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Introduction Gastrointestinal (GI) involvement is a prevalent manifestation of systemic sclerosis (SSc), influencing dietary habits and elevating the risk of malnutrition. The relationship between GI symptoms, dietary intake, nutritional status, and survival is of critical importance for the management of SSc.Material and Methods This was a prospective cohort study including patients in 2019, with a follow-up period of up to 6 years. Women with SSc fulfilling the 2013 ACR-EULAR classification criteria were included. Clinical data collected included age, disease duration, modified Rodnan skin score (mRSS), and the European Scleroderma Trials and Research Group activity index (EScSG-AI). GI symptoms were evaluated using the UCLA Scleroderma Clinical Trials Consortium GI Tract 2.0 instrument (UCLA SCTC GIT 2.0). Dietary intake was assessed by 24-hour recall, estimating total food intake (FI24), energy (EI24), carbohydrate (CHO24), protein (PRO24), fat (FAT24), and fiber (FIB24). Malnutrition was defined according to ESPEN criteria. Survival analyses included Mann–Whitney tests and Cox proportional hazards regression with follow-up time and vital status.Results The median follow-up time was 5.2 years (IQR 4.91–5.35). Eighty-seven women with SSc (17 diffuse), mean age 60.8±10.2 years, disease duration 12.8 (5.8–17.0) years old, mRSS 4.0 (2.0–10.0) score, and EScSG-AI 1.3 (0.7–1.8) were included. Negative correlations were observed between distension/bloating and EI24 (rho=–0.304, p=0.004), CHO24 (rho=–0.257, p=0.016), and FAT24 (rho=–0.288, p=0.007). Emotional wellbeing correlated with EI24 (rho=–0.269, p=0.012) and CHO24 (rho=–0.195, p=0.07). UCLA mean correlated with EI24 (rho=–0.213, p=0.048). Constipation correlated with FI24 (rho=0.213, p=0.047), EI24 (rho=0.223, p=0.038), CHO24 (rho=0.219, p=0.042), and FAT24 (rho=0.240, p=0.025). Patients with malnutrition (ESPEN) presented higher scores for diarrhoea (p=0.012), social functioning (p=0.034), emotional wellbeing (p=0.005), and UCLA mean (p=0.014).In survival analysis (94 patients, 20 deaths), no GI domain was associated with mortality, but FI24 was and emerged as a protective factor: patients who died had lower intake [median 11.1 g/day] compared to survivors [median 14.6 g/day] (Mann–Whitney p=0.035). In Cox regression, each 1 g/day increase in fiber intake was associated with a 7.7% lower risk of death (HR=0.923; p=0.050).Conclusions Patients with greater GI involvement consumed less food, while higher food intake was associated with more constipation. Malnutrition was linked to worse GI symptoms and poorer emotional wellbeing. Importantly, lower fiber intake was associated with higher mortality, reinforcing the relevance of nutritional assessment and counseling in SSc and the potential role of diet in survival.Abstract P.177 Figure 1Cox proportional hazards model showing the survival function at mean dietary fiber intake among women. Higher dietary fiber intake was associated with improved survival. Hazard ratio (HR) = 0.92: D = 0.050