Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Protein, malnutrition and wasting disorders

The impact of malnutrition on quality of life in patients with systemic sclerosis



Our objective was to investigate the prevalence of malnutrition in patients with systemic sclerosis (SSc) and its impact on their quality of life (QoL).


One hundred and twenty-nine patients with SSc underwent clinical evaluation and were screened with the Malnutrition Universal Screening Tool (MUST). Malnutrition was defined as MUST score ≥2.To investigate QoL, all patients completed the Short Form 36 Questionnaire and the Scleroderma Health Assessment Questionnaire. The data were analyzed with IBM SPSS® Statistics by using χ2/Fisher's test, Mann–Whitney U test, correlation, and linear regression analysis.


One hundred and twenty-nine patients were included in this study (mean age was 59.1 ± 13.8 years, 90.7% women). The prevalence of malnutrition was 10.9%. Age and disease duration were not significantly different between malnourished and well-nourished patients. All QoL scores (except bodily pain and self-reported health) were significantly impaired in malnourished patients. Furthermore, the Scleroderma Health Assessment Score score which assesses disease-specific QoL was significantly higher in the malnourished patients (1.6 ± 0.73 compared to 0.91 ± 0.61 in well-nourished patients; p = 0.001), reflecting a lower QoL due to disease-specific impairments.


Severe malnutrition in SSc patients is associated with reduced QoL. Standardized nutritional screening should routinely be conducted to identify the risk of malnutrition in order to enable an intervention with multimodal treatment and avoid the serious consequences associated with severe malnutrition.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1


  1. Murtaugh MA, Frech TM. Nutritional status and gastrointestinal symptoms in systemic sclerosis patients. Clin Nutr. 2013;32:130–35.

    Article  Google Scholar 

  2. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.

    Article  Google Scholar 

  3. Krause L, Becker MO, Brueckner CS, Bellinghausen C-J, Becker C, Schneider U, et al. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis. 2010;69:1951–57.

    Article  Google Scholar 

  4. Baron M, Hudson M, Steele R. Malnutrition is common in systemic sclerosis: results from the Canadian scleroderma research group database. J Rheumatol. 2009;36:2737–43.

    Article  Google Scholar 

  5. Caporali R, Caccialanza R, Bonino C, Klersy C, Cereda E, Xoxi B, et al. Disease-related malnutrition in outpatients with systemic sclerosis. Clin Nutr. 2012;31:666–71.

    Article  Google Scholar 

  6. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer—a systematic review of the epidemiological literature. Nutr J. 2012;11:27

    Article  Google Scholar 

  7. Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006;12:3380–85.

    Article  Google Scholar 

  8. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, et al. Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis. 2009;53:298–309.

    Article  Google Scholar 

  9. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. Classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2013. 2013;65:2737–47.

    Google Scholar 

  10. Preliminary Criteria for the Classification of S ystemic Sclerosis (Scleroderma) Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum. 1980;23:581–90.

  11. Frantz C, Avouac J, Distler O, Amrouche F, Godard D, Kennedy AT, et al. Impaired quality of life in systemic sclerosis and patient perception of the disease: a large international survey. Semin Arthritis Rheum. 2016;46:115–23.

    Article  Google Scholar 

  12. Furst DE, Clements PJ, Steen VD, Medsger TA JR, Masi AT, D’Angelo WA, et al. The modified Rodnan Skin Score is an accurate reflection of skin biopsy thickness in systemic sclerosis. J Rheumatol. 1998;25:84–88.

  13. Vanthuyne M, Smith V, Arat S, Westhovens R, Keyser F, de, Houssiau FA, et al. Validation of a manual ability questionnaire in patients with systemic sclerosis. Arthritis Rheum. 2009;61:695–703.

    Article  Google Scholar 

  14. Fischer GH, Molenaar IW, editors. Rasch Models: foundations, recent developments, and applications. New York, NY: Springer New York; 1995.

  15. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “Malnutrition Universal Screening Too” (“MUST”) for adults. Br J Nutr. 2004;92:799–808.

    Article  CAS  Google Scholar 

  16. Cereda E, Codullo V, Klersy C, Breda S, Crippa A, Rava ML, et al. Disease-related nutritional risk and mortality in systemic sclerosis. Clin Nutr. 2014;33:558–61.

    Article  Google Scholar 

  17. Ware JE JR, Gandek B, Kosinski M, Aaronson NK, Apolone G, Brazier J. et al. The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1167–70.

  18. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45.

    Article  CAS  Google Scholar 

  19. Steen VD, Medsger TA. JR. The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. Arthritis Rheum. 1997;40:1984–91.

    Article  CAS  Google Scholar 

  20. Rasheed S, Woods RT. An investigation into the association between nutritional status and quality of life in older people admitted to hospital. J Human Nutr Diet Off J Br Diet Assoc. 2014;27:142–51.

    Article  CAS  Google Scholar 

  21. Fukuda W, Omoto A, Ohta T, Majima S, Kimura T, Tanaka T, et al. Low body mass index is associated with impaired quality of life in patients with rheumatoid arthritis. Int J Rheum Dis. 2013;16:297–302.

    Article  Google Scholar 

  22. Tian X-P, Zhang X. Gastrointestinal complications of systemic sclerosis. World J Gastroenterol. 2013;19:7062–68.

    Article  Google Scholar 

  23. Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin N Am. 1998;27:563–94.

    Article  CAS  Google Scholar 

  24. Hudson M, Thombs BD, Steele R, Watterson R, Taillefer S, Baron M. Clinical correlates of quality of life in systemic sclerosis measured with the World Health Organization Disability Assessment Schedule II. Arthritis Rheum. 2008;59:279–84.

    Article  Google Scholar 

  25. Lambova S. Cardiac manifestations in systemic sclerosis. World J Cardiol. 2014;6:993–1005.

    Article  Google Scholar 

  26. Rosato E, Gigante A, Gasperini ML, Molinaro I, Di Lazzaro Giraldi G, Afeltra Amoroso D, Salsano F, Rossi Fanelli F, Laviano A. Nutritional status measured by BMI is impaired and correlates with left ventricular mass in patients with systemic sclerosis. Nutrition. 2013;30:204–9.

    Article  Google Scholar 

  27. Harrison E, Herrick AL, McLaughlin JT, Lal S. Malnutrition in systemic sclerosis. Rheumatology (Oxf). 2012;51:1747–56.

    Article  Google Scholar 

  28. Valentini G, Della Rossa A, Bombardieri S, Bencivelli W, Silman AJ, D’Angelo S, et al. European multicentre study to define disease activity criteria for systemic sclerosis. II. Identification of disease activity variables and development of preliminary activity indexes. Ann Rheum Dis. 2001;60:592–98.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kristina Norman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Preis, E., Franz, K., Siegert, E. et al. The impact of malnutrition on quality of life in patients with systemic sclerosis. Eur J Clin Nutr 72, 504–510 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links