Abstract
<title>Abstract</title> <p>Background Inflammatory bowel disease (IBD) which includes Crohn’s Disease (CD) and Ulcerative Colitis (UC), is a chronic inflammatory condition. Metabolic syndrome (MetS) defined as an aggregation of cardiometabolic risk factors, is becoming more common among individuals with IBD, but the prevalence and significance of MetS in IBD patients have not been well documented, especially in North African populations. Methods We conducted a retrospective cross-sectional study including 161 patients with IBD followed at a secondary care center in Tunisia between 1998 and 2025. Clinical, biological, radiological, and treatment-related data were collected from medical records. MetS was defined according to the modified NCEP ATP III criteria. We assessed its prevalence, identified associated factors through logistic regression, and examined its relationship with IBD outcomes. Results MetS was identified in 52 patients, corresponding to a prevalence of 32.3%. The prevalence was comparable between CD and UC (34.3% vs. 30.8%, p = 0.64). In multivariable analysis, age (OR = 1.07; 95% CI [1.03–1.11]; p < 0.001), BMI (OR = 1.29; 95% CI [1.16–1.44]; p < 0.001), female sex (OR = 1.89; 95% CI [1.02–3.49]; p = 0.042), and hepatic steatosis (OR = 3.12; 95% CI [1.34–7.27]; p = 0.008) were independently associated with MetS. Furthermore, MetS was independently associated with adverse IBD outcomes, including hospitalization, corticosteroid dependency, and treatment escalation (OR = 2.41; 95% CI [1.25–4.66]; p = 0.009). Conclusion In this Tunisian IBD cohort, MetS affected nearly one in three patients and was associated with older age, higher BMI, female sex, and hepatic steatosis. Importantly, MetS was independently linked to a more severe disease course, underscoring the need for systematic metabolic screening in IBD care, particularly in older and overweight patients.</p>