To evaluate the effect of an anti-inflammatory compared to a low-calorie diet on the physical and mental health of patients with knee OA.
In this randomized parallel clinical trial, participants were selected among overweight and obese women aged 40 years or older with mild to moderate OA. Sixty women with a ratio of 1:1 were randomly assigned to receive either low-calorie or anti-inflammatory accompanied by a low-calorie diet for two months. The dietary intake and weight of participants were measured. Study variables were assessed using the Western Ontario and McMaster Index (WOMAC), visual analog pain scale (VAS), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI-I), and the Short Form 36 Health Survey Questionnaire (SF-36) to indicate the quality of life (QoL).
There was no statistically significant difference between the two groups in demographic and baseline variables except for the emotional well-being subscale of QoL. There was significant difference in anti-inflammatory compared to low-calorie diet in terms of weight (MD (95% CI): − 4.02 kg (− 6.77 to − 1.28); p = 0.005), VAS (MD (95% CI): − 0.97 (− 1.53 to − 0.41); p = 0.001), WOMAC-total score (MD (95% CI): − 9.91 (− 15.05 to − 4.78); p < 0.001), WOMAC-pain subscale (MD (95% CI): − 3.30 (− 5.30 to − 1.29); p = 0.002), WOMAC-physical function (MD(95% CI): − 5.48 (− 9.41 to − 1.53); p = 0.007), depression (p = 0.003), anxiety (p = 0.011), QoL-physical functioning (0.041), and QoL-pain (0.010) after the intervention.
An anti-inflammatory accompanied by a low-calorie diet resulted in greater weight loss and greater improvement in pain intensity, functional status, depression, anxiety, and some dimension of QoL in overweight and obese women with knee OA compared to the low-calorie diet.
Trial registration number and date of registration: IRCT201610220030424N2; 2018-04-23.
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Hunter DJ, Bierma-Zeinstra S (2019) Osteoarthritis. Lancet 393:1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9
Deshpande BR, Katz JN, Solomon DH et al (2016) Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res 68(12):1743–1750. https://doi.org/10.1002/acr.22897
Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE (2015) Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 162:46–54. https://doi.org/10.7326/M14-1231
Davatchi F, Tehrani Banihashemi A, Gholami J et al (2009) The prevalence of musculoskeletal complaints in a rural area in Iran: a WHO-ILAR COPCORD study (stage 1, rural study) in Iran. Clin Rheumatol 28:1267–1274. https://doi.org/10.1007/s10067-009-1234-8
Fotouhi A, Maleki A, Dolati S, Aghebati-Maleki A, Aghebati-Maleki L (2018) Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis. Biomed Pharmacother 104:652–660. https://doi.org/10.1016/j.biopha.2018.05.019
Park HM, Kim HS, Lee YJ (2020) Knee osteoarthritis and its association with mental health and health-related quality of life: a nationwide cross-sectional study. Geriatr Gerontol Int 20:379–383. https://doi.org/10.1111/ggi.13879
Chow YY, Chin KY (2020) The role of inflammation in the pathogenesis of osteoarthritis. Mediators Inflamm 2020:8293921. https://doi.org/10.1155/2020/8293921
Robinson WH, Lepus CM, Wang Q et al (2016) Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol 12:580–592. https://doi.org/10.1038/nrrheum.2016.136
Mora JC, Przkora R, Cruz-Almeida Y (2018) Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res 11:2189–2196. https://doi.org/10.2147/JPR.S154002
Grässel S, Muschter D (2020) Recent advances in the treatment of osteoarthritis. F1000Res 9:F1000 Faculty Rev-325. https://doi.org/10.12688/f1000research.22115.1
Katz JN, Arant KR, Loeser RF (2021) Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 325:568–578. https://doi.org/10.1001/jama.2020.22171
Rayman MP (2015) Diet, nutrition and osteoarthritis. BMC Musculoskelet Disord 16:S7. https://doi.org/10.1186/1471-2474-16-S1-S7
Musumeci G, Mobasheri A, Trovato FM, Szychlinska MA, Imbesi R, Castrogiovanni P (2014) Post-operative rehabilitation and nutrition in osteoarthritis. F1000Res 3:116. https://doi.org/10.12688/f1000research
Messina OD, Vidal Wilman M, Vidal Neira LF (2019) Nutrition, osteoarthritis and cartilage metabolism. Aging Clin Exp Res 31:807–813. https://doi.org/10.1007/s40520-019-01191-w
Raymond JL, Morrow K (2020) Krause and mahan’s food and the nutrition care process. e-book.: Elsevier Health Sciences
Eftekhar-Sadat B, Niknejad-Hosseyni SH, Babaei-Ghazani A, Toopchizadeh V, Sadeghi H (2015) Reliability and validity of Persian version of Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis. J Anal Res Clin 3:170–177. https://doi.org/10.15171/jarcm.2015.027
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N (2005) Psychometric properties of a Persian-language version of the Beck Depression Inventory-Second edition: BDI-II-PERSIAN. Depress Anxiety 21:185–192. https://doi.org/10.1002/da.20070
Kaviani H, Mousavi A (2008) Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 66:136–140 ([In Persian])
