Title in English: Association of Mediterranean diet adherence with Familial Mediterranean Fever severity in a Lebanese cohort.
First author: R. Hammoud.
Journal: Pediatric Rheumatology
Reference: Pediatr Rheumatol Online J. 2025 Nov 21;23(1):122.
Link to PubMed: https://pubmed.ncbi.nlm.nih.gov/41272709/
Summary author: Dr Catherine Grandpeix-Guyodo
Introduction:
Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease worldwide. It is associated with pathogenic variants, classically in exon 10 of the MEFV gene. The variable expressivity of this disease is linked to the type of MEFV variant (particularly M694V), but epigenetic and environmental factors probably also play a role. Previous studies have suggested that a diet rich in fat and salt may worsen FMF symptoms, whereas a diet rich in antioxidants and vitamins may improve inflammation and quality of life. The Mediterranean diet, which is recommended for the prevention of other diseases, could therefore be of interest in FMF.
This study aimed to explore the relationship between adherence to the Mediterranean diet (MD) and the severity of familial Mediterranean fever (FMF) in a Lebanese cohort. It also took into account the influence of genetic background, lifestyle, and comorbidities on FMF severity.
Patients and methods:
This was a cross‑sectional questionnaire‑based study of 101 patients with confirmed FMF in Lebanon, conducted between January 2023 and January 2024. Patients were required to be between 18 and 65 years old and to have FMF. Data were collected using a structured questionnaire on demographic information, socioeconomic status, disease manifestations, comorbidities, treatments, and lifestyle habits. The questionnaire was pre‑tested and offered in Arabic or English.
FMF severity, adherence to the Mediterranean diet, and physical activity were assessed using scores.
Results:
A total of 101 patients, 58% of whom were women, were included, with a mean age of 35.7 years, and 55% were smokers. No significant sociodemographic differences were observed according to the different levels of adherence to the Mediterranean diet.
Genotype data were available for only 51/101 patients, of whom 17.6% were M694V homozygotes, and 64.6% were other homozygotes or compound heterozygotes.
Analysis of patients diets showed low adherence to the Mediterranean diet in 34%, moderate adherence in 48%, and good adherence in 19%. Overall, consumption of fish, fruit, and vegetables was below recommendations, whereas intake of cereals, pastries, and red meat was too high.
The only significant difference observed according to Mediterranean‑diet adherence was diarrhea, which was reported almost twice as often in patients with low adherence. Other symptoms, attack frequency, and FMF severity did not differ significantly.
Obesity and the presence of comorbidities (rheumatologic, IBD, cardiovascular) were significantly associated with more severe FMF.
Patients with severe FMF had a longer smoking history and smoked more cigarettes per day. High physical activity levels were more frequent in severe forms (73%), whereas moderate activity predominated in mild (82%) and intermediate (88%) forms.
Discussion:
A potentially beneficial effect of the Mediterranean diet on the digestive tract was observed, with less diarrhea among patients adhering to this diet. This is consistent with the expected effects on the digestive mucosa, microbiota, and the reduction of pro‑inflammatory interleukin secretion.
However, no significant association was found between FMF severity and adherence to the Mediterranean diet.
The association between more severe forms of FMF and intense physical activity should be taken into account: it is advisable to recommend adapted physical activity in order to avoid mechanical stress that could trigger attacks.
The limitations of this study include the cohort size and its specific characteristics, with generally lower adherence to the Mediterranean diet than would be expected.
In conclusion:
This study, the first conducted in Lebanon on this topic, does not demonstrate a direct association between adherence to the Mediterranean diet and FMF severity, but it does suggest a potential protective effect of the Mediterranean diet against FMF‑related diarrhea. It highlights the high prevalence of poor adherence to this diet and the failure to meet nutritional recommendations for most of its components. The multifactorial nature of FMF supports a comprehensive management approach that integrates targeted dietary and lifestyle strategies alongside treatments, with personalized nutrition and behavioral interventions aimed at improving prognosis and patients quality of life.
