India appears to be on the epidemiological crossroads where infectious diseases as well as diseases hitherto considered to be diseases of the Western world are both being witnessed. Incidence and prevalence of IBD is increasing. The clinical spectrum of IBD in India is likely to be different from west because of differences in genetic and environmental influences. This has been partly looked into by a country-wide survey of IBD from India. IBD in the West is characterized by a bimodal age distribution with peaks at age groups 20–39 and 60–79 years. However the mean age at diagnosis of UC and CD was 38.5 and 35.9 years, respectively, in India and is not associated with a second peak. Similarly gender distribution, disease location and behavior in India are expected to be distinct from west. The long-term disease course of Indian IBD patients including need for immunosuppressives, biologics, surgical interventions and rates of complications including colorectal carcinoma needs to be studied in detail. Malnutrition is a major complication of inflammatory bowel disease (IBD). The main determinants of malnutrition in IBD include poor oral intake, malabsorption, chronically stimulated inflammatory cascade, gastrointestinal nutrient loss and increased energy expenditure. IBD can also alter the homeostasis of muscles, bones, and fat leading to sarcopenia (defined as depletion in lean muscle mass coupled with a loss of muscle strength) and dysregulated body composition. Lean mass deficits have been associated with demonstrable morbidity, mortality, and reduced quality of life. Sarcopenia is common in patients with IBD and such patients have higher rates of both surgical interventions and postoperative complications. Other particular concerns in IBD patients are that many of the patients are young, have active inflammation, may be profoundly malnourished and are immunosuppressed. Despite the risks and potential sequelae of low lean muscle mass and sarcopenia in IBD, there is a lack of high-quality data. A correct assessment of muscle mass and strength as well as nutritional status that provides quantitative and qualitative evaluations is important and timely recognition of sarcopenia/malnutrition may help in planning adequate and customized nutritional regimens. The presentation and spectrum of IBD has also changed in last two decades.