Nutritional disorders are significant but often underestimated complications in patients with systemic sclerosis (SSc). The most prevalent nutritional disorders in SSc are malnutrition, affecting up to 62.5% of patients, and sarcopenia, with a frequency of up to 42%. Thus, clinical vigilance is recommended for the detection of eating disorders in SSc patients, particularly those with gastrointestinal involvement, cardiopulmonary complications, an advanced disease stage, and high disease activity. Nutritional treatment should be carefully tailored to the patients’ clinical condition to ensure that it effectively addresses their specific needs. Studies focusing on enteral nutrition in SSc patients demonstrate its effectiveness in stabilizing or improving nutritional status in malnourished patients. In severe cases, parenteral nutrition offers viable options to support patient health. The findings highlight the importance of early nutritional assessment and intervention in improving patient outcomes and suggest that individualized nutritional therapy can be a critical component of comprehensive care for SSc patients.

(1) Background: Impaired nutritional status in systemic sclerosis (SSc) is prevalent. (2) Objective: This study aimed to identify pre-cachexia and malnutrition in SSc patients and to estimate the effectiveness of a high-protein oral nutritional supplement (ONS) in improving their nutritional status. (3) Materials and methods: The SSc population comprised 56 patients and a control group of 49 healthy persons. After a baseline clinical evaluation, bioelectrical impedance analysis (BIA), and laboratory tests, SSc patients were divided into well-nourished, pre-cachectic, and malnourished categories. SSc patients with a nutritional disbalance received a high-protein ONS once daily for 3 months. Patients were reassessed at 3 and 12 months after inclusion in the study. (4) Results: SSc patients, in comparison to the control group, had a significantly lower seven-point SGA value [6(0) vs. 7(1), p < 0.001)], lean tissue mass [LTM, 35.1 (10.5) vs. 40.1 (10.10), p = 0.008], and lean tissue index [LTI, 13.5 (3) vs. 14.9 (4), p = 0.009]. Of the 56 SSc patients, 40 (71.4%) were well nourished, 5 (8.9%) had pre-cachexia, and 11 (19.7%) were malnourished. A high-protein ONS in the pre-cachexia group stabilized the SGA value, anthropometric measurements, and BIA after 3 and 12 months. In malnourished patients, it significantly improved the SGA value [5(0) vs. 6(0), p = 0.002], LTI [12.1 (2.1) vs. 12.7 (3.2), p = 0.021] and LTM [31.1 (7.7) vs. 35.1 (9.1), p = 0.021], and that effect remained stable at 12 months. (5) Conclusion: Malnutrition is a common complication of SSc that can be improved with nutritional intervention.

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.³ Objectives The aim of the study was to determine whether nutritional support has an impact on improvement of nutritional status in SSc patients. Methods The 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). Results Impaired 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. Conclusions Assessment 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 Interest None declared