Nutritional effect on lipoproteins and their subfractions in patients with Psoriatic Arthritis: a 12-week randomized trial-the DIETA trial.

INTRODUCTION: Patients with psoriatic arthritis have some lipid metabolism changes and higher risk of metabolic syndrome (MetS) and cardiovascular diseases, regardless of traditional risk factors, suggesting that chronic inflammation itself plays a central role concerning the atherosclerosis. However, there is a lack of information regarding atherogenic pattern and lipoprotein subfractions burden in these individuals. AIM: To evaluate the HDL and LDL-cholesterol plasmatic levels and their subfractions after a nutritional intervention in patients with psoriatic arthritis (PsA). METHODS: This was a randomized, placebo-controlled clinical trial of a 12-week nutritional intervention. PsA patients were randomly assigned to 1-Placebo: 1 g of soybean oil daily, no dietetic intervention; 2-Diet + Supplementation: an individualized diet, supplemented with 604 mg of omega-3 fatty acids, three times a day; and 3-Diet + Placebo: individualized diet + 1 g of soybean oil. The LDL subfractions were classified as non-atherogenic (NAth), atherogenic (Ath) or highly atherogenic (HAth), whereas the HDL subfractions were classified as small, medium, or large particles, according to the current recommendation based on lipoproteins electrophoresis. RESULTS: A total of 91 patients were included in the study. About 62% of patients (n = 56) had an Ath or HAth profile and the main risk factors associated were male gender, longer skin disease duration and higher BMI. Thirty-two patients (35%) had a high-risk lipoprotein profile despite having LDL plasmatic levels below 100 mg/dL. The 12-week nutritional intervention did not alter the LDL subfractions. However, there were significant improvement of HDL subfractions. CONCLUSION: Recognizing the pro-atherogenic subfractions LDL pattern could be a relevant strategy for identifying PsA patients with higher cardiovascular risk, regardless total LDL plasmatic levels and disease activity. In addition, a short-term nutritional intervention based on supervised and individualized diet added to omega-3 fatty acids changed positively the HDLLARGE subfractions, while LDLLARGE subfraction was improved in hypercholesterolemic individuals. CLINICALTRIALS: gov identifier: NCT03142503 ( http://www. CLINICALTRIALS: gov/ ).

Higher bodily adiposity, fat intake, and cholesterol serum levels are associated with higher disease activity in psoriatic arthritis patients: is there a link among fat and skin and joint involvement?

INTRODUCTION/ OBJECTIVES: Assuming that there is a link between lipid and glucose metabolism and inflammation in patients with psoriatic arthritis (PsA), our aim was to evaluate the relationships among body composition measurements, food intake, and disease activity in patients with PsA. METHODS: A total of 97 patients with PsA, according to the CASPAR criteria, were included in this cross-sectional study. Body composition measurements (whole-body DXA, GE-Lunar), food intake (3-day registry) and biochemical and inflammatory serum markers were evaluated. Skin and joint disease activity were assessed by using PASI, BSA, DAS28, and minimal disease activity (MDA). The level of significance was set as p < 0.05. RESULTS: A higher prevalence of obesity, according to the fat mass index (FMI) (92.7%), and metabolic syndrome (MetS) (54%) were found, but no significant changes regarding lean or bone mass were found. Joint disease activity was positively correlated with total body fat (r = 0.4; p < 0.001), FMI (r = 0.33; p < 0.001), body mass index (r = 0.20; p < 0.049) and waist circumference (r = 0.27; p = 0.009). In addition, joint disease activity was negatively associated with muscle mass (r = - 0.38; p < 0.001). Skin disease activity was positively correlated with total cholesterol (r = 0.3; p = 0.003) and LDL-cholesterol (r = 0.28; p = 0.006). After multiple adjustments, patients with severe joint disease activity had higher body adiposity than patients in remission or with low disease activity. Skin disease activity was associated with higher trans-fat intake and lower omega-6 consumption. CONCLUSIONS: Our data suggest a possible harmful link among fat (body adiposity, saturated fat consumption, LDL-cholesterol serum levels) and joint and skin disease activity in patients with PsA.

