Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 02 2026 04 03 11951 11951 Mohamed Shawky Abd Elall Mansoura University Ashraf Abdelmegid Elfakhry Department of Internal Medicine, Hepatology and Gastroenterology unit, Faculty of Medicine, Mansoura University Mohamed Ali Atwa Department of Clinical Pathology, Faculty of Medicine, Mansoura University Fatma Adel Abo Zeid Department of Internal Medicine, Hepatology and Gastroenterology unit, Faculty of Medicine, Mansoura University 2025 12 21 2026 01 25 Leptin and ghrelin are key metabolic hormones involved in energy balance and inflammation. Their dysregulation has been implicated in chronic inflammatory conditions such as inflammatory bowel disease (IBD). However, their association with disease activity and nutritional status remains unclear. This study aimed to evaluate the association between serum ghrelin and leptin concentrations and disease activity, nutritional status, and inflammatory markers in patients with IBD. A case-control study was conducted involving fifty-five IBD patients (31 with ulcerative colitis [UC] and 24 with Crohn’s disease [CD]) and fifty-five healthy controls, recruited from Mansoura Specialized Medical Hospital between January 2022 and January 2023. Disease activity was assessed using the Mayo score for UC, the Crohn’s Disease Activity Index (CDAI) for CD, and fecal calprotectin levels. Plasma ghrelin and leptin concentrations were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits, according to the manufacturer’s instructions. Blood samples were obtained after overnight fasting, immediately centrifuged, and plasma aliquots were stored at −80°C until analysis. All samples were analyzed in duplicate, and concentrations were expressed as pg/mL for ghrelin and ng/mL for leptin. A total of 110 participants were evaluated (34 active IBD, 21 inactive IBD, and 55 controls). Demographic characteristics showed no significant differences among the groups. Both hormones differed significantly across the disease activity categories (P<0.001). Leptin levels were highest in controls and lowest in active IBD, whereas ghrelin levels were highest in controls and lowest in inactive IBD. Ghrelin showed significant negative correlations with BMI, total nutritional score, and ALP, and a positive correlation with folic acid. Leptin correlated positively with BMI, ESR, and fecal calprotectin, and negatively with the nutritional score. Receiver operating characteristic (ROC) analysis demonstrated very poor predictive capacity for food decline, weight loss, and overall nutritional status for both leptin (AUC range: 0.106–0.308) and ghrelin (AUC range: 0.337-0.394). In conclusion, leptin and ghrelin levels in IBD patients appear to be more closely associated with disease activity and inflammatory burden than with nutritional status alone. Their combined assessment may offer descriptive insights into metabolic adaptation during active disease; however, these findings are associative and do not imply causality. Further longitudinal studies are required to clarify their potential clinical utility. https://acta.tums.ac.ir/index.php/acta/article/view/11951 https://acta.tums.ac.ir/index.php/acta/article/download/11951/6024