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Many patients report that different foodstuffs improve or worsen their disease symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> The dietary inflammation index was developed in 2009 and is a method used to precisely measure the inflammatory potential of diet that contributes to many chronic conditions&#46; Dietary inflammation index&#59; assesses the inflammatory potential of the diet based on the balance of pro- and anti-inflammatory properties of dietary components&#44; including macronutrients&#44; vitamins&#44; minerals&#44; flavonoids&#44; and specific foodstuffs&#46; The Western diet pattern &#40;highly concentrated in red meat&#44; high-fat dairy products&#44; and refined grains&#41; is associated with high inflammatory markers&#46; The Mediterranean diet &#40;high consumption of whole grains&#44; fruit and green vegetables&#44; fish&#44; low consumption of red meat and butter&#44; moderate alcohol&#44; and olive oil&#41; is associated with low levels of inflammatory markers&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> In people with RA&#44; it causes an increase in the metabolic index and nutritional needs and reduces food intake due to chronic inflammation&#46; In addition&#44; physical difficulties in purchasing and cooking food&#44; chewing difficulties due to jaw joint involvement&#44; chewing and swallowing difficulties due to decreased secretion in patients with Sj&#246;gren&#39;s syndrome&#44; nausea&#44; and loss of appetite in those with side effects due to drug treatment adversely affect the nutritional status of RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Dietary models evaluated in the medical nutrition therapy of patients with rheumatoid arthritis include Mediterranean&#44; anti-inflammatory&#44; and gluten-free&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> The anti-inflammatory diet is similar to the Mediterranean diet&#44; with a higher content of potential anti-inflammatory components than the Mediterranean diet&#46; It is thought that pro-inflammatory cytokines such as IL-1&#44; IL-6&#44; and TNF-&#945; are effective by reducing gene expression&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> In patients with rheumatoid arthritis&#44; the Mediterranean diet has been reported to reduce pain&#44; increase physical function&#44; and reduce disease activity scores&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> Gluten appears to be a clinically inflammatory glycoprotein&#46; Case reports show that a gluten-free diet can improve symptoms in patients with rheumatoid arthritis resistant to conventional drug therapy&#46; Gluten activates Toll-like receptor 4 and stimulates the production of various pro-inflammatory cytokines such as IL-6&#44; IL-1&#44; and especially IL-17&#46; High levels of anti-gliadin antibodies have been detected in the intestinal fluid of RA patients compared to healthy individuals&#46; This finding supports the possible antigenic effect of gluten&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> More profound knowledge about the relationship between general diet and RA may assist in the remission of RA&#44; a lifelong disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our aim in this study is to investigate the nutritional status of patients with RA and whether a higher dietary inflammatory index contributes to disease activity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 41 RA patients aged 18 years and over&#44; 34 women and 7 men&#44; who were being followed up in the Rheumatology Department of Ayd&#305;n Adnan Menderes University Research and Teaching Hospital&#44; were included in the study&#46; Patients diagnosed with RA were included according to the 2010 American College of Rheumatology &#40;ACR&#41;&#47;European League Against Rheumatism &#40;EULAR&#41; classification criteria&#46; Demographic data of the patients&#44; laboratory results &#40;complete blood count&#44; Erythrocyte Sedimentation Rate &#40;ESH&#41;&#44; C-reactive protein &#40;CRP&#41;&#44; renal and hepatic function tests&#41;&#44; and disease activation score &#40;DAS-28&#41; were recorded&#46; Demographic and nutritional data were collected from the patients through face-to-face interviews with the specialist dietitian&#44; and general information was recorded in the patient data sheet&#46; This sheet was used to collect the general information of the participants&#46; General information includes education level&#44; age&#44; gender&#44; body weight &#40;kg&#41;&#44; height &#40;m&#41;&#44; smoking&#44; alcohol&#44; and general eating habits&#46; This descriptive and cross-sectional study was approved by the Ethics Committee of Faculty of Medicine &#40;2021&#47;151&#41;&#46; An informed consent form was obtained from the patients before the procedure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the 24-h diet recall form&#44; the food and amounts consumed by the participants in the last 24<span class="elsevierStyleHsp" style=""></span>h were recorded&#46; A dietitian checked it&#46; The 24-h diet records of individuals were analyzed with the Nutrition Information Systems Package Program &#40;BEBIS&#41;&#46; Average daily intake of macro and micronutrients such as dietary protein&#44; total fat&#44; carbohydrate &#40;CHO&#41;&#44; free sugar&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; monounsaturated fatty acids &#40;MUFA&#41;&#44; linoleic acid &#40;LA&#41;&#44; omega-3 fatty acids&#46; Purchase quantities were calculated as a result of the analysis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The intake status of 29 nutrients and nutrients used in the study was determined&#46; DII was calculated using the parameters of 29 nutrients &#40;e&#46;g&#46;&#44; energy&#44; carbohydrate&#44; fiber&#44; protein&#41;&#46; From the participants&#8217; daily intake of food and nutrients&#44; &#8220;&#91;&#40;the participant&#39;s daily consumption amount of that nutrient or nutrient-average global daily consumption amount&#41;&#47;the standard deviation value of that nutrient or nutrient X overall inflammatory effect score&#93;&#8221; for each nutrient individually calculated&#46; DII values&#44; which determine the inflammatory load of the participants&#8217; diet&#44; were determined by adding up all the calculated scores&#46; After the calculations were made for the participants&#44; groups were evaluated according to the DII value&#46; Inflammatory index scores were calculated from individuals&#8217; 24-h daily food consumption records&#46; Negative inflammatory index scores represented an anti-inflammatory diet with positive components for health&#46; Positive inflammatory index scores&#44; on the other hand&#44; represented a pro-inflammatory diet&#46; In this study&#44; individuals were divided into quarter groups according to their dietary inflammatory index scores&#59; the groups 1&#46; quartile &#40;Q1&#41;&#44; 2&#46; quartile &#40;Q2&#41;&#44; 3&#46; quartile &#40;Q3&#41;&#44; and 4&#46; quartile &#40;Q4&#41; were compared&#46; The first quartile &#40;Q1&#41; represents the anti-inflammatory diet&#46; The inflammatory load of the diet increases as the quartiles increase&#46; 4&#46; quartile &#40;Q4&#41; indicates a pro-inflammatory diet&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> European Food Safety Authority &#40;EFSA&#41; reference data were used to compare patients&#8217; dietary macro- and micronutrients&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The Kolmogorov&#8211;Smirnov test determined the distributions of quantitative variables&#46; Descriptive statistics were given as X&#175;&#177;SD for normally distributed variables and median &#40;25&#8211;75 percentile&#41; for non-normally distributed variables&#46; Comparison of groups&#44; normally distributed variables ANOVA one-way analysis of variance in independent group comparison&#44; Kruskal&#8211;Wallis <span class="elsevierStyleItalic">H</span> test was used for non-normally distributed variables&#46; Independent analysis of categorical variables Chi-square analysis method was applied&#46; A <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46; Independent samples t test was used in the comparison of two independent groups&#46; Spearman&#39;s correlation test was used to determine the relationship between quantative variables&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">We included 41 patients diagnosed with RA in our study&#44; 83&#37; of whom were women&#46; All patients were taking medication for the treatment of RA&#44; including corticosteroids&#46; The groups were homogeneously distributed regarding age&#44; gender&#44; smoking status&#44; and diabetes&#46; The mean age of the individuals was 53&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7 years in the Q1 group on the anti-inflammatory diet and 58&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1 years in the Q4 group on the pro-inflammatory diet&#46; For the diagnosis of RA&#44; the disease history was 5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;97 years in the Q1 group and 