More than 40% of patients with systemic sclerosis malnourished
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Key takeaways:
- Approximately 43% of the cohort was diagnosed as being malnourished.
- Malnutrition was associated with older age and higher SSc severity.
As much as 43% of patients with systemic sclerosis are malnourished, while 33% demonstrate severe malnutrition, according to data from an Australian study published in Rheumatology.
“People living with SSc are at risk for malnutrition from multiple different perspectives,” Jessica L. Fairley, MD, MPH, of the department of rheumatology at St. Vincent’s Hospital in Melbourne, Australia, told Healio. “A huge number — up to 90% — have experienced gastrointestinal symptoms, plus there is a high prevalence of cardiopulmonary disease, as well as chronic inflammation and polypharmacy. We suspected from both our clinical experience and from other studies that the prevalence would be high, but existing data suggest it varies significantly depending on the tools used.
“Given that multiple different tools have been used to define malnutrition, with many tailored at inpatient cohorts rather than stable outpatients, as is generally the case in our cohort, we were interested in applying the new ‘gold standard’ metrics to estimate this in the Australian Scleroderma Cohort Study (ASCS). Furthermore, we wanted to assess the impact of malnutrition on mortality, physical function and health-related quality of life.”
To examine the frequency and impact of malnutrition in SSc based on the “gold standard” metrics of the Global Leadership Initiative for Malnutrition (GLIM) criteria, Fairley and colleagues analyzed data from 1,903 patients recruited into the multicenter, prospective ASCS. Patients in the study were tracked over a mean follow-up period of 4.5 years.
Malnutrition was diagnosed based on weight loss, BMI and muscle atrophy, as per the GLIM criteria. The patients’ risks for malnutrition, diminished health-related quality of life and physical function, and death were assessed using a variety of statistical models.
According to the researchers, 42.6% of the cohort was diagnosed with malnutrition, of whom 33.1% demonstrated stage 2, or severe, malnutrition, based on GLIM criteria. Patients with malnutrition were older (P = .01), more likely to have diffuse cutaneous SSc (P < .01), and had higher SSc severity scores at baseline (P < .01). Other factors associated with malnutrition were multimorbidity (OR = 1.6; 95% CI, 1.2-2), pulmonary arterial hypertension (OR = 2.1; 95% CI, 1.4-2) and upper gastrointestinal symptoms (OR = 1.6; 95% CI, 1.3-2).
Survival was worse among those with malnutrition (HR = 1.4; 95% CI, 1.1-1.7) after adjusting for age, sex and diffuse cutaneous SSc, the researchers wrote. In addition, health-related quality of life was lower in the malnourished group, which scored worse on the SF-36 Physical Component Summary, Mental Component Summary and FACIT-Fatigue Score (P < .01 for all).
“This means that not only is malnutrition very common, but contributes to suffering in our patients,” Fairley said. “As clinicians, we must be vigilant in diagnosing malnutrition and supporting our patients with interventions aimed at optimizing their nutritional status.
“Many patients tell me their weight fluctuates by a few kg between visits as their gastrointestinal symptoms or general health fluctuates, but this provides confirmation that more than 10% weight loss is important and impactful,” she added. “Further work is needed to confirm what nutritional interventions are particularly effective in modifying the frequency of malnutrition in our patients, and how they impact both survival and quality of life measures.”
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Fairley JL, et al. Rheumatology. 2024;doi:10.1093/rheumatology/keae209.
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