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Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools

European Journal of Clinical Nutrition volume 62, pages 1239–1247 (2008)Cite this article

Abstract

Objective:

To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data.

Subjects and methods:

Study subjects include 60 in-ward patients (83% women, median age 65 years). Anthropometric measures and the nutritional tools Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening tool 2002 (NRS-2002). Body composition was determined by dual-energy X-ray absorptiometry and fat-free mass index (FFMI; kg/m2) and fat mass index (FMI; kg/m2) were calculated.

Results:

Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m2, respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m2, that is, the cutoff value for malnutrition. FFMI indicated 52% of the women and 30% of the men to be malnourished. The sensitivity and specificity for BMI to detect malnutrition according to FFMI were 27 and 100%, whereas for arm muscle circumference the sensitivity was 36% and the specificity 89% and for triceps skin fold 43 and 93%, respectively. For MNA, sensitivity was 85% and specificity 39% and for SGA 46 and 82%. Both MUST and NRS-2002 had sensitivity of 45% and specificity of 19%.

Conclusion:

A large proportion of in-ward RA patients had reduced FFMI. Concurrent elevation of fat mass made BMI a non-reliable tool to detect malnutrition. Of the tested clinical evaluation tools, MNA might be used as a screening instrument, but because of its low specificity it should be followed by body composition determination.

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Acknowledgements

The work was supported by grants from The Swedish Rheumatism Association, King Gustav V 80 year's Foundation, Ugglas Foundation, Capio, the Swedish Research Council and through the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and the Karolinska Institute.

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Authors and Affiliations

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

    A-C Elkan, I-L Engvall, B Tengstrand & I Hafström

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

    T Cederholm

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  1. A-C Elkan
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  2. I-L Engvall
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  3. B Tengstrand
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  4. T Cederholm
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Correspondence to A-C Elkan.

Additional information

Contributors: A-CE has participated in the discussion of the design of the study, has made all the anthropometric measurements and handled the nutritional tools, has put the results together and with some help made the statistic analyses. Further she has been responsible for writing the paper. I-LE has also participated in the design of the study, has performed all the assessments of disease activity measurements and has collaborated in analysis of results and writing of the paper. BT has had the responsibility for all the statistic analyses and interpretation of data. TC has had an active part in the design of the study and an advisory role in malnutrition measurements as well as in paper preparation. IH took the initiative to the study, and has been senior advisor in all parts of the research and paper preparation.

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Elkan, AC., Engvall, IL., Tengstrand, B. et al. Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. Eur J Clin Nutr 62, 1239–1247 (2008). https://doi.org/10.1038/sj.ejcn.1602845

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