12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 years in the Q4 group&#46; The DAS-28 score evaluation showed 4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;53 in the Q1 group on an anti-inflammatory diet and 4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13 in the Q4 group on a pro-inflammatory diet&#46; Furthermore&#44; mean serum CRP level evaluations showed 3&#46;0 in the Q1 group on an anti-inflammatory diet and 17&#46;4 in the Q4 group on the pro-inflammatory diet&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Of the patients in our study&#44; 9&#37; had a history of diabetes&#46; After the dietary inflammatory index quartile groups were evaluated for the body mass index &#40;BMI&#41;&#44; there was no statistically significant association between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;195&#41;&#46; In the evaluation of rheumatoid arthritis for disease duration&#44; the group on an anti-inflammatory diet and the quartile group on a pro-inflammatory diet were significantly different &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; DAS-28 score was lower in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;163&#41;&#46; There was no significant difference between all quartile groups in terms of the treatment &#40;Disease-modifying anti-rheumatic drug and biologic agents&#41; they received &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Sedimentation and CRP values were lower in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was statistically insignificant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;575&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;129&#41;&#46; The difference between the RA quartile groups regarding other blood laboratory parameters was also insignificant &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In the evaluation of dietary macro- and micronutrient analysis among dietary inflammatory quartile groups&#44; dietary iron &#40;Fe&#41; intake was higher in the Q1 group receiving the anti-inflammatory diet than in the Q4 group receiving the pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; It was found that the Q1 and Q2 groups receiving an anti-inflammatory diet had higher magnesium intake than the Q4 group receiving a pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; As a result of the comparison of vitamin C and niacin in the Q1 group receiving an anti-inflammatory diet&#44; the intake level of vitamin C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41; and niacin &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; was higher than the Q4 group receiving the pro-inflammatory diet&#46; Dietary riboflavin intake in the Q1 quartile group receiving the anti-inflammatory diet was higher than in the Q4 quartile group receiving the pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Q1 quartile group receiving the pro-inflammatory diet had a significantly higher dietary protein intake than the Q2 quartile group&#46; However&#44; there was no significant difference between the protein intake levels of the quartile group who received anti-inflammatory and pro-inflammatory diets &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In comparing the quartile group taking an anti-inflammatory diet and the quartile group receiving a pro-inflammatory diet&#44; dietary iron&#44; vitamin C&#44; folic acid&#44; niacin&#44; riboflavin&#44; and magnesium intakes were found to be statistically significantly higher in the quartile group receiving an anti-inflammatory diet&#46; The intake of some micronutrients&#44; such as iron&#44; zinc&#44; riboflavin&#44; thiamine and magnesium was significantly lower than the recommended values in all RA quartile groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">DAS-28 score change is affected by the dietary inflammatory index at a rate of 12&#46;02&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A weak but significant relationship was found between DAS-28 and dietary inflammatory index &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3468&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0263&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">It is known that genes&#44; environmental factors&#44; and hormones play a role in the development of rheumatoid arthritis&#46; The activity of primary female sex hormones explains the more frequent occurrence of the disease&#44; especially in women&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> In addition&#44; many environmental factors&#44; such as trauma&#44; infections&#44; and nutrition&#44; mainly smoking&#44; also affect the development of RA&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> The anti-inflammatory activity of some nutrients has been reported in various primary and clinical studies&#46; It has been reported that polyunsaturated fatty acids have antioxidant and anti-inflammatory effects&#44; and vitamin D has a protective effect on the development of RA&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> In our study&#44; there was no difference in the number of smokers in the Q1 group receiving an anti-inflammatory diet and the Q4 group receiving a pro-inflammatory diet&#46; It was determined that 35&#37; of the patients in the study were smokers&#46; Our study found no significant difference in dietary unsaturated fat intake levels&#46; Omega 3 fatty acids were above the reference intake level in all groups&#46; All study group&#39;s dietary vitamin D intake levels were below the reference levels&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In a study of 184 patients with a diagnosis of rheumatoid arthritis&#44; a linear trend was found from dietary inflammatory index groups to pro-inflammatory areas&#44; with a decrease in lean mass&#44; weight&#44; and energy intake&#46; The increased rheumatoid arthritis disease activity score &#40;DAS-28&#41;&#44; ESR&#44; and CRP levels were detected&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> In a study conducted with newly diagnosed rheumatoid arthritis patients and healthy controls&#44; They stated that inflammatory dietary intake might act as a potential risk factor contributing to the development and severity of RA&#46; It has also been reported that patients with high DII have higher serum inflammatory &#40;hs-CRP and TNF&#41; and clinical markers &#40;tender joint score and DAS-28 score&#41;&#46; Therefore&#44; they thought that dietary modification to lower the DII score might be beneficial to improve clinical outcomes in such patients&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> In our study&#44; ESR and CRP values were high with the increase in the pro-inflammatory effect potential of the diet&#44; but it was not statistically significant&#46; The regression analysis showed that the inflammatory effect of the general diet in rheumatoid arthritis patients had a 12&#46;02&#37; effect on the activity of the disease&#46; A weak but significant relationship was found between DAS-28 and DII&#46; The DAS-28 score was lower in the group receiving an anti-inflammatory diet&#46; Studies have reported that plasma inflammatory adipokines such as leptin&#44; adiponectin&#44; and visfatin released from white adipose tissue were higher in RA than in healthy individuals&#46; In addition&#44; obesity is reported to be a risk factor for RA patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16&#8211;18</span></a> In our study&#44; the mean BMI of the patients with the highest DAS-28 score was between 29&#46;8 and 30&#46;8&#46; A study evaluating daily energy intake reported that women with movement restrictions had lower energy intake than healthy individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In Bekar et al&#46;&#8217;s study with rheumatoid arthritis patients&#44; the daily dietary energy intake &#40;1641&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>447&#46;58<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#41; of patients in the patient group was lower than healthy individuals &#40;1816&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>535&#46;62<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#41; was not statistically significant&#46; It has been reported that people with rheumatoid arthritis provide 44&#46;8&#37; of daily dietary energy from carbohydrates&#44; 37&#46;5&#37; from fats&#44; and 14&#46;4&#37; from proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> In our study&#44; the daily energy intakes of the quartile group&#44; which received an anti-inflammatory and pro-inflammatory diet&#44; were found to be 1518<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274<span class="elsevierStyleHsp" style=""></span>kcal&#47;day and 1285<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>433<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#44; respectively&#46; According to the EFSA &#40;European Food Safety Authority&#41; reference values&#44; it is recommended to provide 45&#8211;60&#37; of the daily energy of individuals from carbohydrates&#44; 12&#8211;20&#37; from proteins&#44; and 20&#8211;35&#37; from fats for adequate and balanced