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Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis
  1. Lijana Krause1,
  2. Mike O Becker1,
  3. Claudia S Brueckner1,
  4. Christina-Julia Bellinghausen1,
  5. Corinna Becker1,
  6. Udo Schneider1,
  7. Thomas Haeupl1,
  8. Katharina Hanke1,
  9. Karin Hensel-Wiegel2,
  10. Heidrun Ebert1,
  11. Sabine Ziemer2,
  12. Ulf-Müller Ladner3,
  13. Matthias Pirlich4,
  14. Gerd R Burmester1,
  15. Gabriela Riemekasten1
  1. 1Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
  2. 2Department of Biochemistry, Charité Universitätsmedizin Berlin, Berlin, Germany
  3. 3Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
  4. 4Department of Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Gabriela Riemekasten, CC12, CCM, Department of Rheumatology and Clinical Immunology, Charitéplatz 1, 10117 Berlin, Germany; Gabriela.Riemekasten{at}


Objective To assess and analyse nutritional status in patients with systemic sclerosis (SSc) and identify possible associations with clinical symptoms and its prognostic value.

Methods Body mass index (BMI) and parameters of bioelectrical impedance analysis (BIA) were assessed in 124 patients with SSc and 295 healthy donors and matched for sex, age and BMI for comparisons. In patients with SSc, BMI and BIA values were compared with clinical symptoms in a cross-sectional study. In a prospective open analysis, survival and changes in the nutritional status and energy uptake induced by nutritional treatment were evaluated.

Results Patients with SSc had reduced phase angle (PhA) values, body cell mass (BCM), percentages of cells, increased extracellular mass (ECM) and ECM/BCM values compared with healthy donors. Malnutrition was best reflected by the PhA values. Of the patients with SSc, 69 (55.7%) had malnutrition that was associated with severe disease and activity. As assessed by multivariate analysis, low predicted forced vital capacity and high N-terminal(NT)-proBNP values discriminated best between good and bad nutritional status. Among different clinical parameters, low PhA values were the best predictors for SSc-related mortality. BMI values were not related to disease symptoms or mortality. Fifty per cent of patients with SSc had a lower energy uptake related to their energy requirement, 19.8% related to their basal metabolism. Nutritional treatment improved the patients' nutritional status.

Conclusions In patients with SSc, malnutrition is common and not identified by BMI. BIA parameters reflect disease severity and provide best predictors for patient survival. Therefore, an assessment of nutritional status should be performed in patients with SSc.

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  • Funding The study was supported by Fresenius AG, Germany. Furthermore, Roche Diagnostics GmbH, Mannheim, Germany kindly provided the ELISA system for determination of the NT-proBNP values.

  • Competing interests LK was paid for assessment of body composition in patients with SSc by Fresenius AG, Germany. The other authors have no competing interests.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Charité Local Ethical committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.