Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis

Krause, Lijana; Becker, Mike; Brueckner, Claudia S; Bellinghausen, Christina-Julia; Becker, Corinna; Schneider, Udo; Haeupl, Thomas; Hanke, Katharina; Hensel-Wiegel, Karin; Ebert, Heidrun; Ziemer, Sabine; Ladner, Ulf-Müller; Pirlich, Matthias; Burmester, Gerd R.; Riemekasten, Gabriela

doi:10.1136/ard.2009.123273

Cited by 100 publications

(57 citation statements)

References 34 publications

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“…However, previous studies have failed to show that PPI usage per se causes significant aberrations in colonic microbiota composition [37]. In agreement with a previous study and interpretation by Krause et al [36], we suggest that regular use of PPI primarily is an unspecific marker of symptomatic GI SSc. In this study, all patients were questioned about GI symptoms, and indeed, dysbiosis was more common in patients with GI symptoms indicating that a validated questionnaire, such as the UCLA SCTC GIT 2.0 should be included in future studies [38].…”

Section: Discussionsupporting

confidence: 91%

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Intestinal dysbiosis is common in systemic sclerosis and associated with gastrointestinal and extraintestinal features of disease

et al. 2016

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BackgroundRecent evidence suggests a link between autoimmunity and the intestinal microbial composition in several rheumatic diseases including systemic sclerosis (SSc). The objective of this study was to investigate the prevalence of intestinal dysbiosis in SSc and to characterise patients suffering from this potentially immunomodulatory deviation.MethodsThis study consisted of 98 consecutive patients subject to in-hospital care. Stool samples were analysed for intestinal microbiota composition using a validated genome-based microbiota test (GA-map™ Dysbiosis Test, Genetic Analysis, Oslo, Norway). Gut microbiota dysbiosis was found present as per this standardised test. Patients were examined regarding gastrointestinal and extraintestinal manifestations of SSc by clinical, laboratory, and radiological measures including esophageal cineradiography, the Malnutrition Universal Screening Tool (MUST), levels of plasma transthyretin (a marker of malnutrition) and faecal (F-) calprotectin (a marker of intestinal inflammation).ResultsA majority (75.5%) of the patients exhibited dysbiosis. Dysbiosis was more severe (rs = 0.31, p = 0.001) and more common (p = 0.013) in patients with esophageal dysmotility. Dysbiosis was also more pronounced in patients with abnormal plasma levels of transthyretin (p = 0.045) or micronutrient deficiency (p = 0.009). In 19 patients at risk for malnutrition according to the MUST, 18 exhibited dysbiosis. Conversely, of the 24 patients with a negative dysbiosis test, only one was at risk for malnutrition. The mean ± SEM levels of F-calprotectin were 112 ± 14 and 45 ± 8 μg/g in patients with a positive and negative dysbiosis test, respectively. Dysbiosis was more severe in patients with skin telangiectasias (p = 0.020), pitting scars (p = 0.023), pulmonary fibrosis (p = 0.009), and elevated serum markers of inflammation (p < 0.001). However, dysbiosis did not correlate with age, disease duration, disease subtype, or extent of skin fibrosis.ConclusionsIn this cross-sectional study, intestinal dysbiosis was common in patients with SSc and was associated with gastrointestinal dysfunction, malnutrition and with some inflammatory, fibrotic and vascular extraintestinal features of SSc. Further studies are needed to elucidate the potential causal relationship of intestinal microbe-host interaction in this autoimmune disease.

