Frequency and implications of malnutrition in systemic sclerosis

Jessica L Fairley; Dylan Hansen; Alannah Quinlivan; Susanna Proudman; Joanne Sahhar; Gene-Siew Ngian; Jennifer Walker; Lauren V Host; Kathleen Morrisroe; Wendy Stevens; Laura Ross; Mandana Nikpour

doi:10.1093/rheumatology/keae209

Frequency and implications of malnutrition in systemic sclerosis

Rheumatology (Oxford). 2024 Mar 28:keae209. doi: 10.1093/rheumatology/keae209. Online ahead of print.

Authors

Jessica L Fairley^{1

2}, Dylan Hansen², Alannah Quinlivan^{1

2}, Susanna Proudman^{3

4}, Joanne Sahhar^{5

6}, Gene-Siew Ngian^{5

6}, Jennifer Walker⁴, Lauren V Host⁷, Kathleen Morrisroe^{1

2}, Wendy Stevens², Laura Ross^{1

2}, Mandana Nikpour^{1

2

8

9}

Affiliations

¹ Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
² Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
³ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁴ Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁵ Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.
⁶ Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
⁷ Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
⁸ School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Department of Rheumatology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia.

PMID: 38548670
DOI: 10.1093/rheumatology/keae209

Abstract

Objectives: To quantify the frequency and impact of malnutrition in systemic sclerosis (SSc), as diagnosed by the Global Leadership Initiative on Malnutrition (GLIM) criteria, based on weight loss, body mass index (BMI) and muscle atrophy.

Methods: Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc with ≥1 concurrent weight and height measurement were included. Chi-squared tests, two-sample t-tests or Wilcoxon rank-sum tests were used for between-group comparison as appropriate. Multivariable logistic regression models were used to establish the determinants of malnutrition diagnosis. Kaplan-Meier and Cox proportional hazard models were used for survival analyses, based on malnutrition diagnosis, and individual GLIM criteria (% weight loss, BMI thresholds and presence of muscle atrophy).

Results: In this study of 1903 participants, 43% were diagnosed with malnutrition according to GLIM criteria, of whom 33% had severe malnutrition. Participants diagnosed with malnutrition were older, and more likely to have dcSSc, higher SSc severity scores and RNA polymerase-3 positivity. Gastrointestinal (GI) involvement, multimorbidity, cardiopulmonary disease, raised inflammatory markers, hypoalbuminaemia and anaemia were more common in malnourished participants (p< 0.01). Multimorbidity (OR1.6, 95%CI1.2-2.0, p< 0.01), pulmonary arterial hypertension (OR2.1, 95%CI1.4-2.0, p< 0.01) and upper GI symptoms (OR1.6, 95%CI1.3-2.0, p< 0.01) were all associated with malnutrition.Health-related quality-of-life (HRQoL) and physical function were poorer in malnourished participants. Survival was worse in those with malnutrition after adjusting for age, sex and dcSSc (HR 1.4, 95%CI1.1-1.7, p< 0.01).

Conclusions: Malnutrition is common in SSc and confers poorer survival, HRQoL and physical function.

Keywords: Malnutrition; body mass index; quality of life; survival; systemic sclerosis.