Factors affecting
The Pain of Osteoarthritis Patients
Seo
Yeong-Mi*1, Won Hee Choi2, Tae
Kyung Kim3
1Dept. Nursing, Gyeongnam National University of
Science and Technology, Chiram-dong, 150, Jinju-Si,
Gyeonsangnam-Do, 52725, Republic of Korea
2Dept. Nursing, Kyungsung University, Suyeong-ro,
Nam-gu, 309, Busan, 48435, Republic of Korea
3Dept. Nursing,
Dong-Eui Institute of Technology, Yanggi-Ro,
Busan Jin-Gu, 54, Busan, 47230,
Republic of
Korea
*Corresponding
Author E-mail: asfirst@gntech.ac.kr, whchoi@ks.ac.kr, phoebetk@dit.ac.kr
ABSTRACT:
Background/Objectives: Osteoarthritis, which is the disease that results in
the largest number of adult activity restriction days, is a chronic disease and
a major disease in terms ofloss of gross domestic product. It causes severe
pain and joint deformity in individuals. This study aimed to investigate
nutrient intake in relation to patient pain in order to provide basic data for
nutrition intervention necessary for patient pain control. Methods/Statistical
analysis: This study is a secondary analysis study using the Korea National
Health and Nutrition Examination Survey (2015), and data of 403 people were
used in the final analysis. This study analyzed the sociodemographic
characteristics, pain, and nutrient intake of osteoarthritis patients using the
SPSS 23.0 Windows statistical program. Findings: The prevalence of
osteoarthritis was high because the subjects of this study were women and their
economic and education levels were low. Most osteoarthritis patients ingested
less than the recommended daily intake of vitamin B1, iron,
potassium, and calcium. For vitamin B1 and calcium, there were
statistically meaningful correlations between pain and nutrient intake. The pain of osteoarthritis patients showed
statistically significant differences according to the recommended daily intake
levels of vitamin B1 and calcium. Meanwhile, no statistically
significant differences were revealed according to the recommended daily intake
levels of potassium and iron. Correlations were shown between the nutrient
intake and pain of osteoarthritis patients, and the quality of life of the
group with pain was lower than that of the group without pain. Improvements/Applications: Based on
the findings of this study, studies to examine proper nutrient intake as an
active measure for prevention of the induction and worsening of osteoarthritis
patient pain are needed. The
findings of this study are expected to contribute to the establishment of
intervention measures for the guidelines of osteoarthritis patients with pain
and to their quality of life improvement.
KEYWORDS: Osteoarthritis,
Pain, Nutrient intake, Quality of life, Korea National Health and Nutrition Examination Survey.
1.
INTRODUCTION:
Nowadays, changes in
nutrition state and living environment, due to national income improvement, are
bringing about a surge of chronic diseases, and chronic diseases are emerging
as a major health problem affecting individuals, their families, and national
competitiveness.
According to the Korea
National Health and Nutrition Examination Survey carried out in 2015,
osteoarthritis patients were 99.1 persons per 1,000 population, and
osteoarthritis posted the third highest prevalence among chronic diseases1.
Osteoarthritis, as a chronic disease, was identified as a major disease causing
a loss of gross domestic product (GDP) because the number of adult activity
restriction days due to osteoarthritis is the largest among diseases; thus
osteoarthritis is regarded as a serious social problem. Osteoarthritis causes
severe pain and physical discomfort owing to joint deformity. Consequently, the
social functions and vitality of osteoarthritis patients diminish and the
disease brings about restrictions in independent everyday life, which reduces
the quality of life2. Patients experiencing osteoarthritis complain
that one of their biggest difficulties is pain. In this regard, the goal of
osteoarthritis treatment is reducing pain and minimizing the everyday life
hindrances of osteoarthritis patients, thereby enhancing their quality of life.
Although the causes of pain
accompanied by osteoarthritis have yet to be clearly determined, osteoarthritis
is assumed to be caused by arthritis, bursitis around knee joint, damage to
knee joint ligament or meniscus, muscle pain or muscular membrane origin pain,
and associated pain from other joint diseases. For this reason, there is no
clear method for the prevention and control of osteoarthritis pain.. Muscle
pain or muscular membrane origin pain assumed to be the cause of osteoarthritis
pain is known to occur because of energy supply hindrance stemming from
improper nutrition together with psychology factors, physical stimuli, abnormal
metabolism, and chronic infection.
