Adherence to the mediterranean diet and its association with disease activity and damage accrual in women with systemic lupus erythematosus

Background: There is limited evidence regarding the impact of the Mediterranean Diet (Med Diet) on autoimmune diseases although it has been proposed that adherence to the Med Diet may decrease the risk of certain autoimmune diseases. However, the potential usefulness of the Med Diet as a high-quality dietary pattern for other autoimmune diseases such as SLE has not yet been investigated. Objectives: The aim of this study was to evaluate the potential association between the adherence to the Med Diet and disease activity, damage accrual and SLE-related clinical markers in a large cohort of women with SLE. Methods: In this cross-sectional study, we assessed Med Diet adherence through a 14-item questionnaire in 253 women with SLE (mean age 46.74 ± 12.70 years). The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Levels of C-reactive protein (CRP; mg/dL), homocysteine (Hcy; mol/L), anti-double stranded DNA antibodies (anti-dsDNA) (IU/mL), complement C3 (mg/dL), and complement C4 (mg/dL) were determined. Results: The Med Diet adherence score was classified as follows: low adherence (≤ 5 points); medium adherence (6–9 points) and good adherence (≥ 10 points). Only 50.2% of the SLE women had good adherence to the Med Diet. The ANCOVA models showed significant differences between patients with good adherence to the Med Diet and those with medium and low adherence in SLEDAI (p ≤ 0.001) and SDI (p ≤ 0.001). Age, medical treatment (immunosuppressors, corticoids, or antimalarials), smoking status, and body mass index (BMI) were included as confounding factors. The odds ratio (OR) for having active SLE (SLEDAI ≥ 5) or the presence of damage (SDI ≥ 1) was lower among patients whose Med Diet score was higher (p ≤ 0.001). Conclusion: Adherence to the Med Diet influences disease activity and damage accrual in SLE women. Thus, these patients would benefit from nutritional counselling and education on modification, to help adapt their lifestyles towards the Med Diet pattern. This would help slow the progression of SLE and the damage it causes. References: [1]Sedaghat F, Jessri M, Behrooz M, Mirghotbi M, Rashidkhani B. Mediterranean diet adherence and risk of multiple sclerosis: a case-control study. Asia Pac J Clin Nutr. 2016;25(2):377–84. [2]orsyth C, Kouvari M, D’Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, et al. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018 May 18;38(5):737–47. [3]Minihane AM, Vinoy S, Russell WR, Baka A, Roche HM, Tuohy KM, et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr. 2015 Oct 14;114(7):999–1012. Acknowledgements: This research was supported by the grant PI0523-2016 from “Consejeria de igualdad, salud y politicas sociales” (Junta de Andalucia) and is part of the research group LyDIMED “Lupus y Dieta Mediterranea”. Disclosure of Interests: None declared