Background The risk of malnutrition increases in patients with systemic sclerosis (SSc) which has a negative prognostic effect. Additionally malnutrition is a significant cause of morbidity and mortality.
Objectives The aim of this study was to evaluate the associations between malnutrition and clinical features of the disease, depression in SSc patients.
Methods Concomitant SSc patients followed in our outpatient and inpatient clinics were enrolled in the study. Skin involvement was assessed with modified Rodnan skin score (mRSS), joint/tendon involvement with finger-tip to palm distance (FTP). İnterstitial lung disease (ILD) and heart involvement were evaluated with clinical and radiological methods. Patients were questioned for dysphagia and gastroesofageal reflux as an indicator of esophageal involvement, early satiety and vomiting as gastric involvement, and diarrhea, constipation and bloating as bowel involvement.1 Interincisal distance measurement was used to assess the maximal mouth opening capacity. Malnutrition risk was assessed by the Malnutrition universal screening tool (MUST). The Beck Depression Inventory (BDI) was used for measuring the severity of depression. sWe examined associations between malnutrition risk and clinical features of the disease, depression in SSc patients.
Results Ninety eight SSc patients with 69 diffuse and 29 limited type of the disease were enrolled in the study. 84.7% of the patients were female and the mean age was 52.67±11.28 years. According to MUST scores 61.2% of patients have low, 15.3% medium and 23.5% high risk for malnutrition. We found no difference between the malnutrition risk among genders (p=0.065). mRSS and FTP were significantly different between malnutrition risk groups (p=0.005, 0.050 respectively). Malnutrition risk was higher with patients with ILD than the patients without ILD (p=0.044). Malnutrition risk was higher with patients with bowel involvement than the patients without bowel involvement. (p=0.021).
Interincisal distance was significantly different between malnutrition risk groups (p=0.003). 78.7% of SSc patients have BDI scores ≥10, 54.3% of SSc patients have BDI scores ≥17. BDI scores were significantly different between malnutrition risk groups (p<0.001). Factors affecting malnutrition risk were evaluated with logistic regression analysis. Interincisal distance and bowel involvement were found to be the most relevant factors for malnutrition risk. SSc patients with bowel involvement have 2.519-fold increased risk of malnutrition compared to patients without bowel involvement (95% Cl 1.039–6.105). Every 1 mm decrement in interincisal distance was associated with 1.101 fold increase in malnutrititon risk of SSc patients (95% Cl 1.032–1.176).
Conclusions Malnutrition is common in SSc patients. Malnutrition risk is associated with skin, tendon/joint involvement, DU count, ILD, bowel involvement, microstomia and depression severity.
Walker UA, Tyndall A, Czirják L et al. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials And Research group database. Ann Rheum Dis. 2007;66:754–63.
Disclosure of Interest None declared
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