ASSESSING THE NUTRITIONAL STATUS AND MACRONUTRIENT INTAKE OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AT OUT-PATIENT DEPARTMENT, RHEUMATOLOGY DEPARTMENT, YANGON SPECIALITY HOSPITAL, YANGON, MYANMAR
Patients with systemic lupus erythematosus (SLE) suffer from nutritional changes due to disease process or treatment. The nutritional status may vary from malnourishment to overweight. The dietary intake of the SLE patients is reduced due to low appetite, GI symptoms and dietary changes. The study aimed to assess the nutritional status and macronutrients intake in patients with SLE. The study was carried out at the OPD of Rheumatology department, Yangon Speciality Hospital, Yangon, Myanmar. Cross-sectional descriptive study design was conducted. 53 patients were included by convenience sampling in the study with their voluntary consent.
Mean age of SLE patients is 31 ± 10 years. In the current study, a high prevalence of malnutrition was found. The nutritional status was assessed by Body Mass Index (BMI) and Subjective Global Assessment (SGA). Mean BMI is 20.5 ± 4 kg/m2. 45.3% of malnourishment (undernutrition, overweight and obesity) was detected by using BMI. According to SGA, 57% of malnutrition was detected. Therefore, BMI alone is not enough to assess the nutritional status in such patients because these patients are prone to oedema and disease activity can also affect the nutritional status.
Macronutrient intake was assessed by 24 Hour Food Recall was collected for 2 non-consecutive days. Mean energy intake was 877 ± 190 kcal per day while the TEE was 1866 ± 224 kcal per day. Whether the patients have good or bad nutritional status, their dietary intake was lower than the recommended range in patients with SLE. Carbohydrate intake of the patients was between the acceptable range of 45-65%. Protein intake was near the lower limit of the range. Fat intake was found out to be nearly upper limit of the distribution range. In this study, Patients with SLE who consume less than or equal to 877 kcal per day have normal and underweight BMI scores. It was significant with P value 0.004. 60.9% of patients were consuming >33 grams of protein per day and they had SGA grade A. It was also significant with the P value of 0.005.
Hence, it is proved that the assessment of nutritional status should be an integral part of patient care, as the imbalance between adequate metabolism and immunity leads to malnutrition. Also, BMI alone cannot reflect the nutritional status of the patients with SLE. So, using BMI together with SGA will be more beneficial in such high risk patients. Malnutrition is more prone in patients with SLE and early detection of malnutrition will impact disease outcome and treatment. Thus, interventions aimed at promoting adequate nutritional status and food intake may contribute to reduction of comorbidities and improved quality of life in these patients.