nutrition&#46; Furthermore&#44; it is also recommended to increase omega-3 &#40;<span class="elsevierStyleItalic">n</span>&#8722;3&#41; fatty acids in the diet&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> Our study evaluated the percentage of daily dietary energy from carbohydrates&#44; fat&#44; and protein&#46; The anti-inflammatory quartile group&#39;s carbohydrate&#44; fat&#44; and protein values were 48&#46;8&#37;&#44; 30&#46;5&#37;&#44; and 18&#46;5&#37;&#44; respectively&#46; We found 47&#46;8&#37;&#44; 33&#46;7&#37;&#44; and 16&#46;5&#37; for the pro-inflammatory quartile group&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Omega fatty acids are essential components of the diet and are commonly known as omega-3&#44; omega-6&#44; and omega-9&#46; The richest dietary sources of omega fatty acids are vegetable and fish oils&#46; Omega-3 and omega-6 are essential fatty acids that must be externally taken&#46; Omega-3&#44; &#945;-linolenic acid &#40;ALA&#41; is of vegetable origin&#44; and eicosapentaenoic acid &#40;EPA&#41; and docosahexaenoic acid &#40;DHA&#41; are abundantly in fish&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> It has been reported that omega-3&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; especially EPA and DHA&#44; may have protective effects by reducing the formation of pro-inflammatory eicosanoids in RA disease or healing effect on the disease process&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> It has been reported that omega-3&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; and especially EPA and DHA may be protective against RA by reducing the formation of proinflammatory eicosanoids or may have healing effects on the disease process&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> In Tadeschi et al&#46; study&#44; it has been reported that greater fish consumption associated with lower disease activity in RA&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> Classically&#44; the intake of anti-inflammatory fatty acids such as n-3 fatty acids and &#947;-linolenic acid has been reported to reduce inflammation and disease activity in RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> In our study&#44; the dietary omega-3 intakes of the patients were above the EFSA dietary reference value in the whole patient quartile group&#46; Patients reported that they rarely consumed fish&#46; Dietary monounsaturated fatty acid &#40;MUFA&#41; intake levels were compared&#46; The MUFA intake level was higher in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was not statistically significant&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In a study of female rheumatoid arthritis patients with a normal BMI&#44; daily intakes of energy and micronutrients&#44; including dietary calcium&#44; folic acid&#44; zinc&#44; magnesium&#44; and vitamin B6&#44; were significantly lower than dietary reference values&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> In our study&#44; when we compared the dietary reference values in patients with RA&#44; daily dietary magnesium&#44; zinc&#44; and iron intakes were low in all quartile groups&#46; Folate was found to be low only in the pro-inflammatory quartile group&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">DAS-28 is the most commonly used method for clinical assessment of disease activity in RA&#46; The DAS-28 score is a composite score that includes the condition of 28 joints &#40;tenderness and swelling&#41;&#44; markers of inflammation along with erythrocyte sedimentation rate &#40;ESR&#41; or C-reactive protein &#40;CRP&#41;&#44; and a person&#39;s perceived health using a visual analog scale &#40;VAS&#41;&#46; In the evaluation of the DAS-28 score&#44; &#8804;2&#46;6&#44; indicates low disease activity&#44; &#62;3&#46;2 and &#8805;5&#46;1&#44; moderate disease activity and &#62;5&#46;1 high disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> In our study&#44; patients in anti-inflammatory&#44; pro-inflammatory&#44; and other quartile groups had moderate disease activity in terms of DAS-28 score&#46; We compared the groups receiving anti-inflammatory and pro-inflammatory diets regarding the history of RA disease&#46; We found that individuals with a more extended disease history took a more pro-inflammatory diet&#46; There was no significant difference between the quartile groups in terms of RA treatment &#40;disease-modifying anti-rheumatic drug and biologic agents&#41;&#46; Regarding its limitations&#44; our study is cross-sectional and reports data from a single institution&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this study&#44; we observed that patients with a long-term diagnosis of rheumatoid arthritis generally tended to follow a poor diet with a high inflammatory index&#46; The reason for this is decreased appetite due to the duration of the disease&#44; complaints related to the gastrointestinal system&#44; and long-term use of a wide variety of drugs reasons may be considered&#46; In addition&#44; it is thought that they are malnourished in terms of micronutrients such as iron&#44; zinc&#44; and vitamin D&#44; and they are fed with low calories due to movement restriction&#46; In this respect&#44; making adjustments to patients&#8217; diets can be recommended&#46; We think the anti-inflammatory effect of the diet might be effective in the new onset period of the disease&#46; Individuals with chronic and long-term diseases pose a greater risk for nutritional deficiencies&#46; As a result of our study and literature review&#44; this patient group should increase the frequency of fish consumption&#44; and those with low micronutrients such as zinc&#44; iron&#44; and vitamin D should be supplemented&#46; There seem to be limited studies on this subject in the literature&#46; Therefore&#44; we believe that our study is essential for both being the first study in Turkiye and its contribution to the literature&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethics committee approval</span><p id="par0105" class="elsevierStylePara elsevierViewall">The study protocol was approved by the Adnan Menderes University Medical Faculty Ethics Committee &#40;date&#58; 09&#46;09&#46;2021&#44; No&#58; E-53043469-050&#46;04&#46;04-75261&#41;&#46; The study was conducted in accordance with the principles of the Declaration of Helsinki&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research and&#47;or authorship of this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Introduction"
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              "titulo" => "Materials and methods"
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              "titulo" => "Introducci&#243;n"
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              "titulo" => "Materiales y m&#233;todos"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2023-05-12"
    "fechaAceptado" => "2024-02-01"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1846910"
          "palabras" => array:5 [
            0 => "Diet"
            1 => "Dietary inflammatory index"
            2 => "Rheumatoid arthritis"
            3 => "Inflammation"
            4 => "Disease activity score"
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        ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:5 [
            0 => "Dieta"
            1 => "&#205;ndice inflamatorio diet&#233;tico"
            2 => "Artritis reumatoide"
            3 => "Inflamaci&#243;n"
            4 => "Puntuaci&#243;n de actividad de la enfermedad"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Many patients diagnosed with rheumatoid arthritis &#40;RA&#41; report relief of symptoms after consuming certain foods&#46; Diet plays a vital role in rheumatoid arthritis-related inflammation regulation&#46; This study investigates the relationship between dietary inflammation index &#40;DII&#41; scores and RA disease activity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forty-one RA patients were enrolled in the study&#46; The general inflammatory index of the diet was analyzed by recording the 24-h food consumption of the patients&#44; and the nutrients were analyzed using the Nutrition Information Systems Package Program&#46; Dietary inflammatory indices were calculated for each patient using the patients&#8217; macro and micronutrient intake levels&#46; RA disease activity was assessed using the Disease Activity Score-28 &#40;DAS-28&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The DAS-28 score was lower in the anti-inflammatory diet group compared to the pro-inflammatory diet group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;163&#41;&#46; A weak but significant relationship was found between diet inflammation index score and DAS-28 &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3468&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0263&#41;&#46; The effect of the dietary inflammatory index on the DAS-28 was 12&#46;02&#37;&#46; Dietary iron&#44; vitamin C&#44; niacin&#44; and magnesium intakes were statistically significantly higher in the quartile group that received an