Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study / Ácidos graxos ômega-3, estado inflamatório e marcadores bioquímicos de pacientes com lúpus eritematoso sistêmico: estudo piloto

Abstract Background: Studies have shown that omega-3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C-reactive protein (CRP) and other inflammatory mediators. Objective: To investigate the effects of omega-3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE). Methods: Experimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega-3 group (daily intake of 1080 mg EPA + 200 mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega-3 group were compared using Wilcoxon test. U-Mann-Whitney test was used to compare variations of measured variables [ΔV = pre-treatment (T0) − post-treatment (T1) concentrations] between groups. p < 0.05 was considered significant. Results: The median (interquartile range - IQR) of age was 37 (29-48) years old, of disease duration was 7 (4-13) years, and of SLEDAI-2K was 1 (0-2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega-3 group while there was an increase in control group (p = 0.008). The serum concentrations of IL-6 and IL-10, leptin and adiponectin did not change after a 12 week treatment. Conclusions: Supplementation with omega-3 had no impact on serum concentrations of IL-6, IL-10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega-3 may impact total and LDL-cholesterol.

Resumo Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentrações de eicosanoides, citocinas, quimiocinas, proteína C-reativa (PCR) e outros mediadores inflamatórios. Objetivo: Investigar os efeitos dos ácidos graxos ômega-3 sobre os níveis circulantes de mediadores inflamatórios e marcadores bioquímicos em mulheres com lúpus eritematoso sistêmico (LES). Métodos: Ensaio clínico randomizado (ensaio clínico: NCT02524795); randomizaram-se 49 mulheres com LES (ACR1982/1997): 22 para o grupo ômega-3 (dose diária de 1.080 mg de EPA + 200 mg de DHA durante 12 semanas) e 27 para o grupo controle. Os mediadores inflamatórios e marcadores bioquímicos em T0 e T1 no grupo ômega-3 foram comparados pelo teste de Wilcoxon. O teste U de Mann-Whitney foi usado para comparar variações das variáveis mensuradas [ΔV = concentrações pré-tratamento (T0) menos concentrações pós-tratamento (T1)] entre os grupos. Um p < 0,05 foi considerado significativo. Resultados: A mediana (intervalo interquartil-IIQ) da idade foi de 37 anos (29-48), a duração da doença foi de sete anos (4-13) anos e o Systemic Lupus Disease Activity Index (Sledai-2 K) foi de 1 (0-2). A mediana (IIQ) da variação nos níveis de PCR entre os dois grupos mostrou um decréscimo no grupo ômega-3, enquanto houve um aumento no grupo controle (p = 0,008). As concentrações séricas de IL-6 e IL-10, leptina e adiponectina não se alteraram após um tratamento de 12 semanas. Conclusões: A suplementação de ômega-3 não teve impacto sobre as concentrações séricas de IL-6, IL-10, leptina e adiponectina em mulheres com LES e baixa atividade da doença. Houve uma diminuição significativa nos níveis de PCR, bem como evidências de que o ômega-3 pode impactar sobre o colesterol total e LDL.

[Polyunsaturated omega-3 fatty acids and systemic lupus erythematosus: what do we know?]. / Ácidos graxos poli-insaturados ômega-3 e lúpus eritematoso sistêmico: o que sabemos?

Various studies have demonstrated the impact of omega-3 fatty acids on the concentration of C reactive protein (CRP), pro-inflammatory eicosanoids, cytokines, chemokines and other inflammatory mediators. Therefore, the supplementation of these types of lipids may represent additional option treatment for chronic systemic diseases, such as Systemic Lupus Erythematous and other rheumatic diseases. The role of these lipids has not been well established, yet. However, it seems there is a direct relationship between its intake and the decrease of the disease clinical manifestations as well as of the inflammatory status of the patients. Thus, the aim of this manuscript is to present a thorough review on the effects of omega-3 fatty acids in patients with SLE. Bibliographic data set as the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) were searched using as key words: systemic lupus erythematous (SLE), polyunsaturated fatty acids omega-3, eicosapentanoic acid (EPA), docosahexanoic acid (DHA), antioxidants and diet. Manuscripts published up to September 2013 were included. There were 43 articles related to the topic, however only 15 pertained human studies, with three review articles and 12 clinical studies.

