Prevalence, incidence and prognostic impact of GLIM-Defined malnutrition in systemic sclerosis: A longitudinal cohort study.

BACKGROUND AND AIMS: Malnutrition is a known complication in systemic sclerosis (SSc), yet longitudinal data using standardised diagnostic criteria in Asian populations are limited. We aimed to determine the prevalence and incidence of malnutrition, identify risk factors for its development and evaluate its association with mortality in the SSc cohort using the Global Leadership Initiative on Malnutrition (GLIM) criteria.

METHODS

Patients aged 18 years and above, fulfilling the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology or 1980 ACR classification criteria for SSc who were consecutively recruited into the Singapore Systemic Sclerosis Cohort (SCORE) between January 2008 and December 2020 were eligible for inclusion. Patients were included if they had at least one baseline assessment and ≥6 months of follow-up. Patients with follow-up of less than 6 months were excluded. Malnutrition was defined using the GLIM criteria. Demographics, clinical, serological, treatment and mortality data were collected. Cox proportional hazards regression was used to assess predictors of incident malnutrition and factors associated with mortality.

RESULTS

Among 341 patients with SSc, baseline malnutrition was 14.4%, with an incidence rate of 16.83 per 1000 person-years. No baseline clinical variables were significantly associated with the development of malnutrition. In contrast, increasing age [HR 1.04 (95% CI: 1.01-1.08), p = 0.005], disease duration [HR 0.99 (95% CI: 0.99-1.00), p = 0.001], and malnutrition [HR 2.76 (95% CI: 1.25-6.10), p = 0.012] were independently associated with increased mortality among patients with SSc.

CONCLUSION

Despite a relatively low incidence, GLIM-defined malnutrition had a strong independent association with mortality in SSc. These findings are of prognostic value and support the integration of routine screening and standardized malnutrition diagnosis in SSc care in Asian populations.