Elkan A-C, Engvall I-L, Tengstrand B, Cederholm T, Hafström I
Department of Rheumatology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Eur J Clin Nutr. 2008 Oct;62(10):1239-47. doi: 10.1038/sj.ejcn.1602845. Epub 2007 Jul 18.
To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data.
Study subjects include 60 in-ward patients (83% women, median age 65 years). Anthropometric measures and the nutritional tools Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening tool 2002 (NRS-2002). Body composition was determined by dual-energy X-ray absorptiometry and fat-free mass index (FFMI; kg/m(2)) and fat mass index (FMI; kg/m(2)) were calculated.
Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m(2), respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m(2), that is, the cutoff value for malnutrition. FFMI indicated 52% of the women and 30% of the men to be malnourished. The sensitivity and specificity for BMI to detect malnutrition according to FFMI were 27 and 100%, whereas for arm muscle circumference the sensitivity was 36% and the specificity 89% and for triceps skin fold 43 and 93%, respectively. For MNA, sensitivity was 85% and specificity 39% and for SGA 46 and 82%. Both MUST and NRS-2002 had sensitivity of 45% and specificity of 19%.
A large proportion of in-ward RA patients had reduced FFMI. Concurrent elevation of fat mass made BMI a non-reliable tool to detect malnutrition. Of the tested clinical evaluation tools, MNA might be used as a screening instrument, but because of its low specificity it should be followed by body composition determination.
评估用于评估类风湿关节炎(RA)患者营养状况的诊断工具与客观身体成分数据之间的关系。
研究对象包括60名住院患者(83%为女性,中位年龄65岁)。进行人体测量,并使用营养工具微型营养评定法(MNA)、主观全面评定法(SGA)、营养不良通用筛查工具(MUST)和营养风险筛查工具2002(NRS - 2002)。通过双能X线吸收法测定身体成分,并计算去脂体重指数(FFMI;kg/m²)和脂肪量指数(FMI;kg/m²)。
RA女性和男性的平均体重指数(BMI)分别为24.4和26.9 kg/m²。12%的女性和极少数男性的BMI<18.5 kg/m²,即营养不良的临界值。FFMI显示52%的女性和30%的男性营养不良。根据FFMI,BMI检测营养不良的敏感性和特异性分别为27%和100%,而臂肌围的敏感性为36%,特异性为89%,肱三头肌皮褶厚度的敏感性和特异性分别为43%和93%。对于MNA,敏感性为85%,特异性为39%;对于SGA,敏感性为46%,特异性为82%。MUST和NRS - 2002的敏感性均为45%,特异性均为19%。
很大一部分住院RA患者的FFMI降低。脂肪量的同时升高使BMI成为检测营养不良的不可靠工具。在所测试的临床评估工具中,MNA可作为筛查工具,但由于其特异性较低,应在其后进行身体成分测定。