Inadequate Dietary Nutrient Intake in Patients With Rheumatoid Arthritis in Southwestern Sweden: A Cross-Sectional Study

Anna Turesson Wadell, Linnea Bärebring, Erik Hulander, Inger Gjertsson, Helen M Lindqvist, Anna Winkvist, Anna Turesson Wadell, Linnea Bärebring, Erik Hulander, Inger Gjertsson, Helen M Lindqvist, Anna Winkvist

Abstract

Background: Patients with rheumatoid arthritis (RA), who suffer from impaired physical function and fatigue, may have difficulties with grocery shopping and preparing meals. Also, to improve symptoms, patients often experiment with diets but seldom consult a dietitian. Although this could lead to a nutritiously deprived diet, an up-to-date, thorough description of the nutrient intake in Swedish patients with RA is absent. Here, we investigated the habitual dietary energy and nutrient intake in patients with RA living in southwestern Sweden.

Materials and methods: Three-day food records performed at two time points during the ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis) trial, were used. The intake of energy and nutrients was analyzed using The Swedish Food Composition Database.

Results: A total of 62 participants (50 females, 12 males) were included in the study, where 18 participants completed one 3-day food record and 44 participants completed two 3-day food records. Median (IQR) intake of total fat was above or in the upper range of recommendations (females: 37.1 [32.5, 41.7] energy percent (E%), and males: 40.3 [37.5, 42.9] E%). Median (IQR) intake of saturated fatty acids exceeded recommendations (females: 14.9 [12.5, 17.0] E% and males: 15.4 [12.2, 17.0] E%), while median (IQR) carbohydrate and fiber intakes were below recommendations (females: 41.7 [36.3, 45.4] E% and 17.2 [12.8, 20.9] g, respectively, and males: 38.8 [35.2, 40,3] E% and 18.5 [15.7, 21.0] g, respectively). The reported intake of other macronutrients was in line with recommendations. For several micronutrients, e.g., vitamin A and D, folate, and calcium, median intake was below recommended intake. Vitamin A intake was especially low and did not reach lower intake level (LI) for 14 and 17% of females and males, respectively. For females, about 10% did not reach LI for vitamin D, calcium, and riboflavin.

Conclusion: We found that patients with RA residing in southwestern Sweden reported a high intake of saturated fatty acids and low intake of fiber and several micronutrients.

Clinical trial registration: [https://ichgcp.net/clinical-trials-registry/NCT02941055?term=NCT02941055&draw=2&rank=1], identifier [NCT02941055].

Keywords: dietary fiber; energy intake; fatty acids; micronutrients; nutrients; nutritional requirements; rheumatoid arthritis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Turesson Wadell, Bärebring, Hulander, Gjertsson, Lindqvist and Winkvist.

Figures

FIGURE 1
FIGURE 1
Flowchart showing inclusion of study participants. The gray boxes represent the ADIRA trial, and the white boxes represent this study. ADIRA, anti-inflammatory diet in rheumatoid arthritis; DAS28, disease activity score-28.
FIGURE 2
FIGURE 2
Percentage of study population1 (n = 62) reporting a fatty acid and fiber intake corresponding to recommendations.2 n-3 FA was calculated as the sum of alpha linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid. Essential FA was calculated as the sum of alpha linolenic acid and linoleic acid. 1Patients with rheumatoid arthritis residing in southwestern Sweden. 2Nordic Council of Ministers (31). Nordic Nutrition Recommendations 2012: Integrating nutrition and physical activity [Internet]. Copenhagen: Nordisk Ministerråd; [cited 2021 1 November]. Available from http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-2561. ALA, alpha linolenic acid; E%, energy percent; FA, fatty acids; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids; SFA, saturated fatty acids.
FIGURE 3
FIGURE 3
Percentage of study population,1 stratified by sex, reporting a micronutrient intake below recommended intake.2 1Patients with rheumatoid arthritis residing in southwestern Sweden (females n = 50, males n = 12). 2Nordic Council Of Ministers (31). Nordic Nutrition Recommendations 2012: Integrating nutrition and physical activity [Internet]. Copenhagen: Nordisk Ministerråd; [cited 2021 1 November]. Available from http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-2561.
FIGURE 4
FIGURE 4
Percentage of study population,1 stratified by sex, reporting a micronutrient intake below average requirement.2 1Patients with rheumatoid arthritis residing in southwestern Sweden (females n = 50, males n = 12). 2Nordic Council Of Ministers (31). Nordic Nutrition Recommendations 2012: Integrating nutrition and physical activity [Internet]. Copenhagen: Nordisk Ministerråd; [cited 2021 1 November]. Available from http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-2561.

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