Otoimmün Hastalıklarda Güncel Beslenme Yaklaşımları

Abstract

Otoimmün hastalıklar, vücudun normal dokularına karşı normal olmayan bağışıklık tepkisi ile karakterize edilen bir dizi hastalıktır. Bu hastalıkların nüfusun %3-5’ini etkilediği tahmin edilmektedir. Otoimmün hastalıkların etiyolojisi tam olarak anlaşılamamıştır ancak genetik, hormonal ve çevresel faktörlerle ilişkilendirilmiştir. Otoimmün hastalıklara klinikte çeşitli farmasötik ilaç tedavileri uygulanmakla birlikte bu konudaki önemli tedavilerden biri de beslenme ve diyet müdahaleleridir. Araştırmalar, sağlıklı bir diyet modeli müdahalesinin otoimmün hastalıkların hem önlenmesinde hem de tedavisinde yardımcı olabileceğini düşündürmektedir. Birçok çalışma omega-3 ve omega-6 yağ asitleri, D vitamini, bazı otoimmün hastalıklarda gıda eliminasyonları gibi diyet bileşiklerinin anti-inflamatuar ve immünomodülatör etki göstererek otoimmün hastalıklarda tedavi edici etkiler gösterdiğini bildirmiştir. Değiştirilebilir bir faktör olarak diyet, otoimmün hastalıkların önlenmesi ve tedavisinde umut verici bir potansiyele sahiptir. Bu derlemenin amacı, en bilinen otoimmün hastalıkların önlenmesi ve tedavisinde etkili olabileceği düşünülen güncel beslenme ve diyet yaklaşımlarına değinmek ve otoimmün hastalıkların tedavisinde beslenmenin rolüne ilişkin bakış açılarını sunmaktır.

Keywords

• Otoimmün hastalık
• beslenme ve diyet müdahalesi
• multiple skleroz
• hashimoto tiroidi
• romatoid artrit
• inflamatuar bağırsak hastalıkları
• hashimoto

Current Nutritional Approaches in Autoimmune Diseases

Abstract

Autoimmune diseases are a set of diseases characterized by an abnormal immune response against the normal tissues of the body. These diseases are estimated to affect 3-5% of the population. The etiology of autoimmune diseases is not fully understood but has been associated with genetic, hormonal and environmental factors. Various pharmaceutical drug treatments are applied to autoimmune diseases in the clinic, but the high costs of these treatments have led to the search for different treatment methods. One of the different treatment methods is nutrition and dietary interventions. Research suggests that a healthy dietary pattern intervention can help both prevent and treat autoimmune diseases. Many studies have reported that dietary compounds such as omega-3 and omega-6 fatty acids, vitamin D, food eliminations in some autoimmune diseases, by showing anti-inflammatory and immunomodulatory effects, have therapeutic effects in autoimmune diseases. Diet as a modifiable factor has promising potential in the prevention and treatment of autoimmune diseases. The aim of this review is to address current nutritional and dietary approaches that are thought to be effective in the prevention and treatment of the most prominent autoimmune diseases, and to present perspectives on the role of nutrition in the treatment of autoimmune diseases.

Keywords

• Autoimmune disease
• nutrition and dietary intervention
• multiple sclerosis
• hashimoto
• rheumatoid arthritis
• inflammatory bowel diseases

