Inflammation, Arthritis, and Nutrition

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1 Inflammation, Arthritis, and Nutrition Kristin Baker, PhD Assistant Research Professor ENACT Sargent College at Boston University ENACT website:

2 Brief Bio Primary research interests include examining the role of exercise and nutrition in the development and progression of knee osteoarthritis, both structurally and clinically. Developed and tested a strengthening protocol for knee osteoarthritis Examined the role of dietary fatty acids on inflammation in osteoarthritis Recipient of various grants from National Institute of Health (NIH) National Institute of Disability and Rehabilitation Research (NIDRR) American Federation of Aging Research (AFAR) Arthritis Foundation.

3 Overview What is inflammation? General Concept Acute vs. Chronic Innate vs. Adaptive Inflammation and Disease (Arthritis) How does nutrition impact inflammation? Macronutrients (Carbohydrate and Fats) Micronutrients (Antioxidants) Dietary Patterns

4 Inflammation Latin "inflammo", meaning "I set alight, I ignite

5 Inflammation This is fundamentally a protective response Without inflammation Wounds would never heal Infections would go unchecked

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9 Innate and Adaptive Immunity

10 Inflammation

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13 Osteoarthritis

14 Rheumatoid Arthritis

15 Impact of Nutrition on Inflammation Nutrition

16 Macronutrients Excess calories Excess carbohydrate Glycemic index Sugar intake Fats Trans fats Saturated fats Omega 6 and Omega 3 fats

17 Excess Calories Calorie Restriction Society 30% reduction (1800 kcal/day) serum levels of pro-inflammatory factors and body fat, improved BMI, glucose tolerance, insulin sensitivity, and lipoprotein profiles. Fontana L, Klein S. Aging, adiposity, and calorie restriction. JAMA. 2007;297(9):

18 Macronutrient Simple Carbohydrate High-GI diets rich in refined carbohydrate stimulate pro-inflammatory production Huffman KM, et al. Dietary carbohydrate and high-sensitivity C-reactive protein in atrisk women and men. Am Heart J. 2007;154(5):

19 Added Sugar Average American consumes around 22.2 teaspoons of added sugar every day American Heart Association Recommendations Men: 150 calories per day (37.5 grams or 9 teaspoons) Women: 100 calories per day (25 grams or 6 teaspoons) (Circulation. 2009; 120: )

20 Macronutrient Complex Carbohydrate Low-GI high fiber diet for one year resulted in significantly lower plasma levels of CRP in a clinical randomized trial of subjects with type 2 diabetes compared with adhering to high-gi and low-carbohydrate diets Wolever TM, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index carbohydrate in type 2 diabetes: no effect on glycated hemoglobin, but reduction C-reactive protein. Am J Clin Nutr. 2008;87(1):

21 Macronutrient Trans Fats Trans fatty acids cell membranes 18:2 fatty acids 2x rate of cis 18:2 fatty acids in human aortic endothelial Cells clump and bind to arterial walls Release of pro-inflammatory cytokines Chronic Heart Failure Association between trans fatty acid level of red blood cell membranes and plasma biomarkers of inflammation Harvey KA, et al. Trans-fatty acids induce pro-inflammatory responses and endothelial cell dysfunction. Br J Nutr. 2008;99(4):

22 Macronutrient Saturated Fats Pro-inflammatory markers in mice with a diet comparable to the level in the average American diet

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24 Macronutrients Omega 3 s and 6 s Omega 3 Alpha Linolenic Acid (Chia and flax seeds, walnuts) Eicosapentaenoic (EPA) and Docosahexaenoic (DHA) (fatty fish) Ratio Historic 1:2 Current1:12 Omega 6 Linoleic Acid Safflower Corn Soybean Sunflower Patterson E, et al. Health implications of high dietary omega-6 polyunsaturated fatty acids. J Nutr Metab. 2012;2012: Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006;83(6 Suppl):1505S-1519S.

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27 MUFA Olive Oil Olive Oil Beauchamp, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature, 2005, 437, J Nutr Biochem Dec;25(12):

28 Antioxidants Ascorbic Acid Vitamin E Polyphenols Flavonoids Lignans Calder PC, Albers R, Antoine J-M, et al. Inflammatory disease processes and interactions with nutrition. Br J Nutr. 2009;101 Suppl 1:S1-S45

29 Dietary Patterns Mediterranean Diet Vitamins Minerals Fiber Polyphenols Estruch R. Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc. 2010;69(3): Root MM, et al. Combined fruit and vegetable intake is correlated with improved inflammatory and oxidant status from a cross-sectional study in a community setting. Nutrients. 2012;4(1):29-41.

30 Summary Regulated Inflammation Essential response for infection and injury, restores homeostasis Chronic or Unregulated Inflammation Loss of barrier function Response to a normally benign substance Increased production of inflammatory cells and in places not normally found Why resolution is not normal is still largely unknown Nutrition and Inflammation Nutrition can reinforce the regulatory pathways controlling inflammatory responses Nutrition may contribute to the robustness of homeostatic control to reduce the risk that acute inflammatory responses derail into uncontrolled chronic inflammatory responses Nutrition may widen the boundaries within which the inflammatory responses can deal with the challenges Potential dietary components include, carbohydrate intake, fatty acid intake, and antioxidants Lots of preliminary suggestive data Clear need for more good-quality studies assessing the impact of nutrition and specific nutrients on chronic inflammatory responses

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