Precision Medicine in Inflammatory Bowel Disease: The Emerging Role of Metabolic Dysfunction

Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), is a chronic inflammatory disorder of the gastrointestinal tract with a rapidly increasing global prevalence. In parallel, metabolic comorbidities including obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), and sarcopenia are becoming increasingly common among patients with IBD and are now recognized as important modifiers of disease course and outcomes. As the therapeutic landscape of IBD continues to evolve, these intersecting trends create an opportunity to advance precision medicine through more individualized approaches to care. This review synthesizes established and emerging evidence on the role of metabolic dysfunction in IBD, focusing on epidemiology, risk factors, and prognostic implications. We highlight key domains relevant to personalized care, including metabolic phenotypes, energy metabolism, circulating biomarkers, and nutrition, and discuss how these factors may complement traditional inflammatory markers in risk stratification and longitudinal disease monitoring. Collectively, the available evidence suggests that metabolic comorbidities are not merely coincidental but represent clinically meaningful phenotypes that influence treatment response, complications, and long-term outcomes in IBD. Integrating metabolic assessment into routine IBD care may enable more precise, patient-centered management strategies and help address the growing heterogeneity of IBD in the era of precision medicine.