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From the RHEUMATOLOGY UNIT at the DEPARTMENT OF MEDICIN HUDDINGE Karolinska Institutet, Stockholm, Sweden

NUTRITIONAL STATUS, BODY COMPOSITION AND DIET IN PATIENTS WITH RHEUMATOID ARTHRITIS

Ann-Charlotte Elkan

Stockholm 2009

All previously published papers were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by [E-PRINT] © Ann-Charlotte Elkan, 2009 ISBN 978-91-7409-367-4

ABSTRACT Rheumatoid arthritis (RA) is a chronic inflammatory disease with higher mortality rate than in the general population, which is largely attributed to cardiovascular disease (CVD). Another consequence of the inflammatory process is change in body composition with decreased muscle mass and increased fat mass. This condition has been named rheumatoid cachexia and is difficult to detect in clinical practice, as it is associated with little or no weight loss and with a maintained body mass index. The aims of this thesis were to evaluate different diagnostic instruments for assessment of nutritional status and body composition in patients with RA and to study if the diet was associated with body composition derangement and dyslipidemia, especially antibodies against phosphorylcholine (anti- PC). In- and out-ward RA patients at the Karolinska University Hospital and Södersjukhuset in Stockholm were included in the studies. They were assessed by anthropometric measures, dualenergy x-ray absorptiometry (DXA), bioelectrical impedance analyses (BIA) and nutritional questionnaires. Further blood samples and adipose tissue were analysed. Sixty-six patients were randomized to either a vegan diet free of gluten or a well-balanced non-vegan diet for 1 year and assessed as to disease activity and dyslipidemia. Twelve per cent of the in-ward women, only one of the out-wards and none of the men had BMI