Advertisement

NOTICE: We are experiencing technical issues with Academy members trying to log into the JAND site using Academy member login credentials. We are working to resolve the issue as soon as possible. Alternatively, if you are an Academy member, you can access the JAND site by registering for an Elsevier account and claiming access using the links at the top of the JAND site. Email us at [email protected] for assistance. Thanks for your patience!

Effectiveness and Safety of Dietary Interventions for Rheumatoid Arthritis: A Systematic Review of Randomized Controlled Trials

      Abstract

      This systematic review assesses the effectiveness and safety of dietary interventions for rheumatoid arthritis. Randomized controlled trials comparing any dietary manipulation with an ordinary diet were included. Eight randomized controlled trials with a total of 366 patients were included. One trial found that fasting, followed by 13 months on a vegetarian eating plan, might reduce pain (mean difference on a zero to 10 scale −1.89, 95% confidence interval [CI] −3.62 to −0.16). Another single trial found that a 12-week Cretan Mediterranean eating plan might reduce pain (mean difference on a 0 to 100 scale −14.00, 95% CI −23.6 to −4.37). Due to inadequate data reporting, the effects of vegan eating plans and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a higher total drop-out of 8% (risk difference 0.08, 95% CI −0.01 to 0.17), higher treatment-related drop-out of 5% (risk difference 0.05, 95% CI −0.03 to 0.14) and a significantly higher weight loss (weighted mean difference −3.24, 95% CI −4.81 to −1.67 kg) in the diet groups compared to the control groups. The effects of dietary manipulation, including vegetarian, Mediterranean, and elemental eating plans, and elimination diets on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. We conclude that higher dropout rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Uhlig T.
        • Kvien T.K.
        Is rheumatoid arthritis disappearing?.
        Ann Rheum Dis. 2005; 64: 7-10
        • Uhlig T.
        • Loge J.H.
        • Kristiansen I.S.
        • Kvien T.K.
        Quantification of reduced health-related quality of life in patients with rheumatoid arthritis compared to the general population.
        J Rheumatol. 2007; 34: 1241-1247
        • Kjeldsen-Kragh J.
        • Haugen M.
        • Borchgrevink C.F.
        • Laerum E.
        • Eek M.
        • Mowinkel P.
        • Hovi K.
        • Førre Ø.
        Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.
        Lancet. 1991; 338: 899-902
        • Skoldstam L.
        • Hagfors L.
        • Johansson G.
        An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis.
        Ann Rheum Dis. 2003; 62: 208-214
        • Darlington L.G.
        • Ramsey N.W.
        • Mansfield J.R.
        Placebo-controlled, blind-study of dietary manipulation therapy in rheumatoid-arthritis.
        Lancet. 1986; 1: 236-238
        • Kavanagh R.
        • Workman E.
        • Nash P.
        • Smith M.
        • Hazleman B.L.
        • Hunter J.O.
        The effects of elemental diet and subsequent food reintroduction on rheumatoid-arthritis.
        Br J Rheumatol. 1995; 34: 270-273
        • Müller H.
        • Wilhelmi de Toledo F.
        • Resch K.-L.
        Fasting followed by vegetarian diet in patients with rheumatoid arthritis: A systematic review.
        Scand J Rheumatol. 2001; 30: 1-10
        • Rennie K.L.
        • Hughes J.
        • Lang R.
        • Jebb S.A.
        Nutritional management of rheumatoid arthritis: A review of the evidence.
        J Hum Nutr Diet. 2003; 16: 97-109
        • Arnett F.
        • Edworthy S.
        • Bloch D.
        • McShane D.
        • Fries J.
        • Cooper N.S.
        • Healy L.A.
        • Kaplan S.R.
        • Liang M.H.
        • Luthra H.S.
        The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.
        Arthritis Rheum. 1988; 31: 315-324
        • Hagen K.B.
        • Byfuglien M.G.
        • Falzon L.
        • Olsen S.U.
        • Smedslund G.
        Dietary interventions for rheumatoid arthritis.
        Cochrane Database Syst Rev. 2009; 1 (CD006400)
        • Maxwell L.
        • Santesso N.
        • Tugwell P.S.
        • Wells G.A.
        • Judd M.
        • Buchbinder R.
        • editorial board of the Cochrane musculoskeletal group
        Method guidelines for Cochrane musculoskeletal group systematic reviews.
        J Rheumatol. 2006; 33: 2304-2311
        • Haugen M.
        • Kjeldsen-Kragh J.
        • Førre Ø.
        A pilot study of the effect of elemental diet in the management of rheumatoid arthritis.
        Clin Exp Rheumatol. 1994; 12: 275-279
        • Podas T.
        • Nightingale J.M.D.
        • Oldham R.
        • Roy S.
        • Sheehan N.J.
        • Mayberry J.F.
        Is rheumatoid arthritis a disease that starts in the intestine?.
        Postgrad Med J. 2007; 83: 128-131
        • van de Laar M.
        • van der Korst J.K.
        Food intolerance in rheumatoid arthritis. I. A double blind, controlled trial of the clinical effects of elimination of milk allergens and azo dyes.
        Ann Rheum Dis. 1992; 51: 298-302
        • McKellar G.
