Background Diet in RA is generally considered to be inadequate/inappropriate. Rheumatologists often neglect this important patient concern. ACR/EULAR guidelines do not provide adequate advice. Ayurveda (ancient India medicine system) with highly restricted diet is popular with Indian patients.
Objectives To evaluate diet adequacy in patients of RA in our setting
Methods 139 consenting patients (ACR 1987 classified)on long term supervised care and 165 unmatched healthy subjects (mean age 37.7 years) were interviewed in no particular order as per protocol; cross sectional design. A 10 day diet recall period and a-priori validated questionnaires was used. National (India) recommended daily allowance (RDA) and diet analysis (web based and food composition tables) methods were used.Standard CRF captured clinical data [mean pain VAS 4.6 cms,mean HAQ score (Indian version) 6.5]. Standard statistical analysis (SPSS) was done; significant p<0.05.
Results Table 1 (women) and 2 (men) show average daily energy expenditure and consumption of selected food items, RDA and p values (on comparison: P (1) for patient versus control, P (2) for patient versus RDA: p by Mann Whitney). Compared to RDA, patient consumption was significantly higher for most of the items except K; includes calcium, phosphorus, zinc, iron, folic acid, vitamin B group (data not shown in Tables). When compared to healthy subjects, consumption was significantly lower for female patients but not different for men (except for K). Reduction in diet K in RA group was more pronounced for women. All patients tested normokalemic (mean serum K+ 4.37 mEq/l). No meaningful correlation between diet components and disease measures (data not shown).Food avoidance patterns identified a-priori did not seem to impact disease measures (data not shown). 44% RA and 77% controls consumed vegetarian diet (excluding eggs). Patient dependence for diet recall and measure was the important limiation.
Conclusions The diet of RA patients seemed adequate except for an intriguingly low K. We speculate that patients eat lesser vegetables and fruits that source K. K sub serves several physiological functions that may be deranged in RA and contribute to disease progression. This would need further investigation.
Acknowledgements In contrary to our expectations and reassuringly, the diet of RA patients seemed adequate except for an intriguingly low potassium which should be investigated. We speculate that patients eat lesser vegetables and fruits that source potassium.
Disclosure of Interest None declared