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Moinzadeh P, Bonella F, Oberste M, Weliwitage J, Blank N, Riemekasten G, Müller-Ladner U, Henes J, Siegert E, Günther C, Kötter I, Pfeiffer C, Schmalzing M, Zeidler G, Korsten P, Susok L, Juche A, Worm M, Jandova I, Ehrchen J, Sunderkötter C, Keyßer G, Ramming A, Schmeiser T, Kreuter A, Lorenz HM, Hunzelmann N, Kreuter M. Impact of Systemic Sclerosis-Associated Interstitial Lung Disease With and Without Pulmonary Hypertension on Survival: A Large Cohort Study of the German Network for Systemic Sclerosis. Chest 2024; 165:132-145. [PMID: 37582424 DOI: 10.1016/j.chest.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD with pulmonary hypertension [ILD-PH]). The aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis. RESEARCH QUESTION Does SSc-associated ILD-PH or ILD without PH affect survival differently, and are there any risk factors that have an additional impact? STUDY DESIGN AND METHODS Clinical data of 5,831 patients with SSc were collected in the German Network for Systemic Sclerosis registry. Kaplan-Meier estimates were used to compare overall survival in patients with SSc-associated ILD-PH and ILD without PH with patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival. RESULTS Clinical data of 3,257 patients with a mean follow-up time of 3.45 ± 1.63 years have been included in our analysis. At baseline, ILD was present in 34.5%, whereas PH without ILD had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of patients with SSc had ILD, 15.2% had ILD-PH, and 6.5% had PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), whereas PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs ILD-PH vs ILD without PH were found for age at diagnosis, sex, SSc subsets, antibody status, FVC, diffusing capacity of the lung for carbon monoxide, and therapy. Overall survival at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD without PH, PAH, and being worst in patients with ILD-PH. Female sex (hazard ratio [HR], 0.3), higher BMI (HR, 0.9), and higher diffusing capacity of the lung for carbon monoxide values (HR, 0.98) were associated with a lower mortality risk. INTERPRETATION ILD is the most prevalent pulmonary involvement in SSc, whereas the combination of ILD and PH is associated with the most detrimental survival.
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Affiliation(s)
- Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany.
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Jithmi Weliwitage
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Nobert Blank
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriela Riemekasten
- Clinic for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | | | - Jörg Henes
- Centre for Interdisciplinary Rheumatology, Auto-inflammatory Diseases and Internal Medicine 2, University Hospital Tübingen, Tübingen, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg, Rheumatology Clinic, Bad Bramstedt, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Medical Center Ulm, Ulm, Germany
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Osteology and Pain Therapy, Center for Rheumatology Brandenburg, Johanniter-Hospital Treuenbrietzen, Treuenbrietzen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital Bochum, Bochum, Germany
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital Berlin-Buch, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ilona Jandova
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Cord Sunderkötter
- Departments of Dermatology, University Hospital Halle (Saale), Halle, Germany
| | - Gernot Keyßer
- Internal Medicine, Division of Rheumatology, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Tim Schmeiser
- Internal Medicine - Rhematology and Osteology, Hospital St. Josef, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
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Volkmann ER, McMahan ZH, Smith V, Jouneau S, Miede C, Alves M, Herrick AL. Risk of Malnutrition in Patients With Systemic Sclerosis-Associated Interstitial Lung Disease Treated With Nintedanib in the Randomized, Placebo-Controlled SENSCIS Trial. Arthritis Care Res (Hoboken) 2023; 75:2501-2507. [PMID: 37357024 DOI: 10.1002/acr.25176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To assess adverse events (AEs) in relation to baseline body mass index (BMI) and the risk of malnutrition in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) treated with nintedanib. METHODS Among patients with SSc-ILD randomized to receive nintedanib or placebo in the SENSCIS trial, we assessed AEs in subgroups by baseline BMI ≤20 kg/m2 and BMI >20 kg/m2 , and the risk of malnutrition using a modified version of the Malnutrition Universal Screening Tool (MUST), over 52 weeks. RESULTS The AE profile of nintedanib was similar between subgroups with a baseline BMI ≤20 kg/m2 (n = 61) and a baseline BMI >20 kg/m2 (n = 515). In these subgroups, respectively, AEs led to treatment discontinuation in 16.7% and 15.9% of the nintedanib group and 13.5% and 8.0% of the placebo group, respectively. Based on the modified MUST, the proportions of patients who had a low risk of malnutrition at baseline and at their last assessment were 74.0% in the nintedanib group and 78.1% in the placebo group, while the proportions who were classified as at low risk at baseline but at high risk by their last assessment were 4.5% in the nintedanib group and 1.0% in the placebo group. CONCLUSION In the SENSCIS trial, most patients with SSc-ILD remained at low risk of malnutrition over 52 weeks, but the proportion at high risk was higher in patients who received treatment with nintedanib compared to those who received placebo. Management of disease manifestations and AEs that may be associated with weight loss is important to reduce the risk of malnutrition in patients with SSc-ILD.
