Changing phenotype of inflammatory bowel disease and neglected metabolic health

With modern treatment, an increasing proportion of patients with inflam-matory 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. on the non-drug management of patients with chronic gastrointestinal conditions including factors such as diet, metabolic health, co-morbid conditions and side-effects of medical interventions. The goal of such research is to improve both patient care and health outcomes. PUBLIC INTEREST STATEMENT Previously, patients with inflammatory bowel disease (IBD) were often underweight and mal-nourished. This appears to no longer be the case for the majority of patients in part due to improved care pathways and better control of inflammation and associated complications. Our study has demonstrated a significant rise in body mass index (BMI) over a ten year period for patients attending a specialty outpatient clinic for care of patients with IBD. Together with a high proportion of abnormal metabolic blood markers, these findings suggest greater attention must be given to the metabolic health of patients with IBD where complications of overweight and metabolic health abnormalities are of increasing concern. In addition, coexistence of inflammatory and metabolic conditions may be influenced by host gut microbes which affect the signalling mechanisms that are common to the development of both types of disorders.