Efeito dos ácidos graxos na Síndrome Metabólica: uma revisão de literatura / Effects of fatty acids on the Metabolic Syndrome: a literature review

Changes in the diet pattern have been considered a major cause of overweight rate increase and Metabolic Syndrome (MS) in the world. A diet with high energy density can contribute to fat accumulation in metabolic active tissues and increase of proinflammatory adipokines, favoring the inflammatory condition of this syndrome. However, not all types of high fat diet are malefic to the body. The objective of this study was to conduct a literature review on the effect of fatty acids on the Metabolic Syndrome and on the important relationship between diet, obesity, MS and cardiovascular disease. It was possible to observe that a diet rich in saturated fat is associated with overweight, non-alcoholic fatty liver disease, and increased levels of cholesterol, leptin, insulin and glucose. It was also possible to observe that increased levels of saturated fatty acids and decreased levels of polyunsaturated fatty acids are associated with metabolic syndrome. Supplementation with ?-3 was effective in reducing the effects of saturated fatty acids, such as the serum levels of triglycerides, total cholesterol, LDL-c, decreasing blood pressure, and increasing the serum levels of HDL-c. After further studies confirm the safety of use and the ideal dose of ?-3 to prevent and treat MS, the supplementation should be associated with a diet that is balanced, low in saturated fat and rich in vitamins, as well as with a change in lifestyle.

Los cambios en los hábitos alimentícios han sido considerados como una de las causas más importantes del aumento mundial del sobrepeso y, por lo tanto, del Síndrome Metabólico (SM). Una dieta con alta densidad energética puede contribuir a la acumulación de grasa en los tejidos metabólicamente activos y al aumento de adipoquinas proinflamatorias, favoreciendo, así, el cuadro inflamatorio de este síndrome. Sin embargo, no todos los tipos de dietas hiperlipídicas son perjudiciales para el organismo. Por lo tanto, el objetivo de este estudio fue revisar en la literatura los efectos de los ácidos grasos en el SM y la importante relación entre dieta, obesidad, síndrome metabólico y enfermedad cardiovascular. Se observó que una dieta rica en grasas saturadas se asocia con el exceso de peso, hígado graso, elevación de los niveles séricos de colesterol, leptina, insulina y glucosa, puesto que el alto consumo de grasas saturadas y la disminución de los niveles de ácidos grasos poliinsaturados se correlacionan con el Síndrome Metabólico. La ingesta de suplementos de ácidos grasos poliinsaturados ha demostrado su eficacia a la hora de mitigar los efectos de la dieta alta en grasas, además de reducir los triglicéridos, el colesterol total, LDL-c, la presión arterial y mejorar los niveles de HLD-c. Después de que estudios posteriores confirmen la seguridad del uso y la dosis ideal del Omega 3 para la prevención y el tratamiento del Síndrome Metabólico, se hace necesario que su uso sea associado con una dieta balanceada, baja en grasas saturadas, rica en vitaminas, e incentivar al cambio en el estilo de vida.

As mudanças nos padrões alimentares têm sido consideradas como uma das principais causas do aumento mundial do excesso de peso e, consequentemente, da Síndrome Metabólica (SM). Uma dieta com alta densidade energética pode contribuir para acúmulo de gordura em tecidosmetabolicamente ativos e aumento de adipocinas pró-inflamatórias, favorecendo o quadro inflamatório desta Síndrome. Porém, nem todos ostipos de dietas hiperlipídicas são maléficos para o organismo. Assim, o presente estudo teve como objetivo revisar na literatura os efeitos dos ácidos graxos na SM e a importante relação entre dieta, obesidade, SM e doenças cardiovasculares. Observou-se que a alimentação rica em gordura saturada está relacionada com excesso de peso, esteatose hepática, elevação dos níveis séricos de colesterol, leptina, insulina e glicose, sendo que a elevação do consumo de gordura saturada ea diminuição de ácidos graxos poli-insaturados estão correlacionadas com a presença da Síndrome Metabólica. A suplementação de ácidograxo poli-insaturado mostrou-se eficaz para amenizar os efeitos da dieta hiperlipídica, além de diminuir triglicérides, colesterol total, LDL-c e pressão arterial, e melhorar os níveis de HLD-c. Após estudos posteriores confirmarem a segurança e a dose da utilização do ômega 3 para prevenção e tratamento da Síndrome Metabólica, é necessário que esta utilização seja associada a uma dieta equilibrada, pobre em gordura saturada, rica em vitaminas e com um incentivo à mudança no estilo de vida.