An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study

Abstract

Background Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis. Methods This 9-week single-arm feasibility study recruited participants aged 40–85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval. Results Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m−2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection. Conclusion This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis. Trial registration ACTRN12620000229976 prospectively on 25/2/2020.

The Effectiveness of Intermittent Fasting, Time Restricted Feeding, Caloric Restriction, a Ketogenic Diet and the Mediterranean Diet as Part of the Treatment Plan to Improve Health and Chronic Musculoskeletal Pain: A Systematic Review

“…Visual Analogue Scale (VAS): a scale used to measure pain. It consists of a horizontal or a vertical line that represents the pain intensity with a score from 0 to 10, where the number 0 is synonymous with “no pain” and 10 is synonymous with “very intense pain/worst pain imaginable” [ 43 ].…”

“…Numerical Pain Scale (NPRS): a one-dimensional tool for measuring pain in adults, consisting of 11 items. It is a version of the VAS scale that has scores from 0 to 10, with 0 being synonymous with “no pain” and 10 being “the most intense pain imaginable” [ 43 ].…”

Effectiveness of an anti-inflammatory diet versus low-fat diet for knee osteoarthritis: the FEAST randomised controlled trial protocol

“…Given inherent differences in the FEAST RCT (eg, Australian Dietary Guideline control group, not specifically targeting overweight participants, inclusion of both women and men), we used the lower bound 95% CI to provide a conservative estimate of the anticipated effect size (0.5). This estimated effect size is also a conservative estimate based on our single-arm anti-inflammatory diet pilot trial, which had an effect size of 0.68 28. Recruiting 128 participants (equally distributed between two arms) would yield 80% power to observe such an effect or larger at a two-tailed type I error of 0.05.…”

“…Anti-inflammatory diets have garnered much interest in recent years due to their effectiveness in alleviating symptoms and improving biomarkers for a variety of chronic diseases, including diabetes,18 cardiovascular disease,24 epilepsy25 and rheumatoid arthritis 26. Small studies investigating anti-inflammatory diets for knee OA have demonstrated feasibility and effectiveness in reducing symptoms and inflammation over 12–16 weeks 15 27 28. To date, no fully powered randomised controlled trial (RCT) has evaluated the effectiveness of an anti-inflammatory diet in knee OA.…”

Beneficial Effects of Anti-Inflammatory Diet in Modulating Gut Microbiota and Controlling Obesity

“…Typically, anti-inflammatory diets include the consumption of unrefined and minimally processed foods, nutrients including fiber, mono- and poly unsaturated fatty acids, lean protein sources such as chicken, and various spices, and reducing the consumption of red meat, high-fat dairy foods, and saturated and trans fats that have notably been shown to diminish inflammation [ 89 , 90 ]. The effect of an anti-inflammatory diet on weight loss has been reported many times.…”