Mediterranean Diet and Osteoarticular Diseases

Author(s): Eliana R. Sanpaolo, Addolorata Corrado, Francesco P. Cantatore*

Journal Name: Current Nutrition & Food Science

Volume 16 , Issue 3 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Background: Besides the well-known positive effect on the reduction of the risk of cardiovascular diseases, in the latest decades growing evidence has accumulated on the beneficial effects of MD on various aspects of health outcomes. Nevertheless, data concerning the existence of a direct positive effect of MD, irrespective of its beneficial effect on body weight, in osteo-articular diseases, are still controversial. In osteo-articular diseases, a pro-inflammatory environment is highlighted, with an increased systemic levels of pro-inflammatory cytokines.

Objective: Our objective is to investigate the effects of adherence to the Mediterranean diet and osteo-articular diseases.

Conclusion: Many foods included in MD, have anti-inflammatory properties, due to the presence of nutrients, such as polyunsaturated (PUFA) and monounsaturated (MUFA) fats. The two types of polyunsaturated fatty acids, omega-3 and omega-6, have opposing effects on the inflammatory process. Omega-6 stimulates the production of pro-inflammatory cytokines, while omega-3 fatty acids exert anti-inflammatory effects, including significant reductions in the release of pro-inflammatory cytokines. Some studies have shown that the dietary pattern of MD consumption has an important role in the prevention and development of inflammatory arthritis. Nevertheless, the possible influence of MD on chronic osteo-articular diseases is very limited, this review updates the main experimental and clinical evidences concerning the potential beneficial effects of the Mediterranean Diet on the most diffuse osteo-articular chronic and degenerative joint disease.

Keywords: Adipokines, fatty acids, mediterranean diet, osteoarthritis, osteo-articular diseases, polyphenol, rheumatoid arthritis.

