AB1300-HPR MALNUTRITION SCREENING AND ASSESSMENT TOOLS IN RHEUMATIC DISEASES
Authors: C. M. Gamboa-Alonso, J. D. Ángulo, R. E. Díaz-García, G. Figueroa-Parra, D. Á. Galarza-Delgado, J. C. Riegatorres
Journal: Annals of the Rheumatic Diseases (2020)

Background: Inflammatory disorders have been associated with an increased risk of malnutrition, defined as an abnormal physiologic condition caused by an insufficient, unbalanced or excessive intake of nutrients due to exacerbated metabolic states. 1 Mini Nutritional Assessment (MNA) and Nutritional Risk Screening Tool 2002 (NRS-2002) have been used to evaluate nutritional status in patients with rheumatic diseases. Objectives: Compare MNA and NRS-2002 as tools for nutritional screening in rheumatic patients. Methods: 152 patients with rheumatic diseases were evaluated in a Rheumatology center of México. Anthropometrical measurements were performed using Bioelectrical Impedance Analysis (BIA) TANITA. MNA and NRS-2002 were applied at the same date. MNA is comprised of a dietary questionnaire, subjective and objective global assessment and anthropometrical measurements, classified as adequate (MNA 24-30), risk for malnutrition (MNA 17–23.5) and malnutrition (MNA&lt;17). NRS-2002 consists of nutritional and severity disease score and an age adjustment for patients &gt;70 years (+1); classified as normal (0-3) and risk of malnutrition/established malnutrition (3 or more). For statistical analysis the SPSS v24 was used. A p &lt;0.05 was considered statistically significant. Results: A total of 152 patients with different rheumatic diseases were included, Table 1. The results according to each tool are represented in Graphic 1. A significant difference was found by the Chi-Square-test when comparing both tools, (p&lt;0.004). Table 1. Socio-demographic characteristics of rheumatic patients DISEASES, n (% ) Rheumatoid Arthritis 70 (46.1) Systemic Lupus Erythematosus 19 (12.5) Ostearthrosis 18 (11.8) Sjögren´s Syndrome 5 (3.3) Fibromyalgia 4 (2.6) Ankylosing Spondylitis 2 (1.3) Systemic Sclerosis 6 (3.9) Others 27 (17.8) SOCIO-DEMOGRAPHICS Age, mean years (SD ) 51.98 (13.56) BMI , mean (SD ) 28.14 (5.8) Brachial Circumference, cm, (SD ) 32.57 (4.19) Calf Circumference, cm, (SD ) 37.08 (4.17) A subanalysis in 70 Rheumatoid Arthritis patients was done with a mean age of 50.94 years (SD±12.11) and a mean BMI 28.53 kg/m2 (SD 5.48). The results according to each tool are represented in Table 2. When NRS-2002 was reclassified in 3 parameters (normal &lt;2, risk of malnutrition 2 and malnutrition 3 or more), a significant difference persisted (p. 05) with a low correlation (.43). Table 2. Descriptive data of MNA and NRS-2002 in rheumatic diseases. NUTRITIONAL SCREENING TOOLS MNA NRS-2002 NRS-2002* Rho p All Rheumatic Diseases Total Score , n(SD ) 24.31 (3.48) ___ ___ .23 .004 Malnutrition, n(% ) 4 (2.6) 5 (3.3) 5 (3.3) Risk, n(% ) 55 (36.2) 147 (96.7) 41(27) Normal, n(% ) 93 (61.2) 106 (69.7) Rheumatoid Arthritis Total Score , n(SD ) 24.43 (3.23) ___ ___ .43 .05 Malnutrition, n(% ) 1 (1.4) 2 (2.9) 2 (2.9) Risk, n(% ) 22 (31.4) 68 (97.1) 15 (21.4) Normal, n(% ) 47 (67.1) 53 (75.7) Conclusion: MNA was a more sensible tool for detecting risk of malnutrition when compared to NRS-2002. Screening tools play an important role at nutritional evaluation and should be complemented with objective methods such as BIA. 1 Rheumatologists must be aware that nutritional disorders affect the state of rheumatic diseases; and selecting an appropriate tool to detect malnutrition is of vital importance. References: [1]Elkan, A. C., Engvall, I. L., Tengstrand, B., Cederholm, T., &amp; Hafström, I. (2008). Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. European journal of clinical nutrition , 62 (10), 1239-1247. Figure 1. Graphic 1. Nutritional screening tools in rhematic disorders. Total N= 152 patients. MNA= Mini Nutritional Assessment NRS-2002= Nutritional Risk Screening Tool-2002. NRS-2002*= Nutritional Risk Screening Modified with 3 parameters. Disclosure of Interests: None declared