Few studies address impact of diet on rheumatic IMIDs
CHICAGO — There is a dearth of research evaluating the effects of diet and nutrition on rheumatic immune-mediated inflammatory diseases, and more dietary interventions need to be tested in rigorous clinical trials, according to a presenter at the 2019 Interdisciplinary Autoimmune Summit.
“In terms of exclusive enteral nutrition in immune-mediated inflammatory diseases in rheumatology, there really isn’t much out there,” Lindsey G. Albenberg, DO, of the Children’s Hospital of Philadelphia, told attendees. “I have found two case reports and an uncontrolled study of 13 patients in juvenile idiopathic arthritis.”
In particular, the uncontrolled study featured a high discontinuation rate, with six of the 13 participants ending exclusive enteral nutrition within 2 weeks. However, those who remained in the study demonstrated benefits in active joint count (P = .03), JASAS27 (P = .02), morning stiffness (P = .03) and other markers, according to Albenberg.
A pair of small clinical trials analyzing exclusive enteral nutrition in patients in rheumatoid arthritis found no significant difference in pain, physical function or morning stiffness compared with the control group, she said
However, despite the low numbers and limited data, Albenberg said the potential link between diet and gut microbiome in JIA, demonstrated in the uncontrolled study, is worth further investigation.
“I think the fact that there was potentially a signal in some patients with JIA is incredibly interesting,” she said. “It’s interesting because it suggests a potential link between diet and the gut microbiome in a disease that traditionally is not thought to have gastrointestinal manifestations.”
According to Albenberg, there have also been several small studies of exclusion diets, such as the Mediterranean, Cretan, vegan and anti-inflammatory diets, in patients with RA. However, none have produced definitive results. One trial in particular found that patients with RA who followed the Mediterranean diet demonstrated decreased pain, DAS28, swollen joint count and C-reactive protein.
“Dietary interventions need to be tested in rigorous clinical trials, and there are challenges with that, including the difficulty involved in getting patients to change their behavior, as well as the complexity of food and how it interacts with the patient,” Albenburg said. “We need to better understand the mechanisms that link diet to disease in order to improve the design of dietary interventions.” – by Jason Laday
Albenberg LG. Diet and nutrition in IMIDs. Presented at: Interdisciplinary Autoimmune Summit; April 5-7, 2019; Chicago.
Disclosure: Albenberg reports grant support from Seres Therapeutics.