Body composition of rheumatoid arthritis patients and their perceptions and practices regarding diet, nutritional supplements and other treatments

Lombard, Louise Ann (2011-12)

Thesis (MNutr)--Stellenbosch University, 2011

Thesis

ENGLISH ABSTRACT: Introduction Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass, occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining their body composition and the possible presence of rheumatoid cachexia. Methodology The study design was a cross-sectional study with an analytical component. The study population consisted of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An interviewer-administered questionnaire was used followed by the measurement of weight, height, waist circumference and skinfold thickness. Information was also gathered from the medical records. Results The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity (n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%). Waist circumference measurement classifications showed a substantially increased risk for metabolic complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification. Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in 27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or complementary and alternative medicines and therapies could improve their symptoms of RA and 98% (n=246) of participants used nutritional supplements. The most frequently used supplements included folic acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%) and multivitamin and mineral preparations (n=22; 29.7%). Conclusion The obesity and waist circumference figures were unacceptably elevated in this population and the body composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in the management of RA patients.

AFRIKAANSE OPSOMMING: Inleiding Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike teenwoordigheid van rumatoïede cachexia te bepaal. Metodiek Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool. Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook gemeet. Inligting was ook versamel uit mediese rekords. Resultate Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers (n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24) en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger. Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%), kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en mineraal preparate (n=22; 29.7%). Gevolgtrekking Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span, met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.

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