anti-inflammatory diet than in the quartile group that received a pro-inflammatory diet&#46; The intake of some micronutrients&#44; such as iron&#44; zinc&#44; magnesium&#44; and folic acid&#44; was significantly lower than the recommended values in all RA quartile groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that reducing inflammation through the diet may have a weak but significant effect in controlling disease activity in RA patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Muchos pacientes diagnosticados con artritis reumatoide &#40;AR&#41; informan un alivio de los s&#237;ntomas despu&#233;s de consumir ciertos alimentos&#46; La dieta juega un papel vital en la regulaci&#243;n de la inflamaci&#243;n relacionada con la artritis reumatoide&#46; Este estudio investiga la relaci&#243;n entre las puntuaciones del &#237;ndice de inflamaci&#243;n diet&#233;tica &#40;DII&#41; y la actividad de la enfermedad de AR&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se inscribieron en el estudio 41 pacientes con AR&#46; El &#237;ndice inflamatorio general de la dieta se analiz&#243; registrando el consumo de alimentos de los pacientes durante 24 horas y los nutrientes se analizaron mediante el Programa de Paquetes de Sistemas de Informaci&#243;n Nutricional&#46; Los &#237;ndices inflamatorios diet&#233;ticos se calcularon para cada paciente utilizando los niveles de ingesta de macro- y micronutrientes de los pacientes&#46; La actividad de la enfermedad de AR se evalu&#243; mediante la puntuaci&#243;n de actividad de la enfermedad-28 &#40;DAS-28&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La puntuaci&#243;n DAS-28 fue menor en el grupo de dieta antiinflamatoria en comparaci&#243;n con el grupo de dieta proinflamatoria &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;163&#41;&#46; Se encontr&#243; una relaci&#243;n d&#233;bil pero significativa entre la puntuaci&#243;n del &#237;ndice de inflamaci&#243;n de la dieta y el DAS-28 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3468&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0263&#41;&#46; El efecto del &#237;ndice inflamatorio diet&#233;tico sobre el DAS-28 fue del 12&#44;02&#37;&#46; La ingesta diet&#233;tica de hierro&#44; vitamina C&#44; niacina y magnesio fue estad&#237;sticamente significativamente mayor en el grupo del cuartil que recibi&#243; una dieta antiinflamatoria que en el grupo del cuartil que recibi&#243; una dieta proinflamatoria&#46; La ingesta de algunos micronutrientes&#44; como hierro&#44; zinc&#44; magnesio y &#225;cido f&#243;lico&#44; fue significativamente menor que los valores recomendados en todos los grupos del cuartil de AR&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que la reducci&#243;n de la inflamaci&#243;n a trav&#233;s de la dieta puede tener un efecto d&#233;bil pero significativo en el control de la actividad de la enfermedad en pacientes con AR&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The correlation scatter plot and the regression line of DAS-28 and diet inflammation index score&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; DAS-28&#58; disease activity score-28&#44; DMARD&#58; disease-modifying anti-rheumatic drug&#46;</p>"
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                  \t\t\t\t">61&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;195&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">DAS-28&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#47;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;650&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DMARDs&#47;biologic &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#47;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#47;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#47;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;690&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; RF&#58; rheumatoid factor&#44; CRP&#58; C-reactive protein&#44; ALT&#58; alanine transaminase&#44; AST&#58; aspartate amino transferase&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dietary inflammatory index scores quartiles</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;Lower inflammatory diet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q4 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;Higher inflammatory diet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">145&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>103&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">146&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">131&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;866&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Sedimentation &#40;ESH&#41;&#44; mm&#47;h&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;575&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Anti-CCP&#44; mg&#47;dLMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;0&#46;5&#8211;18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;2 &#40;0&#46;5&#8211;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;3 &#40;0&#46;9&#8211;196&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2 &#40;0&#46;6&#8211;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;404&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">RF&#44; U&#47;mLMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47&#46;0 &#40;7&#8211;252&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#46;5 &#40;8&#46;2&#8211;148&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">131&#46;05 &#40;7&#8211;292&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; EFSA&#58; European Food Safety Authority&#44; DRV&#58; Within rows&#44; means followed by the same letter are significantly different &#40;a&#44; b&#44; ab&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dietary inflammatory index scores quartiles</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">Reference values according to EFSA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q3&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q4&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;Higher inflammatorydiet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Energy&#44; kcal&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">938<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>310<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1356<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>321<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Carbohydrates&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">189&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">149<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Energy from carbohydrates&#44; &#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protein&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;5<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Protein E&#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat E &#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#8211;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FIBER&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholesterol&#44; mg&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">294 &#40;122&#8211;336&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;58&#8211;307&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;71&#8211;197&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">280 &#40;154&#8211;355&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Saturated fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;034</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">As low as possible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monounsaturated fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;023</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Omega3 fatty acids&#44; g&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;25 &#40;0&#46;87&#8211;1&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;7&#8211;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;1&#46;02&#8211;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;8&#8211;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;089&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitamin A mcg&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1189<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>622&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">898<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1070<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>585&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">652<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiamine&#44; mg&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riboflavin&#44; mg&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6 &#40;1&#46;3&#8211;1&#46;88&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original article
The relationship between dietary inflammatory index scores and rheumatoid arthritis disease activity
La relación entre las puntuaciones del índice inflamatorio dietético y la actividad de la enfermedad de la artritis reumatoide
Hüseyin Baygina,
Corresponding author
bayginhuseyin@hotmail.com

Corresponding author.
