Dietary patterns and risk of developing knee osteoarthritis: data from the osteoarthritis initiative

Ultra-processed food consumption, genetic susceptibility, and the risk of hip/knee osteoarthritis

BACKGROUND

The associations between ultra-processed food (UPF) consumption, genetic susceptibility, and the risk of osteoarthritis (OA) remain unknown. This study was to examine the effect of UPF consumption, genetic susceptibility, and their interactions on hip/knee OA.

METHODS

Cohort analyses included 163,987 participants from the UK Biobank. Participants' UPF consumption was derived from their 24-h dietary recall using a questionnaire. Genetic risk scores (GRSs) of 70 and 83 single nucleotide polymorphisms (SNPs) for hip and knee OA were constructed.

FINDINGS

After 1,461,447 person-years of follow-up, 11,540 patients developed OA. After adjustments, compared to participants in the low quartile of UPF consumption, those in the high quartile had a 10 % (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.03-1.18) increased risk of knee OA. No significant association was found between UPF consumption and hip OA. Replacing 20% of UPF diet weight with an equivalent proportion of unprocessed or minimally processed food caused a 6% (HR, 0.94; 95% CI, 0.89-0.98) decreased risk of knee OA, respectively. A significant interaction was found between UPF consumption, genetic predisposition, and the risk of knee OA (P = 0.01). Participants with lower OA-GRS scores experienced higher knee OA risks due to UPF consumption.

INTERPRETATION

UPF consumption was associated with a higher risk of knee OA but not hip OA, particularly in those with lower genetic susceptibility. These results highlight the importance of reducing UPF consumption to prevent knee OA.

Dietary total antioxidant capacity is associated with lower disease severity and inflammatory and oxidative stress biomarkers in patients with knee osteoarthritis

BACKGROUND

This study was designed to evaluate the association between dietary total antioxidant capacity and clinical and biochemical variables in patients with osteoarthritis.

METHODS

This cross-sectional study was conducted among 160 patients with mild-to-moderate knee osteoarthritis. The Likert version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Index) was used to assess the severity of clinical symptoms in patients with knee osteoarthritis. The secondary outcomes included inflammatory and oxidative stress biomarkers. The participants' usual diets were assessed using a food frequency questionnaire (FFQ), and the dietary total antioxidant capacity (TAC) was calculated based on the ferric reducing antioxidant power method. Additionally, clinical and biochemical variables were evaluated using standard methods.

RESULTS

The mean age of the participants was 57.2 ± 8.1 years, and 55.6% of them were females. The dietary TAC scores in this study ranged from 3.67 to 24.72, with a mean of 12.05 ± 5.3. We found a significant inverse trend between the dietary TAC score and the total Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score (P = 0.001), as well as the WOMAC stiffness (P = 0.008) and WOMAC physical function scores (P = 0.001). Furthermore, dietary TAC was inversely associated with serum concentrations of interleukin-6 (IL-6) (β = - 0.18, P = 0.020), tumor necrosis factor-α (TNF-α) (β = - 0.67, P < 0.001), matrix metalloproteinase-1 (MMP-1) (β = - 0.33, P < 0.001), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) (β = - 0.22, P = 0.005) levels.

CONCLUSION

The results of this study demonstrate an inverse association between dietary total antioxidant capacity and clinical and biochemical variables in patients with osteoarthritis.

Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review

PURPOSE OF REVIEW

Metabolic syndrome (MetS), also called the 'deadly quartet' comprising obesity, diabetes, dyslipidemia, and hypertension, has been ascertained to have a causal role in the pathogenesis of osteoarthritis (OA). This review is aimed at discussing the current knowledge on the contribution of metabolic syndrome and its various components to OA pathogenesis and progression.

RECENT FINDINGS

Lately, an increased association identified between the various components of metabolic syndrome (obesity, diabetes, dyslipidemia, and hypertension) with OA has led to the identification of the 'metabolic phenotype' of OA. These metabolic perturbations alongside low-grade systemic inflammation have been identified to inflict detrimental effects upon multiple tissues of the joint including cartilage, bone, and synovium leading to complete joint failure in OA. Recent epidemiological and clinical findings affirm that adipokines significantly contribute to inflammation, tissue degradation, and OA pathogenesis mediated through multiple signaling pathways. OA is no longer perceived as just a 'wear and tear' disease and the involvement of the metabolic components in OA pathogenesis adds up to the complexity of the disease. Given the global surge in obesity and its allied metabolic perturbations, this review aims to throw light on the current knowledge on the pathophysiology of MetS-associated OA and the need to address MetS in the context of metabolic OA management. Better regulation of the constituent factors of MetS could be profitable in preventing MetS-associated OA. The identification of key roles for several metabolic regulators in OA pathogenesis has also opened up newer avenues in the recognition and development of novel therapeutic agents.

Whole grain consumption and risk of radiographic knee osteoarthritis: a prospective study from the Osteoarthritis Initiative

OBJECTIVES

To assess the association of whole grain consumption with the risk of incident knee OA.