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Affiliation(s)
| | | | - Vanessa Smith
- Ghent University Hospital, Ghent University, and VIB Inflammation Research Center, Ghent, Belgium
| | - Stéphane Jouneau
- Competences Centre for Rare Pulmonary Diseases, and Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET, Rennes, France
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Ariane L Herrick
- The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK
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3
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Rivet V, Riviere S, Goulabchand R, Suzon B, Henneton P, Partouche L, Rullier P, Quellec AL, Konate A, Schiffmann A, Vincent T, Ziane R, Flori N, Picot MC, Sultan A, Maria ATJ, Guilpain P. High prevalence of malnutrition in systemic sclerosis: Results from a French monocentric cross-sectional study. Nutrition 2023; 116:112171. [PMID: 37837826 DOI: 10.1016/j.nut.2023.112171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/08/2023] [Accepted: 07/23/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc) can cause malnutrition due to frequent gastrointestinal involvement. However, prevalence of malnutrition in SSc is poorly known. The aim of this study was to evaluate the prevalence of malnutrition in SSc and its potential associations with disease features in patients from a tertiary referral center. METHODS All patients meeting American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc followed between January 1, 1985, and January 1, 2019, at the Department of Internal Medicine, Saint Eloi University Hospital, were included. Malnutrition was assessed using the 2020 French recommendations for SSc and the malnutrition universal screening tool score. Severe malnutrition was defined via the French Haute Autorité de Santé (National Health Authority) 2007 criteria. RESULTS A total of 120 patients were included, with mean age 64 (± 15) y and a female-to-male sex ratio of 5:1. According to 2020 French recommendations, 71 patients (59.2%) were malnourished and 30 (25%) had at least one criterion of severe malnutrition. With the malnutrition universal screening tool score, 41.7%, 20%, and 38.3%, respectively, had low, medium, and high risk of malnutrition. Multivariate analysis revealed the following results: 1) malnutrition was associated with cardiac involvement (P < 0.01); 2) a high malnutrition universal screening tool score was also associated with specific cardiac involvement (P < 0.01); and 3) severe malnutrition was strongly correlated with interincisal distance <35 mm (P = 0.02). CONCLUSIONS Malnutrition affects more than half of SSc patients and is associated with specific cardiac involvement. Interincisal distance <35 mm could be a red flag for severe malnutrition in SSc.
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Affiliation(s)
- Valérian Rivet
- Internal Medicine and Immunopathology Departement, Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, France
| | - Sophie Riviere
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Radjiv Goulabchand
- Montpellier University Hospital, Montpellier, France; Departement of Internal Medicine, University Hospital Center of Nîmes, Nîmes, France
| | - Benoît Suzon
- Department of Internal Medicine, University Hospital of Martinique, Fort-de-France, Martine, France
| | - Pierrick Henneton
- Montpellier University Hospital, Montpellier, France; Vascular Department of Internal Medicine, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Léo Partouche
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Patricia Rullier
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Alain Le Quellec
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France; Montpellier University Hospital, Montpellier, France
| | - Amadou Konate
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Aurélie Schiffmann
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Thierry Vincent
- Immunology Laboratory, Department of Immunology, Saint-Eloi Hospital, CHRU Montpellier, France
| | - Rahima Ziane
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France
| | - Nicolas Flori
- Gastroenterology Unit, Department of Gastroenterology and Nutrition, Cancer Institute of Montpellier, Montpellier, France
| | - Marie Christine Picot
- Montpellier University Hospital, Montpellier, France; Clinical Research and Epidemiology Unit, Medical Information Department, INSERM, Clinical Investigator Center, University Hospital Center of Montpellier, Montpellier, France
| | - Ariane Sultan
- Montpellier University Hospital, Montpellier, France; Diabetes Nutrition Unit, Endocrinology Department, Lapeyronie Hospital, University Hospital Center of Montpellier, Montpellier, France; PhyMedExp, Montpellier University, INSERM, CNRS, University Hospital Center of Montpellier, Montpellier, France
| | - Alexandre Thibaut Jacques Maria
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France; Montpellier University Hospital, Montpellier, France; Department of Internal Medicine and Immuno-Oncology (MEDI²O), Institute for Regenerative Medicine and Biotherapy (IRMB), Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France.
| | - Philippe Guilpain
- Department of Internal Medicine: Multi-Organic Diseases, Saint-Eloi Hospital, University Hospital Center of Montpellier, Montpellier, France; Montpellier University Hospital, Montpellier, France
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Rosato E, Gigante A, Colalillo A, Pellicano C, Alunni Fegatelli D, Muscaritoli M. GLIM-diagnosed malnutrition predicts mortality and risk of hospitalization in systemic sclerosis: A retrospective study. Eur J Intern Med 2023; 117:103-110. [PMID: 37482470 DOI: 10.1016/j.ejim.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Malnutrition is a well-known risk factor for morbidity and mortality in many clinical settings and only few studies assessed the role of malnutrition on systemic sclerosis (SSc) patients' outcomes. The aim of this retrospective study was to evaluate the role of malnutrition as a predictive risk factor for mortality and/or hospitalization in SSc patients during a 4-year follow-up. METHODS One hundred and one SSc patients were included in the study. Biochemical analyses, disease activity index, disease severity scale and anthropometric data were recorded at enrollment. Malnutrition was assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS Malnutrition according to GLIM criteria was found in 22 patients (21.8%). During a 4-year follow-up, 20 (19.8%) SSc patients died or were hospitalized for all causes and 11 of them (55.0%) were malnourished. Kaplan-Meier curves showed that event free-survival for composite end-point of mortality and risk of hospitalization was significantly shorter in malnourished than in non-malnourished patients (p<0.001). The survival probability at 4 years was 0.885 (95% CI=0.818-0.959) in the non-malnourished group and 0.500 (95% CI=0.329-0.759) in the malnourished group (p<0.001). In multivariate analysis, malnutrition [HR=4.380 (95% CI=1.706-11.243), p = 0.002] was the most significant predictive risk factor for the composite end-point. Also, female gender [HR=0.157 (95% CI=0.055-0.449), p<0.001], age [HR=1.0450 (95% CI=1.011-1.090), p = 0.012] and disease severity scale [HR=1.269 (95% CI=1.089-1.479), p = 0.002] were predictive factors for the composite end-point. CONCLUSIONS Malnutrition according to GLIM criteria represents a significant predictive risk factor for composite end-point of mortality and risk of hospitalization in SSc patients.
