Malnutrition Linked to All-Cause Mortality in Patients with Rheumatoid Arthritis

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A study published in , found that malnutrition, common in rheumatoid arthritis (RA) patients, was strongly associated with an increased risk of all-cause mortality. The forefront of nutrition science.1

“Malnutrition has been shown to affect quality of life in older populations with chronic diseases,” the researchers noted. “Illness-related malnutrition is strongly associated with morbidity, disability, short- and long-term mortality, and impaired recovery from illness. Two-thirds have been shown to be malnourished.The high incidence of malnutrition in RA patients may be associated with disuse atrophy due to inflammatory responses, metabolic abnormalities, and activity limitation during the disease. there is potential.”

A total of 1976 adult patients with RA (59.9% female, 69.9% non-Hispanic white, mean age 57.38 years) were evaluated using the National Health and Nutrition Examination Survey (NHANES). National Center for Health Statistics (NCHS), 1999-2014. The primary outcome was all-cause mortality. The controlled nutritional status score (CONUT) and nutritional risk index (NRI) determined the nutritional status of the patient population, and the Kaplan-Meier (KM) survival curve Cox proportional hazards regression model analyzed the association between malnutrition and all-cause mortality. Did.

At baseline, 57.5% (n = 1258) had hypertension, 32.3% (n = 775) had diabetes mellitus (DM), 15.8% (n = 285) had cancer, and 8.8% (n = 184) had congestion heart failure (CHF), and 8.4% (n = 1717) had coronary artery disease (CHD).

The proportion of malnourished patients was observed at 18.8% via CONUT and 26.6% using NRI. This highlights the importance of attention and innervation in the nutritional status of this patient population. Mild malnutrition was reported in 18.3% (n = 391) by CONUT and 15.6% (n = 204) by NRI criteria, with moderate-to-severe malnutrition in 0.4% and 11.0%, respectively.

KM survival curves showed that malnutrition was associated with increased all-cause mortality during the 10-year follow-up period (log-rank test, P. < 0.001). The adjusted hazard ratio (aHR) for all-cause mortality in moderate-to-severely malnourished patients for CONUT was 5.63 (95% CI, 2.55–12.45; P. < 0.001) and NRI 2.56 (95% CI, 1.81–3.62; P. < 0.001) when compared to non-malnourished patients in a fully modified model.

A subgroup analysis of CONUT scores reported a higher risk of all-cause mortality in the female population compared with male RA patients (aHR, 2.04; 95% CI, 1.27–3.28; P = 0.003 and aHR , 1.28; 95% CI, 0.73–2.26. P. = 0.394, respectively). However, NRI score analysis showed that the malnourished male population was at higher risk compared to female patients (aHR, 2.81; 95% CI, 1.74–4.56; P. < 0.001 and aHR, 2.36. 95% CI, 1.72–3.24. P. < 0.001, respectively).

The retrospective study design may have hindered timeliness. Furthermore, the lack of a comparison cohort may have biased the objectivity and accuracy of nutritional status. Finally, researchers did not assess changes in nutritional status over time.

“Malnutrition assessment allows clinicians to determine that RA patients are at increased risk of death,” the researchers concluded. “Proper assessment of nutritional status and necessary nutritional counseling can help improve the prognosis of patients with RA. Further clinical trials are needed to prospectively evaluate the effects of nutritional interventions on the prognosis of patients with RA. “

reference:

Tian P, Xiong J, Wu W, et al. Impact of malnutrition on mortality in patients with rheumatoid arthritis: a cohort study of NHANES 1999-2014. front nut. 2023;9:993061. Published 4 January 2023. doi:10.3389/fnut.2022.993061

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