Rheumatoid cachexia,central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry,Mini Nutritional Assessment and body composition techniques |
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Authors: | Ann-Charlotte?Elkan Inga-Lill?Engvall Tommy?Cederholm Ingi?ld?Hafstr?m |
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Institution: | (1) Department of Rheumatology, R92, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden;(2) Department of Public Health and Caring Science/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden |
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Abstract: | Background and aims The concurrent decrease in fat free mass (FFM) and increase in fat mass (FM), including central obesity, in patients with
rheumatoid arthritis (RA) may be related to increased cardiovascular morbidity as well as to functional decline. The objectives
of this study were to evaluate body composition and nutritional status in patients with RA and the feasibility of bioelectrical
impedance (BIA) to detect rheumatoid cachexia.
Methods Eighty RA outpatients (76% women), mean age 61 (range 22–80) years and with mean disease duration of 6 (range 1–52) years,
were assessed by body mass index (BMI), waist circumference (WC), whole-body dual-energy X-ray absorptiometry (DXA), BIA and
the Mini Nutritional Assessment (MNA).
Results Fat free mass index (FFMI; kg/m2) was low in 26% of the women and in 21% of the men. About every fifth patient displayed concomitant low FFMI and elevated
fat mass index (FMI; kg/m2), i.e. rheumatoid cachexia. BMI and MNA were not able to detect this condition. Sixty-seven percent had increased WC. Reduced
FFM was independently related to age (p = 0.022), disease duration (p = 0.027), ESR (p = 0.011) and function trendwise (p = 0.058). There was a good relative agreement between DXA and BIA (FM r
2 = 0.94, FFM r
2 = 0.92; both p < 0.001), but the limits of agreement were wide for each variable, i.e. for FM −3.3 to 7.8 kg; and for FFM −7.9 to 3.7 kg.
Conclusion Rheumatoid cachexia and central obesity were common in patients with RA. Neither BMI nor MNA could detect this properly. There
was a good relative agreement between DXA and BIA, but the limits of agreement were wide, which may restrict the utility of
BIA in clinical practice.
This work has in part been presented at the Congress of American College of Rheumatology in San Francisco, October 2008. |
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Keywords: | Rheumatoid cachexia Body composition Nutritional status Mini Nutritional Assessment Bioelectrical impedance |
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