Yoshinari Matsumoto1,2, Nitin Shivappa3,4, Yuko Sugioka5, Masahiro Tada6, Tadashi Okano6, Kenji Mamoto6, Kentaro Inui6, Daiki Habu2, James R Hebert3,4, Tatsuya Koike7,8. 1. Shirahama Foundation for Health and Welfare, Search Institute for Bone and Arthritis Disease (SINBAD), Nishimuro-gun, Shirahama-cho 1447, Wakayama, 649-2211, Japan. 2. Department of Medical Nutrition, Osaka City University Graduate School of Human Life Science, Sumiyoshi-ku, Sugimoto-cho 3-3-138, Osaka, 558-8585, Japan. 3. Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 241-2, Columbia, SC, 29208, USA. 4. Department of Nutrition, Connecting Health Innovations LLC, 1417 Gregg St., Columbia, SC, 29201, USA. 5. Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Abeno-ku, Asahimachi 1-4-3, Osaka, 545-8585, Japan. 6. Departments of Orthopaedic Surgery, Osaka City University Medical School, Abeno-ku, Asahimachi 1-4-3, Osaka, 545-8585, Japan. 7. Shirahama Foundation for Health and Welfare, Search Institute for Bone and Arthritis Disease (SINBAD), Nishimuro-gun, Shirahama-cho 1447, Wakayama, 649-2211, Japan. tatsuya@med.osaka-cu.ac.jp. 8. Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Abeno-ku, Asahimachi 1-4-3, Osaka, 545-8585, Japan. tatsuya@med.osaka-cu.ac.jp.
Abstract
BACKGROUND: The dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported. However, the association between DII score and disease activity of rheumatoid arthritis (RA) is unclear. Therefore, this study was designed to test whether higher DII score contributes to disease activity and as a corollary, whether reducing DII score helps to achieve or maintain low disease activity or remission in patients with RA. METHODS: We performed a cross-sectional and longitudinal analysis using 6 years of data (from 2011 to 2017) in TOMORROW, a cohort study consisting of 208 RA patients and 205 gender- and age-matched controls started in 2010. Disease activity of RA patients was assessed annually using DAS28-ESR (disease activity score 28 joints and the erythrocyte sedimentation rate) as a composite measure based on arthritic symptoms in 28 joints plus global health assessment and ESR. Dietary data were collected in 2011 and 2017 using the brief-type self-administered diet history questionnaire (BDHQ). Energy-adjusted DII (E-DII™) score was calculated using 26 nutrients derived from the BDHQ. Data were analyzed with two-group comparisons, correlation analysis, and multivariable logistic regression analysis. RESULTS: One hundred and seventy-seven RA patients and 183 controls, for whom clinical and dietary survey data were available, were analyzed. RA patients had significantly higher E-DII (pro-inflammatory) score compared to controls both in 2011 and 2017 (p < 0.05). In RA patients, E-DII score was not a factor associated with significant change in disease activity. However, anti-inflammatory change in E-DII score was associated maintaining low disease activity (DAS28-ESR ≤ 3.2) or less for 6 years (OR 3.46, 95% CI 0.33-8.98, p = 0.011). CONCLUSIONS: The diets of RA patients had a higher inflammatory potential than controls. Although E-DII score was not a factor associated with significant disease activity change, anti-inflammatory change in E-DII score appeared to be associated with maintaining low disease activity in patients with RA. TRIAL REGISTRATION: UMIN Clinical Trials Registry, UMIN000003876 . Registered 7 Aug 2010-retrospectively registered.
BACKGROUND: The dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported. However, the association between DII score and disease activity of rheumatoid arthritis (RA) is unclear. Therefore, this study was designed to test whether higher DII score contributes to disease activity and as a corollary, whether reducing DII score helps to achieve or maintain low disease activity or remission in patients with RA. METHODS: We performed a cross-sectional and longitudinal analysis using 6 years of data (from 2011 to 2017) in TOMORROW, a cohort study consisting of 208 RApatients and 205 gender- and age-matched controls started in 2010. Disease activity of RApatients was assessed annually using DAS28-ESR (disease activity score 28 joints and the erythrocyte sedimentation rate) as a composite measure based on arthritic symptoms in 28 joints plus global health assessment and ESR. Dietary data were collected in 2011 and 2017 using the brief-type self-administered diet history questionnaire (BDHQ). Energy-adjusted DII (E-DII™) score was calculated using 26 nutrients derived from the BDHQ. Data were analyzed with two-group comparisons, correlation analysis, and multivariable logistic regression analysis. RESULTS: One hundred and seventy-seven RApatients and 183 controls, for whom clinical and dietary survey data were available, were analyzed. RApatients had significantly higher E-DII (pro-inflammatory) score compared to controls both in 2011 and 2017 (p < 0.05). In RApatients, E-DII score was not a factor associated with significant change in disease activity. However, anti-inflammatory change in E-DII score was associated maintaining low disease activity (DAS28-ESR ≤ 3.2) or less for 6 years (OR 3.46, 95% CI 0.33-8.98, p = 0.011). CONCLUSIONS: The diets of RApatients had a higher inflammatory potential than controls. Although E-DII score was not a factor associated with significant disease activity change, anti-inflammatory change in E-DII score appeared to be associated with maintaining low disease activity in patients with RA. TRIAL REGISTRATION: UMIN Clinical Trials Registry, UMIN000003876 . Registered 7 Aug 2010-retrospectively registered.
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