References

1. Abdelhamid, L., & Luo, X. M. (2021). Diet and Hygiene in Modulating Autoimmunity During the Pandemic Era. Frontiers in Immunology, 12, 749774. https://doi.org/10.3389/fimmu.2021.749774
2. Abdulrazaq, M., Innes, J. K., & Calder, P. C. (2017). Effect of ω-3 polyunsaturated fatty acids on arthritic pain: A systematic review. Nutrition, 39-40, 57-66. https://doi.org/10.1016/j.nut.2016.12.003
3. Akamizu, T., & Amino, N. (2017). Hashimoto’s Thyroiditis. Içinde Endotext [Internet]. MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK285557/
4. Alves da Costa, T., Lang, J., Torres, R. M., & Pelanda, R. (2019). The development of human immune system mice and their use to study tolerance and autoimmunity. Journal of Translational Autoimmunity, 2, 100021. https://doi.org/10.1016/j.jtauto.2019.100021
5. Angum, F., Khan, T., Kaler, J., Siddiqui, L., & Hussain, A. (2020). The prevalence of autoimmune disorders in women: a narrative review. Cureus, 12(5), e8094. doi:10.7759/cureus.8094
6. Aniwan, S., Park, S. H., & Loftus, E. V. (2017). Epidemiology, Natural History, and Risk Stratification of Crohn’s Disease. Gastroenterology Clinics of North America, 46(3), 463-480. https://doi.org/10.1016/j.gtc.2017.05.003
7. Asik, M., Gunes, F., Binnetoglu, E., Eroglu, M., Bozkurt, N., Sen, H., Akbal, E., Bakar, C., Beyazit, Y., & Ukinc, K. (2014). Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine, 46(2), 279-284. https://doi.org/10.1007/s12020-013-0065-1
8. Beecham, J. E., Seneff, S., Beecham, J. E., & Seneff, S. (2017). Autoimmune Disease: Budget-buster or Enlightened Solutions?
   (The coming epidemic and the new administration in Washington). Archives of Community Medicine and Public Health, 3(1), 032-040.

