United European Gastroenterol J. 2026 Jul;14(6):e70255. doi: 10.1002/ueg2.70255.
ABSTRACT
BACKGROUND: Metabolic syndrome (MetS) and its cardiometabolic complications are recognized in inflammatory bowel disease (IBD); however, longitudinal trends and their impact on outcomes remain incompletely defined. We aimed to evaluate temporal trends in cardiometabolic comorbidities and assess the impact of MetS on cardiometabolic, hepatic, renal, and IBD-related outcomes.
METHODS: We conducted a real-world cohort study (2010-2024) including adults (≥ 18 years) with Crohn's disease or ulcerative colitis. Annual prevalence and incidence rates (per 1000 person-years) of cardiometabolic comorbidities were calculated by the calendar year. Propensity score-matched analyses compared outcomes among IBD with MetS, IBD alone, and MetS alone. Primary outcomes included major adverse cardiovascular events (MACE), heart failure, stroke, thromboembolism, chronic kidney disease (CKD), hepatic outcomes, all-cause mortality, and IBD-related events.
RESULTS: Among adults with IBD, prevalence increased substantially from 2010-2011 to 2023-2024, including hypertension (12.7%-39.1%), obesity (3.6%-20.5%), diabetes (5.0%-16.0%), and MASLD/MASH (0.9%-8.7%), with parallel rises in incidence rates. Compared with MetS alone, IBD + MetS was associated with higher risks of MACE (adjusted hazard ratio [aHR] 1.19), CKD (1.27), MASLD/MASH (1.75), and cirrhosis (1.94). Compared with IBD alone, IBD + MetS conferred markedly higher risks of MACE (2.05), heart failure (2.17), CKD (2.07), and MASLD/MASH (2.36), as well as higher rates of hospitalization (1.48), corticosteroid use (1.43), and surgery (1.17). Mortality was higher in IBD + MetS than in IBD alone.
DISCUSSION: Cardiometabolic comorbidities have risen sharply in IBD, and the coexistence of MetS substantially amplifies systemic and disease-specific morbidity, supporting the need for integrated, metabolism-informed IBD care.
PMID:42424118 | DOI:10.1002/ueg2.70255