Malnutrition, associated clinical factors, and depression in systemic sclerosis: a cross-sectional study

Türk, İpek; Cüzdan, Nihan; Çiftçi, Volkan; Arslan, Didem; Dogan, Muharrem Cem; Ünal, İlker

doi:10.1007/s10067-019-04598-y

Cited by 21 publications

(21 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In SSc disease, GI tract hypomobility results in a local stasis of ingested nutrients, which leads to altered microbiota (dysbiosis) and malabsorption, the latter promoting malnutrition and weight loss [ 12 , 32 , 33 ]. In our cohort, the prevalence of malnourished SSc patients presenting symptoms of intestinal impairment was 53.8%, in agreement with previous observations [ 27 , 28 ].…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients

et al. 2020

View full text Add to dashboard Cite

Systemic sclerosis (SSc) is a connective tissue disease characterized by initial microvascular damage, immune system activation and progressive fibrosis with insufficiency of internal organs. Gastrointestinal (GI) involvement is characterized by atrophy of the smooth muscle and small bowel hypomotility, mainly resulting from an autonomic nerve dysfunction. These modifications significantly affect gut transit and nutrient absorption, thus leading to malnutrition deficit induced by malabsorption. Nutritional deficit induced by malabsorption might also lead to bone alterations. This study aims to evaluate the relationship between malnutrition and bone status. Thirty-six postmenopausal female patients fulfilling the ACR 2013 criteria for SSc underwent dual-energy X-ray absorptiometry scan (DXA) to detect quantitative lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) analysis to detect bone quality. Data from DXA also allow to assess body composition and provide several quantitative parameters, including free fat mass index (FFMI) that identifies the patient with malnutrition (values <15 kg/m2 in women and 17 kg/m2 in men), according to the ESPEN criteria. Body mass index (BMI) was calculated for all SSc patients and every patient completed a diary reporting GI symptoms. Two groups of SSc patients with or without diagnosed malnutrition according to FFMI parameter were identified. Malnourished SSc patients showed significantly lower weight (p = 0.01) and BMI (p = 0.001), as well as lower serum levels of hemoglobin (p = 0.009), albumin (p = 0.002), PTH (p = 0.02) and 25OH-vitamin D (p = 0.008). DXA analysis showed significantly lower lumbar L1-L4 T-score (p = 0.009) and BMD values (p = 0.029) in malnourished SSc patients. Consistently, TBS values were significantly lower in malnourished patients (p = 0.008) and correlated with BMD (at any site) and serum albumin levels (p = 0.02). In addition, FFMI positively correlated with bone parameters as well as with symptoms of intestinal impairment in malnourished SSc patients. Finally, GI symptoms significantly correlated with BMD but not with TBS. This pilot study shows that in malnourished SSc patients (2015 ESPEN criteria: FFMI<15 kg/m2), an altered bone status significantly correlates with GI involvement, in terms of symptoms being mainly due to intestinal involvement together with the presence of selected serum biomarkers of malnutrition.

show abstract

Section: Discussionsupporting

confidence: 93%

“…As a consequence, a comparison among different studies regarding the prevalence of malnutrition in SSc patients is difficult to perform. In fact, the reported malnutrition prevalence in SSc varies from 5.3% to 55.6%, depending on the different diagnostic criteria used [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Türk et al evaluated the factors linked to higher MUST scores, obtaining a statistically significant relationship between the risk of malnutrition and ILD and gastrointestinal manifestations, but not PAH or overall cardiac involvement [19]. In our study cohort, the presence of PAH was connected to weight loss in lcSSc patients and malnutrition risk in both lcSSc and dcSSc.…”

Section: Discussionsupporting

confidence: 47%

“…The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated [17] and thus remain a subject of debate [18][19][20][21]. Largely due to the lack of scientific evidence on the matter, professional nutritional counseling is seldom regarded as a primary measure for the management of SSc-related weight loss, malnutrition risk, and gastrointestinal symptoms [22,23].…”

