{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T01:47:19Z","timestamp":1789436839517,"version":"build-2803163510"},"reference-count":94,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Systemic sclerosis (SSc) patients exhibit a plethora of risk factors for nutritional decline, including the presence of chronic inflammation and the progressive nature of disease-related multisystem involvement. The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated, its management currently remaining a subject of debate. The main objective of the present study was to perform a detailed assessment of scleroderma patients\u2019 diet as well as their eating habits and to describe the relationships with weight loss and malnutrition risk in the absence of professional nutritional counseling. Methods: We used a translated and validated version of the EPIC-Norfolk FFQ (European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire) to evaluate the patients\u2019 diet and MUST (Malnutrition Universal Screening Tool) to investigate the risk of malnutrition. Disease activity was estimated using the EUSTAR-AI (European Scleroderma Trials and Research group Activity Index). Results: We included 69 patients with SSc, of which 42 underwent a detailed dietary assessment. Dietary factors were connected to body composition and digestive symptoms. We found high sodium intake and frequent suboptimal energy consumption in our study group, including patients with cardiopulmonary involvement. Liver transaminases were inversely correlated with the consumption of nuts and seeds. Malnutrition and weight loss were significantly associated with pulmonary hypertension, heart failure, albumin levels, and the extent of skin fibrosis, but not advanced age. Although the patients with EUSTAR-AI \u2265 2.5 were more frequently included in the moderate and high malnutrition risk categories, these results did not reach statistical significance. Conclusions: Currently, there is an unmet need for longitudinal and interventional research focusing on the long-term significance, ramifications, and management of nutritional impairment in SSc patients with various clinical manifestations. Our results indicate that scleroderma patients could benefit from personalized nutritional counseling in an interdisciplinary setting.<\/jats:p>","DOI":"10.3390\/diagnostics11112118","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:19:20Z","timestamp":1636964360000},"page":"2118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Diet in Scleroderma: Is There a Need for Intervention?"],"prefix":"10.3390","volume":"11","author":[{"given":"Alexandra Maria","family":"Burlui","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Rehabilitation, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-9289","authenticated-orcid":false,"given":"Anca","family":"Cardoneanu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Rehabilitation, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-867X","authenticated-orcid":false,"given":"Luana Andreea","family":"Macovei","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Rehabilitation, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian","family":"Rezus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian Vasile","family":"Boiculese","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Interdisciplinarity, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Graur","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Rezus","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Rehabilitation, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Asano, Y. (2020). The Pathogenesis of Systemic Sclerosis: An Understanding Based on a Common Pathologic Cascade across Multiple Organs and Additional Organ-Specific Pathologies. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092687"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.clnesp.2020.09.030","article-title":"Nutritional status and predictors of weight loss in patients with systemic sclerosis","volume":"40","author":"Hvas","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s10067-017-3932-y","article-title":"Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis","volume":"37","author":"Caimmi","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gullo, A.L., Mandraffino, G., Rodr\u00edguez-Carrio, J., Scuruchi, M., Sinicropi, D., Postorino, M., Morace, C., Giuffrida, C., Sciortino, D., and Gallizzi, R. (2021). Endocan and Circulating Progenitor Cells in Women with Systemic Sclerosis: Association with Inflammation and Pulmonary Hypertension. Biomedicines, 9.","DOI":"10.3390\/biomedicines9050533"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.reumae.2011.09.003","article-title":"Nutrition in Systemic Sclerosis","volume":"8","author":"Recasens","year":"2012","journal-title":"Reumatol. Cl\u00edn. (Engl. Ed.)