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Mostafaei R, Elahi N, Moludi J, Moradi F, Solouki L, Nachvak SM, Behrooz M. Association of Mediterranean diet pattern with disease activity in the patients with rheumatoid arthritis: A cross-sectional study on Iranian patients. Clin Nutr ESPEN 2024; 60:95-101. [PMID: 38479945 DOI: 10.1016/j.clnesp.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Rheumatoid arthritis is a systemic autoimmune disease that causes joint erosion, as well as damage to extra-articular organs. The aim of this study was the investigation of the association between the Mediterranean diet quality index with disease activity in patients with rheumatoid arthritis. METHODS In this cross-sectional study 184 females with rheumatoid arthritis were studied in Kermanshah, Iran. The American College of Rheumatology's 2010 criteria were used to diagnose RA. The biochemical tests including erythrocyte sedimentation rate, C-reactive protein, rheumatoid facto, anti-nuclear antibody titration, antibodies against cyclic citrulline peptide, disease activity score 28 and the food frequency questionnaire was used to assess rheumatoid arthritis activity and the Mediterranean diet quality index, respectively. To compare the dietary intakes of participants across tertiles of Mediterranean diet score, we used Analysis of Variance. Multinomial logistic regression with three adjusted models was used to investigate the association between Mediterranean diet score with disease activity. RESULTS 184 eligible patients with rheumatoid arthritis participated in this study. The mean age and duration of disease, body mass index, waist circumference and percent body fat did not differ significantly among the tertiles of the Mediterranean diet score (P-value>0.05). Participants in the highest tertile of Mediterranean diet score had significantly greater intakes of fruits, vegetables, fish, legume, nuts and had lowest intake of grains (refrain grain) and red and process meats to white meat ratio (P-value<0.05). There was no significant difference in terms of variables related to disease activity among the tertiles of the Mediterranean score (P-value>0.05). In multi-adjusted models, the odds ratio of Mediterranean diet scores no significant different in the third as compared to the first tertile of Mediterranean diet score (P-value>0.05). CONCLUSION Based on our findings there is no association between the Mediterranean diet score and disease activity of people with rheumatoid arthritis.
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Affiliation(s)
- Roghayeh Mostafaei
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; Nutritional Sciences Department, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Elahi
- Nutritional Sciences Department, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalal Moludi
- Nutritional Sciences Department, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fardin Moradi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; Nutritional Sciences Department, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Solouki
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mostafa Nachvak
- Nutritional Sciences Department, School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Maryam Behrooz
- Department of Biochemistry and Diet Therapy, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Westerlind H, Dukuzimana J, Lu X, Alfredsson L, Klareskog L, Di Giuseppe D. Investigation of the association between coffee and risk of RA-results from the Swedish EIRA study. Arthritis Res Ther 2022; 24:178. [PMID: 35883099 PMCID: PMC9317433 DOI: 10.1186/s13075-022-02862-2] [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: 12/22/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on the association between coffee, a modifiable lifestyle factor, and rheumatoid arthritis (RA), a chronic autoimmune disease primarily affecting the joints, have been conflicting. The aim of the present study was to study the association between coffee consumption and risk of RA in the context of different lifestyle factors. METHODS We included 2184 cases (72% women, mean age 55 years) newly diagnosed with RA during 2005-2018 in Sweden and 4201 controls matched on age, sex, and residential area. Data on coffee consumption was collected through a food frequency questionnaire and categorized into < 2 (reference), 2-< 4, 4-< 6, and ≥ 6 cups/day. We calculated odds ratios (OR) with 95% confidence intervals (CI) for coffee consumption and risk of RA, in a crude model (taking matching factors into account), and then adjusted first for smoking and further for BMI, educational level, alcohol consumption, and physical activity. We also stratified analyses on sex, smoking, rheumatoid factor, and anti-CCP2 status. RESULTS In the crude model, high coffee consumption was associated with increased risk of RA (OR = 1.50, 95% CI 1.20-1.88 for ≥ 6 cups/day compared to < 2 cups). After adjusting for smoking, the OR decreased and was no longer statistically significant (OR = 1.16, 95% CI 0.92-1.46) and decreased further in the full model (OR = 1.14 95% CI 0.89-1.45). This pattern held true in all strata. CONCLUSION The findings from this large, population-based case-control study did not support a significant association between coffee consumption and risk of RA as a whole nor within different subgroups.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden.
