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Fedkov D, Peine C, Khalil A, Lang F. Disease activity and fatigue in inflammatory arthritis patients with different dietary preferences: a retrospective exploratory cross-sectional study. Reumatologia 2024; 62:161-168. [PMID: 39055731 PMCID: PMC11267656 DOI: 10.5114/reum/190272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Recently, diet has received considerable attention as an important factor in inflammatory arthritis. The objective of this study was to evaluate disease activity and fatigue in patients with rheumatoid arthritis and spondyloarthritis (including psoriatic arthritis) depending on their dietary preferences. Material and methods We retrospectively evaluated data of 774 patients collected by the Mida Rheuma App from January 2022 to December 2022. We assessed demographic parameters, major dietary patterns, and food groups (dairy products, fruits, vegetables, processed meat, meat, oily fish, white fish, and sugar) by each patient's consumption intensity. Disease activity was measured by Routine Assessment of Patient Index Data 3 (RAPID3), Patient's Global Assessment of Disease Activity (PtGADA), and Patient's Global Assessment of Pain Intensity (PPAIN). Fatigue was assessed by the Brief Fatigue Inventory (BFI). Depending on the food group, patients were divided into a high-consumption group (HCG; consuming the product 0-2 times per day/per week) and a lowconsumption group (LCG; consuming the product 3 and more times per day/per week). Patients on a specific diet which they followed before inclusion in the analysis were compared with the "eat all group" (EAG). Results The Mediterranean diet group had significantly lower (p < 0.05) RAPID3, PtGADA, and PPAIN (by 9.22%, 8.98%, and 14.3%, respectively), compared with the EAG. In the processed meat HCG, RAPID3, PtGADA, PPAIN, and BFI were significantly higher (14.5%, 18.3%, 16.1%, and 11.8%, p < 0.05) vs. the LCG. The PtGADA, PPAIN, and RAPID3 were significantly lower (p < 0.05) in the oily fish HCG vs. the LCG (18.9%, 18.1%, and 10.6%). Conclusions Our study results suggest that Mediterranean diet and oily fish have a potentially positive impact on patient-reported disease activity and fatigue in patients with inflammatory arthritis. In contrast, processed meat consumption has a negative effect.
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Affiliation(s)
- Dmytro Fedkov
- Department of Internal Medicine No. 3, Bogomolets National Medical University, Kyiv, Ukraine
- Medical Center Medical Clinic Blagomed LLC, Kyiv, Ukraine
- Midaia GmbH, Heidelberg, Germany
| | | | | | - Felix Lang
- Medical Center Medical Clinic Blagomed LLC, Kyiv, Ukraine
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Gopalarathinam R, Sankar R, Zhao SS. Role of Anti-Inflammatory Diet and Fecal Microbiota Transplant in Psoriatic Arthritis. Clin Ther 2024:S0149-2918(24)00112-7. [PMID: 38862291 DOI: 10.1016/j.clinthera.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a chronic inflammatory condition with complex and heterogenous manifestations. Although a myriad of treatment options including biologic medications are available to alleviate symptoms and slow disease progression, there is currently no cure for this condition. There has been a recent emergence of understanding about the relationship between the gut microbiome and immune-mediated inflammatory diseases. This has generated interest in the potential role of dietary interventions, particularly anti-inflammatory diets, and fecal microbiota transplant (FMT) as novel therapeutic approaches. The purpose of this narrative review is to examine the role of an anti-inflammatory diet and FMT in turn and whether their combination may offer alternate approaches for the management of PsA. METHODS Our non-systematic narrative review was informed by a literature search using PubMed and Google Scholar using the terms anti-inflammatory diet, FMT, nutrition supplements, and PsA. Preclinical studies and non-English language articles were excluded when synthesizing the narrative review. FINDINGS Current randomized controlled trials (RCTs) and observational evidence suggest that a hypocaloric diet or Mediterranean diet can help achieve weight loss among PsA patients who are overweight or obese, which in turn reduces inflammation and improves disease activity. However, there is no strong data to support the beneficial effects of intermittent fasting, vitamin supplements, turmeric supplements, probiotics, or omega-3 fatty acid supplements in PsA. Current evidence on the use of FMT in PsA is limited as only one small RCT has been conducted which did not demonstrate efficacy for improving clinical symptoms. IMPLICATIONS Clinicians can consider recommending hypocaloric or Mediterranean diets as an adjunct to standard management of PsA, possibly under the guidance of a dietician. Further research is needed to explore the beneficial effects of the synergistic role of combining an anti-inflammatory diet with FMT in PsA.
