J Rheum Dis.  2017 Feb;24(1):35-42. 10.4078/jrd.2017.24.1.35.

Nutrient Intake in Postmenopausal Rheumatoid Arthritis Women with Osteoporosis: Results from the Korean National Health and Nutrition Examination Survey

Affiliations
  • 1Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
  • 2Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea. kideb1@snu.ac.kr
  • 3Department of Nutrition Service, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 4Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 5Graduate School of Public Health, Seoul National University, Seoul, Korea.
  • 6Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract


OBJECTIVE
Osteoporosis (OP) is one of the principal comorbidities in women with rheumatoid arthritis (RA). Proper nutrition for these patients is required not only to improve bone health but to better manage their chronic illness. Thus, our aim was to assess the status of key nutrient intake in postmenopausal RA women with OP.
METHODS
Using cross-sectional data of 4,933 postmenopausal women in the Korean National Health and Nutrition Examination Survey (K-NHANES IV, V) conducted between 2008 and 2011, we investigated the daily nutrient intake in RA subjects and their bone mineral density (BMD). We examined the association of nutrient intake and BMD after adjusting age, level of education, body mass index, family history, alcohol use, and total calorie intake in the osteoporosis, osteopenia, and normal BMD group using multivariable linear regression.
RESULTS
We included 222 RA women and 320 controls whose BMD and T-score data were available. Low calcium and phosphorous intake were associated with reduced BMD T-scores in postmenopausal RA women. Additionally, β-carotene, potassium, riboflavin, and vitamin C intake were significantly lower in RA women with OP. Multivariable linear regression analysis showed a strong positive association of intake of β-carotene, potassium, riboflavin, and calcium with higher T-scores at the lumbar spine, femur neck, and total hip (all p<0.0001, respectively).
CONCLUSION
We found insufficient intake of nutrients such as β-carotene, potassium, riboflavin, and vitamin C in Korean postmenopausal RA women with low BMD. Dietary counseling and recommendations are warranted for these subjects to attain better bone health.

Keyword

Bone density; Nutrition surveys; Osteoporosis; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid*
Ascorbic Acid
Body Mass Index
Bone Density
Bone Diseases, Metabolic
Calcium
Chronic Disease
Comorbidity
Counseling
Education
Female
Femur Neck
Hip
Humans
Linear Models
Nutrition Surveys*
Osteoporosis*
Potassium
Riboflavin
Spine
Ascorbic Acid
Calcium
Potassium
Riboflavin

Figure

  • Figure 1. Scheme of the study subject selection process. K-NHANES: Korean National Health and Nutrition Examination Survey, DXA: dual energy X-ray absorptiometry, RA: rheumatoid arthritis, OA: osteoarthritis, BMD: bone mineral density.


Cited by  1 articles

Risk Factors of Osteoporosis in Rheumatoid Arthritis Patients; Glucocorticoid, Inactivity, or Nutrient Deficiencies
Yoon-Kyoung Sung
J Rheum Dis. 2017;24(2):63-64.    doi: 10.4078/jrd.2017.24.2.63.


