极低卡路里生酮饮食对肥胖合并膝关节骨性关节炎女性的疗效、安全性和耐受性：一项初步干预性研究。

Efficacy, Safety, and Tolerability of a Very Low-Calorie Ketogenic Diet in Women with Obesity and Symptomatic Knee Osteoarthritis: A Pilot Interventional Study.

机构信息

Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.

Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40127 Bologna, Italy.

出版信息

Nutrients. 2024 Sep 24;16(19):3236. doi: 10.3390/nu16193236.

DOI:10.3390/nu16193236

PMID:39408203

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11479182/

Abstract

BACKGROUND/OBJECTIVES: Obesity is a major risk factor for knee osteoarthritis (OA), and weight loss is crucial for its management. This pilot study explores the effects of a Very Low-Calorie Ketogenic Diet (VLCKD) in women with obesity and symptomatic knee OA.

METHODS

Women with symptomatic knee OA and obesity, defined as a body mass index (BMI) ≥ 30 kg/m, were eligible for the VLCKD protocol. The intervention included a ketogenic phase from baseline (T0) to the 8th week (T8), followed by a progressive reintroduction of carbohydrates over the next 12 weeks, ending at the 20th week (T20). Body mass index (BMI), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the EuroQol 5D (EQ-5D), and the 36-item Short Form Health Survey (SF-36) were assessed at all time points. Generalized estimating equations were used to analyze the association between BMI and patient-reported outcomes across the study period.

RESULTS

Twenty participants started the study, but four discontinued the intervention, with two of these being due to adverse effects. The mean age of the 16 patients who completed the 20-week program was 57.3 ± 5.5 years, and their mean BMI was 40.0 ± 4.8 kg/m. The mean BMI significantly decreased to 37.5 ± 4.5 at T4, 36.3 ± 4.6 at T8, and 34.8 ± 4.8 at T20 (all < 0.001 compared to baseline). The total WOMAC score improved from a mean of 43.6 ± 16.9 at T0 to 30.2 ± 12.8 at T4 ( = 0.005) and further to 24.7 ± 10.6 at T8 ( = 0.001) and to 24.8 ± 15.9 at T20 ( = 0.005). The reduction in BMI was significantly correlated with the improvements in WOMAC, EQ-5D, and SF-36 over time. No major adverse effects were observed.

CONCLUSIONS

A 20-week VLCKD in women with obesity and knee OA significantly reduced their weight and improved their outcomes, warranting further research. This trial is registered with number NCT05848544 on ClinicalTrials.gov.

摘要

背景/目的：肥胖是膝关节骨关节炎（OA）的一个主要危险因素，而减肥对于其管理至关重要。本初步研究探讨了极低卡路里生酮饮食（VLCKD）在肥胖且患有膝关节 OA 的女性中的作用。

方法

患有膝关节 OA 和肥胖症（定义为 BMI≥30kg/m²）的女性符合 VLCKD 方案的条件。干预措施包括从基线（T0）到第 8 周（T8）的生酮阶段，随后在接下来的 12 周内逐步重新引入碳水化合物，在第 20 周（T20）结束。在所有时间点评估体重指数（BMI）、西安大略和麦克马斯特大学（WOMAC）骨关节炎指数、欧洲五维健康量表（EQ-5D）和 36 项简短健康调查（SF-36）。使用广义估计方程分析 BMI 与患者报告结果在研究期间的相关性。

结果

共有 20 名参与者开始了研究，但有 4 名参与者退出了干预，其中 2 名因不良反应而退出。完成 20 周计划的 16 名患者的平均年龄为 57.3±5.5 岁，平均 BMI 为 40.0±4.8kg/m²。BMI 平均值从基线时的 43.6±16.9 显著下降到 T4 时的 37.5±4.5（均 <0.001）、T8 时的 36.3±4.6、T20 时的 34.8±4.8（均 <0.001）。WOMAC 总评分从 T0 时的 43.6±16.9 改善到 T4 时的 30.2±12.8（ =0.005），进一步改善到 T8 时的 24.7±10.6（ =0.001）和 T20 时的 24.8±15.9（ =0.005）。BMI 的下降与 WOMAC、EQ-5D 和 SF-36 的改善呈显著相关。未观察到重大不良反应。