Willett WC1. Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995; 61(6)(Suppl.): 1402S-6S.
Estruch R, Ros E, Martínez-González MA. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med 2013; 369(7): 676-7.
[] [PMID: 23944307]
Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies. Int J Cancer 2014; 135(8): 1884-97.
[] [PMID: 24599882]
Andrés Cerezo L, Šumová B, Prajzlerová K, et al. Calgizzarin (S100A11): a novel inflammatory mediator associated with disease activity of rheumatoid arthritis. Arthritis Res Ther 2017; 19(1): 79.
[] [PMID: 28446208]
Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis 2013; 5(2): 77-94.
[] [PMID: 23641259]
El Maghraoui A, Sadni S, El Maataoui A, et al. Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women. Nutr Metab (Lond) 2015; 12: 44.
[] [PMID: 26583038]
Bonaccio M, Pounis G, Cerletti C, Donati MB, Iacoviello L, de Gaetano G. MOLI-SANI Study Investigators. Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study. Br J Clin Pharmacol 2017; 83(1): 107-13.
[] [PMID: 26935858]
Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 2006; 48(4): 677-85.
[] [PMID: 16904534]
Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets 2014; 14(4): 245-54.
[] [PMID: 25244229]
Kjeldsen-Kragh J. Mediterranean diet intervention in rheumatoid arthritis. Ann Rheum Dis 2003; 62(3): 193-5.
[] [PMID: 12594101]
Magdalon J, Vinolo MA, Rodrigues HG, et al. Oral administration of oleic or linoleic acids modulates the production of inflammatory mediators by rat macrophages. Lipids 2012; 47(8): 803-12.
[] [PMID: 22695743]
Musumeci G, Trovato FM, Pichler K, Weinberg AM, Loreto C, Castrogiovanni P. Extra-virgin olive oil diet and mild physical activity prevent cartilage degeneration in an osteoarthritis model: an in vivo and in vitro study on lubricin expression. J Nutr Biochem 2013; 24(12): 2064-75.
[] [PMID: 24369033]
Pattison DJ, Silman AJ, Goodson NJ, et al. Vitamin C and the risk of developing inflammatory polyarthritis: prospective nested case-control study. Ann Rheum Dis 2004; 63(7): 843-7.
[] [PMID: 15194581]
Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol 2013; 25(1): 114-8.
[] [PMID: 23090672]
Ouellette EA, Makowski AL. How men and women are affected by osteoarthritis of the hand. Orthop Clin North Am 2006; 37(4): 541-8.
[] [PMID: 17141010]
Apostolopoulos V, de Courten MP, Stojanovska L, Blatch GL, Tangalakis K, de Courten B. The complex immunological and inflammatory network of adipose tissue in obesity. Mol Nutr Food Res 2016; 60(1): 43-57.
[] [PMID: 26331761]
Lehr S, Hartwig S, Sell H. Adipokines: a treasure trove for the discovery of biomarkers for metabolic disorders. Proteomics Clin Appl 2012; 6(1-2): 91-101.
[] [PMID: 22213627]
Scotece M, Mobasheri A. Leptin in osteoarthritis: Focus on articular cartilage and chondrocytes. Life Sci 2015; 140: 75-8.
[] [PMID: 26094910]
Thijssen E, van Caam A, van der Kraan PM. Obesity and osteoarthritis, more than just wear and tear: pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatology (Oxford) 2015; 54(4): 588-600.
[] [PMID: 25504962]
Masuzaki H, Ogawa Y, Sagawa N, et al. Nonadipose tissue production of leptin: leptin as a novel placenta-derived hormone in humans. Nat Med 1997; 3(9): 1029-33.
[] [PMID: 9288733]
Mutabaruka MS, Aoulad Aissa M, Delalandre A, Lavigne M, Lajeunesse D. Local leptin production in osteoarthritis subchondral osteoblasts may be responsible for their abnormal phenotypic expression. Arthritis Res Ther 2010; 12(1): R20.
[] [PMID: 20141628]
Junker S, et al. Expression of adipokines in osteoarthritis osteophytes and their effect on osteoblasts. Matrix Biol 2016.
[PMID: 27884778]
Bédard A, Riverin M, Dodin S, Corneau L, Lemieux S. Sex differences in the impact of the Mediterranean diet on cardiovascular risk profile. Br J Nutr 2012; 108(8): 1428-34.
[] [PMID: 22221517]
Gray B, Steyn F, Davies PS, Vitetta L. Omega-3 fatty acids: a review of the effects on adiponectin and leptin and potential implications for obesity management. Eur J Clin Nutr 2013; 67(12): 1234-42.
[] [PMID: 24129365]
Schwingshackl L, Hoffmann G. Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis 2014; 24(9): 929-39.
[] [PMID: 24787907]
Fargnoli JL, Fung TT, Olenczuk DM, Chamberland JP, Hu FB, Mantzoros CS. Adherence to healthy eating patterns is associated with increased circulating total and high molecular weight adiponectin and decreased resistin concentrations in women from the Nurses’ Health Study. Am J Clin Nutr 2008; 88(5): 1213-24.
[PMID: 18996855]
Al-Attas OS, Hussain T, Al-Daghri NM, De Rosas E, Kazmi U, Vinodson B. The relationship between a Mediterranean diet and circulating adiponectin levels is influenced by cigarette smoking. J Atheroscler Thromb 2013; 20(4): 313-20.
[] [PMID: 23268983]
Fragopoulou E, Panagiotakos DB, Pitsavos C, et al. The association between adherence to the Mediterranean diet and adiponectin levels among healthy adults: the ATTICA study. J Nutr Biochem 2010; 21(4): 285-9.
[] [PMID: 19369051]
Bédard A, Tchernof A, Lamarche B, Corneau L, Dodin S, Lemieux S. Effects of the traditional Mediterranean diet on adiponectin and leptin concentrations in men and premenopausal women: do sex differences exist? Eur J Clin Nutr 2014; 68(5): 561-6.
[] [PMID: 24595221]