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Section: Discussionsupporting

confidence: 91%

“…We investigated malnutrition by laboratory markers including P-transthyretin, and anthropometric data using the MUST [19, 20]. While malnutrition in SSc has been suggested to be caused by malabsorption [35], additional mechanisms are likely to be involved including cachexia caused by the chronic inflammatory process [36]. …”

Section: Discussionmentioning

confidence: 99%

Intestinal dysbiosis is common in systemic sclerosis and associated with gastrointestinal and extraintestinal features of disease

et al. 2016

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“…However, the current study was intended explorative in nature, to test the greater sensitivity of motion sensors in detecting early alterations in this population. Though at variance with previous reports, poor correlation between daily physical activity and malnutrition (undernutrition) is not unexpected (3,5,6). Among the potential limitations of the current study, it is possible to argue that the number of patients with real malnutrition included in this study was too low to draw conclusions on the nutritional status.…”

Section: Discussioncontrasting

confidence: 67%

“…In addition, sclerodermic patients with abnormal bioelectrical impedance analysis parameters (i.e. in a poor nutritional status) showed more severe disease and higher mortality compared with those in good nutritional status (5).…”

Section: Introductionmentioning

confidence: 98%

Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement

Battaglia

Bellia

Serafino-Agrusa

et al. 2015

Clinical Respiratory J

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“…Background: Patients with systemic sclerosis (SSc) are at risk of malnutrition, which ranges from 18% to 56% of cases. 1,2 The high impact of nutritional status on clinical outcome has been shown for many diseases. The optimal nutritional treatment can lead to improvement or preservation of the current nutritional status and increases probability of long-term survival.…”

mentioning

confidence: 99%

FRI0430 Effect of oral nutritional intervention on nutritional status in patients with systemic sclerosis

Wojteczek¹,

Ziętkiewicz²,

Małgorzewicz³

et al. 2018

Friday, 15 June 2018

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BackgroundPatients with systemic sclerosis (SSc) are at risk of malnutrition, which ranges from 18% to 56% of cases.1,2 The high impact of nutritional status on clinical outcome has been shown for many diseases. The optimal nutritional treatment can lead to improvement or preservation of the current nutritional status and increases probability of long-term survival.3 ObjectivesThe aim of the study was to determine whether nutritional support has an impact on improvement of nutritional status in SSc patients.MethodsThe study included 61 patients with SSc and 49 healthy adults. Nutritional status was determined with subjective global assessment (SGA), body mass index (BMI), bioelectrical impedance analysis (BIA) and anthropometric measurements. Nutrition-related laboratory tests were measured. Appetite was assessed by simplified nutritional appetite questionnaire (SNAQ).ResultsImpaired nutritional status was confirmed in 16 patients with SSc (26,2%). Those patients had significantly lower SGA, BMI (p=0,0019), hand grip strength (p=0,0019), appetite (p=0,019) and BIA parameters such as lean tissue mass (p=0,013), intracellular water (p=0,0006), adipose tissue mass (p=0,04). In laboratory tests levels of haemoglobin, albumin and HDL cholesterol were significantly lower, while erythrocyte sedimentation rate (ESR) was higher (p=0,0025). Thirteen patients had dietary intervention (high-energy, high-protein, oral, liquid nutritional supplements) for 12 weeks. SGA (p=0,017) and hand grip strength (p=0,006) improved after nutritional treatment. BMI, appetite, BIA parameters, lipid profile and ESR after 12 weeks remained stable.ConclusionsAssessment of nutritional status in SSc patients should be performed regularly, because inclusion of oral nutritional intervention may improve SGA and hand grip strength.References[1] Baron M, et al. Malnutrition is common in systemic sclerosis: results from the Canadian scleroderma research group database. J Rheumatol2009;36:2737–43.[2] Krause L, et al. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis2010;69:1951–1957.[3] Harrison E, et al. Long-term outcome of patients with systemic sclerosis requiring home parenteral nutrition. Clinical Nutrition2015;34:991–996.Disclosure of InterestNone declared

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Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis

Abstract: 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.

Cited by 100 publications

References 34 publications

Intestinal dysbiosis is common in systemic sclerosis and associated with gastrointestinal and extraintestinal features of disease

Intestinal dysbiosis is common in systemic sclerosis and associated with gastrointestinal and extraintestinal features of disease

Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement

FRI0430 Effect of oral nutritional intervention on nutritional status in patients with systemic sclerosis

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