Consumption of dairy products in relation to the presence of clinical knee osteoarthritis: The Maastricht Study

Effect of high in comparison to low dairy intake intervention on markers of bone and cartilage remodeling and phosphate metabolism in healthy adults with overweight

BACKGROUND

In the ageing population, issues with bone and joint health are highly prevalent. Both beneficial and potential risks of dairy products on bone and joint health are reported in epidemiological studies. Furthermore, the phosphorus (P) load from dairy could potentially lead to unfavorable changes in P metabolism.

OBJECTIVE

To investigate the effect of dairy intake on markers of bone and joint metabolism and P metabolism in an intervention study with high and low dairy intake.

METHODS

In a post hoc analysis of a randomized cross-over trial with overweight adults, the effect of a standardized high dairy intake [HDI (5-6 dairy portions per day) versus low dairy intake (LDI, ≤ 1 dairy portion/day)] for 6 weeks on markers of bone and joint health was assessed using enzyme-linked immunosorbent assays and electrochemiluminescence immunoassays. Markers indicative for cartilage breakdown, including urinary CTX-II, serum COMP and 4-hydroxyproline, and markers indicative for bone remodeling, such as serum CTX-I, PTH, 25(OH)D, osteocalcin, P1NP and FGF23, were investigated using linear mixed models. Furthermore, changes in P metabolism, including the main phosphate-regulating hormone FGF23 were explored.

RESULTS

This study was completed by 46 adults (57% female, age 59 ± 4 years, BMI 28 ± 2 kg/m2). Following HDI, markers such as urinary CTX-II excretion, COMP, 25(OH)D, PTH and CTX-I were significantly lower after HDI, as compared to LDI. For example, CTX-II excretion was 1688 ng/24 h at HDI, while it was 2050 ng/24 h at LDI (p < 0.001). Concurrently, P intake was higher at HDI than at LDI (2090 vs 1313 mg/day, p < 0.001). While plasma P levels did not differ (1.03 vs 1.04 mmol/L in LDI, p = 0.36), urinary P excretion was higher at HDI than at LDI (31 vs 28 mmol/L, p = 0.04). FGF23 levels tended to be higher at HDI than at LDI (76.3 vs. 72.9 RU/mL, p = 0.07).

CONCLUSIONS

HDI, as compared to LDI, reduced markers that are indicative for joint and bone resorption and bone turnover. No changes in P metabolism were observed.

CLINICAL TRIAL REGISTRY

This trial was registered at https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4899 as NTR4899.

Causal relationship between diet and knee osteoarthritis: A Mendelian randomization analysis

BACKGROUND

Knee osteoarthritis (KOA) is a common disabling joint disease that affects millions of people worldwide. Diet may play a role in the etiology and progression of KOA, but evidence for a causal relationship is limited. We aimed to investigate the causal impact of dietary intake on KOA risk using Mendelian randomization (MR).

METHODS

We used summary-level data from genome-wide association studies (GWAS) including dietary intake (n = 335, 394-462, 342), and KOA (n = 403, 124). We selected 6-77 genetic variants as instrumental variables for 18 dietary factors, including processed meat, poultry, beef, oily fish, non-oily fish, pork, lamb, frequency of alcohol intake, alcoholic beverages, tea, coffee, dried fruit, cereals, cheese, bread, cooked vegetables, salad/raw vegetables, and fresh fruit. We performed univariate and multivariate MR analyses to estimate the causal effect of each dietary factor on KOA risk. We also performed some sensitivity analyses to assess the validity of the MR hypothesis.

RESULTS

We found that higher coffee intake was associated with increased KOA risk, whereas higher intake of dried fruits, grains, cheese, and oily fish was associated with reduced KOA risk. After multivariate adjustment, we found that coffee and oily fish intake may affect KOA through obesity, body mass index (BMI), diabetes, hypertension, and prolonged standing. Sensitivity analyses did not reveal any evidence of pleiotropy.

CONCLUSIONS

Our study provides new causal evidence that dietary intake may influence KOA risk. Specifically, we suggest that increased intake of dried fruits, grains, cheese, and oily fish and decreased coffee intake may be beneficial in preventing and mitigating KOA. further studies are needed to elucidate the underlying mechanisms and to confirm our findings in different populations.

Is diet related to osteoarthritis? A univariable and multivariable Mendelian randomization study that investigates 45 dietary habits and osteoarthritis

Background

Diet is a safe intervention for many chronic diseases as a modifiable lifestyle. However, the potential causal effect of many dietary intake habits on the risk of osteoarthritis has not been fully understood. The purpose of this study was to reveal the potential causal relationship of 45 genetically predicted dietary intakes with osteoarthritis and its subtypes.

Methods

Data on 45 dietary intakes were obtained from the UK Biobank study of approximately 500,000 participants, and data on six osteoarthritis-related phenotypes were obtained from the Genetics of Osteoarthritis Consortium study of 826,690 participants. We performed univariable Mendelian randomization (MR), multivariable MR and linkage disequilibrium score regression (LDSC) analyses.

Results

In univariate analyses, 59 potential associations between diet and osteoarthritis were found. After false discovery rate (FDR) correction and sensitivity analyses, 23 reliable causal evidence were identified. In multivariate analyses, controlling separately for the effects of body mass index, total body bone mineral density, and smoking status, eight robust causal relationships remained: Muesli intake was negatively associated with knee osteoarthritis, spine osteoarthritis and total knee replacement. Dried fruit intake had a negative association with osteoarthritis of knee and total knee replacement. Eating cheese may reduce the risk of osteoarthritis in the knee and spine. And alcohol usually taken with meals was associated with a reduced risk of total knee replacement. LDSC analyses showed significant genetic correlations between all exposures and their corresponding outcomes, respectively, in these eight causal relationships.

Conclusion

Evidence of dietary effects on osteoarthritis is provided in our study, which has important implications for the prevention, management, and intervention of osteoarthritis in common sites through rational dietary modification.

Association between diet quality in adolescence and adulthood and knee symptoms in adulthood: a 25-year cohort study

We aimed to describe associations between diet quality in adolescence and adulthood and knee symptoms in adulthood. Two hundred seventy-five participants had adolescent diet measurements, 399 had adult diet measurements and 240 had diet measurements in both time points. Diet quality was assessed by Dietary Guidelines Index (DGI), reflecting adherence to Australian Dietary Guidelines. Knee symptoms were collected using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analysed using zero-inflated negative binomial regressions. The overall adolescent DGI was not associated with adult knee symptoms, although lower intake of discretionary foods (e.g. cream, alcohol, bacon and cake) in adolescence was associated with lower pain (mean ratio (MR) 0·96) and dysfunction (MR 0·94). The overall adult DGI was not associated with knee symptoms; however, limiting saturated fat was associated with lower WOMAC (Pain: MR 0·93; stiffness: MR 0·93; dysfunction: MR 0·91), drinking water was associated with lower stiffness (MR 0·90) and fruit intake was associated with lower dysfunction (MR 0·90). Higher DGI for dairy products in adulthood was associated with higher WOMAC (Pain: MR 1·07; stiffness: MR 1·13; dysfunction: MR 1·11). Additionally, the score increases from adolescence to adulthood were not associated with adult knee symptoms, except for associations between score increase in limiting saturated fat and lower stiffness (MR 0·89) and between score increase in fruit intake and lower dysfunction (MR 0·92). In conclusion, the overall diet quality in adolescence and adulthood was not associated with knee symptoms in adulthood. However, some diet components may affect later knee symptoms.

Role of dietary patterns and factors in determining the risk of knee osteoarthritis: A meta-analysis

OBJECTIVES

To evaluates the role of diet in determining knee osteoarthritis risk.

METHODS

Literature search was conducted in Ovid, PubMed, Science Direct, and Springer. To estimate knee osteoarthritis risk with high use of vegetarian, prudent, and omnivorous diets, dairy products, vitamin C/E, and carotenoids, the odds ratios (ORs) or relative risks (RRs) reported by included studies were pooled.

RESULTS

Fifteen studies (97,157 individuals) were included. High use of vegetarian diet {OR 0.71 [95% confidence interval (CI): 0.45, 0.97]}, prudent diet [OR 0.87 (95% CI: 0.76, 0.98)/RR 0.89 (95% CI: 0.82, 0.97)], and dairy [OR 0.66 (95% CI: -0.08, 1.39)/RR 0.58 (95% CI: 0.41, 0.75)] were associated with lower risk of knee osteoarthritis but risk was relatively higher with high use of omnivorous diet [OR 1.13 (95% CI: 0.95, 1.30)/RR 1.06 (95% CI: 0.84, 1.29) and 1.05 (0.78, 1.33)]. High intake of vitamin C [OR 0.92 (0.29, 1.56)] or E [OR 0.93 (0.64, 1.21)] did not reduce knee osteoarthritis risk, but high use of carotenoids was associated with the lower risk [OR 0.66 (0.37, 0.96)].

CONCLUSIONS

Knee osteoarthritis risk is low with high use of vegetarian diet, prudent diet, and dairy, but cannt be reduced by high intakes of vitamin C/E.

Nutritional Status and Health-Related Quality of Life among Knee and Hip Osteoarthritis Patients under Rehabilitation Care in Kuala Nerus, Terengganu, Malaysia

Introduction:

The World Health Organisation (WHO) has estimated that 80% of people with osteoarthritis (OA) have movement limitations while 25% of them cannot perform their major daily activities, thus resulting in a decline of their nutritional status and quality of life (QOL). Therefore, this study aimed to compare the nutritional status and health-related quality of life (HRQOL) of OA patients between gender and age group.

Material and Methods:

A cross-sectional study was conducted on 131 OA patients in Rehabilitation Health Organisation, Terengganu. Socio-demographic, clinical, lifestyle histories, 24-hour dietary intake and HRQOL were assessed using a structured questionnaire.

