Changing phenotype of inflammatory bowel disease and neglected metabolic health

With modern treatment, an increasing proportion of patients with inflammatory bowel disease (IBD) are achieving deep, sustained remission. However, as control of inflammation has become more effective, the general health needs of patients become more evident. Therefore, we assessed the metabolic health and trends in body mass index (BMI) of patients over the past decade. 181 patients with IBD were included (102 with Crohn’s disease; 79 with ulcerative colitis), each attending the same IBD clinic (median follow up 18 years). A significant trend for rising BMI was found for Crohn’s disease (p < 0.001) which appeared to be independent of the use of biologic drugs. In addition, the proportion of patients with abnormalities of serum lipids was higher than expected for these young patients, median age 46 (38–55 interquartile range). These serum data, together with a higher proportion of smokers and higher BMI trends among those with Crohn’s disease compared with ulcerative colitis, illustrate the need for metabolic health awareness. Crohn’s disease, once strongly associated with nutritional deficit, is now characterized by rising BMI and the emergence of metabolic disorders. Whether this reflects the interaction between inflammatory and cytokine cascades or is solely related to similar trends in the background population is uncertain, but it appears to be independent of the use of biologic drugs. Regardless, the trends observed over the past decades suggest that the metabolic health of patients with IBD will require greater attention when planning management strategies at sub-specialty clinics.