Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients

Osteoarthritis (OA) is the most common cause of musculoskeletal disability in elderly individuals, and it places an enormous economic burden on society. Management of OA is primarily focused on palliative relief by using agents such as nonsteroidal anti-inflammatory drugs and analgesics. However, such an approach is limited by a narrow therapeutic focus that fails to address the progressive and multimodal nature of OA. Given the favorable safety profile of most nutritional interventions, identifying disease-modifying nutritional agents capable of improving symptoms and also preventing, slowing, or even reversing the degenerative process in OA should remain an important paradigm in translational and clinical research. Applying advances in nutritional science to musculoskeletal medicine remains challenging, given the fluid and dynamic nature of the field, along with a rapidly developing regulatory climate over manufacturing and commerce requirements. The aim of this article is to review the available literature on effectiveness and potential mechanism of macronutrients for OA, with a focus on the following: long-chain ω-3 essential fatty acids eicosapentaenoic acid and docosahexaenoic acid, functional ω-6 fatty acid γ-linolenic acid, and macronutrient composition of background diet. There also is a discussion about the concept of rational polysupplementation via the strategic integration of multiple nutraceuticals with potential complementary mechanisms for improving outcomes in OA. As applied nutritional science evolves, it will be important to stay on the forefront of proteomics, metabolomics, epigenetics, and nutrigenomics, because they hold enormous potential for developing novel therapeutic and prognostic breakthroughs in many areas of medicine, including OA.