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Affiliation(s)
- Rajesh Gopalarathinam
- Division of Rheumatology, Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
| | - Reethika Sankar
- Meenakshi Medical College and Research Institute, Meenakshi Nagar, Tamil Nadu, India
| | - Sizheng Steven Zhao
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Hoffmann MH, Kirchner H, Krönke G, Riemekasten G, Bonelli M. Inflammatory tissue priming: novel insights and therapeutic opportunities for inflammatory rheumatic diseases. Ann Rheum Dis 2024:ard-2023-224092. [PMID: 38702177 DOI: 10.1136/ard-2023-224092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Due to optimised treatment strategies and the availability of new therapies during the last decades, formerly devastating chronic inflammatory diseases such as rheumatoid arthritis or systemic sclerosis (SSc) have become less menacing. However, in many patients, even state-of-the-art treatment cannot induce remission. Moreover, the risk for flares strongly increases once anti-inflammatory therapy is tapered or withdrawn, suggesting that underlying pathological processes remain active even in the absence of overt inflammation. It has become evident that tissues have the ability to remember past encounters with pathogens, wounds and other irritants, and to react more strongly and/or persistently to the next occurrence. This priming of the tissue bears a paramount role in defence from microbes, but on the other hand drives inflammatory pathologies (the Dr Jekyll and Mr Hyde aspect of tissue adaptation). Emerging evidence suggests that long-lived tissue-resident cells, such as fibroblasts, macrophages, long-lived plasma cells and tissue-resident memory T cells, determine inflammatory tissue priming in an interplay with infiltrating immune cells of lymphoid and myeloid origin, and with systemically acting factors such as cytokines, extracellular vesicles and antibodies. Here, we review the current state of science on inflammatory tissue priming, focusing on tissue-resident and tissue-occupying cells in arthritis and SSc, and reflect on the most promising treatment options targeting the maladapted tissue response during these diseases.
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Affiliation(s)
| | - Henriette Kirchner
- Institute for Human Genetics, Epigenetics and Metabolism Lab, University of Lübeck, Lübeck, Germany
| | - Gerhard Krönke
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Michael Bonelli
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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4
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Dorand VAM, Soares NL, da Silva Andrade ADA, Ribeiro MD, de Almeida Filho EJB, Neto MM, Batista KS, de Oliveira GC, Alves AF, de Paiva Sousa MC, Silva AS, Aquino JDS. Intermittent fasting associated with aerobic exercise improves oxidative parameters and causes muscle damage without compromising the performance of Wistar rats. Nutrition 2023; 115:112159. [PMID: 37549455 DOI: 10.1016/j.nut.2023.112159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The aim of this study was to` investigate the effects of intermittent fasting (IF) and the possible association with aerobic exercise on performance, oxidative, biochemical, and somatic parameters of Wistar rats. METHODS Forty rats were randomized into the following groups: sedentary (SC) and trained (TC) controls, sedentary intermittent fasting (SIF), and trained intermittent fasting (TIF). The rats were subjected to IF for 15 h every day and aerobic exercise lasting 30 min, five times a week, at a speed of 15 m/min for 4 wk. Performance tests were performed at the beginning and end of the protocol. Glucose and insulin tolerance, somatic parameters, lipidogram, leptin, insulin, malondialdehyde, antioxidant capacity, C-reactive protein, alpha acid glycoprotein, creatine kinase, lactate dehydrogenase, and muscle histology were analyzed. RESULTS The trained groups had similar performance and significantly improved performance at the end of the experiment. TIF showed lower body weight (-16 g), lean mass (22.49%), homeostatic model assessment for insulin resistance (29%), and lactate dehydrogenase (48%), and higher malondialdehyde (53%) and antioxidant capacity (75%) than the TC group. The SIF and TIF groups showed a fiber area reduction and positivity marking for tumor necrosis factor-α in the muscles. CONCLUSION Although IF associated with aerobic exercise improved antioxidant capacity caused damage to muscle fibers and lean mass loss, it did not change the performance of the rats.
