AB0194 ASSOCIATION OF MALNUTRITION WITH QUALITY OF LIFE IN ELDERLY RA PATIENTS
Authors: W. Tański, J. Wójciga, N. Świątoniowska-Lonc, B. Jankowska-Polańska
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA) is a progressive joint condition that leads to joints destruction and complications in the internal organs and significantly affects the a patient’s functional ability. Elderly patients with RA complain of pain, mood and sleep disturbances, fatigue, and insomnia in addition to weakness, decreased appetite and weight loss. Chronic use of medications results in the risk of comorbidities and decreased physical functioning. All this together significantly contributes to a negative assessment of quality of life (QoL). Objectives: Due to the chronic nature of RA and the high risk of malnutrition in this group of patients, an attempt was made to assess the QoL, activities of daily living and severity of frailty syndrome according to the results of the MNA questionnaire in a group of elderly patients with RA. Methods: The study included 98 patients (age over 60 years) with a diagnosis of RA according to ARA. Standardized tools were used in the study: the WHOQOL-BREF to assess quality of life, the Edmonton Frailty Scale to assess frailty syndrome, MNA to assess nutritional status and MMSE to assess cognitive function. Medical data were taken from the hospital records. Results: Patients significantly differed in the extent of limitations in basic (ADL) and advanced activities of daily living (IADL) according to their nutritional status. The higher the level of malnutrition, the greater the limitations of undertaken activities. In addition, an adverse effect of reduced body weight on the occurrence of cognitive dysfunction was observed (33.33% of malnourished patients were diagnosed with dementia vs. 1.79% in normal weight patients). Similarly, frailty syndrome or vulnerability to frailty syndrome was associated with malnourished patients (33.3% mild, 16.67% moderate, and 16.67% severe frailty syndrome). Malnourished patients had significantly lower QoL scores in all domains of the WHOQOL-BREF questionnaire compared to normal weight patients and multivariate analysis of the effect of selected variables on QoL in the domains of the WHOQOL-BREF questionnaire showed that a significant independent determinant of lower QoL in all domains was the presence of frailty syndrome, respectively: Perception of QoL (R=-0. 069), Self-perception of health (R=-0.172), Physical domain (R=-0.425), Psychological domain (R=-0.432), Social domain (R=-0.415), Environmental domain (R=-0.317). Malnutrition was a significant independent determinant of QoL in the self-perception of health domain (R=-0.08). Additionally, in the regression analysis, a positive effect of male gender was observed on the assessment of QoL in the psychological (R=1.414) and environmental (R=1.123) domains. Table 5. Comparative analysis of quality of life in terms of each domain of the WHOQOL-BREF questionnaire according to nutritional status. WHOQOL BREF MNA p Malnutrition (Mean±SD ) Risk of malnutrition (Mean±SD ) Normal nutrition (Mean±SD ) Perception of quality of life 3,33±1,03 3,33±0,68 3,68±0,58 0,029 Self-perception of health 2,67±0,82 2,47±0,84 3,14±0,98 0,004 Physical health 10,83±3,49 11,31±2,39 12,68±2,27 0,02 Psychological domain 12,5±3,89 13,28±2,73 14,45±2,24 0,056 Social domain 12,33± 2,86 12,67±2,93 14,29±2,61 0,007 Environmental domain 13,83±2,86 13,22±2,28 13,96±2,17 0,34 Conclusion: Malnourished people have a lower quality of life than people of normal weight. Malnutrition is a factor that negatively affects daily functioning, cognitive functioning, and the severity of frailty syndrome. A significant independent determinant of reduced quality of life across all domains of the WHOQOL-BREF questionnaire is frailty syndrome. References: [1]Marcora SM, Chester KR, Mittal G et al. Randomizedphase 2 trial of anti-tumor necrosisfactortherapy for cachexia in patients with earlyrheumatoidarthritis. Am J ClinNutr 2006;84:1463–72. 24 . [2]Kremers HM, Nicola PJ, Crowson CS, et al. Prognosticimportance of low body mass index in relation to cardiovascularmortality in rheumatoidarthritis. ArthritisRheum. 2004;50:3450–7. Disclosure of Interests: None declared