Thesis (MNutr)--Stellenbosch University, 2011 / ENGLISH ABSTRACT: Introduction
Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of
the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the
diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary
therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that
persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass,
occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are
practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and
complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining
their body composition and the possible presence of rheumatoid cachexia.
Methodology
The study design was a cross-sectional study with an analytical component. The study population consisted
of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An
interviewer-administered questionnaire was used followed by the measurement of weight, height, waist
circumference and skinfold thickness. Information was also gathered from the medical records.
Results
The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body
mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity
(n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%).
Waist circumference measurement classifications showed a substantially increased risk for metabolic
complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just
over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification.
Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th
percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in
27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food
could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened
their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or
complementary and alternative medicines and therapies could improve their symptoms of RA and 98%
(n=246) of participants used nutritional supplements. The most frequently used supplements included folic
acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%)
and multivitamin and mineral preparations (n=22; 29.7%).
Conclusion
The obesity and waist circumference figures were unacceptably elevated in this population and the body
composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for
cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in
RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in
the management of RA patients. / AFRIKAANSE OPSOMMING: Inleiding
Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur
inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui
daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die
wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus
aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus
te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte
met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies
ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe
medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike
teenwoordigheid van rumatoïede cachexia te bepaal.
Metodiek
Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit
volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool.
Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook
gemeet. Inligting was ook versamel uit mediese rekords.
Resultate
Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die
gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik
om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en
ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir
metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die
deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë
liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers
(n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24)
en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig
persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon
verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger.
Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en
alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers
het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%),
kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en
mineraal preparate (n=22; 29.7%).
Gevolgtrekking
Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die
liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir
kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak
van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span,
met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/17941 |
| Date | 12 1900 |
| Creators | Lombard, Louise Ann |
| Contributors | Du Plessis, L. M., Visser, J., Nel, D. G., Stellenbosch University. Faculty of Health Science. Dept. of Interdisciplinary Health Sciences. Human Nutrition. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 111 p. : ill. |
| Rights | Stellenbosch University |
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