Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study

Abstract

Objective: To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors. Methods: This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status. Results: The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels <3.8 g/L. Patients with impaired nutritional status had poorer quality of life and physical function. The factors associated with compromised nutritional status (OR [95% CI]) were age (1.0 [1.0–1.1]; p = 0.035), DAS28-ESR (1.8 [1.0–3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9–0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0–0.1]; p = 0.014). Conclusions: Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.

Associations between Rheumatoid Arthritis and Various Comorbid Conditions in Germany—A Retrospective Cohort Study

“…Our study found a significant manifestation of nutritional deficiency in patients with RA. The results of previous studies also support this finding [47,48]. In a study focusing on older RA patients, Cano-Garcia et al found that one-third of older RA patients have impaired nutritional status [48].…”

“…The results of previous studies also support this finding [47,48]. In a study focusing on older RA patients, Cano-Garcia et al found that one-third of older RA patients have impaired nutritional status [48]. RA patients are at risk of nutritional deficiency due to fatigue, pain, loss of motor function, and nausea, which could result in the reduction of food consumption and consequently the decreased intake of vitamins and minerals [49].…”

Gender Differences in the Interplay between Vitamin D and Microbiota in Allergic and Autoimmune Diseases

“…These two factors have different roles depending on age and sex, and both vitamin D and the gut microbiome seem to play a role in the development of immunotolerance, especially at younger ages. This implies that hypovitaminosis D and dysbiosis may be relevant in the genesis of the vast majority of immune-mediated diseases, which develop mainly in younger patients [49,58], while with age they may have a main role as mediators of disease severity, leading the immune system to a more inflammatory phenotype if they are altered [105].…”

“…From a pathophysiological point of view, in older adults with vitamin D deficiency, there are increased levels of markers of inflammation that can potentially spill over into immunemediated diseases [104]. This is the case of what appears to be happening in RA, where in malnourished subjects with reduced levels of vitamin D there is an increased level of inflammation as well as an increase in disease activity [105].…”

Metabolic Syndrome and Rheumatoid Arthritis Activity: An Analysis of Clinical, Laboratory, and Ultrasound Parameters

“…The total body weight usually remains stable in RC, despite the reduced lean body mass, which is compensated by an increased fat mass. The excess visceral body fat in RA patients was reported to be associated with an increased risk of hypertension, insulin resistance, and MetS [2,11]. It seems that RC may accelerate morbidity and mortality in patients with RA and is associated with MetS [2].…”