11/9/2011

Disclosures/Conflict of Interest
Is the Dietary Intake of Patients
With Systemic Lupus • None
Erythematosus Adequate?

Aghdassi E, Ph.D., Yeganeh L, Bsc.,

Balitsky M, Msc., Morrison S, Bsc.,
Frattasi M, MD., Su J, Bsc, Ma, DWL,
Ph.D., Fortin PR. MD

Introduction Background
• Systemic Lupus Erythematosus (SLE) is a chronic and • Patients: 216 Japanese women with inactive SLE
unpredictable disease accompanied by functional disease
disability, psychological distress that can influence the
eating patterns and thus the nutrient intakes.
• Design: 4 years longitudinal study

• Dietary factors may contribute to the etiology and
progression of some of the chronic diseases.
• Nutritional interventions may modify the severity of
pathological abnormalities
Swanson 1989; Danieli 1990; Minamei 1993; Brown 1998; Handerson 1999
• Associations between dietary intakes and autoimmune
disorders and SLE disease activity has been previously
reported
Levy JA, Proc Natl Acad Sci USA 1982; 79: 1974-8; Minami Y, J Rheumatol 2003; 30: 747-754
• Objectives: to investigate associations between dietary
factors and occurrence of active disease and/or vascular
damage
• Results: Inverse associations of intakes of vitamin C
and crude fibers with the risk of active disease (n=43)
• Associations between intake of vegetable fat and
vascular events (n=7)
Minami Y, J Rheumatology 2003

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Objectives Study Design/Protocol

SLE Women

• In a Canadian sample of women with >18 yr

ACR criteria > 4
SLE :
- To estimate the nutrients intake using a 24-hr diet
recall
Demographics Disease Activity CVD Risk Factors Dietary Intake
-Age - SLEDAI-2K (0- -BMI -24 hour recall
- To compare the dietary intake with the WHO
105)
-Ethnicity -Waist / Hip Ratio -ESHA Nutrient
dietary recommendations for North American Disease Damage Analysis Software
-Education -Smoking
women - SDI
-Marital Status -Blood Lipid Profile
-Disease -hs-CRP
Duration
- Medications

Diet Assessment
All foods and beverages consumed in
the last 24 hours are recorded capturing:
*Type of food item
*Description on how it is prepared
*Amount and # of servings
ESHA Nutrient Analysis Software
Food Pyramid
Dietary Reference Intake (DRI)
• Estimated Average Requirement (EAR)
• Recommended Daily Allowances (RDA)
• Adequate Intake (AI)
• Upper Tolerable Intake (UTI)
Food and Nutrition Information Center, U.S. Department of
Agriculture. "Dietary Reference Intakes (DRI) and
Recommended Dietary Allowances (RDA)." Available
from http://www.nal.usda.gov/fnic

All foods a
beverages
consumed
days is rec
2
capturing:
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RESULTS: RESULTS
Patient Characteristics CVD Risk Factors
n=165
n=165

Age (year) 47.2 ± 15.0 Smoking [n (%)] 17 (10.3%)

BMI (kg/m2) 25.8 ± 6.8 Blood Glucose (mmol/L) 4.5 ± 0.8
SLE Disease Duration (year) 19.1 ± 11.7 Systolic Blood Pressure (mmHg) 120.4 ± 16.3
SLEDAI-2K (median, range) 2.0 (0-16) Diastolic Blood Pressure (mmHg) 73.4 ± 8.7
SDI (median, range) 2.0 (0-12) Waist to Hip Ratio 0.83 ± 0.08
Caucasians [n (%)] 97 (58.8%) Serum Total Cholesterol (mmol/L) 4.46 ± 0.87
Married [n (%)] 82 (49.7) Serum LDL-Cholesterol (mmol/L) 2.42 ± 0.71
Post-menopausal [n (%)] 98 (59.4%) Serum HDL-Cholesterol (mmol/L) 1.55± 0.43
Post-secondary Education [n (%)] 113 (68.5%) Serum Triglycerides (mmol/L) 1.12 ± 0.60
Employed [n (%)] 61 (37.0%) High sensitivity C-reactive Protein 3.52 ± 6.12
Optimal: <1

Energy & Macronutrient Intake

Medication Profile
Mean± SD DRI % Subjects Exceeding the
Recommended Levels [n (%)]
n=165
Energy (kcal/kg body 26.4± 13.0 29 kcal/kg 60 (39.4%)
weight)

Prednisone [n (%)] 150 (70.1%) % Kcal from Fat 31.8 ± 10.1 <30% 92 (55.8%)
% Kcal from Saturated 8.8 ± 3.8 <10% 48 (29.1%)
Hypoglycemic [n (%)] 5 (2.2%) Fat
Cholesterol (mg/day) 223.1 ± 207.3 300 44 (26.7%)
Hypotensive [n (%)] 64 (28.4%)
% Subjects Below the
Lipid lowering 26 (11.6%) Recommended Levels

