Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by initial microvascular damage, immune system activation and progressive fibrosis with insufficiency of internal organs. Gastrointestinal (GI) involvement is characterized by atrophy of the smooth muscle and small bowel hypomotility, mainly resulting from an autonomic nerve dysfunction. These modifications significantly affect gut transit and nutrient absorption, thus leading to malnutrition deficit induced by malabsorption. Nutritional deficit induced by malabsorption might also lead to bone alterations. This study aims to evaluate the relationship between malnutrition and bone status. Thirty-six postmenopausal female patients fulfilling the ACR 2013 criteria for SSc underwent dual-energy X-ray absorptiometry scan (DXA) to detect quantitative lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) analysis to detect bone quality. Data from DXA also allow to assess body composition and provide several quantitative parameters, including free fat mass index (FFMI) that identifies the patient with malnutrition (values <15 kg/m2 in women and 17 kg/m2 in men), according to the ESPEN criteria. Body mass index (BMI) was calculated for all SSc patients and every patient completed a diary reporting GI symptoms. Two groups of SSc patients with or without diagnosed malnutrition according to FFMI parameter were identified. Malnourished SSc patients showed significantly lower weight (p = 0.01) and BMI (p = 0.001), as well as lower serum levels of hemoglobin (p = 0.009), albumin (p = 0.002), PTH (p = 0.02) and 25OH-vitamin D (p = 0.008). DXA analysis showed significantly lower lumbar L1-L4 T-score (p = 0.009) and BMD values (p = 0.029) in malnourished SSc patients. Consistently, TBS values were significantly lower in malnourished patients (p = 0.008) and correlated with BMD (at any site) and serum albumin levels (p = 0.02). In addition, FFMI positively correlated with bone parameters as well as with symptoms of intestinal impairment in malnourished SSc patients. Finally, GI symptoms significantly correlated with BMD but not with TBS. This pilot study shows that in malnourished SSc patients (2015 ESPEN criteria: FFMI<15 kg/m2), an altered bone status significantly correlates with GI involvement, in terms of symptoms being mainly due to intestinal involvement together with the presence of selected serum biomarkers of malnutrition.
Highlights
IntroductionGI tract dysfunctions are sustained by diffuse vascular abnormalities
Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by early microvascular damage, immune activation and progressive irreversible fibrosis of skin and internal organs [1,2].Gastrointestinal tract (GI) involvement is frequent in SSc patients, regardless of belonging to the diffuse cutaneous SSc subset or the limited cutaneous SSc subset [3,4,5]. any part of the GI tract can be affected, 90% of patients report symptoms related to upper GI tract involvement and 40% of patients report symptoms related to lower GI involvement [6,7].GI tract dysfunctions are sustained by diffuse vascular abnormalities
Laboratory and bone parameters according to the malnutrition assessment were recorded
Summary
GI tract dysfunctions are sustained by diffuse vascular abnormalities. This leads to ischemia and immunological events and to the conversion of fibroblasts into myofibroblasts, which produce an excessive amount of extracellular matrix proteins, inducing fibrosis and atrophy of smooth muscle and distortion of the normal tissue architecture. These mechanisms, in addition to autonomic nerve dysfunction sustained by anti M3-R antibodies activation, may contribute to GI dysmotility [8,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
