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On diet in ankylosing spondylitis
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to examine the role of diet in ankylosing spondylitis (AS). Patients were examined in: i) a postal questionnaire survey of dietary habits and gastrointestinal (GI) symptoms; ii) a study on biomarkers of diet and disease activity; iii) a comparison of cardiovascular risk factors with the general population using data from the Västerbotten Intervention Programme (VIP), and; iv) a 21-week omega-3 fatty acid supplementation study regarding the effects on disease activity.

The postal survey (111 respondents) revealed no correlation between dietary habits and disease activity measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). However, GI problems, and in particular GI pain, were prevalent in patients with AS irrespective of NSAID usage.Gastrointestinal pain was predicted by higher BASDAI and a higher consumption of vegetables. Overall, 30 (27%) of the patients experienced an aggravation of gastric symptoms when consuming certain foods. In the study of biomarkers (n=66) no correlation was found between diet and disease activity as assessed by BASDAI. There were, however, positive correlations between BASDAI and the content of arachidonic acid (AA) in plasma phospholipids (rs=0.39, p<0.01) and the estimated activity of the enzyme delta-5-desaturase (rs=0.37, p<0.01). This may reflect a process involved in the inflammation associated with AS that requires further investigation. Comparing data from the VIP for patients (n=89) and controls showed no significant differences regarding diet, physical activity or smoking. Nonetheless, more pronounced correlations between blood lipids and diet were identified among patients than in controls. Furthermore, the levels of cholesterol and triglycerides were lower in patients compared with controls. Lastly, in the supplementation study, a high-dose of long-chain omega-3 fatty acids (4.55 grams/day) was found to lower disease activity, as measured by BASDAI, whereas low-dose treatment (1.95 grams/day) caused no change.

In conclusion, within a group of Swedish AS patients we found no correlation between ordinary dietary habits and disease activity. Diet in western populations of patients with AS may, however, be of importance for gastric symptoms and for cardiovascular risk factors. The finding of a lowered disease activity in patients on high-dose supplementation with long-chain omega-3 fatty acids indicates that a radical dietary shift may influence disease activity. The findings of a positive correlation between disease activity and plasma AA, and the decreased levels of blood lipids imply the need for further studies into fatty acid metabolism in AS. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2011. , 50 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1440
Keyword [sv]
diet, ankylosing spondylitits, omega-3, cardiovascular
National Category
Rheumatology and Autoimmunity
Research subject
Medicine, rheumatology
Identifiers
URN: urn:nbn:se:umu:diva-48557ISBN: 978-91-7459-272-6 (print)OAI: oai:DiVA.org:umu-48557DiVA: diva2:451931
Public defence
2011-11-18, Utbildningsnod XI, lokal 135, Umeå Universitet, UMEÅ, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-28 Created: 2011-10-22 Last updated: 2011-10-28Bibliographically approved
List of papers
1. Diet, disease activity, and gastrointestinal symptoms in patients with ankylosing spondylitis
Open this publication in new window or tab >>Diet, disease activity, and gastrointestinal symptoms in patients with ankylosing spondylitis
2011 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 30, no 1, 71-76 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p < 0.01 and p = 0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p < 0.01) and lower consumption of milk and soured milk (p = 0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.

Keyword
Abdominal pain, Ankylosing spondylitis, Diet, Irritable bowel syndrome
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-39671 (URN)10.1007/s10067-010-1625-x (DOI)21110212 (PubMedID)
Available from: 2011-02-03 Created: 2011-02-03 Last updated: 2017-12-11Bibliographically approved
2. Plasma phospholipid fatty acid content is related to disease activity in ankylosing spondylitis
Open this publication in new window or tab >>Plasma phospholipid fatty acid content is related to disease activity in ankylosing spondylitis
Show others...
2012 (English)In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 39, no 2, 327-333 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the fatty acid composition in the diet, plasma phospholipids, and adipose tissue among a cohort of patients with ankylosing spondylitis (AS), and to determine their correlation to disease activity and blood lipids in a cross-sectionally designed study.

Methods: Diet was assessed using a food frequency questionnaire on 66 patients with AS. The polyunsaturated fatty acids (PUFAs) in plasma phospholipids and gluteal adipose tissue were measured using gas chromatography. Disease status was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein and pro-inflammatory cytokines.

Results: Diet did not correlate to disease activity assessed by the BASDAI, but there were negative correlation between the dietary intake of long-chained omega-3 fatty acids and ESR (rs=-0.27, p<0.05). The plasma phospholipid content of arachidonic acid (AA) correlated significantly with the BASDAI score (rs=0.39, p<0.01). There were correlations between the intake of long-chained omega-3 fatty acids and high-density lipoproteins as well as to serum triglycerides (rs=0.26 and rs=-0.25; respectively, p<0.05).

Conclusion: There was a positive correlation between levels of AA in plasma phospholipids and disease activity assessed by BASDAI in patients with AS. A western diet does not appear to influence this correlation, but seems to affect blood lipids involved in atherogenic processes. 

Place, publisher, year, edition, pages
Toronto: Journal of Rheumatology Pub. Co., 2012
Keyword
ankylosing spondylitis, disease activity, fatty acids, diet
National Category
Rheumatology and Autoimmunity
Research subject
Medicine, rheumatology
Identifiers
urn:nbn:se:umu:diva-48556 (URN)10.3899/jrheum.110575 (DOI)
Available from: 2011-10-26 Created: 2011-10-22 Last updated: 2017-12-08Bibliographically approved
3. Diet and cardiovascular risk factors among patients with ankylosing spondylitis in comparison with the general population
Open this publication in new window or tab >>Diet and cardiovascular risk factors among patients with ankylosing spondylitis in comparison with the general population
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: An increased risk of cardiovascular diseases (CVD) has been reported among patients with Ankylosing Spondylitis (AS).  As of today, little is known what causes this increase.  The aim of this study was to evaluate whether diet and traditional CVD risk factors differ among AS patients in comparison to the general population.

Material and method: Eighty-nine patients diagnosed with AS by fulfilling the modified New York criteria were identified in the databases of a community intervention programme, the Västerbotten Intervention Programme (VIP).  The patients were compared with 356 controls matched for age, sex and study period.  As part of the VIP, participants have completed questionnaires regarding diet, physical activity and smoking.  Additionally, the VIP included measurement of blood pressure, height and weight, and blood samples analysed for cholesterol, serum triglycerides and blood glucose.

Results: No significant differences were found between patients and controls regarding diet, physical activity, exercise frequency or smoking habits; nor in measurements of body mass index (BMI), weight or blood pressure.  However, levels of serum triglycerides (p<0.01) and cholesterol (p<0.01) were significantly lower in the patient group.  Among the patients, the level of triglycerides was inversely correlated to the intake of total fat (rs = -0.25, p<0.05), monounsaturated fats (rs = -0.29, p<0.05) and positively correlated to the intake of carbohydrates (rs = 0.26, p<0.05).  These correlations were not seen among the controls.

Conclusions: The patients exhibited significantly lower levels of cholesterol and triglycerides compared with controls.  There were correlations between diet and atherogenic blood lipids among the patients which were not found in the control group.  The results suggest that there may be differences in fat metabolism among patients with AS in comparison to the general population.

Keyword
ankylosing spondylitis, cardiovascular, diet
National Category
Medical and Health Sciences Rheumatology and Autoimmunity
Research subject
Medicine, rheumatology
Identifiers
urn:nbn:se:umu:diva-48554 (URN)
Available from: 2011-10-26 Created: 2011-10-22 Last updated: 2011-10-28Bibliographically approved
4. Supplementation of Omega-3 fatty acids in patients with ankylosing spondylitis
Open this publication in new window or tab >>Supplementation of Omega-3 fatty acids in patients with ankylosing spondylitis
2006 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 35, 359-362 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study the effect of supplementation with omega‐3 fatty acids on disease variables and drug consumption in patients with ankylosing spondylitis (AS).

Methods: Twenty‐four patients were randomized to either a low‐dose (1.95 g omega‐3/day) or a high‐dose (4.55 g omega‐3/day) supplement. Disease activity, functional impairment, erythrocyte sedimentation rate (ESR), and drug consumption were assessed during visits at baseline and at weeks 7, 14, and 21.

Results: Eighteen patients completed the study, nine patients from each group. The patients in the high‐dose group exhibited a significant decrease in disease activity according to the Bath Ankylosing Disease Activity Index (BASDAI; p = 0.038), which was not seen in the low‐dose group. Significant differences were not found on drug consumption or in functional capacity in either of the groups. No significant differences were found when comparing the results between the high‐ and low‐dose groups.

Conclusion: Omega‐3 fatty acids in adequate doses may have the capacity to decrease the disease activity of AS. However, larger and better controlled studies are needed before any further conclusions can be made on the extent of this capacity.

Read More: http://informahealthcare.com/doi/abs/10.1080/03009740600844357

National Category
Rheumatology and Autoimmunity
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-13549 (URN)10.1080/03009740600844357 (DOI)
Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2011-10-28Bibliographically approved

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