Association of low dietary vitamin K intake with radiographic knee osteoarthritis in the Japanese elderly population: dietary survey in a population-based cohort of the ROAD study

doi:10.1007/s00776-009-1395-y

Journal of Orthopaedic Science

Volume 14, Issue 6, November 2009, Pages 687-692

https://doi.org/10.1007/s00776-009-1395-y Get rights and content

Abstract

Background

The present study sought to identify dietary nutrients associated with the prevalence of radiographic knee osteoarthritis (OA) in the Japanese elderly of a population-based cohort of the Research on osteoarthritis Against Disability (ROAD) study.

Methods

From the baseline survey of the ROAD study, 719 participants ≥ 60 years of age (270 men, 449 women) of a rural cohort were analyzed. Dietary nutrient intakes for the previous 1 month were assessed by a self-administered brief diet history questionnaire. The radiographic severity at both knees was determined by the Kellgren/Lawrence (KL) system.

Results

The prevalence of knee OA of KL ≥ 2 was 70.8%. Age, body mass index, and female sex were positively associated with the prevalence. Among the dietary factors, only vitamin K intake was shown to be inversely associated with the prevalence of radiographic knee OA by multivariate logistic regression analysis. The presence of joint space narrowing of the knee was also inversely associated with vitamin K intake. The prevalence of radiographic knee OA for each dietary vitamin K intake quartile decreased with the increased intake.

Conclusions

The present cross-sectional study using a population-based cohort supports the hypothesis that low dietary vitamin K intake is a risk factor for knee OA. Vitamin K may have a protective role against knee OA and might lead to a disease-modifying treatment.

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The knee is the most common site for OA [5]. Risks for knee OA include knee injury, previous knee surgery, lifting, occupational bending, as well as obesity and dietary risk factors [6-8]. The exact pathology of OA remains unclear, however, several studies have found that inflammation is the major mechanism that contributes to the pathogenesis of OA at the early stages [9,10].
The association between vitamin D status and osteoarthritis (OA) and bone remodeling has been shown previously. The present study was conducted to determine the association between vitamin D status and inflammatory biomarkers and clinical symptoms in patients with knee OA.
This case–control study was performed on 124 subjects with mild to moderate knee OA and 65 healthy controls. Demographic data was collected from all participants at baseline. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Index) for evaluating the severity of clinical symptoms in these patients. Serum levels of vitamin D as well as markers of inflammation including interleukin 1-β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and nuclear factor k-B (NF-κB) p65 were evaluated for each participant.
The results of the present study showed that patients with knee OA had lower levels of vitamin D and higher levels of IL-1β, TNF-α, hs-CRP, and NF-кB p65 compared with healthy controls (P < 0.0001). The levels of IL-1β, TNF-α, and NF-кB p65 in knee OA patients with vitamin D insufficiency were significantly higher compared with the knee OA patients with sufficient vitamin D (P < 0.05). Based on the linear regression analysis, serum vitamin D levels were inversely correlated with IL-1β, TNF-α, hs-CRP, and NF-кB p65 levels (P < 0.0001). Patients with sufficient vitamin D levels had lower total and physical function WOMAC scores compared with patients with vitamin D insufficiency (P = 0.011 and P = 0.010, respectively).
The results suggest a strong link between vitamin D deficiency and increased inflammatory biomarkers as well as increased severity of clinical symptoms in knee OA patients.
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Osteoarthritis (OA) is one of the most common forms of arthritis. Pain from OA is a major clinical manifestation as well as a key factor leading patients to seek medical care and an important antecedent to functional disability. With the aging of the population and the obesity epidemic globally, OA will become a great burden on society. Structural pathological lesions of joints can be assessed with plain radiographs; however, the clinical diagnosis of OA is often made based on symptoms and findings from physical examination. OA is more common in women than in men, and incidence and prevalence of OA increase with age. Overweight/obesity and joint injury are two most common risk factors for OA. Thus, weight control and avoiding joint injury as well as overuse of joint are two effective measures to reduce the risk of OA. Approximately two-thirds of patients with OA have comorbidities, including gastrointestinal and cardiovascular diseases. Coexistence of OA and other diseases could be due to either shared risk factors, such as old age and overweight/obesity, or as attributed to OA, such as pain, immobility, low-grade inflammation, and frequent use of pain-relief medications. Strategies aiming to prevent OA occurrence and to mitigate the risk of toxic effects of medications could reduce the burden of OA and its comorbidities on individuals and society.
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We found a relationship between dietary Vitamin K with structural progression of knee osteoarthritis measured by quantitative JSW in a dose response manner. When stratified among KL groups, a significant trend was seen in the KL2 (p < 0.025)
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Citation Excerpt :
There is evidence that the prevalence of knee OA is higher in some Asian regions. Results from a systematic review53 point to overall prevalences of radiographic knee OA ranging from 6.5% in the Netherlands54 to 70.8% in Japan.55 Prevalences of sxKOA across the globe were slightly lower, where the lowest was found in Italy (5.4%)56 and Greece (6.3%) and the highest in Korea (24.2%).57

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: We declare that we have no conflict of interest regarding the present manuscript.

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Original articleAssociation of low dietary vitamin K intake with radiographic knee osteoarthritis in the Japanese elderly population: dietary survey in a population-based cohort of the ROAD study

Abstract

Background

Methods

Results

Conclusions

Nutrition

J Nutr

Nutrition

Blood

Cell

J Mol Cell Cardiol

Biochem Biophys Res Commun

Osteoarthritis Cartilage

Epidemiology of osteoarthritis

Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study

Ann Intern Med

Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis?

Arthritis Rheum

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Curr Opin Rheumatol

Osteoarthritis and nutrition: from nutra-ceuticals to functional foods: a systematic review of the scientific evidence

Arthritis Res Ther

Low vitamin K status is associated with osteoarthritis in the hand and knee

Arthritis Rheum

Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies

Arthritis Rheum

Original article
Association of low dietary vitamin K intake with radiographic knee osteoarthritis in the Japanese elderly population: dietary survey in a population-based cohort of the ROAD study