Results:

Knee and/or hip OA patients recruited consisted of 19.1% of men and 80.9 % of women collectively with a mean age of 61.81 (9.28) years ranging from 38 to 83 years. The percentages of underweight, normal, overweight, and obese patients were 1.5%, 12.2%, 36.7%, and 49.6%, respectively. Further assessment of HRQOL showed that the highest mean score was obtained by the social functioning (SF) domain of 41.25 (27.16), while the mental domain scored the least mean score of 21.15 (20.92). In terms of gender breakdown, the males had significantly greater weight and height but lower body fat (BF) compared to their female counterparts, as well as a significantly higher energy, carbohydrate and protein intake. According to the age group, patients aged < 60 years had significantly greater weight, height, and BF than those aged ≥ 60 years.

Conclusion:

This study is an important baseline reference for proper OA management and prevention by providing crucial nutritional status and HRQOL information.

Lactobacillus delbrueckii subsp. bulgaricus KLDS 1.0207 Exerts Antimicrobial and Cytotoxic Effects in vitro and Improves Blood Biochemical Parameters in vivo Against Notable Foodborne Pathogens

Globally, foodborne diseases (FBDs) result in millions of sicknesses and deaths annually. Cumulative evidence suggests that the use of probiotic lactic acid bacteria (LAB) strains could be a viable alternative in inhibiting the activities of foodborne pathogens. This study aims to evaluate the in vitro antimicrobial, cytotoxic, and tolerance levels of Lactobacillus bulgaricus KLDS 1.0207 against two notable foodborne pathogens – Escherichia coli ATCC25922 and Staphylococcus aureus ATCC25923. Afterward, a 48 BALB/c mice-trial was used to assess its ameliorative effects on weight and serum biochemical parameters. Results showed that the cell-free supernatant (CFS) of this strain significantly inhibited both pathogens, but these effects were abolished at pH 6.5 and 7.0 (P < 0.05). Also, 6.96 ± 0.02 log CFU mL^–1 of L. bulgaricus KLDS 1.0207 was still viable after three hours in simulated gastric juice and at pH 3.0, indicating that this strain was a potential probiotic candidate. Also, inflammatory activities in RAW264.7 cells were significantly inhibited using 10⁹ CFU mL^–1 of L. bulgaricus KLDS 1.0207 cells (P < 0.05). Significant weight losses were also prevented in the T_LBSA (from 19.42 ± 1.04 to 19.55 ± 0.55 g) and T_LBEC (from 22.86 ± 0.90 to 14.77 ± 9.86 g) groups compared to their respective model groups (T_SA – from 21.65 ± 1.80 to 20.14 ± 1.84, and T_EC – from 21.45 ± 0.82 to 14.45 ± 9.70 g). Besides, there was a slight weight gain in the S. aureus prevention group (T_LBSA) compared to the model group (T_SA). Serum biochemical analyses revealed that the total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and some mineral levels were markedly increased by S. aureus and E. coli administrations but were reversed to normalcy in both prevention groups (T_LBSA and T_LBEC). Interestingly, high-density lipoprotein (HDL) levels, which were initially disrupted in the model groups, were restored in the prevention groups (T_LBSA and T_LBEC). This study presents L. bulgaricus KLDS 1.0207 as a promising probiotic candidate with antimicrobial, anti-inflammatory, acid, and bile tolerant and lipid-regulating applications. It also gives valuable insights for targeted future in vivo treatment and prevention studies involving other probiotic LAB candidates. Future in vivo studies elucidating specific mechanisms behind the in vitro antimicrobial, cytotoxic, and in vivo ameliorative effects are warranted.

The Molar Ratio of Total Branched-chain Amino Acids to Tyrosine Predicts a Digit Symbol Test Abnormality in Cirrhotic Patients

Objective We aimed to investigate the association between the digit symbol test (DST) and clinical characteristics, including the nutritional status of liver cirrhosis patients. Methods Fifty-nine cirrhotic patients without a history of overt hepatic encephalopathy were retrospectively evaluated. We examined neuropsychological abnormalities (NPAs) using the DST. We also estimated the detailed nutritional status using the Food Frequency Questionnaire (FFQ). The patients were divided into two groups according to their DST status: patients with normal DST scores (DST-Nor group, n=45) and those with abnormal DST scores (DST-Abn group, n=14). The clinical and nutritional findings of the two groups were compared. Results Overall, 14 (23.7%) patients had a DST abnormality. There were significant differences between the two groups in serum albumin (Alb; p=0.0043), valine (Val; p=0.0016), leucine (Leu; p=0.0078), isoleucine (Ile; p=0.0022), the molar ratio of total branched-chain amino acids to tyrosine (BTR; p=0.00025), total-bilirubin (T-Bil; p=0.0071), prothrombin time (%) (PT; p=0.028), and serum sodium (Na; p=0.035). A multivariate analysis found the BTR to be the only independent predictor of a DST abnormality (hazard ratio, 9.24; p<0.031). An FFQ analysis, revealed that the nutritional findings of patients with and without a DST abnormality, were similar. Conclusion The BTR was useful for predicting the risk of NPAs, as defined by a DST abnormality. The risk of NPAs may be estimated by monitoring the BTR.