{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:26:20Z","timestamp":1792038380582,"version":"4.4.0"},"reference-count":170,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Nutrients"],"abstract":"<jats:p>The gastrointestinal (GI) tract is seriously affected by systemic sclerosis (SSc), due to fibrosis and persistent inflammation. Patients with GI involvement frequently exhibit poor nutritional status, which affects disease burden and quality of life. The aim of the present review was to discuss all nutritional issues in SSc and serve as a primer for the nutritional assessment of patients with scleroderma. Patients with SSc suffer from GI impairments that affect the oral cavity, esophagus, stomach, and small and large intestines. Symptomatology includes microstomia, xerostomia, dysphagia, reflux, esophageal dysmotility, small intestinal bacterial overgrowth (SIBO), and fecal incontinence, among others, which may contribute to inadequate food intake. As a result, patients often suffer from malnutrition, sarcopenia, and frailty, while presenting with micronutrient deficiencies that impact disease outcomes and worsen their condition. This aggravated nutritional status is related to greater disease severity, organ involvement, reduced physical function, and increased length of hospitalization and mortality. GI involvement is well-documented within the SSc population, yet routine nutritional assessments are lacking in the hospital setting. Currently, there is a lack of specific recommendations from scientific societies regarding the nutritional care of patients with SSc. Given the high risk of nutritional impairments in this population, systematic assessments should be undertaken, and novel tools tailored to their unique needs should be developed and implemented.<\/jats:p>","DOI":"10.3390\/nu17193144","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T11:06:02Z","timestamp":1759316762000},"page":"3144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Nutritional Status and Dietary Challenges in Patients with Systemic Sclerosis: A Comprehensive Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7864-5349","authenticated-orcid":false,"given":"Eleni C.","family":"Pardali","sequence":"first","affiliation":[{"name":"Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arriana","family":"Gkouvi","sequence":"additional","affiliation":[{"name":"Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-6595","authenticated-orcid":false,"given":"Maria G.","family":"Grammatikopoulou","sequence":"additional","affiliation":[{"name":"Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41223 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Mitropoulos","sequence":"additional","affiliation":[{"name":"Lifestyle, Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent Rd, Sheffield S10 2BP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1517-8691","authenticated-orcid":false,"given":"Christos","family":"Cholevas","sequence":"additional","affiliation":[{"name":"Laboratory of Pharmaceutical Technology, Division of Pharmaceutical Technology, School of Pharmacy, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-9620","authenticated-orcid":false,"given":"Dimitrios","family":"Poulimeneas","sequence":"additional","affiliation":[{"name":"Department of Nutritional Science and Dietetics, School of Health Sciences, University of the Peloponnese, GR-24100 Kalamata, Greece"},{"name":"Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, GR-17778 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8864-4403","authenticated-orcid":false,"given":"Markos","family":"Klonizakis","sequence":"additional","affiliation":[{"name":"Lifestyle, Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent Rd, Sheffield S10 2BP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1002\/acr.25176","article-title":"SENSCIS Trial Investigators Risk of Malnutrition in Patients With Systemic Sclerosis-Associated Interstitial Lung Disease Treated With Nintedanib in the Randomized, Placebo-Controlled SENSCIS Trial","volume":"75","author":"Volkmann","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109267","DOI":"10.1016\/j.clim.2023.109267","article-title":"Global, Regional, and National Incidence and Prevalence of Systemic Sclerosis","volume":"248","author":"Tian","year":"2023","journal-title":"Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1136\/annrheumdis-2020-eular.4868","article-title":"AB0545 Gastrointestinal Involvement In Systemic Sclerosis","volume":"79","author":"Argibay","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/B978-0-444-63707-9.00013-1","article-title":"Gastrointestinal Involvement in Systemic Sclerosis","volume":"Volume 13","author":"Shreiner","year":"2017","journal-title":"Handbook of Systemic Autoimmune Diseases"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1002\/art.1780370902","article-title":"Gastrointestinal Motility Disorders in Scleroderma","volume":"37","author":"Sjogren","year":"1994","journal-title":"Arthritis Rheum."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/RHU.0000000000000626","article-title":"Gastrointestinal Involvement in Systemic Sclerosis: An Update","volume":"24","author":"Miller","year":"2018","journal-title":"J. Clin. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1136\/ard.51.10.1143","article-title":"Dietary Intake and Nutritional Status in Patients with Systemic Sclerosis","volume":"51","author":"Lundberg","year":"1992","journal-title":"Ann. Rheum. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1093\/rheumatology\/ket441","article-title":"The Canadian Systemic Sclerosis Oral Health Study: Orofacial Manifestations and Oral Health-Related Quality of Life in Systemic Sclerosis Compared with the General Population","volume":"53","author":"Baron","year":"2014","journal-title":"Rheumatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.5301\/jsrd.5000214","article-title":"Gastrointestinal Manifestations of Systemic Sclerosis","volume":"1","author":"Shreiner","year":"2016","journal-title":"J. scleroderma Relat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/BOR.0000000000000899","article-title":"Gastrointestinal Involvement in Systemic Sclerosis: Pathogenesis, Assessment and Treatment","volume":"34","author":"Volkmann","year":"2022","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_11","first-page":"35","article-title":"Nutritional Implications of GI-Related Scleroderma","volume":"40","author":"Chatterjee","year":"2016","journal-title":"Pract. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.nut.2018.03.046","article-title":"Prevalence of Sarcopenia in Systemic Sclerosis: Assessing Body Composition and Functional Disability in Patients with Systemic Sclerosis","volume":"55\u201356","author":"Siegert","year":"2018","journal-title":"Nutrition"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1007\/s00296-019-04401-w","article-title":"Sarcopenia in Systemic Sclerosis: The Impact of Nutritional, Clinical, and Laboratory Features","volume":"39","author":"Corallo","year":"2019","journal-title":"Rheumatol. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jhin.2018.12.012","article-title":"Food for Thought. Malnutrition Risk Associated with Increased Risk of Healthcare-Associated Infection","volume":"101","author":"Fitzpatrick","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.arr.2012.11.003","article-title":"Malnutrition and Quality of Life in Older People: A Systematic Review and Meta-Analysis","volume":"12","author":"Rasheed","year":"2013","journal-title":"Ageing Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"152077","DOI":"10.1016\/j.semarthrit.2022.152077","article-title":"Physical Frailty in Patients with Systemic Sclerosis","volume":"56","author":"Hax","year":"2022","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_17","first-page":"1408","article-title":"Frailty Assessment in Patients with Systemic Sclerosis","volume":"43","author":"Barison","year":"2025","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.autrev.2014.11.008","article-title":"Zinc and Its Role in Immunity and Inflammation","volume":"14","author":"Bonaventura","year":"2015","journal-title":"Autoimmun. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1159\/000354932","article-title":"Global Distribution and Disease Burden Related to Micronutrient Deficiencies","volume":"78","author":"Black","year":"2014","journal-title":"Nestle Nutr. Inst. Workshop Ser."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"105812","DOI":"10.1016\/j.ejps.2021.105812","article-title":"Impact of Gastrointestinal Tract Variability on Oral Drug Absorption and Pharmacokinetics: An UNGAP Review","volume":"162","author":"Vinarov","year":"2021","journal-title":"Eur. J. Pharm. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s13075-020-02323-8","article-title":"Mycophenolate Mofetil for Systemic Sclerosis: Drug Exposure Exhibits Considerable Inter-Individual Variation-a Prospective, Observational Study","volume":"22","author":"Neringer","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/odi.12507","article-title":"The Spectrum of Orofacial Manifestations in Systemic Sclerosis: A Challenging Management","volume":"23","author":"Jung","year":"2017","journal-title":"Oral Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, S., Zhu, J., Zhu, Y., Zhang, X., Wu, R., Li, S., and Su, Y. (2021). Oral Manifestations of Patients with Systemic Sclerosis: A Meta-Analysis for Case-Controlled Studies. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01603-2"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Benz, K., Baulig, C., Knippschild, S., Strietzel, F.P., Hunzelmann, N., and Jackowski, J. (2021). Prevalence of Oral and Maxillofacial Disorders in Patients with Systemic Scleroderma-A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18105238"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Nota, A., Pittari, L., Paggi, M., Abati, S., and Tecco, S. (2022). Correlation between Bruxism and Gastroesophageal Reflux Disorder and Their Effects on Tooth Wear. A Systematic Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11041107"},{"key":"ref_26","first-page":"287","article-title":"Dysphagia in the Elderly: Management and Nutritional Considerations","volume":"7","author":"Sura","year":"2012","journal-title":"Clin. Interv. Aging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.clnesp.2025.03.022","article-title":"Determination of the International Dysphagia Diet Standardization Initiative Level of Commercially Available Oral Nutritional Supplements","volume":"67","author":"Detopoulou","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.gcb.2009.01.014","article-title":"Esophageal Dysmotility in Scleroderma: A Prospective Study of 183 Cases","volume":"33","author":"Lahcene","year":"2009","journal-title":"Gastroenterol. Clin. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1007\/s00296-025-05952-x","article-title":"Frequency of Dysphagia among Patients Submitted to a Rheumatology Department: A Cross-Sectional Analysis Based on the EAT-10 Questionnaire","volume":"45","author":"Pardali","year":"2025","journal-title":"Rheumatol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/jgh3.12138","article-title":"Esophageal Manometry, Esophagogastroduodenoscopy, and Duodenal Mucosal Histopathology in Systemic Sclerosis","volume":"3","author":"Adarsh","year":"2019","journal-title":"JGH Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"325826","DOI":"10.5402\/2011\/325826","article-title":"Esophageal Involvement in Scleroderma: Clinical, Endoscopic, and Manometric Features","volume":"2011","author":"Lahcene","year":"2011","journal-title":"ISRN Rheumatol."