Charoenwoodhipong P, Zick S, Marder W, Hassett AL, McCune WJ, Gordon C, Harlow S, Somers EC (2017) Arthritis Rheumatol. Nov 2017; 69 (suppl 10) http://acrabstracts.org/abstract/omega-polyunsaturated-fatty-acids-and-systemic-lupus-erythematosus-
Omega fatty acids have immunomodulatory properties; omega-3 (n-3) fatty acids are generally anti-inflammatory and omega-6 (n-6) pro-inflammatory. High n-6:n-3 ratios (up to 16:1) are common in Western diets and are thought to contribute to chronic diseases. In small studies omega-3 supplementation in SLE has been associated with reduction of disease activity in systemic lupus erythematosus (SLE), but no study has examined there impact on patient reported outcomes (PROs). We performed a population-based cross-sectional study based on the MILES Program to examine the association between dietary intake of n-3 and n-6 fatty acids and PROs in SLE.
The MILES Program includes a population-based cohort of SLE cases from southeast Michigan. Data on dietary intake of omega fatty acids was collected at baseline using questions from the National Cancer Institute’s Diet History Questionnaire II (DHQ II). Patient reported outcome data included the Systemic Lupus Activity Questionnaire (SLAQ), RAND 36 Health Survey, Fibromyalgia (FM) Scale, PROMIS Sleep Disturbance (short form 8b) and PROMIS Depression (short form 8b). Multivariable regression, adjusted for covariates (age, sex, race, energy intake, and body mass index), was used to assess the association between n-3 and n-6 fatty acid intake and patient reported outcomes.
456/462 (98.7%) of SLE cases enrolled in MILES completed dietary questionnaires at baseline. 425 (93.2%) were female, 207 (45.4%) were black, and mean age at baseline visit was 52.9 years. Controlling for covariates, increasing n-6:n-3 ratios were associated with SLE disease activity (SLAQ score); β 0.322 (95% CI 0.069, 0.574; p=0.013). Intake of n-3 fatty acids was significantly associated with better sleep quality (β -1.114, 95% CI -2.029, -0.198) and trended towards significant decreases in depressive symptoms (β-0.884, 95% CI -1.916, 0.148) and presence of comorbid fibromyalgia (OR 0.817, 95% CI 0.655, 1.020). Associations between fatty acid intake and general health-related quality of life were not observed.
This large, population-based study suggests that dietary intake levels of n-3 and n-6 fatty acids may impact patient reported outcomes in SLE. Future dietary intervention studies modulating the absolute intake and ratios of n-3 and n-6 fatty acids should be considered in SLE.