, Fatih Sirikenb, Gökhan Sargına, Songül Çildaga, Hakan Ozturkc, Taskin Senturka
a Aydin Adnan Menderes University Medical Faculty, Department of Rheumatology, Aydın, Turkey
b Aydın Adnan Menderes University, Research Hospital, Department of Nutrition and Dietetics, Aydın, Turkey
c Aydin Adnan Menderes University Medical Faculty, Department of Biostatistics, Aydın, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic inflammatory and autoimmune disease characterized by systemic inflammation and joint destruction&#46; A prevalence of 0&#46;4&#8211;1&#37; worldwide has been reported in various populations&#46; Treatment of RA includes suppression of synovitis and systemic inflammation to avoid long-term complications such as joint deformity and disability and possibly prolong survival&#46; The goal of treatment is to achieve sustained disease remission&#44; which often requires adjustments in the therapeutic approach&#46; Disease-modifying antirheumatic drugs &#40;DMARDs&#41; are effective in slowing or stopping the progression of RA disease and form the basis of RA treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> Patients diagnosed with RA expect unique dietary advice from their physicians&#46; Many patients report that different foodstuffs improve or worsen their disease symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> The dietary inflammation index was developed in 2009 and is a method used to precisely measure the inflammatory potential of diet that contributes to many chronic conditions&#46; Dietary inflammation index&#59; assesses the inflammatory potential of the diet based on the balance of pro- and anti-inflammatory properties of dietary components&#44; including macronutrients&#44; vitamins&#44; minerals&#44; flavonoids&#44; and specific foodstuffs&#46; The Western diet pattern &#40;highly concentrated in red meat&#44; high-fat dairy products&#44; and refined grains&#41; is associated with high inflammatory markers&#46; The Mediterranean diet &#40;high consumption of whole grains&#44; fruit and green vegetables&#44; fish&#44; low consumption of red meat and butter&#44; moderate alcohol&#44; and olive oil&#41; is associated with low levels of inflammatory markers&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> In people with RA&#44; it causes an increase in the metabolic index and nutritional needs and reduces food intake due to chronic inflammation&#46; In addition&#44; physical difficulties in purchasing and cooking food&#44; chewing difficulties due to jaw joint involvement&#44; chewing and swallowing difficulties due to decreased secretion in patients with Sj&#246;gren&#39;s syndrome&#44; nausea&#44; and loss of appetite in those with side effects due to drug treatment adversely affect the nutritional status of RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Dietary models evaluated in the medical nutrition therapy of patients with rheumatoid arthritis include Mediterranean&#44; anti-inflammatory&#44; and gluten-free&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a> The anti-inflammatory diet is similar to the Mediterranean diet&#44; with a higher content of potential anti-inflammatory components than the Mediterranean diet&#46; It is thought that pro-inflammatory cytokines such as IL-1&#44; IL-6&#44; and TNF-&#945; are effective by reducing gene expression&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> In patients with rheumatoid arthritis&#44; the Mediterranean diet has been reported to reduce pain&#44; increase physical function&#44; and reduce disease activity scores&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> Gluten appears to be a clinically inflammatory glycoprotein&#46; Case reports show that a gluten-free diet can improve symptoms in patients with rheumatoid arthritis resistant to conventional drug therapy&#46; Gluten activates Toll-like receptor 4 and stimulates the production of various pro-inflammatory cytokines such as IL-6&#44; IL-1&#44; and especially IL-17&#46; High levels of anti-gliadin antibodies have been detected in the intestinal fluid of RA patients compared to healthy individuals&#46; This finding supports the possible antigenic effect of gluten&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> More profound knowledge about the relationship between general diet and RA may assist in the remission of RA&#44; a lifelong disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our aim in this study is to investigate the nutritional status of patients with RA and whether a higher dietary inflammatory index contributes to disease activity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 41 RA patients aged 18 years and over&#44; 34 women and 7 men&#44; who were being followed up in the Rheumatology Department of Ayd&#305;n Adnan Menderes University Research and Teaching Hospital&#44; were included in the study&#46; Patients diagnosed with RA were included according to the 2010 American College of Rheumatology &#40;ACR&#41;&#47;European League Against Rheumatism &#40;EULAR&#41; classification criteria&#46; Demographic data of the patients&#44; laboratory results &#40;complete blood count&#44; Erythrocyte Sedimentation Rate &#40;ESH&#41;&#44; C-reactive protein &#40;CRP&#41;&#44; renal and hepatic function tests&#41;&#44; and disease activation score &#40;DAS-28&#41; were recorded&#46; Demographic and nutritional data were collected from the patients through face-to-face interviews with the specialist dietitian&#44; and general information was recorded in the patient data sheet&#46; This sheet was used to collect the general information of the participants&#46; General information includes education level&#44; age&#44; gender&#44; body weight &#40;kg&#41;&#44; height &#40;m&#41;&#44; smoking&#44; alcohol&#44; and general eating habits&#46; This descriptive and cross-sectional study was approved by the Ethics Committee of Faculty of Medicine &#40;2021&#47;151&#41;&#46; An informed consent form was obtained from the patients before the procedure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the 24-h diet recall form&#44; the food and amounts consumed by the participants in the last 24<span class="elsevierStyleHsp" style=""></span>h were recorded&#46; A dietitian checked it&#46; The 24-h diet records of individuals were analyzed with the Nutrition Information Systems Package Program &#40;BEBIS&#41;&#46; Average daily intake of macro and micronutrients such as dietary protein&#44; total fat&#44; carbohydrate &#40;CHO&#41;&#44; free sugar&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; monounsaturated fatty acids &#40;MUFA&#41;&#44; linoleic acid &#40;LA&#41;&#44; omega-3 fatty acids&#46; Purchase quantities were calculated as a result of the analysis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The intake status of 29 nutrients and nutrients used in the study was determined&#46; DII was calculated using the parameters of 29 nutrients &#40;e&#46;g&#46;&#44; energy&#44; carbohydrate&#44; fiber&#44; protein&#41;&#46; From the participants&#8217; daily intake of food and nutrients&#44; &#8220;&#91;&#40;the participant&#39;s daily consumption amount of that nutrient or nutrient-average global daily consumption amount&#41;&#47;the standard deviation value of that nutrient or nutrient X overall inflammatory effect score&#93;&#8221; for each nutrient individually calculated&#46; DII values&#44; which determine the inflammatory load of the participants&#8217; diet&#44; were determined by adding up all the calculated scores&#46; After the calculations were made for the participants&#44; groups were evaluated according to the DII value&#46; Inflammatory index scores were calculated from individuals&#8217; 24-h daily food consumption records&#46; Negative inflammatory index scores represented an anti-inflammatory diet with positive components for health&#46; Positive inflammatory index scores&#44; on the other hand&#44; represented a pro-inflammatory diet&#46; In this study&#44; individuals were divided into quarter groups according to their dietary inflammatory index scores&#59; the groups 1&#46; quartile &#40;Q1&#41;&#44; 2&#46; quartile &#40;Q2&#41;&#44; 3&#46; quartile &#40;Q3&#41;&#44; and 4&#46; quartile &#40;Q4&#41; were compared&#46; The first quartile &#40;Q1&#41; represents the anti-inflammatory diet&#46; The inflammatory load of the diet increases as the quartiles increase&#46; 4&#46; quartile &#40;Q4&#41; indicates a pro-inflammatory diet&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> European Food Safety Authority &#40;EFSA&#41; reference data were used to compare patients&#8217; dietary macro- and micronutrients&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The Kolmogorov&#8211;Smirnov test determined the distributions of quantitative variables&#46; Descriptive statistics were given as X&#175;&#177;SD for normally distributed variables and median &#40;25&#8211;75 percentile&#41; for non-normally distributed variables&#46; Comparison of groups&#44; normally distributed variables ANOVA one-way analysis of variance in independent group comparison&#44; Kruskal&#8211;Wallis <span class="elsevierStyleItalic">H</span> test was used for non-normally distributed variables&#46; Independent analysis of categorical variables Chi-square analysis method was applied&#46; A <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46; Independent samples t test was used in the comparison of two independent groups&#46; Spearman&#39;s correlation test was used to determine the relationship between quantative variables&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">We included 41 patients diagnosed with RA in our study&#44; 83&#37; of whom were women&#46; All patients were taking medication for the treatment of RA&#44; including corticosteroids&#46; The groups were homogeneously distributed regarding age&#44; gender&#44; smoking status&#44; and diabetes&#46; The mean age of the