},{"key":"ref_32","first-page":"165","article-title":"Evaluation and Management of Esophageal Manifestations in Systemic Sclerosis","volume":"31","author":"Denaxas","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.ard.2025.05.946","article-title":"POS0564 Self-Reported Oropharyngeal Dysphagia and Swallowing-Related Quality of Life in People with Systemic Sclerosis: Preliminary Results of a Cross-Sectional Study","volume":"84","author":"Benfaremo","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_34","first-page":"150","article-title":"The Pathophysiology of Malabsorption","volume":"30","author":"Keller","year":"2014","journal-title":"Viszeralmedizin"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1053\/j.gastro.2017.01.031","article-title":"The Risks and Benefits of Long-Term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association","volume":"152","author":"Freedberg","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/j.1365-2036.2012.05201.x","article-title":"Systematic Review: Hypomagnesaemia Induced by Proton Pump Inhibition","volume":"36","author":"Hess","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1001\/jama.2013.280490","article-title":"Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency","volume":"310","author":"Lam","year":"2013","journal-title":"JAMA"},{"key":"ref_38","unstructured":"University of Michigan Health (2025, August 30). Malnutrition for Scleroderma. Available online: https:\/\/www.uofmhealth.org\/conditions-treatments\/rheumatology\/nutrition-scleroderma."},{"key":"ref_39","unstructured":"Gemmell, S., and Gemmell, B. (2021). Nutritional Needs in Scleroderma, Scleroderma Australia Inc."},{"key":"ref_40","first-page":"44","article-title":"Systemic Sclerosis and Gastrointestinal Involvement","volume":"27","author":"Tandaipan","year":"2020","journal-title":"Rev. Colomb. Reumatol. (English Ed.)"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"455","DOI":"10.3899\/jrheum.121087","article-title":"Gastric Antral Vascular Ectasia and Its Clinical Correlates in Patients with Early Diffuse Systemic Sclerosis in the SCOT Trial","volume":"40","author":"Hung","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4503","DOI":"10.1093\/rheumatology\/keac074","article-title":"Gastroparesis in Systemic Sclerosis: A Detailed Analysis Using Whole-Gut Scintigraphy","volume":"61","author":"Adler","year":"2022","journal-title":"Rheumatology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"762546","DOI":"10.1155\/2015\/762546","article-title":"Gastric Antral Vascular Ectasia in Systemic Sclerosis: Current Concepts","volume":"2015","author":"Parrado","year":"2015","journal-title":"Int. J. Rheumatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/ajg.2012.373","article-title":"Clinical Guideline: Management of Gastroparesis","volume":"108","author":"Camilleri","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s13075-022-02790-1","article-title":"Gastric Antral Vascular Ectasia in Systemic Sclerosis: A Study of Its Epidemiology, Disease Characteristics and Impact on Survival","volume":"24","author":"Morrisroe","year":"2022","journal-title":"Arthritis Res. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s00595-006-3430-3","article-title":"Gastric Antral Vascular Ectasia--an Unusual Cause of Gastric Outlet Obstruction: Report of a Case","volume":"37","author":"Tuveri","year":"2007","journal-title":"Surg. Today"},{"key":"ref_47","unstructured":"University of Michigan Health System (2025, August 30). Gastroparesis Nutrition Therapy. Available online: https:\/\/www.med.umich.edu\/1libr\/Gastro\/GastroparesisNutrition.pdf."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1590\/S0102-67202014000400017","article-title":"Nutritional Care in Peptic Ulcer","volume":"27","author":"Vomero","year":"2014","journal-title":"Arq. Bras. Cir. Dig."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"7062","DOI":"10.3748\/wjg.v19.i41.7062","article-title":"Gastrointestinal Complications of Systemic Sclerosis","volume":"19","author":"Tian","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s10620-018-4977-8","article-title":"Intestinal Involvement in Systemic Sclerosis: A Clinical Review","volume":"63","author":"Sakkas","year":"2018","journal-title":"Dig. Dis. Sci."},{"key":"ref_51","first-page":"S82","article-title":"Prevalence and Predictors of Small Intestinal Bacterial Overgrowth in Systemic Sclerosis Patients with Gastrointestinal Symptoms","volume":"32","author":"Tauber","year":"2014","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1093\/rheumatology\/kep226","article-title":"Small Intestinal Bacterial Overgrowth in Systemic Sclerosis","volume":"48","author":"Marie","year":"2009","journal-title":"Rheumatology"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Montoro-Huguet, M.A., Belloc, B., and Dom\u00ednguez-Cajal, M. (2021). Small and Large Intestine (I): Malabsorption of Nutrients. Nutrients, 13.","DOI":"10.3390\/nu13041254"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"101687","DOI":"10.1016\/j.berh.2021.101687","article-title":"The Microbiome and Systemic Sclerosis: A Review of Current Evidence","volume":"35","author":"Tan","year":"2021","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s13075-016-1182-z","article-title":"Intestinal Dysbiosis Is Common in Systemic Sclerosis and Associated with Gastrointestinal and Extraintestinal Features of Disease","volume":"18","author":"Alrawi","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"ref_56","first-page":"2474515","article-title":"Pneumatosis Cystoides Intestinalis in Patients with Systemic Sclerosis: A Case Report and Review of 39 Japanese Cases","volume":"2016","author":"Kaneko","year":"2016","journal-title":"Case Rep. Gastrointest. Med."