Section: Discussionmentioning

confidence: 99%

Diet in Scleroderma: Is There a Need for Intervention?

et al. 2021

View full text Add to dashboard Cite

Systemic sclerosis (SSc) patients exhibit a plethora of risk factors for nutritional decline, including the presence of chronic inflammation and the progressive nature of disease-related multisystem involvement. The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated, its management currently remaining a subject of debate. The main objective of the present study was to perform a detailed assessment of scleroderma patients’ diet as well as their eating habits and to describe the relationships with weight loss and malnutrition risk in the absence of professional nutritional counseling. Methods: We used a translated and validated version of the EPIC-Norfolk FFQ (European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire) to evaluate the patients’ diet and MUST (Malnutrition Universal Screening Tool) to investigate the risk of malnutrition. Disease activity was estimated using the EUSTAR-AI (European Scleroderma Trials and Research group Activity Index). Results: We included 69 patients with SSc, of which 42 underwent a detailed dietary assessment. Dietary factors were connected to body composition and digestive symptoms. We found high sodium intake and frequent suboptimal energy consumption in our study group, including patients with cardiopulmonary involvement. Liver transaminases were inversely correlated with the consumption of nuts and seeds. Malnutrition and weight loss were significantly associated with pulmonary hypertension, heart failure, albumin levels, and the extent of skin fibrosis, but not advanced age. Although the patients with EUSTAR-AI ≥ 2.5 were more frequently included in the moderate and high malnutrition risk categories, these results did not reach statistical significance. Conclusions: Currently, there is an unmet need for longitudinal and interventional research focusing on the long-term significance, ramifications, and management of nutritional impairment in SSc patients with various clinical manifestations. Our results indicate that scleroderma patients could benefit from personalized nutritional counseling in an interdisciplinary setting.

show abstract

“…According to the results, depression and microstomia appeared to be the most relevant factors with malnutrition of the patients. [ 10 ] Severe microstomia may worsen the nutritional status by having a negative impact on eating patterns of the patients. According to the study of Krause et al,[ 11 ] poor nutritional status and reduced phase angle values were present in SSc patients with more active and severe disease; and also, they concluded that patients with malnutrition had a higher risk for SSc-related mortality.…”

Section: Introductionmentioning

confidence: 99%

The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: A single-blind prospective randomized controlled trial

Cüzdan

Türk²,

Çiftçi

et al. 2021

Arch Rheumatol

Self Cite

View full text Add to dashboard Cite

Objectives: This study aims to evaluate the effect of a home-based orofacial exercise program on the oral aperture (OA) of systemic sclerosis (SSc) patients. Patients and methods: This single-blind prospective randomized controlled study performed between March 2017 and January 2019 included 56 SSc patients (3 males, 53 females; mean age 52.9±10.6 years; range, 31 to 70 years) with an OA of <40 mm. Patients were divided into two groups. Group 1 (n=28, mean age 53.8±9.6 years) was given orofacial exercise program twice a day for one month in addition to oral hygiene care advices, followed by no activity for the next month. Group 2 (n=28, mean age 50.0±11 years) received oral hygiene care advices for the first month followed by the same exercise program for the next month. Patients' OA was measured at baseline, and at first and second months. Results: After the first month, OA increased in Group 1 (p<0.001), whereas no change was observed in Group 2 (p=0.579). At the end of two months, there was no additional increase in Group 1 (p=0.352), while there was a significant increase in Group 2 (p<0.001). There was no difference between OAs of the groups at the end of the trial (p=0.564). Conclusion:Our results suggest that home-based orofacial exercise program improves OA of SSc patients.

show abstract

Malnutrition, associated clinical factors, and depression in systemic sclerosis: a cross-sectional study

Cited by 21 publications

References 36 publications

Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients

Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients

Diet in Scleroderma: Is There a Need for Intervention?

The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: A single-blind prospective randomized controlled trial

Contact Info

Product

Resources

About