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:: Volume 6, Issue 3 (Jul-Sep 2019) ::
Nutr Food Sci Res 2019, 6(3): 9-16 Back to browse issues page
Western and Healthy Dietary Patterns and Risk of Rheumatoid Arthritis: A Case-Control Study
Fatemeh Rezazadeh , Masoumeh Akhlaghi , Elham Aflaki
Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran , msm.akhlaghi@gmail.com
Abstract:   (3582 Views)
Background and Objectives: Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by swelling, stiffness and pain in body joints. Based on the epidemiological studies, RA is less severe in Southern Mediterranean regions, where fish, olive oil, fruits and vegetables are consumed in great quantities.
Materials and Methods: This study was carried out in a case-control design. Totally, 100 RA patients (case group) and 100 age, gender and body mass index (BMI) healthy individuals (control group) were participated in the study. Dietary intakes were estimated using validated 160-item semi-quantitative food frequency questionnaire (FFQ). Food items of FFQ were grouped into 20 groups and dietary patterns were detected using principal component factor analysis. Associations between the adherence to dietary patterns and risk of RA were reported using logistic regression.
Results: In general, two dietary patterns were detected, including Western dietary pattern, which was high in sweet snacks, high-fat meats, refined grains, high-fat dairies and salty snacks, and healthy dietary pattern, which was high in fishes, low-fat dairies, fruits, vegetables and olives. The RA patients had a significantly higher Western diet score than that the controls had (P < 0.001). However, no significant differences were seen in scores of healthy diet between the groups. The Western dietary pattern showed a significant positive association with RA either in the crude model (OR = 2.01, P < 0.001) or after adjustments of age, gender, education level, marital status, income, physical activity, smoking, BMI, dietary intake of vitamin E, saturated fatty acids and polyunsaturated fatty acids (OR = 4.28, P < 0.001). In contrast, the healthy dietary pattern showed an inverse significant association only after adding the highlighted parameters to the model (OR = 0.55, P = 0.003).
Conclusions: This study showed a positive association between the Western dietary pattern and RA.

Keywords: Rheumatoid arthritis, RA, Dietary patterns, Shiraz
Full-Text [PDF 606 kb]   (1180 Downloads)    
Article type: Research | Subject: Food Science
Received: 2019/02/13 | Accepted: 2019/05/5 | Published: 2019/07/20
1. Calabresi E, Petrelli F, Bonifacio AF, Puxeddu I, Alunno A. One year in review 2018: pathogenesis of rheumatoid arthritis. Clin Exp Rheumatol. 2018;36(2):175-184.
2. Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012;18(13 Suppl):S295-302.
3. Davatchi F, Sandoughi M, Moghimi N, Jamshidi AR, Tehrani Banihashemi A, Zakeri Z, Sadeghi Abdollahi B. Epidemiology of rheumatic diseases in Iran from analysis of four COPCORD studies. Int J Rheum Dis. 2016 Nov;19(11):1056-1062. doi: 10.1111/1756-185X.12809. [DOI:10.1111/1756-185X.12809] [PMID]
4. Favalli EG, Biggioggero M, Crotti C, Becciolini A, Raimondo MG, Meroni PL. Sex and management of rheumatoid arthritis. Clin Rev Allergy Immunol. 2018 Jan 26. doi: 10.1007/s12016-018-8672-5. [Epub ahead of print] [DOI:10.1007/s12016-018-8672-5] [PMID]
5. Srivastava S, Patel S, Singh D, Singh MR. Rationalized insights on causes of rheumatoid arthritis in the elderly and women: special emphasis on treatment strategies. Crit Rev Ther Drug Carrier Sys. 2017;34(2):97-147. [DOI:10.1615/CritRevTherDrugCarrierSyst.2017017003] [PMID]
6. Tedeschi SK, Costenbader KH. Is there a role for diet in the therapy of rheumatoid arthritis? Curr Rheumatol Rep. 2016;18(5):23. doi: 10.1007/s11926-016-0575-y. [DOI:10.1007/s11926-016-0575-y] [PMID]
7. Pattison DJ, Harrison RA, Symmons DP. The role of diet in susceptibility to rheumatoid arthritis: a systematic review. J Rheumatol. 2004;31(7):1310-9.
