Change in dietary inflammatory index score is associated with control of long-term rheumatoid arthritis disease activity in a Japanese cohort: the TOMORROW study

Yoshinari Matsumoto,Yuko Sugioka,Tadashi Okano,Tatsuya Koike,Masahiro Tada,Kentaro Inui,Nitin Shivappa,James R Hebert,Daiki Habu,Kenji Mamoto

doi:10.1186/s13075-021-02478-y

Abstract

BackgroundThe dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported. However, the association between DII score and disease activity of rheumatoid arthritis (RA) is unclear. Therefore, this study was designed to test whether higher DII score contributes to disease activity and as a corollary, whether reducing DII score helps to achieve or maintain low disease activity or remission in patients with RA.MethodsWe performed a cross-sectional and longitudinal analysis using 6 years of data (from 2011 to 2017) in TOMORROW, a cohort study consisting of 208 RA patients and 205 gender- and age-matched controls started in 2010. Disease activity of RA patients was assessed annually using DAS28-ESR (disease activity score 28 joints and the erythrocyte sedimentation rate) as a composite measure based on arthritic symptoms in 28 joints plus global health assessment and ESR. Dietary data were collected in 2011 and 2017 using the brief-type self-administered diet history questionnaire (BDHQ). Energy-adjusted DII (E-DII™) score was calculated using 26 nutrients derived from the BDHQ. Data were analyzed with two-group comparisons, correlation analysis, and multivariable logistic regression analysis.ResultsOne hundred and seventy-seven RA patients and 183 controls, for whom clinical and dietary survey data were available, were analyzed. RA patients had significantly higher E-DII (pro-inflammatory) score compared to controls both in 2011 and 2017 (p < 0.05). In RA patients, E-DII score was not a factor associated with significant change in disease activity. However, anti-inflammatory change in E-DII score was associated maintaining low disease activity (DAS28-ESR ≤ 3.2) or less for 6 years (OR 3.46, 95% CI 0.33–8.98, p = 0.011).ConclusionsThe diets of RA patients had a higher inflammatory potential than controls. Although E-DII score was not a factor associated with significant disease activity change, anti-inflammatory change in E-DII score appeared to be associated with maintaining low disease activity in patients with RA.Trial registrationUMIN Clinical Trials Registry, UMIN000003876. Registered 7 Aug 2010—retrospectively registered.

Highlights

The dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported
Energy-adjusted dietary inflammatory index (E-DII) score was not a factor associated with significant disease activity change, anti-inflammatory change in E-DII score appeared to be associated with maintaining low disease activity in patients with rheumatoid arthritis (RA)
The association between E-DII scores and age Because E-DII score were lower in 2017 compared to 2011 in both RA patients and controls, to test the possibility that aging has an effect on E-DII, we examined the association between E-DII score and age in RA patients and controls

Summary

Introduction

The dietary inflammatory index (DII®), a quantitative measure of the inflammatory potential of daily food and nutrient intake, and associations between a variety of health outcomes have been reported. The association between DII score and disease activity of rheumatoid arthritis (RA) is unclear. Rheumatoid arthritis (RA) is an autoimmune disease of unknown exact cause, defined by chronic inflammation. RA primarily results in destruction of joints and bones caused by chronic inflammation. RA is triggered locally and systemically and by the over-activation of immune cells and joint synovial cells. RA is mainly treated by pharmacotherapy, which includes disease-modifying antirheumatic drugs (DMARDs), glucocorticoid, and biological or targeted synthetic DMARDs (b-, tsDMARDs) which are molecularly targeted drugs suppressing the immune mediators or JAK-STAT (Janus activated kinase-signal transducers and activators of transcription) pathway, a downstream signaling pathway in cytokine-bound cells. Suppression of various points of inflammation pathways is important for controlling disease activity of RA [2]

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