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1038\/nrgastro.2016.99","article-title":"Current management of the gastrointestinal complications of systemic sclerosis","volume":"13","author":"Emmanuel","year":"2016","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_7","first-page":"S42","article-title":"Assessment of disease severity and prognosis","volume":"21","author":"Medsger","year":"2003","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s00296-017-3753-y","article-title":"Malnutrition is an independent risk factor for mortality in Mexican patients with systemic sclerosis: A cohort study","volume":"37","author":"Saavedra","year":"2017","journal-title":"Rheumatol. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.1002\/art.38098","article-title":"2013 classification criteria for systemic sclerosis: An American College of Rheumatology\/European League against Rheumatism collaborative initiative","volume":"65","author":"Khanna","year":"2013","journal-title":"Arthritis. Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1136\/annrheumdis-2016-209768","article-title":"The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: Derivation and validation of a preliminarily revised EUSTAR activity index","volume":"76","author":"Valentini","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3701","DOI":"10.1007\/s10067-020-05126-z","article-title":"Performance of the 2017 EUSTAR activity index in an scleroderma cohort","volume":"39","author":"Ross","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_12","first-page":"856","article-title":"Can the EPIC food frequency questionnaire be applied to the population in Romania?","volume":"119","author":"Gherasim","year":"2015","journal-title":"Rev. Med. Chir. Soc. Med. Nat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e004503","DOI":"10.1136\/bmjopen-2013-004503","article-title":"A new tool for converting food frequency questionnaire data into nutrient and food group values: FETA research methods and availability","volume":"4","author":"Mulligan","year":"2014","journal-title":"BMJ Open"},{"key":"ref_14","unstructured":"Rolfes, S.R., Pinna, K., and Whitney, E. (2020). Understanding Normal and Clinical Nutrition, Cengage Learning."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10980","DOI":"10.1038\/s41598-018-29362-1","article-title":"Relative fat mass (RFM) as a new estimator of whole-body fat percentage\u2014A cross-sectional study in American adult individuals","volume":"8","author":"Woolcott","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_16","unstructured":"WHO\/Europe (2021, June 11). Nutrition-Body Mass Index-BMI. Available online: https:\/\/www.euro.who.int\/en\/health-topics\/disease-prevention\/nutrition\/a-healthy-lifestyle\/body-mass-index-bmi."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e000782","DOI":"10.1136\/rmdopen-2018-000782","article-title":"Systemic sclerosis: State of the art on clinical practice guidelines","volume":"4","author":"Smith","year":"2019","journal-title":"RMD Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1093\/rheumatology\/kes160","article-title":"Malnutrition in systemic sclerosis","volume":"51","author":"Harrison","year":"2012","journal-title":"Rheumatology"},{"key":"ref_19","first-page":"57","article-title":"Malnutrition, associated clinical factors, and depression in systemic sclerosis: A cross-sectional study","volume":"39","author":"Arslan","year":"2019","journal-title":"Clin. Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cruz-Jentoft, A.J., Romero-Yuste, S., Carmona, E.C., and Nolla, J.M. (2021). Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions. Aging Clin. Exp. Res., 1\u201311.","DOI":"10.1007\/s40520-021-01800-7"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"651748","DOI":"10.3389\/fmed.2021.651748","article-title":"The PREdictor of MAlnutrition in Systemic Sclerosis (PREMASS) Score: A Combined Index to Predict 12 Months Onset of Malnutrition in Systemic Sclerosis","volume":"8","author":"Bagnato","year":"2021","journal-title":"Front. Med."},{"key":"ref_22","first-page":"214","article-title":"Consensus best practice pathway of the UK scleroderma study group: Gastrointestinal manifestations of systemic sclerosis","volume":"32","author":"Hansi","year":"2014","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.rdc.2017.09.002","article-title":"Gastrointestinal and Hepatic Disease in Systemic Sclerosis","volume":"44","author":"Frech","year":"2018","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Li, X., Kimita, W., Cho, J., Ko, J., Bharmal, S., and Petrov, M. (2021). Dietary Fibre Intake in Type 2 and New-Onset Prediabetes\/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study. Nutrients, 13.","DOI":"10.3390\/nu13041112"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s10654-017-0354-8","article-title":"Accordance to the Dietary Approaches to Stop Hypertension diet pattern and cardiovascular disease in a British, population-based cohort","volume":"33","author":"Jones","year":"2018","journal-title":"Eur. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Alegria-Lertxundi, I., Aguirre, C., Bujanda, L., Fern\u00e1ndez, F.J., Polo, F., Ordov\u00e1s, J.M., Etxezarraga, M.C., Zabalza, I., Larzabal, M., and Portillo, I. (2020). Gene\u2013Diet Interactions in Colorectal Cancer: Survey Design, Instruments, Participants and Descriptive Data of a Case\u2013Control Study in the Basque Country. Nutrients, 12.","DOI":"10.3390\/nu12082362"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.jand.2016.10.030","article-title":"Dietary Assessment in the MetaCardis Study: Development and Relative Validity of an Online Food Frequency Questionnaire","volume":"117","author":"Verger","year":"2017","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_28","first-page":"216","article-title":"Mediterranean diet and risk of Sj\u00f6gren\u2019s syndrome","volume":"38","author":"Machowicz","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/nrgastro.2017.116","article-title":"Alcohol, adipose tissue and liver disease: Mechanistic links and clinical considerations","volume":"15","author":"Parker","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Trius-Soler, M., Vilas-Franquesa, A., Tresserra-Rimbau, A., Sasot, G., Storniolo, C.E., Estruch, R., and Lamuela-Ravent\u00f3s, R.M. (2020). Effects of the Non-Alcoholic Fraction of Beer on Abdominal Fat, Osteoporosis, and Body Hydration in Women. Molecules, 25.","DOI":"10.3390\/molecules25173910"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Akahane, T., Namisaki, T., Kaji, K., Moriya, K., Kawaratani, H., Takaya, H., Sawada, Y., Shimozato, N., Fujinaga, Y., and Furukawa, M. (2020). Chronic Alcohol Consumption is Inversely Associated with Insulin Resistance and Fatty Liver in Japanese Males. Nutrients, 12.","DOI":"10.3390\/nu12041036"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lal, A., Peeters, A., Brown, V., Nguyen, P., Tran, H.N.Q., Nguyen, T., Tonmukayakul, U., Sacks, G., Calache, H., and Martin, J. (2020). The Modelled Population Obesity-Related Health Benefits of Reducing Consumption of Discretionary Foods in Australia. Nutrients, 12.","DOI":"10.3390\/nu12030649"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11883-019-0772-z","article-title":"Reciprocal Roles of Sleep and Diet in Cardiovascular Health: A Review of Recent Evidence and a Potential Mechanism","volume":"21","author":"Zuraikat","year":"2019","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Partearroyo, T., Samaniego-Vaesken, M.D.L., Ruiz, E., Aranceta-Bartrina, J., Gil, \u00c1., Gonz\u00e1lez-Gross, M., Ortega, R.M., Serra-Majem, L., and Varela-Moreiras, G. (2019). Sodium Intake from Foods Exceeds Recommended Limits in the Spanish Population: The ANIBES Study. Nutrients, 11.","DOI":"10.3390\/nu11102451"},{"key":"ref_35","first-page":"1","article-title":"Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: A cross-sectional study","volume":"126","author":"Ismail","year":"2020","journal-title":"Br. J. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.3389\/fimmu.2017.01478","article-title":"Effects of Food Additives on Immune Cells as Contributors to Body Weight Gain and Immune-Mediated Metabolic Dysregulation","volume":"8","author":"Neto","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1161\/HYPERTENSIONAHA.116.07289","article-title":"Hemodynamics and Salt-and-Water Balance Link Sodium Storage and Vascular Dysfunction in Salt-Sensitive Subjects","volume":"68","author":"Laffer","year":"2016","journal-title":"Hypertension"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"zvab060.098","DOI":"10.1093\/eurjcn\/zvab060.098","article-title":"Association of age and dietary sodium intake in patients with heart failure: Testing mediating effects of preference for salt and enjoyment of sodium-restricted diet","volume":"20","author":"Chung","year":"2021","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Patel, Y., and Joseph, J. (2020). Sodium Intake and Heart Failure. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21249474"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s10741-019-09781-6","article-title":"Nutrition intervention in heart failure: Should consumption of the DASH eating pattern be recommended to improve outcomes?","volume":"24","author":"Dunbar","year":"2019","journal-title":"Hear. Fail. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.jacc.2019.11.055","article-title":"Salt Reduction to Prevent Hypertension and Cardiovascular Disease","volume":"75","author":"He","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3363","DOI":"10.1093\/eurheartj\/ehaa586","article-title":"Salt and cardiovascular disease: Insufficient evidence to recommend low sodium intake","volume":"41","author":"Mente","year":"2020","journal-title":"Eur. Hear. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1038\/s41569-018-0004-1","article-title":"Role of salt intake in prevention of cardiovascular disease: Controversies and challenges","volume":"15","author":"He","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.soard.2018.07.015","article-title":"Bariatric surgery in patients with pulmonary hypertension","volume":"14","author":"Hanipah","year":"2018","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s11695-020-04852-2","article-title":"Effect of Bariatric Surgery on the Cardiovascular System in Obese Cases with Pulmonary Hypertension","volume":"31","author":"Salman","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Corsetti, G., Pasini, E., Romano, C., Chen-Scarabelli, C., Scarabelli, T., Flati, V., Saravolatz, L., and Dioguardi, F. (2021). How Can Malnutrition Affect Autophagy in Chronic Heart Failure? Focus and Perspectives. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22073332"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1002\/ehf2.13279","article-title":"Differential effect of malnutrition between patients hospitalized with new-onset heart failure and worsening of chronic heart failure","volume":"8","author":"Matsumura","year":"2021","journal-title":"ESC Hear. Fail."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1136\/heartjnl-2018-313312","article-title":"Malnutrition, congestion and mortality in ambulatory patients with heart failure","volume":"105","author":"Sze","year":"2018","journal-title":"Heart"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.3899\/jrheum.121380","article-title":"The 15% Rule in Scleroderma: The Frequency of Severe Organ Complications in Systemic Sclerosis. A Systematic Review","volume":"40","author":"Muangchan","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s41999-019-00204-1","article-title":"Which laboratory malnutrition markers best predict 1-year mortality in hospitalized older adults?","volume":"10","author":"Mashav","year":"2019","journal-title":"Eur. Geriatr. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.clnu.2015.09.008","article-title":"Underweight and malnutrition in home care: A multicenter study","volume":"35","author":"Lahmann","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnesp.2019.11.003","article-title":"The role of nutrition and physical activity in frailty: A review","volume":"35","author":"Coppinger","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jaut.2019.01.008","article-title":"The microbiome and immunodeficiencies: Lessons from rare diseases","volume":"98","author":"Pellicciotta","year":"2019","journal-title":"J. Autoimmun."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11894-019-0671-z","article-title":"The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)","volume":"21","author":"Quigley","year":"2019","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00403-018-1874-0","article-title":"Small intestinal bacterial overgrowth in systemic sclerosis: A review of the literature","volume":"311","author":"Gerkowicz","year":"2019","journal-title":"Arch. Dermatol. Res."},{"key":"ref_56","first-page":"44","article-title":"Systemic sclerosis and gastrointestinal involvement","volume":"27","author":"Tandaipan","year":"2020","journal-title":"Rev. Colomb. Reumatol. (Engl. Ed.)"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/2397198319891282","article-title":"Gastrointestinal involvement in systemic sclerosis: Effects on morbidity and mortality and new therapeutic approaches","volume":"6","author":"Volkmann","year":"2021","journal-title":"J. Scleroderma Relat. Disord."