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The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability

European Journal of Nutrition volume 62, pages 2827–2839 (2023)Cite this article

Abstract

Purpose

To assess the relationship between adherence to the Mediterranean Diet (MD) /individual Dietary Inflammatory Index (DII) and disease activity, disease impact, and functional status in Rheumatoid Arthritis (RA) patients.

Methods

RA patients followed at a hospital in Lisbon, Portugal, were recruited. DII was calculated using dietary intake data collected with a food frequency questionnaire (FFQ). Adherence to the MD was obtained using the 14-item Mediterranean Diet assessment tool. Disease Activity Score of 28 Joints (DAS28) and the DAS28 calculated with C-Reactive Protein (DAS28-CRP) were used to assess disease activity. Impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively.

Results

120 patients (73.3% female, 61.8 ± 10.1 years of age) were included. Patients with higher adherence to the MD had significantly lower DAS28-CRP (median 3.27(2.37) vs 2.77(1.49), p = 0.030), RAID (median 5.65(2.38) vs 3.51(4.51), p = 0.032) and HAQ (median 1.00(0.56) vs 0.56(1.03), p = 0.013) scores. Higher adherence to the MD reduced the odds of having a higher DAS28 by 70% (OR = 0.303, 95%CI = (0.261, 0.347), p = 0.003). Lower adherence to MD was associated with higher DAS28-CRP (β = − 0.164, p = 0.001), higher RAID (β = − 0.311, p < 0.0001), and higher HAQ scores (β = − 0.089, p = 0.001), irrespective of age, gender, BMI and pharmacological therapy. Mean DII of our cohort was not significantly different from the Portuguese population (0.00 ± 0.17 vs − 0.10 ± 1.46, p = 0.578). No associations between macronutrient intake or DII and RA outcomes were found.

Conclusions

Higher adherence to the MD was associated with lower disease activity, lower impact of disease, and lower functional disability in RA patients.

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Fig. 1

Data availability

All data supporting the findings of this study is available within the paper. Further inquiries can be directed to the corresponding author.

Abbreviations

ACR:

American college of rheumatology

bDMARDs:

Biological disease-modifying antirheumatic drugs

BMI:

Body mass index

CRP:

C-reactive protein

DAS28:

Disease activity score in 28 joints

DAS28-CRP:

Disease activity score in 28 joints calculated with C-reactive protein

DII:

Dietary inflammatory index

DMARDs:

Disease-modifying antirheumatic drugs

EULAR:

European league against rheumatism

ESR:

Erythrocyte sedimentation rate

FFQ:

Food frequency questionnaire

HAQ:

Health assessment questionnaire

hs-CRP:

High-sensitivity C-reactive protein

MD:

Mediterranean diet

PREDIMED:

Prevención con dieta Mediterránea

RA:

Rheumatoid arthritis

RAID:

Rheumatoid arthritis impact of disease

RCT:

Randomised clinical trial

RF:

Rheumatoid factor

SD:

Standard deviation

SCFA:

Short-chain fatty acids

SJC:

Swollen joint count

TJC:

Tender joint count

VAS:

Visual analogue scale

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Acknowledgements

The authors wish to express their gratitude to all professionals of the Rheumatology Department of Centro Hospitalar Universitário Lisboa Norte, particularly Drs. Cristina Ponte, Joaquim Pereira, Maria João Saavedra and Rita Barros, for supporting the study.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal

    Sofia Charneca, Margarida Ferro, João Vasques & Catarina Sousa Guerreiro

  2. H&TRC- Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal

    Elisabete Carolino

  3. Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal

    Joana Martins-Martinho, Ana Margarida Duarte-Monteiro, Eduardo Dourado & João Eurico Fonseca

  4. Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Joana Martins-Martinho, Ana Margarida Duarte-Monteiro, Eduardo Dourado & João Eurico Fonseca

  5. Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal

    Catarina Sousa Guerreiro

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  1. Sofia Charneca
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Contributions

SC: investigation, visualization, roles/writing—original draft. MF: investigation, visualization, roles/writing—original draft. JV: data curation, writing—review & editing. EC: formal analysis, writing—review & editing. JM-M: resources, writing—review & editing. AMD-M: resources. ED: resources, writing—review & editing. JEF: conceptualisation, methodology, resources, supervision, validation, project administration, writing—review & editing. CSG: conceptualisation, methodology, resources, supervision, validation, project administration, writing—review & editing.

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Correspondence to Eduardo Dourado.

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This study was conducted in accordance with the Declaration of Helsinki and its later amendments or comparable ethical standards, with the approval of the Lisbon Academic Medical Center Ethical Committee (Ref. Nº 262/19). All participants gave their informed consent prior to their inclusion in the study.

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Charneca, S., Ferro, M., Vasques, J. et al. The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability. Eur J Nutr 62, 2827–2839 (2023). https://doi.org/10.1007/s00394-023-03196-8

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