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Affiliation(s)
- Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | - Amalia Colalillo
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Frech TM, Poole JL, Murtaugh M, Matucci-Cerinic M. Expanding the Treatment Team. Rheum Dis Clin North Am 2023; 49:377-387. [PMID: 37028841 DOI: 10.1016/j.rdc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The optimal systemic sclerosis (SSc) care plan includes an occupational therapist and physical therapist as well as wound care experts and a registered dietitian if indicated. Screening instruments for functional and work disability, hand and mouth limitations, malnutrition, and dietary intake can identify the need for ancillary support services. Telemedicine can assist in developing effective ancillary treatment plans. Reimbursement for services may limit access for patients with SSc to expand their care team but a focus on prevention rather than management of damage is recognized as an important unmet need in SSc. In this review, the role of a comprehensive care team for SSc is discussed.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Janet L Poole
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Maureen Murtaugh
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence and Department of Experimental and Clinical Medicine, University of Florence, Italy
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Abstract
Despite an incomplete overall understanding, nutrition plays an important role in connective tissue disease. Assessment of patients with connective tissue disease for nutritional status and metabolic disturbances may significantly contribute to patient outcomes. Several studies have indicated the multifactorial role of macronutrients, micronutrients, and supplements in the setting of connective tissue disease. There is additional evidence regarding the roles of weight, obesity, and malnutrition. This contribution reviews a growing body of data regarding nutrition in the development and treatment of various connective tissue diseases, including systemic lupus erythematosus, dermatomyositis, and systemic sclerosis.
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Affiliation(s)
- Alexa Lisevick
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA
| | - Neda Shahriari
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut Medical Center, Farmington, Connecticut, USA.
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Bagnato G, Pigatto E, Bitto A, Pizzino G, Irrera N, Abignano G, Ferrera A, Sciortino D, Wilson M, Squadrito F, Buch MH, Emery P, Zanatta E, Gangemi S, Saitta A, Cozzi F, Roberts WN, Del Galdo F. The PREdictor of MAlnutrition in Systemic Sclerosis (PREMASS) Score: A Combined Index to Predict 12 Months Onset of Malnutrition in Systemic Sclerosis. Front Med (Lausanne) 2021; 8:651748. [PMID: 33816531 PMCID: PMC8010181 DOI: 10.3389/fmed.2021.651748] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: Malnutrition is a severe complication in Systemic Sclerosis (SSc) and it is associated with significant mortality. Notwithstanding, there is no defined screening or clinical pathway for patients, which is hampering effective management and limiting the opportunity for early intervention. Here we aim to identify a combined index predictive of malnutrition at 12 months using clinical data and specific serum adipokines. Methods: This was an international, multicentre observational study involving 159 SSc patients in two independent discovery (n = 98) and validation (n = 61) cohorts. Besides routine clinical and serum data at baseline and 12 months, Malnutrition Universal Screening Tool (MUST) score and serum concentration of leptin and adiponectin were measured for each participant at baseline. The endpoint of malnutrition was defined according to European Society of Clinical Nutrition and Metabolism (ESPEN) recommendation. Significant parameters from univariate analysis were tested in logistic regression analysis to identify the predictive index of malnutrition in the derivation cohort. Results: The onset of malnutrition at 12 months correlated with adiponectin, leptin and their ratio (A/L), MUST, clinical subset, disease duration, Scl70 and Forced Vital Capaciy (FVC). Logistic regression analysis defined the formula: -2.13 + (A/L*0.45) + (Scl70*0.28) as the best PREdictor of MAlnutrition in SSc (PREMASS) (AUC = 0.96; 95% CI 0.93, 0.99). PREMASS < -1.46 had a positive predictive value (PPV) > 62% and negative predictive value (NPV) > 97% for malnutrition at 12 months. Conclusion: PREMASS is a feasible index which has shown very good performance in two independent cohorts for predicting malnutrition at 12 months in SSc. The implementation of PREMASS could aid both in clinical management and clinical trial stratification/enrichment to target malnutrition in SSc.