Scoditti E, Massaro M, Carluccio MA, et al. Additive regulation of adiponectin expression by the mediterranean diet olive oil components oleic Acid and hydroxytyrosol in human adipocytes. PLoS One 2015; 10(6): e0128218
[] [PMID: 26030149]
Iqbal SM, Leonard C, Regmi SC, et al. Lubricin / proteoglycan 4 binds to and regulates the activity of toll-like receptors in vitro. Sci Rep 2016; 6: 18910.
[] [PMID: 26752378]
Veronese N, Stubbs B, Noale M, Solmi M, Luchini C, Maggi S. Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative. Am J Clin Nutr 2016; 104(5): 1403-9.
[] [PMID: 27680996]
Veronese N, Stubbs B, Noale M, et al. Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative. Clin Nutr 2017; 36(6): 1609-14.
[] [PMID: 27769781]
The Hong Kong and Amsterdam Consensus Conferences. 1996.
McClung MR. The relationship between bone mineral density and fracture risk. Curr Osteoporos Rep 2005; 3(2): 57-63.
[] [PMID: 16036103]
Glaser DL, Kaplan FS. Osteoporosis. Definition and clinical presentation. Spine 1997; 22(24)(Suppl.): 12S-6S.
[] [PMID: 9431639]
Gubbels Bupp MR. Sex, the aging immune system, and chronic disease. Cell Immunol 2015; 294(2): 102-10.
[] [PMID: 25700766]
Bousson V, Bergot C, Sutter B, et al. Trabecular Bone Score: Where are we now? Joint Bone Spine 2015; 82(5): 320-5.
[] [PMID: 25921803]
Puel C, Mardon J, Agalias A, et al. Major phenolic compounds in olive oil modulate bone loss in an ovariectomy/inflammation experimental model. J Agric Food Chem 2008; 56(20): 9417-22.
[] [PMID: 18800805]
Puel C, Quintin A, Agalias A, et al. Olive oil and its main phenolic micronutrient (oleuropein) prevent inflammation-induced bone loss in the ovariectomised rat. Br J Nutr 2004; 92(1): 119-27.
[] [PMID: 15230995]
Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012; 367(1): 40-9.
[] [PMID: 22762317]
Hilger J, Friedel A, Herr R, et al. A systematic review of vitamin D status in populations worldwide. Br J Nutr 2014; 111(1): 23-45.
[] [PMID: 23930771]
Ovesen L, Andersen R, Jakobsen J. Geographical differences in vitamin D status, with particular reference to European countries. Proc Nutr Soc 2003; 62(4): 813-21.
[] [PMID: 15018480]
Adami S, Giannini S, Bianchi G, et al. Vitamin D status and response to treatment in post-menopausal osteoporosis. Osteoporos Int 2009; 20(2): 239-44.
[] [PMID: 18551242]
Tagliaferri C, Davicco M-J, Lebecque P, et al. Olive oil and vitamin D synergistically prevent bone loss in mice. PLoS One 2014; 9(12): e115817
[] [PMID: 25551374]
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348(26): 2599-608.
[] [PMID: 12826634]
Rivas A, Romero A, Mariscal-Arcas M, et al. Mediterranean diet and bone mineral density in two age groups of women. Int J Food Sci Nutr 2013; 64(2): 155-61.
[] [PMID: 22946650]
Lamb JJ, Holick MF, Lerman RH, et al. Nutritional supplementation of hop rho iso-alpha acids, berberine, vitamin D3, and vitamin K1 produces a favorable bone biomarker profile supporting healthy bone metabolism in postmenopausal women with metabolic syndrome. Nutr Res 2011; 31(5): 347-55.
[] [PMID: 21636012]
Feart C, Lorrain S, Ginder Coupez V, et al. Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporos Int 2013; 24(12): 3031-41.
[] [PMID: 23783645]
Drosos AA, Lanchbury JS, Panayi GS, Moutsopoulos HM. Rheumatoid arthritis in Greek and British patients. A comparative clinical, radiologic, and serologic study. Arthritis Rheum 1992; 35(7): 745-8.
[] [PMID: 1622412]
McEntegart A, Capell HA, Creran D, Rumley A, Woodward M, Lowe GD. Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40(6): 640-4.
[] [PMID: 11426020]
Oliviero F, Spinella P, Fiocco U, Ramonda R, Sfriso P, Punzi L. How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis. Swiss Med Wkly 2015; 145w14190.
Silva S, Sepodes B, Rocha J, et al. Protective effects of hydroxytyrosol-supplemented refined olive oil in animal models of acute inflammation and rheumatoid arthritis. J Nutr Biochem 2015; 26(4): 360-8.
[] [PMID: 25620693]
Rosillo MÁ, Alcaraz MJ, Sánchez-Hidalgo M, Fernández-Bolaños JG, Alarcón-de-la-Lastra C, Ferrándiz ML. Anti-inflammatory and joint protective effects of extra-virgin olive-oil polyphenol extract in experimental arthritis. J Nutr Biochem 2014; 25(12): 1275-81.
[] [PMID: 25294776]
Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62(3): 208-14.
[] [PMID: 12594104]
McKellar G, Morrison E, McEntegart A, et al. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann Rheum Dis 2007; 66(9): 1239-43.
[] [PMID: 17613557]
Michalsen A, Riegert M, Lüdtke R, et al. Mediterranean diet or extended fasting’s influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study. BMC Complement Altern Med 2005; 5: 22.
[] [PMID: 16372904]
Abendroth A, Michalsen A, Lüdtke R, et al. Changes of intestinal microflora in patients with rheumatoid arthritis during fasting or a Mediterranean diet. Forsch Komplement Med 2010; 17(6): 307-13.
[] [PMID: 21196744]
Hu Y, Costenbader KH, Gao X, Hu FB, Karlson EW, Lu B. Mediterranean diet and incidence of rheumatoid arthritis in women. Arthritis Care Res (Hoboken) 2015; 67(5): 597-606.
[] [PMID: 25251857]
Rosell M, Wesley AM, Rydin K, Klareskog L, Alfredsson L. Dietary fish and fish oil and the risk of rheumatoid arthritis. Epidemiology 2009; 20(6): 896-901.
[] [PMID: 19730266]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [242 - 250]
Pages: 9
DOI: 10.2174/1386207322666191203103530
Price: $65

Article Metrics

PDF: 21