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.autrev.2018.05.010","article-title":"Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review","volume":"17","author":"Dupont","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s00296-021-04806-6","article-title":"Progression of gastrointestinal symptoms over time in patients with systemic sclerosis","volume":"41","author":"Bering","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"105081","DOI":"10.1016\/j.jbspin.2020.09.013","article-title":"Ethnic influence on the phenotype of French patients with systemic sclerosis","volume":"88","author":"Steelandt","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1002\/acr2.11293","article-title":"Nutrition Information Resources Used by People With Systemic Sclerosis and Perceived Advantages and Disadvantages: A Nominal Group Technique Study","volume":"3","author":"Jimenez","year":"2021","journal-title":"ACR Open Rheumatol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Yadlapati, R., and Khan, A. (2019). Gastroesophageal Reflux Disease. Gastrointestinal and Liver Disorders in Women\u2019s Health, Springer International Publishing.","DOI":"10.1007\/978-3-030-25626-5_3"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1136\/annrheumdis-2016-209909","article-title":"Update of EULAR recommendations for the treatment of systemic sclerosis","volume":"76","author":"Fransen","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s11894-017-0578-5","article-title":"Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature","volume":"19","author":"Newberry","year":"2017","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.clnesp.2018.03.119","article-title":"Acceptance of texture-modified in-between-meals among old adults with dysphagia","volume":"25","author":"Okkels","year":"2018","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"110747","DOI":"10.1016\/j.nut.2020.110747","article-title":"High risk of disease-related malnutrition in gastroenterology outpatients","volume":"75\u201376","author":"Holm","year":"2020","journal-title":"Nutrition"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1016\/j.clnu.2020.10.043","article-title":"COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study","volume":"40","author":"Sofia","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"104502","DOI":"10.1016\/j.appet.2019.104502","article-title":"Eating less the logical thing to do? Vulnerability to malnutrition with advancing age: A qualitative study","volume":"146","author":"Chatindiara","year":"2020","journal-title":"Appetite"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.3899\/jrheum.090694","article-title":"Malnutrition Is Common in Systemic Sclerosis: Results from the Canadian Scleroderma Research Group Database","volume":"36","author":"Baron","year":"2009","journal-title":"J. Rheumatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s40519-018-0571-5","article-title":"The prevalence of underweight and overweight\/obesity and its correlates among adults in Laos: A cross-sectional national population-based survey, 2013","volume":"25","author":"Pengpid","year":"2018","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"17491","DOI":"10.1038\/s41598-020-74659-9","article-title":"Relative fat mass at baseline and its early change may be a predictor of incident nonalcoholic fatty liver disease","volume":"10","author":"Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3507","DOI":"10.1093\/jn\/nxab253","article-title":"Intake of Nuts and Seeds Is Associated with a Lower Prevalence of Nonalcoholic Fatty Liver Disease in US Adults: Findings from 2005\u20132018 NHANES","volume":"151","author":"Cardoso","year":"2021","journal-title":"J. Nutr."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1093\/nutrit\/nuaa044","article-title":"Effects of macronutrient intake in obesity: A meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome","volume":"79","author":"Willems","year":"2021","journal-title":"Nutr. Rev."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Chmurzynska, A., Muzsik, A., Krzy\u017canowska-Jankowska, P., Walkowiak, J., and Bajerska, J. (2019). The Effect of Habitual Fat Intake, IL6 Polymorphism, and Different Diet Strategies on Inflammation in Postmenopausal Women with Central Obesity. Nutrients, 11.","DOI":"10.3390\/nu11071557"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jpba.2019.06.005","article-title":"Lipidomics in autoimmune diseases with main focus on systemic lupus erythematosus","volume":"174","author":"Ferreira","year":"2019","journal-title":"J. Pharm. Biomed. Anal."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.autrev.2018.03.015","article-title":"Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography","volume":"17","author":"Valle","year":"2018","journal-title":"Autoimmun. Rev."