‘TDR and vitamin D status in elderly obese people with knee osteoarthritis’ – Henning Bliddal

Posted On: 4th August 2020

Henning Bliddal, Parker Institute, Frederiksburg Hospital, Copenhagen, Denmark

Introduction: Among several comorbidities to obesity, osteoarthritis (OA) of the knee is increasingly important. Obesity and kneeOA are linked in several ways and form a vicious circle, each intensifying the other. As the populations grow older and heavier, both individuals and society are facing increasing challenges with the combination of obesity and bad knees. These factors make it especially difficult to obtain and maintain a weight loss(1).

Methods: Over the past decade, the Copenhagen model for weight loss in the obese with kneeOA has been tested thoroughly. This model implies a weight reduction with 8 weeks of TDR, 4 meals a day, in total 415-810 kCal/day reinforced by group therapy lead by a dietician. Continuing in the groups, ordinary food is reintroduced over 4-8 weeks, though with a strict diet of 1200 kCal/day(2). In a later follow-up study, a lasting weight loss maintenance was shown over up to 4 years(3).

Results: In one pivotal study(4), A total of 175 patients (142 women), 91%, completed the 16-week program and had a body weight loss of 14.0 kg (95% confidence interval: 13.3 — 14.7; P<0.0001), consisting of 1.8 kg (1.3 — 2.3; P<0.0001) lean body mass (LBM) and 11.0 kg (10.4 — 11.6; P<0.0001) fat mass. Bone mineral content (BMC) did not change (-13.5 g; P=0.18), whereas bone mineral density (BMD) increased by 0.004 g/cm2 (0.001 –0.008 g/cm2; P=0.025). Plasma vitamin D and B12 increased by 15.3 nmol/l (13.2 — 17.3; P<0.0001) and 43.7 pmol/l (32.1 — 55.4; P<0.0001), respectively. There was no change in plasma ferritin.

Conclusion: With proper guidance, weight loss obtained with meal replacements may lead to a significant and clinically important effect on both symptoms and nutritional status

Henning Bliddal is a specialist in rheumatology. Since 1997 he has been Leader and Professor of Research at the Parker Institute, a clinical research unit of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. HB’s research projects have over the last years concentrated on treatment of patients with knee osteoarthritis (OA) with very significant results in patients with this disease in combination with obesity. HB has supervised numerous medical students and physicians, including 32 PhD students. He has extensive teaching experience and is a regular contributor and guest speaker at national and international congresses. HB has contributed to textbooks, and has published more than peer 350 reviewed papers in international medical journals covering many different aspects of rheumatology.

Total Diet & Meal Replacements Europe (TDMR Europe)’s webinar, ‘Reducing future risk: Obesity co-morbidities and nutritional status’, attracted over 100 academics, policymakers and medical specialists from all over the world.

The webinar, which had been awarded SCOPE World Obesity Federation accreditation, highlighted the use of total diet replacements to reduce future risk of diabetes and cardiovascular disease and diminish severe outcomes in COVID-19 among at-risk subgroups within populations. The speakers discussed a range of diverse and challenging topics, including obesity, nutritional status and COVID-19, TDR to achieve diabetes remission and diabetes risk reduction, TDR and vitamin D status in elderly obese people with knee osteoarthritis, and research needs and translation into practice in the context of diabetes remission.

TDMR Europe represents the voice of European manufacturers and distributors of formula diet products, including Total Diet Replacements (TDRs) and Meal Replacement Products (MRPs), that provide weight loss and weight management programmes for overweight and obese individuals.

If you would like to contact TDMR Europe to discuss the webinar or any other matter, email secretariat@tdmr-europe.com.

1. Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obes Rev 2014 Jul;15(7):578-86.

2. Riecke BF, Christensen R, Christensen P, Leeds AR, Boesen M, Lohmander LS, et al. Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Osteoarthritis Cartilage 2010 Jun;18(6):746-54.

3. Christensen P, Henriksen M, Bartels EM, Leeds AR, Meinert LT, Gudbergsen H, et al. Long-term weight-loss maintenance in obese patients with knee osteoarthritis: a randomized trial. Am J Clin Nutr 2017 Sep;106(3):755-63.

4. Christensen P, Bartels EM, Riecke BF, Bliddal H, Leeds AR, Astrup A, et al. Improved nutritional status and bone health after diet-induced weight loss in sedentary osteoarthritis patients: a prospective cohort study. Eur J Clin Nutr 2012 Apr;66(4):504-9.