‘Tricky public health message’: Smoking, junk food boost lupus risk, alcohol reduces risk
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SAN DIEGO — Although genetics heavily influence patient risk for developing lupus, it is critical to also be aware of “environmental and lifestyle factors,” according to a speaker at the Congress of Clinical Rheumatology West 2023 meeting.
Physicians who see patients predisposed to developing lupus should be aware of the external factors that can impact their risk for the disease, including smoking, alcohol consumption and quality of diet.
“We have been able to look at many different environmental and lifestyle risk factors,” Karen Costenbader, MD, MPH, of Brigham and Women’s Hospital, in Boston, told attendees during the hybrid meeting. “We have definitely been able to look at reproductive hormones and smoking, [while in] other cohorts, silica, obesity, diet, alcohol intake and childhood and adult trauma [affected risk].”
Smoking has a definite negative impact on the chances a person may develop lupus, Costenbader said. However, the benefits of quitting smoking do not appear to be immediate.
“In those people who quit within 0 to 5 years, there was no decrease,” Costenbader said. “However, when you put that activity further in the past, the risk did go down.”
There is more work to be done to determine how smoking might impact certain genes and more deeply understand the ways smoking can impact a patient's risks for developing lupus, she said.
Costenbader also recommends looking at patients' quality of diet.
“The average UPF [ultra-processed food] intake in the American diet increased from 53% to 57%,” Costenbader said, referencing a study taking place between 2001 and 2019. The people who have the highest consumption of ultra-processed foods, Costenbader said, are older, African American or those who do not have a college degree.
Costenbader and colleagues found a “strong relationship between junk food” and lupus.
“Lupus is related to junk food intake in these cohorts,” Costenbader said. “In the highest tertile of junk food intake, there was an almost 50% increased risk.”
Finally, Costenbader recognized the importance of carefully managing lifestyle discussions regarding alcohol with patients. Some of the building blocks of alcohol, including ethanol and antioxidants, may actually aid in reducing systematic inflammation, Costenbader said.
“This is a tricky public health message to get across,” Costenbader said. “Alcohol is actually a little bit anti-inflammatory.”
Compared to none, less than half-a-drink per day may offer protective qualities. However, the cohort that Costenbader and colleagues investigated did not have many cases of participants who drank heavily.
“My message would be that a little bit of alcohol per day, about half-a-drink per day, was protective and did decrease the risk of developing lupus in the future.”
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Costenbader K. Pre-clinical autoimmunity: Identifying risk factors and developing strategies against disease development in SLE. Presented at The Congress of Clinical Rheumatology West; Sept. 7-10, 2023. (hybrid meeting).
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