Antioxidant intake, plasma antioxidants and oxidative stress in a randomized, controlled, parallel, Mediterranean dietary intervention study on patients with rheumatoid arthritis

BACKGROUND: Previously we have reported that patients with rheumatoid arthritis (RA) obtained a significant reduction in disease activity by adopting a Mediterranean-type diet. The present study was carried out to investigate the antioxidant intake, the plasma levels of antioxidants and a marker of oxidative stress (malondialdehyde) during the study presented earlier. METHODS: RA patients randomized to either a Mediterranean type diet (MD group; n = 26) or a control diet (CD group; n = 25) were compared during a three month dietary intervention study. Their antioxidant intake was assessed by means of diet history interviews and their intake of antioxidant-rich foods by a self-administered questionnaire. The plasma levels of retinol, antioxidants (α- and γ-tocopherol, β-carotene, lycopene, vitamin C and uric acid) and urinary malondialdehyde (MDA), a marker for oxidative stress, were determined using high performance liquid chromatography. The Student's t-test for independent samples and paired samples were used to test differences between and within groups. For variables with skewed distributions Mann-Whitney U-test and Wilcoxon signed ranks test were performed. To evaluate associations between dietary intake of antioxidants, as well as between disease activity, MDA and antioxidants we used Pearson's product moment correlation or Spearman's rank correlation. RESULTS: The MD group had significantly higher intake frequencies of antioxidant-rich foods, and also higher intakes of vitamin C (p = 0.014), vitamin E (p = 0.007) and selenium (p = 0.004), and a lower intake of retinol (p = 0.049), compared to the CD group. However, the difference between the groups regarding vitamin C intake was not significant when under- and over-repoters were excluded (p = 0.066). There were no changes in urine MDA or in the plasma levels of antioxidants (after p-lipid adjustments of the tocopherol results), from baseline to the end of the study. The levels of retinol, vitamin C and uric acid were negatively correlated to disease activity variables. No correlation was found between antioxidant intake and the plasma levels of antioxidants. CONCLUSIONS: Despite an increase in reported consumption of antioxidant-rich foods during the Mediterranean diet intervention, the levels of plasma antioxidants and urine MDA did not change. However, the plasma levels of vitamin C, retinol and uric acid were inversely correlated to variables related to RA disease activity

Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets

OBJECTIVES: Several investigators have reported that clinical improvements of patients with rheumatoid arthritis (RA), from participating in therapeutic diet intervention studies, have been accompanied by loss of body weight. This has raised the question whether weight reduction per se can improve RA. In order to test this hypothesis, three previously conducted diet intervention studies, comprising 95 patients with RA, were pooled. Together with Age, Gender, and Disease Duration, change during the test period in body weight, characterised dichotomously as reduction or no reduction (dichoΔBody Weight), as well as Diet (dichotomously as ordinary diet or test diet), were the independent variables. Dependent variables were the difference (Δ) from baseline to conclusion of the study in five different disease outcome measures. ΔESR and ΔPain Score were both characterised numerically and dichotomously (improvement or no improvement). ΔAcute Phase Response, ΔPhysical Function, and ΔTender Joint Count were characterised dichotomously only. Multiple logistic regression was used to analyse associations between the independent and the disease outcome variables. RESULTS: Statistically significant correlations were found between Diet and three disease outcome variables i.e. ΔAcute-Phase Response, ΔPain Score, and ΔPhysical Function. Δ Body Weight was univariately only correlated to ΔAcute-Phase Response but not significant when diet was taken into account. CONCLUSION: Body weight reduction did not significantly contribute to the improvement in rheumatoid arthritis when eating lacto-vegetarian, vegan or Mediterranean diets

A Mediterranean dietary intervention study of patients with rheumatoid arthritis

Case control studies have shown that a high consumption of fish, olive oil, and cooked vegetables is associated with a decreased risk of developing rheumatoid arthritis (RA). These foods have a central position in the traditional Cretan Mediterranean diet, and it has been suggested that dietary factors contribute to the low prevalence of RA in Mediterranean countries. The overall aim of this thesis was to examine whether a modified Cretan Mediterranean diet can reduce signs and symptoms of RA. This was investigated in a three-month dietary intervention trial in which 51 patients with well controlled, although active RA of at least two years duration took part. A further aim was to study the compliance with the experimental and control diets used in the study, and to validate the diet history interview method used to assess the dietary intake. The validation was carried out by means of biological markers of dietary intake. From baseline to the end of the study the group that had adopted the Cretan Mediterranean diet (MD group; n=26) obtained a reduction in disease activity, improved physical function, and improved vitality, while no changes was seen in the control diet group (CD group; n=25). According to the dietary assessments, the intake frequencies of antioxidant-rich food items increased in the MD group. This group also had a significantly higher intake of vitamin E, vitamin C and selenium compared to the CD group. Despite the reported increase in the consumption frequencies of antioxidant-rich foods, the plasma levels of carotenoids, vitamin C, lipid adjusted tocopherols, uric acid and urine malondialdehyde, a marker of oxidative stress, were unchanged at the end of the study. The plasma levels of retinol, vitamin C and uric acid were, however, correlated to indices of disease activity. Changes in the reported consumption of food groups with relevance to the fat intake were also observed in the MD group, including an increased intake of fish, shellfish and poultry, and a decreased intake of meat and high fat dairy products. As a result, the total fat intake was lower in the MD group compared to the CD group. Furthermore, in the MD group a slightly higher percentage of the energy intake was derived from polyunsaturated fatty acids and a lower percentage from saturated fatty acids. This group also had a lower ratio of n-6:n-3 fatty acids. A corresponding change in the relation between n-6 and n-3 fatty acids was also observed in s-phospholipids. The validation of the diet history interview method showed that the diet history interview could capture the dietary intake fairly well. The validity of the reported dietary intake did not differ between the MD and the CD group, which indicates that the dietary assessment was not biased by the dietary intervention

