Diet in Rheumatic diseases at the EULAR 2014 Meeting
in Paris
[SP0022] H. Thorseng reported about " Food as therapy –
supporting healthy choices". The
Danish Rheumatism Assosiation gives free
information either through their website, their mailbox or their hotline advice
service. On the free helpline "people with RMDs and their relatives can
talk to a professional adviser e.g. a nutritionist."
[SP0025]
Another talk was by M. Cutolo, EULAR president, on
Vitamin D status. He pointed out: "80%
of the vit D needs are obtained through exposure to sunlight: ,,," "
a sunscreen with a sun protection factor (SPF) of 8 reduces the capacity of the
skin to produce vit D3 by >95%!" He advises to use dietary supplements and
fortified foods, but I must add that fortified foods aren't available
everywhere due to legislation. Vitamin D is available as D2 (ergocalciferol)
and D3 (cholecalciferol). he suggested taking 1,500 -2,000 IU
per day during in winter.
[SP0025]
K. Betteridge's talk has been on "FOOD CHALLENGES - GETTING IN; GETTING IT ON;
GETTING IT OFF". His conclusion: "With the right information, motivation and support, it
is possible to make healthy choices in order to maintain a healthy diet when
living with an RMD [people with rheumatic or musculoskeletal diseases]."
[SP0106]
J. Richardson talked on "EHEALTH LITERACY ON RHEUMATIC DISEASES: ANALYSING THE
POWER OF THE INTERNET: HEALTH TALK ONLINE - PATIENTS’
EXPERIENCE OF GOUT". In his talk he pointed out: " Many people found a lot of conflicting and confusing information
about diet and complementary treatments on the internet." And that is true
for other diseases as well.
[OP0010-HPR]
Y. Matsumoto and colleagues lokked at
"INTAKE OF MONOUNSATURATED FATTY ACIDS
AS COMPONENTS OF A MEDITERRANEAN DIET SUPPRESSES RHEUMATOID ARTHRITIS DISEASE
ACTIVITY – THE TOMORROW STUDY". T&he study showed that
RA patients' intake is lower than of healthy volunteers. However, a high intake of MUFA was an independent predictor of
remission in patients with RA. The authors concluded: "The daily intake of MUFA, a component of the
Mediterranean diet, might suppress disease activity in patients with RA."
[OP0195]
B. Sundstrom and colleagues presented:
"HIGH SODIUM INTAKE AMONG SMOKERS IS A
RISK FACTOR FOR ACPA POSITIVITY IN RA". Conclusions: "High dietary intake of sodium among smokers was
associated with an increased risk to develop ACPA positive RA and there was a
significant interaction between the two environmental factors – sodium
intake and smoking in conferring to this increased disease risk."
These findings should find way into
preventive medicine. Once the avanlanche is started it runs down. So we have to
warn more against smoking and high intake of sodium.
[THU0030]
S. Abou-Raya and collegues looked at
"NUTRITIONAL STATUS IN RELATION TO
INFLAMMATORY AND OXIDATIVE STRESS MARKERS: ASSOCIATION WITH DISEASE ACTIVITY IN
PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS". They found 27% of pats. were obese, while 10% were malnourished.
" The dietary intake assessment showed a lower intake consumption of fresh
fruit, vegetables, milk and other dairy products and an increased intake of
fats and oils. Low intake of iron, calcium and zinc was found in 35%, 58% and
78% respectively." In their conclusions they stated: "Interventions aimed
at promoting adequate nutritional status may have beneficial effects by
decreasing inflammation and oxidative stress and thus may contribute to
reduction of comorbidities and improved quality of life in these
patients."
[AB0145]
S.M. Jung and colleagues presented the
following study; "SODIUM
CHLORIDE AGGRAVATES ARTHRITIS BY TH17
POLARIZATION". Results: "NaCl promoted the induction of Th17 cells from PBMC in
RA patients. Th17 differentiation was progressively upregulated as NaCl
concentration increased upto 60 mM. Correspondingly, high salt diet exacerbated
the arthritis of CIA mice." Conclusions:
"This study suggests that NaCl can
aggravate arthritis via Th17 differentiation. High salt condition can
contribute to the development and progression of RA." Another hint to
advocate low sodium diets to people with rheumatic or musculoskeletal diseases.
[AB1042]
B. Sundstrom and colleagues looked at:
"DIETARY PATTERNS, MACRONUTRIENTS AND
ALCOHOL AS RISK FACTORS FOR RHEUMATOID ARTHRITIS". "The study included 386 individuals (271 women, 115
men) who previously had stated their dietary habits as part VIP (Vasterbotten
Intervention Program= before the onset of symptoms of RA." Conclusions: "There were no significant associations of the dietary
patterns studied on the risk for development of RA in this cohort. Neither were
there any associations to the risk for RA with alcohol consumption and on diet
examined as macronutrients." That's sobering!
[AB1191-HPR]
S. Meyfroidt and colleagues presented
this meta-study: "NUTRITIONAL
INTERVENTIONS IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS: A REVIEW OF THE
LITERATURE". "Our search
strategy yielded 19 randomized, placebo-controlled clinical
trials including 3 crossover
trials." There were ony two trials on diet therapies. "Evidence was
found for a reduction in inflammatory activity by adjusting to a Mediterranean
or a calorie restriction diet. However, these diets were difficult to comply
with and maintain in the long-term." Conclusions: "Supplementation of n-3 fatty acids, a low n-6 fatty
acids intake and some diet therapies appeared to have a positive effect in
patients with RA. However, most nutritional interventions cannot be effectively
and safely recommended for the management of RA due to the limited number of
trials, the inconsistencies between trials and the limits of applicability in
patients’ daily life. The current evidence suggests that some
supplements and suitable diet therapies may warrant further
investigation."
I think the last study is also the most
interesting. Patients ask what they can do in form of dietary changes, but we
still lack studies.
I'll advise to stop smoking, lower
intake of omega-6 fatty acids, increase omega-3 fatty acids, use olive oil,
supplement viatmin D3, lower sodium intake. Advice, which isn't based on the
above studies might include reducing meat, increasing fruits and veggies,
reducing purines.
