Potential protective role of high mediterranean diet adherence on systemic lupus erythematosus: mediation by liver-kidney biomarkers in the UK biobank cohort

Zi-Cheng Song; Jia-Jia Hu; Xue-Ying Xia; Shu-Ting Liu; Jie Zhang; Hong-Fei Cao; Dong-Qing Ye; Wei Zhao

doi:10.1093/rheumatology/keaf348

Potential protective role of high mediterranean diet adherence on systemic lupus erythematosus: mediation by liver-kidney biomarkers in the UK biobank cohort

Rheumatology (Oxford). 2025 Jun 24:keaf348. doi: 10.1093/rheumatology/keaf348. Online ahead of print.

Authors

Zi-Cheng Song¹, Jia-Jia Hu^{1

2}, Xue-Ying Xia¹, Shu-Ting Liu¹, Jie Zhang^{3

4}, Hong-Fei Cao⁵, Dong-Qing Ye^{5

3

4

6}, Wei Zhao¹

Affiliations

¹ School of Nursing, Anhui Medical University, Hefei, Anhui, China.
² Blood Purification Center, The Second People's Hospital of Hefei, Hefei, Anhui, China.
³ School of Public Health, Anhui University of Science and Technology, Hefei, Anhui, China.
⁴ Anhui Institute of Occupational Safety and Health, Anhui University of Science and Technology, Hefei, China.
⁵ Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
⁶ Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China.

PMID: 40581782
DOI: 10.1093/rheumatology/keaf348

Abstract

Objectives: Despite advances in the treatment of systemic lupus erythematosus (SLE), the complexity and high mortality of the disease drive the need to explore primary prevention strategies. The Mediterranean diet (MD) has shown benefits for various diseases, but its role in SLE remains controversial, lacking evidence from large prospective studies. This study aims to investigate the association between MD and SLE risk and to analyze the potential mediating role of MD-related biomarkers.

Methods: We selected 203 119 participants from the UK Biobank (UKB) who were free of SLE at baseline. Their adherence to the MD was assessed using the Mediterranean Diet Adherence Screener (MEDAS) score. Cox proportional hazards regression models were used to analyze the association between MD and SLE risk. Mediation analysis explored the potential mediating role of specific biomarkers.

Results: During a median follow-up of 10.6 years, 127 cases of SLE were observed. Moderate adherence to the MD did not show a significant association with SLE risk. However, high adherence was significantly associated with a reduced risk of SLE (HR: 0.61; 95% CI, 0.374-0.995). Mediation analysis revealed that this protective effect might be partially mediated by changes in liver and kidney function biomarkers, with mediation proportions ranging from 0.32% to 4.61%.

Conclusions: High adherence to the MD is significantly associated with a reduced risk of developing SLE. This beneficial effect may be partially mediated by improvements in liver and kidney function biomarkers, providing a scientific basis for further exploration of dietary interventions in the prevention of SLE.

Keywords: mediation effect; mediterranean diet; prospective cohort study; systemic lupus erythematosus.

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