MATERIAL AND METHODS

We followed 2846 participants in the Osteoarthritis Initiative ages 45-79 years. Participants were free from radiographic knee OA (Kellgren-Lawrence grade <2) in at least one knee at baseline. Dietary data from baseline were obtained using the Block Brief Food Frequency Questionnaire. We defined radiographic knee OA incidence as a Kellgren-Lawrence grade ≥2 during the subsequent 96 months. Cox proportional hazards models were used to assess the association between whole grain food intake and the risk of incident knee OA.

RESULTS

During the 96 month follow-up, 518 participants (691 knees) developed incident radiographic knee OA. Higher total whole grain consumption was significantly associated with a lower knee OA risk [hazard ratio (HR)quartile 4vs1 = 0.66 (95% CI 0.52, 0.84), P for trend < 0.01] after adjusting for demographic and socio-economic factors, clinical factors and other dietary factors related to OA. Consistently, a significant inverse association of dark bread consumption with knee OA risk was observed [HRquartile 4vs1 = 0.68 (95% CI 0.53, 0.87), P for trend < 0.01). In addition, we observed a significant inverse association between higher cereal fibre intake and reduced knee OA risk [HRquartile 4vs1 = 0.61 (95% CI 0.46, 0.81), P for trend < 0.01).

CONCLUSIONS

Our findings revealed a significant inverse association of whole grain consumption with knee OA risk. These findings provide evidence that eating a diet rich in whole grains may be a potential nutritional strategy to prevent knee OA.

Association of macronutrients intake distribution with osteoarthritis risk among adults in NHANES, 2013-2016

The association between dietary macronutrient distribution and the risk of OA remains unknown. We aimed to evaluate how dietary macronutrient distribution was correlated with the risk of OA in US adults. We performed a cross-sectional study consisting of 7,725 participants from National Health and Nutrition Examination Survey (NHANES) 2013-2016. Dietary macronutrient intake and OA status were assessed by using dietary recall method and self-reported questionnaire, respectively. We evaluated the association between dietary macronutrient distribution and the risk of OA using multivariate regression models. We conducted the isocaloric substitution analysis using the multivariate nutrient density method. Higher percentage of energy intake from fat was associated with higher risk of OA [OR = 1.05 (95% CI, 1.00, 1.09); P = 0.034]. No significant correlation was observed between the percentage of energy intake from carbohydrate or protein and risk of OA. Isocaloric substitution analysis revealed that only the substitution between fat and carbohydrate was significantly associated with the risk of OA [OR = 1.05 (95% CI, 1.003 to 1.09); P = 0.037]. Our findings suggested that a diet with low percentage of energy intake from fat may be beneficial in the prevention of OA. Further prospective cohort studies are needed to assess our results.

Association between Iron Intake and Progression of Knee Osteoarthritis

Background: Iron overload is drawing attention in the development of knee osteoarthritis (OA). To identify the modifiable risk factors for iron-related pathological conditions, we examined the association between iron intake and the risk of knee OA progression. Methods: A total of 1912 participants in the Osteoarthritis Initiative (OAI), aged 45−79 years and with at least one knee radiographic OA at baseline, were identified and were followed up to 6 years. The iron and other nutrient intake was measured by the validated Block Brief 2000 Food Frequency Questionnaire. The outcome measures were by radiographic progression on the basis of the Kellgren−Lawrence (KL) grade and the joint-space-narrowing (JSN) score. The association between the iron intake and the knee OA progression was examined by Cox proportional hazards models and restricted cubic spline (RCS) regression. Results: Among the study participants, 409 participants experienced KL-grade progression, and 684 participants experienced JSN-score progression within 6 years. Overall, the association between iron intake and the risk of KL-grade progression followed a U shape (p for nonlinearity < 0.001). The risk of KL-grade progression was significantly lower in participants with iron intakes of <16.5 mg/day (per mg/day: adjusted hazard ratio (HR), 0.75; 95% CI (confidence interval), 0.64−0.89), and it was higher in those with iron intakes ≥16.5 mg/day (per mg/day: HR, 1.20; 95% CI, 1.04−1.38). Consistently, when the iron intake was assessed as deciles, compared to those in Deciles 3−5 (10.9−23.3 mg/day), the risk of KL-grade progression was higher for Deciles 1−2 (≤10.9 mg/day: HR, 1.57; 95% CI, 1.17−2.10) and for Deciles 6−10 (>23.3 mg/day: adjusted HR, 1.60; 95% CI, 1.19−2.16). Similar U-shaped relations were found for iron intake with the risk of JSN-score progression (p for nonlinearity = 0.035). Conclusions: There was a U-shaped association between the iron intake and the progression of knee OA, with an inflection point at about 16.5 mg/day, and minimal risk from 10.9 to 23.3 mg/day of iron intake. An appropriate iron intake was advisable for knee OA, whereas excessive or deficient iron intake increased the risk of knee OA progression.