title: Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools.
abstract: OBJECTIVE
  To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data.
  
  
  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%.
  
  
  CONCLUSIONS
  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.affiliation: Department of Rheumatology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. ann-charlotte.elkan@karolinska.se
authors.forename: A-C
authors.initials: AC
authors.lastname: Elkan
authors.forename: I-L
authors.initials: IL
authors.lastname: Engvall
authors.forename: B
authors.initials: B
authors.lastname: Tengstrand
authors.forename: T
authors.initials: T
authors.lastname: Cederholm
authors.forename: I
authors.initials: I
authors.lastname: Hafström
mesh_terms: D000368:Aged; D000886:Anthropometry / Q000379:methods*; D001172:Arthritis, Rheumatoid / Q000473:pathology*; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires