The Relationship Between Diet and Osteoarthritis: Part 2
Plant and Animal-Based Foods
A case-control study in India found a lower intake of fruits and a higher intake of green leafy vegetables in patients with knee OA (Sanghi et al., 2014).
Some fruits have also been clinically tested for their efficiency in patients with OA. 40g of freeze-dried blueberries have been tested in a randomized, double-blind, placebo-controlled manner in regard to their effectiveness in improving inflammatory markers beside pain and functional assessments in the WOMAC questionnaire. The blueberries reduced pain and difficulty to perform daily activities, improved gait performance, but didn´t influence the inflammatory markers after 17 weeks (Du et al., 2019).
50g of freeze-dried strawberries were also tested with a comparable research design and included several inflammatory markers and the ICOAP Pain Questionnaire. It found a significant reduction in pain and biomarkers IL-6, IL1β and MMP-3, but not in C-reactive protein and MMP-8 after 26 weeks (Schell et al., 2017). Strawberries might also decease serum TNF- α and lipid peroxidation products in adults with OA (Basu et al., 2018).
200ml of pomegranate juice was tested against a control group and showed a significant intra- group reduction in stiffness and total score but no reduction in pain in the WOMAC index (Ghoochani et al., 2016). Beside that, an increase in physical function score was observed. MMP- 13 levels increased in the control group and remained the same in the pomegranate group leaving a significant between-group difference. MMP-1 stayed the same in the control group while being reduced in the intervention group also leaving a significant between-group difference. MMP-13 and MMP-1 play a role in cartilage matrix breakdown via digestion of type 2 collagen and release of matrix proteoglycans. Another research group tested the effects of 150mg encapsulated passion fruit peel extract for 8 weeks against placebo (Faird et al., 2010). The intervention group showed a significant improvement in WOMAC total, physical function, and pain score while stiffness was not improved.
A 2008 meta-analysis with the 3 available studies at that time showed a reduction in WOMAC pain, stiffness, and physical function scores by administration of 5g of rosehip powder compared to placebo in patients with knee OA, but with conflicting results for the use of pain medications (Christensen et al., 2008).
In a 2015 meta-analysis of randomized controlled trials with a placebo group oral ginger was examined for its effects in patients with knee or hip OA (Bartels et al., 2015). 500mg to 1000mg of ginger extract showed a reduction in pain and disability. A newer 2017 study compared ginger extract with unknown dosage and 1% diclofenac gel after 12 weeks. Both groups improved WOMAC and Patient Global Assessment score with no differences between groups (Amorndoljai et al., 2017).
1000mg of garlic has also been tested in a randomized, double-blind, placebo-controlled trial in patients with knee OA, showing no effect of garlic for improving pain, stiffness, or physical function scores (Salimzadeh et al., 2018).
40g of sesame has also been tested against a control group for 2 months (Sadat et al., 2013). The sesame and control groups Knee Injury and Osteoarthritis Outcome Score (KOOS) and timed-up and go test improved similarly but no statistical test for a comparison of the two groups was done. VAS scale improved more in the sesame group again with no between-group comparison.
Black cumin is another spice tested in a randomized, double-blind trial against placebo. 2g of black cumin powder were given to patients with knee OA showing no between-group differences in KOOS (Salimzadeh et al., 2017).
In a case-control study, regular soy-milk consumption of over or under once a day showed a lower prevalence of osteophytes while not influencing joint space narrowing (Li et al., 2016). In a direct comparison between either 40g of soy or milk-based protein for 3 months both proteins improved knee range of motion, hindrance of activities of daily living and limitations to exercise while also improving work performance and productivity (Arjmandi et al., 2004). In Men soy protein supplementation also improved pain medication use and biomarkers of cartilage metabolism.
In a cohort study, no association was found with eating processed meat under 1.5 times to over 4, chicken under 1.5 times to over 3.5 times, or fish under 1 time to over 2.5 times per week and the risk of getting a hip or knee replacement done (Wang et al., 2011). Eating fresh red meat over 6.5 times per week compared to 3 – 4.4 times per week decreased the relative risk of needing a hip replacement by 6%, while not being associated with needing a knee replacement.
A case-control study found lower odds of radiologically diagnosed knee OA in daily milk consumers, while no association with cheese or yoghurt was found (Kaçar et al., 2004). Another case-control study also found a higher intake of milk, milk products and meat in patients without compared to patients with OA of the knee (Sanghi et al., 2014). In a cross-sectional study it was also found that the intake of over 3.3 servings per day compared to 1.9 servings a day of full- fat dairy reduced the relative risk for knee OA by 32%. The consumption of over 1.7 servings per day compared to under 0.7 servings per day reduced the risk by 27% were most of the effect comes from the consumption of full-fat dairy (Denissen et al., 2019). No association was found for total dairy, semi-skimmed milk, skimmed dairy, non-fermented dairy, fermented dairy, unflavoured milk, yoghurt, and total cheese.
Longitudinal data from the OA Initiative revealed a dose-response relationship for a reduction in joint space width and milk consumption with the best outcome at over 7 glasses a week. This association was not found for men (Lu et al., 2014). A randomized, double-blind, active controlled trial gave participants a milk-based beverage with milk protein concentrate fortified with some vitamins and minerals (Colker et al., 2002). WOMAC total score and daily activities improved compared to the control group, while sport function, knee symptoms and knee pain were unchanged.
The Microbiome and Osteoarthritis
The microbiome is defined as a characteristic microbial community occupying a reasonable well-defined habitat which has distinct physio-chemical properties and communicates with the different systems and organs of the human body, so one might also assume a connection with the joints. As shown in part 1 of this blog series, it has been shown that certain strains of probiotics might differentially influence OA.
