Clinical Rheumatology

, Volume 39, Issue 1, pp 57–67 | Cite as

Malnutrition, associated clinical factors, and depression in systemic sclerosis: a cross-sectional study

  • İpek TürkEmail author
  • Nihan Cüzdan
  • Volkan Çiftçi
  • Didem Arslan
  • Muharrem Cem Doğan
  • İlker Unal
Original Article
Part of the following topical collections:
  1. Updates in Systemic Sclerosis



The aim of this study was to evaluate the associations between malnutrition and the clinical features of the disease and depression in patients with systemic sclerosis (SSc).


Patients with SSc who were followed up in our clinic were enrolled in the study. Malnutrition risk was assessed using the Malnutrition Universal Screening Tool (MUST). Skin involvement was assessed using the modified Rodnan skin score (mRSS) and interincisal distance (ID) measurements were used to assess the maximal mouth opening capacity. The Beck Depression Inventory (BDI) was used for measuring the severity of depression.


Ninety-eight patients with SSc (84.7% women; mean age 52.67 ± 11.26 years) were included in the study. According to the MUST scores, 61.2%, 15.3%, and 23.5% of patients had low, medium, and high risk for malnutrition, respectively. The mRSS was significantly higher in the group with high malnutrition risk compared with low-risk group (p = 0.014). Malnutrition risk was associated with interstitial lung disease and bowel involvement (p = 0.044 and p = 0.021, respectively). Interincisal distance was lower in the group with high malnutrition risk compared with the low-risk group (p = 0.003). Malnutrition risk was higher in patients who had mild-to-severe depressive symptoms than in those without (p = 0.012). Interincisal distance and bowel involvement were the most relevant factors for malnutrition.


The risk of malnutrition is increased in patients with SSc. In our study, microstomia and bowel involvement were the most relevantly associated factors with malnutrition.

Key Points

The risk of malnutrition is increased in patients with systemic sclerosis (SSc).

Microstomia and bowel involvement are found to be the most important factors associated with malnutrition.

Depressive symptoms are seen frequently among patients with SSc, and depression seems to be one of the etiologic factors or the result of malnourishment in SSc.

Assessment of nutritional status and the presence of depression should be a part of routine clinical visits of patients with SSc.


Depression Gastrointestinal involvement Interincisal distance Malnutrition Systemic sclerosis 


Compliance with ethical standards

The study was conducted in accordance with the original Declaration of Helsinki and its later amendments or comparable ethical standards and was approved by the local ethics committee (date, 4 November 2016; reference number, 58/7). Informed consent was received from all the patients.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • İpek Türk
    • 1
    Email author
  • Nihan Cüzdan
    • 2
  • Volkan Çiftçi
    • 3
  • Didem Arslan
    • 1
  • Muharrem Cem Doğan
    • 3
  • İlker Unal
    • 4
  1. 1.Department of Internal Medicine, Division of RheumatologyCukurova University School of MedicineAdanaTurkey
  2. 2.Department of Physical Medicine and Rehabilitation, Division of RheumatologyCukurova University School of MedicineAdanaTurkey
  3. 3.Faculty of Dentistry, Department of Pediatric DentistryÇukurova UniversityAdanaTurkey
  4. 4.Department of BiostatisticsÇukurova UniversityAdanaTurkey

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