1
|
Buck AN, Vincent HK, Newman CB, Batsis JA, Abbate LM, Huffman KF, Bodley J, Vos N, Callahan LF, Shultz SP. Evidence-Based Dietary Practices to Improve Osteoarthritis Symptoms: An Umbrella Review. Nutrients 2023; 15:3050. [PMID: 37447376 PMCID: PMC10347206 DOI: 10.3390/nu15133050] [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: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
While there is some research investigating whole foods or diets that are easily understood and accessible to patients with osteoarthritis, specific nutrients or nutraceuticals are more commonly identified. Unfortunately, guidelines and evidence surrounding individual nutrients, extracts, and nutraceuticals are conflicting and are more difficult to interpret and implement for patients with osteoarthritis. The purpose of this umbrella review is to provide a comprehensive understanding of the existing evidence of whole foods and dietary patterns effects on osteoarthritis-related outcomes to inform evidence-based recommendations for healthcare professionals and identify areas where more research is warranted. A literature search identified relevant systematic reviews/meta-analyses using five databases from inception to May 2022. Five systematic reviews/meta-analyses were included in the current umbrella review. Most evidence supported the Mediterranean diet improving osteoarthritis-related outcomes (e.g., pain, stiffness, inflammation, biomarkers of cartilage degeneration). There was little to no evidence supporting the effects of fruits and herbs on osteoarthritis-related outcomes; however, there was some suggestion that specific foods could potentiate symptom improvement through antioxidative mechanisms. The overall lack of homogeneity between the studies limits the conclusions that can be made and highlights the need for quality research that can identify consumer-accessible foods to improve osteoarthritis-related symptoms.
Collapse
Affiliation(s)
- Ashley N. Buck
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC 27402, USA
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
| | - Heather K. Vincent
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL 33865, USA
| | - Connie B. Newman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - John A. Batsis
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Division of Geriatric Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27402, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27402, USA
| | - Lauren M. Abbate
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- VA Eastern Colorado Geriatric Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
| | - Katie F. Huffman
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Jennifer Bodley
- Lemieux Library, Seattle University, Seattle, WA 98122, USA;
| | - Natasha Vos
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- North Carolina Center for Health and Wellness, University of North Carolina, Asheville, NC 28804, USA
| | - Leigh F. Callahan
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC 27599, USA
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Sarah P. Shultz
- Kinesiology Department, Seattle University, Seattle, WA 98122, USA;
- Osteoarthritis Action Alliance, Chapel Hill, NC 27599, USA; (H.K.V.); (C.B.N.); (J.A.B.); (L.M.A.); (K.F.H.); (N.V.); (L.F.C.)
- School of Nursing and Health Studies, Monmouth University, West Long Branch, NJ 07764, USA
| |
Collapse
|
2
|
Yıldırım Keskin A, Şentürk S, Kimyon G. Eating attitude in patients with rheumatoid arthritis: The relationship between pain, body mass index, disease activity, functional status, depression, anxiety and quality of life. Arch Psychiatr Nurs 2023; 44:52-58. [PMID: 37197863 DOI: 10.1016/j.apnu.2023.04.001] [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: 09/13/2022] [Revised: 01/29/2023] [Accepted: 04/08/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE The aim of this study is to evaluate the relationship between eating attitude and pain, body mass index, disease activity, functional status, depression, anxiety and quality of life in patients with rheumatoid arthritis (RA). DESIGN AND METHODS This descriptive and cross-sectional study was conducted with 111 RA patients between January 2021 and May 2021. FINDINGS The Eating Attitudes Test scores of the participants had a positive significant relationship with their Visual Analog Scale scores (r = 0.257), Health Assessment Questionnaire scores (r = 0.221), Beck Anxiety Inventory scores (r = 0.287), Beck Depression Inventory scores (p = 0.224), and Rheumatoid Arthritis Quality of Life Scale scores (r = 0.298) (p < 0.05). This study showed that when the eating attitudes of the RA patients were negative, their anxiety and depression levels increased, and their quality of life was negatively affected. PRACTICE IMPLICATIONS In the positive management of depression and anxiety, by creating treatment guidelines, the moderation of the eating attitudes of patients and increasing their quality of life levels should be ensured.
Collapse
Affiliation(s)
- Alev Yıldırım Keskin
- Assistant Professor, Department of Nursing, Aksehir Kadir Yallagoz Health School, Selcuk University, Aksehir, Konya, Turkey.
| | - Sibel Şentürk
- Associate Professor, Department of Nursing, Bucak Health School, Burdur Mehmet Akif Ersoy University, Bucak, Burdur, Turkey.
| | - Gezmiş Kimyon
- Associate Professor, Department of Rheumatology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Turkey.
| |
Collapse
|
3
|
Turesson Wadell A, Bärebring L, Hulander E, Gjertsson I, Lindqvist HM, Winkvist A. Inadequate Dietary Nutrient Intake in Patients With Rheumatoid Arthritis in Southwestern Sweden: A Cross-Sectional Study. Front Nutr 2022; 9:915064. [PMID: 35799579 PMCID: PMC9255550 DOI: 10.3389/fnut.2022.915064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with rheumatoid arthritis (RA), who suffer from impaired physical function and fatigue, may have difficulties with grocery shopping and preparing meals. Also, to improve symptoms, patients often experiment with diets but seldom consult a dietitian. Although this could lead to a nutritiously deprived diet, an up-to-date, thorough description of the nutrient intake in Swedish patients with RA is absent. Here, we investigated the habitual dietary energy and nutrient intake in patients with RA living in southwestern Sweden.Materials and MethodsThree-day food records performed at two time points during the ADIRA (Anti-inflammatory Diet In Rheumatoid Arthritis) trial, were used. The intake of energy and nutrients was analyzed using The Swedish Food Composition Database.ResultsA total of 62 participants (50 females, 12 males) were included in the study, where 18 participants completed one 3-day food record and 44 participants completed two 3-day food records. Median (IQR) intake of total fat was above or in the upper range of recommendations (females: 37.1 [32.5, 41.7] energy percent (E%), and males: 40.3 [37.5, 42.9] E%). Median (IQR) intake of saturated fatty acids exceeded recommendations (females: 14.9 [12.5, 17.0] E% and males: 15.4 [12.2, 17.0] E%), while median (IQR) carbohydrate and fiber intakes were below recommendations (females: 41.7 [36.3, 45.4] E% and 17.2 [12.8, 20.9] g, respectively, and males: 38.8 [35.2, 40,3] E% and 18.5 [15.7, 21.0] g, respectively). The reported intake of other macronutrients was in line with recommendations. For several micronutrients, e.g., vitamin A and D, folate, and calcium, median intake was below recommended intake. Vitamin A intake was especially low and did not reach lower intake level (LI) for 14 and 17% of females and males, respectively. For females, about 10% did not reach LI for vitamin D, calcium, and riboflavin.ConclusionWe found that patients with RA residing in southwestern Sweden reported a high intake of saturated fatty acids and low intake of fiber and several micronutrients.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT02941055?term=NCT02941055&draw=2&rank=1], identifier [NCT02941055].
Collapse
Affiliation(s)
- Anna Turesson Wadell
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- *Correspondence: Anna Turesson Wadell,
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Hulander
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen M. Lindqvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Buck AN, Shultz SP, Huffman KF, Vincent HK, Batsis JA, Newman CB, Beresic N, Abbate LM, Callahan LF. Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis. Curr Dev Nutr 2022; 6:nzac084. [PMID: 35702382 PMCID: PMC9188467 DOI: 10.1093/cdn/nzac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management. Objectives The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine whether there is a disconnect between what patients want to know about nutrition and OA management and what information health-care professionals (HCPs) are providing to patients. Methods The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in 4 domains: 1) strategies for weight management and a healthy lifestyle; 2) vitamins, minerals, and other supplements; 3) foods or nutrients that may reduce inflammation; and 4) diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources. Results Survey responses from 338 individuals with OA and 104 HCPs were included. The highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods and nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices and herbs (65%), fruits and vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%), and fasting or intermittent fasting (15%). There was greater than 20% discrepancy between interests reported by individuals with OA and discussions reported by HCPs on: weight loss strategies, general information on vitamins and minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion sizes, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging. Conclusions There is disparity between the nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats. This study explored the information gap between what individuals with OA want to know and what HCPs believe they need to know.
