European Journal of Nutrition

, Volume 48, Issue 5, pp 315–322

Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry, Mini Nutritional Assessment and body composition techniques

  • Ann-Charlotte Elkan
  • Inga-Lill Engvall
  • Tommy Cederholm
  • Ingiäld Hafström
Original Contribution

DOI: 10.1007/s00394-009-0017-y

Cite this article as:
Elkan, AC., Engvall, IL., Cederholm, T. et al. Eur J Nutr (2009) 48: 315. doi:10.1007/s00394-009-0017-y


Background and aims

The concurrent decrease in fat free mass (FFM) and increase in fat mass (FM), including central obesity, in patients with rheumatoid arthritis (RA) may be related to increased cardiovascular morbidity as well as to functional decline. The objectives of this study were to evaluate body composition and nutritional status in patients with RA and the feasibility of bioelectrical impedance (BIA) to detect rheumatoid cachexia.


Eighty RA outpatients (76% women), mean age 61 (range 22–80) years and with mean disease duration of 6 (range 1–52) years, were assessed by body mass index (BMI), waist circumference (WC), whole-body dual-energy X-ray absorptiometry (DXA), BIA and the Mini Nutritional Assessment (MNA).


Fat free mass index (FFMI; kg/m2) was low in 26% of the women and in 21% of the men. About every fifth patient displayed concomitant low FFMI and elevated fat mass index (FMI; kg/m2), i.e. rheumatoid cachexia. BMI and MNA were not able to detect this condition. Sixty-seven percent had increased WC. Reduced FFM was independently related to age (p = 0.022), disease duration (p = 0.027), ESR (p = 0.011) and function trendwise (p = 0.058). There was a good relative agreement between DXA and BIA (FM r2 = 0.94, FFM r2 = 0.92; both p < 0.001), but the limits of agreement were wide for each variable, i.e. for FM −3.3 to 7.8 kg; and for FFM −7.9 to 3.7 kg.


Rheumatoid cachexia and central obesity were common in patients with RA. Neither BMI nor MNA could detect this properly. There was a good relative agreement between DXA and BIA, but the limits of agreement were wide, which may restrict the utility of BIA in clinical practice.


Rheumatoid cachexia Body composition Nutritional status Mini Nutritional Assessment Bioelectrical impedance 



Bioelectrical impedance analysis


Body mass index


Disease activity score calculated on 28 joints


Dual X-ray absorptiometry


Fat free mass


Fat free mass index


Fat mass


Fat mass index


Health Assessment Questionnaire


Mini Nutritional Assessment


Rheumatoid arthritis

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ann-Charlotte Elkan
    • 1
  • Inga-Lill Engvall
    • 1
  • Tommy Cederholm
    • 2
  • Ingiäld Hafström
    • 1
  1. 1.Department of Rheumatology, R92, Karolinska InstituteKarolinska University Hospital HuddingeStockholmSweden
  2. 2.Department of Public Health and Caring Science/Clinical Nutrition and MetabolismUppsala UniversityUppsalaSweden

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