Ma Zhuang, Wu Shixin, Xiong Lin-En, Zhong Juncheng, Lin Baiwen, Chen Liangkai, Xiong Ting, Wu Yuanjue
School of Public Health, Guangzhou Medical University, Guangzhou, 51136, China.
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Clin Rheumatol. 2025 Apr 28. doi: 10.1007/s10067-025-07458-0.
Malnutrition and systemic inflammation are frequently prevalent in individuals with rheumatoid arthritis (RA). However, limited studies have explored the combined impacts of nutritional and inflammatory levels on all-cause mortality among RA. This study is aimed at investigating these potential associations.
We involved 2213 RA patients from the National Health and Nutrition Examination Survey (2001-2018). Nutritional risk index (NRI) and systemic inflammatory response index (SIRI) were used to evaluate the nutritional and inflammatory status of participants, respectively. Weight-based Kaplan-Meier survival curves and COX proportional hazard models were employed to ascertain the independent and joint association.
Over a median follow-up of 7.98 years, 544 deaths occurred. Following the adjustment for confounding factors, we found that individuals with moderate/severe malnutrition (HR, 2.13; 95%CI, 1.50-3.03) or high SIRI (HR, 1.49; 95%CI, 1.07-2.07) were independently associated with an increased risk of all-cause mortality. Furthermore, the simultaneous moderate/severe malnutrition and high SIRI further elevated the mortality risk (HR, 2.34; 95%CI, 1.53-3.56). An additive interaction was observed between malnutrition and high SIRI, yielding an excess risk of 0.34 (95%CI 0.06-0.62, P = 0.014), and the attributable proportion for the interaction was 20.9% (95%CI 7.6-34.2%).
This research indicated that malnutrition and high systemic inflammation levels were independent risk factors for the prognosis of RA patients, and co-occurrence can further deteriorate the prognosis. Our findings highlight the importance of maintaining nutrition and anti-inflammation in patients with RA, providing new insights into the prognosis of RA patients.
营养不良和全身炎症在类风湿关节炎（RA）患者中经常普遍存在。然而，有限的研究探讨了营养水平和炎症水平对RA患者全因死亡率的综合影响。本研究旨在调查这些潜在关联。
我们纳入了来自国家健康与营养检查调查（2001 - 2018年）的2213例RA患者。营养风险指数（NRI）和全身炎症反应指数（SIRI）分别用于评估参与者的营养和炎症状态。采用基于体重的Kaplan-Meier生存曲线和COX比例风险模型来确定独立和联合关联。
在中位随访7.98年期间，发生了544例死亡。在对混杂因素进行调整后，我们发现中度/重度营养不良（HR，2.13；95%CI，1.50 - 3.03）或高SIRI（HR，1.49；95%CI，1.07 - 2.07）的个体与全因死亡率增加独立相关。此外，同时存在中度/重度营养不良和高SIRI进一步提高了死亡风险（HR，2.34；95%CI，1.53 - 3.56）。在营养不良和高SIRI之间观察到相加交互作用，产生了0.34的超额风险（95%CI 0.06 - 0.62，P = 0.014），交互作用的归因比例为20.9%（95%CI 7.6 - 34.2%）。
本研究表明，营养不良和高全身炎症水平是RA患者预后的独立危险因素，两者同时出现会进一步恶化预后。我们的研究结果强调了在RA患者中维持营养和抗炎的重要性，为RA患者的预后提供了新的见解。
