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Dietary interventions for rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

The question of what potential benefits and harms are associated with certain dietary regimes used in rheumatoid arthritis is an important one for many patients and health care providers.

Objectives

To assess the effectiveness and safety of dietary interventions in the treatment of rheumatoid arthritis.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, issue 1 2008), MEDLINE, EMBASE, AMED, CINAHL and reference lists of relevant articles (up to January 2008), and contacted authors of included articles.

Selection criteria

Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) where the effectiveness of dietary manipulation was evaluated. Dietary supplement studies (including fish oil supplements) were not included.

Data collection and analysis

Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information.

Main results

Fourteen RCTs and one CCT, with a total of 837 patients, were included. Due to heterogeneity of interventions and outcomes, baseline imbalance and inadequate data reporting, no overall effects were calculated. A single trial with a moderate risk of bias found that fasting, followed by 13 months on a vegetarian diet, may reduce pain (mean difference (MD) on a 0 to 10 scale -1.89, 95% confidence interval (CI) -3.62 to -0.16), but not physical function or morning stiffness immediately after intervention. Another single trial with a moderate risk of bias found that a 12-week Cretan Mediterranean diet may reduce pain (MD on a 0 to 100 scale -14.00, 95% CI -23.6 to -4.37), but not physical function or morning stiffness immediately after intervention. Two trials compared a 4-week elemental diet with an ordinary diet and reported no significant differences in pain, function or stiffness. Due to inadequate data reporting, the effects of vegan and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a significantly higher total drop-out of 10% (risk difference (RD) 0.10, 95% CI 0.02 to 0.18), higher treatment-related drop-out of 5% (RD 0.05, 95% CI -0.03 to 0.14) and a significantly higher weight loss (weighted mean difference -3.23, 95% CI -4.79 to -1.67 kg) in the diet groups compared to the control groups.

Authors' conclusions

The effects of dietary manipulation, including vegetarian, Mediterranean, elemental and elimination diets, on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. Higher drop-out rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.

摘要

背景

飲食處置於類風濕性關節炎之治療

對許多健康照護成員及病人,飲食對於類風濕性關節炎之治療好壞處是重要課題。

目標

研究飲食對於類風濕性關節炎之治療好壞處。

搜尋策略

搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, issue 1 2008) EDLINE, EMBASE, AMED, CINAHL (up to January 2008)。相關文章之參考文獻及詢問文章之作者。

選擇標準

選入隨機對照試驗或對照控制試驗研究飲食對於類風濕性關節炎治療的效果,排除飲食添加如魚油等之研究。

資料收集與分析

兩位作者進行資料摘錄,並對每篇試驗研究的效度進行評估。若有遺失資料則詢問作者。

主要結論

包括了14個隨機對照試驗及1個對照控制試驗研究含蓋837例病患。因為處置及結果之異質性、不平均的基礎、資料不足而無法做綜合效果評量。一篇中等偏差風險的試驗發現禁食,然後13個月素食,可減少疼痛平均差異1.89 (95% 信賴區間C 3.62 to −0.16)(0 – 10等級),但對身體功能及晨僵無顯著差異。另一中等偏差風險的試驗發現12週地中海食療,可減少疼痛平均差異14.00 (95% 信賴區間C 23.6 to −4.37) (0 – 100等級),但對身體功能及晨僵無顯著差異。二篇試驗比較4週元素飲食與一般飲食,發現兩者無顯著差異。因報告資料不足,素食及排除飲食效果無法估計。當與一般飲食相比,其他飲食組退出率高10% (風險差異risk difference (RD) 0.10, 95% 信賴區間CI 0.02 to 0.18),較高治療相關退出5% (風險差異RD 0.05, 95% 信賴區間CI −0.03 to 0.14),較多體重減輕 (加權平均差異weighted mean difference −3.23 公斤, 95% 信賴區間CI −4.79 to −1.67)。

作者結論

飲食治療包括素食、地中海食療、元素飲食、排除飲食與一般飲食,對類風濕性關節炎治療的效果,因為樣本數少、中等到高度偏差風險、單篇試驗,效果仍不清楚。但應注意較高退出率及體重減輕問題表示潛在的副作用且不能被忽視。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

飲食處置於類風濕性關節炎之效果:回顧了影響飲食處置於類風濕性關節炎患者之效果,是由研究人員在Cochrane Collaboration完成。在搜尋後了所有有關的研究,他們發現了其他研究人員所進行的15項研究。他們的研究結果歸納如下。 什麼是類風濕關節炎和何種飲食處置曾被嘗?類風濕關節炎是一種疾病,指人體的免疫系統攻擊關節內面。通常,手和腳關節都首當其衝。關節會腫脹,僵硬和疼痛。目前沒有根治類風濕性關節炎的治療,所以治療的目標是減輕疼痛和僵硬,提高移動能力。為了改善症狀,一些人試圖改變他們的飲食,改用各種各樣的特殊飲食。有些人會盡量不吃東西 7至10天,看它是否有差別。但是人們通常會設法限制或只增加某些食物。最常見的飲食是素食主義者或素食嘗試,地中海,‘元素’,或排除飲食。素食飲食不包括肉,魚,蛋,奶製品,而有些素食會食用雞蛋和牛奶。地中海飲食通常包括少量肉類,多吃魚,多吃水果和蔬菜和橄欖油。元素飲食通常包含被分解營養成份的流質,使其更容易消化。排除飲食是用來尋找食物中,哪些可能是造成症狀的。人們通常是排除他們認為會引起他們症狀的食物,然後再添加在食物中一次,看看哪些會造成症狀。研究表明,不確定是否飲食會改善疼痛,僵硬和讓行動能力更好。相反地,飲食可能難以堅持,即使他們不打算減肥,但可能因為這樣的飲食而體重減輕比起不執行特殊飲食,執行特殊飲食的人會減重3公斤(6又1/2磅)以上,即使他們並沒有打算減重。

