Analysis of Anthropometric Measurements and Dietary Intake in Patients Undergoing a Multi-Professional Osteoarthritis Education Program (PARQVE-Project Arthritis Recovering Quality of Life by Means of Education)
Background: Osteoarthritis (OA) has a major impact on mobility and the loss of productivity of patients, especially knee OA (KOA). Obesity is one of the main risk factors for the incidence and prevalence of KOA. Weight loss alone decreases pain and improves quality of life and functional scores. Objective: To use BMI, body fat, and calorie intake to measure the effect of a multi-professional educational program on patients with KOA and correlate these measurements with subjective questionnaire results. Methods: A total of 198 patients undergoing standard treatment for KOA were randomized to 4 groups. All groups received written and video information regarding KOA. Three groups (1, 2 and 3) also attended two days of lectures 1, 2 and 3 months apart, respectively, whereas group 4 did not. Each group was divided into subgroups A (bimonthly telephone calls) and B (no telephone calls). All patients were evaluated at baseline and at one year for BMI, waist-hip ratio (WHR), percentage of body fat, and calorie intake and with the WOMAC, LEQUESNE, VAS and SF-36 questionnaires. Results: The WHR showed 89.4% of android obesity at baseline and 87.9% at one year without improvement (p = 0.38). Body fat decreased by 0.44% regardless of group or subgroup. Calorie intake was different between groups (p = 0.019) according to phone calls and follow-up (p = 0.03). BMI and body fat percentage were correlated with the WOMAC, WOMAC pain, VAS and LEQUESNE scores at baseline and at reassessment. Weight was correlated with the baseline results of the WOMAC pain (r = 0.175, p = 0.014), VAS (r = 0.155, p = 0.029), LEQUESNE (r = 0.161, p = 0.023), SF-36-PCS (r = ?0.186, p = 0.009) and SF-36-MCS (r = 0.155, p = 0.029) scores and with the one-year results of the WOMAC (r = 0.155, p = 0.029) and WOMAC pain (r = 0.151, p = 0.034) scores. Conclusion: The multi-professional treatment program had very little impacts on the percentage of body fat. This improvement was independent of classes, telephone calls, or improvements in pain, function and quality of life. Calorie intake improvement was influenced by telephone calls and classes but was not associated with objective measurements of/or changes in weight, BMI, or body fat percentage or with subjective improvements.
References
[1]
Sharma, L. and Kapoor, D. (2007) Epidemiology of Osteoarthritis. In: Moskowitz, R.W., Altman, R.D., Hochberg, M.C., Buckwalter, J.A., Goldberg, V.M., Eds., Ostearthritis, 4th Edition, Lippincott Williams & Wilkins, Philadelphia, 3-26.
[2]
Jorgensen, K.T., Pedersen, B.V., Nielsen, N.M., Hansen, A.V., Jacobsen, S. and Frisch, M. (2011) Socio-Demographic Factors, Reproductive History and Risk of Osteoarthritis in a Cohort of 4.6 Million Danish Women and Men. Osteoarthritis and Cartilage, 19, 1176-1182. http://dx.doi.org/10.1016/j.joca.2011.07.009
[3]
Dixon, T., Shaw, M., Ebrahim, S. and Dieppe, P. (2004) Trends in Hip and Knee Joint Replacement: Socioeconomic Inequalities and Projection of Need. Annals of the Rheumatic Diseases, 63, 825-830. http://dx.doi.org/10.1136/ard.2003.012724
[4]
Mahomed, N.N., Barrett, J., Katz, J.N., Baron, J.A., Wright, J. and Losina, E. (2005) Epidemiology of Total Knee Replacement in the United States Medicare Population. The Journal of Bone & Joint Surgery, 87, 1222-1228. http://dx.doi.org/10.2106/JBJS.D.02546
[5]
Blagojevic, M., Jinks, C., Jeffery, A. and Jordan, K.P. (2010) Risk Factors for Onset of Osteoarthritis of the Knee in Older Adults: A Systematic Review and Meta-Analysis. Osteoarthritis and Cartilage, 18, 24-33. http://dx.doi.org/10.1016/j.joca.2009.08.010
[6]
Felson, D.T., Anderson, J.J., Naimark, A., Walker, A.M. and Meenan, R.F. (1988) Obesity and Knee Osteoarthritis. The Framingham Study. Annals of Internal Medicine, 109, 18-24. http://dx.doi.org/10.7326/0003-4819-109-1-18
[7]
Wills, A.K., Black, S., Cooper, R., Coppack, R.J., Hardy, R., Martin, K.R., et al. (2012) Life Course Body Mass Index and Risk of Knee Osteoarthritis at the Age of 53 Years: Evidence from the 1946 British Birth Cohort Study. Annals of the Rheumatic Diseases, 71, 655-660. http://dx.doi.org/10.1136/ard.2011.154021
[8]
Parmet, S., Lynm, C. and Glass, R.M. (2003) JAMA Patient Page. Osteoarthritis of the Knee. JAMA, 289, 1068. http://dx.doi.org/10.1001/jama.289.8.1068
[9]
Brasil Instituto Brasileiro de Geografia e Estatística (2008) Pesquisa nacional por amostra de domicílios. IBGE, Rio de Janeiro. http://www.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2008/brasilpnad2008.pdf
[10]
Brasil Instituto Brasileiro de Geografia e Estatistica (2010) Dados preliminares do Censo 2010 ja revelam mudancas na piramideetaria brasileira. IBGE, Rio de Janeiro.
