Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage

Background Obesity is an important risk factor for knee osteoarthritis (OA), Weight loss can reduce the symptoms of knee OA. No prospective studies assessing the impact of weight loss on knee cartilage structure and composition have been performed. Objectives To assess the impact of weight loss on knee cartilage thickness and composition. Methods 111 obese adults were recruited from either laparoscopic adjustable gastric banding or exercise and diet weight loss programmes from two tertiary centres. MRI was performed at baseline and 12-month follow-up to assess cartilage thickness. 78 eligible subjects also underwent delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), an estimate of proteoglycan content. The associations between cartilage outcomes (cartilage thickness and dGEMRIC index) and weight loss were adjusted for age, gender, body mass index (BMI) and presence of clinical knee OA. Results Mean age was 51.7±11.8 years and mean BMI was 36.6±5.8 kg/m2; 32% had clinical knee OA. Mean weight loss was 9.3±11.9%. Percentage weight loss was negatively associated with cartilage thickness loss in the medial femoral compartment in multiple regression analysis (β=0.006, r2=0.19, p=0.029). This association was not detected in the lateral compartment (r2=0.12, p=0.745). Percentage weight loss was associated with an increase in medial dGEMRIC in multiple regression analysis (β=3.9, r2=0.26; p=0.008) but not the lateral compartment (r2=0.14, p=0.34). For every 10% weight loss there was a gain in the medial dGEMRIC index of 39 ms (r2=0.28; p=0.014). The lowest weight loss cut-off associated with reduced medial femoral cartilage thickness loss and improved medial dGEMRIC index was 7%. Conclusions Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage. This was not observed in the lateral compartment. This could ultimately lead to a reduced need for total joint replacements and is thus a finding with important public health implications.

[1]  Felix Eckstein,et al.  Varus-valgus alignment: reduced risk of subsequent cartilage loss in the less loaded compartment. , 2011, Arthritis and rheumatism.

[2]  S. Ikramuddin,et al.  Comparison of DXA and water measurements of body fat following gastric bypass surgery and a physiological model of body water, fat, and muscle composition. , 2010, Journal of applied physiology.

[3]  C E Hutchinson,et al.  Measurement and visualisation of focal cartilage thickness change by MRI in a study of knee osteoarthritis using a novel image analysis tool. , 2010, The British journal of radiology.

[4]  T. Schnitzer,et al.  Change in regional cartilage morphology and joint space width in osteoarthritis participants versus healthy controls: a multicentre study using 3.0 Tesla MRI and Lyon–Schuss radiography , 2008, Annals of the rheumatic diseases.

[5]  L. March,et al.  Cartilage defects are associated with physical disability in obese adults. , 2009, Rheumatology.

[6]  F. Eckstein,et al.  Relationship of compartment-specific structural knee status at baseline with change in cartilage morphology: a prospective observational study using data from the osteoarthritis initiative , 2009, Arthritis research & therapy.

[7]  L. Dahlberg,et al.  Relationship between cartilage glycosaminoglycan content (assessed with dGEMRIC) and OA risk factors in meniscectomized patients. , 2009, Osteoarthritis and cartilage.

[8]  L. March,et al.  Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage: Clinical Associations in Obese Adults , 2009, The Journal of Rheumatology.

[9]  F Eckstein,et al.  Regional analysis of femorotibial cartilage loss in a subsample from the Osteoarthritis Initiative progression subcohort. , 2009, Osteoarthritis and cartilage.

[10]  Steven N. Blair,et al.  Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women , 2009, PloS one.

[11]  L. March,et al.  Obesity and the musculoskeletal system , 2009, Current opinion in rheumatology.

[12]  F. Eckstein,et al.  One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status , 2008, Annals of the rheumatic diseases.

[13]  S Totterman,et al.  Change in cartilage morphometry: a sample of the progression cohort of the Osteoarthritis Initiative , 2008, Annals of the rheumatic diseases.

[14]  Tuomas Liikavainio,et al.  Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. , 2008, Archives of physical medicine and rehabilitation.

[15]  Annegret Mündermann,et al.  In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  F. Eckstein,et al.  Imaging in osteoarthritis. , 2008, Rheumatic diseases clinics of North America.

[17]  Carl Johan Tiderius,et al.  Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. , 2008, Arthritis and rheumatism.

[18]  J. H. Ahroni,et al.  Laparoscopic adjustable gastric banding in an ambulatory surgery center. , 2008, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[19]  B. Nicklas,et al.  Inflammatory Biomarkers and Physical Function in Older, Obese Adults with Knee Pain and Self‐Reported Osteoarthritis After Intensive Weight‐Loss Therapy , 2008, Journal of the American Geriatrics Society.

[20]  Martha L. Gray,et al.  Magnetic resonance imaging of cartilage glycosaminoglycan: Basic principles, imaging technique, and clinical applications , 2008 .

[21]  L. March,et al.  The impact of obesity on the musculoskeletal system , 2008, International Journal of Obesity.

[22]  Martin Underwood,et al.  Osteoarthritis: national clinical guideline for care and management in adults , 2008 .

