Mediterranean diet and risk of Sjögren’s syndrome

Aleksander Machowicz, Isaac Hall, Paola De Pablo, Saaeha Rauz, Andrea Richards, Jon Higham, Ana Poveda Gallego, Fumiaki Imamura, Simon Bowman, Francesca Barone, Benjamin Fisher

Research output: Contribution to journalArticlepeer-review


Objectives: Non-genetic risk factors for Sjögren’s syndrome (SS) are poorly understood. Adherence to a Mediterranean diet has been associated with reduction in other autoimmune diseases. We examined the association of Mediterranean diet with SS.

Methods: New patients attending a single centre warranting investigation for primary SS (pSS) were recruited into the Optimising Assessment in Sjögren’s Syndrome cohort established in Birmingham, UK (2014-2018). Participants were classified into pSS and non-SS sicca, considered as cases and non-cases, respectively, and asked to complete an optional food frequency questionnaire on their diet before onset of symptoms. A semi-quantitative Mediterranean diet score (MDS) was calculated (possible range=0 to 18). Using multivariate logistic regression, corrected for energy intake, body-mass index, sex, age, symptom duration, and smoking status, we examined the association of MDS with SS.

Results: Dietary data were available for 133/243 (55%) eligible patients (n=82 pSS and n=51 sicca). In the adjusted model, a higher total MDS (mean±SD, 9.41±2.31 points) was associated with lower odds of pSS (OR 0.81, 95% CI 0.66-0.99; p=0.038) per one unit of MDS. Among MDS components, the strongest association was seen with fish with OR 0.44 (95% CI 0.24-0.83; p=0.01) in the comparison between <1 portion/week and 1 to 2.5 portions/week. Higher galactose, vitamin A-retinol-equivalents and vitamin C showed associations with lower odds of pSS in multivariate analysis, where the association of vitamin C was attenuated when adjusted for MDS.

Conclusion: When adjusted for potential confounders, adherence to the Mediterranean diet was associated with lower likelihood of having pSS.
Original languageEnglish
Pages (from-to)S216-S221
Number of pages6
JournalClinical and Experimental Rheumatology
Issue numberSupplement 126
Publication statusPublished - 23 Oct 2020


  • Sjögren’s syndrome
  • Mediterranean diet
  • risk factors
  • unsaturated fatty acids
  • ascorbic acid


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