Reference

1. Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014; 73:62–8.
Article
2. Ikuyama S, Imamura-Takase E, Tokunaga S, Oribe M, Nishimura J. Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods. Mod Rheumatol. 2009; 19:253–9.
Article
3. Fukuda W, Yamazaki T, Akaogi T, Hayashi H, Kusakabe T, Tsubouchi Y, et al. Malnutrition and disease progression in patients with rheumatoid arthritis. Mod Rheumatol. 2005; 15:104–7.
Article
4. Hong H, Kim EK, Lee JS. Effects of calcium intake, milk and dairy product intake, and blood vitamin D level on osteoporosis risk in Korean adults: analysis of the 2008 and 2009 Korea National Health and Nutrition Examination Survey. Nutr Res Pract. 2013; 7:409–17.
Article
5. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999; 69:727–36.
Article
6. Prentice A. Diet, nutrition and the prevention of osteoporosis. Public Health Nutr. 2004; 7:227–43.
Article
7. McCann K. Nutrition and rheumatoid arthritis. Explore (NY). 2007; 3:616–8.
Article
8. Stamp LK, James MJ, Cleland LG. Diet and rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum. 2005; 35:77–94.
Article
9. Korea National Health & Nutrition Survey [Internet]. Cheongju: Korea Centers for Disease Control & Prevention;[cited 2015 May]. Available from:. https://knhanes.cdc.go.kr/knhanes/index.do.
10. Hur NW, Choi CB, Uhm WS, Bae SC. The prevalence and trend of arthritis in Korea: results from Korea National Health and Nutrition Examination Surveys. J Korean Rheum Assoc. 2008; 15:11–26.
Article
11. Nesheim RO, Abrams IJ, Blackburn H, Calloway DH, Guthrie HA, Hammonds TM, et al. National Research Council (US) Committee on Food Consumption Patterns. Assessing changing food consumption patterns. Washington (DC): National Academies Press (US);1981.
12. Fukuda W, Omoto A, Oku S, Tanaka T, Tsubouchi Y, Kohno M, et al. Contribution of rheumatoid arthritis disease activity and disability to rheumatoid cachexia. Mod Rheumatol. 2010; 20:439–43.
Article
13. Lee S, Kim TN, Kim SH, Kim YG, Lee CK, Moon HB, et al. Obesity, metabolic abnormality, and knee osteoarthritis: a cross-sectional study in Korean women. Mod Rheumatol. 2015; 25:292–7.
Article
14. Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997; 65(4 Suppl):1220S–1228S.
Article
15. Shin CS, Choi HJ, Kim MJ, Kim JT, Yu SH, Koo BK, et al. Prevalence and risk factors of osteoporosis in Korea: a com-munity-based cohort study with lumbar spine and hip bone mineral density. Bone. 2010; 47:378–87.
Article
16. Arshad A, Rashid R, Benjamin K. The effect of disease activity on fat-free mass and resting energy expenditure in patients with rheumatoid arthritis versus noninflammatory arthropathies/soft tissue rheumatism. Mod Rheumatol. 2007; 17:470–5.
Article
17. Peters BS, Martini LA. Nutritional aspects of the prevention and treatment of osteoporosis. Arq Bras Endocrinol Metabol. 2010; 54:179–85.
Article
18. Hooshmand S, Arjmandi BH. Viewpoint: dried plum, an emerging functional food that may effectively improve bone health. Ageing Res Rev. 2009; 8:122–7.
Article
19. Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, et al. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr. 2012; 51:637–63.
Article
20. Park HM, Heo J, Park Y. Calcium from plant sources is bene-ficial to lowering the risk of osteoporosis in postmenopausal Korean women. Nutr Res. 2011; 31:27–32.
Article
21. Maggio D, Polidori MC, Barabani M, Tufi A, Ruggiero C, Cecchetti R, et al. Low levels of carotenoids and retinol in in-volutional osteoporosis. Bone. 2006; 38:244–8.
Article
22. Yang Z, Zhang Z, Penniston KL, Binkley N, Tanumihardjo SA. Serum carotenoid concentrations in postmenopausal women from the United States with and without osteoporosis. Int J Vitam Nutr Res. 2008; 78:105–11.
Article
23. Melhus H, Michaëlsson K, Holmberg L, Wolk A, Ljunghall S. Smoking, antioxidant vitamins, and the risk of hip fracture. J Bone Miner Res. 1999; 14:129–35.
Article
24. Sahni S, Hannan MT, Blumberg J, Cupples LA, Kiel DP, Tucker KL. Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham Osteoporosis Study. Am J Clin Nutr. 2009; 89:416–24.
Article
25. De Pablo P, Dietrich T, Karlson EW. Antioxidants and other novel cardiovascular risk factors in subjects with rheumatoid arthritis in a large population sample. Arthritis Rheum. 2007; 57:953–62.
Article
26. Yoon EH, Noh H, Lee HM, Hwang HS, Park HK, Park YS. Bone mineral density and food-frequency in Korean adults: the 2008 and 2009 Korea National Health and Nutrition Examination Survey. Korean J Fam Med. 2012; 33:287–95.
Article
27. Mun SO, Kim J, Yang YJ. Factors associated with bone mineral density in Korean postmenopausal women aged 50 years and above: using 2008-2010 Korean National Health and Nutrition Examination Survey. Korean J Community Nutr. 2013; 18:177–86.
Article
28. Haugen M, Homme KA, Reigstad A, Teigland J. Assessment of nutritional status in patients with rheumatoid arthritis and osteoarthritis undergoing joint replacement surgery. Arthritis Care Res. 1999; 12:26–32.
Article
29. Kajiyama H, Akama H, Yamanaka H, Shoji A, Matsuda Y, Tanaka E, et al. One third of Japanese patients with rheumatoid arthritis use complementary and alternative medicine. Mod Rheumatol. 2006; 16:355–9.
Article
30. Cho SK, Sung YK, Choi CB, Kwon JM, Lee EK, Bae SC. Development of an algorithm for identifying rheumatoid arthritis in the Korean National Health Insurance claims database. Rheumatol Int. 2013; 33:2985–92.
Article
Full Text Links
  • JRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr