Despite Benefits, Mediterranean Diet Adherence in RA Remains Low | ACR Convergence

Although they are open to education, many patients with rheumatoid arthritis do not follow the evidence-based Mediterranean dietary patterns, according to research presented at ACR Convergence 2024.¹

The Mediterranean diet is largely considered one of the healthiest diets. | Image credit: monticellllo - stock.adobe.com

This research follows the 2023 publication of a conditional recommendation by the American College of Rheumatology for patients living with rheumatoid arthritis to follow a Mediterranean-style diet.² The Mediterranean diet is based on traditional eating habits seen in countries bordering the Mediterranean Sea and varies based on individual cultures. However, commonalities include the high consumption of fruits, vegetables, bread and other grains, potatoes, beans, nuts, and seeds; the use of olive oil as a primary fat source; and low to moderate amounts of dairy products, eggs, fish, and poultry.³

In the current descriptive study, researchers evaluated the adherence and barriers to adopting the Mediterranean diet in a racially, culturally, and economically diverse population of Americans with rheumatoid arthritis.

A total of 1385 individuals with rheumatoid arthritis completed the study survey. Demographically, 91% of respondents were women; all regions of the country were represented, and education and income levels matched the wider US population.

Most participants scored low on the Mediterranean Diet Adherence Scores questionnaire; 20% of respondents met screening criteria for food insecurity, which was significantly associated with low scores. Additional factors associated with low questionnaire scores included living in the Southern or Midwestern regions of the US, lower levels of education, lower levels of income, and African American race. Conversely, respondents who were self-described vegans or vegetarians had the highest questionnaire scores (27% in the high adherence category).

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Daily time spent meal prepping was also significantly associated with scores: those who spent less than 60 minutes on meal prep had lower scores. Up to 30% of respondents reported a major food aversion to 1 or more components of the Mediterranean diet; beans and whole grains represented the most disliked category of foods (30% each).

While 84% of respondents were open to trying a Mediterranean diet as a complementary rheumatoid arthritis treatment, only 27% reported receiving information about the relationship between diet and rheumatoid arthritis from their health care provider—and those who did receive that information did not have significantly higher questionnaire scores. Conversely, individuals who sought out and received information about diet and rheumatoid arthritis from patient advocacy organizations had significantly higher questionnaire scores compared with patients who were unfamiliar with patient-facing advocacy groups.

“Although Americans living with [rheumatoid arthritis] from diverse backgrounds are open to additional education…most do not follow this evidence-backed dietary pattern,” investigators concluded. “Food insecurity and food aversions to components of the Mediterranean diet represent major barriers to implementation."

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Reference

1. Thompson C, Ventura I, Edens C, et al. Assessing the feasibility of a Mediterranean-style diet for patients with rheumatoid arthritis in a racially and culturally diverse population across the United States. Presented at: ACR Convergence 2024; November 14-19, 2024; Washington, DC. Abstract 1673.

2. England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis. Arthritis Care Res. 2023;75(8):1603-1615. doi:10.1002/acr.25117

3. What is the Mediterranean diet? American Heart Association. Reviewed May 15, 2024. Accessed November 20, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet