Systemic Sclerosis Patients Likely to Develop Micronutrient Deficiencies

Researchers  in Switzerland recently presented data revealing that patients with systemic sclerosis are likely to be deficient in certain micronutrients, and the deficiencies correlate with their disease. The data was presented at the American College of Rheumatology (ACR) Annual Meeting, held in San Francisco in November, and the abstract is titled “Deficiency in Micronutrients Is a Frequent Burden in Patients with Systemic Sclerosis.”

Micronutrients are essential dietary components that play a role in several metabolic processes, including collagen synthesis and wound healing, key mechanisms in systemic sclerosis pathogenesis. In systemic sclerosis, the body’s immune system attacks healthy tissues, resulting in a hardening and tightening (fibrosis) of the skin and connective tissues, including internal organs such as the gastrointestinal tract. Patients with systemic sclerosis can experience nutritional impairment and malabsorption at the intestine, which can lead to deficiencies in certain nutrients and micronutrients.

The research team at the University Hospital Zurich analyzed a cohort of 176 patients with systemic sclerosis enrolled between 2009 and 2014. Patients were evaluated based on the European Scleroderma Trials and Research (EUSTAR) criteria, and all completed the Scleroderma Clinical Trial Consortium Gastrointestinal Tract (SCTC-GIT) questionnaire of the University of California, Los Angeles (UCLA). Researchers also assessed the concentration of specific micronutrients in patients, namely folic acid, zinc, prealbumin, selenium, and holotranscobalamin.

Researchers found that almost half of the patients studied (43.7%) had low levels of at least one of the micronutrients analyzed, while 19.3% of the patients had multiple deficiencies. The most common micronutrient found to be deficient was selenium (21.9%), followed by folic acid (16.6%) and prealbumin (15%).

In addition, the team observed that low levels of zinc were significantly associated with low levels of folic acid, selenium or prealbumin. A lower body mass index (BMI) was also found to be linked to lower zinc levels, while stomach symptoms were correlated to low prealbumin levels.

The team reported that a higher proximal skin thickening and modified Rodnan Skin Scores (a method to measure the extent and severity of dermal skin thickness), and lower hemoglobin levels were strongly associated with a deficit in any of the micronutrients assessed in the study. Proximal skin thickening, low hemoglobin, and low BMI were found to be independent predictors of micronutrient deficiency.

“In our cohort, patients with proximal skin fibrosis and lower BMI were more likely to show a deficiency in micronutrients, suggesting that screening for micronutrient status should be prioritized in these patients,” the research team said, according to a news release.

The authors concluded that patients with systemic sclerosis are more prone to become deficient in micronutrients, especially selenium, folic acid and prealbumin, and that these deficits correlate with clinical aspects of the disease. The team emphasizes that clinicians and healthcare providers should be aware of the need to monitor micronutrient levels in this patient population.