Abstract Background Crohn’s disease (CD) is a leading cause of Short Bowel Syndrome (SBS) in adults, which may progress to intestinal failure (IF) when intravenous nutritional or electrolyte supplementation is required. Patients with CD are at increased risk of malnutrition, sarcopenia, and altered eating habits. Early identification of risk and protective factors is crucial to optimize nutritional management, guide therapy, and improve clinical outcomes. Methods We conducted a cross-sectional study including CD outpatients. Clinical characteristics, surgical history, anthropometric measurements (including bioimpedance analysis BIA and hand grip strength), and dietary habits were assessed. Statistical significance was set at p 0.05. Results A total of 232 CD patients were included (47.4% female; mean age 49.8 ± 13.6 years). According to the Montreal Classification, 47.0% were B2 and 27.2% B3. Overall, 67.7% had undergone bowel resections, and 11.2% had SBS or ≥ 3 bowel resections. Nearly half (49.6%) had received two or more advanced therapies. Anthropometric measures were: BMI 24.1 ± 4.8 kg/m², fat-free mass 77.1 ± 11.6 %, fat mass 22.7 ± 11.0 %, appendicular skeletal muscle mass (ASMM) 16.5 ± 4.5 kg, phase angle 6.17 ± 1.08°, and hand grip strength 28.0 ± 18.7 kg. High protein intake was protective against sarcopenia (OR 0.25; 95% CI 0.08–0.73; p = 0.012), while older age (OR 1.03; 95% CI 1.00–1.07; p = 0.023) and SBS or multiple resections (OR 3.47; 95% CI 1.24–9.70; p = 0.017) increased risk. Number of advanced therapies, ultra-processed food intake, and other dietary habits were not significantly associated with sarcopenia. Conclusion In patients with Crohn’s disease, higher protein intake appears to exert a protective effect against sarcopenia, whereas older age and the presence of SBS or multiple resections markedly increase vulnerability to muscle loss. These findings underscore the importance of comprehensive nutritional assessment and detailed evaluation of surgical history to enable early risk stratification and guide personalized therapeutic strategies. Funded by: 2.1 “Rafforzamento e potenziamento della ricerca biomedica del SSN”, finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project “Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets”code: PNRR-MAD-2022-12376791. Conflict of interest: Becherucci, Guia: No conflict of interest Del Gaudio, Angelo: No conflict of interest Iaccarino , Jacopo: No conflict of interest Foscarini, Elisa: No conflict of interest Profeta, Francesca: No conflict of interest Rondinone, Barbara: No conflict of interest Distante, Sonia: No conflict of interest Petito, Valentina: No conflict of interest Masi, Letizia: No conflict of interest Troisi, Sara: No conflict of interest Pane, Cesare: No conflict of interest Di Vincenzo, Federica: No conflict of interest Covello, Carlo: No conflict of interest Calvez, Valentino: No conflict of interest Laterza, Lucrezia: No conflict of interest Marmo, Clelia: No conflict of interest Mignini, Irene: No conflict of interest Pizzoferrato, Marco: No conflict of interest Ennas, Sara: No conflict of interest Cammarota, Giovanni: No conflict of interest Mentella, Maria Chiara: No conflict of interest Lopetuso, Loris Riccardo: Personal Fees: none Gasbarrini, Antonio: No conflict of interest Papa, Alfredo: No conflict of interest Scaldaferri, Franco: Consultancy fee/board for Janseen, Takeda, Pfizer, MSD, Sandoz, Galapagos, Celltrion, Ferring, Abbvie, Lilly, Alfasigma, Abivax
Becherucci et al. (Thu,) studied this question.