Dietary Intake of Free Sugars is Associated with Disease Activity and Dyslipidemia in Systemic Lupus Erythematosus Patients

Abstract

Diet has been closely associated with inflammatory autoimmune diseases, including systemic lupus erythematosus (SLE). Importantly, the consumption of dietary sugars has been positively linked to elevated levels of some inflammation markers, but the potential role of their consumption on the prognosis of autoimmune diseases has not yet been examined. The aim of this study was to evaluate the association between the dietary intake of free sugars and clinical parameters and cardiovascular (CVD) risk markers in patients with SLE. A cross-sectional study including a total of 193 patients with SLE (aged 48.25 ± 12.54 years) was conducted. The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Levels of C-reactive protein (CRP; mg/dL), homocysteine (Hcy; µmol/L), anti-double stranded DNA antibodies (anti-dsDNA) (IU/mL), complement C3 (mg/dL), and complement C4 (mg/dL), among other biochemical markers, were measured. The main factors we considered as risk factors for CVD were obesity, diabetes mellitus, hypertension, and blood lipids. The dietary-intrinsic sugar and added-sugar content participants consumed were obtained via a 24-h patient diary. Significant differences were observed in dietary sugar intake between patients with active and inactive SLE (in grams: 28.31 ± 24.43 vs. 38.71 ± 28.87; p = 0.035) and free sugar intake (as a percentage: 6.36 ± 4.82 vs. 8.60 ± 5.51; p = 0.020). Linear regression analysis revealed a significant association between free sugars intake (by gram or percentage) and the number of complications (β (95% CI) = 0.009 (0.001, 0.0018), p = 0.033)); (β (95% CI) = 0.046 (0.008, 0.084), p = 0.018)), and SLEDAI (β (95% CI) = 0.017 (0.001, 0.034), p = 0.043)); (β (95% CI) = 0.086 (0.011, 0.161), p = 0.024)) after adjusting for covariates. Free sugars (g and %) were also associated with the presence of dyslipidaemia (β (95% CI) = −0.003 (−0.005, 0.000), p = 0.024)) and (β (95% CI) = −0.015 (−0.028, −0.002), p = 0.021)). Our findings suggest that a higher consumption of free sugars might negatively impact the activity and complications of SLE. However, future longitudinal research on SLE patients, including dietary intervention trials, are necessary to corroborate these preliminary data.