POS0956 MEDITERRANEAN DIET IN AXIAL SPONDYLOARTHRITIS: A NUTRITIONAL INTERVENTION STUDY
Authors: F. Ometto, D. M. Farber, M. Lorenzin, A. Ortolan, G. Dellamaria, M. Felicetti, M. Favero, R. Valentini, A. Doria, R. Ramonda
Journal: Annals of the Rheumatic Diseases (2021)

Background: Mediterranean diet (MD) proved to be beneficial on disease activity in patients affected by rheumatoid arthritis. A few data are available in other rheumatic conditions. Objectives: A prospective monocentric study was conducted to evaluate the effect of a nutritional intervention based on the MD and to investigate the impact of such modification on disease activity of axial spondyloarthitis (ax-SpA). Methods: Patients affected by ax-SpA randomized to a nutritional intervention arm (N) or a control arm (C) and were assessed at baseline (T0) and at month 6 (T6). Patients in N underwent a nutritional evaluation and received suggestions for dietary modification at T0, and then every 2 months. Adherence to the MD was evaluated with the PREDIMED questionnaire (range 0-10) [1]. A multivariable regression analysis was conducted to identify independent predictors of PREDIMED and of ASDAS-CRP improvement at T6. Results: Eligible patients (161) were randomized to either N (81) or C (80); 47 in N and 63 in C completed the study. No relevant change of anthropometric or laboratory measures was observed at T6 in either group. A ≥20%PREDIMED improvement was more frequent in N (22/47, 46.8%) compared to C (13/63, 20.6%) (p&lt;0.01). Also, a ≥20%ASDAS-CRP improvement was more frequent in N (8/47, 57.1%) compared to C (39/63, 40.6%) (p=0.020); and especially in those who achieved a ≥20%PREDIMED improvement (12/35, 34.3%) vs those who did not (2/73, 2.7%) (p&lt;0.01). The nutritional intervention, a higher age, and a lower BMI increased the odds of achieving a ≥20%PREDIMED improvement; the ≥20%PREDIMED improvement was associated higher odds of achieving a ≥20%ASDAS-CRP improvement; psoriasis was negatively associated to the ASDAS-CRP improvement (Figure 1). Conclusion: A nutritional intervention is effective in improving adherence to the MD in ax-SpA. A higher adherence to the MD may have a beneficial impact on activity of ax-SpA. Patients with psoriasis may have a limited benefit from the dietary improvement. References: [1]Martínez-González, M.A. et al. A 14-item mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial. PLoS One 2012 , 7 . Table 1. Characteristics of the patients. All patients Nutrition Controls All patients Nutrition Controls Baseline Month 6 Females, n, (%) 40 (36.4) 18 (38.3) 22 (34.9) Age, years, mean±SD 51.7±1.3 53.0±1.3 49.6±1.3 HLA-B27 positivity, n (%) 58 (52.7) 22 (46.8) 37 (57.1) Psoriasis, n (%) 58 (50.7) 26 (55.3) 32 (50.8) Disease duration (years), mean±SD 15.3±9.7 15.7±10 15±9.5 Duration of b/tsDMARD treatment overall, years, mean±SD 5±4.1 5.8±4.5 4.5±3.8 NSAID, n (%) 76 (69.1) 30 (63.8) 46 (73) csDMARD, n (%) 14 (12.7) 5 (10.6) 9 (14.3) BMI, Kg/meters 2 , mean±SD 26.5±5.4 26.5±4.3 26.6±6.1 26.4±5.3 26.3±4 26.6±6.1 ASDAS-CRP, mean±SD 2.1±1 2.1±0.9 2.1±1 2±1.1 1.8±0.9 2.1±1.2 BASDAI, mean±SD 37.6±23 37.4±23.2 37.7±22.9 39.3±24.1 37.3±23.6 41.2±24.6 BASFI, mean±SD 20.5±21.4 21.6±19.2 19.7±23 19.8±19.6 19.1±18.8 20.5±20.4 BASMI, mean±SD 1.6±2 1.9±2.2 1.4±1.7 1.8±2.1 1.9±2.4 1.7±1.9 Tender joint count, mean±SD 1.1±2.3 0.8±2.1 1.4±2.5 0.9±2 0.8±2 0.9±1.9 Swollen joint count, mean±SD 0.3±1.3 0.4±2 0.1±0.5 0.2±1.3 0.3±1.8 0.2±0.8 Leeds Enthesitis Index, mean±SD 0.2±0.8 0.3±1 0.2±0.6 1.1±2 1.3±2.2 1±1.8 CRP, mg/L, mean ±SD 3.4±6.2 3.2±3.9 3.7±7.4 3.5±5.6 2.6±3.1 4.1±6.9 LDL-c, mg/dl, mean ±SD 130.8±36.5 132.3±35 129.7±38.4 130.6±34.7 125.7±34.8 134.4±34.5 PREDIMED score, mean ±SD 6.7±1.8 7±2.1 6.6±1.6 7.6±2.1 8.6±1.9 6.8±2 b/tsDMARD biological/targeted synthetic DMARDs; csDMARD conventional DMARDs. PREDIMED questionnaire to assess adherence to the Mediterranean diet. Disclosure of Interests: None declared.