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Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial

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Abstract

Purpose

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics.

Methods

Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30 kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16 g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6 months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed.

Results

Significant between group differences were detected for the change in timed-up-and-go test, 40 m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6 months and trunk fat (%) at 3 months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6 months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6 months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic.

Conclusion

Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted.

Clinical Trial Registration

Clinicaltrials.gov/study/NCT04172688.

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Data availability

The data and materials of the current study is available from the corresponding author upon reasonable request.

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Acknowledgements

The authors acknowledge Dr. Rachel Schachar and Dr. Kelly Johnston for assistance with recruitment. We thank Beneo GmbH, Mannheim, Germany for providing the prebiotic and placebo product. Metabolomics data were acquired by Marija Drikic at the Calgary Metabolomics Research Facility, which is supported by the International Microbiome Centre and the Canada Foundation for Innovation.

Funding

This work was supported by a Weston Foundation Microbiome Initiative Grant and a McCaig Encore Catalyst Grant. RF was supported by an Alberta Innovates Postdoctoral Fellowship and a Dr. Cy Frank Trainee Award in Nutrition, Bone and Joint Health. WW was supported by an Eyes High Postdoctoral Fellowship.

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Authors and Affiliations

  1. Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada

    Rafael Fortuna, Weilan Wang, Erin W. Noye Tuplin, Kara Sampsell & Raylene A. Reimer

  2. Department of Biochemistry, Memorial University of Newfoundland, 45 Artic Ave, St. John’s, NL, A1C 5S7, Canada

    Shyamchand Mayengbam

  3. Department of Physiology and Pharmacology, Cumming School of Medicine, Hotchkiss Brain Institute and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada

    Keith A. Sharkey

  4. Department of Surgery, and Faculty of Kinesiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

    David A. Hart

  5. Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Raylene A. Reimer

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  1. Rafael Fortuna
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Contributions

RF, RAR, DAH, and KAS conceived the study; RF conducted the trial; WW conducted the gut microbiota analysis; SM conducted the metabolomics analysis; EWNT conducted the SCFA analysis; KS conducted the diet analysis; RF and RAR drafted the manuscript; all authors reviewed and approved the final submitted manuscript.

Corresponding author

Correspondence to Raylene A. Reimer.

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Conflict of interest

RF, WW, SM, EWNT, KS, KAS, DAH declare no conflict of interest. RAR has received honoraria from Beneo for presentations distinct from this work.

Ethical approval and consent to participate

The study protocol was approved by the Conjoint Health Research Ethics Board of the University of Calgary (REB17-2363). This study was registered at www.clinicaltrial.gov NCT04172688. Informed consent was obtained from all participants.

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Fortuna, R., Wang, W., Mayengbam, S. et al. Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03415-w

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