[23]  Arne Astrup,et al.  Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. , 2008, The New England journal of medicine.

[24]  D. Burstein,et al.  2007 Elizabeth Winston Lanier Award Winner. Magnetic resonance imaging of cartilage glycosaminoglycan: basic principles, imaging technique, and clinical applications. , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[25]  B. Koes,et al.  Prognostic factors of progression of osteoarthritis of the knee: a systematic review of observational studies. , 2007, Arthritis and rheumatism.

[26]  C. Lewis,et al.  Mortality and cardiac and vascular outcomes in extremely obese women. , 2006, JAMA.

[27]  L. Sharma,et al.  dGEMRIC as a function of BMI. , 2006, Osteoarthritis and cartilage.

[28]  R Burgkart,et al.  Proposal for a nomenclature for magnetic resonance imaging based measures of articular cartilage in osteoarthritis. , 2006, Osteoarthritis and cartilage.

[29]  F. Cicuttini,et al.  Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years , 2006, Arthritis research & therapy.

[30]  P. Conaghan.  Is MRI useful in osteoarthritis? , 2006, Best practice & research. Clinical rheumatology.

[31]  F. Eckstein,et al.  Magnetic resonance imaging (MRI) of articular cartilage in knee osteoarthritis (OA): morphological assessment. , 2006, Osteoarthritis and cartilage.

[32]  P. Stanwell,et al.  Glycosaminoglycan content of knee cartilage following posterior cruciate ligament rupture demonstrated by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). A case report. , 2005, The Journal of bone and joint surgery. American volume.

[33]  Charles A McKenzie,et al.  Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in knee osteoarthritis: findings at different radiographic stages of disease and relationship to malalignment. , 2005, Arthritis and rheumatism.

[34]  Felix Eckstein,et al.  Accuracy and precision of quantitative assessment of cartilage morphology by magnetic resonance imaging at 3.0T. , 2005, Arthritis and rheumatism.

[35]  F. Cicuttini,et al.  The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study. , 2005, Rheumatology.

[36]  T. Vail,et al.  A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. , 2005, Arthritis and rheumatism.

[37]  F. Nyquist,et al.  Cartilage glycosaminoglycan loss in the acute phase after an anterior cruciate ligament injury: delayed gadolinium-enhanced magnetic resonance imaging of cartilage and synovial fluid analysis. , 2005, Arthritis and rheumatism.

[38]  W. Ambrosius,et al.  Is serum leptin related to physical function and is it modifiable through weight loss and exercise in older adults with knee osteoarthritis? , 2004, International Journal of Obesity.

[39]  F. Cicuttini,et al.  Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study , 2004, Annals of the rheumatic diseases.

[40]  Gösta Samuelson,et al.  Global strategy on diet, physical activity and health , 2004 .

[41]  Bruce C. Po,et al.  Glycosaminoglycan distribution in cartilage as determined by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC): potential clinical applications. , 2004, AJR. American journal of roentgenology.

[42]  F. Cicuttini,et al.  Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint. , 2003, Arthritis and rheumatism.

[43]  Carl Johan Tiderius,et al.  Delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) in early knee osteoarthritis , 2003, Magnetic resonance in medicine.

[44]  E. Stüssi,et al.  The effects of immobilization on the characteristics of articular cartilage: current concepts and future directions. , 2002, Osteoarthritis and cartilage.

[45]  K. T. Scott,et al.  Protocol issues for delayed Gd(DTPA)2–‐enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage , 2001, Magnetic resonance in medicine.

[46]  Mao‐Hsiung Huang,et al.  The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. , 2000, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[47]  S. Trattnig,et al.  Anatomy, Biochemistry, and Physiology of Articular Cartilage , 2000, Investigative radiology.

[48]  W. Ettinger,et al.  Exercise and Weight Loss in Obese Older Adults with Knee Osteoarthritis: A Preliminary Study , 2000, Journal of the American Geriatrics Society.

[49]  H J Helminen,et al.  Normal and pathological adaptations of articular cartilage to joint loading , 2000, Scandinavian journal of medicine & science in sports.

[50]  T. Spector,et al.  Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. , 1999, Arthritis and rheumatism.

[51]  D. Burstein,et al.  Glycosaminoglycan in articular cartilage: in vivo assessment with delayed Gd(DTPA)(2-)-enhanced MR imaging. , 1997, Radiology.

[52]  R. Putz,et al.  Determination of knee joint cartilage thickness using three‐dimensional magnetic resonance chondro‐crassometry (3D MR‐CCM) , 1996, Magnetic resonance in medicine.

[53]  J A Buckwalter,et al.  Osteoarthritis and articular cartilage use, disuse, and abuse: experimental studies. , 1995, The Journal of rheumatology. Supplement.

[54]  D. Mikulis,et al.  Quantitative cartilage imaging. , 1995, British journal of rheumatology.

[55]  T. Brown,et al.  Mechanical determinants of osteoarthrosis. , 1991, Seminars in arthritis and rheumatism.

[56]  D. Felson,et al.  Obesity and knee osteoarthritis. The Framingham Study. , 1988, Annals of internal medicine.

[57]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.