Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial

Panos Papandreou; Aristea Gioxari; Efstratia Daskalou; Maria G Grammatikopoulou; Maria Skouroliakou; Dimitrios P Bogdanos

doi:10.3390/nu15030676

Mediterranean Diet and Physical Activity Nudges versus Usual Care in Women with Rheumatoid Arthritis: Results from the MADEIRA Randomized Controlled Trial

Nutrients. 2023 Jan 28;15(3):676. doi: 10.3390/nu15030676.

Authors

Panos Papandreou¹, Aristea Gioxari², Efstratia Daskalou³, Maria G Grammatikopoulou⁴, Maria Skouroliakou⁵, Dimitrios P Bogdanos⁴

Affiliations

¹ Department of Nutrition, IASO Hospital, 37 Chomatianou Str., Marousi, GR-15123 Athens, Greece.
² Department of Nutritional Science and Dietetics, School of Health Sciences, University of the Peloponnese, GR-24100 Kalamata, Greece.
³ Department of Nutrition, General Hospital of Thessaloniki "G. Gennimatas", 41 Ethnikis Aminis Str., GR-54635 Thessaloniki, Greece.
⁴ Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece.
⁵ Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 70 Eleftheriou Venizelou Ave., GR-17676 Athens, Greece.

Abstract

In rheumatoid arthritis (RA), diet quality and nutritional status have been shown to impact the disease activity and adherence to the Mediterranean diet (MD) has been suggested as an anti-inflammatory regime to improve disease status and reduce cardiovascular risk. The Mediterranean DiEt In Rheumatoid Arthritis (MADEIRA) was a single-blind (statistician), two-arm randomized clinical trial, investigating the effects of a 12-week lifestyle intervention, including a personalized isocaloric MD plan with the promotion of physical activity (PA), supported through a clinical decision support systems (CDSS) platform, versus usual care in women with RA. Forty adult women with RA on remission were randomly allocated (1:1 ratio) to either the intervention or the control arm. The intervention group received personalized MD plans and lifestyle consultation on improving PA levels, whereas the controls were given generic dietary and PA advice, based on the National Dietary Guidelines. The primary outcome was that the difference in the MD adherence and secondary outcomes included change in disease activity (DAS28), anthropometric indices (BodPod), dietary intake, PA, vitamin D concentrations, and blood lipid profiles after 12 weeks from the initiation of the trial. At 3 months post-baseline, participants in the MD arm exhibited greater adherence to the MD compared with the controls (p < 0.001), lower DAS28 (p < 0.001), favorable improvements in dietary intake (p = 0.001), PA (p = 0.002), body weight and body composition (p < 0.001), blood glucose (p = 0.005), and serum 1,25(OH)₂D concentrations (p < 0.001). The delivery of the MD and PA promotion through CDSS nudges in women with RA in an intensive manner improves the MD adherence and is associated with beneficial results regarding disease activity and cardiometabolic-related outcomes, compared with the usual care.

Keywords: 25(OH)D; anti-inflammatory diet; immunonutrition; lifestyle medicine; medical nutrition therapy; nutritional status; obesity; patient involvement; rheumatic disease.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Arthritis, Rheumatoid* / therapy
Body Weight
Diet, Mediterranean*
Exercise
Female
Humans
Single-Blind Method

Grants and funding

This research received no external funding.