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


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


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


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


      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
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          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).
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