Association of Dietary Inflammatory Index (DII) with disease activity and inflammatory cytokines in the patients with rheumatoid arthritis

Abstract

Objectives This study aimed, at first, to assess Dietary Inflammatory Index (DII) in participants with rheumatoid arthritis (RA) and compare them with healthy controls. Then, to evaluate the association of DII with the risk of RA occurrence, the severity of disease, and systemic inflammation. Methods This case‐control study enrolled 100 newly diagnosed cases with RA and 100 age and sex‐matched healthy controls. DII was computed based on the individuals’ FFQ‐derived dietary data. Serum levels of inflammatory markers, including the high sensitivity C‐reactive protein (hs‐CRP) and Tumour Necrosis Factor‐alpha (TNF‐α), were measured using the ELISA method; and the severity of the disease was assessed based on the disease activity score 28 (DAS‐28). Results The mean DII score was higher in the RA patients as compared with that in the controls (0.66 ± 0.23 vs. −0.58 ± 0.19, P = .002). Patients with the highest DII had significantly higher serum inflammatory (hs‐CRP and TNF) and clinical markers (DAS‐28 score and the number of tender joints). A significant univariate relationship between DII score and risk of RA incident [6.48 (95% CI: 1.79 to 23.44)] disappeared in multivariate analysis. For each 1‐unit increase in DII, the DAS‐28 score was raised by 1.11 times (P = .001). Conclusion An inflammatory diet may act as a potential risk factor contributing to the development of RA and its severity. Therefore, dietary modification with the goal of reducing the DII score could be a beneficial strategy to improve the clinical outcomes in such patients.

Association between dietary inflammatory index scores and the increased disease activity of rheumatoid arthritis: a cross-sectional study

“…To our knowledge, there was limited study conducted on the association of DII score and activity of rheumatoid arthritis disease and its components. Similar to our findings, Tandorost et al in a study on patients with rheumatoid arthritis reported that the highest DII had significantly higher serum inflammatory (hs-CRP and TNF) and clinical markers (The number of tender joints and DAS-28 score) [ 38 ]. In a cohort study by Dainty et al in the UK Biobank population was shown a significant association between inflammation (CRP) and diet and RA [ 39 ].…”

A Systematic Review of Nutritional Interventions on Key Cytokine Pathways in Rheumatoid Arthritis and Its Implications for Comorbid Depression: Is a More Comprehensive Approach Required?

“…From the analyzed publications, four main overarching themes stand out: 1. Poor diet quality and/or poor adherence to anti-inflammatory diets in patients with RA results in increased inflammatory markers and pain scores [22][23][24][25][26][27][28][29][30][31]; 2. Dietary consumption of antioxidants, PUFAs, and fiber have preferable disease outcomes in patients with RA, whereas salt does not [32][33][34][35][36][37][38]; 3.…”

“…The studies looked at various factors like anthropometrics and diet quality, in addition to identifying various interventions analyzing the effect of fasting diets, other specific diets, and intake of salt, fiber, antioxidants, and PUFAs on the inflammatory status of patients with RA. Generally, poor diet quality and diets considered inflammatory has been shown to worsen cytokine profiles and DAS [22,[24][25][26][27][28]. Several studies in this review [24][25][26][27][28], found that diets defined as "poor" in quality (diets with low intake of fish, shellfish, whole grains, fruits, and vegetables and high intake of smoked meats and sweets), diets with higher dietary inflammatory index (DII) scores, diets with low adherence to the Anti-inflammatory Diet in Rheumatoid Arthritis (ADIRA) protocol, or diets with low adherence to the Mediterranean diet are associated with poorer outcomes including higher CRP and ESR levels and increased pain levels.…”

“…Generally, poor diet quality and diets considered inflammatory has been shown to worsen cytokine profiles and DAS [22,[24][25][26][27][28]. Several studies in this review [24][25][26][27][28], found that diets defined as "poor" in quality (diets with low intake of fish, shellfish, whole grains, fruits, and vegetables and high intake of smoked meats and sweets), diets with higher dietary inflammatory index (DII) scores, diets with low adherence to the Anti-inflammatory Diet in Rheumatoid Arthritis (ADIRA) protocol, or diets with low adherence to the Mediterranean diet are associated with poorer outcomes including higher CRP and ESR levels and increased pain levels. Elimination diets excluding foods known to trigger inflammatory processes, for example, red meat, gluten, and dairy have also been explored as adjuvant treatment for RA patients, with one study showing a significant reduction in CRP levels, in addition to improved pain scores, lower levels of circulating leukocytes and neutrophils, and improved quality of life in patients with RA compared to controls [22].…”

Functional Role of Novel Anthranilic Acid Derivatives as Anti-inflammatory Agents

“…Elevated rheumatoid factor is an important surrogate of RA and, together with serum levels of inflammatory cytokines, can be used to monitor disease progression and treatment outcomes. [47][48] Experimentally, induction of RA by injecting CFA elevates blood levels of rheumatoid factor, 43 IL-1β, and IL-6, 49 which indicates a dysregulated immune function in response to autoimmunity. 50 Rheumatoid factor generation in arthritis involves B cell activation and several genetic predispositions to arthritic diseases.…”