The hidden burden of sarcopenia in inflammatory bowel disease: a strong predictor of complications

Background Sarcopenia is an emerging predictor of adverse outcomes in inflammatory bowel disease (IBD). We assessed its prevalence and prognostic impact in a prospective cohort. Methods Consecutive adults with IBD were prospectively enrolled (December 2023–August 2024). Sarcopenia was assessed using handgrip strength and bioelectrical impedance analysis (BIA) and patients were classified as non sarcopenic, with probable sarcopenia, or confirmed sarcopenia. Clinical worsening, IBD-related hospitalization, surgery, and infectious complications were prospectively assessed over 12 months. Results We enrolled 113 IBD patients: 32 (28.3%) were non-sarcopenic, 73 (64.6%) had probable sarcopenia, and 8 (7.1%) had confirmed sarcopenia. Confirmed sarcopenia was associated with lower BMI, higher CRP levels, and a higher prevalence of high nutritional risk. During follow-up, clinical worsening occurred in 46.9%, 45.2%, and 87.5% of patients, respectively (p=0.074), while IBD-related hospitalization occurred in 6.2%, 11.0%, and 62.5% (p<0.001). After adjustment for baseline clinical activity, confirmed sarcopenia remained independently associated with IBD-related hospitalization (adjusted OR [aOR] 18.30, 95% CI 3.21–141.14; p<0.001). Confirmed sarcopenia was also independently associated with infectious complications after adjustment for advanced-therapy exposure (aOR 7.40, 95% CI 1.17–54.63; p=0.034). No independent association was observed between sarcopenia and clinical worsening after adjustment for age, baseline clinical activity, BMI, and CRP. Conclusions In this prospective cohort of patients with IBD, confirmed sarcopenia was independently associated with an increased risk of IBD-related hospitalization and infectious complications over 12 months. These findings suggest that assessment of muscle strength and mass may provide clinically relevant prognostic information beyond conventional measures of disease activity and nutritional status.