吃还是不吃——一项关于类风湿关节炎禁食与植物性饮食的探索性随机对照试验（营养禁食研究）
To eat or not to eat-an exploratory randomized controlled trial on fasting and plant-based diet in rheumatoid arthritis (NutriFast-Study).
作者信息
Hartmann Anika M, Dell'Oro Melanie, Spoo Michaela, Fischer Jan Moritz, Steckhan Nico, Jeitler Michael, Häupl Thomas, Kandil Farid I, Michalsen Andreas, Koppold-Liebscher Daniela A, Kessler Christian S
机构信息
Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
出版信息
Front Nutr. 2022 Nov 2;9:1030380. doi: 10.3389/fnut.2022.1030380. eCollection 2022.
BACKGROUND
Fasting is beneficial in many diseases, including rheumatoid arthritis (RA), with lasting effects for up to 1 year. However, existing data dates back several decades before the introduction of modern therapeutic modalities.
OBJECTIVE
This exploratory RCT compares the effects of a 7-day fast followed by a plant-based diet (PBD) to the effects of the dietary recommendations of the German society for nutrition (Deutsche Gesellschaft für Ernährung, DGE) on RA disease activity, cardiovascular (CV) risk factors, and well-being.
METHODS
In this RCT we randomly assigned 53 RA patients to either a 7-day fast followed by an 11-week PBD or a 12-week standard DGE diet. The primary endpoint was the group change from baseline to 12 weeks on the Health Assessment Questionnaire Disability Index (HAQ-DI). Further outcomes included other disease activity scores, body composition, and quality of life.
RESULTS
Of 53 RA patients enrolled, 50 participants (25 per group) completed the trial and were included into the per-protocol analysis. The primary endpoint was not statistically significant. However, HAQ-DI improved rapidly in the fasting group by day 7 and remained stable over 12 weeks (Δ-0.29, = 0.001), while the DGE group improved later at 6 and 12 weeks (Δ-0.23, = 0.032). DAS28 ameliorated in both groups by week 12 (Δ-0.97, < 0.001 and Δ-1.14, < 0.001; respectively), with 9 patients in the fasting but only 3 in the DGE group achieving ACR50 or higher. CV risk factors including weight improved stronger in the fasting group than in the DGE group (Δ-3.9 kg, < 0.001 and Δ-0.7 kg, = 0.146).
CONCLUSIONS
Compared with a guideline-based anti-inflammatory diet, fasting followed by a plant-based diet showed no benefit in terms of function and disability after 12 weeks. Both dietary approaches had a positive effect on RA disease activity and cardiovascular risk factors in patients with RA.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT03856190, identifier: NCT03856190.
背景
禁食对包括类风湿关节炎（RA）在内的多种疾病有益，其效果可持续长达1年。然而，现有数据可追溯到现代治疗方法出现前的几十年。
目的
这项探索性随机对照试验（RCT）比较了为期7天的禁食后采用植物性饮食（PBD）与德国营养学会（Deutsche Gesellschaft für Ernährung, DGE）的饮食建议对RA疾病活动度、心血管（CV）危险因素及健康状况的影响。
方法
在这项RCT中，我们将53例RA患者随机分为两组，一组进行为期7天的禁食，随后采用为期11周的PBD，另一组采用为期12周的标准DGE饮食。主要终点是从基线到12周时健康评估问卷残疾指数（HAQ-DI）的组内变化。其他结局包括其他疾病活动评分、身体成分和生活质量。
结果
在纳入的53例RA患者中，50名参与者（每组25名）完成了试验并纳入符合方案分析。主要终点无统计学意义。然而，禁食组的HAQ-DI在第7天时迅速改善，并在12周内保持稳定（Δ-0.29，P = 0.001），而DGE组在第6周和12周时改善较晚（Δ-0.23，P = 0.032）。两组在第12周时疾病活动评分28（DAS28）均有所改善（分别为Δ-0.97，P < 0.001和Δ-1.14，P < 0.001），禁食组有9例患者达到美国风湿病学会（ACR）50或更高标准，而DGE组仅有3例。包括体重在内的CV危险因素在禁食组的改善程度强于DGE组（Δ-3.9 kg，P < 0.001和Δ-0.7 kg，P = 0.146）。
结论
与基于指南的抗炎饮食相比，禁食后采用植物性饮食在12周后并未在功能和残疾方面显示出优势。两种饮食方法对RA患者的RA疾病活动度和心血管危险因素均有积极影响。
临床试验注册
https://clinicaltrials.gov/ct2/show/NCT03856190，标识符：NCT03856190。
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