9. Bjørnevik, K., Chitnis, T., Ascherio, A., & Munger, K. L. (2017). Polyunsaturated fatty acids and the risk of multiple sclerosis. Multiple Sclerosis (Houndmills, Basingstoke, England), 23(14), 1830-1838. https://doi.org/10.1177/1352458517691150
10. Calder, P. C. (2013). n-3 fatty acids, inflammation and immunity: New mechanisms to explain old actions. The Proceedings of the Nutrition Society, 72(3), 326-336. https://doi.org/10.1017/S0029665113001031
11. Cifu, D. X. (2020). Braddom’s Physical Medicine and Rehabilitation E-Book. Elsevier Health Sciences.
12. Deane, K. D., Demoruelle, M. K., Kelmenson, L. B., Kuhn, K. A., Norris, J. M., & Holers, V. M. (2017). Genetic and environmental risk factors for rheumatoid arthritis. Best Practice & Research. Clinical Rheumatology, 31(1), 3-18. https://doi.org/10.1016/j.berh.2017.08.003
13. Deuschl, G., Beghi, E., Fazekas, F., Varga, T., Christoforidi, K. A., Sipido, E., Bassetti, C. L., Vos, T., & Feigin, V. L. (2020). The burden of neurological diseases in Europe: An analysis for the Global Burden of Disease Study 2017. The Lancet. Public Health, 5(10), e551-e567. https://doi.org/10.1016/S2468-2667(20)30190-0
14. Di Franco, M., Barchetta, I., Iannuccelli, C., Gerardi, M. C., Frisenda, S., Ceccarelli, F., Valesini, G., & Cavallo, M. G. (2015). Hypovitaminosis D in recent onset rheumatoid arthritis is predictive of reduced response to treatment and increased disease activity: A 12 month follow-up study. BMC Musculoskeletal Disorders, 16, 53. https://doi.org/10.1186/s12891-015-0505-6
15. Dinu, M., Pagliai, G., Casini, A., & Sofi, F. (2018). Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials. European Journal of Clinical Nutrition, 72(1), 30-43. https://doi.org/10.1038/ejcn.2017.58
16. Eaton, W. W., Rose, N. R., Kalaydjian, A., Pedersen, M. G., & Mortensen, P. B. (2007). Epidemiology of autoimmune diseases in Denmark. Journal of Autoimmunity, 29(1), 1-9. https://doi.org/10.1016/j.jaut.2007.05.002
17. Firestein, G. S., & McInnes, I. B. (2017). Immunopathogenesis of Rheumatoid Arthritis. Immunity, 46(2), 183-196. https://doi.org/10.1016/j.immuni.2017.02.006
18. Fletcher, J., Cooper, S. C., Ghosh, S., & Hewison, M. (2019). The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management. Nutrients, 11(5), E1019. https://doi.org/10.3390/nu11051019
19. Freeman, H. J. (2016). Endocrine manifestations in celiac disease. World Journal of Gastroenterology, 22(38), 8472-8479. https://doi.org/10.3748/wjg.v22.i38.8472
20. Fugger, L., Jensen, L. T., & Rossjohn, J. (2020). Challenges, Progress, and Prospects of Developing Therapies to Treat Autoimmune Diseases. Cell, 181(1), 63-80. https://doi.org/10.1016/j.cell.2020.03.007
21. Garg, N., & Smith, T. W. (2015). An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosis. Brain and Behavior, 5(9), e00362. https://doi.org/10.1002/brb3.362
22. Habek, M., Hojsak, I., & Brinar, V. V. (2010). Nutrition in multiple sclerosis. Clinical Neurology and Neurosurgery, 112(7), 616-620. https://doi.org/10.1016/j.clineuro.2010.03.029
23. Ihnatowicz, P., Drywień, M., Wątor, P., & Wojsiat, J. (2020). The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Annals of Agricultural and Environmental Medicine: AAEM, 27(2), 184-193. https://doi.org/10.26444/aaem/112331
24. Ihnatowicz, P., Wątor, P., Gębski, J., Frąckiewicz, J., & Drywień, M. E. (2021). Are Nutritional Patterns among Polish Hashimoto Thyroiditis Patients Differentiated Internally and Related to Ailments and Other Diseases? Nutrients, 13(11), 3675. https://doi.org/10.3390/nu13113675
25. Illescas-Montes, R., Melguizo-Rodríguez, L., Ruiz, C., & Costela-Ruiz, V. J. (2019). Vitamin D and autoimmune diseases. Life Sciences, 233, 116744. https://doi.org/10.1016/j.lfs.2019.116744
26. Johansson, K., Askling, J., Alfredsson, L., Di Giuseppe, D., & EIRA study group. (2018). Mediterranean diet and risk of rheumatoid arthritis: A population-based case-control study. Arthritis Research & Therapy, 20(1), 175. https://doi.org/10.1186/s13075-018-1680-2
