Background and aims:

Sarcopenia is an emerging predictor of adverse outcomes in inflammatory bowel disease (IBD). We evaluated its prevalence and prognostic impact in a prospective IBD cohort

Methods:

Consecutive IBD patients were prospectively enrolled at an Italian tertiary referral centre (April 2023–August 2024). Sarcopenia was defined according to EWGSOP2 criteria using handgrip strength and fat-free mass index(FFMI) assessed by bioelectrical impedance analysis (BIA). Patients were classified as non-sarcopenic, probable, or confirmed sarcopenic. We also evaluated disability scores, quality of life and serum inflammatory biomarker. Patients were followed for a median time of 12 months. Clinical outcomes included disease relapse, IBD-related hospitalization, surgery and infectious complications. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of outcomes.

Results:

We enrolled 113 IBD patients [65 with CD and 48 with UC, median age: 38 years].Table 1. Among the study population, 53.1% of patients were classified as non-sarcopenic, 38.9% as having probable sarcopenia, and 8.0% as having confirmed sarcopenia. Sarcopenia was significantly associated with impaired nutritional status, with a progressive increase in high malnutrition risk across groups (p<0.001). Baseline disease activity indices were comparable among groups. Median CRP levels differed significantly according to sarcopenia status, with higher values observed in patients with confirmed sarcopenia compared to non-sarcopenic cases (4.50 [IQR 4.00–7.80] vs 3.00 [2.00–4.00]mg/L),while patients with probable sarcopenia showed more variable values (2.00[1.00–10.50] mg/L)(p=0.04). No significant differences were observed in serum albumin levels, in disability scores, quality of life, extra-intestinal manifestations, or use of biologic therapy among groups. After a median follow-up of 12 months, a stepwise increase in adverse outcomes was observed according to sarcopenia status. Patients with probable and confirmed sarcopenia showed higher rates of disease relapse compared with non-sarcopenic patients (63.6%and 88.9% vs 31.7%),hospitalization (22.7%,44.4% vs1.7%),and infectious complications(18.2% and44.4% vs 1.7%) (all p<0.001).Surgery was also more frequent in sarcopenic patients(p=0.003).In multivariable analysis, both probable and confirmed sarcopenia were independently associated with disease relapse (OR 4.14,95% CI 1.72–10.50;OR 19.49, 95% CI 2.77–406.71, respectively), IBD-related hospitalization (OR21.56, 95%CI 3.65–415.65; OR56.47, 95%CI 6.00–1338.68), and infections (OR 11.34, 95% CI 1.90–217.57; OR 52.97, 95% CI 5.84–1241.66).Figure 1.

Conclusions:

Probable sarcopenia in addiction to confirmed sarcopenia, independently predicts adverse clinical outcomes in IBD, even at initial stages, emphasizing its early prognostic relevance. These findings support incorporation of sarcopenia assessment into routine risk stratification.

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