Mediterranean diet and symptom severity in Sjogren's syndrome

Sjogren's syndrome (SS) is a multifaceted clinical condition characterized by various features, including ocular dryness (OD), dry mouth, arthralgia, and fatigue, which plays a substantial role in shaping the clinical presentation of the disease and has detrimental effects on quality of life. Recent research has acknowledged the advantages of the Mediterranean diet (MD) for its positive impact on various autoimmune diseases. This study aims to investigate the effect of Mediterranean diet on Sjogren disease using two validated scores: the Ocular Surface Disease Index (OSDI) score and the Eular Sjogren's Syndrome Patient Reported Index (ESSPRI).

This was a cross-sectional observational study of previously diagnosed patients of Sjogren Syndrome using the ACR EULAR 2016 criteria. Patients were recruited from the archives of a tertiary university hospital. Data were collected through a telephone questionnaire, including demographic and disease data, the Ocular Surface Disease Index (OSDI) score to evaluate the OD severity, the Mediterranean Diet Adherence Screener (MEDAS) score to determine adherence to the MD and the Eular Sjogren's Syndrome Patient Reported Index (ESSPRI). The primary outcome of the study, the association between OSDI/ESSPRI and MEDAS scores, was evaluated using Spearman's correlation coefficient.

The study comprised 75 patients with a mean age of 50.1 ± 13.3 years. There were 88% women among the patients. The median scores were 5.0 for the ESSPRI (IQR 3.0-6.7), 25.0 for the OSDI (IQR 10.4-40.6), and 8.0 for the MEDAS (IQR 4.5-11.0). The Spearman correlation analysis revealed a significant negative correlation between MEDAS and OSDI (ρ = -0.78, p < 0.001). None of the covariates were statistically significant in the ESSPRI model, whereas treatment exhibited 2 a positive correlation with OSDI (β = +6.44, 95% CI 0.84 to 12.03; p = 0.025), likely indicating confounding by indication.

The study results suggest that higher adherence to a Mediterranean dietary pattern was consistently associated with lower symptom burden. This approach may serve as a complementary strategy with multiple health benefits, alongside conventional treatment options.