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Affiliation(s)
- Victor Augusto Mathias Dorand
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba, UFPB, João Pessoa-PB, Brazil; Post Graduate Program in Nutrition Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Naís Lira Soares
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba, UFPB, João Pessoa-PB, Brazil; Post Graduate Program in Nutrition Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | | | - Mateus Duarte Ribeiro
- Laboratory of Applied Studies in Physical Training to Performance and Health - LETFADS, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil; Associate Graduate Program in Physical Education - UPE/UFPB, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Eder Jackson Bezerra de Almeida Filho
- Laboratory of Applied Studies in Physical Training to Performance and Health - LETFADS, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Manoel Miranda Neto
- Laboratory of Applied Studies in Physical Training to Performance and Health - LETFADS, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Kamila Sabino Batista
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba, UFPB, João Pessoa-PB, Brazil; Post Graduate Program in Nutrition Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | | | - Adriano Francisco Alves
- Laboratory of General pathology, Department of Physiology and Pathology, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Maria Carolina de Paiva Sousa
- Laboratory of General pathology, Department of Physiology and Pathology, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Alexandre Sergio Silva
- Post Graduate Program in Nutrition Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil; Laboratory of Applied Studies in Physical Training to Performance and Health - LETFADS, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil; Associate Graduate Program in Physical Education - UPE/UFPB, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Jailane de Souza Aquino
- Laboratory of Experimental Nutrition, Department of Nutrition, Federal University of Paraíba, UFPB, João Pessoa-PB, Brazil; Post Graduate Program in Nutrition Sciences, Federal University of Paraíba (UFPB), João Pessoa, Paraíba, Brazil; Department of Nutrition at the Federal University of Paraíba, João Pessoa, Brazil.
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Lavallee CM, Bruno A, Ma C, Raman M. A review of the role of intermittent fasting in the management of inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231171756. [PMID: 37284561 PMCID: PMC10240551 DOI: 10.1177/17562848231171756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
Intermittent fasting (IF) may be a weight management strategy for patients with inflammatory bowel disease (IBD). The aim of this short narrative review is to summarize the evidence related to IF in the management of IBD. A literature search of English publications related to IF or time-restricted feeding and IBD, Crohn's disease, or ulcerative colitis was conducted in PubMed and Google Scholar. Four publications on studies of IF in IBD were found: three randomized controlled trials in animal models of colitis and one prospective observational study in patients with IBD. The results from animal studies suggest either moderate or no changes in weight but improvements in colitis with IF. These improvements may be mediated through changes in the gut microbiome, decreased oxidative stress and increased colonic short-chain fatty acids. The study in humans was small and uncontrolled, and it did not assess changes in weight, making it difficult to draw conclusions around the effects of IF on changes in weight or disease course. Given that preclinical evidence suggests intermittent fasting may play a beneficial role in IBD, randomized controlled trials in large patients with active disease are warranted to determine whether intermittent fasting could be an integrated therapy for patients with IBD management, either for weight or for disease management. These studies should also explore the potential mechanisms of action related to intermittent fasting.
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Affiliation(s)
| | - Andreina Bruno
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), Palermo, Italy
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Kondo N, Kanai T, Okada M. Rheumatoid Arthritis and Reactive Oxygen Species: A Review. Curr Issues Mol Biol 2023; 45:3000-3015. [PMID: 37185721 PMCID: PMC10137217 DOI: 10.3390/cimb45040197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that causes progressive joint damage and can lead to lifelong disability. Numerous studies support the hypothesis that reactive oxygen species (ROS) are associated with RA pathogenesis. Recent advances have clarified the anti-inflammatory effect of antioxidants and their roles in RA alleviation. In addition, several important signaling pathway components, such as nuclear factor kappa B, activator-protein-1, nuclear factor (erythroid-derived 2)-like 2/kelch-like associated protein, signal transducer and activator of transcription 3, and mitogen-activated protein kinases, including c-Jun N-terminal kinase, have been identified to be associated with RA. In this paper, we outline the ROS generation process and relevant oxidative markers, thereby providing evidence of the association between oxidative stress and RA pathogenesis. Furthermore, we describe various therapeutic targets in several prominent signaling pathways for improving RA disease activity and its hyper oxidative state. Finally, we reviewed natural foods, phytochemicals, chemical compounds with antioxidant properties and the association of microbiota with RA pathogenesis.
