ADHERENCE TO MEDITERRANEAN DIET AND NUTRITIONAL STATE IN ITALIAN WOMEN WITH ISOLATED SJÖGREN’S SYNDROME

Background: The Mediterranean Diet (MD) has anti-inflammatory and immunomodulatory effects suggesting a protective role in rheumatic diseases. There is limited knowledge about the eating habits and the nutritional state in patients with isolated Sjögren Syndrome (SS) living within the Mediterranean area. Objectives: assessment of adherence to the MD and analysis of the nutritional state in women with SS and their correlations with the clinical, laboratory and histological data of the disease. Methods: patients classified as isolated SS according to AECG criteria 2002 who had undergone to minor salivary gland biopsy during the previous twelve months were consecutively enrolled during follow-up visits. The adherence to the MD was assessed by the Med Diet (MDiet) which includes eleven groups of foods; to each group is assigned a value ranging between 0 and 5 based on the frequency of monthly intake. The total score spans from 0 (poor adherence) to 55 (maximum adherence). The level of physical activity was measured by the 6-minutes walking test (6MWT) and by the International Physical Activity Questionnaire (IPAQ). Systemic disease activity was evaluated with the EULAR SS disease activity index (ESSDAI); EULAR SS patient-reported index (ESSPRI) was calculated as well. A subgroup of patients was asked to fill a daily food diary processed with FOOD CONS software which allows to study in detail their eating habits. Nutritional state, muscle strength and basal metabolic rate were assessed. Alcoholism or drug abuse, diabetes mellitus, specific dietary models, treatment with drugs and/or food supplements with anti-inflammatory and/or antioxidant activity were considered exclusion criteria. Multivariate linear regression was performed with R project for Statistical Computing. Results: N= 40 N= 26 Age, median (range) 53 (25-80) 33 (25-71) BMI, median (range) 21 (19-29.3) 25.1 (19-33.7) MedDiet score, median (range) 33 (26-43) 33 (23-40) ESSDAI, median (range) 2 (0-16) 1 (0-16) ESSPRI, median (range) 6 (0-8.6) 5.3 (1.6-9) ESSPRI dryness, median (range) 6 (0-10) 6 (2-10) Focus score, median (range) 2.5 (0-9.6) 1.7 (0.8-6.24) ASM kg, median (range) - 16.8 (13.3-21.7) IPAQ meters, median (range) - 1386 (99-11865) 6MWT meters, median (range) - 595 (536-680) BMI, body mass index; ASM appendicular skeletal mass; IPAQ International Physical Activity Questionnaire; 6MWT, six minute walking test. MDiet was administered to 40 female SS outpatients. Even if not reaching significativity, patients with a higher focus score in their MSG have a lower value of MDiet score (p = 0.058, r = -1.00). The MDiet score is not associated with ESSDAI (p = 0.85, r 0.02), but only with lower serum levels of C3 (p = 0.004, r = - 0.08). In 26 patients, daily food questionnaire shows that their diet consists of 43% of carbohydrates while fats represent 40% of total energy intake, the remaining 17% daily energy comes from proteins. Fat consumption is higher compared to the levels of energy and nutrient intake for the Italian population . Six patients had a reduction in muscle mass; sarcopenia is not associated to ESSDAI (p = 0.610).The MDiet score and the amount eaten of polyunsaturated fatty acids (PUFA) were reduced in patients with high value of subscale dryness of ESSPRI (p = 0.057, r -1.21; p =0.610, r -1.00). Conclusion: This study highlights a lower degree of glandular lymphocytic infiltration (expressed as focus score) in minor salivary glands in patients following MD, so its anti-inflammatory role of seems to be confirmed. SS patients have an unbalanced diet because of a higher intake of fat foods, likely for their lubricating effect. Despite the absence of correlation with objective parameters, the increased dryness in patients with a reduced intake of PUFA arouses our interest in a future study including omega-3 supplementation. REFERENCES: [1] Schwingshackl L et al., Nutr Metab Cardiovasc Dis 2014 [2] Mena MP et al., Am J Clin Nutr. 2009 [3] Vitali C et al, ARD 2002 [4] Panagiotakos D et al., J Med Food 2007 [5] LARN 2014 Disclosure of Interests: None declared Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 1183Session: SLE, Sjögren’s and APS - clinical aspects (other than treatment) (Publication Only)