Mediterranean diet and health outcomes in idiopathic inflammatory myopathies
Sreoshy Saha, Lekshmi Minikumari Rahulan, Manali Sarkar, Maria Rosa Pellico, Elena Philippou, Rishi Balse, Praggya Yaadav, Tsvetelina Velikova, Abraham Edgar Gracia-Ramos, Aviya Lanis Levy, Karen Cheng, Dzifa Dey, Elena Nikiphorou, Jasmine Parihar, , Dimitri Luz Felipe da Silva, Odirlei Andre Monticielo, Samuel Katsuyuki Shinjo, Simone Appenzeller, Vidya Sadanand Limaye, Jessica Day, Binit Vaidya, Chafia Dahou Makhloufi, Leandro Gabriel Ferreyra Garrott, Valentina Vardanyan, Vidya Sadanand Limaye, Jessica Day, A T M Tanveer Hasan, Marharyta Volkava, Sonam Yangchen, Dimitri Luz Felipe da Silva, Odirlei Andre Monticielo, Samuel Katsuyuki Shinjo, Simone Appenzeller, Russka Shumnalieva, Rositsa Svetoslavova Dacheva, Tsvetelina Velikova, Koy Rattanak, Fernando Kemta Lekpa, Océane Landon-Cardinal, Vanessa Ocampo, María Francisca Bozán Pérez, Antonia Valenzuela, Guochun Wang, Ho So, Iris Tang, Edmund K M Wong, Carlos Enrique Toro Gutiérrez, Sebastian Herrera Uribe, Carlo Vinicio Caballero-Uribe, Ivan Padjen, Zeljka Kardum, Konstantinos Parperis, Karen Schreiber, Jossiell Then Báez, Reem Hamdy Abdellatif Mohammed, Hala Mohamed Lotfy, Walaa Abdel Rahman Saleh, Mervat Eissa, Tamer A Gheita, Carlos Rios, Sandra Meisalu, Becky Abdissa Adugna, Margherita Giannini, Julien Campagne, Alain Meyer, Francis Guillemin, Hannah Labinsky, Gerd-Rüdiger Burmester, Johannes Knitza, Dzifa Dey, Alexandros Panagiotopoulos, Eirini Vasarmidi, Katerina Antoniou, Andrea Bran Ordóñez, Melinda Nagy-Vincze, Vikas Agarwal, Bhupen Barman, Yogesh Preet Singh, Arunkumar R Pande, Jasmine Parihar, Lekshmi M R, Meera Shah, Suryo Anggoro Kusumo Wibowo, Maryam Masoumi, Avin Maroof, Asal Adnan Redha, Or Aharonov, Marta Mosca, Nicoletta Del Papa, Fabiola Atzeni, Marco Sebastiani, Franco Franceschini, Pier Paolo Sainaghi, Maria Giovanna Danielli, Vincenzo Venerito, Alessandro Giollo, Laura Andreoli, Alessia Alluno, Devis Benfaremo, Valentino Paci, Giovanni Damiani, Elvis Hysa, Matteo Lucchini, Alberto Lo Gullo, Lorenzo Cavagna, Marco Fornaro, Akira Yoshida, Saori Abe, Masataka Kuwana, Ran Nakashima (Sasai), Fatima Alnaimat, Gulzhan Trimova, Dana Bekaryssova, Akerke Auanassova, Eugene Kalman Genga, Nelly Ziade, Soad Salem Hashad, Laila Ayoub, Syahrul Sazliyana Shaharir, Tan Chou Luan, Rosalie Magro, Erick Adrian Zamora Tehozol, Ignacio García-De La Torre, Iris J Colunga‑Pedraza, Javier Merayo-Chalico, Deshire Alpizar-Rodriguez, Miguel Angel Saavedra Salinas, Abraham Edgar Gracia-Ramos, Victoria Sadovici-Bobeica, Zulgerel Dandii, Ihsane Hmamouchi, Binit Vaidya, Luis Fernando Perez Garcia, Nicola Dalbeth, Idania Calixta Escalante Mendoza, Christian Mauriel Uriarte Hernandez, Moussa Elh Ibrahim Fanata, Uyiekpen Ima-Edomwonyi, Ibukunoluwa Dedeke, Airenakho Emorinken, Henry Madu Nwankwo, Hakeem Babatunde Olaosebikan, Celestine Okwara, Tralagba Uchechukwu, Batool Hassan, Uzma Rasheed, Babur Salim, Nelly Colman Mc Leod, Manuel Francisco Ugarte-Gil, Victor Pimentel-Quiroz, Lisa S Traboco, Joanna Makowska, Aleksandra Opinc-Rosiak, Marcin Milchert, Luís Sousa Inês, Eduardo Dourado, Samar Al Emadi, Cristina Alexandru, Anca Bobircă, Claudia Cobilinschi, Margarita Aleksandrovna Gromova, Mubirigi