Nutrition for Joint HealthOARSI 2003 World Congress
on OsteoarthritisOctober, 14 -Berlin, Germany
Nutrition for Joint HealthOARSI 2003 World Congress
on OsteoarthritisOctober, 14 -Berlin, Germany
Kristine Clark, Ph.D., R.D.Director of Sports Nutrition
Penn State OrthopedicsThe Pennsylvania State University
Kristine Clark, Ph.D., R.D.Director of Sports Nutrition
Penn State OrthopedicsThe Pennsylvania State University
Factors effecting joint Factors effecting joint healthhealth
Factors effecting joint Factors effecting joint healthhealth
WeightWeight
Normal Aging ProcessNormal Aging Process
Impact of physical activity Impact of physical activity (frequency/duration)(frequency/duration)
Food choices/nutrientsFood choices/nutrients
SupplementsSupplements
WeightWeight
Normal Aging ProcessNormal Aging Process
Impact of physical activity Impact of physical activity (frequency/duration)(frequency/duration)
Food choices/nutrientsFood choices/nutrients
SupplementsSupplements
OsteoarthritisOsteoarthritis• Most common type of arthritisMost common type of arthritis• The leading cause of physical disability in people > The leading cause of physical disability in people >
65 years of age65 years of age• One quarter of adults > 55 years have knee pain > 1 One quarter of adults > 55 years have knee pain > 1
month/yearmonth/year- 50% have associated radiological changes of OA- 50% have associated radiological changes of OA- 50% have associated and physical disability- 50% have associated and physical disability- 1.6% are severely disabled- 1.6% are severely disabled
• The numbers with physical disability associated with The numbers with physical disability associated with OA will rise by 66% by 2020OA will rise by 66% by 2020
How does weight impact joints?Compression? Compression?
Sedentary lifestyle? Sedentary lifestyle?
How does weight impact joints?Compression? Compression?
Sedentary lifestyle? Sedentary lifestyle?
In the U. S.- obesity is the new epidemic– 64% of all adults are overweight
or obese
– Men and women
– All ethnicities
– 6 of 10 children are either overweight or obese
In the U. S.- obesity is the new epidemic– 64% of all adults are overweight
or obese
– Men and women
– All ethnicities
– 6 of 10 children are either overweight or obese
47
32
15
56
33
23
61
34
27
65
3431
0
10
20
30
40
50
60
70
Prevalence of Overweight and Obesity
Among US Adults, Age 20-74 Years*Overweight or
obeseBMI >25.0
Overweight BMI 25.0-29.9
Obese BMI ≥30.0
Percent
BMI = body mass index.*Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years.
NHANES II1976-80
(n=11207)
NHANES III1988-94
(n=14468)
NHANES 1999
(n=1446)
NHANES III1999-2000(n=4115)
BMI Shift: 2008
• Assuming weight gain at the present rate
• Obesity rate will be 39%
BMI10 20 30 40 50 60
0
.02
.04
.06
.08
.1
NHANES III1988-1994
NHANES1999-2000
Projected 2008
Hill JO, Wyatt HR, et al. Science Feb 2003
RAND Institute DATA
R. Sturm. Health Affairs 21:2002 pg 245-253.
Body Mass Index Impacts OABody Mass Index Impacts OA
Risk of knee OA Risk of knee OA increased from 0.1 for increased from 0.1 for a BMI <20 to 13.6 for a BMI <20 to 13.6 for a BMI of 36 kg/ma BMI of 36 kg/m2 2 or or higherhigher
Coggon, D.et al. Intl J. Obesity,(2001) 25:622-627
Reduction of weight by Reduction of weight by 5 kg or decrease in 5 kg or decrease in body mass, 24% of body mass, 24% of surgical cases of OA surgical cases of OA of the knee could be of the knee could be avoided avoided
AgingAging
We’re living longer
More people over 80
Maintenance of mobility to prevent other chronic diseases
We’re living longer
More people over 80
Maintenance of mobility to prevent other chronic diseases
Impact of long term physical activity on joint
health
Impact of long term physical activity on joint
health Impact of physical activity
Frequency and durationMode of activity (running vs
walking)
Chronic stress on joints?
Impact of physical activity Frequency and durationMode of activity (running vs
walking)
Chronic stress on joints?
Athletes vs ExercisersAthletes vs Exercisers
• Olympic athletes train 6-7 hours/dayOlympic athletes train 6-7 hours/day
• Collegiate athletes train 3-4 hours/dayCollegiate athletes train 3-4 hours/day
• 32% of U.S. population exercises regularly32% of U.S. population exercises regularly– 30-60 minutes (3-7 days /week)30-60 minutes (3-7 days /week)– Strong interest in voluntary prevention of joint
discomfort
Nutrition and Food Selection
Nutrition and Food Selection
Food choice matters for delivery of optimal nutrients– Nutrients that play a role in healthy
collagen,bone,and cartilage formation
Calcium Protein
Vitamin D Vitamin C
Phosphorus Zinc
Food choice matters for delivery of optimal nutrients– Nutrients that play a role in healthy
collagen,bone,and cartilage formation
Calcium Protein
Vitamin D Vitamin C
Phosphorus Zinc
NUTRIENTS AND FOODS AFFECTING BONE, CARTILAGE, AND
COLLAGEN FORMATION
NUTRIENTS AND FOODS AFFECTING BONE, CARTILAGE, AND
COLLAGEN FORMATION Calcium - dairy products, fish bones
Vitamin D - milk, sunlight
Phosphorus - animal based foods
Vitamin C - citrus fruits, juices, vegetables
Protein - milk, eggs, meats, fish, grains, vegetables, beans, nuts, seeds
Calcium - dairy products, fish bones
Vitamin D - milk, sunlight
Phosphorus - animal based foods
Vitamin C - citrus fruits, juices, vegetables
Protein - milk, eggs, meats, fish, grains, vegetables, beans, nuts, seeds
Dietary Patterns affecting Nutrient Dietary Patterns affecting Nutrient IntakeIntake
• Fast Food Diets Fast Food Diets - vitamin C, D, calcium- vitamin C, D, calcium• Vegetarian diets Vegetarian diets - protein, calcium - protein, calcium • Food Frequency/ Random Food SelectionFood Frequency/ Random Food Selection - may have - may have
one or two servings of meat or dairy products per week one or two servings of meat or dairy products per week (daily nutrient needs ?)(daily nutrient needs ?)
• Nutrient Profile of US Population based on RDA’s:Nutrient Profile of US Population based on RDA’s:
– 26% consume < 75% vitamin C26% consume < 75% vitamin C– 44.5% consume < 75% calcium44.5% consume < 75% calcium– 11.6% consume < 75% phosphorus11.6% consume < 75% phosphorus– 8.0% consume < 75% protein8.0% consume < 75% proteinReference:CSFII data: 1997Reference:CSFII data: 1997
Awareness of Food Related Issues:Dietary Supplements
0%
10%
20%
30%
40%
50%
60%
Level of Awareness
A lotSomeA little
From: ADA Nutrition and You: Trends 2002 final report.
Percent of U.S. Population using Dietary Supplements
(data from NHANES III)
From: Dickinson A. The Benefits of Nutritional Supplements. Council for Responsible Nutrition 2002.
Demographics of Supplement Use
• Women Most Likely to use Supplements– Former smokers– Former alcohol users/abusers– Those who exercise regularly– Those who use non-conventional healthcare– Those diagnosed with chronic health problems
From: Vitamin-Mineral Supplement use Among U.S Women 2000. Journal of the American Medical Women’s Association July 2000.
Clinical Practice:Clinical Practice:Nutritional supplements taken Nutritional supplements taken
for joint discomfortfor joint discomfort– GingerGinger– Omega 3 fatty acidsOmega 3 fatty acids– Gamma Linoleic Acid (GLA’s)Gamma Linoleic Acid (GLA’s)– Glucosamine Glucosamine – Condroitin SulfateCondroitin Sulfate– Collagen Hydrolysate/ Gelatine HydrolysateCollagen Hydrolysate/ Gelatine Hydrolysate
Sources of Nutrition Information1. Television (>75%)2. Magazine3. Newspaper4. Reference/general books5. Family/Friends6. Radio7. Doctors (<10%)8. Internet9. Work/job10. School (<5%)
From: ADA Nutrition and You: Trends 2002 final report.
Nutrition and Joint HealthNutrition and Joint Health
Treat or Prevent or a continuum?Treat or Prevent or a continuum?At Risk Populations:At Risk Populations:
1.1. Older individuals experiencing joint Older individuals experiencing joint discomfort due to normal agingdiscomfort due to normal aging
2. Overweight individuals in the long process of 2. Overweight individuals in the long process of weight lossweight loss
3. Athletes and Recreational Exerciser3. Athletes and Recreational Exerciser
Using the Cardiovascular Disease Using the Cardiovascular Disease Model?Model?