In the study by Coulsen on green-lipped mussel extract it was shown that OA symptoms improved, and Clostridium and Staphylococcus species tended to decrease while Lactobacillus, Streptococcus and Eubacterium species tended to increase. In the Rotterdam cohort study, it was shown that the abundance of Streptococcus species is associated with an increase in knee pain (Boer et al., 2019). It is important to know that “Streptococcus species” refers to the general genus of this bacteria that include different species in that genus which might have different effects. It was also shown that the abundance of lipopolysaccharides as a pro-inflammatory secondary metabolite of microbiome gram-negative bacteria found in the joints of patients with knee OA are associated with an increased abundance of activated macrophages in the knee, osteophyte and joint space narrowing severity, WOMAC total score and self-reported knee pain score (Huang et al., 2016).
In terms of nutrition, dietary fibre and phytonutrients exert the most beneficial effects for the microbiome because those can be metabolized be certain parts of the microbiome which thrive on a fibre and phytonutrient rich diet (30+ grams of fibre with lots of variety in whole plant-based foods per day) and produce secondary metabolites which have physiological effects outside the gut. A diet-modulating effect of fibre has been shown earlier, but it has not yet been researched if the mediating effect comes from an effect of fibre on the microbiome.
Dietary Patterns and Osteoarthritis
As mentioned above, inflammation plays a role in the aetiology of OA. The dietary inflammatory index (DII®) is a dietary tool developed to assess the overall inflammatory potential of an individual’s diet with higher values to be associated with some elevated inflammatory markers (Shivappa et al., 2014). It was shown that a more pro-inflammatory diet increased the risk for symptomatic knee OA (Veronese et al., 2017). In another cross-sectional study, it has been shown that a good overall diet quality was not associated with knee structure and OA symptoms but associated with greater limb muscle strength, lower depressive symptoms and better quality of life which was mainly driven by vegetable intake (Ruan et al., 2021). For the progression of existing knee OA, it has been shown that a standard western diet is associated with more severe radiographic and symptomatic progression of knee OA. On the other hand, an overall healthier dietary pattern decreased the risk of radiographic and symptomatic OA progression (Xu et al., 2020).
A dietary pattern that has generally been advised as health promoting is the Mediterranean Diet. Two cross-sectional studies assessed how following a Mediterranean Diet might influence OA. In one study a higher adherence to a Mediterranean Diet decreased the prevalence for knee OA, especially driven by the consumption of healthy cereals. In another study quality of life, physical function and mental health increased with increased adherence to the Mediterranean Diet while pain, stiffness and disability and depressive symptoms decreased (Veronese et al., 2016; Veronese et al., 2016). A 2019 longitudinal study found that a higher adherence to a Mediterranean Diet reduced the risk of pain worsening in people with knee OA and reduced the risk of symptomatic incident radiographic knee OA but not incident asymptomatic radiographic knee OA after 4 years (Veronese et al., 2019). In an interventional trial, patients with OA were randomized to either following a Mediterranean Diet or their normal diet for 16 weeks (Dyer et al.., 2017). The Arthritis Impact Measurement Scale questionnaire showed no differences between groups and only the inflammatory biomarker IL-1α decreased in the intervention group while also a significant improvement in knee flexion and hip rotation in the Mediterranean Diet group was seen. A small decrease of 1,5 Kg of body weight was also seen. It is also important to notice that only 30 of the 50 participants in the intervention group achieved a predefined high compliance with the Mediterranean Diet.
See below a summary of common diets / dietary patterns.
|Standard western diet||High in energy, red and processed meat, sugar, desserts, sweets, and sugar sweetened beverages, refined grains, salt, and high fat dairy products|
|Low in fish, fibre, fruits and vegetables, whole grains, legumes, nuts, and seeds|
|Synthesized guidelines world-wide recommendations||High in fruits and vegetables, whole grains, legumes, nuts, and water|
|Moderate in in energy, fish, white meat, eggs, and dairy products|
|Low in red and processed meat, sugar, desserts, sweets, and sugar sweetened beverages, refined grains, salt, and alcohol|
|Mediterranean diet||High in fruits and vegetables, whole grains, legumes, nuts and seeds, native oils, fish|
|Moderate in energy, white meat, dairy products, eggs, refined grains, and wine|
|Low in red and processed meat, sugar, desserts, sweets, and sugar sweetened beverages, and salt|
Researchers also examined whether a low-carb of low-fat diet would improve functional pain, self-reported pain, quality of life and depressive symptoms in patients with knee OA after 3 months (Strath et al., 200). Patients were assigned to either a control, low-carb or low-fat diet. The low-carb dieters were instructed to restrict their total carbohydrate intake to 20g to 40g per day with a restriction in fruits and while vegetables were permitted in limited quantities of two cups of leafy greens and one cup per day of non-starchy vegetables. The low-fat dieters should eat a maximum of 50g-67g of total fat with 800-1200 kcal per day. Protein was matched to 100g day. Because of reduced appetite a low-carb diet can lead to weight loss which is why men in the low-fat group were meant to eat 500 kcal and females 250-300 Kcal less than maintenance calories to induce weight loss. Body weight in the low carb group was reduced by around 9 Kg in the low-carb and 7 Kg in the low-fat group. Pain as assessed with the Brief Pain Inventory (BPI) and KOOS did not change between groups as did depressive symptoms, several inflammatory markers like c-reactive protein, oxidative stress, and leptin as a hormone of fat tissue. Some unvalidated tests for physical function were also taken with some improvements within the low-carb group, only one significant difference between groups and many null findings within and between groups.
While interpreting these results, one must keep in mind that this meaningful weight loss alone can induce symptom improvement, especially when starting from a higher body weight as did the low-carb group. The authors also state that the low-fat group ate 20% of total daily calories from fat. 50g-67g of fat are 450-603 kcal. When eating 800-1200 kcal this would indicate at least 37,5% of daily calories from fat but 75% are also possible which is not a low-fat diet. There is also no overview over the specific foods consumed within the diets which is important since a low-carb and low-fat diet are defined by a low consumption of a macronutrient while the rest of the diet can vary substantially and even fat subtypes might play a role for OA as mentioned earlier. It is also important to know that an energy matched low-fat and low-carb diet results in similar weight loss over time, so choosing one diet over the other solely should be based on personal preferences (Hall et al., 2015; Hall et al., 2016; Hall et al., 2017).
