A recent study published in Rheumatology International has highlighted the substantial burden of malnutrition and micronutrient deficiencies among patients with systemic sclerosis (SSc), with zinc and copper deficiencies affecting almost the entire study population. The findings underscore the need for routine nutritional assessment and targeted interventions as part of comprehensive SSc management.
Systemic sclerosis is a chronic autoimmune connective tissue disease characterized by immune dysregulation, microvascular damage, and progressive fibrosis of the skin and internal organs. Gastrointestinal involvement, impaired nutrient absorption, chronic inflammation, and increased metabolic demands place patients at heightened risk of malnutrition, which may adversely affect disease outcomes, quality of life, and overall prognosis.
Trace elements such as zinc, copper, selenium, and chromium are essential for immune regulation, antioxidant defense, wound healing, and tissue repair. Emerging evidence suggests that disturbances in trace element homeostasis may not only result from chronic autoimmune diseases but may also contribute to disease pathogenesis by influencing inflammatory responses, vascular dysfunction, and fibrotic processes. However, data on the nutritional and micronutrient status of patients with SSc remain limited.
To address this gap, investigators conducted a cross-sectional observational study involving 50 patients with systemic sclerosis. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria alongside comprehensive biochemical evaluation, including serum vitamins (A, B1, B6, B12, D, and folic acid), trace elements (copper, zinc, selenium, and chromium), and nutritional proteins such as prealbumin and ceruloplasmin. Trace element concentrations were measured using inductively coupled plasma mass spectrometry (ICP-MS), and associations with demographic characteristics, disease subtype, and nutritional status were analyzed.
Nearly half of the patients (48%) were found to be malnourished, with 46% classified as having moderate malnutrition and 2% as having severe malnutrition. The burden was significantly greater among patients with diffuse cutaneous systemic sclerosis (dcSSc), in whom 70% had moderate malnutrition compared with 30% of those with limited cutaneous systemic sclerosis (lcSSc) (p = 0.004). Zinc deficiency was identified in 98% of patients, while copper deficiency was present in 96%, making these the most prevalent nutritional abnormalities observed. Patients with dcSSc also exhibited significantly lower median copper concentrations than those with lcSSc (12.9 vs. 22.5 μg/dL; p = 0.022), as well as lower zinc levels (11.1 vs. 18.4 μg/dL; p = 0.013). Vitamin D deficiency was also common, affecting 72% of the study cohort.
The investigators noted that these deficiencies may have important clinical implications because zinc and copper are integral to immune function, collagen metabolism, antioxidant activity, and tissue repair, all processes closely linked to the pathophysiology of systemic sclerosis. Deficiencies in these micronutrients could potentially exacerbate inflammation, vascular injury, and fibrosis, although causal relationships remain to be established.
The authors concluded that malnutrition and micronutrient deficiencies are highly prevalent in patients with systemic sclerosis, particularly among those with diffuse cutaneous disease. They emphasized that regular nutritional evaluation, including screening for zinc, copper, and vitamin D deficiencies, may help identify patients requiring nutritional intervention and support more comprehensive disease management. They cautioned that larger, multicenter prospective studies are needed to determine whether correcting these deficiencies can improve clinical outcomes or alter disease progression.
The findings reinforce the growing recognition that nutritional assessment should be considered an integral component of multidisciplinary care for patients with systemic sclerosis, alongside immunomodulatory therapy and organ-specific management.
References
- Yılmaz E, Oğuz Kökoğlu E, Şenel AS, Gündoğan K. High prevalence of serum zinc and copper deficiencies in systemic sclerosis: a cross-sectional study. Rheumatol Int. 2026 Jun 3;46(6):125.
- priș-Belinski D, Cobilinschi CO, Caraiola S, Ungureanu R, Cotae AM, Grințescu IM, Cobilinschi C, Andrei AC, Țincu R, Ene R, Mirea L. Trace Element Deficiency in Systemic Sclerosis-Too Much Effort for Some Traces? Nutrients. 2024 Jun 27;16(13):2053.