AB0424 NUTRIENT DEFICIENCIES IN SYSTEMIC SCLEROSIS: A SYSTEMATIC REVIEW
Authors: A. Nguyen, Z. Mcmahan, E. Volkmann
Journal: Annals of the Rheumatic Diseases (2021)

Background: Malnutrition is a critical concern in patients with systemic sclerosis (SSc). 1,2 However, the extent and types of nutrient deficiencies in SSc remain unclear. Objectives: 1) To identify the nutrient deficiencies commonly reported in SSc; 2) To evaluate associations between specific nutrient deficiencies and SSc subtype and clinical manifestations. Methods: We conducted a systematic review of all published reports on SSc and nutrition in PubMed from its inception to August 2020. Clinical trials, observational studies, and case series (with ≥20 cases) containing data on nutritional deficiency and SSc were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting our findings. Two reviewers (ADN and ERV) studied the titles and abstracts of all search results with pre-specified inclusion and exclusion criteria (Figure 1). Results: Among 790 retrieved publications, 35 full-length articles and 3 abstracts met the inclusion criteria. Included studies took place across multiple geographic locations and included patients with both diffuse and limited cutaneous SSc. Vitamin D deficiency was the most commonly reported deficiency described in SSc, followed by vitamin B12, folate, selenium, zinc, and iron (Table 1). In addition, some small studies found deficiencies in thiamine, pyridoxine, alpha-tocopherol, and carotene. Interstitial lung disease was associated with vitamin D deficiency and elevated homocysteine (Hcy), while pulmonary hypertension was associated with elevated Hcy. Vitamin D deficiency was also associated with increased modified Rodnan skin score (mRSS) and increased risk of SSc-related organ involvement. Conclusion: Nutrient deficiencies are common in SSc and are associated with specific SSc features. Routine screening for nutrient deficiencies may lead to early detection of malnutrition. Future studies are needed to understand how nutritional interventions affect patient outcomes in SSc. References: [1]Harrison E, Herrick AL, McLaughlin JT, Lal S. Malnutrition in systemic sclerosis. Rheumatology . 2012;51(10):1747-1756. doi:10.1093/rheumatology/kes160 [2]Baron M, Hudson M, Steele R, et al. Malnutrition is common in systemic sclerosis: Results from the Canadian Scleroderma Research Group database. J Rheumatol . 2009;36(12):2737-2743. doi:10.3899/jrheum.090694 Table 1. Nutrient deficiencies and their clinical correlates in SSc. Number of studies that found deficiency a Number of studies that did not find deficiency Clinical correlates of nutrient deficiency Vitamin D 23 0 Increased risk of SSc-related organ involvement ILD c Higher mRSS c Homocysteine b 5 4 ILD c PH Vitamin B12 3 4 None identified Folate 3 2 None identified Vitamin C 2 0 None identified Selenium 5 0 Increased risk of SSc-related organ involvement Zinc 3 1 None identified Iron 1 1 None identified Copper 0 2 None identified Other nutrients None identified for all nutrients Thiamine 1 0 Pyridoxine 1 0 Alpha-tocopherol 1 0 Carotene 1 0 a Deficiency defined as below normal levels based on study reference ranges b Studies looked for elevation versus no elevation of homocysteine in SSc c Some studies found significant correlation while others did not Acknowledgements: I have no acknowledgements to declare. Disclosure of Interests: None declared