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