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Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools.
Eur J Clin Nutr 2008; 62(10):1239-47EJ

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/m(2)) and fat mass index (FMI; kg/m(2)) were calculated.

RESULTS

Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m(2), respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m(2), 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.

Authors+Show Affiliations

Department of Rheumatology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. ann-charlotte.elkan@karolinska.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17637600

Citation

Elkan, A-C, et al. "Malnutrition in Women With Rheumatoid Arthritis Is Not Revealed By Clinical Anthropometrical Measurements or Nutritional Evaluation Tools." European Journal of Clinical Nutrition, vol. 62, no. 10, 2008, pp. 1239-47.
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. 2008;62(10):1239-47.
Elkan, A. C., Engvall, I. L., Tengstrand, B., Cederholm, T., & Hafström, I. (2008). Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. European Journal of Clinical Nutrition, 62(10), pp. 1239-47.
Elkan AC, et al. Malnutrition in Women With Rheumatoid Arthritis Is Not Revealed By Clinical Anthropometrical Measurements or Nutritional Evaluation Tools. Eur J Clin Nutr. 2008;62(10):1239-47. PubMed PMID: 17637600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. AU - Elkan,A-C, AU - Engvall,I-L, AU - Tengstrand,B, AU - Cederholm,T, AU - Hafström,I, Y1 - 2007/07/18/ PY - 2007/7/20/pubmed PY - 2009/1/13/medline PY - 2007/7/20/entrez SP - 1239 EP - 47 JF - European journal of clinical nutrition JO - Eur J Clin Nutr VL - 62 IS - 10 N2 - 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/m(2)) and fat mass index (FMI; kg/m(2)) were calculated. RESULTS: Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m(2), respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m(2), 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. SN - 0954-3007 UR - https://www.unboundmedicine.com/medline/citation/17637600/Malnutrition_in_women_with_rheumatoid_arthritis_is_not_revealed_by_clinical_anthropometrical_measurements_or_nutritional_evaluation_tools_ L2 - http://dx.doi.org/10.1038/sj.ejcn.1602845 DB - PRIME DP - Unbound Medicine ER -