4. Discussion
RA, TG, comorbidity, MNT
CVD, DISEASE, INFLAMMATORY DISEASE, INSULIN SENSITIVITY
The present study showed that a 12-week personalized MD plan, paired with PA promotion and delivered with the support of CDSS was successful in improving adherence to the MD, disease activity, PA levels, and a plethora of cardiometabolic outcomes among female patients with RA.Adherence to the MD can be a useful tool to combat immune-mediated inflammatory diseases, including RA [RCTs delivering traditional Cretan MD or other anti-inflammatory dietary interventions in patients with RA have revealed improvements regarding disease activity [In the present study, disease activity was also associated with BMI. The overall combined prevalence of overweight and obesity in the sample was high, namely 35% and 10%, respectively, and this observation is in accordance with previous studies indicating that excessive body weight is an important comorbidity in RA [RA, especially in the active disease state, is associated with considerable changes in blood lipids levels and insulin sensitivity, while metabolic changes, such as elevated TC, LDL, and TG concentrations, occur even in preclinical RA [There is evidence that the adoption of anti-inflammatory diets, including the MD, is negatively associated with inflammatory biomarkers in RA, such as CRP. In the randomized controlled study of Sköldstam and co-authors [The role of vitamin D in immune-mediated inflammatory diseases, such as RA, has been extensively discussed in the literature. Vitamin D has been shown to exert immunomodulatory effects and downregulate pro-inflammatory agents [Patients with RA tend to be inactive, in particular at the period following the diagnosis [Nudge policies aiming to modify health-related decisions, including dietary choices, are increasingly gaining popularity [Furthermore, the lifestyle intervention performed in the present RCT was carried out by experienced RDNs. Research has shown that when medical nutrition therapy (MNT) is applied by expert dietitians, patients tend to adhere to a greater degree and significant improvements are observed regarding their disease management [Patients with RA tend to underestimate the risk for developing CVD and are less concerned about the beneficial effects of protective lifestyle factors, such as the MD [The small sample size and the possible bias that self-reported tools can cause comprise the limitations of the present study. For controlling these issues, a randomization protocol and validated questionnaires in Greek ample populations have been applied. In addition, the assigned RDNs were well experienced, and were able to detect unclear records and ask patients for proper clarifications.