Gerwin (1997) asserts that
inappropriate nutrition intake and the lack of some invisible nutrients cause
and worsen muscle pain or muscular membrane pain. In detail, he reports
that,among nutrients essential for the human body, a lack of calcium, iron, and
potassium, which are essential to normal muscle functions, as well as a lack of
vitamin B1, B6, B12, folic acid, and vitamin
C, which are engaged in energy production,are major factors activating or
worsening pain. Intake of nutrients such as calcium and vitamins and some foods
are reported to have effects on the prevention and relief of osteoarthritis3.
In conclusion, the nutrient
control of osteoarthritis patients appears to affect the prevention of the
disease and pain control; however, few previous studies in this field are
found. Although Korea shows high prevalence of osteoarthritis, almost no
studies searching for pain causing factors or treatment effects in the dietary
life or nutrient intake been conducted. In this context, there is a need for an
analysis on the pain and nutrient intake of osteoarthritis patients using nationally
representative survey results.
This study aims to examine
nutrient intake in relation tothe pain of Korean osteoarthritis patients using
the National Health and Nutrition Examination Survey (2015) and to provide
basic data of nutrition intervention necessary for the pain control of
osteoarthritis patients. That
is, this study aims to offer the basic data of nutrition intervention necessary
for efficient pain control of osteoarthritis patients by identifying the pain
and nutrient intake of osteoarthritis. The specific objectives of this study
are as follows:
1.
Analyze the
sociodemographic characteristics, pain, and nutrient intake of osteoarthritis
patients.
2.
Analyze the status of
pain according to the sociodemographic characteristics of osteoarthritis patients.
3.
Analyze nutrient
intake according to the pain of osteoarthritis patients.
4.
Analyze the factors
affecting the pain of osteoarthritis patients.
2. MATERIALS AND METHODS:
This study is a secondary
analysis study using the Korea National Health and Nutrition Examination Survey
(2015) conducted by the Korea Centers for Disease Control and Prevention. This
study surveyed the sociodemographic characteristics, pain, and nutrient intake
of osteoarthritis patients.
2.1. Research subjects and data collection:
The 2015 Korea National
Health and Nutrition Examination Survey data was used in order to examine
nutrient intake in relation to the pain of osteoarthritis patients. A total of
34,152 subjects participated in the 6th Korea National Health and Nutrition
Examination Survey (2015). For the first phase, 816 subjects were selected who
were diagnosed as having osteoarthritis and had responded to the intake of
vitaminB1, calcium, iron, and potassium. For the final analysis, 403
osteoarthritis patients who had responded to the questions on the status of
experiencing pain for one year were used.
2.2. Tools:
1. Sociodemographic characteristics:
The sociodemographic
characteristics included gender, age, the status of having a spouse (marital
status), education level, monthly income, occupation, subjective health state,
the status of currently receiving treatment, drinking, smoking, and activity restriction.
For subjective health
state, the answers to the question, “What do you usually think of your health?”
were classified into very good, good, fair, bad, and very bad.
Concerning the current
status of osteoarthritis treatment with the question, “Do you currently receive
treatment?”, the answers were classified into receiving no treatment due to
complete recovery, receiving no treatment despite no full recovery, and
currently receiving treatment.
For drinking, the answers
to the question “Have you drunk at least one glass of alcohol in your life?”
were divided into yes and no. Regarding smoking, the answers to the question
“Have you ever smoked at least one cigarette?” were divided into yes and no.
Concerning activity restriction with the question “Do you have any restrictions
in daily life and social activity due to a health problem or physical or mental
disability?”, the answers were classified into yes and no.
2.
Pain:
For pain, the answers to
the question “Have you ever experienced pain, stiffness, or swelling around
joints during the past one year?” were classified into yes and no.
3.
Nutrient intake:
With regard to nutrient
intake, this study used the results of daily intake of each person from the
foods intake survey using 24-hour recall in the Korea National Health and
Nutrition Examination Survey. Vitamin B1, calcium, iron, and potassium were
used for the analysis. Based on the daily recommended intake of vitamin B1,
calcium, iron, and potassium of an adult aged 20 or over presented in the
Dietary Reference Intakes for Koreans, 2005 (KDRIs), this study classified the
subjects into a sufficient ingesting group of the recommended intake and an
insufficient ingesting group of the recommended intake. The recommended intake
of vitamin B1is 1.2 ㎎/day for men and 1.1 ㎎/day for women and that of calcium is 700 ㎎/day and 700-800 ㎎/day for men and women, respectively.
Sufficient intake of potassium is indicated as 4.7 g/day for both men and
women.
2.3. Statistical analysis:
SPSS/win 23.0 program was
used for data analysis. Chi-square
tests were conducted to compare the nutrient intake of the subjects in accordance with differences in their sociodemographic
characteristics and pain. A
Pearson correlation analysis was conducted to check the correlations between
pain and nutrient intake, and a logistic regression analysis was also carried
out to ascertain the variables affecting pain.
3. RESULTS AND DISCUSSION:
3.1. Sociodemographic characteristics in accordance with pain:
The items showing
statistically significant differences in the comparison of osteoarthritis
patients with pain and those without pain were gender, age, marital status,
education level, monthly income, subjective health state, the status of
currently receiving treatment, and activity restriction. By gender, 22% of
osteoarthritis patients with pain were male and 78% were female, while 36% of
osteoarthritis patients without painwere male and 64% were female; therefore,
there were more female osteoarthritis patients with pain (
=4.686, p=.030). By age, 47% of
osteoarthritis patients with pain were aged 65 or over, while 28% of those
without pain were aged 65 years or over; therefore, the former were more (
=6.402, p=.011).
With regard to marital
status, 66% of osteoarthritis patients with pain had a spouse and 93% of
patients without pain hada spouse; thus,a higher proportion of osteoarthritis
patients without pain had a spouse (
=5.492, p=.019). For education level, 37%
of the osteoarthritis patients with pain were elementary school graduates and
31% had no education, whereas 32% of those without pain were elementary school
graduates and 30% were high school graduates; therefore, the education level of
those without pain was higher ( =5.492, p=.019). With regard to monthly
income, the monthly income of osteoarthritis patients with pain was smaller
than that of patients without pain (=7.828, p=.050).
For subjective health
state, 57% of osteoarthritis patients with pain and 36% of patients without
pain said their health was bad ( =12.985, p=.002). For the status of
currently receiving treatment, 53% of patients with pain were currently
receiving treatment, while only 13% of those without pain were currently
receiving treatment; therefore, a higher proportion of patients with pain were
currently receiving treatment ( =122.816, p=.000). For activity
restriction, 27% of osteoarthritis patients with pain had activity restrictions
and 6% of those without pain had activity restrictions; thus,a higher
proportion of osteoarthritis patients with pain had activity restrictions (=9.884, p=.002) (Table 1).
Table
1-Pain according to
General Characteristics
|
|
Existed
pain
|
|
p
|
|
Yes
|
No
|
|
Gender
|
Male
|
78(21.91)
|
17(36.17)
|
4.686*
|
.030
|
|
Femail
|
278(78.09)
|
30(63.83)
|
|
Age
|
below 65
|
188(52.81)
|
34(72.34)
|
6.402*
|
.011
|
|
65 over
|
168(47.19)
|
13(27.66)
|
|
Mate
|
Yes
|
235(66.01)
|
39(82.98)
|
5.492*
|
.019
|
|
No
|
121(33.99)
|
8(17.02)
|
|
Education
status
|
None
|
109(30.62)
|
4(8.51)
|
23.541**
|
.000
|
|
Elementary
school
|
131(36.80)
|
15(31.91)
|
|
Middle
school
|
45(12.64)
|
5(10.64)
|
|
High school
|
49(13.76)
|
14(29.79)
|
|
College or
University
|
22(6.18)
|
9(19.15)
|
|
Income/month
(10,000)
|
≤ 100
|
102(66.67)
|
10(50.00)
|
7.828*
|
.050
|
|
101-200
|
32(20.92)
|
3(15.00)
|
|
201-300
|
11(7.19)
|
5(25.00)
|
|
≥ 301
|
8(5.23)
|
2(10.00)
|
|
Occupation
|
Professional
|
11(4.47)
|
4(9.52)
|
7.002
|
.220
|
|
Officer
|
2(.81)
|
2(4.76)
|
|
Sale &
Servive worker
|
36(14.63)
|
6(14.29)
|
|
Agriculture
& Fishery
|
58(23.58)
|
7(16.67)
|
|
Laborer
|
46(18.70)
|
6(14.29)
|
|
Housewife
|
93(37.80)
|
17(40.48)
|
|
Perceived
Health
Status
|
Good to
Excellent
|
204(57.30)
|
17(36.17)
|
12.985**
|
.002
|
|
Average
|
122(34.27)
|
19(40.43)
|
|
Fair to
Poor
|
30(8.43)
|
11(23.40)
|
|
Treatment
status of Osteoarthritis
|
Treated and
cured completely
|
7(1.97)
|
21(44.68)
|
122.816**
|
.000
|
|
Not treated
though were not cured
|
162(45.51)
|
20(42.55)
|
|
Treating
now
|
187(52.53)
|
6(12.77)
|
|
Anemia
|
Yes
|
37(10.39)
|
4(8.51)
|
.161
|
.688
|
|
No
|
319(89.61)
|
43(91.49)
|
|
Alcohol
|
Yes
|
181(50.84)
|
30(63.83)
|
2.807
|
.094
|
|
No
|
175(49.16)
|
17(36.17)
|
|
Smoking
|
Yes
|
48(13.48)
|
9(19.15)
|
1.098
|
.295
|
|
No
|
308(86.52)
|
38(80.85)
|
|
Restrict of
activity
|
Yes
|
98(27.53)
|
3(6.38)
|
9.884**
|
.002
|
|
No
|
258(72.47)
|
44(93.62)
|
|
Total
|
356(100.00)
|
47(100.00)
|
|
|
*p<.05;
**p<.01
3.2. Comparison of Nutrient intake between Osteoarthritis Patients with
Pain and those without Pain:
In the comparison between
osteoarthritis patients with pain and those without pain, the items showing
statistically significant differences were vitamin B1 and calcium. Of the
osteoarthritis patients with pain, 28% took the recommended intake of vitamin
B1, while 51% of those without pain took the recommended intake of vitamin B1;
therefore, a higher proportion of osteoarthritis patients without pain ingested
sufficient vitamin B1 ( =10.287, p=.001). Of the osteoarthritis
patients with pain, 16% ingested the recommended intake of calcium, whereas 31%
of those without pain ingested the recommended intake of calcium; therefore, a
higher proportion of osteoarthritis patients without pain ingested sufficient
calcium ( =7.156, p=.007) (Table 2).
3.3. Comparison of Correlations between Pain and Nutrient Intake
A comparison of
correlations between pain and nutrient intake (Table 3) shows that pain had a
statistically meaningful correlation with both vitamin B1 (r=.160) and
calcium(r=.133).
Table
2. Pain according to Nutrient intake
|
|
Existed
pain
|
|
p
|
|
Yes
|
No
|
|
Vitamin B1
|
Yes
|
100(28.09)
|
24(51.06)
|
10.287**
|
.001
|
|
No
|
256(71.91)
|
23(48.94)
|
|
Fe
|
Yes
|
203(57.02)
|
30(63.83)
|
.789
|
.374
|
|
No
|
153(42.98)
|
17(36.17)
|
|
Ca
|
Yes
|
57(16.01)
|
15(31.91)
|
7.156**
|
.007
|
|
No
|
299(83.99)
|
32(68.09)
|
|
K
|
Yes
|
23(6.46)
|
5(10.64)
|
1.121
|
.290
|
|
No
|
333(93.54)
|
42(89.36)
|
|
Total
|
356(100.00)
|
47(100.00)
|
|
|
*p<.05;
**p<.01
Table 3. Correlation
between Nutrient intake and Pain
|
|
Vitamin
B1
|
Fe
|
Ca
|
K
|
|
Nutrient
intake
|
Vitamin B1
|
1
|
|
|
|
|
Fe
|
.330**
|
1
|
|
|
|
Ca
|
.293**
|
.320**
|
1
|
|
|
K
|
.346**
|
.233**
|
.433**
|
1
|
|
Pain
|
.160**
|
.044
|
.133**
|
.053
|
*p<.05;
**p<.01
4. Factors affecting pain:
Among the total of 403
subjects, 356 (88.3%) belonged to the group with pain and 47 belonged to the
group without pain. To determine how well this group classification was
conducted by the affecting variables, a logistic regression analysis assigning
weighted values to the group with pain and the group without pain was carried
out in order to equalize the number of respondents in each group. According to the
logistic regression analysis results, the variables affecting the status of
pain were the status of currently receiving treatment and the status of
ingesting more than the recommended intake of calcium. For the status of
currently receiving treatment, the case of receiving no treatment due to
complete recovery had a103.28 times higher possibility of being classified as
having no pain than the case of currently receiving treatment. In the case of
receiving no treatment despite no full recovery, the possibilityof being
classified as having no pain was 3.89 times higher than the case of currently
receiving treatment. In case more than the recommended intake of calcium was
ingested, the possibility of being classified into the group without pain was
3.06 times higher than the case of not ingesting at least the recommended
intake. The correct classification rate of the status of pain, according to the
variables of the status of currently receiving treatment and the status of
ingesting the recommended intake of calcium, was 91.8% (Table 4).
Table
4. Related Factors of Pain: Logistic Regression Results
|
|
|
Odds
ratio(95% CI)
|
|
General
Characteristics
|
Gender
|
Male
|
2.020(1.059,
3.853)
|
|
Female
|
1
|
|
Age
|
below 65
|
2.337*(1.193,
4.577)
|
|
65 over†
|
1
|
|
Mate
|
Yes
|
2.510*(1.137,
5.540)
|
|
No†
|
1
|
|
Education
status
|
None†
|
1
|
|
Elementary
school
|
3.120**(1.006,
9.677)
|
|
Middle
school
|
3.028(.777,
11.795)
|
|
High school
|
7.786**(2.438,
24.866)
|
|
College or
University
|
11.148**(3.150,
39.448)
|
|
Income/month
(10,000)
|
≤ 100
|
.392(.073,
2.104)
|
|
101-200
|
.375(.053,
2.635)
|
|
201-300
|
1.818(.279,
11.865)
|
|
≥ 301†
|
1
|
|
Occupation
|
Professional
|
1.989(.567,
6.983)
|
|
Officer
|
5.471(.721,
41.529)
|
|
Sale &
Service worker
|
.912(.333,
2.496)
|
|
Agriculture
& Fishery
|
.660(.258,
1.689)
|
|
Laborer
|
.714(.264,
1.931)
|
|
Housewife†
|
1
|
|
Perceived
Health
Status
|
Bad†
|
1
|
|
Moderate
|
1.869(.936,
3.732)
|
|
Good
|
4.400**(1.881,
10.292)
|
|
Treatment
status of Osteoarthritis
|
Treated and
cured completely
|
93.500**(28.729,
304.296)
|
|
Not treated
though were not cured
|
3.848*(1.509,
9.813)
|
|
Treating
now†
|
1
|
|
Alcohol
|
Yes
|
1.706(.909,
3.204)
|
|
No†
|
1
|
|
Smoking
|
Yes
|
1.520(.691,
3.341)
|
|
No†
|
1
|
|
Restrict of
activity
|
Yes
|
.179*(.054,
.591)
|
|
No†
|
1
|
|
Nutrient
intake
|
Vitamin B1
|
Yes
|
2.671**(1.442,
4.950)
|
|
No†
|
1
|
|
Fe
|
Yes
|
1.330(.708,
2.500)
|
|
No†
|
1
|
|
Ca
|
Yes
|
2.459**(1.251,
4.832)
|
|
No†
|
1
|
|
K
|
Yes
|
1.724(.622,
4.775)
|
|
No†
|
1
|
*p<.05;
**p<.01; †Reference group
4. CONCLUSION:
Interest in controlling and
preventing chronic diseases through proper nutrient intake has been increasing
recently. In this regard, there is a need to ascertain any correlations between
osteoarthritis (the main chronic disease in Korea) and nutrient intake. Use of
data from the Korea National Health and Nutrition Examination Survey, which investigates
systematically individual health, dietary habits, and relevant factors by
selecting representative target groups of Korean people, will be an efficient
method for the health promotion of osteoarthritis patients.
This study was conducted to
target osteoarthritis patients and compare the correlations between nutrient
intake, pain, and the quality of life. An analysis of the status of pain and
nutrient intake of osteoarthritis patients using the data of the Korea National
Health and Nutrition Examination Survey of 2015 is expected to be very helpful
considering the lack of studies regarding the nutrients related to the pain of
osteoarthritis patients.
From the general
characteristics of osteoarthritis patients, it was shown that women’s
prevalence of osteoarthritis was 77%, which is higher than men’s prevalence.
This result matches the results of a previous study that reported that women’s
osteoarthritis prevalence is higher than men’s. As the economic and education
levels of women were lower, osteoarthritis prevalence was higher, which
supports existing study results. The result of this study implies that there is
a need for the development of osteoarthritis control programs for women with
low economic and education levels.
An examination of the intake
characteristics of each nutrient shows that osteoarthritis patients ingesting
less than the recommended intake of vitamin B1, iron, potassium, and
calcium accounted for 63.5%, 44.3%, 32.4%, and 85%, respectively, of the total
osteoarthritis patients.
