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Nutrition for JointHealthOARSI 2003 World Congresson OsteoarthritisOctober, 14 -Berlin, Germany Kristine Clark, Ph.D., R.D. Director of Sports Nutrition Penn State Orthopedics The Pennsylvania State University
Factors effecting joint health • Weight • Normal Aging Process • Impact of physical activity (frequency/duration) • Food choices/nutrients • Supplements
Osteoarthritis • Most common type of arthritis • The leading cause of physical disability in people > 65 years of age • One quarter of adults > 55 years have knee pain > 1 month/year - 50% have associated radiological changes of OA - 50% have associated and physical disability - 1.6% are severely disabled • The numbers with physical disability associated with OA will rise by 66% by 2020
How does weight impact joints?Compression? 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
Overweight or obese BMI >25.0 Overweight BMI 25.0-29.9 Prevalence of Overweight and Obesity Among US Adults, Age 20-74 Years* Percent Obese BMI ≥30.0 NHANES II 1976-80 (n=11207) NHANES III 1988-94 (n=14468) NHANES 1999 (n=1446) NHANES III 1999-2000 (n=4115) 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.
Assuming weight gain at the present rate Obesity rate will be 39% .1 NHANES III 1988-1994 .08 .06 NHANES 1999-2000 .04 Projected 2008 .02 0 10 20 30 40 50 60 BMI BMI Shift: 2008 HillJO, Wyatt HR, et al. Science Feb 2003
RAND Institute DATA R. Sturm. Health Affairs 21:2002 pg 245-253.
Body Mass Index Impacts OA Risk of knee OA increased from 0.1 for a BMI <20 to 13.6 for a BMI of 36 kg/m2 or higher Coggon, D.et al. Intl J. Obesity,(2001) 25:622-627 Reduction of weight by 5 kg or decrease in body mass, 24% of surgical cases of OA of the knee could be avoided
Aging • 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 physical activity • Frequency and duration • Mode of activity (running vs walking) • Chronic stress on joints?
Athletes vs Exercisers • Olympic athletes train 6-7 hours/day • Collegiate athletes train 3-4 hours/day • 32% of U.S. population exercises regularly • 30-60 minutes (3-7 days /week) • Strong interest in voluntary prevention of joint discomfort
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
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
Dietary Patterns affecting Nutrient Intake • Fast Food Diets - vitamin C, D, calcium • Vegetarian diets - protein, calcium • Food Frequency/ Random Food Selection - may have one or two servings of meat or dairy products per week (daily nutrient needs ?) • Nutrient Profile of US Population based on RDA’s: • 26% consume < 75% vitamin C • 44.5% consume < 75% calcium • 11.6% consume < 75% phosphorus • 8.0% consume < 75% protein Reference:CSFII data: 1997
Awareness of Food Related Issues:Dietary Supplements 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:Nutritional supplements taken for joint discomfort • Ginger • Omega 3 fatty acids • Gamma Linoleic Acid (GLA’s) • Glucosamine • Condroitin Sulfate • Collagen Hydrolysate/ Gelatine Hydrolysate
Sources of Nutrition Information • Television (>75%) • Magazine • Newspaper • Reference/general books • Family/Friends • Radio • Doctors (<10%) • Internet • Work/job • School (<5%) From: ADA Nutrition and You: Trends 2002 final report.
Nutrition and Joint Health Treat or Prevent or a continuum? At Risk Populations: 1. Older individuals experiencing joint discomfort due to normal aging 2. Overweight individuals in the long process of weight loss 3. Athletes and Recreational Exerciser
Using the Cardiovascular Disease Model? In conclusion: MULTIFACTORIAL APPROACH • Physical Activity • Amount? • Balanced Diet • Calories/Macronutrients • Micronutrients • Dietary Supplement Recommendations? • Safety, Experimental and Clinical Data • Clinical observation: Use with Clients
Collagen-Hydrolysate Odorless, flavorless white powder Cold water soluble, non gelling Obtained by the enzymatic degradation of collagen Mean M.W. 3.5 kD (peptides ranging from 0.5-13 kD)
Absorption profile of collagen-hydrolysate Collagen-Hydrolysate UV absorption [%] control (0.9% NaCl) time [min]
Radioactivity in cartilage after oral administration of [14C]- collagen-hydrolysate [14C]- collagen-hydrolysate P < 0,01 radioactivity in cartilage [Bq / g tissue] [14C]- proline time [h] MW ± SD, n = 6
Stimulation of type II collagen secretion Collagen hydrolysate (0.5 mg/ml) Control (BM) Type II collagen [µg / µg DNA] P < 0,01 Culture Time [days] MW ± SD, n = 4
Immuncytochemical visualisation of type II collagen Detection of newly synthesized collagen II (brown coloring) Control Collagen-Hydrolysate Culture day 11
Dose-dependent stimulation of type II collagen secretion P < 0,01 P < 0,01 Type II collagen [µg / µg DNA] MW ± SD, n = 6 Collagen-Hydrolysate [mg / ml]
Collagen-Fragments Synthesis and maintenance of the ECM by chondrocytes MATRIX Catabolism Anabolism Collagen Hydrolsate Proteases Collagen (Type II) PG (Aggrecan) Chondrocyte Regulation
Increase of pericellular proteoglycans Collagen hydrolysate (0.5 mg/ml) Control (BM) P < 0,05 O.D. / 1 Mio cells MW ± SD, n = 4 Culture Time [days]
Summary of the experimental findings Collagen hydrolysate treatment: chain of evidences Absorption Collagen hydrolysate peptides pass the intestinal wall after oral application and appear in the blood stream Distribution Collagen hydrolysate accumulates in cartilage tissue Stimulation Collagen hydrolysate stimulates type II collagen and aggrecan biosynthesis Collagen hydrolysate can support the maintenance and regeneration of cartilage tissue
Clinical studies All studies support the positive effect of collagen hydrolysate on joint health: - Significant reduction of pain - Reduced need for analgesics - Improvement of joint mobility Overall clinical studies are supporting the experimental results
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 Summary Therapeutic value of collagen hydrolysate