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Shahid A, Thirumaran AJ, Christensen R, Venkatesha V, Henriksen M, Bowden JL, Hunter DJ. Comparison of weight loss interventions in overweight and obese adults with knee osteoarthritis: A systematic review and network meta-analysis of randomized trials. Osteoarthritis Cartilage 2024:S1063-4584(24)01367-0. [PMID: 39233046 DOI: 10.1016/j.joca.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/22/2024] [Accepted: 08/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To ascertain the comparative effectiveness of weight-loss strategies for osteoarthritis (OA) to develop rational treatment algorithms aimed at improving OA-related symptoms in overweight/obese individuals. DESIGN Medline, Embase, CINAHL, Scopus, and Web of Science were searched from inception to June 2023 for observational studies and randomized trials. Network meta-analyses were performed using a frequentist approach. Effect sizes for pain and function were computed as standardized mean differences, while change in body weight was computed as mean differences. RESULTS 13 RCTs on knee OA (KOA) (2800 participants) with 7 interventions: diet (D); exercise (E); diet and exercise (DE); pharmacological (L); psychological (P); psychological, diet, and exercise (PDE); and Mediterranean diets (M) were networked. For weight change (kg), all interventions significantly outperformed control comparators, with effect sizes ranging from -11.2 (95% CI, -16.0, -6.5 kg) for the most effective approach (PDE) to -4.7 (95% CI, -6.7, -2.7 kg) for the least effective approach (DE). In terms of pain (0-20 scale), only DE outperformed control comparators (-2.2, 95% CI: -4.1, -0.21), whereas PDE was not superior to control comparators (-3.9, 95% CI: -8.4, 0.5) in improving the pain. Regardless of the chosen intervention, prediction intervals from meta-regression analysis indicate that significant pain relief may be anticipated when patients achieve at least a weight reduction of 7%. CONCLUSIONS PDE and DE interventions may offer the most effective approach for weight loss, potentially leading to improvements in pain and physical function among overweight/obese individuals with KOA if they achieve more than 7% weight loss.
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Affiliation(s)
- Arashi Shahid
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, 2065 NSW, Australia; National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan; Section for Biostatistics and Evidence-Based Research, the Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Aricia Jieqi Thirumaran
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, 2065 NSW, Australia; Nepean Hospital, Kingswood, NSW 2747, Australia
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Venkatesha Venkatesha
- Northern Sydney Local Health District Executive, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Marius Henriksen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; The Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Jocelyn L Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, 2065 NSW, Australia; Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia.
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, 2065 NSW, Australia; Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia.
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Stanfar K, Hawes C, Ghajar M, Byham-Gray L, Radler DR. Diet modification reduces pain and improves function in adults with osteoarthritis: a systematic review. J Hum Nutr Diet 2024; 37:847-884. [PMID: 38739860 DOI: 10.1111/jhn.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/14/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The effect of dietary modifications on pain and joint function in adults with osteoarthritis (OA) is an emerging area of study. This systematic review aimed to evaluate if adults with OA who consume diets with a higher proportion of plant phenols and omega-3 fatty acids would have less pain and improved joint function than those with a higher proportion of saturated fatty acids, omega-6 fatty acids and refined carbohydrates. METHODS Database searches of CINAHL (EBSCO), Clinical Trials (NIH-NLM), Cochrane Library (Wiley), Dissertation & Thesis Global (ProQuest), Embase (Elsevier), Medline (OVID), PubMed (NLM), Scopus (Elsevier), Web of Sciences (Clarivate) for clinical trials identified 7763 articles published between January 2015 and May 2023. After an independent review of the articles, seven randomised clinical trials and one nonrandomised clinical trial were included in the analysis. Because of the heterogeneity of the outcome measures, a meta-analysis was not possible. RESULTS Participants who were instructed to consume high-phenol/high-omega-3 fatty acid diets reported significant improvements in pain and physical function scores. The greatest improvement was reported by those who consumed a diet that had the most omega-3 fatty acids. CONCLUSION Because of the high risk of bias, the strength of the evidence is limited. However, there is evidence that counselling adults with OA to replace refined grains and processed foods with whole plant foods, fish and plant oils may have a favourable effect on pain and physical function. Routine follow-up care regarding these diet modifications may be necessary to ensure adherence to this therapy.
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Affiliation(s)
- Karen Stanfar
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Corey Hawes
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Mina Ghajar
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Diane R Radler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA
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Orchard T, McLaughlin E, Winschel T, Shadyab A, Laddu D, Vitolins M, Constantinescu F, Jackson R. Fatty Acid Intake and Polyunsaturated Fatty Acid Biomarkers and Risk of Total Knee or Hip Arthroplasty Among Older Women in the Women's Health Initiative. Arthritis Care Res (Hoboken) 2024; 76:993-1005. [PMID: 38412867 PMCID: PMC11209811 DOI: 10.1002/acr.25319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/23/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The objective was to determine whether baseline fatty acid intake and erythrocyte omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) can predict risk of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older women. METHODS This was a prospective analysis of 34,990 women in the Women's Health Initiative. Dietary fatty acids were estimated from food frequency questionnaires. Imputed erythrocyte PUFAs were available in a subcohort of 3,428 women. Arthroplasty (THA and TKA), used as a surrogate of severe osteoarthritis, was identified via linked Medicare data. Cox proportional hazards models were constructed to estimate risk of arthroplasty. RESULTS Risk of THA was associated with higher intake of arachidonic acid, (multivariable hazard ratio [HR] quartile 4 [Q4] vs Q1: 1.16; 95% confidence interval [CI] 1.01-1.34; P = 0.03) and higher intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA; HR Q4 vs Q1: 1.20; 95% CI 1.05-1.39; P = 0.003). There was a linear trend (P = 0.04) for patients to have a higher risk of THA with higher erythrocyte EPA and DHA in body mass index-adjusted models; however, there was no significant difference in patients who had THAs by quartiles of erythrocyte EPA and DHA (P = 0.10). Dietary fatty acids and erythrocyte PUFAs were not significantly associated with risk of TKA. CONCLUSION Higher baseline intakes of arachidonic acid and EPA and DHA were associated with a modestly higher risk of THA. No association was found between fatty acids and patients who had TKAs. Further research in populations with direct measures of osteoarthritis severity is needed to better understand the importance of PUFAs in modulating osteoarthritis and arthroplasty risk.
