Nutritional status and its association with sarcopenic body composition phenotype and obesity in women with rheumatoid arthritis

Purpose of the study . To evaluate the association of nutritional status with the presence of a sarcopenic body composition phenotype and obesity in postmenopausal women with rheumatoid arthritis. Materials and methods . The study included 121 postmenopausal women with RA (mean age 62.1 ± 7.9 years). Nutritional status was determined using the Russian version of the Mini Nutritional Assessment (MNA) questionnaire. Body composition was studied using dual-energy X-ray densitometry (‘Whole Body’ program). Clinical and laboratory examinations were also carried out. Results . Reduced nutritional status was detected in 42.1% of patients. Individuals with reduced nutritional status had a higher ESR and higher disease activity as assessed by the DAS28 index (p = 0.024 and p = 0.003, respectively), a greater 10-year likelihood of osteoporotic fractures of all major sites (p = 0.029) and hip fractures (p = 0.016). Correlations were established between nutritional status, according to the MNA questionnaire, and appendicular muscle mass (r = 0.21; p = 0.044), waist circumference (r = 0.32; p = 0.001) and waist-to-hip ratio (r = 0.29; p = 0.006), a negative association was found with DAS28 (r = –0.26; p = 0.009). Univariate logistic regression analysis showed an association of the sarcopenic phenotype with dietary calcium intake less than 500 mg/day (odds ratio [OR] = 7.55; 95% confidence interval [CI]: 3.09–18.44; p < 0.001), the shoulder circumference of the non-dominant arm is less than 25 cm (OR = 6.51; 95% CI: 2.21–19.12; p = 0.001). Obesity phenotype was associated with upper arm circumference greater than 25 cm (OR = 8.28; 95% CI: 2.78–24.66; p < 0.001) and serum vitamin D deficiency (OR = 1.04; 95% CI: 1.00–1.07; p = 0.043). Conclusions . The incidence of reduced nutritional status in postmenopausal women with RA according to MNA was 42.1%. An association was found between MNA nutritional status, daily calcium intake and the sarcopenic phenotype. No association with nutritional status was found for the obesity phenotype.