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Patti, A.M., Carruba, G., Cicero, A.F.G., Banach, M., Nikolic, D., Giglio, R.V., Terranova, A., Soresi, M., Giannitrapani, L., and Montalto, G. (2020). Daily Use of Extra Virgin Olive Oil with High Oleocanthal Concentration Reduced Body Weight, Waist Circumference, Alanine Transaminase, Inflammatory Cytokines and Hepatic Steatosis in Subjects with the Metabolic Syndrome: A 2-Month Intervention Study. Metabolites, 10.","DOI":"10.3390\/metabo10100392"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Klonizakis, M., Grammatikopoulou, M.G., Theodoridis, X., Milner, M., Liu, Y., and Chourdakis, M. (2019). Effects of Long-Versus Short-Term Exposure to the Mediterranean Diet on Skin Microvascular Function and Quality of Life of Healthy Adults in Greece and the UK. Nutrients, 11.","DOI":"10.3390\/nu11102487"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Rogerson, D., Ma\u00e7\u00e3s, D., Milner, M., Liu, Y., and Klonizakis, M. (2018). Contrasting Effects of Short-Term Mediterranean and Vegan Diets on Microvascular Function and Cholesterol in Younger Adults: A Comparative Pilot Study. Nutrients, 10.","DOI":"10.3390\/nu10121897"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Trombetta, A.C., Smith, V., Gotelli, E., Ghio, M., Paolino, S., Pizzorni, C., Vanhaecke, A., Ruaro, B., Sulli, A., and Cutolo, M. (2017). Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179062"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s00011-020-01337-x","article-title":"Vitamin D and connective tissue diseases","volume":"69","author":"Berardi","year":"2020","journal-title":"Inflamm. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3119","DOI":"10.2147\/DDDT.S144860","article-title":"Vitamin D levels in systemic sclerosis patients: A meta-analysis","volume":"11","author":"An","year":"2017","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2478\/jim-2021-0018","article-title":"Digestive Dysbiosis in Systemic Scleroderma: A Review","volume":"6","author":"Bratoiu","year":"2021","journal-title":"J. Interdiscip. Med."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Isola, G., Palazzo, G., Polizzi, A., Murabito, P., Giuffrida, C., and Gullo, A.L. (2021). Association of Systemic Sclerosis and Periodontitis with Vitamin D Levels. Nutrients, 13.","DOI":"10.3390\/nu13020705"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1007\/s10067-017-3861-9","article-title":"Risk association between scleroderma disease characteristics, periodontitis, and tooth loss","volume":"36","author":"Isola","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.archger.2017.01.009","article-title":"Coexisting severe frailty and malnutrition predict mortality among the oldest old in nursing homes: A 1-year prospective study","volume":"70","author":"Kamo","year":"2017","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.37358\/RC.18.5.6308","article-title":"Nutritional Decline in Scleroderma Patients Data from a single Romanian center","volume":"69","author":"Burlui","year":"2018","journal-title":"Rev. Chim."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"3580","DOI":"10.1002\/hed.26426","article-title":"Prognostic value of nutritional impairment on treatment-related toxicity and survival in patients with nasopharyngeal carcinoma taking normal nutrition before radiotherapy","volume":"42","author":"Su","year":"2020","journal-title":"Head Neck"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s40620-020-00840-y","article-title":"Sarcopenia in chronic kidney disease: What have we learned so far?","volume":"34","author":"Sabatino","year":"2021","journal-title":"J. Nephrol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1017\/S0029665120006898","article-title":"The relationship between lifestyle components and dietary patterns","volume":"79","author":"Gherasim","year":"2020","journal-title":"Proc. Nutr. Soc."},{"key":"ref_91","first-page":"26","article-title":"The role of adipokines in inflammation and connective tissue diseases: Can we face the challenge","volume":"8","author":"Burlui","year":"2018","journal-title":"Int. J. Med. Dent."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1038\/s41430-020-0642-3","article-title":"Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China","volume":"74","author":"Li","year":"2020","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Besora-Moreno, M., Llaurad\u00f3, E., Tarro, L., and Sol\u00e0, R. (2020). Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 12.","DOI":"10.3390\/nu12030737"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jgo.2017.08.003","article-title":"NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer","volume":"9","author":"Guily","year":"2018","journal-title":"J. Geriatr. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/11\/2118\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:30:33Z","timestamp":1760167833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/11\/2118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,15]]},"references-count":94,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["diagnostics11112118"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11112118","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,15]]}}}