Lifestyle Interventions and Weight Management in Systemic Lupus Erythematosus Patients: A Systematic Literature Review and Metanalysis

Abstract

Background We aimed to identify and describe different types of lifestyle interventions primarily or secondarily focused on weight loss in SLE patients. Methods A systematic search of controlled trials published until June 2021 that assigned adults patients after dietary or exercise intervention resulted in 248 studies initially screened. Results Six studies with seven interventions (3 dietary and 4 exercise training programs) fulfilled the eligibility criteria and were included in the meta-analysis with a median of age 35.8 (31.3 to 49.0 years); median of BMI 26.6 (25.2 to 33.6 kg/m 2 ). After six to twelve weeks of diet or exercise program, no differences were observed in body weight [-1.539 (-4.482 to 1.405) kg (CI 95%), p = 0.306]. Also, a subgroup analysis also revelated no body weight difference following dietary intervention [-3.561 (-9.604 to 2.481) kg (CI 95%), p = 0.248] or exercise intervention [-0.910 (-4.279 to 2.460) kg (CI 95%), p = 0.597]. Conclusion The results showed that different protocols of exercise intervention or diets were not effective to reduce body weight in patients with SLE. However, only one of the selected trials had a specific study design and protocol focusing on weight loss management.

Differential impact of environmental factors on systemic and localized autoimmunity

“…Losing weight may be difficult for SLE patients, as the small number of studies exploring lifestyle-based dietary and exercise regimens have been mostly ineffective at promoting weight loss. However, weight loss was not a primary outcome in most and corticosteroid use may be a confounding factor ( 193 ). Nonetheless, one study did achieve significant weight loss in SLE patients who were on either a low-calorie or low-glycemic index diet, with a reduction in fatigue as well ( 194 ).…”

“…Contributing factors in obesity and connections to SLE development include a high-fat diet, gut dysbiosis, medications, and physical hypoactivity. A high-fat diet can lead to weight gain and gut dysbiosis, which may lead to impaired immune regulation and tolerance to beneficial intestinal microbes (191,192). Losing weight may be difficult for SLE patients, as the small number of studies exploring lifestyle-based dietary and exercise regimens have been mostly ineffective at promoting weight loss.…”

Impact of overweight and obesity on disease activity and remission in systemic lupus erythematosus: A systematic review and meta-analysis protocol

“…Obesity is associated with complications in diverse autoimmune diseases and is very common in patients with inflammatory rheumatic diseases, of which 27% and 37% of patients with rheumatoid and psoriatic arthritis, respectively have a body mass index ≥30 kg/m 2 [ 24 ]. In patients with SLE, the frequency of obesity is similar or higher than that in the general population, with a prevalence ranging from 28% to 50%, and it has been implicated as a risk factor for exacerbation of clinical manifestations of disease and inflammatory processes [ 25 ]. It may be attributed because one of the characteristics of obesity is a state of chronic low-grade inflammation.…”

A Comprehensive Literature Review on Managing Systemic Lupus Erythematosus: Addressing Cardiovascular Disease Risk in Females and Its Autoimmune Disease Associations

“…Lifestyle modifications such as regular exercise, healthy diet, and smoking cessation can reduce the risk of CVD in this population [ 196 ], considering that obesity is more common among patients with SLE than in the general population [ 197 ], with prevalence ranging from 28% to 50% [ 198 ]. Established risk factors such as hypertension, dyslipidemia, and diabetes must be managed appropriately [ 199 ].…”