Short communication Relevance of the new pre-cachexia and cachexia definitions for patients with rheumatoid arthritis Marian A.E. van Bokhorst e de van der Schueren a, * , Nicole P.C. Konijn a, b , Irene E.M. Bultink b , Willem F. Lems b , Carrie P. Earthman c , Lilian H.D. van Tuyl b a Department of Nutrition and Dietetics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands b Department of Rheumatology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands c Department of Food Science & Nutrition, University of Minnesota,1334 Eckles Avenue, St. Paul, MN 55108-6099, United States article info Article history: Received 23 November 2011 Accepted 17 May 2012 Keywords: Pre-cachexia Cachexia Rheumatoid arthritis Malnutrition Nutritional assessment summary Background & aims: The recently proposed definitions of ’pre-cachexia’ and ’cachexia’ might offer new possibilities for the detection of malnutrition in patients with rheumatoid arthritis (RA). Methods: The prevalence of different components of nutritional status and the compiled definitions of ’precachexia’ and ’cachexia’ were measured in a cohort of 103 patients with moderately active RA. Nutritional status was determined by measuring unintentional weight loss, BMI, and muscle strength. Bio-electrical Impedance Analysis (BIA) was used to determine fat free mass index (FFMI) and fat mass index. In addition, appetite, pain, fatigue, and inflammatory activity were assessed. The prevalence of ’pre-cachexia’ and ’cachexia’ was calculated from different combinations of these parameters. Results: 20% of the study population had a low FFMI (<10th percentile), and 95% had a decreased muscle strength (<lowest tertile). Weight loss and loss of appetite, both essential elements in the newly proposed (pre-)cachexia definitions, were uncommon. The prevalence of ’pre-cachexia’ and ’cachexia’ was both 1% (n ¼ 1). Conclusions: In spite of altered body composition and impaired body function, the recently proposed definitions of both ’pre-cachexia’ and ’cachexia’ were unable to identify and diagnose impaired nutri- tional status in RA patients mainly because of low prevalences of weight loss and decreased appetite. Ó 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Both ‘cachexia’ and ‘pre-cachexia’ have recently attracted much attention in the international literature. Consensus definitions 1,2 have been drafted and are now ready to be applied in different patient populations. In patients with rheumatoid arthritis (RA), an altered body composition, specifically a decreased fat free mass (FFM) in combination with a stable or increased fat mass (FM) has been described, so-called ‘rheumatoid cachexia’. 3 Low physical activity, joint stiffness, pain, swelling, disuse of muscles, and metabolic changes in the body are all factors which may contribute to loss of muscle mass and strength in RA patients. The prevalence of ‘rheumatoid cachexia’ has been described to occur in up to two thirds of patients. 4,5 In daily clinical practice, easy bed-side methods for the early detection of malnutrition in RA patients are lacking. If the new definitions of pre-cachexia and cachexia would be able to identify patients at increased nutrition risk, their practical application could be of additional value in the evaluation of RA patients. Therefore, we studied the applicability of the new consensus definitions of pre-cachexia and cachexia in patients with rheuma- toid arthritis. 2. Methods 2.1. Population From March to June 2011 we cross-sectionally determined the nutritional status of 103 consecutive RA patients visiting the outpatient or day treatment department of Rheumatology at the VU University Medical Center, Amsterdam, the Netherlands. This study was approved by the medical ethical committee of the VU University Medical Center and all patients gave their written informed consent before inclusion. * Corresponding author. Tel.: þ31 20 4443410. E-mail address: m.vanbokhorst@vumc.nl (M.A.E. van Bokhorst e de van der Schueren). Contents lists available at SciVerse ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ e see front matter Ó 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2012.05.012 Clinical Nutrition 31 (2012) 1008e1010