Malnutrition and disease progression in patients with rheumatoid arthritis

Abstract

To examine the changes in nutritional status during the progression of rheumatoid arthritis (RA), we studied anthropometric and biochemical variables in 97 Japanese patients with RA. Anthropometric data included body mass index (BMI), triceps skinfold thickness (TSF), and arm muscle area (AMA). Levels of albumin and cholesterol in serum, and lymphocyte count were studied as biochemical variables. The prevalence of malnutrition defined as hypoalbuminemia less than 3.4 g/dl was 24.7%, similar to the reports in other countries. Analysis of the data according to disease stage showed that malnutrition in RA was characterized by a progressive reduction in body protein. Body mass index and TSF were increased in patients with stage 1 disease, whereas serum albumin and AMA were within normal range. Stage 2 patients had normal BMI with decreased body protein, albumin, and AMA. Progression to stages 3 and 4 was associated with a stepwise decrease in AMA; serum albumin and BMI remained in the same range as stage 2. Albumin values and AMA were significantly lower in patients with poor functional class and high C-reactive protein. The characteristic progression of malnutrition in RA is attributed to excessive protein catabolism evoked by inflammatory cytokines and by disuse atrophy due to functional impairment.

Nutrient Intake in Postmenopausal Rheumatoid Arthritis Women with Osteoporosis: Results from the Korean National Health and Nutrition Examination Survey

“…This result aligned with the previous study in Japan [3]. However, this was not the case with the results within the RA subgroups (OP, ON, NL) ( Table 2).…”

“…Other limitations may include the definition of the study population mainly based on questionnaire (RA and non-arthritis), the presented number of the postmenopausal RA subjects with DXA results, lack of information regarding osteoporotic fractures, and the estimation of nutrient intake using the 24 hour-recall survey. Nevertheless, daily intake of nutrients in our study is largely comparable with previous studies [3]. In terms of prevalence of RA, that in K-NHANES was slightly lower than expected (0.26%) compared with previous reports [30].…”

“…Under the potential assumption that nutritional status can be assessed by daily nutrient intake [11], we are able to state that BMD in postmenopausal Korean RA women is in part affected by their nutritional status. As shown in our data, anthro- pometric variables (BMI, waist circumference, whole body fat mass, and whole body total lean mass) are largely low in osteoporotic females [3,13]. Therefore, our results demonstrate that both anthropometric measures and nutrient intake are compromised in low BMD RA women compared with the normal population.…”

“…One study in Japan showed that information of dietary supplements or health foods is only obtained in a small portion (1.7%) of RA patients from health professionals [2]. Moreover, the relationship between nutritional status and progression of RA remains poorly understood [3]. Nutritional impact on bone mineral density (BMD) or on RA have been published separately [4][5][6][7][8], yet the nutritional status of RA patients with OP has not been largely investigated.…”

Asymptomatic Pericardial Effusion in Patients with Rheumatoid Arthritis

“…Acute-phase proteins are defined as one whose plasma concentration increases (positive acute-phase proteins) or decreases (negative acute-phase proteins) during inflammatory disorder [8]. Serum albumin has been reported to fall in severe inflammatory states and hypoalbuminemia is frequently encountered in RA [9,10,11,12,13]. Because no one has assessed the two major pathophysiologic bases causing PE in patients with RA, we designed a study to determine the frequency and clinical correlates associated with the occurrence of asymptomatic PE in patients with RA.…”