AB0424 NUTRIENT DEFICIENCIES IN SYSTEMIC SCLEROSIS: A SYSTEMATIC REVIEW

Abstract

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.