Collapse
Affiliation(s)
- Ashley N Buck
- Kinesiology Department, Seattle University, Seattle, WA, USA
| | - Sarah P Shultz
- Kinesiology Department, Seattle University, Seattle, WA, USA
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
| | | | - Heather K Vincent
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - John A Batsis
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connie B Newman
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Lauren M Abbate
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
- Department of Emergency Medicine University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh F Callahan
- Osteoarthritis Action Alliance, Chapel Hill, NC, USA
- Division of Rheumatology, Allergy and Immunology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
5
|
McGarrity-Yoder ME, Insel KC, Crane TE, Pace TWW. Diet quality and disease activity in rheumatoid arthritis. Nutr Health 2021; 28:581-590. [PMID: 34668452 DOI: 10.1177/02601060211044311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective:This study examined associations between diet quality and disease activity in adults with rheumatoid arthritis (RA). Perceived stress was also compared to diet and disease activity. Methods: In a cross-sectional design, 50 adults with RA were recruited. The Arizona Food Frequency Questionnaire was used to measure dietary intake (four weeks) and diet quality scores were calculated with the Healthy Eating Index - 2015. Perceived stress was measured with the Perceived Stress Scale. Disease activity was measured with the Health Assessment Questionnaire-Disability Index and Pain Scale, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein, and Disease Activity Score Including 28 Joints-ESR. Results: Diet quality (56; SD ± 12) in participants was lower than the national mean (59). Age (p = 0.015) and gender (p = 0.003) were associated with higher diet quality. The belief that diet affects RA disease activity was reported by 44% of the participants, and these participants were significantly more likely to report dietary changes (p < 0.0001). Higher educational level (at least some college) was associated with this belief (B = -1.535, p = 0.023). Participants with lower diet quality also had significantly higher pain (B = -0.396, p = 0.022) and ESR scores (p = 0.019). Women were more likely to have higher HAQ-DI scores (B = 0.570, p = 0.001). Perceived stress was significantly associated with HAQ-DI and pain scores (B = 0.445, p = 0.001 and B = 0.289, p = 0.042, respectively). Medical cannabis was reportedly used by 8% of participants. Conclusion: In RA patients, lower diet quality may be associated with more pain and inflammation, and perceived stress may be associated with higher disability and disease activity.
Collapse
|
6
|
Improvement of Inflammation and Pain after Three Months' Exclusion Diet in Rheumatoid Arthritis Patients. Nutrients 2021; 13:nu13103535. [PMID: 34684536 PMCID: PMC8539601 DOI: 10.3390/nu13103535] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting the synovial joints and causing severe disability. Environmental and lifestyle factors, including diet, have been proposed to play a role in the onset and severity of RA. Dietary manipulation may help to manage the symptoms of RA by lowering inflammation and potentially decreasing pain. Methods: In 40 patients with long-standing RA with stable symptoms and treated with conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs), the effect of a 3-month diet avoiding meat, gluten, and lactose (and all dairy products; privative diet) was evaluated in comparison with a control balanced diet including those foods. Both diets were designed to reduce weight since all patients were overweight or obese. Patients were randomly assigned to one of the diets, and RA was clinically assessed at Time 0 (T0), through the Visual Analogue Scale (VAS), for pain, and the Disease Activity Score of 28 joints (DAS 28) for RA activity. Patients were also administered the Short Form Health survey (SF-36) and the Health Assessment Questionnaire (HAQ). At T0, a blood sample was collected for laboratory tests and adipokines measurements, and anthropometric measurements were compared. These evaluations were repeated at the end of the 3 months’ dietary regimens. Results: A significant decrease in VAS and the improvement of the overall state of physical and mental health, assessed through SF-36, was observed in patients assigned to the privative diet. Both dietary regimens resulted in the improvement of quality of life compared to baseline values; however, the change was significant only for the privative diet. With either diet, patients showed significant decreases in body weight and body mass index, with a reduction in waist and hips circumference and lower basal glucose and circulating leptin levels. A privative diet was also able to significantly reduce systolic (p = 0.003) and diastolic (p = 0.025) arterial pressure. The number of circulating leukocytes and neutrophils, and the level of hs-C-Reactive Protein also decreased after 3 months of the meat-, lactose-, and gluten-free diet. Conclusions: Our results suggest that a privative diet can result in a better control of inflammation in RA patients under stable optimized drug treatment.
Collapse
|
7
|
Comee L, Taylor CA, Nahikian-Nelms M, Ganesan LP, Krok-Schoen JL. Dietary patterns and nutrient intake of individuals with rheumatoid arthritis and osteoarthritis in the United States. Nutrition 2019; 67-68:110533. [DOI: 10.1016/j.nut.2019.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/06/2019] [Accepted: 06/16/2019] [Indexed: 12/26/2022]
|