},{"key":"ref_57","first-page":"498","article-title":"Gastrointestinal Manifestations Associated with Systemic Sclerosis: Results from the Nationwide Inpatient Sample","volume":"30","author":"Alastal","year":"2017","journal-title":"Ann. Gastroenterol."},{"key":"ref_58","unstructured":"Healy, M., Claghorn, K.V.B., and Van Horn, A. (2025, August 30). Low Fiber Diet for Diarrhea. OncoLink. Available online: https:\/\/www.oncolink.org\/support\/nutrition-and-cancer\/during-and-after-treatment\/low-fiber-diet-for-diarrhea."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1111\/apt.12479","article-title":"Meta-Analysis: Antibiotic Therapy for Small Intestinal Bacterial Overgrowth","volume":"38","author":"Shah","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_60","first-page":"101","article-title":"Gut Microbiome in Systemic Sclerosis: A Potential Therapeutic Target","volume":"39","author":"Gerkowicz","year":"2020","journal-title":"Postepy Dermatol. Alergol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1111\/j.1572-0241.2007.01758.x","article-title":"Small Intestinal Bacterial Overgrowth in Patients Suffering From Scleroderma: Clinical Effectiveness of Its Eradication","volume":"103","author":"Parodi","year":"2008","journal-title":"Am. J. Gastroenterol."},{"key":"ref_62","first-page":"8","article-title":"Digestive Involvement in Progressive Systemic Sclerosis","volume":"25","year":"1988","journal-title":"Arq. Gastroenterol."},{"key":"ref_63","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_64","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s00296-003-0286-3","article-title":"Assessment of Intestinal Permeability and Orocecal Transit Time in Patients with Systemic Sclerosis: Analysis of Relationships with Epidemiologic and Clinical Parameters","volume":"23","author":"Caserta","year":"2003","journal-title":"Rheumatol. Int."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1002\/art.39572","article-title":"Association of Systemic Sclerosis With a Unique Colonic Microbial Consortium","volume":"68","author":"Volkmann","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Dai, C., and Huang, Y.-H. (2025). An Unusual Etiology of Diarrhea: Primary Intestinal Lymphangiectasia. Rev. Esp. Enfermedades Dig.","DOI":"10.17235\/reed.2025.11483\/2025"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s100670170038","article-title":"Colonic Transit Disorders in Systemic Sclerosis","volume":"20","author":"Wang","year":"2001","journal-title":"Clin. Rheumatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1177\/23971983241241203","article-title":"Systemic Sclerosis and Anorectal Dysfunction: The Leeds Experience","volume":"9","author":"Suresh","year":"2024","journal-title":"J. Scleroderma Relat. Disord."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"992","DOI":"10.3899\/jrheum.110826","article-title":"Effect of Gastrointestinal Manifestations on Quality of Life in 87 Consecutive Patients with Systemic Sclerosis","volume":"39","author":"Omair","year":"2012","journal-title":"J. Rheumatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1136\/gut.35.6.857","article-title":"Progressive Systemic Sclerosis of the Internal Anal Sphincter Leading to Passive Faecal Incontinence","volume":"35","author":"Engel","year":"1994","journal-title":"Gut"},{"key":"ref_71","first-page":"S214","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_72","doi-asserted-by":"crossref","unstructured":"Burlui, A.M., Cardoneanu, A., Macovei, L.A., Rezus, C., Boiculese, L.V., Graur, M., and Rezus, E. (2021). Diet in Scleroderma: Is There a Need for Intervention?. Diagnostics, 11.","DOI":"10.3390\/diagnostics11112118"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1177\/23971983231185465","article-title":"A Survey of Australian Rheumatologists\u2019 Perspectives of Nutrition Needs in Systemic Sclerosis","volume":"8","author":"Samm","year":"2023","journal-title":"J. Scleroderma Relat. Disord."},{"key":"ref_74","first-page":"28","article-title":"Dietary Intake of Nutrients and Its Correlation with Fatigue in Multiple Sclerosis Patients","volume":"13","author":"Bitarafan","year":"2014","journal-title":"Iran. J. Neurol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/acr2.11627","article-title":"Adherence to the Mediterranean Diet in Italian Patients With Systemic Sclerosis: An Epidemiologic Survey","volume":"6","author":"Natalello","year":"2024","journal-title":"ACR Open Rheumatol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.clnesp.2022.09.265","article-title":"P136 Views of Nutrition in Patients with Scleroderma","volume":"54","author":"Samm","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_77","first-page":"S42","article-title":"Screening and Therapy for Malnutrition and Related Gastro-Intestinal Disorders in Systemic Sclerosis: Recommendations of a North American Expert Panel","volume":"28","author":"Baron","year":"2010","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_78","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_79","doi-asserted-by":"crossref","unstructured":"Paolino, S., Pacini, G., Schenone, C., Patan\u00e8, M., Sulli, A., Sukkar, S.G., Lercara, A., Pizzorni, C., Gotelli, E., and Cattelan, F. (2020). Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients. Nutrients, 12.","DOI":"10.3390\/nu12061632"},{"key":"ref_80","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":"2018","journal-title":"Clin. Rheumatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/jpen.1872","article-title":"Assessing Malnutrition in Systemic Sclerosis With Global Leadership Initiative on Malnutrition and European Society of Clinical Nutrition and Metabolism Criteria","volume":"45","author":"Rosato","year":"2021","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_82","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_83","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1136\/annrheumdis-2020-eular.6459","article-title":"SAT0343 Nutritional Status of Systemic Sclerosis Patients: A Pilot Study","volume":"79","author":"Szabo","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Bagnato, G., Pigatto, E., Bitto, A., Pizzino, G., Irrera, N., Abignano, G., Ferrera, A., Sciortino, D., Wilson, M., and Squadrito, F. (2021). The PREdictor of MAlnutrition in Systemic Sclerosis (PREMASS) Score: A Combined Index to Predict 12 Months Onset of Malnutrition in Systemic Sclerosis. Front. Med., 8.","DOI":"10.3389\/fmed.2021.651748"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"112171","DOI":"10.1016\/j.nut.2023.112171","article-title":"High Prevalence of Malnutrition in Systemic Sclerosis: Results from a French Monocentric Cross-Sectional Study","volume":"116","author":"Rivet","year":"2023","journal-title":"Nutrition"},{"key":"ref_86","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_87","first-page":"1623","article-title":"AB0820 The Risk of Malnutrition Is a Problem Associated with Systemic Sclerosis","volume":"82","author":"Redondo","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.clnu.2012.02.010","article-title":"Disease-Related Malnutrition in Outpatients with Systemic Sclerosis","volume":"31","author":"Caporali","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.clnu.2013.08.010","article-title":"Disease-Related Nutritional Risk and Mortality in Systemic Sclerosis","volume":"33","author":"Cereda","year":"2014","journal-title":"Clin. Nutr."},{"key":"ref_90","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_91","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1177\/0148607115597883","article-title":"Medical Nutrition Therapy for Patients With Advanced Systemic Sclerosis (MNT PASS): A Pilot Intervention Study","volume":"41","author":"Doerfler","year":"2017","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1093\/rheumatology\/keae209","article-title":"Frequency and Implications of Malnutrition in Systemic Sclerosis","volume":"64","author":"Fairley","year":"2025","journal-title":"Rheumatology"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00296-025-05830-6","article-title":"Controlling Nutritional Status Score as a Sensitive Instrument for Malnutrition Screening in Systemic Sclerosis\u2014A Retrospective Study","volume":"45","author":"Gajdecki","year":"2025","journal-title":"Rheumatol. Int."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1136\/ard.2009.123273","article-title":"Nutritional Status as Marker for Disease Activity and Severity Predicting Mortality in Patients with Systemic Sclerosis","volume":"69","author":"Krause","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1002\/jpen.1999","article-title":"Left Ventricular Mass Index as Potential Surrogate of Muscularity in Patients With Systemic Sclerosis Without Cardiovascular Disease","volume":"45","author":"Molfino","year":"2021","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.clnu.2012.06.005","article-title":"Nutritional Status and Gastrointestinal Symptoms in Systemic Sclerosis Patients","volume":"32","author":"Murtaugh","year":"2013","journal-title":"Clin. Nutr."},{"key":"ref_97","first-page":"283","article-title":"Nutritional Support in Patients with Systemic Sclerosis","volume":"10","author":"Puig","year":"2014","journal-title":"Reumatol. Clin."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/s41430-018-0116-z","article-title":"The Impact of Malnutrition on Quality of Life in Patients with Systemic Sclerosis","volume":"72","author":"Preis","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ejim.2023.07.017","article-title":"GLIM-Diagnosed Malnutrition Predicts Mortality and Risk of Hospitalization in Systemic Sclerosis: A Retrospective Study","volume":"117","author":"Rosato","year":"2023","journal-title":"Eur. J. Intern. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"111946","DOI":"10.1016\/j.nut.2022.111946","article-title":"Phase Angle, Nutritional Status, and Mortality in Systemic Sclerosis: An Exploratory Pilot Study","volume":"107","author":"Rosato","year":"2023","journal-title":"Nutrition"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1093\/rheumatology\/kex014","article-title":"Prevalence of Malnutrition and Validation of Bioelectrical Impedance Analysis for the Assessment of Body Composition in Patients with Systemic Sclerosis","volume":"56","author":"Spanjer","year":"2017","journal-title":"Rheumatology"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/RHU.0000000000000686","article-title":"Evaluation of Vitamin B12 Deficiency and Associated Factors in Patients With Systemic Sclerosis","volume":"24","author":"Akdogan","year":"2018","journal-title":"J. Clin. Rheumatol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s10067-019-04598-y","article-title":"Malnutrition, Associated Clinical Factors, and Depression in Systemic Sclerosis: A Cross-Sectional Study","volume":"39","author":"Arslan","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Wojteczek, A., Dardzi\u0144ska, J., Zi\u0119tkiewicz, M., Smole\u0144ska, \u017b., Czuszy\u0144ska, Z., De Cock, D., Zdrojewski, Z., Ma\u0142gorzewicz, S., and Chmielewski, M. (2024). High-Protein Nutritional Supplements Improve Nutritional Status in Malnourished Patients with Systemic Sclerosis. Nutrients, 16.","DOI":"10.3390\/nu16162622"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s10067-019-04810-z","article-title":"Prevalence of Malnutrition in Systemic Sclerosis Patients Assessed by Different Diagnostic Tools","volume":"39","author":"Wojteczek","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_106","first-page":"127","article-title":"The Assessment of Malnutrition and Severity of Gastrointestinal Disease by Using Symptom-Based Questionnaires in Systemic Sclerosis: Is It Related to Severe Organ Involvement or Capillary Rarefaction at Microcirculation?","volume":"38","author":"Yalcinkaya","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0261-5614(84)80003-5","article-title":"Nutritional Assessment Using a Microcomputer 2. Programme Evaluation","volume":"3","author":"Chang","year":"1984","journal-title":"Clin. Nutr."