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Affiliation(s)
- Gianluca Bagnato
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Erika Pigatto
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriele Pizzino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppina Abignano
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
- Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Antonino Ferrera
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Davide Sciortino
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Michelle Wilson
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Paul Emery
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Saitta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Franco Cozzi
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | | | - Francesco Del Galdo
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals National Health Service (NHS) Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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8
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Hvas CL, Harrison E, Eriksen MK, Herrick AL, McLaughlin JT, Lal S. Nutritional status and predictors of weight loss in patients with systemic sclerosis. Clin Nutr ESPEN 2020; 40:164-170. [PMID: 33183531 DOI: 10.1016/j.clnesp.2020.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS Systemic sclerosis (SSc) commonly affects the gastrointestinal (GI) tract and predisposes to malnutrition. Few studies assessed body composition in outpatients with SSc or used more than one method for comparison over time. The aim of this study was to describe markers of nutrition and body composition in patients with SSc and to identify predictors of unintentional weight loss. METHODS We consecutively included outpatients with SSc and performed a one-year follow-up. Gastrointestinal (GI) involvement was evaluated from clinical investigations. Patients completed questionnaires for organ involvement and functional status. Clinical assessment included body mass index (BMI), the malnutrition universal screening tool (MUST), inter-incisor distance, anthropometry, and bio-electrical impedance analysis (BIA). RESULTS In total, 168 consecutive patients with SSc were included, and 127 (76%) completed one-year follow-up. Thirteen (8%) died before follow-up. Based on MUST scores, 12% of patients were at high and 14% at medium risk of malnutrition. A low BMI was associated with small intestinal involvement (p < 0.0001). Percentage body fat correlated with BMI, both when using four-site anthropometry (r = 0.65, p < 0.01) and BIA (r = 0.49, p < 0.01). Nine (7%) patients had >5% unintentional weight loss at follow-up. Independent baseline predictors of unintentional weight loss included upper GI involvement and disease severity estimated by Health Assessment Questionnaire Disability Index score. CONCLUSIONS Nutritional risk and GI involvement are frequent and closely correlated in patients with SSc. BIA and four-site anthropometry are comparable in the clinical assessment of patients with SSc. Unintentional weight loss is discrete and related to disease-specific characteristics.
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Affiliation(s)
- Christian L Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | - Elizabeth Harrison
- Department of Gastroenterology, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, United Kingdom
| | - Marcel K Eriksen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 93, UK
| | - John T McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK
| | - Simon Lal
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK; Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
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Di Battista M, Barsotti S, Monaco A, Rossi A, Della Rossa A, Mosca M. Bioelectrical Impedance Vector Analysis for Nutritional Status Assessment in Systemic Sclerosis and Association With Disease Characteristics. J Rheumatol 2020; 48:728-734. [PMID: 33060305 DOI: 10.3899/jrheum.200964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To use bioelectrical impedance vector analysis (BIVA) in a cohort of patients with systemic sclerosis (SSc) in order to assess their nutritional status in comparison to other groups of patients and to find any correlation with clinical characteristics and outcome of the disease. METHODS We retrospectively collected data from 50 SSc patients who underwent BIVA for clinical suspicion of malnutrition and compared them with patients affected by other chronic autoimmune rheumatic diseases (OCAD, n = 27) and those who were only symptomatic of malnutrition but without autoimmune features (n = 15), and with 50 healthy controls (HC). RESULTS Patients with SSc presented significantly lower values of phase angle (PhA), basal metabolic rate (BMR), and body cellular mass (BCM), and an increase in extracellular water (ECW; P < 0.01 for all) than HC; instead, there were no significant differences for BMI. No significant differences were found between SSc and OCAD. Among patients with SSc, age directly correlated with ECW (ρ = 0.342, P = 0.015) and inversely with PhA (ρ = -0.366, P = 0.009). Female sex, anemia, hypoalbuminemia, reflux, and early satiety/abdominal distension associated with relevant alterations in BIVA results. BIVA variables were significantly different when cardiopulmonary and microvascular involvement was present. Four patients died during the study: they had significantly (P ≤ 0.01) lower PhA, BMR, and BCM, with an increased ECW. CONCLUSION BIVA, unlike BMI, allowed an accurate characterization of SSc patients at risk of malnutrition, correlating with serological malnutrition markers, with SSc-specific organ manifestations (cardiopulmonary involvement and microvascular damage), and with mortality. BIVA variables might represent a surrogate marker of damage accrual that leads to malnutrition, thus playing a leading role in the prognostic stratification of SSc patients.