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Affiliation(s)
- Naoki Kondo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Tomotake Kanai
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata 951-8510, Japan
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Ortolan A, Felicetti M, Lorenzin M, Cozzi G, Ometto F, Striani G, Favero M, Doria A, Ramonda R. The impact of diet on disease activity in spondyloarthritis: A systematic literature review. Joint Bone Spine 2023; 90:105476. [PMID: 36404571 DOI: 10.1016/j.jbspin.2022.105476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Our study aimed to systematically review the evidence about the effect of diet or dietary supplements on spondyloarthritis (SpA) disease activity. METHODS a systematic literature review (SLR) was conducted in MEDLINE, EMBASE, Cochrane and SCOPUS according to the "PEO" format (Population, Exposure, Outcome). The population was SpA (axial or peripheral, axSpA/pSpA, including Psoriatic Arthritis-PsA); the intervention any kind of diet/dietary supplement; the outcome disease activity. Inclusion criteria were: adult patients, Randomized Controlled Trials (RCTs) and longitudinal studies (so that a pre-and post-intervention assessment were available), papers in English. Risk of bias (RoB) was conducted with different tools according to the design of the study. RESULTS Literature search yielded 1390 publications, of which 15 were finally inlcuded: 12 interventional and 3 observational studies. Among those with the lower RoB: a) 2 RCTs, one at unclear and one at low RoB, failed to show benefit of probiotics in SpA b) Two RCTs at unclear RoB provided evidence that weight loss, but not hypocaloric diet, was associated to MDA achievement in PsA. The remaining interventional studies were at high RoB. Among the observational studies, one study on Mediterranean diet demonstrated an association between diet adherence and a ≥ 20% decrease of ASDAS in axSpA. The other two observational studies were judged of poor quality. CONCLUSIONS weight loss seem to be able to impact disease activity in PsA, while probiotics do not seem useful in SpA; evidence for dietary behaviors is scarce and heterogeneous.
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Affiliation(s)
- Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; ULSS 6 Euganea Company, Padova, Italy
| | - Giovanni Striani
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy; Internal Medicine Unit I, Ca' Foncello Hospital, Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, PD, Italy.
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Answer to Ben Nessib et al. Joint Bone Spine 2023;90:105539. Joint Bone Spine 2023; 90:105542. [PMID: 36764574 DOI: 10.1016/j.jbspin.2023.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
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9
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Comment on: "The impact of diet on disease activity in spondyloarthritis: A systematic literature review" by Ortolan et al. Joint Bone Spine 2022;90:105476. Joint Bone Spine 2023; 90:105539. [PMID: 36758894 DOI: 10.1016/j.jbspin.2023.105539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
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10
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Yang M, Chen W, He L, Liu D, Zhao L, Wang X. Intermittent Fasting—A Healthy Dietary Pattern for Diabetic Nephropathy. Nutrients 2022; 14:nu14193995. [PMID: 36235648 PMCID: PMC9571963 DOI: 10.3390/nu14193995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic nephropathy (DN), a metabolic disease, is characterized by severe systemic metabolic disorders. A unique dietary pattern, such as intermittent fasting (IF) has shown promising protective effects on various metabolic diseases, such as diabetes and cardiovascular and nervous system diseases. However, its role in regulating kidney disease, especially in DN, is still being investigated. Here, we summarize the current research progress, highlighting the relationship between IF and the risk factors for the progression of DN, and discuss the potential mechanisms by which IF improves renal injury in DN. Finally, we propose IF as a potential strategy to prevent and delay DN progression. Abbreviation: DN: Diabetic nephropathy; IF: Intermittent fasting; CPT1A: Carnitine palmitoyltransferase 1A; L-FABP: Liver-type fatty acid-binding protein; STZ: Streptozotocin; LDL: Low-density lipoproteins; HIIT: High-intensity interval training; CKD: Chronic kidney disease; ACEI: Angiotensin-converting enzyme inhibitors; ARB: Angiotensin receptor blockers; MDA: Malondialdehyde; mtDNA: Mitochondrial DNA; UCP3: Uncoupling protein-3; MAM: Mitochondria-associated endoplasmic reticulum membrane; PBMCs: Peripheral blood mononuclear cells; ERK1/2: Extracellular signal-regulated kinase 1/2; DRP1: Dynamin-related protein 1; β-HB: β-Hydroxybutyrate; AcAc: Acetoacetate; GEO: Gene Expression Omnibus; NCBI: National Center for Biotechnology Information; mTORC1: Mechanistic target of rapamycin complex 1; HMGCS2: 3-Hydroxy-3-methylglutaryl-CoA synthase 2; GSK3β: Glycogen synthase kinase 3β; AKI: Acute kidney injury; CMA: Chaperone-mediated autophagy; FGF21: Fibroblast growth factor 21.