27. Kawicka, A., Regulska-Ilow, B., & Regulska-Ilow, B. (2015). [Metabolic disorders and nutritional status in autoimmune thyroid diseases]. Postepy Higieny I Medycyny Doswiadczalnej (Online), 69, 80-90. https://doi.org/10.5604/17322693.1136383
28. Kl, M., T, C., Al, F., E, G., D, S., & A, A. (2011). Dietary intake of vitamin D during adolescence and risk of multiple sclerosis. Journal of Neurology, 258(3). https://doi.org/10.1007/s00415-010-5783-1
29. Krysiak, R., Szkróbka, W., & Okopień, B. (2019). The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association, 127(7), 417-422. https://doi.org/10.1055/a-0653-7108
30. Lee, Y. H., & Bae, S.-C. (2016). Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clinical and Experimental Rheumatology, 34(5), 827-833.
31. Lerner, A., Jeremias, P., & Matthias, T. (2016). The World Incidence and Prevalence of Autoimmune Diseases is Increasing. International Journal of Celiac Disease, 3(4), 151-155. https://doi.org/10.12691/ijcd-3-4-8
32. Lerner, A., & Matthias, T. (2015). Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease. Autoimmunity Reviews, 14(6), 479-489. https://doi.org/10.1016/j.autrev.2015.01.009
33. Lewis, J. D., & Abreu, M. T. (2017). Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology, 152(2), 398-414.e6. https://doi.org/10.1053/j.gastro.2016.10.019
34. Lewis, P. A., & Spillane, J. E. (2018). The Molecular and Clinical Pathology of Neurodegenerative Disease. Academic Press.
35. Limketkai, B. N., Wolf, A., & Parian, A. M. (2018). Nutritional Interventions in the Patient with Inflammatory Bowel Disease. Gastroenterology Clinics of North America, 47(1), 155-177. https://doi.org/10.1016/j.gtc.2017.09.007
36. Liontiris, M. I., & Mazokopakis, E. E. (2017). A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hellenic Journal of Nuclear Medicine, 20(1), 51-56. https://doi.org/10.1967/s002449910507
37. Maggini, S., Beveridge, S., Sorbara, P. J. P., & Senatore, G. (2008). Feeding the immune system: The role of micronutrients in restoring resistance to infections. CAB Reviews: Perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources, 3(098), 1-21.
38. Mak, T. W., Saunders, M. E., & Jett, B. D. (Ed.). (2014). Chapter 19—Autoimmune Diseases. Içinde Primer to the Immune Response (Second Edition) (ss. 517-552). Academic Cell. https://doi.org/10.1016/B978-0-12-385245-8.00019-4
39. Manzel, A., Muller, D. N., Hafler, D. A., Erdman, S. E., Linker, R. A., & Kleinewietfeld, M. (2014). Role of “Western diet” in inflammatory autoimmune diseases. Current Allergy and Asthma Reports, 14(1), 404. https://doi.org/10.1007/s11882-013-0404-6
40. Mazdeh, M., Seifirad, S., Kazemi, N., Seifrabie, M. A., Dehghan, A., & Abbasi, H. (2013). Comparison of vitamin D3 serum levels in new diagnosed patients with multiple sclerosis versus their healthy relatives. Acta Medica Iranica, 51(5), 289-292.
41. Mazzucca, C. B., Scotti, L., Cappellano, G., Barone-Adesi, F., & Chiocchetti, A. (2022). Nutrition and Rheumatoid Arthritis Onset: A Prospective Analysis Using the UK Biobank. Nutrients, 14(8), 1554. https://doi.org/10.3390/nu14081554
42. Meena, N., Singh Chawla, S. P., Garg, R., Batta, A., & Kaur, S. (2018). Assessment of Vitamin D in Rheumatoid Arthritis and Its Correlation with Disease Activity. Journal of Natural Science, Biology, and Medicine, 9(1), 54-58. https://doi.org/10.4103/jnsbm.JNSBM_128_17
43. Meydani, S. N., Guo, W., Han, S. N., & Wu, D. (2020). Chapter 30—Nutrition and autoimmune diseases. Içinde B. P. Marriott, D. F. Birt, V. A. Stallings, & A. A. Yates (Ed.), Present Knowledge in Nutrition (Eleventh Edition) (ss. 549-568). Academic Press. https://doi.org/10.1016/B978-0-12-818460-8.00030-7
44. Mierzecki, A., Strecker, D., & Radomska, K. (2011). A pilot study on zinc levels in patients with rheumatoid arthritis. Biological Trace Element Research, 143(2), 854-862. https://doi.org/10.1007/s12011-010-8952-2