        • Morrison E.
        • McEntegart A.
        • Hampson R.
        • Tierney A.
        • Mackle G.
        • Scoular J.
        • Scott J.A.
        • Capell H.A.
        A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow.
        Ann Rheum Dis. 2007; 66: 1239-1243
        • Hansen G.V.
        • Nielsen L.
        • Kluger E.
        • Thysen M.
        • Emmertsen H.
        • Stengaard-Pedersen K.
        • Hansen E.L.
        • Unger B.
        • Andersen P.W.
        Nutritional status of Danish rheumatoid arthritis patients and effects of a diet adjusted in energy intake, fish-meal, and antioxidants.
        Scand J Rheumatol. 1996; 25: 325-330
        • Panush R.S.
        • Carter R.L.
        • Katz P.
        • Kowsari B.
        • Longley S.
        • Finnie S.
        Diet therapy for rheumatoid-arthritis.
        Arthritis Rheum. 1983; 26: 462-471
        • Sarzi-Puttini P.
        • Comi D.
        • Boccassini L.
        • Muzzupappa S.
        • Turiel M.
        • Panni B.
        • Salvaggio A.
        Diet therapy for rheumatoid arthritis.
        Scand J Rheumatol. 2000; 29: 302-307
        • Skoldstam L.
        • Larsson L.
        • Lindstrom F.D.
        Effects of fasting and lacto-vegetarian diet on rheumatoid-arthritis.
        Scand J Rheumatol. 1979; 8: 249-255
        • Hafstrom I.
        • Ringertz B.
        • Spangberg A.
        • von Zweigbergk L.
        • Brannemark S.
        • Nylander I.
        • Ronnelid J.
        • Laasonen L.
        • Klareskog L.
        A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: The effects on arthritis correlate with a reduction in antibodies to food antigens.
        Rheumatology. 2001; 40: 1175-1179
        • Nenonen M.T.
        • Helve T.A.
        • Rauma A.L.
        • Hanninen O.O.
        Uncooked, lactobacilli-rich, vegan food and rheumatoid arthritis.
        Br J Rheumatol. 1998; 37: 274-281
        • Holst-Jensen S.E.
        • Pfeiffer-Jensen M.
        • Monsrud M.
        • Tarp U.
        • Buus A.
        • Hessov I.
        • Thorling E.
        • Stengard-Pedersen K.
        Treatment of rheumatoid arthritis with a peptide diet: A randomized, controlled trial.
        Scand J Rheumatol. 1998; 27: 329-336
        • Solomon D.
        • Goodson N.
        • Katz J.
        • Weinblatt M.
        • Avorn J.
        • Setoguchi S.
        Patterns of cardiovascular risk in rheumatoid arthritis.
        Ann Rheum Dis. 2006; 65: 1608-1612
        • van Staa T.
        • Geusens P.
        • Bijlsma J.
        • Leufkens H.
        • Cooper C.
        Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.
        Arthritis Rheum. 2006; 54: 3104-3112
        • Arshad A.
        • Rashid R.
        • Benjamin K.
        The effect of disease activity on fat-free mass and resting energy expenditure in patients with rheumatoid arthritis vs noninflammatory arthropathies/soft tissue rheumatism.
        Mod Rheumatol. 2007; 17: 470-475
        • Chiang E.
        • Bagley P.
        • Selhub J.
        • Nadeau M.
        • Roubenoff R.
        Abnormal vitamin B(6) status is associated with severity of symptoms in patients with rheumatoid arthritis.
        Am J Med. 2003; 114: 283-287
        • Munro R.
        • Capell H.
        Prevalence of low body mass in rheumatoid arthritis: Association with the acute phase response.
        Ann Rheum Dis. 1997; 56: 326-329
        • Metsios G.
        • Stavropoulos-Kalinoglou A.
        • Douglas K.
        • Koutedakis Y.
        • Nevill A.
        • Panoulas V.
        Blockade of tumour necrosis factor-alpha in rheumatoid arthritis: Effects on components of rheumatoid cachexia.
        Rheumatology. 2007; 46: 1824-1827
        • Kremers H.
        • Nicola P.
        • Crowson C.
        • Ballman K.
        • Gabriel S.
        Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis.
        Arthritis Rheum. 2009; 50: 326-329

      Biography

      G. Smedslund is a senior researcher, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and the Norwegian Knowledge Center, Oslo, Norway.

      Biography

      M. G. Byfuglien is a clinical dietitian, Diakonhjemmet Hospital, Oslo, Norway

      Biography

      S. U. Olsen is a clinical dietitian, Diakonhjemmet Hospital, Oslo, Norway

      Biography

      K. Birger Hagen is a senior researcher, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

      Linked Article

      • Nutrient Adequacy of Vegetarian Diets
        Journal of the American Dietetic AssociationVol. 110Issue 10
        • Preview
          Smedslund and colleagues presented important findings about the role diet can play in the management of rheumatoid arthritis (RA) (1). I have a concern that there are several statements in the discussion section that are not referenced to the literature and, in fact, are not supported by research. The authors stated that a vegan eating plan “may cause deficiency in several vitamins and minerals and protein.” Two of the dietary interventions for RA found no differences in serum albumin levels between the vegan or vegetarian diet plans and controls (2,3) and one found an increase in protein intake among the vegan diet group (3).
        • Full-Text
        • PDF