Background

Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are associated with hypermobility, musculoskeletal pain, a decreased bone mineral density (BMD) and gastrointestinal (GI) complications. The role of GI symptoms and diet in BMD has not been established in this population. The GI complications can lead to an energy deficit due to lack of essential macronutrients. The primary objective of this study was to determine the severity of GI symptoms compared to body composition and BMD in individuals with hEDS/HSD. The secondary objective is to examine GI symptoms on energy balance, body composition and strength.

Methodology

This study was IRB approved. Eighteen female participants (aged 28.2 ± 4.9; BMI 22.5 ± 4.9) with a diagnosis of hEDS or HSD and 18 female healthy control participants (aged 28.1 ± 3.8; BMI 22.8 ±3.9) signed consent to participate. Participants were matched by sex, age, and BMI. The Gastrointestinal Symptom Rating Scale (GSRS) was used to investigate severity of GI symptoms. Dual X-ray absorptiometry was used to determine body composition (body fat%, lean body mass (LBM). BMD was measured by Z- scores of both femurs and lumbar spine. Resting metabolic rate (RMR) was measured using indirect calorimetry and strength was determined using a hand grip dynamometer.

Results

All hEDS/HSD participants reported GI symptoms. There was no difference in body composition between hEDS/HSD and controls. Participants with hEDS/HSD had lower BMD both femoral z scores (p=0.02,0.004) and spine z scores (p= 0.04). There was no difference in caloric intake between groups; yet both groups demonstrated caloric deficits. Additionally, hEDS/HSD consumed less protein and more carbohydrates (p=0.03, p=0.03). There were no differences in grip strength.

Conclusions

This study identified that pre-menopausal women with hEDS/HSD presented with significant GI complications and lower BMD than age matched controls. The GI complications and the reduced protein intake long-term may have a lasting impact on bone health. This study found that the GSRS identified and quantified GI symptoms in persons with hEDS/HSD. Future studies are needed for the longitudinal effects of a caloric/protein deficit in this population and to help guide future preventive and nutritional treatment approaches in individuals with hEDS/HSD.

中文翻译：

---

胃肠功能评估及其对过度运动谱系障碍和过度运动型埃勒斯-当洛斯综合征患者骨密度和身体成分的影响

背景

过度活动的埃勒斯-当洛斯综合征 (hEDS) 和过度活动谱系障碍 (HSD) 与过度活动、肌肉骨骼疼痛、骨矿物质密度 (BMD) 降低和胃肠道 (GI) 并发症有关。GI 症状和饮食在 BMD 中的作用尚未在该人群中确定。由于缺乏必需的常量营养素，胃肠道并发症会导致能量不足。本研究的主要目的是确定与 hEDS/HSD 患者的身体成分和 BMD 相比，胃肠道症状的严重程度。次要目标是检查有关能量平衡、身体成分和力量的 GI 症状。

方法

该研究获得 IRB 批准。18 名被诊断为 hEDS 或 HSD 的女性参与者（年龄 28.2 ± 4.9；BMI 22.5 ± 4.9）和 18 名女性健康对照参与者（年龄 28.1 ± 3.8；BMI 22.8 ±3.9）签署了参与同意书。参与者按性别、年龄和 BMI 匹配。胃肠道症状评定量表 (GSRS) 用于调查胃肠道症状的严重程度。双 X 射线吸收测定法用于确定身体成分（体脂%、去脂体重 (LBM)）。骨密度通过股骨和腰椎的 Z 值测量。静息代谢率 (RMR) 使用间接量热法和强度法测量使用手持式测力计测定。

结果

所有 hEDS/HSD 参与者都报告了 GI 症状。hEDS/HSD 和对照组之间的身体成分没有差异。hEDS/HSD 参与者的 BMD 较低，股骨 z 评分 (p=0.02,0.004) 和脊柱 z 评分 (p=0.04)。两组之间的热量摄入没有差异；然而，两组都表现出热量不足。此外，hEDS/HSD 消耗更少的蛋白质和更多的碳水化合物 (p=0.03, p=0.03)。握力没有差异。

结论

这项研究发现，与年龄匹配的对照组相比，患有 hEDS/HSD 的绝经前女性表现出明显的 GI 并发症和较低的 BMD。胃肠道并发症和长期蛋白质摄入量减少可能对骨骼健康产生持久影响。该研究发现 GSRS 识别并量化了 hEDS/HSD 患者的胃肠道症状。需要进一步研究该人群热量/蛋白质缺乏的纵向影响，并帮助指导 hEDS/HSD 患者未来的预防和营养治疗方法。