Nutritional Screening Needed to Identify SSc Patients at Risk of Malnutrition, Study Says

Severe malnutrition significantly decreases the quality of life of patients with systemic sclerosis (SSc), according to researchers.

Standardized nutritional screening is needed to identify those at risk of malnutrition so that interventions are rapidly introduced to avoid disease worsening.

The study, “The impact of malnutrition on quality of life in patients with systemic sclerosis,” was published in the European Journal of Clinical Nutrition.

Researchers investigated the affects of malnutrition on the the lives
 of 129 patients with SSc, most of them women (90.7%) with a mean age of 59.1 years.

“Although the association between malnutrition and QoL [quality of life] is well documented in older people admitted to hospital, chronic diseases such as cancer, or in patients on hemodialysis, it has not been systematically studied in rheumatic diseases,” researchers wrote.

The study was conducted at the Department of Rheumatology and Clinical Immunology Charite — University Medicine Berlin, Germany.

Patients were screened with the Malnutrition Universal Screening Tool (MUST), a scale that assesses the risk for malnutrition with a score in which 0 represents a low risk; 1 a medium risk; and 2 or higher a high risk of malnutrition.

For the evaluation of overall quality of life, researchers used the validated Medical Outcomes Study 36-item Short Form General Health Survey. This questionnaire assesses both patients’ mental and physical health, including physical function, bodily pain, and general health.

They also used the Scleroderma Health Assessment Score (SHAQ) to determine disease-specific impairments in quality of life.

Results showed a high risk for malnutrition (MUST score equal or higher than 2 ) in 10.9 percent of the patients. These patients, all female, showed a lower body mass index and had experienced weight loss more frequently.

Researchers saw no significant differences in age and disease duration between patients who were badly nourished and those who were well-nourished.

All SF-36 quality of life scores, with the exception of body pain and self-reported health, were significantly impaired in badly nourished patients.

“The SHAQ [Scleroderma Health Assessment] score which assesses disease-specific QoL [quality of life] was also significantly higher in the malnourished patients, reflecting a lower QoL due to disease-specific impairments,” researchers wrote.

Researchers detected a higher impairment in physical health-related quality of life in later stages of the disease, while mental health was more affected in earlier disease stages.

Gastrointestinal problems were few, although they were more frequent in malnourished patients. However, the team found no association with quality of life. Heart problems were significantly more frequent in malnourished patients.

These results show that quality of life was significantly impaired in badly nourished systemic sclerosis patients compared to patients who had sufficient nutrition.

“Severe malnutrition in SSc patients is associated with reduced [quality of life],” researchers concluded.

“Standardized nutritional screening should routinely be conducted to identify the risk of malnutrition in order to enable an intervention with multimodal treatment and avoid the serious consequences associated with severe malnutrition,” they suggested.