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Affiliation(s)
- Marco Di Battista
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Simone Barsotti
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessia Monaco
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessandra Rossi
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessandra Della Rossa
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy.
| | - Marta Mosca
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
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10
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Prevalence of malnutrition in systemic sclerosis patients assessed by different diagnostic tools. Clin Rheumatol 2019; 39:227-232. [DOI: 10.1007/s10067-019-04810-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
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Dupont R, Longué M, Galinier A, Cinq Frais C, Ingueneau C, Astudillo L, Arlet P, Adoue D, Alric L, Prévot G, Cabarrou B, Sailler L, Pugnet G. Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review. Autoimmun Rev 2018; 17:1081-1089. [DOI: 10.1016/j.autrev.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
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12
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Preis E, Franz K, Siegert E, Makowka A, March C, Riemekasten G, Cereda E, Norman K. The impact of malnutrition on quality of life in patients with systemic sclerosis. Eur J Clin Nutr 2018. [DOI: 10.1038/s41430-018-0116-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis. Clin Rheumatol 2017; 37:987-997. [PMID: 29196890 DOI: 10.1007/s10067-017-3932-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease which may lead to malnutrition. Previous studies have defined it with different criteria. No thorough evaluations of sarcopenia in SSc are available. The aim of the present study was to assess the prevalence and the potential association of malnutrition and sarcopenia in a large cohort of SSc cases. A total of 141 SSc consecutive outpatients were enrolled. Body composition was analyzed by densitometry. Malnutrition was defined according to recently published ESPEN criteria, whereas sarcopenia was diagnosed in patients with reduced skeletal muscle index. Malnutrition was diagnosed in 9.2% of patients (95% CI, 4.4-14.0%). Malnourished patients had worse gastrointestinal symptoms according to UCLA SCTC GIT 2.0 questionnaire (p = 0.007), lower physical activity (p = 0.028), longer disease duration (p = 0.019), worse predicted DLCO/VA and FVC (p = 0.009, respectively), worse disease severity according to Medsger severity score (p < 0.001), lower hemoglobin (p = 0.023), and fat-free mass (p < 0.001) and were more often sarcopenic (p < 0.001). In multivariate analysis, only FVC (p = 0.006) and disease severity (p = 0.003), in particular for the lungs (p = 0.013), were confirmed to be worse in malnourished patients. Sarcopenia was diagnosed in 29\140 patients (20.7%; 95% CI, 14.0-27.4%); 11\29 were also malnourished. In multivariate analysis, sarcopenic patients had longer disease duration (p = 0.049), worse DLCO/VA (p = 0.002), and lung (p = 0.006) and skin (p = 0.014) involvement. In SSc, malnutrition defined with ESPEN criteria was found to be lower than previously reported. Sarcopenia was found to be somewhat common. Lung involvement was significantly associated with nutritional status and may not be explained only by muscle weakness.
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Spanjer MJ, Bultink IEM, de van der Schueren MAE, Voskuyl AE. Prevalence of malnutrition and validation of bioelectrical impedance analysis for the assessment of body composition in patients with systemic sclerosis. Rheumatology (Oxford) 2017; 56:1008-1012. [PMID: 28340004 DOI: 10.1093/rheumatology/kex014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives The aims were to assess the prevalence of malnutrition and to validate bioelectrical impedance analysis (BIA) against whole-body DXA for the assessment of body composition in patients with SSc. Methods Malnutrition was defined as BMI <18.5 kg/m 2 or unintentional weight loss >10% in combination with a fat-free mass index (FFMI) <15 kg/m 2 for women or <17 kg/m 2 for men or BMI <20.0 kg/m 2 (age <70 years) or <22 kg/m 2 (age >70 years). Body composition was assessed in 72 patients with whole-body DXA (Hologic, Discovery A) and BIA (Bodystat Quadscan 400). The manufacturer's equation and the Geneva equation were used to estimate FFM and fat mass. The agreement between BIA and whole-body DXA was assessed with Bland-Altman analysis and intraclass correlation coefficient. Results Malnutrition was found in 8.3% (n = 6) and low FFMI in 20.8% (n = 15) of patients. The mean difference in FFM between BIA and DXA applying the Geneva equation was 0.02 ( s . d . 2.4) kg, intraclass correlation coefficient 0.97 (95% CI: 0.95, 0.98). Limits of agreement were ±4.6 kg. The manufacturer's equation was less adequate to predict FFM. Conclusion This study shows a relatively low prevalence of malnutrition in comparison with other studies, but a high prevalence of low FFMI, underlining the necessity of measuring body composition in SSc patients with a standardized and validated method. A good validity of BIA in determining FFM was found at a group level, while at an individual level the FFM may vary by 4.6 kg.
