Disease-related nutritional risk and mortality in systemic sclerosis.

BACKGROUND & AIMS: 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.

Disease-related malnutrition in outpatients with systemic sclerosis.

BACKGROUND & AIM: Disease-related malnutrition is known to negatively affect clinical outcomes. The aim of the present study was to evaluate the prevalence of malnutrition in a cohort of outpatients affected by Systemic Sclerosis (SSc) and its association with clinical variables. METHODS: One hundred sixty SSc patients were consecutively evaluated. The following clinical variables were assessed: disease duration, activity and severity, treatments, functional status, gastrointestinal involvement. Nutritional assessment included: body mass index (BMI), weight loss (WL) history, nutritional intakes and serum prealbumin. Malnutrition was defined as BMI <20 kg/m² and/or previous 6-month WL ≥ 10%. RESULTS: Prevalence of malnutrition was 15% (10-21%). Logistic regression showed that malnutrition was independently associated with disease activity (OR 3.72; p < 0.001) and low serum prealbumin (OR 8.58; p < 0.001). The association with gastrointestinal involvement was not statistically significant, although a trend was detected (OR 1.88). CONCLUSION: Malnutrition is common in SSc outpatients. It appears associated with disease activity and not influenced by nutritional intakes; gastrointestinal involvement might contribute to its development over time. Serum prealbumin could be an early marker of malnutrition in SSc, whose role should be confirmed by further longitudinal investigations. Prospective studies are also required to clarify the clinical significance of the association between malnutrition and disease activity in SSc.

A 4-year survey of the activity of a malnutrition task force in an Italian research hospital.

OBJECTIVE: The proper management of nutritional support remains a challenging task in many Western hospitals. This study aimed at reporting a 4-y survey on the centralized management of nutritional support by a malnutrition task force in an Italian research hospital. METHODS: The requests for nutritional supports, the number of patients treated with enteral nutrition in the medical and surgical units, and the number of home artificial nutritional support activated were recorded from 2005 to 2008. RESULTS: The median number of first and follow-up visits per month significantly increased from 16 (25th-75th percentiles 13-26) in 2005 to 74 (25th-75th percentiles 69-82) in 2008 (P < 0.001) and from 56 (25th-75th percentiles 42-82) in 2005 to 101 (25th-75th percentiles 90-120) in 2008 (P = 0.001), respectively. This trend was observed also in the number of patients treated with enteral nutrition (from 95 in 2004 to 190 in 2008) and in those on home artificial nutritional support (from 25 in 2004 to 65 in 2008), whereas the number of parenteral nutrition bags produced remained substantially stable. CONCLUSION: The centralized management of nutritional support is a successful strategy, which provides the appropriate prescription of artificial nutrition during hospitalization and at discharge. Multidisciplinary nutrition support teams or task forces should be created in every hospital.