Ácidos graxos poli-insaturados ômega-3 e lúpus eritematoso sistêmico: o que sabemos? / Polyunsaturated omega-3 fatty acids and systemic lupus erythematosus: what do we know?

Diversos estudos têm demonstrado a habilidade dos ácidos graxos ômega-3 em reduzir asconcentrações de proteína C-reativa (PCR), eicosanoides pró-inflamatórios, citocinas, quimiocinas e de outros biomarcadores da inflamação. Por essas propriedades, a suplementação com essa classe de lipídeos pode representar terapia adicional ao tratamento de doençasinflamatórias crônicas sistêmicas, como o lúpus eritematoso sistêmico (LES) e outrasdoenças reumáticas. O papel dessa classe de lipídeos no LES ainda não está bem estabelecido. No entanto, parece haver relação entre o consumo deste tipo de gordura e a diminuiçãodas manifestações e da atividade inflamatória da doença. Sendo assim, este artigo apresentarevisão da literatura científica sobre os efeitos dos ácidos graxos ômega-3 em pacientescom LES. Realizou-se levantamento bibliográfico junto aos bancos de dados Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), utizando-se como palavras-chave: lúpus eritematoso sistêmico (LES), ácidos graxos poli-insaturados ômega-3, ácido eicosapentaenoico(EPA), ácido docosahexaenoico (DHA), antioxidantes e dieta. Foram incluídos artigos publicados até setembro de 2013. Quarenta e três artigos relacionados ao tema foram encontrados. Após limitar a busca apenas para estudos realizados em seres humanos foram encontrados 15 artigos, sendo três de revisão e 12 ensaios clínicos.

Various studies have demonstrated the impact of omega-3 fatty acids on the concentration of C reactive protein (CRP), pro-inflammatory eicosanoids, cytokines, chemokines and other inflammatory mediators. Therefore, the supplementation of these types of lipids may represent additional option treatment for chronic systemic diseases, such as Systemic Lupus Erythematous and other rheumatic diseases. The role of these lipids has not been well established, yet. However, it seems there is a direct relationship between its intake and the decrease of the disease clinical manifestations as well as of the inflammatory status of the patients. Thus, the aim of this manuscript is to present a thorough review on the effects of omega-3 fatty acids in patients with SLE. Bibliographic data set as the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) were searched using as key words: systemic lupus erythematous (SLE), polyunsaturated fatty acids omega-3, eicosapentanoic acid (EPA), docosahexanoic acid (DHA), antioxidants and diet. Manuscripts published up to September 2013 were included. There were 43 articles related to the topic, however only 15 pertained human studies, with three review articles and 12 clinical studies.

Excess weight and associated risk factors in patients with systemic lupus erythematosus.

The objective of this study is to determine the socio-demographic, clinical and laboratory characteristics of outpatients with SLE who present with excess weight as well as to assess the immunosuppressive therapy used. One hundred and seventy women with SLE were evaluated consecutively in a transversal study. The relationship between excess weight and the patients' characteristics was evaluated using univariate and multivariate Poisson regression analysis. Of the 170 patients evaluated, 109 presented with excess weight, two were malnourished and 59 were classified as eutrophic. Age and disease duration of those with excess weight were 42.4 ± 8.7 and 10.4 ± 6.2 years, respectively. Risk factors associated with excess weight were the following: age ≥40 years, <8 years of education, lack of occupation, damage index ≥1, systemic high blood pressure, diabetes mellitus and triglycerides ≥150 mg/dL levels. The use of antimalarial therapy and steroids was associated with a lower frequency of excess weight. Age ≥40 years and the non-usage of methotrexate were the variables independently associated with excess weight in the multivariate analysis. Patients with SLE who have excess weight present distinct clinical-laboratory findings, socio-demographic characteristics and treatment options when compared to normal weight patients. Prospective studies should assess whether these characteristics will interfere with the outcome or prognosis of lupus.