[11]
Brasil. Instituto Brasileiro de Geografia e Estatistica. POF 2008-2009: Desnutricao cai e peso das criancas brasileiras ultrapassa padrao internacional. http://www.ibge.gov.br/home/presidencia/noticias/noticia_visualiza.php?id_noticia=1699&id_pagina=1
[12]
Brasil. Instituto Brasileiro de Geografia e Estatística (2010) Censo demográfico 2010: Resultados gerais da amostra. IBGE, Rio de Janeiro. http://biblioteca.ibge.gov.br/visualizacao/periodicos/99/cd_2010_resultados_gerais_amostra.pdf
[13]
Losina, E., Walensky, R.P., Reichmann, W.M., Holt, H.L., Gerlovin, H., Solomon, D.H., et al. (2011) Impact of Obesity and Knee Osteoarthritis on Morbidity and Mortalityin Older Americans. Annals of Internal Medicine, 154, 217-226. http://dx.doi.org/10.7326/0003-4819-154-4-201102150-00001
[14]
Zhang, W. (2010) Risk Factors of Knee Osteoarthritis—Excellent Evidence but Little Has Been Done. Osteoarthritis and Cartilage, 18, 1-2. http://dx.doi.org/10.1016/j.joca.2009.07.013
[15]
Zhang, W., Moskowitz, R.W., Nuki, G., Abramson, S., Altman, R.D., Arden, N., et al. (2008) OARSI Recommendations for the Management of Hip and Knee Osteoarthritis, Part II: OARSI Evidence-Based, Expert Consensus Guidelines. Osteoarthritis and Cartilage, 16, 137-162. http://dx.doi.org/10.1016/j.joca.2007.12.013
[16]
Bliddal, H., Leeds, A.R., Stigsgaard, L., Astrup, A. and Christensen, R. (2011) Weight Loss as Treatment for Knee Osteoarthritis Symptoms in Obese Patients: 1 Year Results from a Randomized Controlled Trial. Annals of the Rheumatic Diseases, 70, 1798-1803. http://dx.doi.org/10.1136/ard.2010.142018
[17]
Zhang, W., Nuki, G., Moskowitz, R.W., Abramson, S., Altman, R.D., et al. (2010) OARSI Recommendations for the Management of Hip and Knee Osteoarthritis Part III: Changes in Evidence Following Systematic Cumulative Update of Research Published through January 2009. Osteoarthritis and Cartilage, 18, 476-499. http://dx.doi.org/10.1016/j.joca.2010.01.013
[18]
Bruyère, O., Cooper, C., Pelletier, J.P., Branco, J., Luisa Brandi, M., Guillemin, F., et al. (2014) An Algorithm Recommendation for the Management of Knee Osteoarthritis in Europe and Internationally: A Report from a Task Force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 44, 253-263. http://dx.doi.org/10.1016/j.semarthrit.2014.05.014
[19]
Shin, D. (2014) Association between Metabolic Syndrome, Radiographic Knee Osteoarthritis, and Intensity of Knee Pain: Results of a National Survey. The Journal of Clinical Endocrinology & Metabolism, 99, 3177-3183. http://dx.doi.org/10.1210/jc.2014-1043
[20]
Schrieber, L. and Colley, M. (2004) Patient Education. Best Practice & Research Clinical Rheumatology, 18, 465-476. http://dx.doi.org/10.1016/j.berh.2004.03.008
[21]
Buszewicz, M., Rait, G., Griffin, M., Nazareth, I., Patel, A., Atkinson, A., et al. (2006) Self Management of Arthritis in Primary Care: Randomised Controlled Trial. BMJ, 333, 879. http://dx.doi.org/10.1136/bmj.38965.375718.80
[22]
