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Diet has been closely associated with inflammatory autoimmune diseases, including systemic lupus erythematosus (SLE). Importantly, the consumption of dietary sugars has been positively linked to elevated levels of some inflammation markers, but the potential role of their consumption on the prognosis of autoimmune diseases has not yet been examined. The aim of this study was to evaluate the association between the dietary intake of free sugars and clinical parameters and cardiovascular (CVD) risk markers in patients with SLE. A cross-sectional study including a total of 193 patients with SLE (aged 48.25 &plusmn, 12.54 years) was conducted. The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Levels of C-reactive protein (CRP, mg/dL), homocysteine (Hcy, &micro, mol/L), anti-double stranded DNA antibodies (anti-dsDNA) (IU/mL), complement C3 (mg/dL), and complement C4 (mg/dL), among other biochemical markers, were measured. The main factors we considered as risk factors for CVD were obesity, diabetes mellitus, hypertension, and blood lipids. The dietary-intrinsic sugar and added-sugar content participants consumed were obtained via a 24-h patient diary. Significant differences were observed in dietary sugar intake between patients with active and inactive SLE (in grams: 28.31 &plusmn, 24.43 vs. 38.71 &plusmn, 28.87, p = 0.035) and free sugar intake (as a percentage: 6.36 &plusmn, 4.82 vs. 8.60 &plusmn, 5.51, p = 0.020). Linear regression analysis revealed a significant association between free sugars intake (by gram or percentage) and the number of complications (&beta, (95% CI) = 0.009 (0.001, 0.0018), p = 0.033)), (&beta, (95% CI) = 0.046 (0.008, 0.084), p = 0.018)), and SLEDAI (&beta, (95% CI) = 0.017 (0.001, 0.034), p = 0.043)), (95% CI) = 0.086 (0.011, 0.161), p = 0.024)) after adjusting for covariates. Free sugars (g and %) were also associated with the presence of dyslipidaemia (&beta, (95% CI) = &minus, 0.003 (&minus, 0.005, 0.000), p = 0.024)) and (&beta, 0.015 (&minus, 0.028, &minus, 0.002), p = 0.021)). Our findings suggest that a higher consumption of free sugars might negatively impact the activity and complications of SLE. However, future longitudinal research on SLE patients, including dietary intervention trials, are necessary to corroborate these preliminary data.

Objective To analyse the influence of the Mediterranean diet (Med Diet) on SLE activity, damage accrual and cardiovascular disease risk markers. Methods A cross-sectional study was conducted on 280 patients with SLE [46.9 (12.85) years]. Med Diet adherence was assessed through a 14-item questionnaire on food consumption frequency and habits (total score from 0 to 14 points; higher score is greater adherence to the Med Diet). CRP, homocysteine, SLEDAI-2K (SLE disease activity), and SLICC/ACR and SDI (damage accrual) were measured. Obesity, diabetes mellitus, hypertension and blood lipids, among others, were considered cardiovascular disease risk factors. Results Greater adherence to the Med Diet was significantly associated with better anthropometric profiles, fewer cardiovascular disease risk factors, and lower disease activity and damage accrual scores (P ≤ 0.001 for SLEDAI and SDI). An inverse relationship between the Med Diet score and SLEDAI (P ≥ 0.001; β = −0.380), SDI (P ≤ 0.001; β = −0.740) and hsCRP (P = 0.039; β = −0.055) was observed. The odds ratio for having active SLE (SLEDAI ≥5) or the presence of damage (SDI ≥1) was lower among patients whose Med Diet score was higher (P ≤ 0.001). Finally, greater consumption of Med Diet foods (olive oil, fruits, vegetables, fish, etc.) and abstaining from red meat and meat products, sugars and pastries was associated with less SLE clinical activity and damage. Conclusion Greater adherence to the Med Diet seems to exert a beneficial effect on disease activity and cardiovascular risk in SLE patients. To confirm these findings, further longitudinal studies would be of interest.

The prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and nutritional risk index (NRI) have been described as useful screening tools for patient prognosis in several diseases. The aim of this study was to examine the relationship between PNI, CONUT and NRI with clinical disease activity and damage in 173 patients with systemic lupus erythematous (SLE). Disease activity was assessed with the SLE disease activity index (SLEDAI-2K), and disease-related organ damage was assessed using the SLICC/ACR damage index (SDI) damage index. PNI and NRI were significantly lower in active SLE patients than in inactive SLE patients (p &lt, 0.001 and p = 0.012, respectively). PNI was inversely correlated with the SLEDAI score (p &lt, 0.001) and NRI positively correlated with SLEDAI and SDI scores (p = 0.027 and p &lt, 0.001). Linear regression analysis adjusting for age, sex and medications showed that PNI was inversely correlated with SLEDAI (&beta, (95% CI) = &minus, 0.176 (&minus, 0.254, &minus, 0.098), p &lt, 0.001) and NRI positively correlated with SLEDAI (&beta, (95% CI) = 0.056 (0.019, 0.093), p = 0.003) and SDI (&beta, (95% CI) = 0.047 (0.031, 0.063), p &lt, 0.001). PNI (odds ratio (OR) 0.884, 95% confidence interval (CI) 0.809&ndash, 0.967, p = 0.007) and NRI ((OR) 1.067, 95% CI 1.028&ndash, 1.108, p = 0.001) were independent predictors of active SLE. These findings suggest that PNI and NRI may be useful markers to identify active SLE in clinical practice.