individuals was 53&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7 years in the Q1 group on the anti-inflammatory diet and 58&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1 years in the Q4 group on the pro-inflammatory diet&#46; For the diagnosis of RA&#44; the disease history was 5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;97 years in the Q1 group and 12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 years in the Q4 group&#46; The DAS-28 score evaluation showed 4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;53 in the Q1 group on an anti-inflammatory diet and 4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13 in the Q4 group on a pro-inflammatory diet&#46; Furthermore&#44; mean serum CRP level evaluations showed 3&#46;0 in the Q1 group on an anti-inflammatory diet and 17&#46;4 in the Q4 group on the pro-inflammatory diet&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Of the patients in our study&#44; 9&#37; had a history of diabetes&#46; After the dietary inflammatory index quartile groups were evaluated for the body mass index &#40;BMI&#41;&#44; there was no statistically significant association between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;195&#41;&#46; In the evaluation of rheumatoid arthritis for disease duration&#44; the group on an anti-inflammatory diet and the quartile group on a pro-inflammatory diet were significantly different &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; DAS-28 score was lower in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;163&#41;&#46; There was no significant difference between all quartile groups in terms of the treatment &#40;Disease-modifying anti-rheumatic drug and biologic agents&#41; they received &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Sedimentation and CRP values were lower in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was statistically insignificant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;575&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;129&#41;&#46; The difference between the RA quartile groups regarding other blood laboratory parameters was also insignificant &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In the evaluation of dietary macro- and micronutrient analysis among dietary inflammatory quartile groups&#44; dietary iron &#40;Fe&#41; intake was higher in the Q1 group receiving the anti-inflammatory diet than in the Q4 group receiving the pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; It was found that the Q1 and Q2 groups receiving an anti-inflammatory diet had higher magnesium intake than the Q4 group receiving a pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; As a result of the comparison of vitamin C and niacin in the Q1 group receiving an anti-inflammatory diet&#44; the intake level of vitamin C &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41; and niacin &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; was higher than the Q4 group receiving the pro-inflammatory diet&#46; Dietary riboflavin intake in the Q1 quartile group receiving the anti-inflammatory diet was higher than in the Q4 quartile group receiving the pro-inflammatory diet &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Q1 quartile group receiving the pro-inflammatory diet had a significantly higher dietary protein intake than the Q2 quartile group&#46; However&#44; there was no significant difference between the protein intake levels of the quartile group who received anti-inflammatory and pro-inflammatory diets &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In comparing the quartile group taking an anti-inflammatory diet and the quartile group receiving a pro-inflammatory diet&#44; dietary iron&#44; vitamin C&#44; folic acid&#44; niacin&#44; riboflavin&#44; and magnesium intakes were found to be statistically significantly higher in the quartile group receiving an anti-inflammatory diet&#46; The intake of some micronutrients&#44; such as iron&#44; zinc&#44; riboflavin&#44; thiamine and magnesium was significantly lower than the recommended values in all RA quartile groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">DAS-28 score change is affected by the dietary inflammatory index at a rate of 12&#46;02&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A weak but significant relationship was found between DAS-28 and dietary inflammatory index &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3468&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0263&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">It is known that genes&#44; environmental factors&#44; and hormones play a role in the development of rheumatoid arthritis&#46; The activity of primary female sex hormones explains the more frequent occurrence of the disease&#44; especially in women&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> In addition&#44; many environmental factors&#44; such as trauma&#44; infections&#44; and nutrition&#44; mainly smoking&#44; also affect the development of RA&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> The anti-inflammatory activity of some nutrients has been reported in various primary and clinical studies&#46; It has been reported that polyunsaturated fatty acids have antioxidant and anti-inflammatory effects&#44; and vitamin D has a protective effect on the development of RA&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> In our study&#44; there was no difference in the number of smokers in the Q1 group receiving an anti-inflammatory diet and the Q4 group receiving a pro-inflammatory diet&#46; It was determined that 35&#37; of the patients in the study were smokers&#46; Our study found no significant difference in dietary unsaturated fat intake levels&#46; Omega 3 fatty acids were above the reference intake level in all groups&#46; All study group&#39;s dietary vitamin D intake levels were below the reference levels&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In a study of 184 patients with a diagnosis of rheumatoid arthritis&#44; a linear trend was found from dietary inflammatory index groups to pro-inflammatory areas&#44; with a decrease in lean mass&#44; weight&#44; and energy intake&#46; The increased rheumatoid arthritis disease activity score &#40;DAS-28&#41;&#44; ESR&#44; and CRP levels were detected&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> In a study conducted with newly diagnosed rheumatoid arthritis patients and healthy controls&#44; They stated that inflammatory dietary intake might act as a potential risk factor contributing to the development and severity of RA&#46; It has also been reported that patients with high DII have higher serum inflammatory &#40;hs-CRP and TNF&#41; and clinical markers &#40;tender joint score and DAS-28 score&#41;&#46; Therefore&#44; they thought that dietary modification to lower the DII score might be beneficial to improve clinical outcomes in such patients&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> In our study&#44; ESR and CRP values were high with the increase in the pro-inflammatory effect potential of the diet&#44; but it was not statistically significant&#46; The regression analysis showed that the inflammatory effect of the general diet in rheumatoid arthritis patients had a 12&#46;02&#37; effect on the activity of the disease&#46; A weak but significant relationship was found between DAS-28 and DII&#46; The DAS-28 score was lower in the group receiving an anti-inflammatory diet&#46; Studies have reported that plasma inflammatory adipokines such as leptin&#44; adiponectin&#44; and visfatin released from white adipose tissue were higher in RA than in healthy individuals&#46; In addition&#44; obesity is reported to be a risk factor for RA patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16&#8211;18</span></a> In our study&#44; the mean BMI of the patients with the highest DAS-28 score was between 29&#46;8 and 30&#46;8&#46; A study evaluating daily energy intake reported that women with movement restrictions had lower energy intake than healthy individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In Bekar et al&#46;&#8217;s study with rheumatoid arthritis patients&#44; the daily dietary energy intake &#40;1641&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>447&#46;58<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#41; of patients in the patient group was lower than healthy individuals &#40;1816&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>535&#46;62<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#41; was not statistically significant&#46; It has been reported that people with rheumatoid arthritis provide 44&#46;8&#37; of daily dietary energy from carbohydrates&#44; 37&#46;5&#37; from fats&#44; and 14&#46;4&#37; from proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> In our study&#44; the daily energy intakes of the quartile group&#44; which received an anti-inflammatory and pro-inflammatory diet&#44; were found to be 1518<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274<span class="elsevierStyleHsp" style=""></span>kcal&#47;day and 1285<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>433<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#44; respectively&#46; According to the EFSA &#40;European Food Safety Authority&#41; reference values&#44; it is recommended to provide 45&#8211;60&#37; of the daily energy of individuals from carbohydrates&#44; 12&#8211;20&#37; from proteins&#44; and 20&#8211;35&#37; from fats for adequate and balanced nutrition&#46; Furthermore&#44; it is also recommended to increase omega-3 &#40;<span class="elsevierStyleItalic">n</span>&#8722;3&#41; fatty acids in the diet&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> Our study evaluated the percentage of daily dietary energy from carbohydrates&#44; fat&#44; and protein&#46; The anti-inflammatory quartile group&#39;s