Rosemann, T., Joos, S., Laux, G., Gensichen, J. and Szecsenyi, J. (2007) Case Management of Arthritis Patients in Primary Care: A Cluster-Randomized Controlled Trial. Arthritis & Rheumatology, 57, 1390-1397. http://dx.doi.org/10.1002/art.23080
[23]
Ravaud, P., Flipo, R.M., Boutron, I., Roy, C., Mahmoudi, A., et al. (2009) ARTIST (Osteoarthritis Intervention Standardized) Study of Standardized Consultation versus Usual Care for Patients with Osteoarthritis of the Knee in Primary care in France: Pragmatic Randomised Controlled Trial. BMJ, 338, b421. http://dx.doi.org/10.1136/bmj.b421
[24]
Plapler, P.G., Saron, T.R.P. and Rezende, M.U. (2014) Education and Physical Activity in Osteoporosis. Journal of Osteoporosis and Physical Activity, 2, 118.
[25]
Moher, D., Hopewell, S., Schulz, K.F., Montori, V., Gotzsche, P.C., Devereaux, P.J., et al. (2012) CONSORT 2010 Explanation and Elaboration: Updated Guidelines for Reporting Parallel Group Randomised Trials. International Journal of Surgery, 10, 28-55. http://dx.doi.org/10.1016/j.ijsu.2011.10.001
[26]
Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., et al. (1986) Development of Criteria for the Classification and Reporting of Osteoarthritis: Classification of Osteoarthritis of the Knee. Arthritis & Rheumatology, 29, 1039-1049. http://dx.doi.org/10.1002/art.1780290816
[27]
Bellamy, N., Buchanan, W.W., Goldsmith, C.H., Campbell, J. and Stitt, L.W. (1988) Validation Study of WOMAC: A Health Status Instrument for Measuring Clinically Important Patient Relevant Outcomes to Antirheumatic Therapy in Patient with Osteoarthritis of the Hip or Knee. The Journal of Rheumatology, 15, 1833-1840.
[28]
Lequesne, M.G. (1997) The Algofunctional Indices for Hip and Knee Osteoarthritis. The Journal of Rheumatology, 24, 779-781.
[29]
McHorney, C.A., Ware, J.E. and Raczek, A.E. (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and Clinical Tests of Validity in Measuring Physical and Mental Health Construct. Medical Care, 31, 247-263. http://dx.doi.org/10.1097/00005650-199303000-00006
[30]
Kellgren, J.H. and Lawrence, J.S. (1957) Radiological Assessment of Rheumatoid Arthritis. Annals of the Rheumatic Diseases, 16, 485-493. http://dx.doi.org/10.1136/ard.16.4.485
[31]
Rezende, M.U., Campos, G.C., Pailo, A.F., Frucchi, R., Pasqualin, T. and Camargo, O.P. (2013) PARQVE-Project Arthritis Recovering Quality of Life by Means of Education Short-Term Outcome in a Randomized Clinical Trial. Journal of Arthritis, 2, 133.
[32]
Sanghi, D., Srivastava, R.N., Singh, A., Kumari, R., Mishra, R. and Mishra, A. (2011) The Association of Anthropometric Measures and Osteoarthritis Knee in Non-Obese Subjects: A Cross Sectional Study. Clinics, 66, 275-279. http://dx.doi.org/10.1590/S1807-59322011000200016
[33]
Christensen, R., Bartels, E.M., Astrup, A. and Bliddal, H. (2007) Effect of Weight Reduction in Obese Patients Diagnosed with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Annals of the Rheumatic Diseases, 66, 433-439. http://dx.doi.org/10.1136/ard.2006.065904