Romatoid Artrit’li Bireylerin Vücut Kompozisyonlarının ve Beslenme Alışkanlıklarının İncelenmesi: Karşılaştırmalı Bir Çalışma

Abstract

Amaç: Bu çalışmanın amacı Romatoid Artrit’li (RA) bireylerin vücut kompozisyonlarını ve beslenme alışkanlıklarını araştırmak ve sağlıklı bireylerle karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya 64 birey (RA n: 32 ve ort. yaş: 55,18±1,52 yıl; Sağlıklı Grup n: 32 ve ort. yaş: 54,50±1,54 yıl) dahil edildi. Vücut kompozisyonları (vücut kütle indeksi, vücut yağ oranı, iskelet kası kütlesi, iskelet kas kütlesi indeksi) vücut analiz sistemi cihazı (Polosmart PSC12 Prolife) ile, beslenme alışkanlıkları (et/balık tüketimi, kurubaklagil tüketimi, yumurta tüketimi, süt/süt ürünü tüketimi, sıvı tüketimi) çalışmacılar tarafından oluşturulan sorular ile değerlendirildi. Bağımsız grup farklarının karşılaştırılmasında, parametrik test varsayımları karşılandığında Bağımsız Örneklem T testi, karşılanmadığında Mann Whitney U testi kullanıldı. Bulgular: Vücut kompozisyonları karşılaştırıldığında, iskelet kası kütlesi (p=0,001) ve iskelet kas kütlesi indeksinde (p=0,002) sağlıklı grup lehine anlamlı bir fark vardı; fakat vücut kütle indeksi ve vücut yağ oranları benzerdi (p>0,05). Beslenme alışkanlıkları karşılaştırıldığında; süt/süt ürünü (p=0,008), et-balık (p=0,001), kurubaklagil (p=0,008) ve sıvı tüketimleri (p=0,046) sağlıklı grupta daha yüksekti, ancak yumurta tüketimleri benzer idi (p>0,05). Sonuç: RA’lı hastaların sağlıklı kontrollere kıyasla, kas kütlesi daha az ve iskelet kas kütlesi indeks skorları daha düşük ve beslenme düzeyleri daha kötü idi. Bu sonuçlar ışığında, RA’lı bireylerin kas kütlesini artırıcı egzersiz yöntemlerinin yanı sıra beslenme alışkanlıklarını düzenleyen profesyonel merkezlerden destek almasını önermekteyiz

Keywords

• Romatoid artrit
• Vücut kompozisyonu
• Beslenme alışkanlıkları

Investigation of Body Compositions and Dietary Habits of Patients with Rheumatoid Arthritis: A Case Control Study

Abstract

Aim: The aim of this study was to investigate the body composition and dietary habits of patients with Rheumatoid Arthritis (RA) and to compare them with healthy controls. Material and Methods: 64 participants (RA n=32 and mean age: 55.2±1.5 years; Healthy Group n=32 and mean age: 54.5±1.5 years) were included in the study. Body compositions (body mass index, body fat ratio, skeletal muscle mass, skeletal muscle mass index) were evaluated with the body analysis system device (Polosmart PSC12 Prolife) and dietary habits (meat/fish consumption, legumes consumption, egg consumption, milk/dairy product consumption and liquid consumption) were evaluated with questions created by the researchers. In the comparison of independent group differences, the Independent Samples T Test was used when the parametric test assumptions were met, and the Mann Whitney U test was used when the parametric test assumptions were not met.. Results: When comparing body compositions, there was a significant difference in skeletal muscle mass (p=0.001) and skeletal muscle mass index (p=0.002) in favor of the healthy group; but body mass index and body fat ratios were similar (p>0.05). When comparing the dietary habits, milk/dairy product (p=0.008), meat/fish (p=0.001), legumes (p=0.001) and liquid (p=0.046) consumptions were higher in healthy group; but egg consumption was similar (p>0.05) Conclusion: The patients with RA had less muscle mass, lower skeletal muscle mass index scores, and worse nutritional levels compared to healthy controls. In the light of these results, we recommend that patients with RA receive support from professional centers regulating dietary habits, as well as exercise methods that increase muscle mass.

