Eating during immunotherapy sessions: a cross-sectional study of meal quality in patients with rheumatic diseases undergoing intravenous therapy with immunomodulators.

INTRODUCTION/

objectivesIntravenous (IV) immunotherapy sessions are common among patients with rheumatic and musculoskeletal diseases (RMDs). Although immunotherapy plays an important role in disease management, treatment-specific evidence-based nutritional guidance is currently lacking. The present cross-sectional study aimed to evaluate meal quality in patients with RMDs on the days of IV infusion immunotherapy sessions and make recommendations on how to improve dietary intake on these days, aiming to achieve ameliorated therapeutic results with less adverse events.

methodsA total of 168 outpatient visits on days of IV immunotherapy sessions were included, involving 124 patients with RMDs. Each patient provided detailed information regarding the breakfast they had consumed prior to the session and whether they had brought with them a snack to consume during treatment. The Main Meal Quality Index (MMQI) was used to evaluate meal quality of the breakfast and snack meals of each participant, ranging between 0 to 100, with greater scores indicating better meal quality.

resultsMost patients (74%) reported having consumed breakfast, while only 29% had brought a snack with them for consumption during the sessions. Median MMQI score was 54.4 for breakfast and 50.0 for snack meals, respectively. Breakfast MMQI scores were positively associated with patient age (p = 0.040). Belimumab administration was associated with greater breakfast quality (β = 22.23, p = 0.003) compared to rituximab, while tocilizumab use was independently associated with lower snack quality (β = - 11.96, p = 0.030). Patients with systemic lupus erythematosus and axial spondyloarthritis reported consuming a breakfast of better quality.

conclusionAlthough many patients consumed breakfast prior to their IV infusion immunotherapy sessions, only a small number chose to bring a snack with them. Breakfast quality appeared to be influenced by the type of immunomodulatory therapy patients were receiving. These findings highlight the need for individualized nutritional care and tailored meal guidance on the days of IV treatment, as nutrition may represent a potentially modifiable factor warranting further investigation in relation to therapeutic response and disease outcomes. Key Points • On intravenous immunotherapy treatment days, patients consumed energy-dense breakfast and meal snacks, with moderate protein and high saturated fat content. • Meal composition was influenced by the type of immunomodulatory therapy. • Individualized nutrition guidance is essential, promoting high-protein, plant-based, fiber-rich, and unsaturated fat-rich meals, to support therapy and disease outcomes.