A Meta-Analysis of the Impact of Nutritional Supplementation on Osteoarthritis Symptoms

Nutrients
Q1
Apr 2022
Citations:47
Influential Citations:3
Systematic Reviews / Meta-Analyses
87
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Enhanced Details

Methods
OA patients (predominantly knee OA); randomized controlled trials; 52 trials included; total participants 4744 (2410 in nutrients group; 2336 controls); comparisons included placebo or active comparators (NSAIDs, chondroitin, glucosamine, paracetamol, vitamin B, fish oil); outcomes included pain, stiffness, function (WOMAC), quality of life, ESR, and CRP.
Intervention
Vitamin D: 2000–3000 IU/day, oral, 1–2 years; Curcumin: 1000 mg/day, oral, 4–16 weeks; Ginger: 250 mg/day, oral, 12 weeks (other studies: 6 or 24 weeks); Vitamin E: 400–500 IU/day, oral, 3, 8, or 96 weeks; Multivitamin: oral, dosage and duration not reported; Herbal formulations (ayurvedic blends with Boswellia, Curcuma, Urtica dioica, Piper Nigrum, Tinospora cordifolia): oral, durations 2–32 weeks; Omega-3 (fish oil): dosage not reported, oral, 12–24 weeks; Other nutritional strategies (strawberries, deer bone, melon, sesame, cherry, garlic, green mussel): oral, duration not reported.
Results
Curcumin (1000 mg/day, 4–16 weeks) improved pain, total WOMAC, and WOMAC function; stiffness improvement was borderline; ESR decreased; CRP not consistently changed. Ginger (about 250 mg/day in 12 weeks in one trial; other durations 6–24 weeks) reduced pain and decreased ESR/CRP; results sensitive to inclusion of certain studies. Vitamin D (2000–3000 IU/day, 1–2 years) yielded small pain and function benefits but did not change total WOMAC or stiffness; Vitamin E and omega-3 showed no clear OA symptom benefits. Multivitamins showed reduced pain and improved KOOS function in small samples. Herbal formulations improved stiffness (more evident vs placebo; less clear vs active comparators) with good safety; several other foods (strawberries, deer bone, melon, sesame, cherry, garlic, green mussel) associated with some symptom and QoL improvements. Overall, curcumin and ginger appear the most promising for knee OA symptoms; evidence for other nutrients is limited or inconsistent. More high-quality trials with standardized formulations are needed.
Limitations
Small sample sizes for several supplements (notably omega-3, vitamin D, multivitamins); high heterogeneity across studies (I2 often >80%); varied herbal formulations and dosages; potential publication bias; many trials used active comparators, complicating interpretation; some outcomes based on single or few studies; short durations for some supplements.

Abstract

Conflicting evidence exists concerning the effects of nutrient intake in osteoarthritis (OA). A systematic literature review and meta-analysis were performed using PubMed, EMBASE, and Cochrane Library up to November 2021 to assess the effects of nutr...