The effect of heart-friendly nutritional advice on change in diet and cardiovascular disease risk factors in patients with inflammatory joint disease

Background: Patients with inflammatory joint diseases (IJD) have an increased risk of atherosclerotic cardiovascular disease (CVD) compared to the general population. An increased presence of traditional risk factors combined with cardiovascular effects of chronic inflammation may be contributing factors. Nutritional advice has shown to influence CVD risk factors and may be essential in prevention of CVD in these patients. Objective: To test in patients with IJD, whether an individually tailored, extended dietary counselling on cholesterol-lowering and heart-friendly diet had comparable effect on change of diet, lipids, blood pressure (BP), inflammatory markers and body composition, as a standardized brief advice on heart-friendly diet, Method: Thirty one patients with IJD (rheumatoid arthritis (RA) n=16, Psoriatic Arthritis (PsA) n=7, Ankylosing Spondylitis (AS) n=8), aged 40-80 years, screened for CVD risk at the Preventive Cardio-Rheuma Clinic at Diakonhjemmet Hospital, received a brief standardized advice (3-4 minutes) on heart-friendly food by a physician and a written “shopping guide” for heart healthy food items. Sixteen patients were randomized to receive an individually tailored, extended dietary counselling (60 minutes), on heart-friendly and cholesterol-lowering diet (diet group [DG]), by a student in clinical dietetics. The remaining 15 patients (control group [CG]), received no further dietary information. Change in dietary habits, assessed by a validated questionnaire (SmartDiet), lipids, BP, C-reactive protein (CRP) and body composition, obtained by Bioelectrical impedance analysis (BIA) and Dual Energy X-ray Absorptiometry (DXA), were assessed after eight weeks of follow-up. Results: Average increase in mean SmartDiet score were 5.1 points and 5.7 points in the DG and the CG, respectively after eight weeks follow-up (p=0.65). Eight weeks after intervention a more frequent use of vegetable oil/liquid margarine (p=0.04), bread high in fibre (p=0.04) and a less frequent use of butter/hard margarine (p=0.02) in the DG, compared to the CG was observed. LDL-cholesterol (LDL-c) and total cholesterol (TC) was reduced by 12.6 % and 2.4 % (p=0.05) vs.6.3 % and 0.4 % (p=0.19) in the DG and CG, respectively. There were no significant differences between the two groups in mean change in BP, lipids, CRP or body composition after eight weeks. Conclusion: Our findings point to that the clinical effects of brief advice is comparable to an extended nutritional advice on cholesterol friendly food/diets in patients with IJD. This may be important in a clinical setting, with limited resources. Although, the extended dietary counselling seems to be superior to standardized brief advice in promoting heart-friendly food choices and possible in LDL-c- and TC-lowering effects. Nevertheless, both tailored, extended dietary counselling and brief advice showed equal improvement in SmartDiet score and there were no significant differences between the groups in either change in BP, CRP or body composition after eight weeks follow-up.