title: Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) independent of traditional risk factors. The aim of this study was to analyze the associations between diet, body composition, lipids and atheroprotective natural antibodies against phosphorylcholine (anti-PC) in patients with RA.
  
  
  METHODS
  A total of 80 RA patients (76% women), mean age (standard deviation (SD)) 61.4 (12) years and median disease duration of 6 years, were assessed by food frequency questionnaire (FFQ), fatty acid profile in adipose tissue and whole-body dual energy x ray absorptiometry (DXA). Rheumatoid cachexia was defined as fat free mass index below the 25th percentile and fat mass index above the 50th percentile of a reference population. Blood lipids, oxidized low-density lipoprotein (oxLDL) and anti-PC levels were determined.
  
  
  RESULTS
  The mean body mass index for the women and men was 25.0 and 27.0, respectively. Central obesity was found in 57% of the women (waist circumference >80 cm) and in 89% of the men (waist circumference >94 cm). In all, 18% of the women and 26% of the men had rheumatoid cachexia. These patients had significantly higher total cholesterol (P < 0.033), LDL (P < 0.029), and trendwise oxLDL (P = 0.056) as well as lower anti-PC IgM (P = 0.040), higher frequency of hypertension (69%) and metabolic syndrome (25%) than those without. The patients reported a high dietary intake of saturated fat, which partly correlated with fatty acid composition in adipose tissue and significantly with disease activity. However, patients with or without cachexia did not differ with respect to dietary fat intake or intake of Mediterranean-like diet. Additionally, patients on a Mediterranean-like diet had high levels of anti-PC (P < 0.001).
  
  
  CONCLUSIONS
  About one in five patients with low-active RA displayed rheumatoid cachexia. This condition was associated with high levels of LDL cholesterol, low levels of atheroprotective anti-PC and high frequency of hypertension, which is of interest in the context of CVD in RA. The cachexia could not be related to diet fat intake. However, patients on a Mediterranean-like diet had high anti-PC levels in spite of similar frequency of cachexia. High anti-PC levels may provide some protection against CVD.
authors.affiliation: Department of Rheumatology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. ann-charlotte.elkan@karolinska.se
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Elkan
authors.forename: Niclas
authors.initials: N
authors.lastname: Håkansson
authors.forename: Johan
authors.initials: J
authors.lastname: Frostegård
authors.forename: Tommy
authors.initials: T
authors.lastname: Cederholm
authors.forename: Ingiäld
authors.initials: I
authors.lastname: Hafström
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000150:complications*; D015992:Body Mass Index; D002100:Cachexia / Q000209:etiology* / Q000276:immunology; D003430:Cross-Sectional Studies; D004041:Dietary Fats; D050171:Dyslipidemias / Q000209:etiology*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D009765:Obesity / Q000150:complications; D010767:Phosphorylcholine / Q000276:immunology*; D011795:Surveys and Questionnaires; D055105:Waist Circumference
chemical_list: D000906:Antibodies; D004041:Dietary Fats; D018836:Inflammation Mediators; D010767:Phosphorylcholine