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.clnu.2015.03.001","article-title":"Diagnostic Criteria for Malnutrition\u2014An ESPEN Consensus Statement","volume":"34","author":"Cederholm","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"112729","DOI":"10.1016\/j.exger.2025.112729","article-title":"Molecular Crosstalk and Potential Causal Mechanisms of Rheumatoid Arthritis and Sarcopenia Co-Morbidity: A Gene Integration Analysis","volume":"203","author":"Ren","year":"2025","journal-title":"Exp. Gerontol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"M326","DOI":"10.1093\/gerona\/57.5.M326","article-title":"Relationship of Interleukin-6 and Tumor Necrosis Factor-Alpha with Muscle Mass and Muscle Strength in Elderly Men and Women: The Health ABC Study","volume":"57","author":"Visser","year":"2002","journal-title":"J. Gerontol.-Ser. A Biol. Sci. Med. Sci."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"R30","DOI":"10.1186\/ar2634","article-title":"High Frequency of Corticosteroid and Immunosuppressive Therapy in Patients with Systemic Sclerosis despite Limited Evidence for Efficacy","volume":"11","author":"Hunzelmann","year":"2009","journal-title":"Arthritis Res. Ther."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1007\/s00223-017-0335-7","article-title":"Glucocorticoids, Inflammation and Bone","volume":"102","author":"Hoes","year":"2018","journal-title":"Calcif. Tissue Int."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s10067-020-04929-4","article-title":"Glucocorticoid Use Is an Independent Risk Factor for Developing Sarcopenia in Patients with Rheumatoid Arthritis: From the CHIKARA Study","volume":"39","author":"Yamada","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Pardali, E.C., Klonizakis, M., Goulis, D.G., Papadopoulou, S.K., Cholevas, C., Giaginis, C., Tsigalou, C., Bogdanos, D.P., and Grammatikopoulou, M.G. (2025). Sarcopenia in Rheumatic Diseases: A Hidden Issue of Concern. Diseases, 13.","DOI":"10.3390\/diseases13050134"},{"key":"ref_115","first-page":"1645","article-title":"AB0865 Body Composition Assessment in Patients with Systemic Scleroderma","volume":"82","author":"Ajdynan","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Hax, V., Do Espirito Santo, R.C., Dos Santos, L.P., Farinon, M., de Oliveira, M.S., Tr\u00eas, G.L., Gasparin, A.A., De Andrade, N.P.B., Bredemeier, M., and Xavier, R.M. (2021). Practical Screening Tools for Sarcopenia in Patients with Systemic Sclerosis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245683"},{"key":"ref_117","first-page":"65","article-title":"Advanced Microvascular Damage Associated with Occurence of Sarcopenia in Systemic Sclerosis Patients: Results from a Retrospective Cohort Study","volume":"38","author":"Paolino","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s00296-025-05821-7","article-title":"Screening and Diagnosis of Sarcopenia in Rheumatic and Musculoskeletal Diseases: Findings from a Cross-Sectional Study","volume":"45","author":"Pardali","year":"2025","journal-title":"Rheumatol. Int."},{"key":"ref_119","first-page":"1657","article-title":"Sarcopenia in Systemic Sclerosis","volume":"71","author":"Alak","year":"2019","journal-title":"Arthritis Rheumatol."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Sangaroon, A., Foocharoen, C., Theerakulpisut, D., Srichompoo, K., Mahakkanukrauh, A., Suwannaroj, S., Seerasaporn, P., and Pongchaiyakul, C. (2022). Prevalence and Clinical Association of Sarcopenia among Thai Patients with Systemic Sclerosis. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-21914-w"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"110999","DOI":"10.1016\/j.nut.2020.110999","article-title":"Evaluating Skeletal Muscle Mass with Ultrasound in Patients with Systemic Sclerosis","volume":"84","author":"Sari","year":"2021","journal-title":"Nutrition"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Yuce Inel, T., Dervis Hakim, G., and Birlik, M. (2025). Assessment of Factors Related to Sarcopenia in Patients with Systemic Sclerosis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14051573"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European Consensus on Definition and Diagnosis","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European Consensus on Definition and Diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/ggi.12197","article-title":"Development of a Simple Screening Test for Sarcopenia in Older Adults","volume":"14","author":"Ishii","year":"2014","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.3899\/jrheum.130032","article-title":"Low Bone Density in Systemic Sclerosis. A Systematic Review","volume":"40","author":"Omair","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Atteritano, M., Sorbara, S., Bagnato, G., Miceli, G., Sangari, D., Morgante, S., Visalli, E., and Bagnato, G. (2013). Bone Mineral Density, Bone Turnover Markers and Fractures in Patients with Systemic Sclerosis: A Case Control Study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0066991"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejr.2013.08.001","article-title":"Bone Mineral Density in Patients with Systemic Sclerosis and Its Association with Hand Involvement","volume":"35","author":"Shahin","year":"2013","journal-title":"Egypt. Rheumatol."