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.
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.
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.
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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All data supporting the findings of this study is available within the paper. Further inquiries can be directed to the corresponding author.
American college of rheumatology
Biological disease-modifying antirheumatic drugs
Body mass index
Disease activity score in 28 joints
Disease activity score in 28 joints calculated with C-reactive protein
Dietary inflammatory index
Disease-modifying antirheumatic drugs
European league against rheumatism
Erythrocyte sedimentation rate
Food frequency questionnaire
Health assessment questionnaire
High-sensitivity C-reactive protein
Prevención con dieta Mediterránea
Rheumatoid arthritis impact of disease
Randomised clinical trial
Short-chain fatty acids
Swollen joint count
Tender joint count
Visual analogue scale
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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.
No funding was received for conducting this study.
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The authors declare that they have no conflict of interest to disclose.
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