Cibo e artrosi. Dr U Massafra UOS Reumatologia Osp San pietro Fbf Roma

Size: px

Start display at page:

Download "Cibo e artrosi. Dr U Massafra UOS Reumatologia Osp San pietro Fbf Roma"

Erin Corey Carpenter
5 years ago
Views:

1 Cibo e artrosi Dr U Massafra UOS Reumatologia Osp San pietro Fbf Roma

2 CIBO

4 Fast food tradizionale salutista

5 ARTROSI

6 Intern Med J Feb;46(2): What's new in osteoarthritis pathogenesis? Jones G. osteoarthritis should be regarded as an umbrella term for a number of pathophysiological processes leading to pain and/or cartilage loss. If these are inside the joint (such as bone marrow lesions, cartilage defects or meniscal tear) then they can be considered osteoarthritis, Those outside the joint (such as obesity, weak muscles and vitamin D deficiency) could be considered the osteoarthritis syndrome

8 T. Funck-Brentano, M. Cohen-Solal. Cytokine & Growth Factor Reviews 22 (2011)

9 T. Funck-Brentano, M. Cohen-Solal. Cytokine & Growth Factor Reviews 22 (2011)

10 Proc Natl Acad Sci U S A May 13;111(19): Bhumiratana S et Al

11 Il-4 IL-10 Il-13 Il-6 IL-15 Il-17 IL-18 Il-1 β

12 CIBO ARTROSI

156 articoli 27 selezionati 17 inclusi 8 US 2 India 1 UK Canada Australia Malesia Tailandia Turchia WHO defined CAM as health practices that involved diverse approaches to incorporate understand and

13 156 articoli 27 selezionati 17 inclusi 8 US 2 India 1 UK Canada Australia Malesia Tailandia Turchia WHO defined CAM as health practices that involved diverse approaches to incorporate understand and beliefs related to medicines of plant or animal origin, and other traditional or spiritual approaches to manage illness Alternative medical System : omeopatia medicina cinese tradizionale Mind Body Intervantion : tecniche che aumentano capacità mentali e fisiche Biologically based therapy : suppl. dietetici, prodotti a base di erbe o cartil di squalo Manipulative and Body based method: movimentazione di parti corporee Energy theraphy : uso di energie verso il corpo Journal of Clinical and Diagnostic Research Feb, Vol-10(2):

14 8 US 232 pts 2\3 sperimentato CAM (44% massaggi) 24% responders Utilizzatori + frequenti: OA pts NON condivisione con medico curante 480 pts 28% sperimentato CAM (90% chiropratica) 26% users di provenienza rurale 29% urbana Motivo utilizzo: non risposta dalla terapia convenzionale Popolazione ispanica e non ispanica in US 90% sperimentato CAM (31.2% integratori di glucosamina\condroitina) Motivo utilizzo: aiuto alla terapia convenzionale National Health Survey pts 75% sperimentato CAM (biologiche) 1121 OA pts 33% sperimentato CAM (90% chiropratica e massaggi) Popolazione afro-americana in US 95% sperimentato CAM (integratori di erbe) Maschi in prevalenza Journal of Clinical and Diagnostic Research Feb, Vol-10(2):

16 Deficit nutrizionali Errori nutrizionali

17 Deficit nutrizionali e artrosi 139 patients 71.4 years( ) 24% prevalence of vitamin D deficiency in group of elderly patients with advanced OA mean preoperative KSS significantly lower in the vitamin D deficient group than in the vitamin D sufficient group (31.5 vs 37.1, p=0.047) mean postoperative KSS at 6 months lower in the vitamin D deficient group (74.6 vs 80.4) difference not statistically significant (p=0.075).

18 Deficit nutrizionali e artrosi Ann Rheum Dis Apr;73(4): Moderate vitamin D deficiency is associated with changes in knee and hip pain in older adults: a 5-year longitudinal study. Laslett LL, Quinn S, Burgess JR, Parameswaran V, Winzenberg TM, Jones G Ding C Longitudinal population-based cohort study 769 randomly selected older adults mean 62 years; 50% M Serum 25-hydroxyvitamin D (25-OHD) assessed at baseline pain assessed at baseline, 2.6 and/or 5 years by WOMAC. Linear regression with adjustment for age, sex, body mass index and season, further adjusted for radiographic OA, BMLs, chondral defects and muscle strength. Mean total knee WOMAC score was 3.2 (range 0-39). 4.2% had moderate vitamin D deficiency at baseline (25-OHD nmol/l). 25-OHD <25 nmol/l predicted change in knee pain (using total WOMAC score) over 5 years (β=2.41, p=0.002) with a similar effect size for hip pain over 2.4 years (β=2.20, p=0.083). Results were consistent within pain subscales, and the association was independent of demographic, anthropometric and structural covariates..