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Affiliation(s)
- Ming Yang
- Department of Nutrition, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Wei Chen
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Liyu He
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Di Liu
- Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Li Zhao
- Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xi Wang
- Department of Nutrition, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Correspondence:
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Lanspa M, Kothe B, Pereira MR, Kesselman MM, Petrosky SN. A Systematic Review of Nutritional Interventions on Key Cytokine Pathways in Rheumatoid Arthritis and Its Implications for Comorbid Depression: Is a More Comprehensive Approach Required? Cureus 2022; 14:e28031. [PMID: 35990558 PMCID: PMC9380898 DOI: 10.7759/cureus.28031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with both local and systemic inflammatory processes via the aberrant regulation of inflammatory pathways and imbalances in several mediators of inflammation. Cytokines, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1B, IL-6, IL-17, IL-18, rheumatoid factor, anti-cyclic citrullinated protein, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have been used in diagnosing and tracking the progression of RA. The primary objective of this review is to identify and summarize which specific dietary patterns and nutritional interventions go beyond symptom management to improve the response to known inflammatory cytokines and possibly decrease markers of inflammation in the RA disease process. Analysis of the 41 identified publications demonstrated that certain dietary patterns, the consumption of specific macronutrients, and supplementation with herbals or other compounds have shown some effect on improving cytokine profiles in patients with RA. This review illustrates the importance of proper patient education on the anti-inflammatory and potential protective impacts substantial dietary change may have on the disease progression and symptoms of RA. Identifying nutritional interventions and dietary patterns that improve the inflammatory cytokine profile, and therefore disease progression and inflammatory comorbidities of RA will help further focus research on treatments that may provide a better overall improvement in quality of life for RA patients by focusing on the root cause inflammatory processes that affect not only joint destruction but also depression-rated disability. This review further notes that while depression is commonly found in patients who suffer from chronic illnesses, it is especially prevalent in the RA population. The pathology of depression is associated with systemic inflammation, which is a known outcome of RA and may explain this strong association. Cytokines IL-6, IL-1, and TNF-α, known mediators involved in the progression of RA, are strongly associated with stress-related disorders including depression and anxiety. The presence of these cytokines is also correlated with the severity and duration of depression. This may signal a potential use of cytokines in diagnosing and following the progression of depression not only in patients with RA but also others. Given the statistics presented on depression and suicide in patients with RA, and the shared inflammatory pathway between the two diseases, depression and suicide screening scales should be included along with analysis of inflammatory markers and disease activity scores (DAS) in any future RA study.
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12
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Caron JP, Kreher MA, Mickle AM, Wu S, Przkora R, Estores IM, Sibille KT. Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum. Nutrients 2022; 14:nu14122536. [PMID: 35745266 PMCID: PMC9228511 DOI: 10.3390/nu14122536] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Dietary behavior can have a consequential and wide-ranging influence on human health. Intermittent fasting, which involves intermittent restriction in energy intake, has been shown to have beneficial cellular, physiological, and system-wide effects in animal and human studies. Despite the potential utility in preventing, slowing, and reversing disease processes, the clinical application of intermittent fasting remains limited. The health benefits associated with the simple implementation of a 12 to 16 h fast suggest a promising role in the treatment of chronic pain. A literature review was completed to characterize the physiologic benefits of intermittent fasting and to relate the evidence to the mechanisms underlying chronic pain. Research on different fasting regimens is outlined and an overview of research demonstrating the benefits of intermittent fasting across diverse health conditions is provided. Data on the physiologic effects of intermittent fasting are summarized. The physiology of different pain states is reviewed and the possible implications for intermittent fasting in the treatment of chronic pain through non-invasive management, prehabilitation, and rehabilitation following injury and invasive procedures are presented. Evidence indicates the potential utility of intermittent fasting in the comprehensive management of chronic pain and warrants further investigation.
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Affiliation(s)
- Jesse P. Caron
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Margaret Ann Kreher
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Angela M. Mickle
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Stanley Wu
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Rene Przkora
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
- Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Irene M. Estores
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
| | - Kimberly T. Sibille
- Pain TRAIL—Translational Research in Assessment & Intervention Lab, Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 32607, USA; (J.P.C.); (M.A.K.); (A.M.M.); (S.W.); (R.P.); (I.M.E.)
- Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Correspondence:
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Negm M, Bahaa A, Farrag A, Lithy RM, Badary HA, Essam M, Kamel S, Sakr M, Abd El Aaty W, Shamkh M, Basiony A, Dawoud I, Shehab H. Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study. BMC Gastroenterol 2022; 22:203. [PMID: 35462542 PMCID: PMC9036734 DOI: 10.1186/s12876-022-02272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. Methods Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. Results 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. Conclusions In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).
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Popa SL, Dumitrascu DI, Brata VD, Duse TA, Florea MD, Ismaiel A, Muntean LM, Grad S. Nutrition in Ankylosing Spondyloarthropathies and Related Immune-Mediated Disorders. Nutrients 2022; 14:nu14061278. [PMID: 35334935 PMCID: PMC8951113 DOI: 10.3390/nu14061278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022] Open
Abstract
Recent research on the pathogenesis of spondyloarthritis and related immune-mediated diseases associated with human leukocyte antigen class I molecule B27 (HLA-B27) has led to significant progress in terms of management and prognosis, with multiple treatments being constantly evaluated and implemented. Correlations between the genetic background of spondyloarthritis and inflammatory bowel diseases and the inflammatory processes involving gut microbiota have been established. This knowledge has allowed progress in pharmacological therapy. The role of diet in the pathogenesis and treatment of diseases pertaining to the HLA-B27 spectrum is of great significance, considering possible future applications in individualized medicine. Diet impacts the composition of gut microbiota, representing a substrate for the synthesis of metabolites affecting the mucosal immune system. Certain pro-inflammatory mediators, such as emulsifiers and microparticles, induce a more profound cytokine response, promoting inflammation. Numerous diets, including the low-starch diet, the Mediterranean diet, diets with low contents of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP diets), gluten-free diets and fasting, have been analysed and correlated with patients’ symptomatology and dietary adherence. The aim of this review is to provide an extensive perspective on the diets available to patients with spondyloarthritis and related immune-mediated disorders.
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Affiliation(s)
- Stefan Lucian Popa
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.)
| | - Dinu Iuliu Dumitrascu
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Correspondence:
| | - Vlad Dumitru Brata
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (M.D.F.)
| | - Traian Adrian Duse
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (M.D.F.)
| | - Maria Delia Florea
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (M.D.F.)
| | - Abdulrahman Ismaiel
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.)
| | - Laura Mirela Muntean
- Rheumatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj, 400012 Cluj-Napoca, Romania;
| | - Simona Grad
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.)
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15
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Stromal cell regulation of inflammatory responses. Curr Opin Immunol 2021; 74:92-99. [PMID: 34847474 DOI: 10.1016/j.coi.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022]
Abstract
In the last fifteen years it has become apparent that tissue-resident mesenchymal cells such as fibroblasts, which are the structural elements of all organs, play a cardinal role in the pathology of immune-mediated inflammatory diseases. We now know that all fibroblasts originate from universal pan-organ cellular ancestors and that they are diversified into more specific subsets according to the functional needs of their home tissue-and its activation state. In arthritis, a plethora of activated joint-resident and migrating fibroblast types have been recently described that are central for pathogenesis and persistence of inflammatory joint-disease. Here we provide a current overview on the multiple inflammatory and immune-related functions of fibroblasts and how they could be curbed to induce long-lasting abatement of disease.
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Ben Nessib D, Maatallah K, Ferjani H, Triki W, Kaffel D, Hamdi W. Sustainable positive effects of Ramadan intermittent fasting in rheumatoid arthritis. Clin Rheumatol 2021; 41:399-403. [PMID: 34505214 DOI: 10.1007/s10067-021-05892-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/23/2022]
Abstract
The short-term positive effects of intermittent fasting during the month of Ramadan on rheumatic inflammatory diseases have been previously evaluated. The objective of this study was to assess the sustainability of these effects on rheumatoid arthritis (RA) activity. This prospective study included 35 patients with RA, who observed fasting during Ramadan 2019. The disease activity was assessed and compared between three time points: T1 (6 months before the beginning of Ramadan), T2 (during the month between the 7th day of fasting and the 7th day after Ramadan), and T3 (averagely 3.4 months after fasting). The disease activity score 28 (DAS28) was used to evaluate the disease activity. After a significant decrease of all disease activity parameters between T1 and T2, a gradual increase of clinical and biological outcomes was seen between T2 and T3. Except for CRP, which was significantly higher at T3 (p = 0.02), the changes of the other disease activity parameters were not statistically significant. By reference to baseline data (T1), the decrease of ESR, DAS28 CRP, and DAS28 ESR induced after Ramadan fast was maintained until T3, with statistically significant differences. We can therefore conclude that this study has been conducted at the beginning of the fading-out of the effects of Ramadan fast, and that the duration of 3 months may be the recommended interval between fasting periods to maintain the positive effects of intermittent fasting on RA activity. Key Points • Intermittent fasting can induce a rapid improvement of rheumatoid arthritis activity. • The positive effects of this model of fasting can last up to 3 months. • The recommended interval between fasting periods may be estimated at 3 months.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia.
