BACKGROUND: Sarcopenia is an age-related condition marked by muscle loss and weakened muscular strength. It is a new predictor of poor clinical outcomes in several illnesses. The association between sarcopenia and poor outcomes in Crohn's disease is still debated. Our main objective is to evaluate the impact of sarcopenia vs non-sarcopenia on the development of adverse outcomes in patients with Crohn's disease. METHODS: We conducted a systematic review and meta-analysis synthesizing observational studies, which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, EMBASE, and Cochrane until October 1, 2024. The odd ratio (OR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. RESULTS: There were fourteen studies with a total of 2334 patients. The sarcopenia group was associated with a higher risk of hospitalization (OR, 1.87 with 95% CI [1.19-2.93], P = 0.006) and developing abscess (OR, 5.03 with 95% CI [2.05-12.38], P = 0.0004). However, there was no statistically significant difference between sarcopenia and non-sarcopenia groups, regarding the need for surgery (OR, 1.12 with 95% CI [0.5-2.5], P = 0.79), loss of biological response (OR, 1.11 with 95% CI [0.34-3.66], P = 0.86), need for biological therapy (OR, 0.77 with 95% CI [0.43-1.36], P = 0.36), and surgical site leak (OR, 2.01 with 95% CI [0.66-6.18], P = 0.22). CONCLUSION: Our study showed that sarcopenia is associated with an increased risk of hospitalization and abscess formation in patients with Crohn's. However, sarcopenia does not significantly affect the need for surgery, loss of biological response, need for biological therapy, or the occurrence of surgical site leaks. Further studies are required to explore the mechanisms underlying these associations.