Nutritional Approaches to Modulate Cardiovascular Disease Risk in Systemic Lupus Erythematosus: A Literature Review

Abstract

Systemic lupus erythematosus (SLE) is a chronic pathology characterized by a bimodal mortality pattern attributed to clinical disease activity and cardiovascular disease (CVD). A complex interaction between traditional CVD risk factors such as obesity, dyslipidemia, smoking, insulin resistance, metabolic syndrome, and hypertension, as well as the presence of non-traditional CVD risk factors such as hyperhomocysteinemia, pro-inflammatory cytokines, and C-reactive protein levels, has been suggested as a cause of the high prevalence of CVD in SLE patients. On the other hand, environmental factors, such as nutritional status, could influence the disease’s prognosis; several nutrients have immunomodulators, antioxidants, and anti-cardiometabolic risk properties which could reduce SLE severity and organ damage by decreasing the development of traditional and non-traditional CVD risk factors. Therefore, this critical literature review discusses the therapeutic potential of nutritional approaches that could modulate the development of the main comorbidities related to CVD risk in SLE patients.

Diet, DNA methylation and systemic lupus erythematosus: evidence and perspectives focused on personalized nutrition

“…Common food sources of methyl donor nutrients including green vegetables, eggs, red meat, milk, cheese, and yogurts should be included daily in the diet of patients with SLE. Also, taking account of the lack of clinical trials on methyl donor dietary supplementation in SLE, nutrient intake according to recommendations should be encouraged [29].…”

“…In addition, a dietary pattern to prevent/control the increased risk of cardiovascular diseases may be beneficial for these patients [28]. Some nutrients with immunomodulatory and antioxidant capacity, as well as anti-cardiometabolic dietary patterns, could reduce SLE severity and organ damage [29]. Available literature has shown that a diet with high contents of fiber, mono/polyunsaturated fatty acids, vitamins, minerals (especially those with antioxidant activity), and polyphenols can modify disease activity by modulating the inflammation and immune functions of SLE [30].…”

Relationship of serum and dietary vitamin D with high cardiometabolic risk in Mexican systemic lupus erythematosus patients: A cross-sectional study

“…8,9 Several therapeutic approaches have been proposed to prevent the development of hypovitaminosis D and CVD in SLE patients; some studies have suggested that diet represents a modifiable lifestyle risk factor that can significantly influence clinical disease activity and cardiometabolic outcomes by modulating inflammatory and immune responses in autoimmune diseases. 4,10 Previous studies have reported that SLE patients show malnutrition characterized by dietary intake deficiencies of immunomodulatory micronutrients such as vitamins A, C, and D. 11 Moreover, the study of dietary patterns (DPs) is a valid approximation of diet, considering food, nutrients, and other dietary components that reflect population eating habits. 12 In the general population, westernized DPs positively correlate with CVD risk; conversely, a higher diet quality that includes healthy foods, such as fruits, vegetables, whole grains, and unsaturated fats, has been associated with lower cardiometabolic risk factors and CVD.…”

Megamonas funiformis, Plasma Zonulin, and Sodium Intake Affect C3 Complement Levels in Inactive Systemic Lupus Erythematosus

“…SLE is one of the most prevalent extra-intestinal autoimmune diseases and is characterized by the unregulated production of autoantibodies and immunemediated tissue damage [4]. The cause of SLE is not fully understood, but genetic and environmental factors are thought to play a role [5][6][7].…”