Alexandre, Lina El Kibbe, Hussein Mohammed Halabi, Rada Miskovic, Anindita Santosa, Tze Chin Tan, Desmond Chua, Cristiana Sieiro Santos, Jesús Loarce-Martos, Sergio Prieto-González, Juan Molina-Collada, Chathurika Lakmini Dandeniya, Ahmed Seri Ibrahim Mohamed, Manasik Mamoun, Ioannis Parodis, Raphael Micheroli, Lisa Christ, Oliver Distler, Nada Alchama, Yi-Ming Chen, Chih-Wei Tseng, Phonpen Akarawatcharangura, Wanruchada Katchamart, Kotchakorn Kaewboot, Pichaya O-charoen, Wafa Hamdi, Döndü Üsküdar Cansu, Reşit Yıldırım, Tugba Izci Duran, Neslihan Gokcen, Myroslava Kulyk, Nesreen Mohamed Ismail Moustafa, Latika Gupta, Elena Nikiphorou, John D Pauling, Chris Wincup, Ai Lyn Tan, Tania Gudu, Valentina Pucino, Sarah Dyball, James Lilleker, Aurelie Najm, Arvind Nune, Yusuf A Rajabally, Anne-Marie Russell, Aarat Patel, Shikha Singla, Tulika Chatterjee, Ashima Makol, Mazen Dimachkie, Vahed Maroufy, Yurilís Fuentes-Silva, Bich Ngoc Nguyen, Lan Nguyen, Hung Nguyen, Thu Hoai Pham, Panganani Njobvu, Hugo Alonzo, Carlos Benito Santiago Pastelin, Generoso Guerra Bautista, Enrique Julio Giraldo Ho, Vahed Maroufy, Vincenzo Venerito, Vikas Agarwal, Latika GuptaAbstract
Objectives
The clinical relevance of Mediterranean diet (MedDiet) and determinants shaping adherence across disease phenotypes remain largely unexplored in idiopathic inflammatory myopathies (IIM). In this study, we evaluated MedDiet adherence across IIM subtypes, identified factors associated with it, and examined its association with patient-reported health outcomes.
Methods
Adults with self-reported specialist-diagnosed IIM participating in the international COVAD-3 survey were included. Mediterranean diet adherence was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). Linear regression models were used to identify demographic, disease-related, and socioeconomic predictors of MEDAS adherence. Additional multivariable models evaluated associations between MEDAS scores and patient-reported outcomes after adjustment for demographic, socioeconomic, disease-related, and treatment-related covariates. Phenotypes were explored using factorial analysis with hierarchical clustering.
Results
Among 859 participants with IIM, MedDiet adherence was generally modest and varied across disease subtypes, with the lowest adherence observed in inclusion body myositis. Female sex, autoimmune multimorbidity, and fewer household members were independently associated with higher MEDAS scores. In adjusted outcome models, higher MEDAS adherence was independently associated with better physical function (PROMIS PF-4), better global physical health (PROMIS GPH), lower disease activity, lower fatigue, and lower pain. These associations remained significant after adjustment for disease activity, glucocorticoid exposure, immunosuppressant use, food security and income adequacy.
Conclusion
Higher MedDiet adherence was associated with more favourable patient-reported physical health, function, and symptom burden among individuals with IIM. However, because of the cross-sectional design, the direction and causality of these relationships cannot be determined. Prospective studies are needed to establish whether improving dietary adherence can influence clinical outcomes in IIM.