carbohydrate&#44; fat&#44; and protein values were 48&#46;8&#37;&#44; 30&#46;5&#37;&#44; and 18&#46;5&#37;&#44; respectively&#46; We found 47&#46;8&#37;&#44; 33&#46;7&#37;&#44; and 16&#46;5&#37; for the pro-inflammatory quartile group&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Omega fatty acids are essential components of the diet and are commonly known as omega-3&#44; omega-6&#44; and omega-9&#46; The richest dietary sources of omega fatty acids are vegetable and fish oils&#46; Omega-3 and omega-6 are essential fatty acids that must be externally taken&#46; Omega-3&#44; &#945;-linolenic acid &#40;ALA&#41; is of vegetable origin&#44; and eicosapentaenoic acid &#40;EPA&#41; and docosahexaenoic acid &#40;DHA&#41; are abundantly in fish&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> It has been reported that omega-3&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; especially EPA and DHA&#44; may have protective effects by reducing the formation of pro-inflammatory eicosanoids in RA disease or healing effect on the disease process&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> It has been reported that omega-3&#44; polyunsaturated fatty acids &#40;PUFA&#41;&#44; and especially EPA and DHA may be protective against RA by reducing the formation of proinflammatory eicosanoids or may have healing effects on the disease process&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> In Tadeschi et al&#46; study&#44; it has been reported that greater fish consumption associated with lower disease activity in RA&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> Classically&#44; the intake of anti-inflammatory fatty acids such as n-3 fatty acids and &#947;-linolenic acid has been reported to reduce inflammation and disease activity in RA patients&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> In our study&#44; the dietary omega-3 intakes of the patients were above the EFSA dietary reference value in the whole patient quartile group&#46; Patients reported that they rarely consumed fish&#46; Dietary monounsaturated fatty acid &#40;MUFA&#41; intake levels were compared&#46; The MUFA intake level was higher in the quartile group receiving an anti-inflammatory diet than in the quartile group receiving a pro-inflammatory diet&#44; but this difference was not statistically significant&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In a study of female rheumatoid arthritis patients with a normal BMI&#44; daily intakes of energy and micronutrients&#44; including dietary calcium&#44; folic acid&#44; zinc&#44; magnesium&#44; and vitamin B6&#44; were significantly lower than dietary reference values&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a> In our study&#44; when we compared the dietary reference values in patients with RA&#44; daily dietary magnesium&#44; zinc&#44; and iron intakes were low in all quartile groups&#46; Folate was found to be low only in the pro-inflammatory quartile group&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">DAS-28 is the most commonly used method for clinical assessment of disease activity in RA&#46; The DAS-28 score is a composite score that includes the condition of 28 joints &#40;tenderness and swelling&#41;&#44; markers of inflammation along with erythrocyte sedimentation rate &#40;ESR&#41; or C-reactive protein &#40;CRP&#41;&#44; and a person&#39;s perceived health using a visual analog scale &#40;VAS&#41;&#46; In the evaluation of the DAS-28 score&#44; &#8804;2&#46;6&#44; indicates low disease activity&#44; &#62;3&#46;2 and &#8805;5&#46;1&#44; moderate disease activity and &#62;5&#46;1 high disease activity&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> In our study&#44; patients in anti-inflammatory&#44; pro-inflammatory&#44; and other quartile groups had moderate disease activity in terms of DAS-28 score&#46; We compared the groups receiving anti-inflammatory and pro-inflammatory diets regarding the history of RA disease&#46; We found that individuals with a more extended disease history took a more pro-inflammatory diet&#46; There was no significant difference between the quartile groups in terms of RA treatment &#40;disease-modifying anti-rheumatic drug and biologic agents&#41;&#46; Regarding its limitations&#44; our study is cross-sectional and reports data from a single institution&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this study&#44; we observed that patients with a long-term diagnosis of rheumatoid arthritis generally tended to follow a poor diet with a high inflammatory index&#46; The reason for this is decreased appetite due to the duration of the disease&#44; complaints related to the gastrointestinal system&#44; and long-term use of a wide variety of drugs reasons may be considered&#46; In addition&#44; it is thought that they are malnourished in terms of micronutrients such as iron&#44; zinc&#44; and vitamin D&#44; and they are fed with low calories due to movement restriction&#46; In this respect&#44; making adjustments to patients&#8217; diets can be recommended&#46; We think the anti-inflammatory effect of the diet might be effective in the new onset period of the disease&#46; Individuals with chronic and long-term diseases pose a greater risk for nutritional deficiencies&#46; As a result of our study and literature review&#44; this patient group should increase the frequency of fish consumption&#44; and those with low micronutrients such as zinc&#44; iron&#44; and vitamin D should be supplemented&#46; There seem to be limited studies on this subject in the literature&#46; Therefore&#44; we believe that our study is essential for both being the first study in Turkiye and its contribution to the literature&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethics committee approval</span><p id="par0105" class="elsevierStylePara elsevierViewall">The study protocol was approved by the Adnan Menderes University Medical Faculty Ethics Committee &#40;date&#58; 09&#46;09&#46;2021&#44; No&#58; E-53043469-050&#46;04&#46;04-75261&#41;&#46; The study was conducted in accordance with the principles of the Declaration of Helsinki&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research and&#47;or authorship of this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            1 => "Dietary inflammatory index"
            2 => "Rheumatoid arthritis"
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            0 => "Dieta"
            1 => "&#205;ndice inflamatorio diet&#233;tico"
            2 => "Artritis reumatoide"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Many patients diagnosed with rheumatoid arthritis &#40;RA&#41; report relief of symptoms after consuming certain foods&#46; Diet plays a vital role in rheumatoid arthritis-related inflammation regulation&#46; This study investigates the relationship between dietary inflammation index &#40;DII&#41; scores and RA disease activity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forty-one RA patients were enrolled in the study&#46; The general inflammatory index of the diet was analyzed by recording the 24-h food consumption of the patients&#44; and the nutrients were analyzed using the Nutrition Information Systems Package Program&#46; Dietary inflammatory indices were calculated for each patient using the patients&#8217; macro and micronutrient intake levels&#46; RA disease activity was assessed using the Disease Activity Score-28 &#40;DAS-28&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The DAS-28 score was lower in the anti-inflammatory diet group compared to the pro-inflammatory diet group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;163&#41;&#46; A weak but significant relationship was found between diet inflammation index score and DAS-28 &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3468&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0263&#41;&#46; The effect of the dietary inflammatory index on the DAS-28 was 12&#46;02&#37;&#46; Dietary iron&#44; vitamin C&#44; niacin&#44; and magnesium intakes were statistically significantly higher in the quartile group that received an anti-inflammatory diet than in the quartile group that received a pro-inflammatory diet&#46; The intake of some micronutrients&#44; such as iron&#44; zinc&#44; magnesium&#44; and folic acid&#44; was significantly lower than the recommended values in all RA quartile groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that reducing inflammation through the diet may have a weak but significant effect in controlling disease activity in RA patients&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Muchos pacientes diagnosticados con artritis reumatoide &#40;AR&#41; informan un alivio de los s&#237;ntomas despu&#233;s de consumir ciertos alimentos&#46; La dieta juega un papel vital en la regulaci&#243;n de la inflamaci&#243;n relacionada con la artritis reumatoide&#46; Este estudio investiga la relaci&#243;n entre las puntuaciones del &#237;ndice de inflamaci&#243;n diet&#233;tica &#40;DII&#41; y la actividad de la enfermedad de AR&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se inscribieron en el estudio 41 pacientes con AR&#46; El &#237;ndice inflamatorio general de la dieta se analiz&#243; registrando el consumo de alimentos de los pacientes durante 24 horas y los nutrientes se analizaron mediante el Programa de Paquetes de Sistemas de Informaci&#243;n Nutricional&#46; Los &#237;ndices inflamatorios diet&#233;ticos se calcularon para cada paciente utilizando los niveles de ingesta de macro- y micronutrientes de los pacientes&#46; La actividad de la enfermedad de AR se evalu&#243; mediante la puntuaci&#243;n de actividad de la enfermedad-28 &#40;DAS-28&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La puntuaci&#243;n DAS-28 fue menor en el grupo de dieta antiinflamatoria en comparaci&#243;n con el grupo de dieta proinflamatoria &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;163&#41;&#46; Se encontr&#243; una relaci&#243;n d&#233;bil pero significativa entre la puntuaci&#243;n del &#237;ndice de inflamaci&#243;n de la dieta y el DAS-28 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3468&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0263&#41;&#46; El efecto del &#237;ndice inflamatorio diet&#233;tico sobre el DAS-28 fue del 12&#44;02&#37;&#46; La ingesta diet&#233;tica de hierro&#44; vitamina C&#44; niacina y magnesio fue estad&#237;sticamente significativamente mayor en el grupo del cuartil que recibi&#243; una dieta antiinflamatoria que en el grupo del cuartil que recibi&#243; una dieta proinflamatoria&#46; La ingesta de algunos micronutrientes&#44; como hierro&#44; zinc&#44; magnesio y &#225;cido f&#243;lico&#44; fue significativamente menor que los valores recomendados en todos los grupos del cuartil de AR&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que la reducci&#243;n de la inflamaci&#243;n a trav&#233;s de la dieta puede tener un efecto d&#233;bil pero significativo en el control de la actividad de la enfermedad en pacientes con AR&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The correlation scatter plot and the regression line of DAS-28 and diet inflammation index score&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; DAS-28&#58; disease activity score-28&#44; DMARD&#58; disease-modifying anti-rheumatic drug&#46;</p>"
