Proposed Anti-Inflammatory Diet Reduces Inflammation in Compliant, Weight-Stable Patients with Rheumatoid Arthritis in a Randomized Controlled Crossover Trial

Abstract

Background It is unclear to what extent adjuvant dietary intervention can influence inflammation in rheumatoid arthritis (RA). Objectives The objective was to assess the effects of dietary manipulation on inflammation in patients with RA. Methods In a crossover design, participants [n = 50, 78% females, median BMI (in kg/m2) 27, median age 63 y] were randomly assigned to begin with either a 10-wk portfolio diet of proposed anti-inflammatory foods (i.e., a high intake of fatty fish, whole grains, fruits, nuts, and berries) or a control diet resembling a Western diet with a 4-mo washout in between. This report evaluates the secondary outcome markers of inflammation among participants with stable medication. Analyses were performed using a linear mixed ANCOVA model. Results There were no significant effects on CRP or ESR in the group as a whole. In those with high compliance (n = 29), changes in ESR within the intervention diet period differed significantly compared with changes within the control diet period (mean: –5.490; 95% CI: –10.310, –0.669; P = 0.027). During the intervention diet period, there were lowered serum concentrations of C-X-C motif ligand 1 (CXCL1) (mean: –0.268; 95% CI: –0.452, –0.084;P = 0.006), CXCL5 (mean: –0.278; 95% CI: –0.530, –0.026 P = 0.031), CXCL6 (mean: –0.251; 95% CI: –0.433, –0.069; P = 0.009), and tumor necrosis factor ligand superfamily member 14 (TNFSF14) (mean: –0.139; 95% CI: –0.275, –0.002; P = 0.047) compared with changes within the control diet period. Conclusion A proposed anti-inflammatory diet likely reduced systemic inflammation, as indicated by a decreased ESR in those who completed the study with high compliance (n = 29). These findings warrant further studies to validate our results, and to evaluate the clinical relevance of changes in CXCL1, CXCL5, CXCL6, and TNFSF14 in patients with RA.

Olive Oil and Nuts in Rheumatoid Arthritis Disease Activity

“…Several studies have previously assessed the role of olive oil, olives, and nuts, alone or as components of the Mediterranean diet, in RA disease activity [ 20 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Except for one Iranian trial dealing with the efficacy of topical olive oil in controlling pain through skin absorption [ 42 ], the remaining trials considered a supplementary herbal formulation of olive oil, fig and olive fruits, together with routine DMARDs regimen (vs. routine DMARDs regimen alone) [ 43 ], or a combination of fish oil omega-3 fatty acids (3 grs/day) and 9.6 mL of olive oil (vs. fish oil omega-3 fatty acid (3 grs/day) or a soy oil placebo), in addition to the usual medication [ 41 ].…”

“…To our knowledge, no trials in humans have targeted nuts as foods rich in omega-3 fatty acids. Evidence may be still indirectly obtained from trials proposing a portfolio diet of anti-inflammatory foods (i.e., a high intake of fatty fish, whole grains, fruits, nuts, berries, and canola—but not olive—oil) [ 36 , 38 ] or a Mediterranean-like dietary pattern, where olive oil is traditionally consumed too [ 39 , 40 ]. In a cross-over trial, no significant difference in DAS28 was found between the proposed portfolio diet and a control diet similar to the general dietary intake in Sweden, although it was significantly lower after the intervention than after the control period in the participants who completed both periods [ 36 ].…”

Ceramides in Autoimmune Rheumatic Diseases: Existing Evidence and Therapeutic Considerations for Diet as an Anticeramide Treatment

“…Nonetheless, nutrition plays an important auxiliary role in the prevention and management of AIRDs [ 10 ]. A plethora of evidence has linked disease progression, severity, relapse and pharmacotherapy-induced adverse events to specific dietary interventions/changes [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Furthermore, the large majority of patients with AIRDs also demonstrate overweight and obesity, aggravated by physical inactivity [ 18 , 19 ].…”

Influence of Dietary n-3 Long Chain Polyunsaturated Fatty Acid Intake on Oxylipins in Erythrocytes of Women with Rheumatoid Arthritis

“…Intervention diets rich in EPA and DHA increased these fatty acids in both studies, and the fatty acid pattern changed significantly in erythrocytes and plasma. Despite this, the effects on inflammation markers were limited [ 21 , 22 ]. Because changes in pro and anti-inflammatory lipid mediators, such as oxylipins, precede changes in other inflammatory markers such as cytokines, it would be of value to establish if oxylipins changed in line with changed dietary fatty-acid intake.…”