Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Little is known about the effect of
adherence to the Dietary Guidelines
for Americans on risk of developing rheumatoid arthritis (RA). The Alternative
Healthy Eating Index 2010 (AHEI-2010) measures how well Americans’ diets
conform to these guidelines. We aimed to evaluate the association between
AHEI-2010 and risk of RA in young and middle-aged women using Nurses’ Health
Study II (NHS II), a large prospective cohort study.
Methods: The NHS II was initiated in 1989 and
comprised 116,430 female registered nurses, aged 25–42 years. RA cases were
initially self-reported then confirmed by a connective tissue disease screening
questionnaire and medical record review according to the 1987 ACR criteria.
Seropositive RA was defined as positive rheumatoid factor or anti-citrullinated peptide antibody and was determined by chart
review or laboratory measurement.Dietary data were obtained from validated food
frequency questionnaires at baseline and approximately every 4 years during
follow-up. The AHEI-2010 was derived based on foods and nutrients that have
been consistently associated with lower risk of chronic diseases in clinical
and epidemiologic investigations. Each of the 11 components including
vegetables, fruits, whole grains, nuts and legumes, sugar-sweetened
beverages, red /processed meat, trans-fat % of energy, long-chain
omega-3 fats, polyunsaturated fat,
sodium and alcohol has a minimum score of 0 and a maximum score of 10 according
to the dietary guidelines and daily intakes. AHEI-2010 ranges from 0 to
110. Time-varying Cox regression models were used to explore the association
between cumulative averaged AHEI-2010 and risk of RA after adjusting for
potential confounding factors.
Results: During the 1,751,803person-years of
follow-up from 1991 to 2011 in NHS II, 347 RA cases (215 seropositive,
132 seronegative) were identified. In the
multivariable adjusted model, we found greater adherence to AHEI-2010 was
associated with reduced risk of RA. Women in the highest quartile of AHEI-2010
had 33% (HR=0.67, 95% confidence interval 0.49-0.91) reduced risk compared to
the women in the lowest quartile (p-trend 0.006) (Table). After additional adjustmentfor BMI, the results were
consistent.Further stratified analyses
demonstrated that the association of AHEI-2010 with RA risk was stronger in
seronegative RA than in seropositive RA.
Conclusion: Data from this large prospective
cohort study suggest that better adherence to the Dietary Guidelines for
Americans is associated with reduced risk of developing RA in young and
middle-aged women. Our results suggest that diet may be particularly important
for risk of seronegative RA and further research is
warranted to confirm these findings.
|
Table. Hazard ratios (95% CI) for incident RA according to cumulative AHEI-2010 in Nurses’ Health Study II (NHS II, 1991-2010)1
|
|||||
|
AHEI-2010 quartiles |
P-trend2
|
||||
|
Q1 |
Q2 |
Q3 |
Q4 |
||
|
All RA |
|||||
|
Case/person-years |
100/437,225 |
90/438,122 |
80/438,142 |
77/438,314 |
|
|
Age adjusted model |
1.00 |
0.85(0.64,1.13) |
0.74(0.55,0.99) |
0.69(0.51,0.93) |
0.010 |
|
Multivariable-model3 |
1.00 |
0.85(0.64,1.13) |
0.73(0.54,0.98) |
0.67(0.49,0.91) |
0.006 |
|
Multivariable-model4 |
1.00 |
0.85(0.64,1.14) |
0.75(0.56,1.01) |
0.72(0.53,0.98) |
0.026 |
|
Sero-positive RA |
|||||
|
Case/person-years |
62/436,775 |
51/437,712 |
51/437,780 |
51/438,009 |
|
|
Age adjusted model |
1.00 |
0.79(0.54,1.14) |
0.78(0.53,1.12) |
0.76(0.52,1.10) |
0.164 |
|
Multivariable-model3 |
1.00 |
0.78(0.54,1.13) |
0.75(0.52,1.10) |
0.72(0.50,1.06) |
0.102 |
|
Multivariable-model4 |
1.00 |
0.79(0.55,1.15) |
0.79(0.54,1.14) |
0.80(0.54,1.17) |
0.254 |
|
Sero-negative RA |
|||||
|
Case/person-years |
38/436,452 |
39/437,429 |
29/437,494 |
26/437,712 |
|
|
Age adjusted model |
1.00 |
0.95(0.61,1.48) |
0.69(0.42,1.11) |
0.59(0.35,0.97) |
0.017 |
|
Multivariable-model3 |
1.00 |
0.95(0.61,1.49) |
0.69(0.42,1.12) |
0.59(0.35,0.97) |
0.019 |
|
Multivariable-model4 |
1.00 |
0.95(0.61,1.49) |
0.70(0.43,1.14) |
0.61(0.37,1.02) |
0.032 |
|
1Hazard ratios were calculated by using time-varying Cox proportional hazards models. 2p-trend was derived from tests of linear trend across categories of AHEI scores by treating the median value of each category as a continuous variable. 3 Adjusted for age, smoking (pack-years), total calorie intake. Additional adjustment for census tract median family income, alcohol use and physical activity did not change the statistical significance. 4Additional adjustment for BMI (kg/m2; <25, 25–29.9, or ≥30).
|
|||||
To cite this abstract in AMA style:
Hu Y, Sparks JA, Costenbader KH, Hu F, Karlson EW, Lu B. Adherence to the Dietary Guidelines for Americans and Risk of Developing Rheumatoid Arthritis in Young and Middle-Aged Women [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/adherence-to-the-dietary-guidelines-for-americans-and-risk-of-developing-rheumatoid-arthritis-in-young-and-middle-aged-women/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-the-dietary-guidelines-for-americans-and-risk-of-developing-rheumatoid-arthritis-in-young-and-middle-aged-women/