Study Demonstrates Benefits of Medical Nutrition Therapy Intervention in SSc Patients with Gastrointestinal Involvement

In a recent study published in the Journal of Parenteral & Enteral Nutrition, a team of researchers found that a short-term tailored MNT intervention can improve symptom burden and potentially the appendicular lean height in patients with systemic sclerosis involving the gastrointestinal tract.

Scleroderma, or systemic sclerosis (SSc), is a chronic autoimmune multisystem disease affecting connective tissue, which results in the overproduction of collagen. It is an incurable disease with limited effective pharmacologic therapies designed to manage symptoms.

The gastrointestinal (GI) tract is the second most common site of SSc organ damage. Manifestations of SSc can impair the multiple functions of the GI tract, collectively affecting motility, digestion, absorption, and excretion. GI manifestations affect >90% of people with this disease, and symptoms can be severe, resulting in pain, dysmotility, pseudo-obstruction, GI reflux disease, malabsorption, small bowel bacterial overgrowth, and weight loss.

While the importance of early nutrition assessment in SSc is advocated, there is a paucity of data regarding patients with SSc when parenteral nutrition (PN) is not yet indicated. In the study titled “Medical Nutrition Therapy for Patients With Advanced Systemic Sclerosis (MNT PASS): A Pilot Intervention Study,” Patricia Sheean, PhD, RD. from the Loyola University Chicago and colleagues evaluated the feasibility and associated effects of a short-term, tailored MNT intervention on outcomes in patients with SSc.  The team of researchers also characterized the nutrition status and body composition of patients with SSc.

A total of 18 SSc patients who had gastrointestinal (GI) involvement and unintentional weight loss took part in a 6-week MNT intervention, in addition to their usual medical management.

The intervention consisted of an increase in calories and protein intake and lifestyle modifications. The researchers measured participants at baseline and post-intervention symptoms, anthropometrics, diet (24-hour recall), and body composition (dual-energy X-ray absorptiometry). Sarcopenia was defined as appendicular lean height (ALH) for women <5.45 kg/m² and for men <7.26 kg/m

After the MNT intervention, the results showed significant decreases in nutrition symptom scores (12.8 at baseline versus 7.6 pos-intervention) and improvements in ALH (5.6 ± 0.8 at baseline versus 5.8 ± 0.8 kg/m²) pos-intervention. Sarcopenia was observed in 54% of participants at baseline and 39% at follow-up. Caloric intake (1400 vs 1577 kcal/d) and macronutrient distribution did not change significantly before and after the intervention.

Based on the results, the researchers indicate that the study provided estimates on the occurrence of malnutrition, nutrition impact symptoms, and sarcopenia, and more importantly, established the feasibility and associations of a short-term MNT intervention on decreased symptom burden.

The researchers indicate that future studies should include direct measures of body composition and should seek to determine the durability of MNT on symptom improvement in a larger number of patients with SSc involving the GI tract.