Another example of how diet might be able to influence OA is not by eating, but by not eating! In a 2018 study without a control group, patients with OA of different joints underwent fasting for 8 days (Drinda et al., 2018). The patients did 3 preparatory days with a lacto-vegetarian diet and 800 kcal, followed by 8 fasting days with 300 calories and 4 refeeding days during the interventions period. They drank over 2.5L of liquids of which 250ml were fruit or vegetable juice and stayed away from caffeine, alcohol, and nicotine. They also received magnesium supplementation and probiotics. The participants were also advised to do aerobic physical exercise and activities promoting a mental and emotional balance. Pain was reduced by WOMAC and VAS scale and the physical subscale of the SF-36 quality of life questionnaire also improved. The participants also lost weight while lowering waist circumference which might indicate a loss of visceral fat. Another uncontrolled study with a comparable design had comparable results and did also reduce weight (Schmidt et al., 2010).
Conclusion and Application to Clinical Practice
While dietary advice is by no means the primary role of a physiotherapist, modern physiotherapy often includes aspects of various health-related fields like medicine, psychology, sports science, and nutrition. Patients might even ask if this new diet trend or supplement they have heard of can really help them or is a waste of money and effort.
Nutrition made it into the 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee in the form of strongly recommended weight loss in patients with hip and knee OA; while glucosamine, chondroitin, fish oil and vitamin D are strongly not recommended (Kolasinski et al., 2020). Vitamin D and fish oil might work best in people with low overall intake and status which is not uncommon and can be tested by the measurement of 25-Hydroxy-Vitamin-D and the Omega-3 Index, with optimal ranges around 30-60ng/dl (75-150nmol/dl) and over 8%, respectively.
The overall lack of recommendations for nutritional interventions in osteoarthritis is based on a sparsity of evidence despite the presented studies. The presented studies are often of low to moderate quality with a moderate to high risk of bias, not enough participants, of short duration in people with different age and disease stage, not tested against standard care, and mostly in patients with knee OA, making it difficult to make definitive statements regarding effectiveness for the patient in front of the practitioner. What´s positive is the safety profile of the tested supplements as they show similar or less adverse effects in the short- and middle-term compared to standard medications, while mostly not being researched for safety in the long-term usage. One must also keep in mind that a recommendation for a supplement can lead to less engagement in other forms of effective therapy like exercise, which might lead to unfavourable results. If a person is already taking a supplement, I would check the dosage and if it has at least been tested in a clinical trial. I personally do not discourage the use of an already- taken supplement (that is safe), because it might take away a beneficial or placebo effect.
The safest, cheapest but also most complex way of treating symptomatic osteoarthritis with diet might be the adoption of a healthy dietary pattern in which the synthesized dietary guidelines world-wide or a Mediterranean diet are adopted, and might or might not be paralleled with weight loss. To support adaptations of exercise therapy, it might also be feasible to recommend a relatively high protein intake (1.6g/kg bodyweight). Importantly however, specific dietary advice should not be given by a physiotherapist and requires referral to a dietician or other nutrition professional.
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- Amorndoljai, Punyanut; Taneepanichskul, Surasak; Niempoog, Sunyarn; Nimmannit, Ubonthip (2017): A Comparative of Ginger Extract in Nanostructure Lipid Carrier (NLC) and 1% Diclofenac Gel for Treatment of Knee Osteoarthritis (OA). In: Journal of the Medical Association of Thailand = Chotmaihet thangphaet 100 (4), S. 447–456.
- Appelboom, T.; Schuermans, J.; Verbruggen, G.; Henrotin, Y.; Reginster, J. Y. (2001): Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study. In: Scandinavian journal of rheumatology 30 (4), S. 242–247. DOI: 10.1080/030097401316909602.
- Arjmandi, B. H.; Khalil, D. A.; Lucas, E. A.; Smith, B. J.; Sinichi, N.; Hodges, S. B. et al. (2004): Soy protein may alleviate osteoarthritis symptoms. In: Phytomedicine : international journal of phytotherapy and phytopharmacology 11 (7-8), S. 567–575. DOI: 10.1016/j.phymed.2003.11.001.
- Azamar-Llamas, Daniel; Hernández-Molina, Gabriela; Ramos-Ávalos, Bárbara; Furuzawa-Carballeda, Janette (2017): Adipokine Contribution to the Pathogenesis of Osteoarthritis. In: Mediators of inflammation 2017, S. 5468023. DOI: 10.1155/2017/5468023.
- Baghban, Farnaz; Hosseinzadeh, Mahdieh; Mozaffari-Khosravi, Hassan; Dehghan, Ali; Fallahzadeh, Hossein (2021): The effect of L-Carnitine supplementation on clinical symptoms, C-reactive protein and malondialdehyde in obese women with knee osteoarthritis: a double blind randomized controlled trial. In: BMC musculoskeletal disorders 22 (1), S. 195. DOI: 10.1186/s12891-021-04059-1.
- Baker, K. R.; Matthan, N. R.; Lichtenstein, A. H.; Niu, J.; Guermazi, A.; Roemer, F. et al. (2012): Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study. In: Osteoarthritis and cartilage 20 (5), S. 382–387. DOI: 10.1016/j.joca.2012.01.021.
- Bartels, E. M.; Folmer, V. N.; Bliddal, H.; Altman, R. D.; Juhl, C.; Tarp, S. et al. (2015): Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. In: Osteoarthritis and cartilage 23 (1), S. 13–21. DOI: 10.1016/j.joca.2014.09.024.
