{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:02:06Z","timestamp":1784520126009,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Nutritional abnormalities, alterations in body composition, and impaired muscle function are increasingly recognized as clinically relevant features in patients with Systemic Lupus Erythematosus (SLE). However, the relationship between multidimensional nutritional assessment and disease activity remains incompletely characterized. This study aimed to evaluate the associations between nutritional status, body composition, muscle strength, nutritional risk indices, and disease activity in patients with SLE. Materials and Methods: This exploratory retrospective study included hospitalized patients with SLE. Clinical data, anthropometric measurements, and nutritional status were assessed using the body mass index (BMI), prognostic nutritional index (PNI), controlling nutritional status (CONUT), and nutritional risk index (NRI). Muscle function was evaluated using the SARC-F scale. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K). Multivariable linear regression models were constructed to assess the independent association between nutritional indices and disease activity, adjusting for age, sex, glucocorticoid exposure, and immunosuppressive therapy. Correlation analyses were performed between nutritional indices and disease activity-related variables, and supplementary exploratory Spearman correlations were performed between the SARC-F score and SLEDAI-2K, CRP, complement C3, complement C4, and ESR. False discovery rate correction using the Benjamini\u2013Hochberg procedure was applied to exploratory correlation analyses. Results: A total of 67 patients were included. Nutritional indices (BMI, PNI, CONUT, and NRI) were not independently associated with SLEDAI-2K in multivariable regression analyses. In correlation analyses, after FDR adjustment, the PNI remained significantly associated with SLEDAI-2K, lymphocyte counts, and complement C3 levels, while CONUT remained significantly associated with lymphocyte count and C3 levels. The BMI and NRI were not significantly associated with disease activity or inflammatory markers after correction. SARC-F showed a weak positive correlation with SLEDAI-2K (r = 0.328; p = 0.008; qFDR = 0.040), which remained statistically significant after FDR correction. No significant correlations were observed between SARC-F and CRP, complement C3, complement C4, or ESR after FDR adjustment. Conclusions: Nutritional indices showed limited independent association with disease activity in SLE after adjustment for available confounders. Although the PNI and CONUT retained selected correlations with disease activity-related or immunological markers after FDR correction, these associations should be interpreted cautiously, as albumin- and lymphocyte-based indices may reflect inflammatory activity or disease burdens rather than nutritional status alone. SARC-F remains significantly associated with disease activity (SLEDAI-2K) after FDR adjustment. These findings should be validated in future prospective studies with a larger number of patients.<\/jats:p>","DOI":"10.3390\/diseases14070258","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T02:32:08Z","timestamp":1784514728000},"page":"258","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Nutritional Status, Body Composition, and Disease Activity in Systemic Lupus Erythematosus: An Exploratory Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jos\u00e9 Luis","family":"S\u00e1nchez-Reynoso","sequence":"first","affiliation":[{"name":"Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sol","family":"Ram\u00edrez-Ochoa","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenice","family":"Vicente-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-4737","authenticated-orcid":false,"given":"Gabino","family":"Cervantes-Guevara","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterolog\u00eda, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Jalisco, Mexico"},{"name":"Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Guadalajara 46200, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2935-8703","authenticated-orcid":false,"given":"Alejandro","family":"Gonz\u00e1lez-Ojeda","sequence":"additional","affiliation":[{"name":"Unidad Biom\u00e9dica 02, Hospital de Especialidades, Centro M\u00e9dico Nacional de Occidente, Guadalajara 44350, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6230-8359","authenticated-orcid":false,"given":"Clotilde","family":"Fuentes-Orozco","sequence":"additional","affiliation":[{"name":"Unidad Biom\u00e9dica 02, Hospital de Especialidades, Centro M\u00e9dico Nacional de Occidente, Guadalajara 44350, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Hern\u00e1ndez-Mora","sequence":"additional","affiliation":[{"name":"Departamento de Cl\u00ednicas de la Reproducci\u00f3n Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"},{"name":"Departamento de Obstetricia, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-7384","authenticated-orcid":false,"given":"Mauricio Alfredo","family":"Ambriz-Alarc\u00f3n","sequence":"additional","affiliation":[{"name":"Divisi\u00f3n de Medicina, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1177-1815","authenticated-orcid":false,"given":"Luis