Impact of disease burden or inflammation on nutritional assessment by the GLIM criteria in female patients with rheumatoid arthritis.

Abstract

In 2018, the Global Leadership Initiative on Malnutrition (GLIM) released a global standard for evaluating malnutrition. The etiologies of malnutrition in the GLIM criteria includes disease burden/inflammation, but how this view affects nutritional assessment remains unclear. This study aimed to investigate the impact of disease burden/inflammation on the proportion of malnourished patients defined by GLIM criteria, and how differences in methods for determining disease burden/inflammation in GLIM criteria affect existing nutritional indices among patients with rheumatoid arthritis (RA). We also investigated factors associated with malnutrition in RA patients. Data from 135 female RA patients (66.8±12.6 years) were cross-sectionally analyzed. Among the etiologies of malnutrition, disease burden/inflammation was defined as: (1) moderate or higher disease activity score (disease activity score composite of the 28-joint score and erythrocyte sedimentation rate [DAS28-ESR] ≥ 3.2) [DAS-malnutrition (MN)]; (2) elevated C-reactive protein (CRP) ≥0.5mg/dL (CRP-MN); and (3) presence of RA (RA-MN). In each of the three conditions, nutritional indicators between well-nourished and malnourished groups were compared by analysis of covariance. Factors associated with malnutrition were analyzed with logistic regression analysis. The frequencies of malnutrition as defined by DAS-MN, CRP-MN, and RA-MN were 39%, 30%, and 71%, respectively. When malnutrition was defined by the DAS-MN and/or the CRP-MN, grip strength and serum ceruloplasmin, iron, and zinc levels showed significant differences between the well-nourished and malnourished groups (p<0.05). The use of targeted synthetic or biological disease-modifying antirheumatic drugs (ts-/b-DMARD) (OR=0.29; 95% CI 0.11-0.82), grip strength (OR=0.83; 95% CI 0.75-0.91), subjective reduction in walking speed (OR=5.24; 1.85-14.86) were significantly associated with malnutrition as determined by DAS-MN. Differences in disease burden/inflammation affect nutritional assessments. The number of malnourished patients with RA was negatively associated with the use of ts-/b-DMARDs and high physical function in women.