19 Deficit nutrizionali e artrosi Rheumatology (Oxford).2014 Oct;53(10): doi: /rheumatology/keu178. Epub 2014 May 9. Serum 25-hydroxyvitamin D and the risk of knee and hip osteoarthritis leading to hospitalization: a cohort study of 5274 Finns. Konstari S, Kaila-Kangas L, Jääskeläinen T, Heliövaara M, Rissanen H, Marniemi J, Knekt P, Arokoski J, Karppinen J 5274 from National Health Examination Survey no knee or hip OA at baseline. Data from National Health Care Register. Follow-up of 10 years ( person-years), 127 subjects developed incident, physician-diagnosed OA in the knee and 45 in the hip joint. Covariates, including age, sex, education, BMI, work load, leisure time physical activity, smoking history, knee or hip complaint during the past month and previous injuries, gathered at baseline. Serum 25(OH)D concentrations were determined from baseline serum After adjustment for age and gender, serum 25(OH)D showed statistically significant associations with known risk factors for OA except injuries. In the fully adjusted model, low serum 25(OH)D concentration did not predict increased incidence of knee and hip OA

20 60,000 IU per day for 10 days followed by 60,000 IU once a month for 12 months

21 JAMA 2016 Mar 8;315(10): doi: /jama Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. Jin X, Jones G, Cicuttini F, Wluka A, Zhu Z, Han W, Antony B, Wang X, Winzenberg T, Blizzard L, Ding C. multicenter randomized, double-blind, placebo-controlled 413 enrolled participants (63.2 ; 50% F) 340 (82.3%) completed the study UI Vit D vs placebo level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/l) than in the placebo group (6.7 nmol/l) (P <.001) over 2 years. No significant differences in annual change of tibial cartilage volume or WOMAC pain score. No significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. AE ( 1 per patient) in 56 vitamin D group and in 37 placebo group (P =.04).

22 Deficit nutrizionali e artrosi 1626 chinese pts KL 2 OARSI atlas PLoS ONE (5): e

23 Buon profilo lipo-proteico cattivo profilo lipo-proteico

Errori nutrizionali e artrosi Mice were fed high-fat diets rich in various fatty acids (FAs) including saturated FAs (SFAs), ω-6 polyunsaturated FAs (PUFAs), and ω-3 PUFAs.

24 Errori nutrizionali e artrosi Mice were fed high-fat diets rich in various fatty acids (FAs) including saturated FAs (SFAs), ω-6 polyunsaturated FAs (PUFAs), and ω-3 PUFAs. OA was induced by destabilizing the medial meniscus. Wound healing was evaluated using an ear punch. OA, synovitis and wound healing were determined histologically, while bone changes were measured using microct. Activity levels and serum cytokines were measured at various time-points. Multivariate models were performed to elucidate the associations of dietary, metabolic, and mechanical factors with OA and wound healing.

25 Our results indicate that dietary FA content is a primary regulator of OA severity and wound regeneration with obesity, supporting the need for further studies of dietary FA supplements as a potential therapeutic approach for OA

26 overall prevalence of BML was 17 % (grade 1: 10.7 %, grade 2: 4.3 %, grade 3: 1.8 %)

27 1,001 knee OA, 993 hip OA and 933 control Increasing beer consumption was associated with an increasing risk of OA (P for trend 0.001). Compared to those who did not consume beer, aors for people who consumed 20 or more servings of beer were 1.93 (95% CI 1.26 to 2.94) and 2.15 (95% CI 1.45 to 3.19) for knee OA and hip OA, respectively increasing levels of wine consumption were associated with decreased likelihood of knee OA (P for trend <0.001). Compared to those who did not consume wine, aor for knee OA among those who consumed 4 to 6 glasses of wine per week and 7 glasses of wine per week was 0.55 (95% CI 0.34 to 0.87) and 0.48 (95% CI 0.29 to 0.80), respectively potential beneficial antioxidant activity and favourable modification of gut microbiota conferred by dietary polyphenols in wine

28 Clin Rheumatol Jan 19. Associations between dietary antioxidants intake and radiographic knee osteoarthritis. Li H, Zeng C, Wei J Yang T, Gao SG, Li YS, Lei GH cross-sectional associations between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee osteoarthritis (OA) pts. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) grade 2 in at least one leg. A multivariable logistic analysis model to test the relationship between dietary antioxidants (carotenoid, vitamin C, E, and selenium) intake and radiographic knee OA with adjustment of a number of potential confounding factors. A significant positive association between dietary vitamin C intake (P value for trend was 0.04 in multivariable adjusted analysis) and radiographic knee OA was observed. The relative OR of RX knee OA were increased by 0.39 times in the third quintile (OR 1.39, 95 % CI ), 0.42 times in the fourth quintile (OR 1.42, 95 % CI ), and 0.33 times in the fifth quintile (OR 1.33, 95 % CI ). RX knee OA was not significantly associated with dietary carotenoid, vitamin E, and selenium.

30 Missbach et al. (2015), PeerJ, 1337

32 OA e cibo: relazioni? Cibo come fonte di terapie farmacologiche per l artrosi P&T June 2014 Vol. 39 No. 6

33 Cibo come terapia per l artrosi Il-4 IL-10 Il-13 Il-6 IL-15 Il-17 IL-18 Il-1 β

34 Curcuma

35 Cibo come terapia per l artrosi

36 Avocado-soybean unsaponifiables

37 Avocado-soybean unsaponifiables

38 Boswellia serrata

39 49 randomised controlled studies (33 interventions, 5980 participants) were included. 17 studies of confirmatory design (sample and effect sizes pre-specified) were mostly at moderate risk of bias. The remaining 32 studies of exploratory design were at higher risk of bias.

40 Vit D : effetti controversi Magnesio: possibili effetti protettivi Grassi saturi: effetto accellerante OA Vino: effetto protettivo? birra accellerante Vit C: possibile effetto accellerante? Boswellia\ ASU\ curcuma: antiossidanti Glutine:????

Xingzhong (Jason) Jin

Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain among Patients with Symptomatic Knee Osteoarthritis: a Randomized Controlled Trial Xingzhong (Jason) Jin Research Fellow, NDARC,