Asdruval","family":"Zepeda-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-9082","authenticated-orcid":false,"given":"Enrique","family":"Cervantes-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico"},{"name":"Departamento de Disciplinas Filos\u00f3ficas, Metodol\u00f3gicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico"},{"name":"Departamento de Cl\u00ednicas, Centro Universitario de Tlajomulco, Universidad de Guadalajara, Guadalajara 45641, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1001\/jama.2024.2315","article-title":"Systemic Lupus Erythematosus: A Review","volume":"331","author":"Siegel","year":"2024","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/nrrheum.2016.186","article-title":"New insights into the immunopathogenesis of systemic lupus erythematosus","volume":"12","author":"Tsokos","year":"2016","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1093\/rheumatology\/keac685","article-title":"Systemic lupus erythematosus incidence and prevalence in a large population-based study in northeastern Italy","volume":"62","author":"Zen","year":"2023","journal-title":"Rheumatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1080\/1744666X.2018.1538789","article-title":"Mortality in systemic lupus erythematosus: Causes, predictors and interventions","volume":"14","year":"2018","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_5","first-page":"1934","article-title":"The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus","volume":"31","author":"Uribe","year":"2004","journal-title":"J. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.1002\/art.21400","article-title":"Obesity is an independent contributor to functional capacity and inflammation in systemic lupus erythematosus","volume":"52","author":"Oeser","year":"2005","journal-title":"Arthritis Rheum."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Correa-Rodr\u00edguez, M., Pocovi-Gerardino, G., Callejas-Rubio, J.L., Fern\u00e1ndez, R.R., Mart\u00edn-Amada, M., Cruz-Caparros, M.G., Ortego-Centeno, N., and Rueda-Medina, B. (2019). The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus. Nutrients, 11.","DOI":"10.3390\/nu11030638"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1080\/1744666X.2017.1327352","article-title":"Epidemiology of systemic lupus erythematosus","volume":"13","year":"2017","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"An, H.J., Tizaoui, K., Terrazzino, S., Cargnin, S., Lee, K.H., Nam, S.W., Kim, J.S., Yang, J.W., Lee, J.Y., and Smith, L. (2020). Sarcopenia in Autoimmune and Rheumatic Diseases: A Comprehensive Review. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21165678"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-Negr\u00edn, H., Ricci, M., Mancebo-Sevilla, J.J., Sanz-C\u00e1novas, J., L\u00f3pez-Sampalo, A., Cobos-Palacios, L., Romero-G\u00f3mez, C., P\u00e9rez de Pedro, I., Ayala-Guti\u00e9rrez, M.D.M., and G\u00f3mez-Huelgas, R. (2022). Obesity, Diabetes, and Cardiovascular Risk Burden in Systemic Lupus Erythematosus: Current Approaches and Knowledge Gaps\u2014A Rapid Scoping Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192214768"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"8891","DOI":"10.2147\/JIR.S486792","article-title":"Investigation of Nutritional Factors and Malnutrition Risk Prediction Model in Hospitalized Patients with Systemic Lupus Erythematosus in China","volume":"17","author":"Xia","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Meza-Meza, M.R., Vizmanos-Lamotte, B., Mu\u00f1oz-Valle, J.F., Parra-Rojas, I., Garaulet, M., Campos-L\u00f3pez, B., Montoya-Buelna, M., Cerpa-Cruz, S., Mart\u00ednez-L\u00f3pez, E., and Oregon-Romero, E. (2019). Relationship of Excess Weight with Clinical Activity and Dietary Intake Deficiencies in Systemic Lupus Erythematosus Patients. Nutrients, 11.","DOI":"10.3390\/nu11112683"},{"key":"ref_13","first-page":"166","article-title":"S\u00edndrome metab\u00f3lico en mujeres mexicanas con lupus eritematoso sist\u00e9mico","volume":"61","author":"Fuentes","year":"2016","journal-title":"An. Med. Asoc. Med. Hosp. ABC"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.semarthrit.2017.05.011","article-title":"Obesity and the risk of systemic lupus erythematosus among women in the Nurses\u2019 Health Studies","volume":"47","author":"Tedeschi","year":"2017","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/09612033231220726","article-title":"Patients with systemic lupus erythematosus who are underweight have distinct disease characteristics","volume":"33","author":"Kwon","year":"2024","journal-title":"Lupus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1177\/0961203318787058","article-title":"Prognostic nutritional index is correlated with disease activity in patients with systemic lupus erythematosus","volume":"27","author":"Ahn","year":"2018","journal-title":"Lupus"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ahn, S.S., Yoo, J., Jung, S.M., Song, J.J., Park, Y.B., and Lee, S.W. (2019). Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis. Nutrients, 11.","DOI":"10.3390\/nu11071456"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1136\/annrheumdis-2018-214819","article-title":"2019 European League Against Rheumatism\/American College of Rheumatology classification criteria for systemic lupus erythematosus","volume":"78","author":"Aringer","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","first-page":"288","article-title":"Systemic lupus erythematosus disease activity index 2000","volume":"29","author":"Gladman","year":"2002","journal-title":"J. Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31579\/2637-8914\/047","article-title":"SARC-F test in sarcopenia and frailty: A narrative review","volume":"4","author":"Bahat","year":"2021","journal-title":"J. Nutr. Food Process."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.4081\/hi.2011.e2","article-title":"Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: An ACAP-HF data analysis","volume":"6","author":"Aziz","year":"2011","journal-title":"Heart Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.2147\/DMSO.S420924","article-title":"Prognostic Nutritional Index (PNI) as a Predictor in Patients with Metabolic Syndrome and Heart Failure","volume":"16","author":"Zhang","year":"2023","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_23","first-page":"38","article-title":"CONUT: A tool for controlling nutritional status. First validation in a hospital population","volume":"20","author":"Mancha","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e001204","DOI":"10.1136\/lupus-2024-001204","article-title":"Frequency of sarcopenia in Turkish women with systemic lupus erythematosus","volume":"11","author":"Bilici","year":"2024","journal-title":"Lupus Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-8587(24)00316-4","article-title":"Definition and diagnostic criteria of clinical obesity","volume":"13","author":"Rubino","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"5185","DOI":"10.1093\/rheumatology\/keab217","article-title":"Independent associations of lymphopenia and neutropenia in patients with systemic lupus erythematosus: A longitudinal, multinational study","volume":"60","author":"Louthrenoo","year":"2021","journal-title":"Rheumatology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1002\/art.22224","article-title":"Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: Association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual","volume":"55","author":"McGwin","year":"2006","journal-title":"Arthritis Rheum."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.3899\/jrheum.091028","article-title":"Serum albumin as a marker for disease activity in patients with systemic lupus erythematosus","volume":"37","author":"Yip","year":"2010","journal-title":"J. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gremese, E., Bruno, D., Varriano, V., Perniola, S., Petricca, L., and Ferraccioli, G. (2023). Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice. J. Clin. Med., 12.","DOI":"10.20944\/preprints202308.1613.v1"},{"key":"ref_30","first-page":"313","article-title":"Update and clinical management of anti-DNA auto-antibodies","volume":"2","year":"2021","journal-title":"Adv. Lab Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Dossybayeva, K., Bexeitov, Y., Mukusheva, Z., Almukhamedova, Z., Assylbekova, M., Abdukhakimova, D., Rakhimzhanova, M., and Poddighe, D. (2022). Analysis of Peripheral Blood Basophils in Pediatric Systemic Lupus Erythematosus. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071701"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Poddighe, D., Dossybayeva, K., Kozhakhmetov, S., Rozenson, R., and Assylbekova, M. (2024). Double-Negative T (DNT) Cells in Patients with Systemic Lupus Erythematosus. Biomedicines, 12.","DOI":"10.3390\/biomedicines12010166"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ayano, M., and Horiuchi, T. (2023). Complement as a Biomarker for Systemic Lupus Erythematosus. Biomolecules, 13.","DOI":"10.3390\/biom13020367"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Hou, J., He, C., He, W., Yang, M., Luo, X., and Li, C. (2020). Obesity and Bone Health: A Complex Link. Front. Cell Dev. Biol., 8.","DOI":"10.3389\/fcell.2020.600181"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1177\/0961203320988595","article-title":"The impact of low muscle function on health-related quality of life in Indonesian women with systemic lupus erythematosus","volume":"30","author":"Sumantri","year":"2021","journal-title":"Lupus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"20180252","DOI":"10.1259\/bjr.20180252","article-title":"MRI adipose tissue and muscle composition analysis-a review of automation techniques","volume":"91","author":"Borga","year":"2018","journal-title":"Br. J. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.21037\/qims.2020.03.02","article-title":"Body composition with dual energy X-ray absorptiometry: From basics to new tools","volume":"10","author":"Messina","year":"2020","journal-title":"Quant. Imaging Med. Surg."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/258\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:08:29Z","timestamp":1784516909000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/7\/258"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diseases14070258"],"URL":"https:\/\/doi.org\/10.3390\/diseases14070258","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}