MEDITERRANEAN diet adherence was lowest in fibromyalgia and associated with greater disease burden and lifestyle differences.
Mediterranean Diet Adherence Lowest in Fibromyalgia
Patients with fibromyalgia showed significantly lower adherence to the Mediterranean diet than those with rheumatoid arthritis or psoriatic arthritis, according to findings from a monocentric cross-sectional study of 422 participants.
The study included 165 patients with rheumatoid arthritis, 85 with psoriatic arthritis, and 172 with fibromyalgia. Mediterranean diet adherence was assessed using the 14 item PREDIMED questionnaire, while participants also reported sociodemographic characteristics, cardiovascular comorbidities, bowel habits, and dietary behaviors. Disease activity and severity were evaluated using validated disease specific measures.
Adherence differed significantly across the three diagnostic groups, with the highest scores observed in rheumatoid arthritis, intermediate scores in psoriatic arthritis, and the lowest adherence in fibromyalgia. The findings suggest that dietary patterns may vary meaningfully across rheumatologic diseases, even within the same clinical setting.
Fibromyalgia Burden Linked to Dietary Patterns
In the fibromyalgia group, higher Mediterranean diet adherence was associated with lower disease severity and impact. High adherence was significantly linked to lower Fibromyalgia Impact Questionnaire Revised scores, with a β value of -16.9 and a 95% CI of -32.1 to -1.7. Higher adherence was also associated with lower Polysymptomatic Distress Scale scores, with a β value of -4.34 and a 95% CI of -7.81 to -0.86.
Sensitivity analyses using continuous PREDIMED scores confirmed these associations, strengthening the link between Mediterranean diet adherence and fibromyalgia burden. No equivalent disease outcome associations were highlighted as central findings in rheumatoid arthritis or psoriatic arthritis.
Lifestyle factors also differed across groups. Participants with fibromyalgia more frequently reported food intolerances, affecting 46.5% of the group, and were more likely to follow restrictive diets. Lactose free diets were reported by 34.9% of participants with fibromyalgia, while 15.1% reported gluten free diets.
Nutritional Counseling May Support Rheumatology Care
The findings point to nutritional counseling as a potentially relevant component of multidisciplinary care in rheumatologic disease, particularly for patients with fibromyalgia, who may already be making self-directed dietary changes.
The results do not establish causality, and the cross-sectional design limits conclusions about whether Mediterranean diet adherence reduces disease burden or whether lower disease burden supports healthier dietary patterns. However, the data support further longitudinal and interventional studies evaluating the Mediterranean diet as part of comprehensive management for fibromyalgia and other rheumatologic conditions.
Reference
Iannuccelli C et al. Lower Adherence to the Mediterranean Diet in Fibromyalgia Compared with Rheumatoid and Psoriatic Arthritis and Its Association with Disease Burden and Lifestyle Factors. Nutrients. 2026;18(7):1019.
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