Inflammatory potential of diet and risk of incident knee osteoarthritis: a prospective cohort study
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RESEARCH ARTICLE
Open Access
Inflammatory potential of diet and risk of incident knee osteoarthritis: a prospective cohort study Qiang Liu1,2, James R. Hebert3,4, Nitin Shivappa3,4, Jianjun Guo5, Ke Tao1, Chao Zeng6, Guanghua Lei6, Jianhao Lin1* and Yuqing Zhang2*
Abstract Background: To examine the relation between inflammatory potential of diet and incident knee osteoarthritis (OA) and the role of BMI in the association of interest. Methods: In the Osteoarthritis Initiative, the energy-adjusted dietary inflammatory index (E-DII™) scores were calculated based on the Block Brief 2000 Food Frequency Questionnaire and categorized into sex-specific quartiles. Outcomes were incident (1) radiographic knee OA (ROA) (i.e., a KL grade ≥ 2) and (2) symptomatic knee OA (SxOA) (i.e., a combination of frequent knee pain and ROA). We fitted generalized estimating equation models to examine the association between E-DII scores and incident knee OA. We performed mediation analyses to assess the potential mediation by BMI in the DII-OA relation. Results: Over a 48-month follow-up period, 232 and 978 knees developed ROA and SxOA, respectively. Compared with the lowest (most anti-inflammatory) E-DII quartile, the odds ratio (OR) of incident ROA for the highest (most pro-inflammatory) E-DII quartile was 1.73 (95% confidence interval (CI) 1.15 to 2.62, Ptrend = 0.007). The corresponding OR for SxOA was 1.43 (95% CI 1.16 to 1.76, Ptrend = 0.001). The DII-OA association was significantly mediated via BMI with an indirect effect of 1.08 (95% CI 1.04, 1.13) for ROA and 1.13 (95% CI 1.09, 1.16) for SxOA, accounting for 20.4% and 44.5% of the total effect, respectively. Conclusions: A higher inflammatory potential of diet increased the risk of knee OA. The association was significantly mediated via BMI. Targeting the inflammatory potential of diet may be beneficial to reduce the risk of knee OA. Keywords: Osteoarthritis, Diet, Inflammation, Body mass index, Cohort
Background Diet plays a fundamental role in preventing many chronic diseases [1, 2]. One of the mechanisms is through regulating inflammation [3–5]. Indeed, the inflammatory potential of diet has been shown to be associated with obesity [6, 7] and cardiovascular diseases [8, 9], two conditions * Correspondence: [email protected]; [email protected] 1 Arthritis Clinic and Research Center, Peking University People’s Hospital, No.11 Xizhimen South Road, Xicheng District, Beijing 100044, China 2 Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA Full list of author information is available at the end of the article
well known to be related to chronic, systemic inflammation. Osteoarthritis (OA), a common form of arthritis that is pathologically associated with biomechanics and inflammation [10], is highly prevalent among the elderly and is a leading cause of disability [11, 12]. A limited number of risk factors for OA are modifiable [13]. Diet can be modified on a daily basis, a
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