Keywords

• Rheumatoid arthritis
• Body composition
• Dietary habits

References

1. 1. Suzuki T, Ikari K, Yano K, Inoue E, Toyama Y, Taniguchi A, Yamanaka H, Momohara S. PADI4 and HLA-DRB1 are genetic risks for radiographic progression in RA patients, independent of ACPA status: Results from the IORRA cohort study. PloS One. 2013;8:e61045.
2. 2. Sandoughi M, Kaykhaei MA, Shahrakipoor M, Darvishzadeh R, Nikbakht M, Shahbakhsh S, Zakeri Z. Clinical manifestations and disease activity score of rheumatoid arthritis in southeast of Iran. Rheumatology Research. 2017;2:61-64.
3. 3. Firestein GS, Kelley WN. Etiology and pathogenesis of rheumatoid arthritis. eds. Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia, Pa. Saunders/Elsevier. 2009; 1035-1086.
4. 4. Firestein GS. Pathogenesis of rheumatoid arthritis: The intersection of genetics and epigenetics. Trans Am Clin Climatol Assoc. 2018;129:171-182.
5. 5. England BR, Thiele GM, Anderson DR, Mikuls TR. Increased cardiovascular risk in rheumatoid arthritis: Mechanisms and implications. BMJ. 2018;361:1036.
6. 6. Habib HM, Eisa AA, Arafat WR, Marie MA. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol. 2011;30:217-221.
7. 7. Widdifield J, Paterson JM, Huang A, Bernatsky S. Causes of death in rheumatoid arthritis: Hhow do they compare to the general population? Arthritis Care Res. 2018;70:1748-1755.
8. 8. Book C, Karlsson MK, Akesson K, Jacobsson LTH. Early rheumatoid arthritis and body composition. Rheumatol Oxf Engl. 2009; 48:1128-1132.