45. Morales-Tisnés, T., Quintero-Ortiz, L., Quintero-Muñoz, E., Sierra-Matamoros, F., Arias-Aponte, J., & Rojas-Villarraga, A. (2021). Prevalence of hospital readmissions and related factors in patients with autoimmune diseases. Journal of Translational Autoimmunity, 4, 100121. https://doi.org/10.1016/j.jtauto.2021.100121
46. Mullin, G. E., Shepherd, S. J., Chander Roland, B., Ireton-Jones, C., & Matarese, L. E. (2014). Irritable bowel syndrome: Contemporary nutrition management strategies. JPEN. Journal of Parenteral and Enteral Nutrition, 38(7), 781-799. https://doi.org/10.1177/0148607114545329
47. Oh, J., Vidal-Jordana, A., & Montalban, X. (2018). Multiple sclerosis: Clinical aspects. Current Opinion in Neurology, 31(6), 752-759. https://doi.org/10.1097/WCO.0000000000000622
48. Pattison, D. J., Harrison, R. A., & Symmons, D. P. M. (2004). The role of diet in susceptibility to rheumatoid arthritis: A systematic review. The Journal of Rheumatology, 31(7), 1310-1319.
49. Pyzik, A., Grywalska, E., Matyjaszek-Matuszek, B., & Roliński, J. (2015). Immune disorders in Hashimoto’s thyroiditis: What do we know so far? Journal of Immunology Research, 2015, 979167. https://doi.org/10.1155/2015/979167
50. Radu, A.-F., & Bungau, S. G. (2021). Management of Rheumatoid Arthritis: An Overview. Cells, 10(11), 2857. https://doi.org/10.3390/cells10112857
51. Ramos, G. P., & Papadakis, K. A. (2019). Mechanisms of Disease: Inflammatory Bowel Diseases. Mayo Clinic Proceedings, 94(1), 155-165. https://doi.org/10.1016/j.mayocp.2018.09.013
52. Schwingshackl, L., & Hoffmann, G. (2014). Mediterranean dietary pattern, inflammation and endothelial function: A systematic review and meta-analysis of intervention trials. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD, 24(9), 929-939. https://doi.org/10.1016/j.numecd.2014.03.003
53. Shivashankar, R., Tremaine, W. J., Harmsen, W. S., & Loftus, E. V. (2017). Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, 15(6), 857-863. https://doi.org/10.1016/j.cgh.2016.10.039
54. Smolen, J. S., Aletaha, D., Barton, A., Burmester, G. R., Emery, P., Firestein, G. S., Kavanaugh, A., McInnes, I. B., Solomon, D. H., Strand, V., & Yamamoto, K. (2018). Rheumatoid arthritis. Nature Reviews. Disease Primers, 4, 18001. https://doi.org/10.1038/nrdp.2018.1
55. Sworczak, K., & Wiśniewski, P. (2011). The role of vitamins in the prevention and treatment of thyroid disorders. Endokrynologia Polska, 62(4), 340-344.
56. Tonutti, E., & Bizzaro, N. (2014). Diagnosis and classification of celiac disease and gluten sensitivity. Autoimmunity Reviews, 13(4-5), 472-476. https://doi.org/10.1016/j.autrev.2014.01.043
57. Wahren-Herlenius, M., & Dörner, T. (2013). Immunopathogenic mechanisms of systemic autoimmune disease. Lancet (London, England), 382(9894), 819-831. https://doi.org/10.1016/S0140-6736(13)60954-X
58. Wang, L., Wang, F.-S., & Gershwin, M. E. (2015). Human autoimmune diseases: A comprehensive update. Journal of Internal Medicine, 278(4), 369-395. https://doi.org/10.1111/joim.12395
59. Wessels, I., & Rink, L. (2020). Micronutrients in autoimmune diseases: Possible therapeutic benefits of zinc and vitamin D. The Journal of Nutritional Biochemistry, 77, 108240. https://doi.org/10.1016/j.jnutbio.2019.108240
60. Xin, L., Yang, X., Cai, G., Fan, D., Xia, Q., Liu, L., Hu, Y., Ding, N., Xu, S., Wang, L., Li, X., Zou, Y., & Pan, F. (2015). Serum Levels of Copper and Zinc in Patients with Rheumatoid Arthritis: A Meta-analysis. Biological Trace Element Research, 168(1), 1-10. https://doi.org/10.1007/s12011-015-0325-4
61. Yu, N., Han, F., Lin, X., Tang, C., Ye, J., & Cai, X. (2016). The Association Between Serum Selenium Levels with Rheumatoid Arthritis. Biological Trace Element Research, 172(1), 46-52. https://doi.org/10.1007/s12011-015-0558-2
62. Zhang, S. M., Willett, W. C., Hernán, M. A., Olek, M. J., & Ascherio, A. (2000). Dietary fat in relation to risk of multiple sclerosis among two large cohorts of women. American Journal of Epidemiology, 152(11), 1056-1064. https://doi.org/10.1093/aje/152.11.1056