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Affiliation(s)
- Moon J Spanjer
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center
| | - Irene E M Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center
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Codullo V, Cereda E, Klersy C, Cavazzana I, Alpini C, Bonardi C, Turri A, Franceschini F, Caccialanza R, Montecucco C, Caporali R. Serum prealbumin is an independent predictor of mortality in systemic sclerosis outpatients. Rheumatology (Oxford) 2015; 55:315-9. [DOI: 10.1093/rheumatology/kev322] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/15/2022] Open
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Doerfler B, Allen TS, Southwood C, Brenner D, Hirano I, Sheean P. Medical Nutrition Therapy for Patients With Advanced Systemic Sclerosis (MNT PASS): A Pilot Intervention Study. JPEN J Parenter Enteral Nutr 2015. [PMID: 26209221 DOI: 10.1177/0148607115597883] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The objective of this study was to demonstrate the feasibility and associations with short-term outcomes of a medical nutrition therapy (MNT) intervention in patients with systemic scleroderma (SSc). MATERIALS AND METHODS Eighteen patients with SSc, gastrointestinal (GI) involvement, and unintentional weight loss were consented and recruited for a 6-week MNT intervention, in addition to their usual medical management. MNT emphasized increased calorie and protein intake, modified textures, and lifestyle modifications. Symptoms, anthropometrics, diet (24-hour recall), and body composition (dual-energy x-ray absorptiometry) were assessed pre- and postintervention. Sarcopenia was defined as appendicular lean height (ALH) for women <5.45 kg/m2 and for men <7.26 kg/m2. Descriptive, parametric, and nonparametric statistics were conducted. RESULTS Participants (n = 18) were predominantly white (78%), female (89%), malnourished (83%), and 51.3 ± 11.0 years of age with a body mass index of 22.6 ± 6.7 kg/m2. Significant decreases in nutrition symptom scores (12.8 vs 7.6, P < .05) and improvements in ALH (5.6 ± 0.8 vs 5.8 ± 0.8 kg/m2, respectively; P = .05) occurred pre- vs postintervention, respectively (n = 14). Sarcopenia was observed in 54% of participants at baseline and 39% at follow-up ( P = .02). Caloric intake (1400 vs 1577 kcal/d, P = .12) and macronutrient distribution (ie, % fat, protein, carbohydrate) did not change significantly pre- vs postintervention, respectively. CONCLUSIONS Individually tailored MNT can improve symptom burden and potentially ALH in patients with SSc involving the GI tract. This study underscores the clinical potential of multidisciplinary patient management and the need for larger nutrition intervention trials of longer duration in these patients.
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Affiliation(s)
- Bethany Doerfler
- 1 Digestive Health Center, Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois
| | - Tara S Allen
- 2 Advocate South Suburban Hospital, Hazel Crest, Illinois
| | | | - Darren Brenner
- 1 Digestive Health Center, Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois
| | - Ikuo Hirano
- 1 Digestive Health Center, Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois
| | - Patricia Sheean
- 4 University of Illinois at Chicago, Institute for Health Policy and Research, Chicago, Illinois
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