Amelia Keller, MD, MSc is the Director of Pediatric IUS, and Co-Director of the Pediatric IBD Program and is cross-appointed to both Pediatric and Adult Gastroenterology at the University of Chicago. 

Amelia Kellar, MD, MSc

Visceral Adipose Tissue Linked to Elevated Inflammatory Markers in Pediatric IBD, Independent of BMI

Preliminary data suggest visceral adipose tissue (VAT) is associated with inflammatory markers in pediatric

, independent of body mass index (BMI), based on findings presented at 

The single-center retrospective study adds to emerging evidence identifying VAT as a metabolically and immunologically active compartment with potential relevance for disease monitoring in pediatric IBD.

The retrospective analysis, led by Amelia Kellar, MD, MSc, Director of Pediatric IUS and Co-Director of the Pediatric IBD Program at the University of Chicago, included 29 patients younger than 18 years with IBD who underwent intestinal ultrasound (IUS) between July and October 2025.

The cohort had a median age of 15 years, 48% were female, and 76% had Crohn disease. Median BMI was 21.2 kg/m². VAT was quantified using a linear transducer as the distance from the linea alba to the anterior aortic wall, while subcutaneous tissue (SCT) was defined as the distance from the rectus abdominis muscle to the dermal interface.

Investigators identified significant associations between VAT and multiple inflammatory markers. VAT correlated with elevated fecal calprotectin (FCP; R²=0.31;

 = .03), white blood cell count (R²=0.17; 

 <.01). These associations were independent of BMI, which showed no correlation with VAT (R²=0.001; 

In contrast, BMI was strongly associated with SCT (R²=0.66; 

 <.01), reinforcing the distinction between adipose tissue compartments.

“I think it’s important for clinicians to separate these compartments. When we look at BMI, it’s far more likely to reflect subcutaneous tissue rather than visceral adipose tissue. So when I have a patient with a higher BMI, that may translate into more subcutaneous tissue, but not necessarily more visceral adipose tissue—very different things,” Kellar said.

The findings support existing evidence that VAT is more metabolically active than subcutaneous fat and may contribute to systemic and intestinal inflammation through cytokine and adipokine signaling. While mesenteric fat has been studied in IBD, broader VAT measurement using IUS has not previously been explored in pediatric populations.

Laboratory data within 1 month of IUS were available for a subset of patients (n = 24 for C-reactive protein, n = 22 for erythrocyte sedimentation rate, n = 16 for FCP), reflecting real-world limitations of retrospective data collection.

“Visceral adipose tissue is very immunologically active, and what we saw was that it correlated with markers like fecal calprotectin, white blood cell count, and platelets. I think this really highlights its inflammatory role and why it’s important for us to better understand how it may influence disease and treatment decisions,” Kellar said.

IUS Visualization Unaffected by Adiposity

Investigators also found that IUS visualization quality was not meaningfully affected by BMI, SCT, or VAT. Adequate visualization, defined as measurable bowel wall thickness, was achieved across all evaluated bowel segments, including the terminal ileum and colon.

This finding may address concerns regarding the utility of IUS in patients with higher adiposity and supports its use as a practical tool for routine monitoring.

Kellar emphasized the advantages of IUS compared with cross-sectional imaging modalities, particularly for repeated assessments. IUS can be performed at the bedside without preparation, discomfort, or radiation exposure, making it well suited for longitudinal evaluation.

Clinical Implications and Future Directions

These findings highlight the potential importance of distinguishing adipose tissue compartments in pediatric IBD and suggest VAT may serve as a more relevant biomarker of inflammation than BMI alone.

The study’s retrospective design, small sample size (n = 29), and single-center setting limit generalizability. Multivariate analyses are ongoing, and findings should be interpreted as preliminary.

Future research will focus on longitudinal assessment of VAT, identification of predictors of elevated VAT, and evaluation of its relationship with clinical outcomes and treatment response. Investigators are also analyzing parallel pediatric and adult datasets and expanding prior work on mesenteric fat to broader VAT compartments.

As interest grows in therapies that affect adipose tissue biology, including GLP-1 receptor agonists, understanding the role of VAT in IBD pathophysiology may inform future treatment strategies.

Editor’s Note: Kellar reports no relevant disclosures. 

Kellar A, Bhuva D, George T, St-Pierre J. The role of visceral adipose tissue and subcutaneous tissue on intestinal ultrasound visualization and disease activity in pediatric inflammatory bowel disease. Presented at: Digestive Disease Week (DDW) 2026; May 2026; Chicago, IL.

Dranse HJ, Rourke JL, Sinal CJ. Adipose tissue and metabolic disease: roles of adipokines beyond energy balance. Endocrinology. 2013;154(7):2314-2323. doi:10.1210/en.2013-1336

Amelia Kellar, MD, MSc

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