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;36 &#40;&#8722;0&#46;19&#8211;1&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;85 &#40;2&#46;49&#8211;3&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;484&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">8&#47;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Body mass index &#40;BMI&#41; &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Disease duration &#40;years&#41;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;015</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DAS-28&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Current smoker &#40;yes&#47;no&#41;&#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DMARDs&#47;biologic &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#47;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#47;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#47;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;690&nbsp;\t\t\t\t\t\t\n
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                  """
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                0 => "xTab3591708.png"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic and anthropometric characteristics of participants according to dietary inflammatory index quartiles&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; RF&#58; rheumatoid factor&#44; CRP&#58; C-reactive protein&#44; ALT&#58; alanine transaminase&#44; AST&#58; aspartate amino transferase&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dietary inflammatory index scores quartiles</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q1 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;Lower inflammatory diet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q3 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q4 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;Higher inflammatory diet&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fasting blood glucose&#44; mg&#47;dL&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">145&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>103&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">119&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;866&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sedimentation &#40;ESH&#41;&#44; mm&#47;h&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">48&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;575&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti-CCP&#44; mg&#47;dLMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;0&#46;5&#8211;18&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2 &#40;0&#46;5&#8211;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;3 &#40;0&#46;9&#8211;196&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2 &#40;0&#46;6&#8211;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF&#44; U&#47;mLMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;0 &#40;7&#8211;252&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">20&#46;5 &#40;8&#46;2&#8211;148&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&#46;05 &#40;7&#8211;292&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;5 &#40;7&#46;6&#8211;192&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;902&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CRP&#44; mg&#47;dLMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;0 &#40;2&#8211;15&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;3 &#40;2&#8211;14&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;9 &#40;3&#46;4&#8211;72&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;4 &#40;2&#46;4&#8211;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobin&#44; g&#47;dL&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;651&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Q&#58; quartile&#44; SD&#58; standard deviation&#44; EFSA&#58; European Food Safety Authority&#44; DRV&#58; Within rows&#44; means followed by the same letter are significantly different &#40;a&#44; b&#44; ab&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q3&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Q4&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;Higher inflammatorydiet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Energy&#44; kcal&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1518<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">938<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>310<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1356<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>321<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1285<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>433<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carbohydrates&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Energy from carbohydrates&#44; &#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#8211;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protein&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;9<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;3<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;5<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;2<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protein E&#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#8211;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;8<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;4<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;5<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fat E &#37;&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#8211;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FIBER&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholesterol&#44; mg&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">294 &#40;122&#8211;336&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;58&#8211;307&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;71&#8211;197&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">280 &#40;154&#8211;355&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Saturated fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;6<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;034</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">As low as possible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monounsaturated fat&#44; g&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;023</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Omega3 fatty acids&#44; g&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;25 &#40;0&#46;87&#8211;1&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;7&#8211;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;1&#46;02&#8211;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;8&#8211;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;089&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitamin A mcg&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1189<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>622&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">898<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1070<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>585&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">652<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiamine&#44; mg&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riboflavin&#44; mg&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6 &#40;1&#46;3&#8211;1&#46;88&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;6&#8211;1&#46;3&#41;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2 &#40;0&#46;9&#8211;1&#46;6&#41;<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0 &#40;0&#46;8&#8211;1&#46;2&#41;<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;010</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Niacin&#44; mg&#47;dayMedian &#40;25&#8211;75p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2 &#40;8&#46;7&#8211;15&#46;8&#41;<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#40;3&#46;6&#8211;9&#46;1&#41;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;5 &#40;5&#46;8&#8211;10&#46;3&#41;<span class="elsevierStyleSup">ab</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8 &#40;5&#46;1&#8211;11&#46;3&#41;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;013</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vitamin B12&#44; mcg&#47;day&#40;Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735743
Original language: English
DOI:10.1016/j.reumae.2024.07.001
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