Systemic sclerosis (SSc) is a connective tissue disease characterized by endothelial dysfunction, microvascular and macrovascular damage and fibrosis of the skin and internal organs. Raynaud¿s phenomenon is one of the hallmarks of SSc and involves both the macro and microvasculature. Many of the severe internal organ complications of SSc are vascular, including pulmonary arterial hypertension and gastrointestinal complications. Chronic diseases associated with systemic inflammatory response have been frequently associated with malnutrition. In SSc, the prevalence of protein¿energy malnutrition (PEM) ranges from 15% to 30%. The involvement of the gastro-intestinal tract can significantly contribute to nutritional status deterioration. Several studies reported that moderate risk of malnutrition is associated with markers of gastrointestinal involvement and physician global assessment of disease severity. The body composition derangements are significantly associated with disease activity and mortality. Evidence exists on the prognostic impact of disease-related malnutrition and muscle wasting and the importance of including the nutritional domain in the general assessment of patients affected by SSc. In the small intestine, bacterial overgrowth due to luminal content stasis or decreased permeability secondary to intestinal fibrosis, may cause malabsorption. Recent studies report alterations in gut microbiota in the SSc. Microbial signatures of dysbiosis in the gut microbiota of SSc patients are associated with clinical evidence of gastrointestinal disease and disease severity. More recently, the possible role of altered gut microbiota profile in the pathogenesis of GI tract symptoms in SSc led to exploration of probiotic therapy for symptomatic bloating in SSc. Aim of this study is to evaluate body composition in SSc patients and to ascertain whether correlations exist between body composition, microvascular damage and gut microbiota.
It is well known that body composition and nutritional status influence both severity and activity of disease. Body composition parameters correlate with disease severity and provide best predictors for patient survival. Patients with malnutrition had a higher risk for SSc-related mortality and body composition was the best predictor for mortality in comparison with other clinical features. A positive correlation exists between nutritional status and cardiac mass. The body composition and nutritional status are predictive markers of disease progression. Gut microbiota may be involved in the pathogenesis of immune-mediated disorders. In SSc patients an alteration of gut microbiota is present respect to healthy controls. Dysbiosis is more frequent in SSc patients with GI damage and alteration of body composition and malnutrition.
We aim to demonstrate for the first time that alterations of body composition influence the severity of vascular damage evaluated by serological tests and several techniques of microvascular digital damage. In addition, the gut microbiota represents a risk factor for the development of alteration of body composition and malnutrition. We can suppose that the dysbiosis may play a role in the pathogenesis of microvascular damage in SSc patients. In some studies the gut microbiota alteration is reported as risk factor for cardiovascular diseases. We can suppose that a complex interaction exists among body mass composition, gut microbiota and microvascular damage in SSc patients.
We can hypothesize that in SSc patients with alterations of body composition and/or malnutrition and/or dysbiosis the follow-up to evaluate microvascular damage of finger and internal organs should be performed with major frequency. The correction of body composition and dysbiosis could represent an important target for therapy. In SSc patients with alteration of body composition and/or dysbiosis a more frequent follow-up is needed to detect an early microvascular damage. Early administration of vasoactive drugs represents a therapeutic intervention that can delay the development of cutaneous and visceral fibrosis. The correction of dysbiosis by probiotics, selected according to the profile of the bacterial species, could lead to an improvement not only in the nutritional status but also in a slow progression of the microvascular damage. The assessment of body composition and gut microbiota should be performed routinely in all SSc patients and the early correction could represent an important target for the physicians.
These results will be useful to reduce morbidity, mortality and to improve the quality of life of SSc patients through specific and personalized nutritional and/or pharmacological interventions.
Essential references:
Volkmann ER,. Arthritis Rheumatol 2016
Rosato E, Nutrition 2014