2025-05-19
IBD: a double burden
Gastroenterology and Hepatology
#MetabolicSyndrome #IBD #CrohnsDisease #CorticosteroidTherapy
#UlcerativeColitis #ChronicInflammation
Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, are known for their impact not only on the digestive system but also systemically. Among the associated complications, metabolic syndrome (MetS) is emerging as an increasingly concerning issue. Patients with IBD face a higher metabolic risk, stemming from a complex interplay between chronic inflammation, immune dysregulation, and profound metabolic alterations.
Low-grade inflammation plays a central role in the development of MetS by promoting insulin resistance, the accumulation of visceral adipose tissue, and disruption of glucose and lipid metabolism. Persistent intestinal dysbiosis exacerbates this condition by impairing the epithelial barrier and facilitating the translocation of pro-inflammatory molecules into systemic circulation. At the same time, adipokine levels become imbalanced, reinforcing the pro-inflammatory metabolic state. Finally, prolonged corticosteroid use directly contributes to weight gain, hyperglycemia, and dyslipidemia. Behavioral factors such as physical inactivity and restrictive diets also play a role in shaping a high-risk cardiometabolic profile.
Despite this pathophysiological convergence between IBD and MetS, available epidemiological data remain fragmented and heterogeneous, with sometimes contradictory findings. This study was therefore conducted to accurately estimate the prevalence of metabolic syndrome among patients with IBD. It also aimed to compare the rates between ulcerative colitis (UC) and Crohn’s disease (CD), and to identify associated clinical factors such as age, sex, and exposure to immunosuppressive therapies.
Twelve observational studies – both cohort and cross-sectional – including over 1.1 million IBD patients from various countries (United States, Italy, Serbia, South Korea, Japan, Turkey, etc.) were selected. Statistical analysis was conducted according to PRISMA standards using CMA v4.0 software with a random-effects model.
The overall prevalence of MetS in IBD patients was estimated at 21.8%. This prevalence was significantly higher in patients with ulcerative colitis (32.7%) compared to those with Crohn’s disease (14.1%). Additionally, IBD patients with MetS were on average older than those without, with a mean age difference of 9.89 years.
Although inter-study heterogeneity was substantial, sensitivity analyses confirmed the robustness of these estimates, highlighting a clear trend. Metabolic syndrome appears to be a frequent and clinically significant comorbidity in IBD patients, particularly in colonic forms and older populations.
Inflammatory bowel diseases are chronic intestinal disorders with varied clinical presentations, primarily represented by ulcerative colitis and Crohn’s disease. Long viewed through a solely gastrointestinal lens, they are now recognized for their systemic effects, particularly on metabolism. The key challenge is to better understand and anticipate metabolic complications associated with IBD, especially in the context of an aging patient population, persistent inflammation, and long-term exposure to immunosuppressive treatments. These factors collectively increase the risk of metabolic syndrome, a pathological condition known to elevate cardiovascular morbidity.
The objective of this study was to quantify the prevalence of MetS in IBD patients, compare the data between UC and CD, and identify clinical risk profiles. The results show that nearly a quarter of IBD patients present with MetS, with a marked predominance in those with UC and older individuals. These findings confirm that MetS is a growing public health concern in this population, associated with an increased cardiovascular risk.
Multicenter longitudinal studies are now needed to establish robust causal links and more precisely assess the impact of treatments (corticosteroids, anti-TNF agents, biologics) on metabolic risk. Ultimately, systematically integrating MetS screening into IBD care pathways, alongside personalized nutritional and endocrinological management, appears essential to limiting long-term complications.
Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, are known for their impact not only on the digestive system but also systemically. Among the associated complications, metabolic syndrome (MetS) is emerging as an increasingly concerning issue. Patients with IBD face a higher metabolic risk, stemming from a complex interplay between chronic inflammation, immune dysregulation, and profound metabolic alterations.
Low-grade inflammation plays a central role in the development of MetS by promoting insulin resistance, the accumulation of visceral adipose tissue, and disruption of glucose and lipid metabolism. Persistent intestinal dysbiosis exacerbates this condition by impairing the epithelial barrier and facilitating the translocation of pro-inflammatory molecules into systemic circulation. At the same time, adipokine levels become imbalanced, reinforcing the pro-inflammatory metabolic state. Finally, prolonged corticosteroid use directly contributes to weight gain, hyperglycemia, and dyslipidemia. Behavioral factors such as physical inactivity and restrictive diets also play a role in shaping a high-risk cardiometabolic profile.
Despite this pathophysiological convergence between IBD and MetS, available epidemiological data remain fragmented and heterogeneous, with sometimes contradictory findings. This study was therefore conducted to accurately estimate the prevalence of metabolic syndrome among patients with IBD. It also aimed to compare the rates between ulcerative colitis (UC) and Crohn’s disease (CD), and to identify associated clinical factors such as age, sex, and exposure to immunosuppressive therapies.
IBD and metabolism: a duo worth monitoring?
Twelve observational studies – both cohort and cross-sectional – including over 1.1 million IBD patients from various countries (United States, Italy, Serbia, South Korea, Japan, Turkey, etc.) were selected. Statistical analysis was conducted according to PRISMA standards using CMA v4.0 software with a random-effects model.
The overall prevalence of MetS in IBD patients was estimated at 21.8%. This prevalence was significantly higher in patients with ulcerative colitis (32.7%) compared to those with Crohn’s disease (14.1%). Additionally, IBD patients with MetS were on average older than those without, with a mean age difference of 9.89 years.
Although inter-study heterogeneity was substantial, sensitivity analyses confirmed the robustness of these estimates, highlighting a clear trend. Metabolic syndrome appears to be a frequent and clinically significant comorbidity in IBD patients, particularly in colonic forms and older populations.
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From IBD to metabolic diseases
Inflammatory bowel diseases are chronic intestinal disorders with varied clinical presentations, primarily represented by ulcerative colitis and Crohn’s disease. Long viewed through a solely gastrointestinal lens, they are now recognized for their systemic effects, particularly on metabolism. The key challenge is to better understand and anticipate metabolic complications associated with IBD, especially in the context of an aging patient population, persistent inflammation, and long-term exposure to immunosuppressive treatments. These factors collectively increase the risk of metabolic syndrome, a pathological condition known to elevate cardiovascular morbidity.
The objective of this study was to quantify the prevalence of MetS in IBD patients, compare the data between UC and CD, and identify clinical risk profiles. The results show that nearly a quarter of IBD patients present with MetS, with a marked predominance in those with UC and older individuals. These findings confirm that MetS is a growing public health concern in this population, associated with an increased cardiovascular risk.
Multicenter longitudinal studies are now needed to establish robust causal links and more precisely assess the impact of treatments (corticosteroids, anti-TNF agents, biologics) on metabolic risk. Ultimately, systematically integrating MetS screening into IBD care pathways, alongside personalized nutritional and endocrinological management, appears essential to limiting long-term complications.
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