PR156 – Dietary intake in relation to oral health in adults with severe periodontitis

Background & Aim: Periodontitis is a chronic disease which can result in progressive loss of the teeth's supportive tissue. About 40% of the world's population is affected by periodontitis of which approximately 10% have a severe form. Periodontitis can affect the dietary intake for diseased individuals due to mobile teeth that making it painful to eat or by missing teeth. The aim of the study was to investigate self-assessed oral health in relation to dietary intake in adult individuals with severe periodontitis treated in specialist-dental care. The aim was also to study self-assessed oral health and dietary intake in relation to the number of teeth, age and sex. Methods: The study was a cross-sectional study including 62 participants. The material was collected via questionnaires regarding background and the areas of oral health and dietary intake. Participants were recruited via a special-dental care clinic in Sweden during September 2017. Referred patients diagnosed with severe periodontitis were invited to participate in the study and the participation was confidential. Chi-square test, Fisher's exact test and Mann Whitney U test were used. Alpha was set at p<0.05. Results: Half of the participants reported that their oral health condition constituted an obstacle to eating the foods they wanted. Participants who had ≥20 teeth ate fruits and berries, red meat, fish and poultry more often than participants with fewer teeth. Participants with ≤19 teeth assessed their chewing and biting ability as poorer than individuals with ≥20 teeth. Conclusion: The result shows that a large proportion of the participants with periodontitis experience that their oral health affects dietary intake . Multidisciplinary collaboration between dental care and dietitian clinic could increase the ability to prevent and/or treat further ill-health in individuals with periodontitis that adversely affects the energy and nutritional intake due to oral health condition. Disclosure: No significant relationships

Fat intake and composition of fatty acids in serum phospholipids in a randomized, controlled, Mediterranean dietary intervention study on patients with rheumatoid arthritis

Abstract Background We have previously reported that rheumatoid arthritis patients, who adopted a modified Cretan Mediterranean diet, obtained a reduction in disease activity and an improvement in physical function and vitality. This shift in diet is likely to result in an altered intake of fatty acids. Therefore, the objective of the present study was to examine the dietary intake of fatty acids, as well as the fatty acid profile in serum phospholipids, during the dietary intervention study presented earlier. Results From baseline to the end of the study, changes in the reported consumption of various food groups were observed in the Mediterranean diet group. The change in diet resulted in a number of differences between the Mediterranean diet group and the control diet group regarding the fatty acid intake. For instance, a lower ratio of n-6 to n-3 fatty acids was observed in the Mediterranean diet group, both assessed by diet history interviews (dietary intake) and measured in serum phospholipids. Moreover, the patients in the Mediterranean diet group that showed a moderate or better clinical improvement during the study (diet responders), had a higher reported intake of n-3 fatty acids and a lower ratio of n-6 to n-3 fatty acids compared to the patients with minor or no improvement. Also the fatty acid profile in serum phospholipids differed in part between the diet responders and the diet non-responders. Conclusion The changes in the fatty acid profile, indicated both by dietary assessments and through fatty acids in s-phospholipids may, at least in part, explain the beneficial effects of the Cretan Mediterranean diet that we have presented earlier.</p

Low carbohydrate high fat-diet in real life assessed by diet history interviews

Background: Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet. Methods: A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed. Results: The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits. Conclusions: Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern

What happens to food choices when a gluten-free diet is required? : A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers

A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of celiac disease (CD) and its gluten-free (GF) treatment. Food intake, was reported using a food frequency questionnaires (FFQ) and intake reported by the adolescents who was screened to CD was compared with the intake of two same-aged referent groups: i) adolescents diagnosed to CD prior screening and ii) adolescents without CD.. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later. The result showed that the food intakes are affected by a screen detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers, and pastries. The result also indicated that the bread intake was lower before the screened diagnosis compared to the other studied groups, but increased afterwards. Specially manufactured GF-products (e.g. pasta and bread) were frequently used in the screened CDgroup after changing to a GF-diet. Our results suggest that changing to a GF-diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF-replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden