# Dietary Recommendations from the Moroccan Society for Rheumatology (SMR) for Patients with Chronic Inflammatory Rheumatic Diseases

## TL;DR

The Moroccan Society for Rheumatology created dietary guidelines to help manage chronic inflammatory rheumatic diseases, emphasizing the Mediterranean diet and omega-3s.

## Contribution

The paper introduces standardized dietary recommendations tailored to Moroccan cultural and socio-economic contexts for managing inflammatory rheumatic diseases.

## Key findings

- Diet should complement pharmacological treatment and consider cultural and socio-economic factors.
- Weight loss and a Mediterranean diet rich in omega-3 are recommended for overweight patients.
- Exclusion diets and probiotic supplementation are not advised due to insufficient evidence.

## Abstract

This work was conducted under the auspices of the Moroccan Society of Rheumatology (SMR) with the aim of developing best practice medical guidelines for the dietary management of patients with Chronic Inflammatory Rheumatic Diseases (IRDs). A working group composed of rheumatology experts and two nutritionists was formed. This group relied on a synthesis of the literature and expert opinions. These guidelines were then validated by a group of rheumatology experts. The methodology followed the procedure proposed by the European League Against Rheumatism (EULAR). Five general principles and eleven recommendations were established. These principles emphasise that diet should complement, rather than replace, pharmacological treatment and should be integrated into the overall management of patients with IRDs. Additionally, it should be associated with appropriate physical activity and take cultural and socio-economic context into account. These recommendations highlight the importance of weight loss for overweight or obese patients and advocate for the Mediterranean diet as well as a diet rich in omega-3. However, exclusion diets such as gluten-free, vegetarian, and dairy-free diets, as well as supplementation with probiotics or spices, are currently not recommended for patients with IRDs. Supplementation with vitamins or trace elements is not systematically recommended, and the data concerning Ramadan fasting or intermittent fasting are limited or contradictory. Furthermore, two specific recommendations for the Moroccan diet were proposed. These recommendations standardise dietary management in IRDs, making it accessible for practitioners and patients.