9. 9. Giles JT, Ling SM, Ferrucci L, Bartlett SJ, Andersen RE, Towns M, Muller D, Fontaine KR, Bathon JM. Abnormal body composition phenotypes in older rheumatoid arthritis patients: Association with disease characteristics and pharmacotherapies. Arthritis Rheum. 2008; 59:807-815.
10. 10. Engvall IL, Brismar K, Hafström I, Tengstrand B. Treatment with low-dose prednisolone is associated with altered body composition but no difference in bone mineral density in rheumatoid arthritis patients: A controlled cross-sectional study. Scand J Rheumatol. 2011; 40:161-168.
11. 11. Toussirot É, Mourot L, Dehecq B, Wendling D, Grandclément E, Dumoulin G. TNFα blockade for inflammatory rheumatic diseases is associated with a significant gain in android fat mass and has varying effects on adipokines: A 2-year prospective study. Eur J Nutr. 2014; 53:951-961.
12. 12. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48:16-31.
13. 13. Arshad A, Rashid R, Benjamin K. The effect of disease activity on fat-free mass and resting energy expenditure in patients with rheumatoid arthritis versus non-inflammatory arthropathies/soft tissue rheumatism. Mod Rheumatol. 2007; 17:470-475.
14. 14. Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y, Nevill AM, Douglas KM, Jamurtas A, van Zanten JJ, Labib M, Kitas GD. Redefining overweight and obesity in rheumatoid arthritis patients. Ann Rheum Dis. 2007; 66(10):1316-1321.
15. 15. Walsmith J, Roubenoff R. Cachexia in rheumatoid arthritis. Int J Cardiol. 2002; 85(1):89 -99.
16. 16. Letarouilly JG, Flipo RM, Cortet B, Tournadre A, Paccou J. Body composition in patients with rheumatoid arthritis: A narrative literature review. Ther Adv Musculoskelet Dis. 2021;13:1759720X211015006.
17. 17. Book C, Karlsson MK, Nilsson JA, Akesson K, Jacobsson LT. Changes in body composition after 2 years with rheumatoid arthritis. Scand J Rheumatol. 2011;40:95-100.
18. 18. Dao HH, Do QT, Sakamoto J. Abnormal body composition phenotypes in Vietnamese women with early rheumatoid arthritis. Rheumatology (Oxford). 2011;50:1250-1258.
19. 19. Gómez-Vaquero C, Nolla JM, Fiter J, Ramon JM, Concustell R, Valverde J, Roig-Escofet D. Nutritional status in rheumatoid arthritis. Joint Bone Spine. 2001; 68(5):403-409.
20. 20. Mahan LK, Escott-Stump S. Krause’s Food, Nutrition and Diet Therapy. WB Saunders, 1996;403-423.
21. 21. Berube LT, Kiely M Yazici Y, Woolf K. Diet quality of individuals with rheumatoid arthritis using the healthy eating index (HEI)-2010. Nutr Health. 2017; 23 (1):17-24
22. 22. Grimstvedt ME, Woolf K, Milliron BJ, Manore MM. Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls. Public Health Nutr. 2010;13(8):1170-1177.
23. 23. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-2581.
24. 24. Bahat G, Tufan A, Tufan F, Kilic C, Akpinar TS, Kose M, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clinical Nutrition. 2016;35(6):1557-63.
25. 25. Guigoz Y. The Mini-Nutritional Assessment (MNA® ) Review of the Literature - What does it tell us? J Nutr Health Aging. 2006;10:466-487.
26. 26. Alkan Melikoğlu M. Presarcopenia and its Impact on Disability in Female Patients With Rheumatoid Arthritis. Arch Rheumatol. 2017;32(1):53-59.
27. 27. Roubenoff R, Walsmith J, Lundgren N, Snydman L, Dolnikowski GJ, Roberts S. Low physical activity reduces total energy expenditure in women with rheumatoid arthritis: implications for dietary intake recommendations. Am J Clin Nutr. 2002; 76:774-9.
28. 28. Binymin K, Herrick A, Carlson G, Hopkins S. The effect of disease activity on body composition and resting energy expenditure in patients with rheumatoid arthritis. J Inflamm Res. 2011; 4:61-6.
29. 29. Elkan AC, Engvall IL, Tengstrand B, Cederholm T, Hafström I. Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. Eur J Clin Nutr. 2008; 62:1239- 1247.
30. 30. Lemmey AB, Wilkinson TJ, Clayton RJ, Sheikh F, Whale J, Jones HSJ, et al. Tight control of disease activity fails to improve body composition or physical function in rheumatoid arthritis patients. Rheumatology. 2016; 55:1736-1745.
31. 31. Turk SA, van Schaardenburg D, Boers M, de Boer S, Fokker C, Lems WF, et al. An unfavorable body composition is common in early arthritis patients: a case control study. PLoS One. 2018; 13:e0193377.
32. 32. Brance ML, Di Gregorio S, Pons-Estel BA, Quagliato NJ, Jorfen M, Berbotto G, et al. Prevalence of Sarcopenia and Whole-Body Composition in Rheumatoid Arthritis. J Clin Rheumatol. 2021; 27(6):153-160.
33. 33. Reina D, Gómez-Vaquero C, Díaz-Torné C, Solé JMN, Rheumatology Service. Hospital Moisès Broggi. Rheumatology Service. Hospital Moisès Broggi. Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: a case-control study. Medicine (Baltimore). 2019; 98:e14361.
34. 34. Şahin G, Güler H, Incel N, Sezgin M, As I. Soft tissue composition, axial bone mineral density and grip strength in postmenopausal Turkish women with early rheumatoid arthritis: Is lean body mass an indicator of bone mineral density in rheumatoid arthritis? Int J Fertil. 2006; 51(2):70-74.
35. 35. Westhovens R, Nijs J, Taelman V, Dequeker J. Body composition in rheumatoid arthritis. Br J Rheumatol. 1997; 36:444-448.
36. 36. Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr. 2008; 87:1562-66.
37. 37. Naseeb MA,Volpe SL. Protein and exercise in the prevention of sarcopenia and aging.Nutr Res. 2017; 40:1-20.
38. 38. Bosaeus I, Rothenberg E, Nutrition and physical activity for the prevention and treatment of age-related sarcopenia. Proc Nutr Soc. 2016; 75:174-180.
39. 39. Mangge H, Hermann J, Schauenstein K. Diet and rheumatoid arthritis - a review. Scand J Rheumatol. 1999; 28:201-209.
40. 40. Woolf K, Manore MM. Nutrition, exercise, and rheumatoid arthritis. Top Clin Nutr. 1999; 14:30-42.
41. 41. Kremer JM, Bigaouette J. Nutrient intake of patients with rheumatoid arthritis is deficient in pyridoxine, zinc, copper, and magnesium. J Rheumatol. 1996; 23(6):990-994.
42. 42. Woolf K, Manore MM. Elevated plasma homocysteine and low vitamin B-6 status in non-supplementing older women with rheumatoid arthritis. J Am Diet Assoc. 2008; 108:443- 453.
43. 43. Helliwell M, Coombes EJ, Moody BJ, Batstone GF, Robertson JC. Nutritional status in patients with rheumatoid arthritis. Ann Rheum Dis. 1984;43:386-390.
44. 44. Tański W, Wójciga J, Jankowska-Polańska B. Association between malnutrition and quality of life in elderly patients with rheumatoid arthritis. Nutrients. 2021; 13(4):1259.
45. 45. Bekar C, Armağan B, Sari A, Ayaz A. Assessment of nutritional status and physical activity levels of patient with rheumatoid arthritis. Clinical Nutrition. 2018; 37(1):111.
46. 46. Doubek JGC, Kahlow BS, Nisihara R, Skare TL. Rheumatoid arthritis and nutritional profile: A study in Brazilian females. Int J Rheum Dis. 2022; 25:1145-1151.
47. 47. Hejazi J, Mohtadinia J, Kolahi S, Bakhtiyari M, Delpisheh A. Nutritional status of Iranian women with rheumatoid arthritis: An assessment of dietary intake and disease activity. Women’s Health. 2011; 7(5):599-605.
48. 48. Niksolat F, Zandieh Z, Roshani F, Larijani SS, Mirfakhraee H, Bahadori F, Niksolat M. Geriatric Syndromes among Patients with Rheumatoid Arthritis: A Comparison between Young and Elderly Patients. Ethiop J Health Sci. 2022; 32(4):791-798.
49. 49. Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003; 62(3):208-214.
50. 50. Sala-Climent M, López de Coca T, Guerrero MD, Muñoz FJ, López-Ruíz MA, Moreno L, Alacreu M, Dea-Ayuela MA. The effect of an anti-inflammatory diet on chronic pain: a pilot study. Front Nutr. 2023; 10:1205526.