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Diet, disease activity, and gastrointestinal symptoms in patients with ankylosing spondylitis
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
2011 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 30, no 1, 71-76 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p < 0.01 and p = 0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p < 0.01) and lower consumption of milk and soured milk (p = 0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.

Place, publisher, year, edition, pages
2011. Vol. 30, no 1, 71-76 p.
Keyword [en]
Abdominal pain, Ankylosing spondylitis, Diet, Irritable bowel syndrome
National Category
Rheumatology and Autoimmunity
URN: urn:nbn:se:umu:diva-39671DOI: 10.1007/s10067-010-1625-xPubMedID: 21110212OAI: diva2:394678
Available from: 2011-02-03 Created: 2011-02-03 Last updated: 2011-10-28Bibliographically approved
In thesis
1. On diet in ankylosing spondylitis
Open this publication in new window or tab >>On diet in ankylosing spondylitis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to examine the role of diet in ankylosing spondylitis (AS). Patients were examined in: i) a postal questionnaire survey of dietary habits and gastrointestinal (GI) symptoms; ii) a study on biomarkers of diet and disease activity; iii) a comparison of cardiovascular risk factors with the general population using data from the Västerbotten Intervention Programme (VIP), and; iv) a 21-week omega-3 fatty acid supplementation study regarding the effects on disease activity.

The postal survey (111 respondents) revealed no correlation between dietary habits and disease activity measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). However, GI problems, and in particular GI pain, were prevalent in patients with AS irrespective of NSAID usage.Gastrointestinal pain was predicted by higher BASDAI and a higher consumption of vegetables. Overall, 30 (27%) of the patients experienced an aggravation of gastric symptoms when consuming certain foods. In the study of biomarkers (n=66) no correlation was found between diet and disease activity as assessed by BASDAI. There were, however, positive correlations between BASDAI and the content of arachidonic acid (AA) in plasma phospholipids (rs=0.39, p<0.01) and the estimated activity of the enzyme delta-5-desaturase (rs=0.37, p<0.01). This may reflect a process involved in the inflammation associated with AS that requires further investigation. Comparing data from the VIP for patients (n=89) and controls showed no significant differences regarding diet, physical activity or smoking. Nonetheless, more pronounced correlations between blood lipids and diet were identified among patients than in controls. Furthermore, the levels of cholesterol and triglycerides were lower in patients compared with controls. Lastly, in the supplementation study, a high-dose of long-chain omega-3 fatty acids (4.55 grams/day) was found to lower disease activity, as measured by BASDAI, whereas low-dose treatment (1.95 grams/day) caused no change.

In conclusion, within a group of Swedish AS patients we found no correlation between ordinary dietary habits and disease activity. Diet in western populations of patients with AS may, however, be of importance for gastric symptoms and for cardiovascular risk factors. The finding of a lowered disease activity in patients on high-dose supplementation with long-chain omega-3 fatty acids indicates that a radical dietary shift may influence disease activity. The findings of a positive correlation between disease activity and plasma AA, and the decreased levels of blood lipids imply the need for further studies into fatty acid metabolism in AS. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 50 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1440
diet, ankylosing spondylitits, omega-3, cardiovascular
National Category
Rheumatology and Autoimmunity
Research subject
Medicine, rheumatology
urn:nbn:se:umu:diva-48557 (URN)978-91-7459-272-6 (ISBN)
Public defence
2011-11-18, Utbildningsnod XI, lokal 135, Umeå Universitet, UMEÅ, 09:00 (Swedish)
Available from: 2011-10-28 Created: 2011-10-22 Last updated: 2011-10-28Bibliographically approved

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