Assessing nutritional status is the first step in diagnosing sarcopenia. When done properly, nutritional assessment provides quantitative and qualitative information which can demonstrate not only changes in body composition but also the effectiveness of nutritional support over time [9]. A variety of tools are currently used in both clinical and research settings for the assessment of sarcopenia. Choosing the most suitable tool depends on several aspects such as patient characteristics, clinical setting and intended use [10].

Imaging techniques used to assess muscle mass include dual-energy X-ray absorptiometry, bioelectrical impedance analysis, computed tomography and magnetic resonance imaging. There is good correlation between these methods and they are often complemented with functional tests such as handgrip strength. However, not all of these techniques are easily accessible or practical in healthcare settings, and there is limited evidence on their validation in IBD; hence putting them into clinical practice remains challenging [10].

Nonetheless, current evidence suggests that muscle ultrasound may serve as a promising, non-invasive tool for evaluating muscle mass and nutritional status. However, diagnostic accuracy may vary depending on the type of muscle measured, standards used for reference and patient populations [11]. Despite the potential of ultrasound in assessing muscle mass and guiding nutritional interventions, its use in routine dietetic practice remains limited and further research on validation and practical implementation is needed before ultrasound can be fully applied in daily practice by registered dietitians and other healthcare professionals [12].

Provision of early and adequate nutritional support is key to the management of sarcopenia, particularly when disease-related malnutrition is present or there is a risk of its development. In order to help preserve muscle mass and function, patients with IBD are advised to increase their daily protein intake to 1.2 to 1.5 g/kg/day when they are at risk of malnutrition, when malnutrition is confirmed, during active disease phases or in the presence of sarcopenic obesity [13].

Whenever possible, these energy and protein requirements should be met through a well-balanced oral diet or, if necessary, oral nutrition supplements that are high in energy and protein. However, if oral intake proves inadequate, nutritional support should be escalated to enteral or, if this is not possible, parenteral feeding [13].

In addition to nutritional management, an important factor in the treatment of sarcopenia is exercise. Specifically, resistance training is widely recommended in age-related sarcopenia. Although its effects have not been specifically studied in patients with IBD, resistance training is encouraged for those with sarcopenia or its features (e.g. reduced muscle mass, strength or performance). Such interventions are considered safe and beneficial not only in the management of sarcopenia but also for the overall physical and psychosocial well-being of patients with IBD [5, 14].

Given the high prevalence and overlap of micronutrient deficiencies and sarcopenia (such micronutrient deficiencies are often seen in sarcopenic obesity), patients with IBD who follow restrictive diets are at heightened risk of further deficiencies and muscle loss, particularly during catabolic states like disease flares. For this reason, low-calorie diets are discouraged in the presence of active disease. When weight loss is necessary, endurance training should be the preferred initial approach to help maintain muscle mass while supporting metabolic health [15].

Sarcopenia represents a critical, yet often underrecognised, component of the nutritional burden in patients with IBD. Its high prevalence, association with poor outcomes and complex interplay with disease mechanisms necessitate early identification and comprehensive management. Although current diagnostic tools are helpful, further validation and standardisation, particularly for promising modalities like muscle ultrasound, are essential. Expanding the role of dietitians and integrating emerging technologies may strengthen nutritional care and improve long-term outcomes in this vulnerable population.

Although there is still limited evidence in this field, there are consistent emerging themes for sarcopenia evaluation and management in clinical practice. First and foremost, it is important for clinicians to recognise that sarcopenia is highly prevalent in patients with IBD and is independently associated with poor clinical outcomes. The evidence suggests that all patients with IBD should be screened for sarcopenia, as it can affect patients with a wide range of BMIs (from underweight to obese) and can impact those with active disease as well as those with quiescent disease.

Therefore, patients who are identified as sarcopenic should undergo detailed nutritional evaluation by a registered dietitian with expertise in IBD in order to optimise energy and protein intake and ensure micronutrient adequacy. In addition, although there is no clear evidence on the impact of an exercise routine in patients with sarcopenia and IBD, it is likely beneficial to encourage patients to be physically active, with a combination of cardio (aerobic) exercise and strength (or resistance) training, as extrapolated from other diseases. Finally, treating the underlying IBD will likely improve muscle health, although further research is needed to better understand this relationship.