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Assessment of protein-energy malnutrition in children and adolescents with juvenile rheumatoid arthritis.

The incidence of protein-energy malnutrition (PEM) in juvenile rheumatoid arthritis (JRA) patients referred to a dietitian was compared with PEM in a nonreferred JRA population. One pediatric dietitian evaluated all 28 patients using a standardized, 11-parameter comprehensive nutritional assessment profile. Thirty-six percent (10) were found to have PEM (greater than or equal to 6 of 11 parameters abnormal as defined for this study), 36% (10) had no abnormal parameters, and 28% (8) had one-five abnormal parameters. Seventy percent (7 of 10) of the patients referred to a dietitian had PEM: 17% (3 of 18) of the nonreferred JRA patients had PEM. PEM was found in all onset types of JRA. In the ten patients with PEM, 80% had weight less than 5th percentile, 30% had heights less than 5th percentile, 50% had subnormal visceral proteins, 90% had subnormal somatic proteins, and none showed depletion of subcutaneous fat reserves. The high prevalence of PEM supports the need for greater involvement of pediatric dietitians in the evaluation and treatment of JRA patients.