Background/Purpose: Osteoarthritis (OA) is a major source of disability worldwide yet dietary exposures that might be associated with its progression have not received significant research attention. We aimed to examine the prospective association of major dietary patterns derived by principal component analysis (PCA) with symptomatic progression of knee OA.

Methods: From the Osteoarthritis Initiative (OAI), 2,757 individuals with mild to moderate knee OA in at least one knee (defined as Kellgren-Lawrence (KL) grade of 1, 2, or 3) at baseline were followed annually up to 72 months. Dietary intake was assessed with a Block Brief Food Frequency Questionnaire completed at baseline. Two dietary patterns were identified by PCA: the prudent pattern characterized by high intakes of fruit/vegetables, legumes, whole grains, fish, etc.; the Western pattern characterized by high intakes of red / processed meats, refined grains, French fries, etc. (Table 1). A combined score was calculated as the difference between the Western and prudent pattern scores to evaluate the overall dietary quality since the two patterns are uncorrelated. We categorized the Western Ontario & McMaster Universities Arthritis Index (WOMAC) pain, disability and total scores at each time point into 5 grades: (zero and quartile thresholds based on baseline non-zero scores). Symptomatic progression, defined as either an increase in WOMAC grade or remaining in one of the two highest WOMAC grades, was evaluated at each follow-up time point. Generalized linear mixed models for repeated binary responses were developed to evaluate the associations after adjusting for age, sex, race, baseline K-L grades, injury/surgery, depression, pain medications and total energy intake. BMI and weight changes from baseline were additionally adjusted in separate models to assess the potential mediation effect.

Results: The progression increased significantly with higher Western pattern quartiles in a dose-response fashion (p trend < 0.01) (Table 2). In contrast, symptomatic knee OA progression generally decreased with a higher score of prudent dietary pattern. Consistent with a Western pattern, we observed a strong dose-response relationship between the combined score, which indicated not only high consumption of a Western diet but also low consumption of a prudent diet, and symptomatic knee OA progression (p trend < 0.01). The observed associations generally remained after additionally adjusting for BMI and weight change from baseline.

Conclusion: Adherence to a Western dietary pattern was associated with increased symptomatic knee OA progression, while following a prudent dietary pattern was associated with reduced knee OA progression. For participants already diagnosed with knee OA, eating a healthy diet rich in fruits, vegetables, fish, whole grains and legumes, lower in red/processed meats, refined grains and French fries, may slow symptomatic disease progression.

Symptomatic Progression of Knee OA_final_tables

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dietary-patterns-and-symptomatic-progression-of-knee-osteoarthritis-data-from-the-osteoarthritis-initiative/