| | - Justine Dukuzimana
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Xiaomin Lu
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Division, Department of Medicine (Solna), Karolinska Institutet, Solna, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
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Turesson Wadell A, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Inadequate Dietary Nutrient Intake in Patients With Rheumatoid Arthritis in Southwestern Sweden: A Cross-Sectional Study. Front Nutr 2022; 9:915064. [PMID: 35799579 PMCID: PMC9255550 DOI: 10.3389/fnut.2022.915064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with rheumatoid arthritis (RA), who suffer from impaired physical function and fatigue, may have difficulties with grocery shopping and preparing meals. Also, to improve symptoms, patients often experiment with diets but seldom consult a dietitian. Although this could lead to a nutritiously deprived diet, an up-to-date, thorough description of the nutrient intake in Swedish patients with RA is absent. Here, we investigated the habitual dietary energy and nutrient intake in patients with RA living in southwestern Sweden.Materials and MethodsThree-day food records performed at two time points during the ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis) trial, were used. The intake of energy and nutrients was analyzed using The Swedish Food Composition Database.ResultsA total of 62 participants (50 females, 12 males) were included in the study, where 18 participants completed one 3-day food record and 44 participants completed two 3-day food records. Median (IQR) intake of total fat was above or in the upper range of recommendations (females: 37.1 [32.5, 41.7] energy percent (E%), and males: 40.3 [37.5, 42.9] E%). Median (IQR) intake of saturated fatty acids exceeded recommendations (females: 14.9 [12.5, 17.0] E% and males: 15.4 [12.2, 17.0] E%), while median (IQR) carbohydrate and fiber intakes were below recommendations (females: 41.7 [36.3, 45.4] E% and 17.2 [12.8, 20.9] g, respectively, and males: 38.8 [35.2, 40,3] E% and 18.5 [15.7, 21.0] g, respectively). The reported intake of other macronutrients was in line with recommendations. For several micronutrients, e.g., vitamin A and D, folate, and calcium, median intake was below recommended intake. Vitamin A intake was especially low and did not reach lower intake level (LI) for 14 and 17% of females and males, respectively. For females, about 10% did not reach LI for vitamin D, calcium, and riboflavin.ConclusionWe found that patients with RA residing in southwestern Sweden reported a high intake of saturated fatty acids and low intake of fiber and several micronutrients.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT02941055?term=NCT02941055&draw=2&rank=1], identifier [NCT02941055].
