Disease-related nutritional risk and mortality in systemic sclerosis.
OBJECTIVE
To evaluate the relationship between mortality and nutritional risk associated with disease activity in Systemic Sclerosis (SSc).


METHODS
A single-centre prospective cohort study involving 160 SSc outpatients (median age, 62 years [25th-75th, 54-68]). Nutritional risk was assessed by the Malnutrition Universal Screening Tool (MUST), a screening tool that combines anthropometric parameters of nutritional status (body mass index [BMI] and percentage of unintentional weight loss [WL]) with the presence of an "acute disease" (as defined by a disease activity score ≥3 according to Valentini's criteria).


RESULTS
Prevalence of high nutritional risk (MUST score ≥2) was 24.4% [95%CI, 17.4-31.3]. A low nutritional risk (MUST = 1) was detected in 30% of our study sample. In hazard analysis (median follow-up duration = 46 months [25th-75th percentile, 31-54]), high nutritional risk was significantly associated with mortality (HR = 8.3 [95%CI, 2.1-32.1]). The performance of the model based on nutritional risk including disease activity (Harrell's c = 0.74 [95%CI, 0.59-0.89]) was superior to that based on active disease alone (HR = 6.3 [95%CI, 1.8-21.7]; Harrell's c = 0.68 [95%CI, 0.53-0.84]). Risk scored only by anthropometric parameters (prevalence, 9.4% [95%CI, 4.6-14.2]) was not associated with mortality: HR = 2.8 [95%CI, 0.6-13.2].


CONCLUSIONS
In SSc outpatients MUST significantly predicts mortality. The combined assessment of nutritional parameters and disease activity significantly improves the evaluation of mortality risk. Disease-related nutritional risk screening should be systematically included in the clinical workup of every SSc patient.
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it.
Emanuele
E
Cereda
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Veronica
V
Codullo
Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Catherine
C
Klersy
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Silvia
S
Breda
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Anna
A
Crippa
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Maria Luisa
ML
Rava
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Margherita
M
Orlandi
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Chiara
C
Bonardi
Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Maria Lina
ML
Fiorentini
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Roberto
R
Caporali
Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Riccardo
R
Caccialanza
D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications / Q000401:mortality*; D015431:Weight Loss
Disease activity; Mortality; Nutritional risk; Systemic sclerosis