Dietary Patterns and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative

Abstract

Background: While some individual foods and nutrients have been associated with knee osteoarthritis (KOA) progression, the association between dietary patterns and KOA progression has received little research attention.

Objective: The objective of this study was to determine whether dietary patterns, derived by principal components analysis (PCA), are associated with KOA progression.

Methods: In the Osteoarthritis Initiative (OAI), a prospective cohort with clinical centers in Maryland, Ohio, Pennsylvania, and Rhode Island, 2757 participants with existing KOA (mean age 62 y) and diet assessed at baseline were followed for ≤72 mo. Using PCA, Western and prudent dietary patterns were derived. Radiographic KOA progression was assessed using 2 separate measures, 1 full Kellgren-Lawrence (KL) grade increase and loss in joint space width (JSW). Symptomatic KOA progression was defined as an increase in or remaining in 1 of the 2 highest classification categories of the Western Ontario and McMaster Universities Arthritis Index (WOMAC).

Results: Adherence to Western and prudent dietary patterns was significantly associated with radiographic and symptomatic progression of KOA. With increasing Western pattern score, there was increased KL-worsening risk (compared with quartile 1, HR for quartile 4: 1.30; 95% CI: 1.05, 1.61; P-trend < 0.01) and increased odds of progression to higher WOMAC score (compared with quartile 1, OR for quartile 4: 1.39; 95% CI: 1.18, 1.63; P-trend < 0.01) but no significant change in JSW loss. With increasing prudent pattern score there was decreased KL-worsening risk (compared with quartile 1, HR for quartile 4: 0.79; 95% CI: 0.64, 0.98; P-trend = 0.02), decreased JSW loss (quartile 1: 0.46 mm; quartile 4: 0.38 mm; P-trend < 0.01), and decreased odds of higher WOMAC progression (compared with quartile 1, OR for quartile 4 0.73; 95% CI: 0.62, 0.86; P-trend < 0.01) in multivariable adjusted models.

Conclusions: Adherence to a Western dietary pattern was associated with increased radiographic and symptomatic KOA progression, while following a prudent pattern was associated with reduced progression. In general, for people already diagnosed with KOA, eating a diet rich in fruits, vegetables, fish, whole grains, and legumes may be related to decreased radiographic and symptomatic disease progression.

Keywords: Western diet; dietary patterns; prudent diet; radiographic knee osteoarthritis progression; symptomatic knee osteoarthritis progression.

FIGURE 1

Study population and exclusions in the Osteoarthritis Initiative. After baseline, participants were lost to follow-up due to death, total knee replacement, or nonresponse: 129 in year 2, 139 in year 3, 221 in year 4, and 1377 in year 6. KL, Kellgren–Lawrence; OA, osteoarthritis; OAI, Osteoarthritis Initiative.