8. Forsyth C, Kouvari M, D'Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018;38(5):737-747. doi: 10.1007/s00296-017-3912-1. [DOI:10.1007/s00296-017-3912-1] [PMID]
9. Berube LT, Kiely M, Yazici Y, Woolf K. Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010. Nutr Health. 2017;23(1):17-24. doi: 10.1177/0260106016688223. [DOI:10.1177/0260106016688223] [PMID]
10. Grimstvedt ME, Woolf K, Milliron BJ, Manore MM. Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls. Public Health Nutr. 2010;13(8):1170-7. [DOI:10.1017/S136898001000008X] [PMID]
11. Khanna S, Jaiswal KS, Gupta B. Managing rheumatoid arthritis with dietary interventions. Front Nutr. 2017;4:52. doi: 10.3389/fnut.2017.00052. [DOI:10.3389/fnut.2017.00052] [PMID] [PMCID]
12. Badsha H. Role of diet in influencing rheumatoid arthritis disease activity. Open Rheumatol J. 2018;12:19-28. doi: 10.2174/1874312901812010019. [DOI:10.2174/1874312901812010019] [PMID] [PMCID]
13. Reedy J, Subar AF, George SM, Krebs-Smith SM. Extending methods in dietary patterns research. nutrients. 2018 May 7;10(5). pii: E571. doi: 10.3390/nu10050571. [DOI:10.3390/nu10050571] [PMID] [PMCID]
14. Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr. 2001 Jan;73(1):1-2. [DOI:10.1093/ajcn/73.1.1] [PMID]
15. Linos A, Kaklamani VG, Kaklamani E, Koumantaki Y, Giziaki E, Papazoglou S, Mantzoros CS. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clin Nutr. 1999;70(6):1077-82. [DOI:10.1093/ajcn/70.6.1077] [PMID]
16. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81. doi: 10.1002/art.27584. [DOI:10.1002/art.27584] [PMID]
17. Willett W. Nutritional epidemiology. Oxford University Press, New York. 1998. [DOI:10.1093/acprof:oso/9780195122978.001.0001]
18. Akhlaghi M, Kamali M, Dastsouz F, Sadeghi F, Amanat S. Increased waist-to-height ratio may contribute to age-related increase in cardiovascular risk factors. Int J Prev Med. 2016;7:68. [DOI:10.4103/2008-7802.181328] [PMID] [PMCID]
19. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the international physical activity questionnaire short form (IPAQ‑SF): A systematic review. Int J Behav Nutr Phys Act. 2011;8:115. [DOI:10.1186/1479-5868-8-115] [PMID] [PMCID]
20. Centers for Disease Control and Prevention, "Cigarette smoking among adults-United States, 1992, and changes in the definition of current cigarette smoking," Morbidity and Mortality Weekly Report, vol. 43, no. 19, pp. 342-346, 1994.
21. Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol. 2009;20(2):150-8. [DOI:10.2188/jea.JE20090083] [PMID] [PMCID]
22. Cerhan JR, Saag KG, Merlino LA, Mikuls TR, Criswell LA. Antioxidant micronutrients and risk of rheumatoid arthritis in a cohort of older women. Am J Epidemiol. 2003;157(4):345-54. [DOI:10.1093/aje/kwf205] [PMID]
23. Pattison DJ, Symmons DP, Young A. Does diet have a role in the aetiology of rheumatoid arthritis? Proc Nutr Soc. 2004;63(1):137-43. [DOI:10.1079/PNS2003319] [PMID]
24. Di Giuseppe D, Wallin A, Bottai M, Askling J, Wolk A. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis. 2014;73(11):1949-53. [DOI:10.1136/annrheumdis-2013-203338] [PMID]
25. Rosell M, Wesley AM, Rydin K, Klareskog L, Alfredsson L; EIRA study group. Dietary fish and fish oil and the risk of rheumatoid arthritis. Epidemiology. 2009;20(6):896-901. doi: 10.1097/EDE.0b013e3181b5f0ce. [DOI:10.1097/EDE.0b013e3181b5f0ce] [PMID]
26. He J, Wang Y, Feng M, Zhang X, Jin YB, Li X, et al. Dietary intake and risk of rheumatoid arthritis-a cross section multicenter study. Clin Rheumatol. 2016;35(12):2901-2908. [DOI:10.1007/s10067-016-3383-x] [PMID] [PMCID]
27. Pattison DJ, Symmons DP, Lunt M, Welch A, Luben R, Bingham SA, Khaw KT, Day NE, Silman AJ. Dietary risk factors for the development of inflammatory polyarthritis: evidence for a role of high level of red meat consumption. Arthritis Rheum. 2004;50(12):3804-12. [DOI:10.1002/art.20731] [PMID]
28. Matsumoto Y, Sugioka Y, Tada M, Okano T, Mamoto K, Inui K, Habu D, Koike T. Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study. Clin Nutr. 2018;37(2):675-680. doi: 10.1016/j.clnu.2017.02.011. [DOI:10.1016/j.clnu.2017.02.011] [PMID]
29. Scrivo R, Massaro L, Barbati C, Vomero M, Ceccarelli F, Spinelli FR, Riccieri V, Spagnoli A, Alessandri C, Desideri G, Conti F, Valesini G. The role of dietary sodium intake on the modulation of T helper 17 cells and regulatory T cells in patients with rheumatoid arthritis and systemic lupus erythematosus. PLoS One. 2017;12(9):e0184449. doi: 10.1371/journal.pone.0184449. [DOI:10.1371/journal.pone.0184449] [PMID] [PMCID]
30. Berbert AA, Kondo CR, Almendra CL, Matsuo T, Dichi I. Supplementation of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition. 2005;21(2):131-6. [DOI:10.1016/j.nut.2004.03.023] [PMID]
31. Pedersen M, Stripp C, Klarlund M, Olsen SF, Tjønneland AM, Frisch M. Diet and risk of rheumatoid arthritis in a prospective cohort. J Rheumatol. 2005;32(7):1249-52.
32. Hu Y, Costenbader KH, Gao X, Hu FB, Karlson EW, Lu B. Mediterranean diet and incidence of rheumatoid arthritis in women. Arthritis Care Res (Hoboken). 2015;67(5):597-606. doi: 10.1002/acr.22481. [DOI:10.1002/acr.22481] [PMID] [PMCID]
33. Wall R, Ross RP, Fitzgerald GF, Stanton C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 2010;68(5):280-9. [DOI:10.1111/j.1753-4887.2010.00287.x] [PMID]
34. Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012;43(5):356-62. [DOI:10.1016/j.arcmed.2012.06.011] [PMID]
35. Serafini M, Peluso I. Functional foods for health: the interrelated antioxidant and anti-inflammatory role of fruits, vegetables, herbs, spices and cocoa in humans. Curr Pharm Des. 2016;22(44):6701-6715. doi: 10.2174/1381612823666161123094235. [DOI:10.2174/1381612823666161123094235] [PMID] [PMCID]