- Basu, Arpita; Kurien, Biji T.; Tran, Huyen; Byrd, Bre’Ana; Maher, Joey; Schell, Jace et al. (2018): Strawberries decrease circulating levels of tumor necrosis factor and lipid peroxides in obese adults with knee osteoarthritis. In: Food & function 9 (12), S. 6218–6226. DOI: 10.1039/c8fo01194j.
- Beer, A-M; Wegener, T. (2008): Willow bark extract (Salicis cortex) for gonarthrosis and coxarthrosis–results of a cohort study with a control group. In: Phytomedicine : international journal of phytotherapy and phytopharmacology 15 (11), S. 907–913. DOI: 10.1016/j.phymed.2008.07.010.
- Belcaro, G.; Cesarone, M. R.; Errichi, S.; Zulli, C.; Errichi, B. M.; Vinciguerra, G. et al. (2008): Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol. In: Redox report : communications in free radical research 13 (6), S. 271–276. DOI: 10.1179/135100008X309019.
- Bergink, Arjan P.; Uitterlinden, André G.; van Leeuwen, Johannes P. T. M.; Buurman, Cok J.; Hofman, Albert; Verhaar, Jan A. N.; Pols, Huibert A. P. (2009): Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: The Rotterdam Study. In: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 15 (5), S. 230–237. DOI: 10.1097/RHU.0b013e3181b08f20.
- Biegert, Claudia; Wagner, Irmela; Lüdtke, Rainer; Kötter, Ina; Lohmüller, Claudia; Günaydin, Ilhan et al. (2004): Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. In: The Journal of rheumatology 31 (11), S. 2121–2130.
- Bitler, Catherine M.; Matt, Kathleen; Irving, Mary; Hook, Ginger; Yusen, Joseph; Eagar, Forrest et al. (2007): Olive extract supplement decreases pain and improves daily activities in adults with osteoarthritis and decreases plasma homocysteine in those with rheumatoid arthritis. In: Nutrition Research 27 (8), S. 470–477. DOI: 10.1016/j.nutres.2007.06.003.
Blankenhorn, G. (1986): Klinische Wirksamkeit von Spondyvit (Vitamin E) bei aktivierten Arthrosen. Eine multicentrische placebokontrollierte Doppelblindstudie. In: Zeitschrift fur Orthopadie und ihre Grenzgebiete 124 (3), S. 340–343. DOI: 10.1055/s-2008-1044572.
- Blotman, F.; Maheu, E.; Wulwik, A.; Caspard, H.; Lopez, A. (1997): Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. In: Revue du rhumatisme (English ed.) 64 (12), S. 825–834.
- Blundell, John E.; Baker, Jennifer Lyn; Boyland, Emma; Blaak, Ellen; Charzewska, Jadwiga; Henauw, Stefaan de et al. (2017): Variations in the Prevalence of Obesity Among European Countries, and a Consideration of Possible Causes. In: Obesity facts 10 (1), S. 25–37. DOI: 10.1159/000455952.
- Boer, Cindy G.; Radjabzadeh, Djawad; Medina-Gomez, Carolina; Garmaeva, Sanzhima; Schiphof, Dieuwke; Arp, Pascal et al. (2019): Intestinal microbiome composition and its relation to joint pain and inflammation. In: Nature Communications 10. DOI: 10.1038/s41467-019-12873-4.
- Bolten, Wolfgang W.; Glade, Michael J.; Raum, Sonja; Ritz, Barry W. (2015): The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double-blind, placebo-controlled trial. In: Arthritis 2015, S. 251521. DOI: 10.1155/2015/251521.
- Brand, C.; Snaddon, J.; Bailey, M.; Cicuttini, F. (2001): Vitamin E is ineffective for symptomatic relief of knee osteoarthritis: a six month double blind, randomised, placebo controlled study. In: Annals of the rheumatic diseases 60 (10), S. 946–949. DOI: 10.1136/ard.60.10.946.
- Brien, S.; Lewith, G.; Walker, A. F.; Middleton, R.; Prescott, P.; Bundy, R. (2006): Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. In: QJM : monthly journal of the Association of Physicians 99 (12), S. 841–850. DOI: 10.1093/qjmed/hcl118.
- Cai, Guoqi; Jiang, Matthew; Cicuttini, Flavia; Jones, Graeme (2019): Association of age, sex and BMI with the rate of change in tibial cartilage volume: a 10.7-year longitudinal cohort study. In: Arthritis research & therapy 21 (1), S.
273. DOI: 10.1186/s13075-019-2063-z.
- Catunda, I. S.; Vasconcelos, B. C. do E.; Andrade, E. S. de S.; Costa, D. F. N. (2016): Clinical effects of an avocado- soybean unsaponifiable extract on arthralgia and osteoarthritis of the temporomandibular joint: preliminary study. In: International journal of oral and maxillofacial surgery 45 (8), S. 1015–1022. DOI: 10.1016/j.ijom.2016.01.008.
- Chaganti, R. K.; Parimi, N.; Cawthon, P.; Dam, T. L.; Nevitt, M. C.; Lane, N. E. (2010): Association of 25- hydroxyvitamin D with prevalent osteoarthritis of the hip in elderly men: the osteoporotic fractures in men study. In: Arthritis and rheumatism 62 (2), S. 511–514. DOI: 10.1002/art.27241.
- Chaganti, R. K.; Tolstykh, I.; Javaid, M. K.; Neogi, T.; Torner, J.; Curtis, J. et al. (2014): High plasma levels of vitamin C and E are associated with incident radiographic knee osteoarthritis. In: Osteoarthritis and cartilage 22 (2), S. 190– 196. DOI: 10.1016/j.joca.2013.11.008.
- Chen, J. S.; Hill, C. L.; Lester, S.; Ruediger, C. D.; Battersby, R.; Jones, G. et al. (2016): Supplementation with omega-3 fish oil has no effect on bone mineral density in adults with knee osteoarthritis: a 2-year randomized controlled trial. In: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 27 (5), S. 1897–1905. DOI: 10.1007/s00198- 015-3438-x.