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Hanene Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Wafa Triki
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
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Beverages in Rheumatoid Arthritis: What to Prefer or to Avoid. Nutrients 2020; 12:nu12103155. [PMID: 33076469 PMCID: PMC7602656 DOI: 10.3390/nu12103155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The role of nutrition in the pathogenesis of rheumatic diseases, including rheumatoid arthritis (RA), has gained increasing attention in recent years. A growing number of studies have focussed on the diverse nutritional contents of beverages, and their possible role in the development and progression of RA. Main body: We aimed to summarise the current knowledge on the role of a range of beverages in the context of RA. Beverages have a key role within the mosaic of autoimmunity in RA and potential to alter the microbiome, leading to downstream effects on inflammatory pathways. The molecular contents of beverages, including coffee, tea, and wine, have similarly been found to interfere with immune signalling pathways, some beneficial for disease progression and others less so. Finally, we consider beverages in the context of wider dietary patterns, and how this growing body of evidence may be harnessed by the multidisciplinary team in patient management. Conclusions: While there is increasing work focussing on the role of beverages in RA, integration of discussions around diet and lifestyle in our management of patients remains sparse. Nutrition in RA remains a controversial topic, but future studies, especially on the role of beverages, are likely to shed further light on this in coming years.
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Ben Nessib D, Maatallah K, Ferjani H, Kaffel D, Hamdi W. The potential effect of Ramadan fasting on musculoskeletal diseases: new perspectives. Clin Rheumatol 2020; 40:833-839. [PMID: 32683662 DOI: 10.1007/s10067-020-05297-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/14/2022]
Abstract
Ramadan, the ninth month of the Muslim lunar calendar, is a period of intermittent fasting alternated with moments of refeeding. The last decades have seen a growing number of reports that examine the potential effect of Ramadan intermittent fasting (RIF) on chronic musculoskeletal disorders. In this paper, we reviewed data that assessed the relationship of intermittent diurnal fasting during Ramadan with rheumatic diseases. Currently, recent evidence indicates that RIF may attenuate the inflammatory state by suppressing pro-inflammatory cytokine expression and reducing the body fat and the circulating levels of leukocytes. Therefore, it may be a promising non-pharmacological approach for managing the course of rheumatic inflammatory diseases. Despite differences between studies in daily fasting duration and dietary norms, there appears to be a consensus that most of the patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) who fasted Ramadan experienced relief of their symptoms. Nevertheless, further clinical trials are required to assess the effect of RIF on other musculoskeletal and bone disorders. Additionally, we evaluated the impact of RIF on chronic medication intake. Even if a few studies on this issue are available, the primary outcomes indicate that RIF does not significantly impair either compliance or tolerance to chronic medications. These findings may give some reassurance to patients with a specific fear of drug intake during this month. Key Points • Intermittent diurnal fasting during Ramadan can modulate the inflammatory status through the down-regulation of metabolic syndrome, the reduction of pro-inflammatory cytokines, and the reduction of circulating levels of leukocytes • Ramadan intermittent fasting (RIF) can effectively improve the activity of rheumatic inflammatory diseases. • Although further studies are still required, there seems no harm for patients with gout to participate in RIF. • Primary outcomes indicate that RIF may be a promising non-pharmacological intervention for the management of patients with osteoarthritis and osteoporosis.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Said, Tunisia. .,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia. .,Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia.
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Said, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Hanene Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Said, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Said, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Said, Tunisia.,Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.,Research Unit UR17SP04, 2010, Ksar Said, Tunis, Tunisia
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