuqiao@zju.edu.cn

Purpose: Visceral adipose tissue (VAT) is integral to the pathology of Crohn’s disease (CD). While trace element imbalances affect both adipose tissue function and CD progression, their interplay remains poorly characterized. This study aimed to examine whether trace element status affects CD outcomes and whether this relationship is moderated by visceral adiposity.
Patients and Methods: The data were collected retrospectively based on a prospective cohort of 300 patients newly diagnosed with CD from July 2019 to June 2022. Baseline plasma trace element levels were assessed, and VAT was measured via computed tomography (CT) scans at the time of diagnosis. Logistic regression analyses were performed.
Results: Lower zinc and magnesium levels predicted clinical outcomes including intestinal complications and surgery (OR = 0.51, P = 0.002; OR = 0.52, P = 0.001), and poorer treatment response (OR = 0.39, P < 0.001; OR = 0.57, P = 0.004). Elevated copper levels were associated with clinical outcomes (OR = 1.68, P = 0.012). Notably, stratified analysis revealed that magnesium’s protective effect was significant exclusively in patients with visceral-to-subcutaneous adipose tissue ratio (VAT/SAT) ≥ 1, whereas the effect of copper was significant solely in the VAT/SAT < 1 group concerning clinical outcomes.
Conclusion: Dysregulated trace element homeostasis at baseline independently predicts adverse clinical outcomes in CD. The intricate relationship between trace elements and VAT could influence disease progression, suggesting potential targets for personalized treatment.

Keywords: Crohn’s disease, clinical outcomes, drug outcomes, visceral adipose tissue, trace elements