Plain language summary

The effect of diets on rheumatoid arthritis

A review of the effect of diets for people with rheumatoid arthritis was conducted by researchers in the Cochrane Collaboration.  After searching for all relevant studies, they found 15 studies done by other researchers.  Their findings are summarised below. 

What is rheumatoid arthritis and what diets have been tried?

Rheumatoid arthritis is a disease in which the body's immune system attacks the lining of the joints.  Usually, the joints of the hands and feet are affected first.  Joints will become swollen, stiff and painful.  There is no cure for RA at present, so treatments aim to relieve pain and stiffness, and improve the ability to move. 

To improve symptoms, some people have tried to change what they eat by following a wide variety of special diets.  Some people will try to not eat anything for 7 to 10 days to see if it makes a difference.  But usually people will try to limit or increase only certain foods.  The most common diets tried are vegetarian or vegan, Mediterranean, 'elemental' , or elimination diets.   Vegan diets do not include meat, fish, eggs and milk products, while some vegetarian diets allow eggs and milk.  Mediterranean diets usually include a small amount of meat, more fish, more fruits and vegetables and olive oil.  Elemental diets are usually liquid diets that contain nutrients that are broken down to make digestion easier.  Elimination diets are used to find foods that might be the cause of symptoms.  People usually eliminate foods they think are causing symptoms, and then add in the foods one at a time and see which ones cause symptoms.     

What the research says

It is uncertain whether diets improve pain, stiffness and the ability to move better.

Instead, diets may be difficult to stick to, and people may lose weight on these diets even though they did not plan to.

- people who follow special diets may lose 3 kg (6 ½ pounds) more than people who do not follow special diets, even though they did not plan to.

Laički sažetak

Učinak različitih vrsta prehrane na reumatoidni artritis

Znanstvenici Cochrane kolaboracije su izradili sustavni pregledni članak o učincima različitih vrsta prehrane za osobe s reumatoidnim artritisom. Nakon pregleda literature pronašli su 15 studija koje su proveli drugi znanstvenici. Rezultati pretraživanja literature sažeti su u nastavku.

Što je reumatoidni artritis i koje vrste prehrane su iskušane?

Reumatoidni artritis je bolest u kojoj imunološki sustav napada zglobove. Obično su prvo napadnuti zglobovi šaka i stopala. Zglobovi natiču i postaju ukočeni i bolni. Trenutno ne postoji lijek koji će potpuno izliječiti reumatoidni artritis pa se različitim terapijama nastoji olakšati bol i ukočenost te poboljšati pokretljivost.

Neki su za poboljšanje simptoma pokušali promijeniti prehranu pridržavajući se raznih posebnih dijeta. Drugi su pokušali ne jesti ništa 7 do 10 dana da vide ima li razlike. No većina je pokušala ograničiti ili povećati unos određene hrane. Najčešće isprobavani tipovi prehrane su vegetarijanska ili veganska, mediteranska, elementarna ili eliminacijska. Veganska prehrana isključuju meso, ribu, jaja i mliječne proizvode dok neke vegetarijanske dijete dopuštaju jaja i mlijeko. Mediteranska prehrana obično uključuju male količine mesa, a mnogo ribe, voća, povrća i maslinovog ulja. Elementarne dijete su najčešće tekuće dijete koje sadrže hranjive tvari koje su usitnjene kako bi olakšale probavljanje. Eliminacijske dijete se koriste za pronalaženje namirnica koje su mogući uzročnik simptoma. Ljudi obično eliminiraju namirnice za koje misle da uzrokuju simptome nakon čega dodaju jednu po jednu namirnicu kako bi utvrdili koje uzrokuju simptome.

Rezultati istraživanja

Rezultati istraživanja su pokazali da nije sigurno olakšavaju li različite vrste prehrane bol, ukočenost i pokretljivost.

S druge strane, ljudima može biti teško pridržavati se određenih vrsta prehrane, koje mogu uzrokovati gubitak težine kod osoba koje to nisu planirale.

- Osobe koje se pridržavaju posebnih vrsta prehrane mogu izgubiti 3kg više u odnosu na osobe koje se ne pridržavaju posebnih dijeta, čak i ako to nisu planirale.

Bilješke prijevoda

Prevoditelj:: Croatian Branch of the Italian Cochrane Centre
Prijevod financira:: Ministry of Education, Science and Sports

Ancillary