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The effects of dietary patterns and food groups on symptomatic osteoarthritis: A systematic review.
Zeng, J, Franklin, DK, Das, A, Hirani, V
Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2023;80(1):21-43
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Osteoarthritis is a chronic joint disease that can lead to disability, characterised by the deterioration and loss of joint cartilage, inflammation, pain, aches, and stiffness. Research has shown a positive association between osteoarthritis progression and pro-inflammatory diets, such as Western diets, and a negative association with anti-inflammatory diets, such as the DASH and Mediterranean diets. This systematic review evaluated the evidence from the literature to show the positive and negative associations between osteoarthritis and diet. The Prudent diet, Mediterranean diet, and increased fibre intake were effective in reducing the progression of osteoarthritis and alleviating its symptoms, while the Western diet increased the progression of symptomatic osteoarthritis. The Prudent diet was found to be particularly effective in alleviating symptomatic osteoarthritis. The beneficial effects of anti-inflammatory diets and increased fibre intake are thought to be due to the reduction and suppression of inflammatory cytokines, while inflammatory diets have the opposite effect. Although there is high heterogeneity between the studies, healthcare professionals can use the results of this systematic review to understand the therapeutic clinical utility of anti-inflammatory diets and high-fibre intake in reducing the progression of symptomatic osteoarthritis in people above the age of 45 years. Further robust studies are needed to evaluate the effectiveness of other therapeutic dietary strategies.
Abstract
AIM: To systematically review current literature to determine the association between symptomatic osteoarthritis and dietary patterns, diet quality and food groups in adults aged ≥45 years. METHODS The review was registered on PROSPERO (CRD42021270891). Cochrane Central Library, Cumulative Index of Nursing and Allied Health Literature, Embase, Medline and Web of Science databases were searched. A total of 3816 records were identified. Eligible articles involved populations aged ≥45 years with symptomatic osteoarthritis, assessing dietary patterns, diet quality or food groups, with pain in joints as outcomes. The Joanna Briggs Institute Critical Appraisal Checklists were used for quality assessment. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence. RESULTS Six cohort studies were included. The Prudent dietary pattern and the Mediterranean dietary pattern reduced the progression of osteoarthritis symptoms. The Western dietary pattern increased symptomatic osteoarthritis progression. Increased total fibre consumption reduced symptomatic osteoarthritis progression and pain worsening, but the effects of fibre from each food group were inconclusive. Diet with high inflammatory potential increased risk of new onset symptomatic osteoarthritis, but the effects of overall diet quality were inconclusive. CONCLUSIONS The Prudent dietary pattern showed the highest protection on symptomatic osteoarthritis in adults aged 45 years and over. The body of evidence is limited, suggesting that further research is needed to corroborate the estimated effect at a high certainty of evidence, and to incorporate previously unstudied dietary patterns and food groups. Identifying the most beneficial dietary pattern may inform future guidelines for reducing symptomatic osteoarthritis in middle aged and older adults.
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Effects of a 6 Week Low-Dose Combined Resistance and Endurance Training on T Cells and Systemic Inflammation in the Elderly.
Despeghel, M, Reichel, T, Zander, J, Krüger, K, Weyh, C
Cells. 2021;10(4)
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As age advances, a gradual deterioration of immune function happens termed Immunosenescence, where different components of the immune system make a behavioural shift towards gradual decline. Immune ageing is characterized by changes in the ratio of naive memory T cells and CD4:CD8 and is associated with inflammatory cytokine production, which accelerates inflammatory ageing. This randomised controlled trial aimed to examine the effect of low-dose combined resistance and endurance training on the ageing immune system and inflammation in elderly subjects. Thirty participants (between the ages of 65 and 75) took part in a controlled low-threshold and care-oriented combined resistance and endurance training program for six weeks. This study showed an increase in CD4:CD8 ratio, decrease in low-grade inflammation and an improvement in strength capacity denoting improved immunosenescence and inflammaging among elderly participants. However, the study was conducted on a small sample for a short period. Therefore, robust long-term studies are required to elucidate further positive effects of different levels of physical activities in the elderly. Healthcare professionals can use these findings to understand how exercise influences immunosenescence and inflammation in the ageing body.
Abstract
With increasing age, the immune system undergoes a remodeling process, affecting the shift of T cell subpopulations and the development of chronic low-grade inflammation. Clinically, this is characterized by increased susceptibility to infections or development of several diseases. Since lifestyle factors can play a significant role in reducing the hallmarks of immune aging and inflammation, we investigated the effect of a 6 week low-dose combined resistance and endurance training program. Forty participants (70.3 ± 5.0 years) were randomly assigned to either a training (TG) or control group (CG) and performed a controlled low-threshold and care-oriented 6-week-long combined resistance and endurance training program. Changes in anthropometrics as well as strength capacity were measured. In subgroups of TG and CG, T cells and their subpopulations (CD4+, CD8+, naïve, central, effector memory, T-EMRA) were analyzed by flow cytometry. The changes of various plasma cytokines, chemokines, growth factors and adipokines were analyzed by luminex assays. The exercise program was followed by an increase in strength capacities. Participants of TG showed an increase of the CD4+/CD8+ T cell ratio over time (p < 0.05). Significant decreases in systemic levels of interleukin (IL-) 6, IL-8, IL-10 and vascular endothelial growth factor (VEGF) (p < 0.05) were observed for participants of TG over time. Even short-term and low-threshold training can reduce some of the hallmarks of immune aging in elderly and thus could be beneficial to stimulate immunity. The specific characteristics of the program make it easily accessible to older people, who may benefit in the longer term in terms of their immunocompetence.
