Nutritional Assessment in Rheumatoid Arthritis

It is important to recognize that patients with RA do not have normal nutritional status. Compared with healthy persons of the same weight, age, race, gender, and height, patients with RA have lower body cell mass (especially muscle mass) and increased fat mass. This condition has been termed 'rheumatoid cachexia,' and it occurs despite adequate and even excessive dietary intake. This cachexia is generally seen in the presence of hypermetabolism (elevated resting energy expenditure) and hypercatabolism (elevated protein breakdown), along with reduced physical activity. These metabolic abnormalities are linked to increased production of the catabolic cyto-kines IL-1/3 and TNF-a. The problems are further exacerbated by reduced physical activity, which reduces the anabolic stimulus to muscle, and disordered growth hormone kinetics. In addition, patients with RA have lower concentrations of serum albumin and other markers of visceral protein status, and often have anemia of chronic disease with disordered iron metabolism.

Although many foods or food components have been considered as possible treatments for RA, most studies have focused on either supplementation (particularly the use of fish oil) or the use of an elimination diet, especially fasting or a vegetarian regimen.

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