Patients with radiographic axial spondylarthritis have an impaired dietary intake—a cross-sectional study with matched controls from northern Sweden

Abstract

Background Radiographic axial spondyloarthritis (r-axSpA) is one of the most common chronic inflammatory rheumatic diseases, affecting about 0.2% of the Swedish population. Adequate nutritional intake is essential for maintaining physiological functions. A poor diet increases the risk of developing conditions such as obesity, osteoporosis, and/or atherosclerosis. Diet quality is also theorized to affect systemic inflammation. Dietary habits in patients with r-axSpA are largely unknown. The aims of this study were to assess dietary nutrient intake in r-axSpA patients and examine whether it differs compared to persons without r-axSpA. Methods r-axSpA patients (modified NY criteria) at the rheumatology clinic in Region Västerbotten, northern Sweden, were invited to take part in the Backbone study which investigates disease severity and comorbidities. In total, 155 patients were included. Nutritional intake was assessed by the semi-quantitative food frequency questionnaire MiniMeal-Q. Controls were collected from the Swedish CArdioPulmonary bioImage Study (n = 30,154), a study that invited participants 50–64 years of age by random selection from the Swedish population register. Out of the 155 r-axSpA patients, 81 were in the same age span. Four controls were identified for each patient, matched on age (± 1 year), sex, and geographic location. Data on dietary intake was available for 319 controls. Statistical comparisons of dietary intake between patients with r-axSpA and controls were done by exact conditional logistic regression analysis, adjusted for country of birth, educational level, single household, weight, smoking status, and energy intake. Results Patients had a comparatively significantly higher energy intake from carbohydrates, a lower fiber density, and a lower intake of marine omega-3 fatty acids. Furthermore, intake of vitamins D, E, and K as well as selenium, folate, calcium, magnesium, phosphorus, potassium, vitamin A, and β-carotene (a precursor of vitamin A and marker of vegetable and fruit intake) was significantly lower among patients compared to controls. Conclusions Our results suggest that r-axSpA patients have an impaired dietary intake. Notably, intake was lower in several nutrients theorized to have anti-inflammatory properties (fiber density, marine-omega-3 fatty acids, vitamin D, and selenium). We further propose that nutrition screening might be incorporated into the management of r-axSpA patients.

Assessment of causal relationships between omega-3 and omega-6 polyunsaturated fatty acids in autoimmune rheumatic diseases: a brief research report from a Mendelian randomization study

“…However, there was no significant association between PUFAs and the risk of other ARDs. According to observational studies, low intake of omega-3 PUFAs increases the risk of radiographic axial spondyloarthritis and disease activity in AS patients in Northern and Western European populations (52,53), and high-dose (4.55 g) omega-3 PUFA supplementation has been shown to improve showed that omega-3 PUFAs could play a critical role in the inflammatory process and the pathogenesis of JIA in children, and omega-3 PUFA deficiency may be a risk factor for JIA; specifically, serum levels of alpha-linolenic acid (one of the main forms of omega-3 PUFAs) are significantly lower in JIA children than in healthy controls. In a double-blind randomized controlled trial, the consumption of omega-3 PUFA supplements was demonstrated to be effective as an add-on therapy to conventional nonsteroidal anti-inflammatory drug (NSAID) treatment to reduce inflammatory cytokines, including interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α), and improve the pediatric ACR response in patients with JIA (56).…”

“…However, there was no significant association between PUFAs and the risk of other ARDs. According to observational studies, low intake of omega-3 PUFAs increases the risk of radiographic axial spondyloarthritis and disease activity in AS patients in Northern and Western European populations ( 52 , 53 ), and high-dose (4.55 g) omega-3 PUFA supplementation has been shown to improve functional capacity and decrease disease activity and drug consumption in AS patients in northern Sweden according to a clinical trial performed by B Sundström et al ( 54 ). Moreover, a retrospective study (including 49 children with JIA and 29 healthy subjects aged between 3 and 18 years) from Anna Górska et al ( 55 ) showed that omega-3 PUFAs could play a critical role in the inflammatory process and the pathogenesis of JIA in children, and omega-3 PUFA deficiency may be a risk factor for JIA; specifically, serum levels of alpha-linolenic acid (one of the main forms of omega-3 PUFAs) are significantly lower in JIA children than in healthy controls.…”