Relationship of Excess Weight with Clinical Activity and Dietary Intake Deficiencies in Systemic Lupus Erythematosus Patients

Abstract

Obesity and nutrients intake deficiencies may contribute to the clinical manifestations and inflammatory processes in systemic lupus erythematosus (SLE). The aim of this study was to assess the relationship between nutritional status and dietary intake with clinical variables in Mexican-mestizo SLE patients. A cross-sectional study was conducted in 130 female SLE patients, classified by the 1997 SLE American College of Rheumatology (ACR) criteria; the clinical activity was evaluated by the Mexican-Systemic Lupus Erythematosus-Disease Activity Index (Mex-SLEDAI); body mass index (BMI) by the World Health Organization (WHO) criteria; the energy calculation and nutritional intake were performed by Nutritionist Pro Diet software. SLE patients with excess weight (BMI > 25 kg/m2) showed a higher score of clinical activity (Mex-SLEDAI = 2; p = 0.003), higher clinical activity prevalence (40.9%; p = 0.039) and a significant association for high clinical activity (odds ratio (OR) = 2.52; 95% confidence interval (CI) = 1.08–5.9; p = 0.033), in comparison with patients without excess weight (BMI < 25 kg/m2). In particular, the excess weight increased the Mex-SLEDAI score (β coefficient = 1.82; R2 = 0.05; p = 0.005). Also, the SLE patients presented a high prevalence (%) of deficient consumption (cut-off point: <67% of dietary adequacy) of vitamin E (100%), iodine (96%), omega 3 (93.44%), biotin (78%), vitamin K (73.33%), iron (67%), vitamin D (63.3%), potassium (59%), folic acid (56.67%), pantothenic acid (43.3%), vitamin A (41.67%) and zinc (32%). In conclusion, in SLE patients the excess weight was associated with increased clinical activity and to the presence of deficiencies in some essential nutrients ingested.

Immunomodulatory Effects of Diet and Nutrients in Systemic Lupus Erythematosus (SLE): A Systematic Review

“…Obesity has a strong impact on organism functioning and is linked to the development of all diseases of civilization, including metabolic syndrome, atherosclerosis and T2DM. Strong evidence also links obesity to many autoimmune disorders including SLE ( 8 , 33 , 34 ). Obesity in SLE patients is associated with a poorer outcome, higher disease activity and higher cumulative organ damage ( 34 , 35 ).…”

“…Strong evidence also links obesity to many autoimmune disorders including SLE ( 8 , 33 , 34 ). Obesity in SLE patients is associated with a poorer outcome, higher disease activity and higher cumulative organ damage ( 34 , 35 ). Therefore, the importance of prevention and treatment of obesity is widely acknowledged.…”

Evidence of Renal Iron Accumulation in a Male Mouse Model of Lupus

“…In contrast, dietary interventions to induce iron deficiency or to supplement dietary iron intake well above normal levels produced corresponding decreases and increases, respectively, in kidney iron levels in female MRL/ lpr mice, but in both cases accelerated the development of proteinuria, worsened histological evidence of renal damage and accelerated mortality ( 31 ). A recent cross-sectional study of Mexican-mestizo SLE patients noted an association between increased disease activity, excess weight, as well as a high prevalence of nutritional deficiencies, including of iron ( 32 ). The mechanisms underlying the pathological effects of iron deficiency or iron excess on disease severity and renal injury specifically in SLE remain to be investigated but likely reflect a combination of direct effects at the tissue level, as well as on the immune system.…”

Association of Food Intake Quality with Vitamin D in SARS-CoV-2 Positive Patients from Mexico: A Cross-Sectional Study

“…Subsequently, patients were classified according to the following categories for the Mexican population [ 23 ]: <90%, insufficient; 90–110%, adequate; and >110%, excessive. The latter analysis was performed based on the methodology reported by Meza-Meza MR, et al 2019 [ 24 ].…”