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Evaluation of psoriasis severity and inflammatory responses under concomitant treatment with methotrexate plus micronutrients for psoriasis vulgaris: a randomized double blind trial.
Yousefzadeh, H, Jabbari Azad, F, Banihashemi, M, Rastin, M, Mahmoudi, M
Acta dermatovenerologica Alpina, Pannonica, et Adriatica. 2017;26(1):3-9
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Psoriasis Vulgaris is an immune-mediated chronic inflammatory disease that causes red, itchy, flaky, scaly skin. Methotrexate is an immune modulatory first-line conventional drug used to treat moderate psoriasis. Previous research suggests beneficial immune-modulatory and anti-inflammatory effects of micronutrient treatments. In this double-blinded trial, 30 Asian Psoriatic patients were randomly assigned either 7.5 to 15 mg of Methotrexate alone weekly or Methotrexate combined with daily micronutrient supplementation for 12 weeks. Patients in the micronutrient supplementation group received higher doses of micronutrients than the RDA and additional 5 mg folate supplementation on all days except the day of Methotrexate consumption. Inflammatory markers were significantly reduced by both treatments. Further, the combination of Methotrexate and micronutrient supplement resulted in greater immune modulation and decreased inflammation. For generalisation of the results, further robust research is needed. Using the results of this study, healthcare professionals can make effective therapeutic clinical decisions in the treatment of psoriasis by combining Methotrexate with micronutrient supplements.
Abstract
INTRODUCTION We evaluated the effectiveness of concomitant treatment with methotrexate (MTX) plus micronutrients in comparison with monotherapy with MTX only in psoriasis patients. Plasma levels of interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) were also measured and their association with clinical severity was evaluated. METHODS Thirty psoriasis patients 20 to 50 years old with a PASI score > 10 were divided randomly into two groups. Both groups were given oral methotrexate (0.2-0.3 mg/kg/week) for 12 weeks. In addition, Group B received one tablet of micronutrient supplement daily. Disease severity was calculated using the psoriasis area and severity index (PASI) score before and after 12 weeks. Levels of IL-1β and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS We found that 13 (86.6%) patients in Group B and 8 (53.3%) patients in Group A attained a mild PASI score (≤ 10% body involvement). IL-1β and TNF-α levels were significantly decreased in favor of Group B (p < 0.05). There was a significant correlation between changes in both IL-1β and TNF-α levels and PASI score after the study (p < 0.05). CONCLUSION The results obtained were positive, and therefore double-blind randomized trials with a larger sample size are highly suggested to confirm or reject these results.
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Superiority of a vitamin B12-containing emollient compared to a standard emollient in the maintenance treatment of mild-to-moderate plaque psoriasis.
Del Duca, E, Farnetani, F, De Carvalho, N, Bottoni, U, Pellacani, G, Nisticò, SP
International journal of immunopathology and pharmacology. 2017;30(4):439-444
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During inflammation, an enzyme named Nitric oxide synthase is produced, causing increased Nitric oxide production in psoriatic lesions. Vitamin B12 binds to Nitric oxide and serves as a scavenger. Earlier studies indicate that Vitamin B12 can reduce immunological factors, inflammation, and skin proliferation in people with psoriasis. This randomised, single-blinded, intra-patient, left-to-right comparison study aimed to evaluate the effectiveness of topical cream containing vitamin B12 as a therapeutic strategy in reducing psoriatic plaque lesions. 24 patients with mild-to-moderate psoriasis who were treated with emollient cream containing vitamin B12 for 16 weeks showed a reduction in the severity of psoriasis. Furthermore, vitamin B12 cream significantly reduced the severity of psoriasis compared to glycerol-petrolatum-based emollient creams. Vitamin B12 cream application also showed a great reduction in itching and psoriatic plaque formation. 16 weeks of treatment demonstrated the anti-inflammatory and immune modulatory effects of Vitamin B12 cream. To fully understand the effects of Vitamin B12 on different pathological pathways of psoriasis, further research is needed. The study can guide healthcare professionals in understanding the benefits of Vitamin B12 cream on mild-to-moderate psoriasis and its clinical applicability.
Abstract
Psoriasis is a chronic inflammatory skin disease affecting 2%-3% of the population. The wide range of drugs currently available for its treatment could be associated, in the long term, with organ toxicity and adverse events, thus, clinical monitoring throughout treatment is required. This investigator-initiated trial (IIT) evaluated the efficacy and the safety of a vitamin B12-containing ointment in comparison with glycerol-petrolatum-based emollient cream used twice a day to treat mild-to-moderate plaque psoriasis for a period over 12 weeks followed by a wash-out observation period of 4 weeks. This study was conducted as a randomized, controlled, single-blind, intra-patient left- to right-side trial comparing the efficacy and safety of vitamin B12-containing ointment (M-treatment) with a glycerol-petrolatum-based emollient cream (C-treatment). The Psoriasis Area Severity Index (PASI) was determined at baseline (T0), at time points T2 (14 days), T4 (4 weeks), T8 (8 weeks), T12 (12 weeks) and 4 weeks after the end of the wash-out period (F1). In total, 24 patients with plaque psoriasis were randomized to receive left- or right-side treatment with B12 ointment. From time point T2 to time point F1, there was a statistically significant difference in PASI reduction between M-treatment side and C-treatment side. At time point T 12, the difference between the mean reductions from baseline PASI scores by 5.92 ± 2.49 (87, 6%) in the M-treatment side versus 1.08 ± 1.02 (23, 1%) C-treatment side was statistically highly significant ( PWex < 0.001). On the contemporary panorama in the treatment of psoriasis, we conclude that vitamin B12 ointment will represent a new concrete therapy option and should be considered in the update of therapeutic algorithm for the treatment of psoriasis.