Authors
David A Kellner, Joshua F Baker, Sitaram Vangala, David A Elashoff, Jin Long, Veena K Ranganath
Published in
Rheumatology advances in practice. Volume 10. Issue 3. Pages rkag080. Epub Jul 13, 2026.
Abstract
Obesity and sarcopenia commonly coexist in RA, compounding metabolic risk and disability. Intentional weight loss may improve outcomes but raises concern for accelerated muscle loss. We conducted a post-hoc analysis of a randomized controlled trial (RCT) of a hypocaloric, high-protein diet in adults with RA and obesity to determine whether diet-induced weight loss was associated with disproportionate reductions in muscle mass.
Adults with RA and obesity were randomized to a 12-week hypocaloric, high-protein diet or to control dietary advice (NCT02881307). DXA was performed at baseline and 12 weeks. Fat mass index (FMI), appendicular lean mass index (ALMI) and adiposity-adjusted ALMI (ALMIFMI) were derived and standardized to Z-scores using national reference data. Between-group differences in change were compared using t-tests, with FDR-adjusted P values reported for all analyses.
Participants in the dietary intervention achieved significant reductions in total fat mass (mean change in FMI Z-score -0.35 vs 0.04; P = 0.003). Changes in ALMI Z-score (-0.37 vs -0.43; P = 0.92) and ALMIFMI Z-score (-0.15 vs -0.55; P = 0.92) did not differ significantly between groups. In the intervention group there was minimal decline in ALMFMI, suggesting parallel reductions in lean and fat tissue.
In adults with RA and obesity, diet-induced weight loss reduced adiposity without evidence of disproportionate muscle loss. These findings support the safety of structured, protein-adequate weight-loss interventions in this population.
PMID:
42472055
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.
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