Purpose of reviewThis article describes the clinical papers published in 2002 and early 2003 on nutritional and metabolic derangement in inflammatory bowel disease.Recent findingsInsulin-like growth factor 1 and Insulin-like growth factor binding protein 3 are decreased in inflammatory bowel disease, and disease therapy hardly reverses this situation. There are promising data on recombinant human growth hormone therapy in paediatric inflammatory bowel disease. Several papers have added some fuel to the debate on the prevalence and pathogenesis of metabolic bone disease in inflammatory bowel disease. Articles have been published investigating the role of dietary fat in the therapeutic action of enteral feeding in Crohn's disease. Low-fat diets are particularly useful, and adding medium-chain triglycerides does not impair the effectiveness of these diets. Balanced amounts of saturated, monounsaturated and polyunsaturated fat should probably be used. Relevant contributions on the usefulness of probiotic preparations (VSL#3) in the treatment and prevention of pouchitis have been published. Other papers deal with the effects of medical and surgical therapy on body composition and metabolism in the inflammatory bowel disease, the treatment of oxidative stress of these patients, and the possible role of some vitamin deficiencies on thrombotic risk in the condition.SummaryInflammatory bowel disease therapy hardly reverses growth hormone-insulin-like growth factor 1 disturbances of patients. The role of inflammation and steroid therapy of metabolic bone disease in inflammatory bowel disease is still controversial. Low-fat diets, with added amounts of medium-chain triglycerides, are useful in decreasing gut inflammation in the condition. The search for the optimal dietary fatty acid composition deserves further investigations. The use of probiotics and prebiotics opens new therapeutic perspectives for the disease.