Nutritional status and food intake in patients with systemic lupus erythematosus.

OBJECTIVE: Systemic inflammation, therapy with corticosteroids, and reduced physical activity may increase the predisposition to accumulate body fat in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the nutritional status and food intake of patients with SLE. METHODS: One hundred seventy women with SLE were evaluated consecutively in a cross-sectional study. Nutritional status was assessed by subjective global assessment and body mass index. Food intake was assessed by a 24-h recall and a semiquantitative food frequency questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), considering P < 0.05 as significant. RESULTS: The mean ± SD age of the patients was 39.14 ± 9.98 y, and the duration of the disease was 9.94 ± 6.18 y. Approximately 91.8% patients were classified as being well nourished; 6.5% were classified as suspected or moderately malnourished, and 1.8% were classified as severely malnourished. In terms of body mass index, malnutrition was found in 1.2% of the patients, normal weight in 35.9%, overweight in 35.3%, and obesity in 27.7%. Most patients reported food consumption below the estimated needs for energy. Calcium was the nutrient with the most inadequate intake. Low consumption of fruits, vegetables, and dairy products and a high consumption of oils and fats were reported. CONCLUSION: The results showed that patients with SLE have inadequate nutritional status and food intake.

Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass.

OBJECTIVE: Assess the lifestyle habits, including food patterns, of patients who underwent Roux-en-Y gastric bypass (RYGB) and to identify predictive factors in weight loss and regain. METHODS: Obese patients (100) who underwent RYGB from 1998 to 2008 were included. Dietary habits were assessed by using 24 h dietary recall and the Food Frequency Questionnaire. Rates of weight regain and the percentage of excess weight loss (EWL) were calculated. Patients were also asked whether they attended nutritional follow-up visits after the operation and about the type and regularity of physical activities. RESULTS: The mean age was 45.1 ± 9.9 y, and the majority of the patients were women (84%). Mean EWL was 59.1 ± 20.3%. Weight regain was seen in 56% of the patients with 29% of the patients having regained over 10.1% of the minimum weight reached after RYGB. Weight regain increased significantly with time after surgery (up to 2 y: 14.7%; from 2 to 5 y: 69.7%; over 5 y: 84.8%). Poor diet quality characterized by excessive intake of calories, snacks, sweets, and fatty foods was statistically higher among those who regained weight. Sedentary lifestyle and lack of nutritional counseling follow-up were also significantly associated with regaining weight. CONCLUSION: Despite satisfactory results of EWL, the patients did not properly maintain the lost weight, mainly after 5 y postsurgery. Major factors that influenced this weight gain were poor diet quality, sedentary lifestyle, and lack of nutritional counseling follow-up.

Avaliação do estado nutricional e da atividade física em pacientes com lúpus eritematoso sistêmico / Assessment of nutritional status and physical activity in systemic lupus erythematosus patients

INTRODUÇÃO: Pacientes com lúpus eritematoso sistêmico (LES) podem apresentar alterações nutricionais desencadeadas pela doença ou pelo tratamento, e essas condições podem interferir no prognóstico. OBJETIVOS: Avaliar o estado nutricional, a atividade física e os aspectos associados em pacientes com LES. MÉTODOS: As características nutricionais, clínico-laboratoriais, sóciodemográficas e de tratamento de 170 mulheres com LES foram avaliadas, em estudo transversal. RESULTADOS: Pacientes com idade entre 18 e 60 anos foram incluídas, com média (DP) de idade e de duração da doença de 39,1 anos (10,0) e 9,9 anos (6,2), respectivamente. Duas (1,2 por cento) pacientes foram classificadas como magreza grau I, 59 (34,7 por cento) como eutróficas, 61 (35,9 por cento) como sobrepeso, 37 (21,8 por cento) como obesidade grau I, sete (4,1 por cento) como obesidade grau II e quatro (2,4 por cento) como obesidade grau III. Pacientes com sobrepeso e obesas apresentaram maior idade, menor escolaridade, maior índice de dano do LES, maior concentração sérica de complemento, maior frequência de hipertensão arterial e de diabetes mellitus, presença de insuficiência ovariana e menor frequência do uso de antimaláricos. Quanto à atividade física, 39 pacientes (22,9 por cento) foram classificadas como inativas, 100 (58,8 por cento) como insuficientemente ativas e 31 (18,2 por cento) como ativas. Destas últimas, 13 (43,3 por cento) se encontravam no grupo de eutróficos. CONCLUSÃO: A frequência de excesso de peso, nesta população, foi elevada e esteve associada a alguns fatores de risco tradicionais para doenças cardiovasculares e a alguns fatores de pior prognóstico do LES. Logo, incentivar o controle do peso deve fazer parte dos principais objetivos do tratamento de todo paciente com LES.

