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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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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.

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Abbreviations

BIA:

Bioelectrical impedance analysis

BMI:

Body mass index

DAS28:

Disease activity score calculated on 28 joints

DXA:

Dual X-ray absorptiometry

FFM:

Fat free mass

FFMI:

Fat free mass index

FM:

Fat mass

FMI:

Fat mass index

HAQ:

Health Assessment Questionnaire

MNA:

Mini Nutritional Assessment

RA:

Rheumatoid arthritis

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Acknowledgments

Supported by grants from The Swedish Rheumatism Association, King Gustav V 80 year’s foundation, Capio, Stig Thunes found, the Swedish Research Council and The regional agreement on medical training and clinical research (ALF) between Stockholm county council and the Karolinska Institute. All authors contributed practically and/or intellectually to this study, as to design, collection of data and analysing data as well as writing or giving input to writing the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Rheumatology, R92, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden

    Ann-Charlotte Elkan, Inga-Lill Engvall & Ingiäld Hafström

  2. Department of Public Health and Caring Science/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden

    Tommy Cederholm

Authors
  1. Ann-Charlotte Elkan
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  2. Inga-Lill Engvall
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  3. Tommy Cederholm
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  4. Ingiäld Hafström
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Corresponding author

Correspondence to Ann-Charlotte Elkan.

Additional information

This work has in part been presented at the Congress of American College of Rheumatology in San Francisco, October 2008.

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Elkan, AC., Engvall, IL., Cederholm, T. et al. Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry, Mini Nutritional Assessment and body composition techniques. Eur J Nutr 48, 315–322 (2009). https://doi.org/10.1007/s00394-009-0017-y

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