Dietary Interventions Reduce CVD Risk in RA and SpA

Dietary interventions can reduce the risk of cardiovascular disease for patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) in just a short time period, but does not significantly change body composition, according to a systemic review published in Clinical Nutrition.

Patients with RA and SpA can have low muscle mass and risk factors for cardiovascular diseases. While patients with RA and SpA on disease-modifying antirheumatic drugs can experience disease remission and a reduction in inflammation, some patients may still experience some inflammation, pain, and fatigue.

Dietary interventions may not significantly change body composition for patients with rheumatoid arthritis and spondyloarthritis, but they can reduce patients' risk of cardiovascular diseases.

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“In these cases, the use of complementary treatment such as lifestyle changes is requested, and dietary interventions are of special interest,” the authors noted. “However, the scientific evidence is insufficient.”

They analyzed the existing knowledge on diets and the degree to which dietary intervention for patients with RA and SpA can affect body composition and lipid profile. A total of 17 original articles reporting on 15 trials for a total of 774 participants were identified and included in the review.

The duration of the intervention studied ranged from 8 to 24 weeks and 395 patients received the intervention while 379 were in the control groups. Most of the trials (n = 14) were randomized controlled trials and 3 were crossover trials. Only 1 trial had patients with psoriatic arthritis, while the remaining 16 trial included patients with RA.

The types of dietary interventions studied were:

• Nutritional education (n = 1), which informed the intervention group on how to improve their eating habits to either a normal healthy or Mediterranean diet.
• Omega-3 fatty acids (n-3) (n = 3), which aimed to increase n-3 intake through various means.
• Exclusion diets (n = 7), which excluded either gluten dairy, and/or meat.
• Anti-inflammatory or Mediterranean diet (n = 6). The anti-inflammatory diet was rich in fatty fish, whole grain, nuts, and vegetables.

Fat mass, fat-free mass, muscle mass, body weight, body mass index (BMI), and waist circumference were all used to report on how dietary interventions impacted body composition. There was no change reported on fat mass in the 3 studies that evaluated it and the one study reporting on muscle mass noted it increased after 12 weeks on the exclusion diet. There was also no significant effect on BMI. It was unclear of the impact on waist circumference.

Studies also evaluated the impact on total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. The meta-analysis of studies reporting on HDL-C showed no effect, 6 studies showed a slight reduction in LDL-C, there was high uncertainty in the pooled effect, and there was no pooled effect for triglycerides. The 8 studies reporting on total cholesterol found a significant reduction.

Some of the strengths of the analysis were the high number of randomized controlled trials included and compliance to dietary interventions was included in all of the studies. However, the lack of high-quality studies on the topic of dietary intervention was the main limitation—the studies had low numbers of participants and a variety of interventions were used. While the intervention duration of 8 to 24 weeks was enough time to detect clinically meaningful changes of blood lipid levels, longer durations are likely needed for significant improvements in body composition and waist circumference.

“As patients with RA and SpA are at an increased risk of [cardiovascular disease], these patients are likely to benefit from individualized nutritional guidance to optimize nutritional status and thereby reduce the risk for lifestyle diseases,” the authors concluded.

Reference

Olsen MN, Halse A-K, Skeie E, Lein RK, Nilsen RM, Tangvik RJ. Effect of dietary interventions on nutritional status in patients with rheumatoid arthritis and spondyloarthritis - A systematic review and meta-analysis. Clin Nutr. 2024;43(4):926-935. doi:10.1016/j.clnu.2024.02.019