- Cho, Se Haeng; Jung, Young Bok; Seong, Sang Cheol; Park, Hyung Bin; Byun, Ki Yong; Lee, Dong Chul et al. (2003): Clinical efficacy and safety of Lyprinol, a patented extract from New Zealand green-lipped mussel (Perna Canaliculus) in patients with osteoarthritis of the hip and knee: a multicenter 2-month clinical trial. In: European annals of allergy and clinical immunology 35 (6), S. 212–216.
- Christensen, R.; Bartels, E. M.; Altman, R. D.; Astrup, A.; Bliddal, H. (2008): Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients?–a meta-analysis of randomized controlled trials. In: Osteoarthritis and cartilage 16 (9), S. 965–972. DOI: 10.1016/j.joca.2008.03.001.
- Cisár, Peter; Jány, Richard; Waczulíková, Iweta; Sumegová, Katarína; Muchová, Jana; Vojtassák, Jozef et al. (2008): Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis. In: Phytotherapy research : PTR 22 (8), S. 1087–1092. DOI: 10.1002/ptr.2461.
- Colker, Carlon M.; Swain, Melissa; Lynch, Leila; Gingerich, Daniel A. (2002): Effects of a milk-based bioactive micronutrient beverage on pain symptoms and activity of adults with osteoarthritis: a double-blind, placebo- controlled clinical evaluation. In: Nutrition 18 (5), S. 388–392. DOI: 10.1016/s0899-9007(01)00800-0.
- Cornish, Stephen M.; Peeler, Jason D. (2018): No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. In: Nutrition research (New York, N.Y.) 51, S. 57–66. DOI: 10.1016/j.nutres.2017.12.010.
- Coulson, Samantha; Vecchio, Phillip; Gramotnev, Helen; Vitetta, Luis (2012): Green-lipped mussel (Perna canaliculus) extract efficacy in knee osteoarthritis and improvement in gastrointestinal dysfunction: a pilot study. In: Inflammopharmacology 20 (2), S. 71–76. DOI: 10.1007/s10787-012-0128-6.
- Dai, Zhaoli; Jafarzadeh, S. Reza; Niu, Jingbo; Felson, David T.; Jacques, Paul F.; Li, Shanshan; Zhang, Yuqing (2018): Body Mass Index Mediates the Association between Dietary Fiber and Symptomatic Knee Osteoarthritis in the Osteoarthritis Initiative and the Framingham Osteoarthritis Study. In: The Journal of nutrition 148 (12), S. 1961– 1967. DOI: 10.1093/jn/nxy231.
- Dai, Zhaoli; Niu, Jingbo; Zhang, Yuqing; Jacques, Paul; Felson, David T. (2017): Dietary intake of fibre and risk of knee osteoarthritis in two US prospective cohorts. In: Annals of the rheumatic diseases 76 (8), S. 1411–1419. DOI: 10.1136/annrheumdis-2016-210810.
- Debbi, Eytan M.; Agar, Gabriel; Fichman, Gil; Ziv, Yaron Bar; Kardosh, Rami; Halperin, Nahum et al. (2011): Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. In: BMC complementary and alternative medicine 11, S. 50. DOI: 10.1186/1472-6882-11-50.
- Denissen, Karlijn F. M.; Boonen, Annelies; Nielen, Johannes T. H.; Feitsma, Anouk L.; van den Heuvel, Ellen G. H. M.; Emans, Pieter J. et al. (2019): Consumption of dairy products in relation to the presence of clinical knee osteoarthritis: The Maastricht Study. In: European journal of nutrition 58 (7), S. 2693–2704. DOI: 10.1007/s00394- 018-1818-7.
- Drinda, Stefan; Franke, Sybille; Schmidt, Sebastian; Stoy, Katrin; Lehmann, Thomas; Wolf, Gunter; Neumann, Thomas (2018): AGE-RAGE Interaction Does Not Explain the Clinical Improvements after Therapeutic Fasting in Osteoarthritis. In: Complementary medicine research 25 (3), S. 167–172. DOI: 10.1159/000486237.
- Du, Chen; Smith, Amy; Avalos, Marco; South, Sanique; Crabtree, Keith; Wang, Wanyi et al. (2019): Blueberries Improve Pain, Gait Performance, and Inflammation in Individuals with Symptomatic Knee Osteoarthritis. In: Nutrients 11 (2). DOI: 10.3390/nu11020290.
- Duclos, M. E.; Roualdes, O.; Cararo, R.; Rousseau, J. C.; Roger, T.; Hartmann, D. J. (2010): Significance of the serum CTX-II level in an osteoarthritis animal model: a 5-month longitudinal study. In: Osteoarthritis and cartilage 18 (11), S. 1467–1476. DOI: 10.1016/j.joca.2010.07.007.
- Dyer, J.; Davison, G.; Marcora, S. M.; Mauger, A. R. (2017): Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis. In: The journal of nutrition, health & aging 21 (5), S. 562–566. DOI: 10.1007/s12603-016-0806-y.
- Ebrahimi, Ali Asghar; Nikniaz, Zeinab; Ostadrahimi, Alireza; Mahdavi, Reza; Nikniaz, Leila (2014): The effect of Elaeagnus angustifolia L. whole fruit and medulla powder on women with osteoarthritis of the knee: A randomized controlled clinical trial. In: European Journal of Integrative Medicine 6 (6), S. 672–679. DOI: 10.1016/j.eujim.2014.07.016.
- Eftekhar Sadat, Bina; Khadem Haghighian, Mahdieh; Alipoor, Beitollah; Malek Mahdavi, Aida; Asghari Jafarabadi, Mohammad; Moghaddam, Abdolvahab (2013): Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. In: International journal of rheumatic diseases 16 (5), S. 578–582. DOI: 10.1111/1756-185X.12133.