In conclusion: MULTIFACTORIAL APPROACHIn conclusion: MULTIFACTORIAL APPROACH
– Physical ActivityPhysical Activity• Amount?Amount?
– Balanced Diet Balanced Diet • Calories/Macronutrients Calories/Macronutrients • MicronutrientsMicronutrients
– Dietary Supplement Recommendations?Dietary Supplement Recommendations?• Safety, Experimental and Clinical DataSafety, Experimental and Clinical Data• Clinical observation: Use with ClientsClinical observation: Use with Clients
22
Collagen-HydrolysateCollagen-Hydrolysate
Obtained by the enzymatic degradationof collagen
Mean M.W. 3.5 kD (peptides ranging from 0.5-13 kD)
Cold water soluble, non gelling
Odorless, flavorless white powder
UV
ab
sorp
tio
n [
%]
time [min]
Collagen-HydrolysateCollagen-Hydrolysate
control (0.9% NaCl) control (0.9% NaCl)
Absorption profile of collagen-hydrolysate Absorption profile of collagen-hydrolysate
MW ± SD, n = 6
[14C]- collagen-hydrolysate[14C]- collagen-hydrolysate
[14C]- proline[14C]- proline
P < 0,01
Radioactivity in cartilage after oral administration of[14C]- collagen-hydrolysateRadioactivity in cartilage after oral administration of[14C]- collagen-hydrolysate
time [h]
rad
ioac
tivi
ty in
car
til a
ge
[Bq
/ g
ti s
sue]
MW ± SD, n = 4 Culture Time [days]
P < 0,01
Stimulation of type II collagen secretion Stimulation of type II collagen secretion
Typ
e II
co
llag
en [
µg
/ µ
g D
NA
]
Collagen hydrolysate (0.5 mg/ml)
Control (BM)
Immuncytochemical visualisation of type II collagenImmuncytochemical visualisation of type II collagen
Control Collagen-Hydrolysate
Culture day 11
Detection of newly synthesized collagen II (brown coloring)
MW ± SD, n = 6
P < 0,01 P < 0,01
Collagen-Hydrolysate [mg / ml]
Dose-dependent stimulation of type II collagen secretionDose-dependent stimulation of type II collagen secretion
Typ
e II
co
llag
en [
µg
/ µ
g D
NA
]
Catabolism Anabolism
Collagen (Type II)PG (Aggrecan)
Synthesis and maintenance of the ECM by chondrocytesSynthesis and maintenance of the ECM by chondrocytes
Proteases
Collagen-Fragments
Collagen Hydrolsate
Collagen Hydrolsate
Chondrocyte
Regulation
O.D
. /
1 M
io c
ells
MW ± SD, n = 4
P < 0,05
Increase of pericellular proteoglycansIncrease of pericellular proteoglycans
Culture Time [days]
Collagen hydrolysate (0.5 mg/ml)
Control (BM)
Summary of the experimental findingsSummary of the experimental findings
Collagen hydrolysate treatment: chain of evidencesCollagen hydrolysate treatment: chain of evidences
Collagen hydrolysate peptides pass the intestinal wallafter oral application and appear in the blood stream
AbsorptionAbsorption
DistributionDistribution
StimulationStimulation
Collagen hydrolysate accumulates in cartilage tissue
Collagen hydrolysate stimulates type II collagen and aggrecan biosynthesis
Collagen hydrolysate can support the maintenance and regeneration of cartilage tissue
31
Overview of clinical studiesOverview of clinical studies
32
Clinical studiesClinical studies
All studies support the positive effect of collagen hydrolysate on joint health:
Overall clinical studies are supporting theexperimental results
Overall clinical studies are supporting theexperimental results
- Significant reduction of pain- Significant reduction of pain
- Reduced need for analgesics- Reduced need for analgesics
- Improvement of joint mobility- Improvement of joint mobility
SummarySummary
Therapeutic value of collagen hydrolysateTherapeutic value of collagen hydrolysate
Important for the maintenance of healthy cartilage tissue
Reduction of degenerative alterations in cartilage tissue
Lack of any adverse side effects even with long-term use
Overall improvement of joint health