Editorial

INFLUENCE OF MEDITERRANEAN DIET ON INCIDENCE AND COURSE OF INFLAMMATORY RHEUMATIC DISEASES

Maurizio Cutolo

Abstract

Th e Greek “Father of Medicine” and physician Hippocrates, said around 400 B.C. “Let thy food be thy medicine and thy medicine be thy food” (Nikiphorou et al. 2018) Therefore, over the last decades we become increasingly aware and concerned about how nutrition affects our
health and the field of nutrition have meet unprecedented interest and expansion. On the other hands, a number of dietary factors might act as environmental triggers in rheumatic and muskuloskeletal diseases (RMDs) development. Overall, a ‘Western’ type diet rich in energy intake, total and saturated fat, an unbalanced ratio of n-3 to n-6 fatty acids, high in sugar and low in fiber and antioxidants might increase the
risk of RMDs both directly through increasing inflammation (Minihane et al. 2015) and indirectly through increasing insulin resistance, obesity and associated co-morbidities, with obesity being a known risk factor for
RMDs (Qin et al. 2015). In detail, high consumption of foods characteristic of the ‘Western-type’ diet such as red meat, meat and meat products combined, or total protein have been shown to increase the risk of inflammatory polyarthritis suggesting a role of advanced glycation end products (AGEs) (Pattison et al. 2004). This is supported by findings of regular consumption of sugar-sweetened soda, but not diet soda, being associated with an increased risk of seropositive rheumatoid arthritis (RA) in women (Hu et al. 2014), and of high fructose corn-syrup sweetened soft drinks, fruit drinks and apple juice being associated with arthritis in young US adults (DeChristopher et al. 2016). It is hypothesized that regular consumption of excess free fructose and HFCS contributes to fructose reactivity in the gastrointestinal tract and intestinal in situ formation of enFruAGEs, which once absorbed, travel beyond the intestinal boundaries to other tissues and promote inflammation (DeChristopher et al. 2016). Individual biomarkers of antioxidant intake have also been previously investigated in relation to RA with some evidence that low serum levels of selenium and alpha tocopherol (Knekt et al. 2000) and beta carotene (Comstock et al. 1997) are associated with an increased disease risk. Interestingly, a meta-analysis also suggests that coffee consumption of ≥ four cups per day is associated with an elevated risk of seropositive RA but not seronegative RA (Lee et al. 2014). However, the results should be interpreted with caution due to other potential confounders. The same meta-analysis found no association between tea consumption and risk of RA (Lee et al. 2014). On the contrary, consumption of longchain omega-3 polyunsaturated fatty acids, derived from fish and fish oil, is associated with a reduced risk of inflammatory RMD like RA (Di et al. 2014) probably due to their anti-inflammatory properties. The Mediterranean diet (MD), rich in plant-based foods such as wholegrains, legumes, fruit, vegetables, extravirgin olive oil and low in red meat consumption, might have the potential to reduce the risk of RA. It has been shown that greater adherence to the MD is associated with lower concentrations of inflammatory biomarkers (Fung et al. 2005), while daily consumption of monounsaturated fatty acids from olive oil is thought to be the key factor in suppressing RA disease activity (Matsumoto et al. 2017). Other nutritional approaches like vegan, elemental or elimination diets did not showed any superiority to the MD (Ciccia et al 2018, Philippou et al. 2018) regarding the interference on RMDs. In addition, recent evidences suggest the diet pattern, by modifying the composition of intestinal microbiome, might influence the activation of innate immune pathways such as inflammasome and autophagy directly involved in the production of pro-inflammatory cytokines such as IL-1b and IL-18 with effects on RMDs Based on current research evidence, it is concluded that adherence to the MD with an increased consumption of fatty fish, reduced consumption of sugar-sweetened drinks and maintenance of a normal body weight, contributes to reducing the risk of RA. Interestingly, looking at the “chrononutrition” following the body circadian rhythms (Nobel Prize for Medicine 2017) it has been assessed that circadian misalignment, behavioral processes such as food intake or sleep occurring at inappropriate endogenous circadian times, commonly occurs during shift work (i.e. night shift workers) are associated with serious health problems over the time including RMDs (Cutolo 2018). In conclusion, both correct quality and timing in nutrition, are essential in prevention and/or co-management of RMD-s

Keywords

Disclosure: None

Hrčak ID:

210510

URI

https://hrcak.srce.hr/210510

Publication date:

5.12.2018.

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