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MESH Headings
- Humans
- Female
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Knee
- Aged
- Prospective Studies
- Biomarkers/blood
- Women's Health
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Hip/blood
- Osteoarthritis, Knee/surgery
- Osteoarthritis, Knee/blood
- Risk Factors
- Erythrocytes/chemistry
- Erythrocytes/metabolism
- Fatty Acids, Omega-6/blood
- Fatty Acids, Unsaturated/blood
- United States/epidemiology
- Fatty Acids, Omega-3/blood
- Fatty Acids, Omega-3/administration & dosage
- Risk Assessment
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Affiliation(s)
| | | | | | | | - Deepika Laddu
- Arbor Research Collaborative for Health, Ann Arbor, MI
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Shawl M, Geetha T, Burnett D, Babu JR. Omega-3 Supplementation and Its Effects on Osteoarthritis. Nutrients 2024; 16:1650. [PMID: 38892583 PMCID: PMC11174396 DOI: 10.3390/nu16111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease characterized by the destruction of the articular cartilage, resulting in a pro-inflammatory response. The progression of OA is multifactorial and is influenced by the underlying cause of inflammation, which includes but is not limited to trauma, metabolism, biology, comorbidities, and biomechanics. Although articular cartilage is the main tissue affected in osteoarthritis, the chronic inflammatory environment negatively influences the surrounding synovium, ligaments, and subchondral bone, further limiting their functional abilities and enhancing symptoms of OA. Treatment for osteoarthritis remains inconsistent due to the inability to determine the underlying mechanism of disease onset, severity of symptoms, and complicating comorbidities. In recent years, diet and nutritional supplements have gained interest regarding slowing the disease process, prevention, and treatment of OA. This is due to their anti-inflammatory properties, which result in a positive influence on pain, joint mobility, and cartilage formation. More specifically, omega-3 polyunsaturated fatty acids (PUFA) have demonstrated an influential role in the progression of OA, resulting in the reduction of cartilage destruction, inhibition of pro-inflammatory cytokine cascades, and production of oxylipins that promote anti-inflammatory pathways. The present review is focused on the assessment of evidence explaining the inflammatory processes of osteoarthritis and the influence of omega-3 supplementation to modulate the progression of osteoarthritis.
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Affiliation(s)
- Megan Shawl
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Thangiah Geetha
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
| | - Donna Burnett
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Jeganathan Ramesh Babu
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
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Melguizo-Ibáñez E, Ubago-Jiménez JL, Sanz-Martín D, Alonso-Vargas JM. Health-Related Quality of Life and Injuries in Physical Education Students: A Multi-Group Model According to the Degree of Adherence to the Mediterranean Diet. Eur J Investig Health Psychol Educ 2024; 14:1140-1152. [PMID: 38785573 PMCID: PMC11120319 DOI: 10.3390/ejihpe14050075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
The Mediterranean diet is considered a healthy eating pattern. It has been shown to improve people's quality of life. When a person suffers injuries, their quality of life suffers. This research aims to accomplish the following: (a) to study the differences in the effect of the health-related quality of life on injuries according to the degree of adherence to the Mediterranean diet, (b) to analyse the existing differences in the variables that make up the health-related quality of life according to the degree of adherence to the Mediterranean diet, and (c) to analyse the degree of adherence to the Mediterranean diet according to whether the participants have suffered any injury. The study was descriptive, cross-sectional, and exploratory in a sample of 556 physical education students. The PREDIMED questionnaire, the SF-36 questionnaire, and a self-administered questionnaire were used. The results showed that high adherence to the Mediterranean diet was associated with higher quality of life and lower injury rates. It was also observed that high adherence to the Mediterranean diet improved the effect of the quality of life on injuries. In conclusion, the Mediterranean diet is beneficial for the quality of life of young university students.
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Affiliation(s)
- Eduardo Melguizo-Ibáñez
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
| | - José Luis Ubago-Jiménez
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
| | - Daniel Sanz-Martín
- Faculty of Humanities and Social Sciences, Universidad Isabel I, 09003 Burgos, Spain
| | - José Manuel Alonso-Vargas
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
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Stubbs A, Clauw DJ. Nutrients and Nocioception: Diet in the management of pain. Best Pract Res Clin Rheumatol 2024; 38:101963. [PMID: 38918099 DOI: 10.1016/j.berh.2024.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
Nutrition can play a pivotal role in the management of pain associated with chronic rheumatic diseases. There is a growing body of research linking certain nutrients from the diet to inflammation. Certain nutrients have been shown to improve pain associated with inflammation. Furthermore, certain dietary patterns have been shown to improve pain across multiple rheumatic conditions. Finally, maintaining a low body mass is associated with improved pain associated with chronic rheumatic diseases.
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Affiliation(s)
- Aaron Stubbs
- Department of Rheumatology, Michigan Medicine, United States.
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, United States
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Pai YH, Chang R, Wei JCC. Letter to Editor: Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis. Int J Rheum Dis 2024; 27:e15025. [PMID: 38287553 DOI: 10.1111/1756-185x.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/23/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Yu-Hsuan Pai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Renin Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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