The Prognostic Nutritional Index and Nutritional Risk Index Are Associated with Disease Activity in Patients with Systemic Lupus Erythematosus

The prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and nutritional risk index (NRI) have been described as useful screening tools for patient prognosis in several diseases. The aim of this study was to examine the relationship between PNI, CONUT and NRI with clinical disease activity and damage in 173 patients with systemic lupus erythematous (SLE). Disease activity was assessed with the SLE disease activity index (SLEDAI-2K), and disease-related organ damage was assessed using the SLICC/ACR damage index (SDI) damage index. PNI and NRI were significantly lower in active SLE patients than in inactive SLE patients (p < 0.001 and p = 0.012, respectively). PNI was inversely correlated with the SLEDAI score (p < 0.001) and NRI positively correlated with SLEDAI and SDI scores (p = 0.027 and p < 0.001). Linear regression analysis adjusting for age, sex and medications showed that PNI was inversely correlated with SLEDAI ( (95% CI) = -0.176 (-0.254, -0.098), p < 0.001) and NRI positively correlated with SLEDAI ( (95% CI) = 0.056 (0.019, 0.093), p = 0.003) and SDI ( (95% CI) = 0.047 (0.031, 0.063), p < 0.001). PNI (odds ratio (OR) 0.884, 95% confidence interval (CI) 0.809–0.967, p = 0.007) and NRI ((OR) 1.067, 95% CI 1.028–1.108, p = 0.001) were independent predictors of active SLE. These findings suggest that PNI and NRI may be useful markers to identify active SLE in clinical practice.This study was supported by the grant PI0523-2016 from “Consejería de igualdad, salud y políticas sociales” (Junta de Andalucía) and is part of the research group LyDIMED “Lupus y Dieta Mediterránea”. G. Pocovi-Gerardino is a predoctoral fellow from the doctoral program “Medicina clínica y salud pública” of the University of Granad

The impact of eating patterns and dietary factors in systemic lupus erythematosus

En conclusión, los hallazgos de esta tesis doctoral apuntan a que la dieta ejercería un importante impacto en el LES, el cual podría explicarse no sólo por sus beneficios en la inflamación y en la disminución de indicadores clínicos de actividad y severidad sino también por su impacto en el nivel grasa y adiposidad visceral, factores que se han relacionado positivamente con un peor pronóstico de la enfermedad. Por lo tanto, sería interesante considerar el asesoramiento dietético como estrategia importante en el manejo de los pacientes con LES junto con las terapias habituales, para ayudarles a mejorar los hábitos nutricionales e implementar un patrón dietético saludable de tipo mediterráneo en estos pacientes.In conclusion, the results of the present doctoral thesis reveal that, diet would have an important impact on SLE, which could be explained not only by its benefits on inflammation and the significant reduction in clinical indicators of activity and damage, but also by its impact on lowering body fat and visceral adiposity, both markers associated with a worsened prognosis of the disease. Therefore, it would be important to consider dietary advice as part of an effective management of SLE patients, which would help to improve their diet quality and to practice healthy dietary patterns such as the Med Diet.Tesis Univ. Granada.Consejería de Salud de la Junta de Andalucía (Proyecto Lupus y Dieta Mediterránea “LYDIMED” – PI-0523-2016

Dietary Intake of Free Sugars is Associated with Disease Activity and Dyslipidemia in Systemic Lupus Erythematosus Patients.

Diet has been closely associated with inflammatory autoimmune diseases, including systemic lupus erythematosus (SLE). Importantly, the consumption of dietary sugars has been positively linked to elevated levels of some inflammation markers, but the potential role of their consumption on the prognosis of autoimmune diseases has not yet been examined. The aim of this study was to evaluate the association between the dietary intake of free sugars and clinical parameters and cardiovascular (CVD) risk markers in patients with SLE. A cross-sectional study including a total of 193 patients with SLE (aged 48.25 ± 12.54 years) was conducted. The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Levels of C-reactive protein (CRP; mg/dL), homocysteine (Hcy; µmol/L), anti-double stranded DNA antibodies (anti-dsDNA) (IU/mL), complement C3 (mg/dL), and complement C4 (mg/dL), among other biochemical markers, were measured. The main factors we considered as risk factors for CVD were obesity, diabetes mellitus, hypertension, and blood lipids. The dietary-intrinsic sugar and added-sugar content participants consumed were obtained via a 24-h patient diary. Significant differences were observed in dietary sugar intake between patients with active and inactive SLE (in grams: 28.31 ± 24.43 vs. 38.71 ± 28.87; p = 0.035) and free sugar intake (as a percentage: 6.36 ± 4.82 vs. 8.60 ± 5.51; p = 0.020). Linear regression analysis revealed a significant association between free sugars intake (by gram or percentage) and the number of complications (β (95% CI) = 0.009 (0.001, 0.0018), p = 0.033)); (β (95% CI) = 0.046 (0.008, 0.084), p = 0.018)), and SLEDAI (β (95% CI) = 0.017 (0.001, 0.034), p = 0.043)); (β (95% CI) = 0.086 (0.011, 0.161), p = 0.024)) after adjusting for covariates. Free sugars (g and %) were also associated with the presence of dyslipidaemia (β (95% CI) = -0.003 (-0.005, 0.000), p = 0.024)) and (β (95% CI) = -0.015 (-0.028, -0.002), p = 0.021)). Our findings suggest that a higher consumption of free sugars might negatively impact the activity and complications of SLE. However, future longitudinal research on SLE patients, including dietary intervention trials, are necessary to corroborate these preliminary data