Evaluation of Nutritional Status and Methods to Identify Nutritional Risk in Rheumatoid Arthritis and Spondyloarthritis

Abstract

Patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) experience several nutritional challenges and are prone to develop malnutrition. This observational study aimed to perform a comprehensive nutritional assessment of outpatients diagnosed with RA and SpA, as well as to evaluate methods to identify nutritional risk. Nutritional status was investigated by anthropometric measures, body composition (DXA, dual energy X-ray absorptiometry), and handgrip strength (HGS). Nutritional risk was classified by Nutritional Risk Screening 2002 (NRS2002) and malnutrition was defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and fat-free mass index (FFMI; kg/m2, <16.7 (M), <14.6 (F)). Out of 71 included patients, 46 (66%) were abdominally obese, 28 (39%) were obese in terms of body mass index (BMI), and 33 (52%) were obese in terms of the fat mass index (FMI; kg/m2, ≥8.3 (M), ≥11.8 (F)). Malnutrition was identified according to FFMI in 12 (19%) patients, according to GLIM criteria in 5 (8%) patients, and on the basis of BMI (<18.5 kg/m2) in 1 (1%) patient. None were identified by NRS2002 to be at nutritional risk. Our study revealed high prevalence of abdominal obesity and low FFMI. Waist circumference was a good indicator of FMI. BMI, NRS2002, and HGS did not capture patients with malnutrition identified by DXA.

Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review

“…Reduced muscle mass was applied as a phenotypic criterion in 72% of studies (n ¼ 57) and was assessed using a variety of methods (Fig. 3 [17,28,29,38,43,59,88,93], computed tomography scans (n ¼ 2; 2%) [67,79], ultrasound scans (n ¼ 1; 1%) [15], and equations to estimate skeletal muscle index (n ¼ 2; 2%) [32,57] (Fig. 8 e Supplementary Material).…”

GLIM criteria to identify malnutrition in patients in hospital settings: A systematic review

“…Some diseases have a greater influence on nutrition status because of their underlying pathophysiology, and thus, the tools can identify malnutrition more easily, 14,18,[25][26][27] as is the case for diagnosing malnutrition using the ESPEN criteria, which include low BMI and identify individuals with significant or more advanced malnutrition. 4 On the other hand, the etiological aspects of the GLIM criteria, which consider the presence of "any chronic condition that affects food assimilation or absorption" associated with reduced muscle mass, are common in patients with systemic sclerosis, indicating a greater number of patients at risk of malnutrition or already malnourished.…”

Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study

“…Previous studies on the prevalence of malnutrition in RA have used different measures to assess nutritional status and cachexia, including body mass index, triceps skinfold thickness, arm muscle area, and biochemical parameters (albumin and cholesterol levels). Based on these parameters, the prevalence of malnutrition in RA ranges from 20% to 50% [ 5 , 31 , 32 , 33 ]. Nevertheless, specific questionnaires, such as the MNA, have been designed for the rapid and accurate evaluation of malnutrition.…”