- El-Brashy, Abd-El Wahab S.; El-Tanawy, Refaat M.; Hassan, Waleed A.; Shaban, Howyda M.; Bhnasawy, Menna M. I. (2016): Potential role of vitamin K in radiological progression of early knee osteoarthritis patients. In: The Egyptian Rheumatologist 38 (3), S. 217–223. DOI: 10.1016/j.ejr.2016.03.001.
- Essouiri, Jamila; Harzy, Taoufik; Benaicha, Nadia; Errasfa, Mourad; Abourazzak, Fatima Ezzahra (2017): Effectiveness of Argan Oil Consumption on Knee Osteoarthritis Symptoms: A Randomized Controlled Clinical Trial. In: Current rheumatology reviews 13 (3), S. 231–235. DOI: 10.2174/1573397113666170710123031.
- Fan, Jiayao; Zhu, Jiahao; Sun, Lingling; Li, Yasong; Wang, Tianle; Li, Yingjun (2020): Causal association of adipokines with osteoarthritis: a Mendelian randomization study. In: Rheumatology (Oxford, England). DOI: 10.1093/rheumatology/keaa719.
- Farid, Reza; Mirfeizi, Zahra; Mirheidari, Mahyar; Rezaieyazdi, Zahra; Mansouri, Hassan; Esmaelli, Habib et al. (2007): Pycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritis. In: Nutrition Research 27 (11), S. 692–697. DOI: 10.1016/j.nutres.2007.09.007.
- Farid, Reza; Rezaieyazdi, Zahra; Mirfeizi, Zahra; Hatef, Mohamad Reza; Mirheidari, Mahyar; Mansouri, Hassan et al. (2010): Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis. In: Nutrition research (New York, N.Y.) 30 (9), S. 601–606. DOI: 10.1016/j.nutres.2010.08.010.
- Felson, D. T.; Misra, D.; LaValley, M.; Clancy, M.; Chen, X.; Lichtenstein, A. et al. (2021): Fatty acids and osteoarthritis: the MOST study. In: Osteoarthritis and cartilage 29 (7), S. 973–978. DOI: 10.1016/j.joca.2021.03.006.
- Felson, D. T.; Zhang, Y.; Anthony, J. M.; Naimark, A.; Anderson, J. J. (1992): Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. In: Annals of internal medicine 116 (7), S. 535– 539. DOI: 10.7326/0003-4819-116-7-535.
- Felson, David T.; Niu, Jingbo; Clancy, Margaret; Aliabadi, Piran; Sack, Burton; Guermazi, Ali et al. (2007): Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. In: Arthritis and rheumatism 56 (1), S. 129–136. DOI: 10.1002/art.22292.
- Fincham, J. E.; Hough, F. S.; Taljaard, J. J.; Weidemann, A.; Schutte, C. H. (1986): Mseleni joint disease. Part II. Low serum calcium and magnesium levels in women. In: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 70 (12), S. 740–742.
- García-Coronado, Juan Mario; Martínez-Olvera, Lorena; Elizondo-Omaña, Rodrigo E.; Acosta-Olivo, Carlos Alberto; Vilchez-Cavazos, Félix; Simental-Mendía, Luis Ernesto; Simental-Mendía, Mario (2019): Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials. In: International orthopaedics 43 (3), S. 531–538. DOI: 10.1007/s00264-018-4211-5.
- Gersing, Alexandra S.; Schwaiger, Benedikt J.; Nevitt, Michael C.; Joseph, Gabby B.; Chanchek, Nattagan; Guimaraes, Julio B. et al. (2017): Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. In: Radiology 284 (2), S. 508–520. DOI: 10.1148/radiol.2017161005.
- Ghoochani, Nasrin; Karandish, Majid; Mowla, Karim; Haghighizadeh, Mohammad Hossein; Jalali, Mohammad Taha (2016): The effect of pomegranate juice on clinical signs, matrix metalloproteinases and antioxidant status in patients with knee osteoarthritis. In: Journal of the science of food and agriculture 96 (13), S. 4377–4381. DOI: 10.1002/jsfa.7647.
- Grannell, Andrew; Fallon, Finian; Al-Najim, Werd; Le Roux, Carel (2021): Obesity and responsibility: Is it time to rethink agency? In: Obesity reviews : an official journal of the International Association for the Study of Obesity, e13270. DOI: 10.1111/obr.13270.
- Gudbergsen, H.; Boesen, M.; Lohmander, L. S.; Christensen, R.; Henriksen, M.; Bartels, E. M. et al. (2012): Weight loss is effective for symptomatic relief in obese subjects with knee osteoarthritis independently of joint damage severity assessed by high-field MRI and radiography. In: Osteoarthritis and cartilage 20 (6), S. 495–502. DOI: 10.1016/j.joca.2012.02.639.
- Hall, Kevin D.; Bemis, Thomas; Brychta, Robert; Chen, Kong Y.; Courville, Amber; Crayner, Emma J. et al. (2015): Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. In: Cell metabolism 22 (3), S. 427–436. DOI: 10.1016/j.cmet.2015.07.021.
- Hall, Kevin D.; Chen, Kong Y.; Guo, Juen; Lam, Yan Y.; Leibel, Rudolph L.; Mayer, Laurel E. S. et al. (2016): Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men12. In: The American journal of clinical nutrition 104 (2), S. 324–333. DOI: 10.3945/ajcn.116.133561.
- Hall, Kevin D.; Guo, Juen (2017): Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. In: Gastroenterology 152 (7), 1718-1727.e3. DOI: 10.1053/j.gastro.2017.01.052.
- Hancke, Juan L.; Srivastav, Shalini; Cáceres, Dante D.; Burgos, Rafael A. (2019): A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. In: Phytotherapy research : PTR 33 (5), S. 1469–1479. DOI: 10.1002/ptr.6339.
- Heidari, Behzad; Heidari, Parham; Hajian-Tilaki, Karaim (2011): Association between serum vitamin D deficiency and knee osteoarthritis. In: International orthopaedics 35 (11), S. 1627–1631. DOI: 10.1007/s00264-010-1186-2.
