Background The relationship between nutrition and systemic lupus erythematosus (SLE) is not well established because SLE is a disease of multifactorial origin with genetic, hormonal and environmental factors. However, the quality of the diet is important in patients with SLE as they have a higher risk of developing nutritional/metabolic-related problems such as coronary artery disease (CAD), low bone mineral density, and anaemia. Obesity also leads to inflammation with increased levels of proinflammatory cytokines exacerbating inflammation present in SLE and increasing the risk of developing diabetes mellitus and CAD.
Objectives To assess whether disease activity was associated with diet, nutritional status, inflammatory and oxidative stress markers in SLE patients.
Methods Seventy-two consecutive SLE patients (59 females, 13 males), mean age 42.1 years and mean disease duration 7.3 years diagnosed according to the American College of Rheumatology (ACR) criteria for SLE were assessed. Nutritional status was determined by body mass index (BMI) and subjective global assessment. Dietary intake at baseline was assessed by a semiquantitative food frequency questionnaire (FFQ). All patients were interrogated about medication usage and sociodemographic factors. The proinflammatory cytokines (tumour necrosis factor alpha (TNF-alpha) and IL-6) and oxidative stress markers (malondialdehyde (MDA) and 8-iso-prostaglandin F2alpha (8iso-PG F2alpha)) in sera were measured. Disease activity was assessed using the SLE disease activity index (SLEDAI).
Results BMI assessment revealed that 48% of SLE patients were overweight, 27% were obese, 10% were malnourished and 18% were of normal weight. The dietary intake assessment showed a lower intake consumption of fresh fruit, vegetables, milk and other dairy products and an increased intake of fats and oils. Low intake of iron, calcium and zinc was found in 35%, 58% and 78% respectively. The levels of the inflammatory markers; TNF-alpha and IL-6 and the levels of the oxidative stress markers; MDA and 8iso-PG F2alpha were increased, r =0.485, p<0.001; r =0.577, p<0.005 respectively. The serum level of MDA and 8iso-PG F2alpha showed a positive correlation to SLEDAI. Increased BMI correlated with lower socioeconomic status, lower level of education, increased disease activity (SLEDAI), higher dosages of corticosteroid intake and decreased physical activity.
Conclusions Patients with SLE have inadequate nutritional status and food intake. Altered serum levels of proinflammatory cytokines and oxidative stress markers may reflect the deterioration that is associated with SLE.The results of the present study show that nutritional status, inflammatory and oxidative stress markers affect SLE disease activity. The identification of malnutrition in patients with SLE is extremely important as this can be potentially modified to promote improvement in the symptoms of SLE patients. Interventions aimed at promoting adequate nutritional status may have beneficial effects by decreasing inflammation and oxidative stress and thus may contribute to reduction of comorbidities and improved quality of life in these patients.
Disclosure of Interest : None declared
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