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Questions about the role of diet in the prevention and treatment of their joint disorder may be among the most frequent posed by patients with osteoarthritis (OA). Interestingly, while there are thousands of lay publications recommending various arthritis diets, physicians have little information to offer based on scientific studies.1 Arguably, in no other aspect of rheumatology is public and medical interest so discrepant. Indeed, the traditional medical approach has been to counsel patients that, other than diets promoting weight loss, scientific research has produced no evidence to suggest that any particular nutritional intervention might be helpful for OA.2 In fact, studies do suggest pathways through which nutritional factors might influence the natural history of OA.
Diet and obesity
Overweight people are at considerably increased risk for the development of OA in their knees, and may also be more susceptible to both hip and hand joint involvement.3 As overweight people do not necessarily have increased load across their hand joints, investigators have wondered for decades whether systemic factors, such as dietary factors or other metabolic consequences of obesity, may mediate some of this association. Indeed, early laboratory studies using strains of mice and rats seemed to suggest an interaction between body weight, genetic factors, and diet, although attempts to demonstrate a direct effect of dietary fat intake proved inconclusive.4 ,5 Irrespective of the mechanism, it seems reasonable to infer that weight reduction, through dietary or other means, may reduce a person’s risk for the development or progression of OA. Observational data from the Framingham OA Study support this notion and suggest that weight loss of approximately 5 kg will reduce a person’s risk for the development of knee OA over the subsequent 10 years by 50%.6
Unfortunately, dietary intervention for obesity in uncontrolled environments is often costly, unpleasant, …