Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Gastroenterology, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, United Kingdom.
Clin Nutr ESPEN. 2020 Dec;40:164-170. doi: 10.1016/j.clnesp.2020.09.030. Epub 2020 Oct 6.
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.
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).
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.
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.
系统性硬化症（SSc）常累及胃肠道（GI），易导致营养不良。少数研究评估了 SSc 门诊患者的身体成分，并使用了一种以上的方法进行随时间的比较。本研究旨在描述 SSc 患者的营养和身体成分标志物，并确定非故意体重减轻的预测因素。
我们连续纳入 SSc 门诊患者，并进行了为期一年的随访。从临床检查评估胃肠道（GI）受累情况。患者完成了器官受累和功能状态的问卷。临床评估包括体重指数（BMI）、营养不良通用筛查工具（MUST）、切牙间距、人体测量学和生物电阻抗分析（BIA）。
共纳入 168 例连续 SSc 患者，127 例（76%）完成了一年的随访。13 例（8%）在随访前死亡。根据 MUST 评分，12%的患者存在高营养风险，14%的患者存在中营养风险。低 BMI 与小肠受累相关（p<0.0001）。体脂肪百分比与 BMI 相关，使用四点人体测量法时（r=0.65，p<0.01）和 BIA 时（r=0.49，p<0.01）均如此。9 例（7%）患者在随访时体重减轻超过 5%。非故意体重减轻的独立基线预测因素包括上胃肠道受累和健康评估问卷残疾指数评分估计的疾病严重程度。
营养风险和 GI 受累在 SSc 患者中很常见且密切相关。BIA 和四点人体测量法在 SSc 患者的临床评估中具有可比性。非故意体重减轻是离散的，与疾病特异性特征有关。