Bunevicius A (2017) Reliability and validity of the SF-36 Health Survey Questionnaire in patients with brain tumors: a cross-sectional study. Health Qual Life Outcomes 15:92. https://doi.org/10.1186/s12955-017-0665-1
Berenbaum F (2013) Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthr Cartil 21:16–21. https://doi.org/10.1016/j.joca.2012.11.012
Hawker GA (2019) Osteoarthritis is a serious disease. Clin Exp Rheumatol 37(Suppl 120):3–6
Johnson KA, Lee AH, Swanson KS (2020) Nutrition and nutraceuticals in the changing management of osteoarthritis for dogs and cats. J Am Vet Med Assoc 15(256):1335–1341. https://doi.org/10.2460/javma.256.12.1335
Cooper I, Brukner P, Devlin BL, Reddy AJ, Fulton M, Kemp JL, Culvenor AG (2022) An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study. BMC Musculoskelet Disord 23:1–3
Huebner JL, Hanes MA, Beekman B, TeKoppele JM, Kraus VB (2002) A comparative analysis of bone and cartilage metabolism in two strains of guinea-pig with varying degrees of naturally occurring osteoarthritis. Osteoarthr Cartil 10:758–767. https://doi.org/10.1053/joca.2002.0821
Mirzaee N, Mohammadi-shahboulaghi F, Nowroozi K, Biglarian A, Rangin H (2016) The effect of self-management training on performance of elderly patients with knee osteoarthritis. Iran J Nurs 28:10–20
Dyer J, Davison G, Marcora SM, Mauger AR (2017) Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. J Nutr Health Aging 21:562–566. https://doi.org/10.1007/s12603-016-0806-y
Vincent HK, Heywood K, Connelly J, Hurley RW (2012) Obesity and weight loss in the treatment and prevention of osteoarthritis. PM&R 4:S59-67. https://doi.org/10.1016/j.pmrj.2012.01.005
Messier SP, Mihalko SL, Legault C et al (2013) Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 25(310):1263–1273. https://doi.org/10.1001/jama.2013.277669
Tolkien K, Bradburn S, Murgatroyd C (2019) An anti-inflammatory diet as a potential intervention for depressive disorders: a systematic review and meta-analysis. Clin Nutr 38:2045–2052. https://doi.org/10.1016/j.clnu.2018.11.007
Kheirouri S, Alizadeh M (2019) Dietary inflammatory potential and the risk of incident depression in adults: a systematic review. Adv Nutr 1(10):9–18. https://doi.org/10.1093/advances/nmy100
Wang J, Zhou Y, Chen K, Jing Y, He J, Sun H, Hu X (2018) Dietary inflammatory index and depression: a meta-analysis. Public Health Nutr 15:1–7. https://doi.org/10.1017/S1368980018002628
Firth J, Marx W, Dash S et al (2019) The effects of dietary improvement on symptoms of depression and anxiety: a meta-analysis of randomized controlled trials. Psychosom Med 81:265–280. https://doi.org/10.1097/PSY.0000000000000673
Barrouin-Melo SM, Anturaniemi J, Sankari S et al (2016) Evaluating oxidative stress, serological- and haematological status of dogs suffering from osteoarthritis, after supplementing their diet with fish or corn oil. Lipids Health Dis 15:139. https://doi.org/10.1186/s12944-016-0304-6
Calder PC (2013) Omega-3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? Br J Clin Pharmacol 75:645–662. https://doi.org/10.1111/j.1365-2125.2012.04374.x
Baker KR, Matthan NR, Lichtenstein AH et al (2012) Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study. Osteoarthr Cartil 20:382–387. https://doi.org/10.1016/j.joca.2012.01.021
Thomas S, Browne H, Mobasheri A, Rayman MP (2018) What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford) 57:iv61–iv74. https://doi.org/10.1093/rheumatology/key011
Farnaghi S, Crawford R, Xiao Y, Prasadam I (2017) Cholesterol metabolism in pathogenesis of osteoarthritis disease. Int J Rheum Dis 20:131–140. https://doi.org/10.1111/1756-185X.13061
Chen QJ, Ou L, Li K, Ou FR (2020) Meta-analysis of the relationship between Dietary Inflammatory Index and esophageal cancer risk. Medicine (Baltimore) 99:e23539. https://doi.org/10.1097/MD.0000000000023539
Lopez-Garcia E, Schulze MB, Manson JE et al (2004) Consumption of (n-3) fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. J Nutr 134:1806–1811. https://doi.org/10.1093/jn/134.7.1806
Jarosz M, Olbert M, Wyszogrodzka G, Młyniec K, Librowski T (2017) Antioxidant and anti-inflammatory effects of zinc. Zinc-dependent NF-κB signaling. Inflammopharmacology 25:11–24. https://doi.org/10.1007/s10787-017-0309-4
The authors would like to thank the Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran for supporting this work (Grant Number: 58560).
Conflict of interest
The authors declare that there is no conflict of interests regarding the publication of this paper.
Written informed consent was obtained from all participants after a full explanation of the objectives and method of study prior to intervention. All research stages were approved by the Research Ethics Committee of Tabriz University of Medical Science (IR.TBZMED.REC.1396.1117).The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Dolatkhah, N., Toopchizadeh, V., Barmaki, S. et al. The effect of an anti-inflammatory in comparison with a low caloric diet on physical and mental health in overweight and obese women with knee osteoarthritis: a randomized clinical trial. Eur J Nutr 62, 659–672 (2023). https://doi.org/10.1007/s00394-022-03017-4