The effectiveness of dietary intervention in osteoarthritis management: a systematic review and meta-analysis of randomized clinical trials.

Abstract

This study aimed to evaluate the impact of various dietary interventions on managing osteoarthritis (OA), a condition significantly affecting global health due to joint alterations driven by inflammatory mediators. A systematic review and meta-analysis, adhering to PRISMA guidelines, examined Randomized Controlled Trials (RCTs) investigating dietary interventions in OA. Two reviewers independently conducted study selection, data extraction, and quality assessment. Random effects models calculated standardized mean differences (SMD) and mean differences (MD). Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB2), and heterogeneity was assessed using I² values. Nine RCTs (898 participants) were identified, assessing various diets: reduced energy (n = 4), Mediterranean (n = 2), low-fat (n = 2), anti-inflammatory (n = 1), low-carbohydrate (n = 1), and plant-based (n = 1). Dietary interventions significantly improved pain (SMD: -0.67; 95% CI: [-1.01, -0.34]; p < 0.0001), and physical function (SMD: -0.62; 95% CI: [-0.94, -0.30]; p = 0.0001) and body weight (MD: -3.18; 95% CI: [-3.52, -2.83], p < 0.0001). Subgroup analyses revealed reduced energy diets improved pain (SMD: -0.85; 95% CI: [-1.15, -0.55], p < 0.0001), physical function (SMD: -0.95; 95% CI: [-1.33, -0.58], p < 0.0001) and body weight (MD: -3.13; 95% CI: [-3.77, -2.49], p < 0.0001). The Mediterranean diet did not significantly impact pain (SMD: -0.27; 95% CI: [-1.14, 0.60], P = 0.54), or physical function (SMD = -0.28; 95% CI: [-0.79, 0.24], p = 0.29). This study emphasizes the significant impact of dietary interventions on pain, physical function, and weight management in people with OA, with reduced energy diets showing the most effectiveness. Specific dietary patterns show promise but require further investigation.