- Hewlings, Susan; Kalman, Douglas; Schneider, Luke V. (2019): A Randomized, Double-Blind, Placebo-Controlled, Prospective Clinical Trial Evaluating Water-Soluble Chicken Eggshell Membrane for Improvement in Joint Health in Adults with Knee Osteoarthritis. In: Journal of medicinal food 22 (9), S. 875–884. DOI: 10.1089/jmf.2019.0068.
- Hill, Catherine L.; March, Lynette M.; Aitken, Dawn; Lester, Susan E.; Battersby, Ruth; Hynes, Kristen et al. (2016): Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. In: Annals of the rheumatic diseases 75 (1), S. 23–29. DOI: 10.1136/annrheumdis-2014-207169.
- Hill, J.; Bird, H. A. (1990): Failure of selenium-ace to improve osteoarthritis. In: British journal of rheumatology 29 (3), S. 211–213. DOI: 10.1093/rheumatology/29.3.211.
- Huang, Z. Y.; Stabler, T.; Pei, F. X.; Kraus, V. B. (2016): Both systemic and local lipopolysaccharide (LPS) burden are associated with knee OA severity and inflammation. In: Osteoarthritis and cartilage 24 (10), S. 1769–1775. DOI: 10.1016/j.joca.2016.05.008.
- Hunter, D. J.; Hart, D.; Snieder, H.; Bettica, P.; Swaminathan, R.; Spector, T. D. (2003): Evidence of altered bone turnover, vitamin D and calcium regulation with knee osteoarthritis in female twins. In: Rheumatology (Oxford, England) 42 (11), S. 1311–1316. DOI: 10.1093/rheumatology/keg373.
- Hunter, David J.; Bierma-Zeinstra, Sita (2019): Osteoarthritis. In: The Lancet 393 (10182), S. 1745–1759. DOI: 10.1016/S0140-6736(19)30417-9.
- Jensen, Niels Hertz (2003): Faerre smerter ved slidgigt i hofte- eller knaeled under behandling med calciumascorbat. Et randomiseret, placebokontrolleret overkrydsningsforsøg i almen praksis. In: Ugeskrift for laeger 165 (25), S. 2563–2566.
- Jiang, Liying; Xie, Xiaohua; Wang, Yidan; Wang, Yingchen; Lu, Yihua; Tian, Tian et al. (2016): Body mass index and hand osteoarthritis susceptibility: an updated meta-analysis. In: International journal of rheumatic diseases 19 (12), S. 1244–1254. DOI: 10.1111/1756-185X.12895.
- Jin, Xingzhong; Beguerie, Julieta Ruiz; Zhang, Weiya; Blizzard, Leigh; Otahal, Petr; Jones, Graeme; Ding, Changhai (2015): Circulating C reactive protein in osteoarthritis: a systematic review and meta-analysis. In: Annals of the rheumatic diseases 74 (4), S. 703–710. DOI: 10.1136/annrheumdis-2013-204494.
- Jin, Xingzhong; Jones, Graeme; Cicuttini, Flavia; Wluka, Anita; Zhu, Zhaohua; Han, Weiyu et al. (2016): Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. In: JAMA 315 (10), S. 1005–1013. DOI: 10.1001/jama.2016.1961.
- Jordan, Joanne M.; Roos, Anneclaire J. de; Renner, Jordan B.; Luta, Gheorghe; Cohen, Amy; Craft, Neal et al. (2004): A case-control study of serum tocopherol levels and the alpha- to gamma-tocopherol ratio in radiographic knee osteoarthritis: the Johnston County Osteoarthritis Project. In: American journal of epidemiology 159 (10), S. 968– 977. DOI: 10.1093/aje/kwh133.
- Kaçar, C.; Gilgil, E.; Tuncer, T.; Bütün, B.; Urhan, S.; Sünbüloglu, G. et al. (2004): The association of milk consumption with the occurrence of symptomatic knee osteoarthritis. In: Clinical and experimental rheumatology 22 (4), S. 473– 476.
- Karimifar, Mansoor; Soltani, Rasool; Hajhashemi, Valiollah; Sarrafchi, Sara (2017): Evaluation of the effect of Elaeagnus angustifolia alone and combined with Boswellia thurifera compared with ibuprofen in patients with knee osteoarthritis: a randomized double-blind controlled clinical trial. In: Clinical rheumatology 36 (8), S. 1849– 1853. DOI: 10.1007/s10067-017-3603-z.
- Kasemsuk, Thitima; Saengpetch, Nadhaporn; Sibmooh, Nathawut; Unchern, Supeenun (2016): Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. In: Clinical rheumatology 35 (10), S.2531–2540. DOI: 10.1007/s10067-016-3363-1.
- Kimmatkar, N.; Thawani, V.; Hingorani, L.; Khiyani, R. (2003): Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. In: Phytomedicine : international journal of phytotherapy and phytopharmacology 10 (1), S. 3–7. DOI: 10.1078/094471103321648593.
- Kolasinski, Sharon L.; Neogi, Tuhina; Hochberg, Marc C.; Oatis, Carol; Guyatt, Gordon; Block, Joel et al. (2020): 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. In: Arthritis & rheumatology (Hoboken, N.J.) 72 (2), S. 220–233. DOI: 10.1002/art.41142.
- Kuszewski, Julia C.; Wong, Rachel H. X.; Howe, Peter R. C. (2020): Fish oil supplementation reduces osteoarthritis- specific pain in older adults with overweight/obesity. In: Rheumatology advances in practice 4 (2), rkaa036. DOI: 10.1093/rap/rkaa036.
- Lei, M.; Guo, C.; Wang, D.; Zhang, C.; Hua, L. (2017): The effect of probiotic Lactobacillus casei Shirota on knee osteoarthritis: a randomised double-blind, placebo-controlled clinical trial. In: Beneficial microbes 8 (5), S. 697–703. DOI: 10.3920/BM2016.0207.
- Lequesne, Michel; Maheu, Emmanuel; Cadet, Christian; Dreiser, Renèe-Liliane (2002): Structural effect of avocado/soybean unsaponifiables on joint space loss in osteoarthritis of the hip. In: Arthritis and rheumatism 47 (1), S. 50–58. DOI: 10.1002/art1.10239.
- Levy, Robert M.; Khokhlov, Alexander; Kopenkin, Sergey; Bart, Boris; Ermolova, Tatiana; Kantemirova, Raiasa et al. (2010): Efficacy and safety of flavocoxid, a novel therapeutic, compared with naproxen: a randomized multicenter controlled trial in subjects with osteoarthritis of the knee. In: Advances in therapy 27 (10), S. 731–742. DOI: 10.1007/s12325-010-0064-z.
- Levy, Robert M.; Saikovsky, Roman; Shmidt, Evgeniya; Khokhlov, Alexander; Burnett, Bruce P. (2009): Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short- term randomized, double-blind pilot study. In: Nutrition research (New York, N.Y.) 29 (5), S. 298–304. DOI: 10.1016/j.nutres.2009.04.003.
- Li, Hui; Zeng, Chao; Wei, Jie; Yang, Tuo; Gao, Shu-Guang; Li, Yu-Sheng; Lei, Guang-hua (2016): Associations between dietary antioxidants intake and radiographic knee osteoarthritis. In: Clinical rheumatology 35 (6), S. 1585– 1592. DOI: 10.1007/s10067-016-3177-1.
- Li, Hui; Zeng, Chao; Wei, Jie; Yang, Tuo; Gao, Shu-Guang; Li, Yu-Sheng et al. (2016): Relationship between soy milk intake and radiographic knee joint space narrowing and osteophytes. In: Rheumatology international 36 (9), S. 1215–1222. DOI: 10.1007/s00296-016-3491-6.
- Li, Yusheng; Xiao, Wenfeng; Luo, Wei; Zeng, Chao; Deng, Zhenhan; Ren, Wenkai et al. (2016): Alterations of amino acid metabolism in osteoarthritis: its implications for nutrition and health. In: Amino acids 48 (4), S. 907–914. DOI: 10.1007/s00726-015-2168-x.
- Lu, Bing; Driban, Jeffrey B.; Duryea, Jeffrey; McAlindon, Timothy; Lapane, Kate L.; Eaton, Charles B. (2014): Milk consumption and progression of medial tibiofemoral knee osteoarthritis: data from the Osteoarthritis Initiative. In: Arthritis care & research 66 (6), S. 802–809. DOI: 10.1002/acr.22297.
- Lu, Bing; Driban, Jeffrey B.; Xu, Chang; Lapane, Kate L.; McAlindon, Timothy E.; Eaton, Charles B. (2017): Dietary Fat Intake and Radiographic Progression of Knee Osteoarthritis: Data From the Osteoarthritis Initiative. In: Arthritis care & research 69 (3), S. 368–375. DOI: 10.1002/acr.22952.
- Lyu, Jia-Ling; Wang, Ting-Ming; Chen, Yen-Hao; Chang, Shu-Ting; Wu, Ming-Shiang; Lin, Yung-Hao et al. (2020): Oral intake of Streptococcus thermophilus improves knee osteoarthritis degeneration: A randomized, double- blind, placebo-controlled clinical study. In: Heliyon 6 (4), e03757. DOI: 10.1016/j.heliyon.2020.e03757.
- MacFarlane, Lindsey A.; Cook, Nancy R.; Kim, Eunjung; Lee, I-Min; Iversen, Maura D.; Gordon, David et al. (2020): The Effects of Vitamin D and Marine Omega-3 Fatty Acid Supplementation on Chronic Knee Pain in Older US Adults: Results From a Randomized Trial. In: Arthritis & rheumatology (Hoboken, N.J.) 72 (11), S. 1836–1844. DOI: 10.1002/art.41416.
- Machtey, I.; Ouaknine, L. (1978): Tocopherol in Osteoarthritis: a controlled pilot study. In: Journal of the American Geriatrics Society 26 (7), S. 328–330. DOI: 10.1111/j.1532-5415.1978.tb01345.x.
- Maheu, Emmanuel; Cadet, Christian; Marty, Marc; Moyse, Dominique; Kerloch, Isabelle; Coste, Philippe et al. (2014): Randomised, controlled trial of avocado-soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. In: Annals of the rheumatic diseases 73 (2), S. 376–384. DOI: 10.1136/annrheumdis-2012-202485.
- Maheu, Emmanuel; Mazires, Bernard; Valat, Jean-Pierre; Loyau, Grard; Le Lot, Xavier; Bourgeois, Pierre et al. (1998): Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: A prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. In: Arthritis and rheumatism 41 (1), S. 81–91. DOI: 10.1002/1529-0131(199801)41:1<81::AID-ART11>3.0.CO;2-9.
- Majeed, Muhammed; Majeed, Shaheen; Narayanan, Narayanan K.; Nagabhushanam, Kalyanam (2019): A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. In: Phytotherapy research : PTR 33 (5), S. 1457–1468. DOI: 10.1002/ptr.6338.
- Malek Mahdavi, Aida; Mahdavi, Reza; Kolahi, Sousan (2016): Effects of l-Carnitine Supplementation on Serum Inflammatory Factors and Matrix Metalloproteinase Enzymes in Females with Knee Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. In: Journal of the American College of Nutrition 35 (7), S. 597–603. DOI: 10.1080/07315724.2015.1068139.
- Malek Mahdavi, Aida; Mahdavi, Reza; Kolahi, Sousan; Zemestani, Maryam; Vatankhah, Amir-Mansour (2015): L- Carnitine supplementation improved clinical status without changing oxidative stress and lipid profile in women with knee osteoarthritis. In: Nutrition research (New York, N.Y.) 35 (8), S. 707–715. DOI: 10.1016/j.nutres.2015.06.003.
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