Disease-related nutritional risk and mortality in systemic sclerosis

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.