NEWS – osteoarthritis patients’ lives could be transformed by turning treatment on its head
Posted On: 6th September 2018
New research set to turn treatment of osteoarthritis on its head, lives could be “transformed”, say researchers.
A solution for England’s heart age problem: Danish study shows 10% weight loss can take 5 years off heart age and ease the pain of osteoarthritis.
Overweight elderly sufferers of osteoarthritis could have their lives “transformed” a leading scientist will today claim at a national conference on obesity.
Speaking at the UK conference on obesity in Newcastle, England on Thursday 6th September, Professor Henning Bliddal, director of the Parker arthritis Institute at Frederiksberg Hospital, Copenhagen will describe how his research team had shown weight loss with TDR (total diet replacement formula diet) and weight maintenance for four years improved symptoms in obese people with osteoarthritis and reduced their heart age by 5 years.
‘Elderly obese people with osteoarthritis have a very high risk of heart attack and stroke’ he said. ‘Our series of published clinical trials shows that an initial 12 to 13% weight loss over 16 weeks with total diet replacement reduces the pain of arthritis and that reduction of pain can be maintained over four years by careful weight maintenance’.
‘This amount of change in so short a time transformed their lives,’ said Professor Anthony Leeds, a bariatric physician at the Central Middlesex Hospital, London and a visiting senior research fellow at the Parker Institute. ‘Although weight loss is a core component in management of KOA, as recommended by the UK’s National Institute of Health and Care Excellence, in practice it is almost impossible to achieve by conventional diet in this type of patient. However, the team at the Parker has shown that a big weight loss with reduction of pain and blood pressure is possible’, he said.
Following the initial weight loss and one-year maintenance phase the Parker research team published the results of a three-year weight maintenance trial using the same participants, in effect showing that a 10% weight loss can be achieved and maintained for four years, with no significant deterioration of symptoms, and with maintained lower blood pressure. Professor Henning Bliddal said ‘These remarkable results should turn osteoarthritis treatment upside down. ‘We should now start with weight loss if the patient with knee osteoarthritis is heavy. ‘We know that most patients can do the programme with well over half getting good results after a total of four years. ‘Pain of osteoarthritis is due to a number of factors including inflammation and a sufficiently restricted diet will reduce the inflammation and hence reduce pain. ‘Pain causes misery for millions of OA patients across the globe, and this diet reduces pain, and the reduction of weight makes moving easier.’
Using the UK’s QRisk2 algorithm Professor Bliddal will present preliminary data showing that heart age before weight loss was on average 6 years greater than chronological age, while four years later heart age had been reduced by 5 years, in the two/thirds of participants who stayed in the programme. The maintenance of reduced blood pressure and reduced weight were probably the important factors contributing to this effect. Use of medications for blood pressure was also slightly reduced reflecting similar findings in other recent weight loss trials.
Prof Bliddal will refer to Public Health England’s announcement on Tuesday expressing concern about excessive heart age in the English population and remind his audience that obesity is linked to a vast portfolio of co-morbidities, the most significant of which are diabetes, vascular disease and osteoarthritis, adding ‘With ageing and heavier populations both Denmark and England are seeing increasing numbers of people with osteoarthritis and diabetes and the healthcare costs are rising rapidly. Achieving weight reduction in those who are overweight and obese is recognised as a ‘core’ feature of osteoarthritis management in European and UK guidelines’.
Notes to Editors
Contacts:
Professor Anthony Leeds, E-mail anthony.leeds1@nhs.net
Professor Henning Bliddal, E-mail Henning.Bliddal@regionh.dk
Key Points:
- Obesity related co-morbidities, such as diabetes, hypertension, osteoarthritis, often occur together in the same patient.
- Osteoarthritis cannot be treated to slow disease progression, we can only treat the symptoms;
- The patients’ main concern is pain, which can cause severe sleep disturbance, making life miserable and leading to depression.
- The second concern is decreased mobility that can lead to social isolation.
- Osteoarthritis is associated with increased cardiovascular risk; risk of heart attack and stroke;
- Helping people with KOA lose weight with conventional diet is very difficult as most dietitians and doctors will agree.
- Research at the Parker Institute, Frederiksberg Hospital, Denmark, showed that more than 10kg weight loss in elderly people with knee osteoarthritis can be achieved [Christensen P, 2011] and is enough to reduce inflammation in the joint and significantly reduce pain in more than 60% of patients.
- In the second phase it was shown that 10% body weight loss can be maintained for one year with maintenance of a proportion of the symptom improvement and improved cardiovascular risk [Christensen R, 2015].
- More than 10kg weight loss was associated with reduced risk of cardiovascular disease, particularly with reduced blood pressure.
- Calculated Heart age which was 6 years greater than chronological age before weight loss, was reduced by five years following 10% weight loss and maintenance (and maintenance of blood pressure reduction) over four years in more than two thirds of participants who stayed in the trial.
- Some of those same participants maintained their weight loss (about 10kg) over a further three years by using one daily meal replacement product or by using intermittent total diet replacement with formula product, as well as maintaining their reduced pain scores and improved cardiovascular risk [Christensen P, 2017].
- More than 50% of the people who originally started the programme completed the full four years and four months, demonstrating the acceptability of this safe intervention.
- TDRs (Total diet replacements), which include very low-calorie diets (VLCDs) and low-calorie diets (LCDs), are specifically formulated programmes that are based around formula foods that aim to replace the whole of the daily diet. These formula foods are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients, and are designed to replace conventional foods for a period to facilitate optimal weight loss. They provide controlled energy intake lower than can be achieved with a reduced intake of normal foods.
References:
Heart age test gives early warning of heart attack and stroke Public Health England press release 4th September 2018 https://www.gov.uk/government/news/heart-age-test-gives-early-warning-of-heart-attack-and-stroke
Chen A, Gupte C, Akhtar K, et al (2012) The Global economic cost of osteoarthritis: How the UK compares. Arthritis. http://dx.doi.org/10.1155/2012/698709
Declaration of interest:
Professor Leeds is also medical director of Cambridge Weight Plan Ltd., and chairman of TDMR Europe (https://tdmr-europe.com/ )
Web:
About TDMR Europe:
TDMR Europe is the European trade body for manufacturers and distributors of formula diet products, including total diet replacement products (TDRs) and meal replacement products (MRPs) which provide weight loss and weight management programmes for the overweight and obese. Our members currently operate predominantly in the Netherlands, Sweden, Finland, the Czech Republic, the United Kingdom, Denmark, Ireland, Cyprus, Greece and Poland.