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.amjms.2024.07.025","article-title":"Clinical Outcomes and Associated Factors with Mortality in Systemic Sclerosis Patients with Sarcopenia","volume":"369","author":"Hongkanjanapong","year":"2025","journal-title":"Am. J. Med. Sci."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1016\/j.clnu.2018.04.018","article-title":"Sarcopenic Obesity: Time to Meet the Challenge","volume":"37","author":"Barazzoni","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2017.05.012","article-title":"Severity and Features of Frailty in Systemic Sclerosis-Associated Interstitial Lung Disease","volume":"129","author":"Guler","year":"2017","journal-title":"Respir. Med."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1016\/j.ard.2025.06.1979","article-title":"ABS0639 Clinical Characteristics of Physical Frailty in Patients with Systemic Sclerosis: An Analysis Using a Japanese Single-Center Cohort","volume":"84","author":"Ito","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Opri\u0219-Belinski, D., Cobilinschi, C.O., Caraiola, S., Ungureanu, R., Cotae, A.-M., Grin\u021bescu, I.M., Cobilinschi, C., Andrei, A.C., \u021aincu, R., and Ene, R. (2024). Trace Element Deficiency in Systemic Sclerosis-Too Much Effort for Some Traces?. Nutrients, 16.","DOI":"10.3390\/nu16132053"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1001\/archinte.1968.00300060041007","article-title":"Anemia and Scleroderma","volume":"122","author":"Westerman","year":"1968","journal-title":"Arch. Intern. Med."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1136\/annrheumdis-2018-eular.7015","article-title":"THU0398 Unexplained Iron Deficiency Is Frequent in Systemic Sclerosis","volume":"77","author":"Sari","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_137","first-page":"650","article-title":"Dietary Intake of Micronutrient Antioxidants in Relation to Blood Levels in Patients with Systemic Sclerosis\u2014PubMed","volume":"23","author":"Herrick","year":"1996","journal-title":"J. Rheumatol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/rheumatology\/ket331","article-title":"Iron Deficiency in Systemic Sclerosis Patients with and without Pulmonary Hypertension","volume":"53","author":"Ruiter","year":"2014","journal-title":"Rheumatology"},{"key":"ref_139","first-page":"120","article-title":"Impaired Micronutrients and Prealbumin in Patients with Established and Very Early Systemic Sclerosis","volume":"38","author":"Dobrota","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/rheumatology\/keu470","article-title":"Abnormalities of Selenium but Not of Copper Homeostasis May Drive Tissue Fibrosis in Patients with Systemic Sclerosis","volume":"54","author":"Hughes","year":"2015","journal-title":"Rheumatology"},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s42358-021-00192-6","article-title":"Dualities of the Vitamin D in Systemic Sclerosis: A Systematic Literature Review","volume":"61","author":"Schneider","year":"2021","journal-title":"Adv. Rheumatol."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1017\/S0007114514000087","article-title":"Relationship between Nutrition Knowledge and Dietary Intake","volume":"111","author":"Spronk","year":"2014","journal-title":"Br. J. Nutr."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/10408398.2022.2104210","article-title":"Efficacy of N-3 Fatty Acid Supplementation on Rheumatoid Arthritis\u2019 Disease Activity Indicators: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials","volume":"64","author":"Gkiouras","year":"2024","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1051\/ocl.2010.0325","article-title":"The Omega-6\/Omega-3 Fatty Acid Ratio: Health Implications","volume":"17","author":"Simopoulos","year":"2010","journal-title":"Ol\u00e9agineux Corps Gras Lipides"},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Charoenngam, N., and Holick, M.F. (2020). Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients, 12.","DOI":"10.3390\/nu12072097"},{"key":"ref_146","doi-asserted-by":"crossref","unstructured":"Gholizadeh, M., Khalili, A., Roodi, P.B., Saeedy, S.A.G., Najafi, S., Keshavarz Mohammadian, M., and Djafarian, K. (2023). Selenium Supplementation Decreases CRP and IL-6 and Increases TNF-Alpha: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Trace Elem. Med. Biol., 79.","DOI":"10.1016\/j.jtemb.2023.127199"},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"Veronese, N., Pizzol, D., Smith, L., Dominguez, L.J., and Barbagallo, M. (2022). Effect of Magnesium Supplementation on Inflammatory Parameters: A Meta-Analysis of Randomized Controlled Trials. Nutrients, 14.","DOI":"10.3390\/nu14030679"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.clnu.2017.02.011","article-title":"Monounsaturated Fatty Acids Might Be Key Factors in the Mediterranean Diet That Suppress Rheumatoid Arthritis Disease Activity: The TOMORROW Study","volume":"37","author":"Matsumoto","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1007\/s10067-017-3814-3","article-title":"The Therapeutic Effect of Probiotics on Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Control Trials","volume":"36","author":"Mohammed","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"30","DOI":"10.31138\/mjr.34.1.30","article-title":"Fly Me to the Immune: Immunonutrition in Rheumatic