36. Joseph SV, Edirisinghe I, Burton-Freeman BM. Fruit polyphenols: a review of anti-inflammatory effects in humans. Crit Rev Food Sci Nutr. 2016;56(3):419-44. doi: 10.1080/10408398.2013.767221. [DOI:10.1080/10408398.2013.767221] [PMID]
37. Rosillo MA, Sánchez-Hidalgo M, Sánchez-Fidalgo S, Aparicio-Soto M, Villegas I, Alarcón-de-la-Lastra C. Dietary extra-virgin olive oil prevents inflammatory response and cartilage matrix degradation in murine collagen-induced arthritis. Eur J Nutr. 2016;55(1):315-25. doi: 10.1007/s00394-015-0850-0. [DOI:10.1007/s00394-015-0850-0] [PMID]
38. Rosillo MÁ, Alcaraz MJ, Sánchez-Hidalgo M, Fernández-Bolaños JG, Alarcón-de-la-Lastra C1, Ferrándiz ML. Anti-inflammatory and joint protective effects of extra-virgin olive-oil polyphenol extract in experimental arthritis. J Nutr Biochem. 2014;25(12):1275-81. [DOI:10.1016/j.jnutbio.2014.07.006] [PMID]
39. Rocha DM, Caldas AP, Oliveira LL, Bressan J, Hermsdorff HH. Saturated fatty acids trigger TLR4-mediated inflammatory response. Atherosclerosis. 2016;244:211-5. [DOI:10.1016/j.atherosclerosis.2015.11.015] [PMID]
40. Priebe MG, Wang H, Weening D, Schepers M, Preston T, Vonk RJ. Factors related to colonic fermentation of nondigestible carbohydrates of a previous evening meal increase tissue glucose uptake and moderate glucose-associated inflammation. Am J Clin Nutr. 2010;91(1):90-7. [DOI:10.3945/ajcn.2009.28521] [PMID]
41. Qi L, Hu FB. Dietary glycemic load, whole grains, and systemic inflammation in diabetes: the epidemiological evidence. Curr Opin Lipidol. 2007;18(1):3-8. [DOI:10.1097/MOL.0b013e328011c6e0] [PMID]
42. Hu Y, Costenbader KH, Gao X, Hu FB, Karlson EW, Lu B. Mediterranean diet and incidence of rheumatoid arthritis in women. Arthritis Care Res (Hoboken). 2015;67(5):597-606. doi: 10.1002/acr.22481. [DOI:10.1002/acr.22481] [PMID] [PMCID]
43. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75(3):492-8. [DOI:10.1093/ajcn/75.3.492] [PMID]
44. Chung CP, Oeser A, Solus JF, Gebretsadik T, Shintani A, Avalos I, Sokka T, Raggi P, Pincus T, Stein CM. Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum. 2008;58(7):2105-12. [DOI:10.1002/art.23600] [PMID] [PMCID]
45. Turesson C, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson LT. High serum cholesterol predicts rheumatoid arthritis in women, but not in men: a prospective study. Arthritis Res Ther. 2015;17:284. doi: 10.1186/s13075-015-0804-1. [DOI:10.1186/s13075-015-0804-1] [PMID] [PMCID]
46. Heliövaara M, Aho K, Knekt P, Reunanen A, Aromaa A. Serum cholesterol and risk of rheumatoid arthritis in a cohort of 52 800 men and women. Br J Rheumatol. 1996;35(3):255-7. [DOI:10.1093/rheumatology/35.3.255] [PMID]
47. Catapano AL, Pirillo A, Norata GD. Vascular inflammation and low-density lipoproteins: is cholesterol the link? A lesson from the clinical trials. Br J Pharmacol. 2017;174(22):3973-3985. [DOI:10.1111/bph.13805] [PMID] [PMCID]
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Rezazadeh F, Akhlaghi M, Aflaki E. Western and Healthy Dietary Patterns and Risk of Rheumatoid Arthritis: A Case-Control Study. Nutr Food Sci Res 2019; 6 (3) :9-16
URL: http://nfsr.sbmu.ac.ir/article-1-336-en.html

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Volume 6, Issue 3 (Jul-Sep 2019) Back to browse issues page
Nutrition and Food Sciences Research
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