Diet and Disease Activity in Patients with Axial Spondyloarthritis: SpondyloArthritis and NUTrition Study (SANUT)

Abstract

Axial Spondyloarthritis (axSpA) patients with inflamed intestines have higher SpA activity. Diets that modulate microbiota may influence inflammation and SpA activity. Today, data concerning the impact of diet on SpA activity are scarce. SANUT was a single-center, noninterventional, cohort study that assessed dietetic profiles associated with SpA activity in axSpA. Demographic, clinical, SpA-related, quality of life (QoL), fatigue, physical activity, and dietary data were collected. SpA activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS) and by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). We assessed whether high SpA activity was associated with nutriment consumption. Between 12 February 2018 and 12 February 2020, 278 patients participated. High SpA activity, as measured by ASDAS and BASDAI, was significantly associated with higher body mass index and waist circumference, negative HLA-B27, lower QoL, higher fatigue, and higher digestive-symptom scores. Furthermore, high SpA activity, as measured by BASDAI, was associated with female sex, smoking status, patients who were not actively employed, reduced physical activity, and high intake of ultra-transformed foods, while high SpA activity, as measured by ASDAS, was associated with low intake of omega-3 PUFAs and fiber. Therefore, low intakes of omega-3 PUFAs and fiber, and high intake of ultra-transformed foods, are associated with high SpA activity.

Keywords: diet; fiber; omega-3 polyunsaturated fatty acids; spondyloarthritis; ultra-transformed food.

Figure 1

Forest plot of univariate analysis of variables associated with higher SpA activity evaluated using ASDAS. ASDAS: Ankylosing Spondylitis Disease Activity Score, ASQoL: Ankylosing Spondylitis Quality of Life, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BMI: body mass index, CI: confidence intervals, HLA-B27: human leucocyte antigen B27, PUFA, polyunsaturated fatty acids, ref: reference value. Significant odds ratios are boxed.

Figure 2

Forest plot of univariate analysis of variables associated with higher SpA activity evaluated using BASDAI. ASDAS: Ankylosing Spondylitis Disease Activity Score, ASQoL: Ankylosing Spondylitis Quality of Life, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BMI: body mass index, CI: confidence intervals, CRP: C-reactive protein, DMARD: disease-modifying antirheumatic drugs, HLA-B27: human leucocyte antigen B27, NSAID: nonsteroidal anti-inflammatory drugs, PUFA, polyunsaturated fatty acids, ref: reference value. Significant odds ratios are boxed.