Diseases","volume":"34","author":"Grammatikopoulou","year":"2023","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Barbalace, M.C., Talotta, R., Rapisarda, F., D\u2019Amico, V., Lagan\u00e0, M., Malaguti, M., Campenn\u00ec, A., Cannav\u00f2, S., Hrelia, S., and Ruggeri, R.M. (2025). Unlocking the Power of the Mediterranean Diet: Two in One-Dual Benefits for Rheumatic and Thyroid Autoimmune Diseases. Nutrients, 17.","DOI":"10.3390\/nu17081383"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"325","DOI":"10.31138\/mjr.31.3.325","article-title":"Let Food Be Thy Medicine: The Case of The Mediterranean Diet in Rheumatoid Arthritis","volume":"31","author":"Vranou","year":"2020","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"100342","DOI":"10.1016\/j.metop.2024.100342","article-title":"Autoimmune Protocol Diet: A Personalized Elimination Diet for Patients with Autoimmune Diseases","volume":"25","author":"Pardali","year":"2025","journal-title":"Metab. Open"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1016\/j.ard.2025.06.1963","article-title":"ABS0465 Impact of Adherence to the Mediterranean Diet on the Severity and Functionality of Patient with Systemic Sclerosis","volume":"84","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1136\/annrheumdis-2020-eular.5470","article-title":"FRI0233 IImpact and Adherence to the Mediterranean Diet in Systemic Sclerosis Italian Patients: Correlation with Gastrointestinal Symptoms, Mood Disturbances and Quality of Life","volume":"79","author":"Natalello","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_156","first-page":"S22","article-title":"Probiotics for the Treatment of Systemic Sclerosis-Associated Gastrointestinal Bloating\/ Distention","volume":"29","author":"Frech","year":"2011","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.semarthrit.2019.05.006","article-title":"A Double-Blind Randomized Placebo-Controlled Trial of Probiotics in Systemic Sclerosis Associated Gastrointestinal Disease","volume":"49","author":"Low","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1093\/rheumatology\/kez160","article-title":"Effect of Probiotics on Gastrointestinal Symptoms and Immune Parameters in Systemic Sclerosis: A Randomized Placebo-Controlled Trial","volume":"58","author":"Marighela","year":"2019","journal-title":"Rheumatology"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"e1601","DOI":"10.1097\/MD.0000000000001601","article-title":"Fructose Malabsorption in Systemic Sclerosis","volume":"94","author":"Marie","year":"2015","journal-title":"Medicine"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/apt.13810","article-title":"Lactose Malabsorption in Systemic Sclerosis","volume":"44","author":"Marie","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"152185","DOI":"10.1016\/j.semarthrit.2023.152185","article-title":"Gastrointestinal Tract Involvement in Systemic Sclerosis: The Roles of Diet and the Microbiome","volume":"60","author":"Nguyen","year":"2023","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1136\/annrheumdis-2018-eular.6703","article-title":"FRI0430 Effect of Oral Nutritional Intervention on Nutritional Status in Patients with Systemic Sclerosis","volume":"77","author":"Wojteczek","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.clnu.2014.11.002","article-title":"Long-Term Outcome of Patients with Systemic Sclerosis Requiring Home Parenteral Nutrition","volume":"34","author":"Harrison","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/MOG.0000000000000615","article-title":"When Is Parenteral Nutrition Indicated in the Hospitalized, Acutely Ill Patient?","volume":"36","author":"Fragkos","year":"2020","journal-title":"Curr. Opin. Gastroenterol."},{"key":"ref_165","doi-asserted-by":"crossref","unstructured":"Smith, T.R., Cawood, A.L., Walters, E.R., Guildford, N., and Stratton, R.J. (2020). Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use\u2014A Randomised Trial in Older Malnourished People in Primary Care. Nutrients, 12.","DOI":"10.3390\/nu12020517"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.clnesp.2022.06.108","article-title":"Oral, Enteral and Parenteral Nutritional Therapies in Scleroderma: A Systematic Review","volume":"51","author":"Keane","year":"2022","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_167","first-page":"Doc17","article-title":"Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine Complications and Monitoring\u2014Guidelines on Parenteral Nutrition, Chapter 11","volume":"7","author":"Hartl","year":"2009","journal-title":"Ger. Med. Sci."},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Romanazzo, S., Rometsch, C., Marangoni, A., Guiducci, S., and Cosci, F. (2024). Psychological Features of Systemic Sclerosis: Results from an Observational Study. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1473587"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1038\/ejcn.2016.73","article-title":"Financial Impact of Sarcopenia on Hospitalization Costs","volume":"70","author":"Sousa","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1186\/s13063-022-06853-1","article-title":"Exploring the Effects of a Combined Exercise Programme on Pain and Fatigue Outcomes in People with Systemic Sclerosis: Study Protocol for a Large European Multi-Centre Randomised Controlled Trial","volume":"23","author":"Mitropoulos","year":"2022","journal-title":"Trials"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3144\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T11:16:06Z","timestamp":1759317366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":170,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17193144"],"URL":"https:\/\/doi.org\/10.3390\/nu17193144","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}