Antimalarial [n (%)] 52 (31.5%) Protein (g/kg body 1.1 ± 0.6 0.66 g/kg 43 (25.8%)
weight)
Anticoagulants/antiplatelets [n (%)] 64 (28.4%) % Kcal from 52.3 ±12.3 45-65% 44 ( 26.7%)
Carbohydrates
Fiber (g/day) 19.6 ± 11.0 21 106 ( 64.2%)

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Inadequacy of Energy & Macronutrient Intakes:

Micronutrients Intake Comparison with the General Population (Women)
Mean Dietary Intake EAR or % Subjects with intakes
n=165 AI Below the EAR [n (%)] % SLE recommendations % General
Exceeding the Population*
Vitamin A (RE) 334.7 ± 341.5 500 128 (77.6%) Recommended Exceeding the
Levels [n (%)] Recommended
Vitamin B1 (mg) 0.9 ± 0.6 0.9 94 (57.0%)
Levels
Vitamin B2 (mg) 1.1 ± 0.7 0.9 77 (46.7%)
Energy 76 (46%) BMI <25 50%
Vitamin B3 (mg) 12.4 ± 7.7 11 80 (48.5%)
% Kcal from Fat 57 (34.7%) 25-35% 22.8%
Vitamin B6 (mg) 1.3 ± 1.5 1.1 92 (55.8%)
% SLE % General
Vitamin B12 (ug) 3.3 ± 4.1 2.0 82 (49.7%) Population Below
Below the
Vitamin C (mg) 111.6 ± 481.9 60 82 (44.7%) Recommended the Recommended
Levels Levels
Vitamin D (ug), median 0.6 10 (AI) 160 (97.0%)
% Kcal from Protein 10 (7%) 10-30% < 3%
Vitamin E (mg) 4.2 ± 5.6 12 150 (90.9%)
Folate (ug) 190.9 ± 227.6 320 140 (84.8%) % Kcal from 44 ( 26.7%) 45-65% 31.8%
Carbohydrates
Calcium (mg), median 532 1200 (AI) 158 (95.8%)
Magnesium 172.5 ± 106.1 265 135 (81.8%)
* Canadian Community Health Survey 2004, Health Canada 2009
Zinc 6.2 ± 4.6 6.8 103 (62.4%)

Inadequacy of Micronutrients Intake: Comparison

with the General Population (Women) Use of Micronutrient Supplements
% SLE % General Population EAR or AI
Intakes < EAR/AI Intakes < EAR/AI
N=165 n (%) % SLE with
Vitamin A (RE) 77.6% 35-40% 500
Inadequate
Vitamin B1 (mg) 57.0% <10% 0.9
Micronutrientintakes
Vitamin B2 (mg) 46.7% <10% 0.9
Vitamin B3 (mg) 48.5% <10% 11 Multivitamin 68 (41%) 44-97%
Vitamin B6 (mg) 55.8% 10-35% 1.1
Vitamin B12 (ug) 49.7% 5-15% 2.0
Vitamin C (mg) 44.7% 10-20% 60 Calcium 114 (69%) 95.8%
Vitamin D (ug) Median: 0.6 Median: 5.2 10 (10)
Folate (ug) 84.8% 20-40% 320
Calcium (mg) Median: 532 1200 (AI) Vitamin D 144 (87%) 97%
Magnesium 81.8% 40-50% 265
Zinc 62.4% 10-20% 6.8

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Summary and Conclusions Acknowledgement

• More than 30% of SLE women have total energy, fat, saturated • Principal Investigators
fat and cholesterol intakes exceeding the recommended levels of Dr. Paul Fortin
intake. Dr. Ellie Aghdassi This study was funded by
The Arthritis Society of
• Intakes of dietary fibers are below the minimum recommended • Co-investigators
Canada
Dr. David Ma
level in more than 60% of the patients.
Dr. Wendy Lou

• Intake of several of micronutrients is suboptimal. However, • Collaborators

suboptimal, intakes of vitamins A, D, E, folate, calcium, Dr. Dafna Gladman
magnesium and zinc observed in >60% of this population. Dr. Murray Urowitz
Dr. Phil Connelly
• The prevalence for inadequate micronutrient intake was much Center for Prognostic Studies in Rheumatic Diseases
higher in SLE women compared to the women in the general
population • CaNIOS team
Stacey Morrison
• Vitamin/mineral supplementation may be required in order to Ladan Yeganeh
meet the daily nutritional requirements of this patient population Michael Frattasi
Cathy Chau