A Mediterranean dietary intervention study of patients with rheumatoid arthritis

Abstract: Case control studies have shown that a high consumption of fish, olive oil, and cooked vegetables is associated with a decreased risk of developing rheumatoid arthritis (RA). These foods have a central position in the traditional Cretan Mediterranean diet, and it has been suggested that dietary factors contribute to the low prevalence of RA in Mediterranean countries. The overall aim of this thesis was to examine whether a modified Cretan Mediterranean diet can reduce signs and symptoms of RA. This was investigated in a three-month dietary intervention trial in which 51 patients with well controlled, although active RA of at least two years duration took part. A further aim was to study the compliance with the experimental and control diets used in the study, and to validate the diet history interview method used to assess the dietary intake. The validation was carried out by means of biological markers of dietary intake.From baseline to the end of the study the group that had adopted the Cretan Mediterranean diet (MD group; n=26) obtained a reduction in disease activity, improved physical function, and improved vitality, while no changes was seen in the control diet group (CD group; n=25).According to the dietary assessments, the intake frequencies of antioxidant-rich food items increased in the MD group. This group also had a significantly higher intake of vitamin E, vitamin C and selenium compared to the CD group. Despite the reported increase in the consumption frequencies of antioxidant-rich foods, the plasma levels of carotenoids, vitamin C, lipid adjusted tocopherols, uric acid and urine malondialdehyde, a marker of oxidative stress, were unchanged at the end of the study. The plasma levels of retinol, vitamin C and uric acid were, however, correlated to indices of disease activity. Changes in the reported consumption of food groups with relevance to the fat intake were also observed in the MD group, including an increased intake of fish, shellfish and poultry, and a decreased intake of meat and high fat dairy products. As a result, the total fat intake was lower in the MD group compared to the CD group. Furthermore, in the MD group a slightly higher percentage of the energy intake was derived from polyunsaturated fatty acids and a lower percentage from saturated fatty acids. This group also had a lower ratio of n-6:n-3 fatty acids. A corresponding change in the relation between n-6 and n-3 fatty acids was also observed in s-phospholipids.The validation of the diet history interview method showed that the diet history interview could capture the dietary intake fairly well. The validity of the reported dietary intake did not differ between the MD and the CD group, which indicates that the dietary assessment was not biased by the dietary intervention.