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Affiliation(s)
- Anna Turesson Wadell
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- *Correspondence: Anna Turesson Wadell,
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Hulander
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen M. Lindqvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Westerlind H, Palmqvist I, Saevarsdottir S, Alfredsson L, Klareskog L, Di Giuseppe D. Is tea consumption associated with reduction of risk of rheumatoid arthritis? A Swedish case-control study. Arthritis Res Ther 2021; 23:209. [PMID: 34362418 PMCID: PMC8349003 DOI: 10.1186/s13075-021-02583-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tea is a popular beverage around the world and has properties that can affect the immune system. The association between tea consumption and the risk of rheumatoid arthritis (RA), a chronic autoimmune disease primarily affecting the joints, is not well studied and results are conflicting. METHODS We collected data on tea consumption for 2237 incident RA cases diagnosed 2005-2018 and 4661 controls matched on age, sex, and residential area. Tea consumption was classified into no (0 cups/day), irregular (< 1 cup/day), regular (1-2 cups/day), and high (≥ 2 cups/day) consumption, and irregular consumption was used as the reference category. Missing data on tea consumption was classified as no consumers, and sensitivity analyses were performed to test this assumption. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression, adjusting for smoking, coffee, alcohol, educational level, and body mass index. We also performed stratified analysis on sex, anti-citrullinated autoantibody (ACPA) status, and smoking habits. RESULTS Among the cases, we found 57.3% to be ever consumers of tea with 19.7 having a high tea consumption. Corresponding figures for the controls were 58.4% ever drinkers with 22.1% high tea consumers. High tea consumption had an inverse association to the risk of RA compared to irregular consumption [OR = 0.78 (95% CI 0.66-0.92)], but the association lost statistical significance in the adjusted model [adjusted OR (adjOR) = 0.85 (95% CI 0.71-1.01)]. Among non-tea consumers, a protective effect was also observed compared to irregular consumers [adjOR = 0.82 (95% CI 0.70-0.88)], but this association did not withstand sensitivity analysis, possibly due to bias. In the ACPA-positive group and among current smokers, a protective effect of tea consumption was observed among the high tea consumers [adjOR = 0.76 (95% CI 0.62-0.94) and adjOR = 0.60 (95% CI 0.38-0.95), respectively]. CONCLUSIONS This study suggests a protective effect of high consumption of tea, among smokers and for ACPA-positive RA. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Ida Palmqvist
- Rheumatology Division, Department of Medicine (Solna), Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Division, Department of Medicine (Solna), Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Comment on "Long-Term Dietary Changes after Diagnosis of Rheumatoid Arthritis in Swedish Women: Data from a Population-Based Cohort". Int J Rheumatol 2019; 2019:1939686. [PMID: 30719045 PMCID: PMC6334344 DOI: 10.1155/2019/1939686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022] Open
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Johansson K, Askling J, Alfredsson L, Di Giuseppe D. Mediterranean diet and risk of rheumatoid arthritis: a population-based case-control study. Arthritis Res Ther 2018; 20:175. [PMID: 30092814 PMCID: PMC6085628 DOI: 10.1186/s13075-018-1680-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background The Mediterranean diet has been associated with lower mortality and lower risk of cardiovascular diseases and cancer. Although its components have been analysed in several studies, only one study has specifically investigated the association between Mediterranean diet and risk of rheumatoid arthritis (RA), and reported no association. Methods Data on 1721 patients with incident RA (cases) and 3667 controls, matched on age, gender and residential area, from the Swedish epidemiological investigation of RA (EIRA), a population-based case-control study, were analysed using conditional logistic regression. The Mediterranean diet score, ranging from 0 to 9, was calculated from a 124-item food frequency questionnaire. Results In the EIRA study (median age of participants 53 years), 24.1% of the patients and 28.2% of the controls had high adherence to the Mediterranean diet (a score between 6 and 9). After adjustments for body mass index, educational level, physical activity, use of dietary supplements, energy intake, and smoking, high adherence reduced the odds of developing RA by 21% (OR 0.79; 95% CI 0.65–0.96) as compared to low adherence (a score between 0 and 2). The OR was even lower among men (OR 0.49; 95% CI 0.33–0.73), but no significant association was found among women (OR 0.94; 95% CI 0.74–1.18). An association between high diet score and low risk of RA was observed in rheumatoid factor (RF)-positive (OR 0.69; 95% CI 0.54–0.88), but not RF-negative RA (OR 0.96; 95% CI 0.68–1.34), and in RA characterised by presence of antibodies to citrullinated peptides (ACPA), but not in ACPA-negative RA. Conclusions In this large population-based case-control study, the Mediterranean diet score was inversely associated with risk of RA. However, an association was only found among men and only in seropositive RA. Electronic supplementary material The online version of this article (10.1186/s13075-018-1680-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kari Johansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Johan Askling
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, SE-171 76, Stockholm, Sweden.,Department of Medicine, Solna, Rheumatology Division, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden
| | - Daniela Di Giuseppe
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
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