INTRODUCTION: Patients with systemic lupus erythematosus (SLE) may present nutritional changes triggered by disease or treatment, and these conditions may interfere with prognosis. OBJECTIVE: Assess the nutritional status, physical activity and associated factors in patients with SLE under treatment at the Service of Rheumatology of Hospital das Clínicas/Universidade Federal de Minas Gerais. METHODS: A cross-sectional study evaluating the nutritional status, clinical laboratory findings, sociodemographic, and treatment characteristics of 170 SLE female patients. RESULTS: Patients aged between 18 and 60 years were included. The mean (SD) age of patients and duration of SLE was 39.1 (10.0) and 9.9 (6.2) years, respectively. Two (1.2 percent) patients were classified as grade I underweight, 59 (34.7 percent) eutrophic, 61 (35.9 percent) as overweight, 37 (21.8 percent) as grade I obesity, seven (4,1 percent) as grade II obesity, and four (2,4 percent) as grade III obesity. Overweight and obesity were significantly associated with older age, lower education, higher SLE damage index, higher serum concentration of complement, higher incidence of hypertension and diabetes mellitus, presence of ovarian failure, and less frequent use of antimalarials Regarding physical activity, 39 patients (22.9 percent) were classified as inactive, 100 (58.8 percent) insufficiently active, and 31 (18.2 percent) active. Of the latter, 13 (43.3 percent) were in the eutrophic group. CONCLUSION: Excess weight was high in this population and associated with some traditional risk factors for cardiovascular disease and SLE poor prognosis. Therefore, encouraging weight control must be part of the main goals in treating SLE patients.

Assessment of nutritional status and physical activity in systemic lupus erythematosus patients.

INTRODUCTION: Patients with systemic lupus erythematosus (SLE) may present nutritional changes triggered by disease or treatment, and these conditions may interfere with prognosis. OBJECTIVE: Assess the nutritional status, physical activity and associated factors in patients with SLE under treatment at the Service of Rheumatology of Hospital das Clínicas/Universidade Federal de Minas Gerais. METHODS: A cross-sectional study evaluating the nutritional status, clinical laboratory findings, sociodemographic, and treatment characteristics of 170 SLE female patients. RESULTS: Patients aged between 18 and 60 years were included. The mean (SD) age of patients and duration of SLE was 39.1 (10.0) and 9.9 (6.2) years, respectively. Two (1.2%) patients were classified as grade I underweight, 59 (34.7%) eutrophic, 61 (35.9%) as overweight, 37 (21.8%) as grade I obesity, seven (4,1%) as grade II obesity, and four (2,4%) as grade III obesity. Overweight and obesity were significantly associated with older age, lower education, higher SLE damage index, higher serum concentration of complement, higher incidence of hypertension and diabetes mellitus, presence of ovarian failure, and less frequent use of antimalarials Regarding physical activity, 39 patients (22.9%) were classified as inactive, 100 (58.8%) insufficiently active, and 31 (18.2%) active. Of the latter, 13 (43.3%) were in the eutrophic group. CONCLUSION: Excess weight was high in this population and associated with some traditional risk factors for cardiovascular disease and SLE poor prognosis. Therefore, encouraging weight control must be part of the main goals in treating SLE patients.