Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review

Objectives

The purpose of our study was to determine the prevalence and risk factors associated with malnutrition, and selenium (Se) and vitamin C (vitC) deficiencies in systemic sclerosis (SSc) patients.

Methods

We included adult SSc patients fulfilling the 2013 ACR/EULAR criteria from the Toulouse University Hospital cohort who underwent a micronutrient workup (including vitC, Se or thiamine levels) between 2011 and 2016. Results: 82 patients were included, mostly women (76%), with a median age of 60?years. SSc was limited in 76% of the cases, with Scl-70 and centromere antibodies in 32% and 44%, respectively. Median disease duration was 7.4?years. Cardiac involvement was noticed in 19% and gastrointestinal tract in and 95%; 9% had pulmonary artery hypertension (PAH) and 63% had interstitial lung disease. Overt malnutrition was present in 14 (17%) patients. Micronutrient deficiencies included Se (35%), vitC (31%) and/or thiamine (6%). Malnourished patients had significantly a higher summed Medsger disease severity scales (7.5 vs. 5, P?=?.003), lower hemoglobin (10.6 vs. 12.9?g/dL, P?vs. 10.6?mg/L, P?=?.003). Cardiac involvement was significantly associated with Se deficiency (OR 6.2, IC 95%[1.48–32.70], P?=?.05). The factors associated with vitC deficiency were malnutrition (OR 8.57, IC 95%[2.16–43.39], P?=?.003), modified Rodnan skin score?≤?14 (OR 0.33, IC95[0.11–1], P?=?.05), PAH (27% in deficient vs. none in non-deficient patients, P?=?.0006) and esophagitis or Barrett's mucosa (OR 4.05, IC95[1.27–13.54], P?=?.02).

Conclusions

Se testing should be considered as soon as cardiac involvement is suspected. VitC testing should be considered in malnourished SSc patients, especially if skin involvement is extensive.