Mediterranean Diet in Axial Spondyloarthritis

An Observational Study in an Italian Monocentric Cohort

Francesca Ometto; Augusta Ortolan; Davide Farber; Mariagrazia Lorenzin; Giulia Dellamaria; Giacomo Cozzi; Marta Favero; Romina Valentini; Andrea Doria; Roberta Ramonda

Disclosures

Arthritis Res Ther. 2021;23(219) 

In This Article

Results

Among a total of 378 axSpA evaluated patients, 222 fulfilled the inclusion criteria and were willing to participate in the study; 61 were excluded because of an ongoing specific diet, other rheumatological overlapping conditions, diabetes mellitus/metabolic syndrome, or very high disease activity. One hundred and sixty-one patients were included in the study: 81 in N and 80 in C. Of these patients, 47 in N and 63 in C completed the evaluation at T6. T6 evaluations of patients included in the study were completed in April 2020.

Characteristics of the Patients

Characteristics of all patients and patients in N and C are reported in Table 1. Among 110 patients with complete data, 40 (36.4%) were females and 70 males (63.6%): the mean age was 51.7 ± 1.3 years, 58 (52.7%) patients were affected with psoriasis, and mean disease duration was 15.3 ± 9.7 years. No significant difference emerged between subjects in the two study groups at T0.

Clinical Measures

Clinical and laboratory characteristics of the patients at T0 and T6 and the T0–T6 change are reported in Table 2 and Table 3. No significant differences emerged between the two groups in characteristics at T0 and T6. A significant difference was observed in the ASDAS-CRP T0–T6 change which improved more in N (Δ −0.1 ± 0.7) compared to C (Δ 0.2 ± 0.8) (p = 0.003). A significant, but slight, worsening of the HbA1c levels was also observed in N (Δ 7.3 ± 21.5) compared to C (Δ 2.7 ± 5.6) (p = 0.01).

Notably, a significant difference was observed in the regular physical activity reported by patients at T6 which was more frequent in N vs. C (p < 0.01) (Table 2).

The PREDIMED Questionnaire

The results of the PREDIMED questionnaire at T0 and T6 and the T0–T6 change are reported in Table 4 and in Figure 1. Overall, adherence to MD was moderate: PREDIMED score was 6.7 ± 1.8 at T0 and 7.6 ± 2.1 at T6. No significant difference in T0 values was observed in the total PREDIMED score between N (7 ± 2.1) and C (6.6 ± 1.6), while a significant difference was observed at T6 between N (8.6 ± 1.9) and C (6.8 ± 2) (p < 0.01) and in the T0–T6 change in N (Δ 1.6 ± 2.4) compared to C (Δ 0.4 ± 2) (p = 0.020). A ≥ 20% improvement in the PREDIMED from T0 was significantly more frequent in N (22/47, 46.8%) compared to C (13/63, 20.6%) (p < 0.01) (Figure 1).

Figure 1.

A PREDIMED score at T0 and T6 in all subjects, in the nutritional group, and in controls. B ASDAS-CRP at T0 and T6 in all subjects, in the nutritional group, and in controls. C ASDAS-CRP at T0 and T6 in all subjects, in subjects achieving a ≥ 20% PREDIMED improvement at T6 vs. T0, and in those who did not. D Frequency of ≥20% PREDIMED improvement at T6 vs T0 in all subjects, in the nutritional group, and in controls. Frequency of ≥20% ASDAS-CRP improvement in all subjects, in the nutritional group, and in controls. F Frequency of ≥20% ASDAS-CRP improvement at T6 vs T0 in all subjects, in subjects achieving a ≥ 20% PREDIMED improvement at T6 vs T0, and in those who did not. In box plots (AC), mean values are represented as X

A significant difference was found at T0 in the frequency of positive response of question 12 (mixed nuts per week) which was higher in N. At T6, a significant difference was found in the frequency of positive responses between the two study groups in the following questions: 4 (fruit per day), 10 (fish consumption per week), and 13 (white meat over red meat consumption), which were higher in N. Furthermore, we observed more frequently an improvement in N compared to C in question 1 (olive oil as the main culinary fat), 4 (fruit per day), 12 (mixed nuts per week), and almost significant in question 2 (olive oil consumption per day) (Table 4 and Additional file 4).

Predictors of PREDIMED Improvement

Characteristics of the patients and of clinical and laboratory values at T0 are reported in Additional file 5 according to the achievement of a ≥ 20% improvement in the PREDIMED score at T6. In the multivariable analysis, the following variables were included: receiving nutritional advice (group N), age, full- or part-time employment, psoriasis, disease duration, use of TNF inhibitors, concomitant treatments, BMI, patient VAS global, and CRP. No variable was excluded because of collinearity. N was associated with a higher probability of achieving an improvement of the PREDIMED score compared to C (OR 4.53, 1.36–15.1, p = 0.014), together with older age (per 10-year increase OR 1.05, 1.02–1.68, p = 0.007) (Figure 2). BMI was associated with a lower probability of achieving an improvement of the PREDIMED score: per unit increase OR 0.77, 0.63–0.9, p = 0.006.

Figure 2.

Predictors of PREDIMED and ASDAS-CRP improvement. Multivariate analysis: A odds for ≥20% PREDIMED total score improvement from T0; B odds for ≥20% ASDAS-CRP score improvement from T0. OR odds ratio; C.I. confidence interval

Predictors of ASDAS-CRP Improvement

Characteristics of the patients and of clinical and laboratory values at T0 are reported in Additional file 6 according to the achievement of a ≥ 20% improvement in the ASDAS-CRP score at T6. A ≥ 20% improvement in the ASDAS-CRP at T6 was significantly more frequent in N (8/47, 17%) compared to C (6/63, 9.5%) (p = 0.020) and especially in those who achieved a ≥ 20% PREDIMED improvement compared to those who did not: 12/35 (34.3%) and 2/75 (2.7%); p < 0.001 (Figure 1).

In the multivariable analysis of predictors of a ≥ 20% improvement in ASDAS-CRP, the following variables were included: receiving nutritional advice (group N), ≥ 20% improvement in PREDIMED score, age, psoriasis, use of steroids, concomitant treatments, disease duration, and patient VAS global and patient VAS pain. Steroid use was excluded because of collinearity with psoriasis (VIF = 2.71). A ≥ 20% improvement in the PREDIMED score resulted in being associated with a 6-fold increased probability of achieving the ASDAS-CRP improvement (OR 6.75,1.8–25.3, p = 0.005). Psoriasis and a longer disease duration resulted in being negatively associated with ASDAS-CRP improvement, although non-significantly (Figure 2).

Cardiovascular Risk Assessment

Overall, a low cardiovascular risk was observed in all patients in our study. At T0, SCORE was 1.7 ± 1.7 in all patients and most patients were in the lowest risk class according to CUORE (specifically 42/117, 53.7%) (Additional file 7). No significant change from T0 and in C and N were observed in SCORE or CUORE, although a trend toward a more consistent improvement of SCORE was observed in N compared to C: −0.4 ± 0.7 in N vs −0.1 ± 1 in C (p = 0.131). No significant difference was observed in the modification of SCORE and CUORE at T6 in the patients who improved for ≥20% in the PREDIMED score from T0.

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