news_2060-obesita_osteoartrite

Obesità: tutto il peso sul ginocchio

L`osteoartrosi del ginocchio (OA), complicata da artrite, è causa frequente di dolore cronico e disabilità, ha origini biomeccaniche e infiammatorie ed è aggravata dall`obesità. 

 

Lo studio

In uno studio clinico randomizzato in singolo cieco alla Wake Forest University tra il luglio 2006 e aprile 2011, della durata di 18 mesi, sono stati reclutati 454 soggetti in sovrappeso e obesi adulti e anziani residenti in comunità (età ≥ 55 anni, con BMI compre-so tra 27-41) che lamentavano dolore e con radiografica del ginocchio positiva per OA. Si procedeva confrontando i risultati ottenuti sulla perdita di peso e sugli indicatori d’infiammazione, con tre tipi d’intervento: solo dietadieta più esercizio fisico, o solo esercizio fisico.

Erano considerati come esiti primari meccanicistici: la forza di compressione sul ginocchio e il livello plasmatico di IL-6. Come esiti clinici secondari si consideravano: il dolore auto-riferito, la funzione recuperata, la mobilità, la salute generale e la qualità di vita correlata. Un buon numero di partecipanti (88% – n=399) ha completato lo studio. Per quando riguarda la perdita di peso si è dimostrato che: nel gruppo dieta + esercizio, era di 10,6 kg (11,4%), nel gruppo con la sola dieta di 8,9 kg (9,5%), e nel gruppo con il solo esercizio fisico era di 1,8 kg (2,0%).

 

Osteoarthritic-Knee-Joint-ImageInoltre, dopo 18 mesi d’intervento,  le forze di compres-sione sul ginocchio erano inferiori nei partecipanti sotto-posti alla sola dieta (in media, 2487 N, 95% CI, 2393-2581), rispetto al gruppo dei par-tecipanti sottoposti a solo esercizio fisico (2687 N, 95% CI, 2590-2784). Le concen-trazioni di IL-6 sono risultate inferiori nel gruppo a dieta + esercizio fisico (2,7 pg / mL, 95% CI, 2,5-3,0). Infine, ma non per ultimo, il gruppo a dieta + esercizio fisico, riferiva meno dolore e una migliore funzione, sia rispetto al gruppo con la sola dieta, sia rispetto al gruppo con il solo esercizio fisico. Gli autori concludono confer-mando l’importanza della dieta nella riduzione del peso e dell’esercizio fisico nella riduzione degli indici infiammatori nei soggetti obesi con osteoartrite nel gruppo a dieta (2,7 pg / mL, 95% CI, 2,4-3,0) rispetto al gruppo con solo esercizio fisico (3,1 pg / mL, 95% CI, 2,9-3,4. del ginocchio.

Clinica pratica

In sostanza, in questo campione, la riduzione del peso ottenuta con la dieta va a supportare un incremento della mobilità e delle funzioni articolari del ginocchio, con ritorno a una qualità di vita migliore, che a sua volta si avvale della ripresa dell’attività fisica.

In altri termini, i risultati dello studio suggeriscono l’importanza del controllo e del monitoraggio della dieta, ossia della perdita di peso, prima di ricorrere a un esercizio fisico intenso, anche per meglio valutare l’efficienza energetica.

In ogni caso, la perdita di peso è un ottimo investimento, a breve termine, per la riduzione del carico articolare, nei pazienti con obesità e gonartrosi, come già dimostrato in studi precedenti. La prima proposta di perdere peso, quando subentra un dolore invalidante, è ben accetta dal paziente che, solo successivamente, potrà essere motivato anche alla ripresa dell’attività fisica, altrimenti scartata per la persistenza del dolore.
Redazione articolo: http://www.obesita.it/html/approfondimenti/it/obesita_tutto_il_peso_sul_ginocchio.asp

 Fonti

http://www.ncbi.nlm.nih.gov/pubmed/24065013 

JAMA. 2013;310(12):1263-1273. doi:10.1001/jama.2013.277669.

Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee OsteoarthritisThe IDEA Randomized Clinical Trial

http://www.ncbi.nlm.nih.gov/pubmed/21440076

Osteoarthritis Cartilage. 2011 Jul;19(7):822-8. doi: 10.1016/j.joca.2011.03.006. Epub 2011 Apr 8.

Effects of an intensive weight loss program on knee  joint loading in obese adults with kneeosteoarthritis.

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