A comparison of the status
of pain and intake of each nutrient showed statistically significant
differences in the pain of osteoarthritis patients in relation to the
recommended intake of vitamin B1 and calcium. Namely, the group with
pain ingested less than the recommended intake of vitamin B1 and
calcium. Osteoarthritis is reported to cause pain because of damage to muscles
or muscular membranes. Meanwhile, the pain of osteoarthritis patients did not
show any statistically significant differences in relation to the recommended
intake of potassium and iron. Such a result is in conflict with the study
results McAlindon et al(2013) and Zeng et al(2015), which reported that potassium and iron
producing and supplying energy within muscles are concerned with the induction
and deterioration of pain. It is difficult to find studies investigating the
correlations between specific nutrients such as vitamins and minerals and pain
targeting osteoarthritis patients in Korea; therefore, further studies are
needed to find out the correlations between patient pain and nutrient intake.
Also, there is a need for the development and application of nutrition
guidelines in order to prevent and control the induction and worsening of pain
of osteoarthritis patients4,5.
The quality of life related
with the health of osteoarthritis patients recorded 7.36 points, but a direct
comparison is difficult because there are almost no studies applying EQ-5D that
target osteoarthritis patients.The assessment of quality of life using EQ-5D can
be appropriate in this study because the subjects were osteoarthritis patients.
Although the tool has differences from tools used in previous studies, the
study result can be seen as matching the results of previous studies reporting
that the quality of life in relation to the health of osteoarthritis patients
was low 6,7.
An examination by subarea
of the tool measuring and assessing the quality of life used in this study
shows that the quality of life related with pain/discomfort was lowest at 1.89
points and the quality of life related with self-control was highest at 1.10
points. Such a result matches the results that the biggest complaint of
osteoarthritis patients is pain and that pain is the biggest difficulty of
musculoskeletal patients, and thereby pain reduces the quality of life 8,9.
From this, it can be concluded that there is a need to devise interventionsthat
improve the quality of life of osteoarthritis patients by reducing pain and
discomfort.
An examination of the
subareas of the quality of life in relation to pain showed that the following
qualities were statistically significantly lower in the group with pain than in
the group without pain: motor ability-related quality of life, everyday
life-related quality of life, pain/discomfort-related quality of life, and
anxiety/depression-related quality of life. Consequently, the assertion that
pain occurrence is an important variable for health-related quality of life is
supported.
Among the variables, age,
occupation, monthly income, subjective health state, the status of currently
receiving treatment, drinking, and activity restriction were revealed as the
factors affecting pain/discomfort-related quality of life. This matches the
results of a study of Messier(2013), which reported that chronic pain and
reduced mobility of patients diminish their quality of life. Such a finding
also matches the results showing that a lower quality of life is associated
with an increase of pain, activity hindrance, and age; while correlations
between the pain level and quality of life of patients have also been reported
in other studies 10,11,. In this regard, there is a need to
consider the sociodemographic characteristics of subjects when establishing
intervention measures for quality of life improvement, and it is especially
important to take into account relevant factors for enhancing the pain/discomfort-related
quality of life.
There was a mutual
relationship between the nutrient intake and pain of osteoarthritis patients,
and the quality of life of the group with pain was lower than that of the group
without pain. Consequently, a study to examine proper nutrient intake is a
necessary measure to prevent the induction and worsening of the pain of
osteoarthritis patients.
Even though this study,
which analyzed the correlations between nutrient intake, pain, and the quality
of life of osteoarthritis patients, was an initial stage study, the results are
expected to be helpful in the establishment of intervention measures for the
nutrition guidelines of osteoarthritis patients with pain and also in
contributing to quality of life improvement.
5. REFERECNCES:
1. Ministry of Health and Welfare of Korea,
Korea Centers for Disease Control and Precvention, 2015 Korea Heath Statistics,
Deoul : Ministry of Health and Welfare of Korea, 2016
2. Honours B V L J, Hunter D J, The
epidemiology of osteoarthritis, Best Practice & Research Clinical
Rheumatology, 2014, 28(1), pp 5-15.
3. Gerwin R D, Myofacial pain syndromes in the
upper extremity, Journal of Hand Therapy, 1997, 10(2), pp 130-136.
4. McAlindon T, LaValley M, Schneider E, Nuite
M, Lee J Y, Price L L, Lo G, Hughes B D, Effect of Viramin D supplementation on
Progression of Knee Pain and Cartilage Volume loss in Patients with Symptomatic
Osteparthritis, JAMA, 2013, 309(2), pp 155-162.
5. Zeng C, Li H, wei J, Yng T, Deng Z, Yang Y,
Zhang Y, Yang T, Lei G, Association between dietary magnesium intake and
radiographic knee osteoarthritis, Magnesium and Osteoarthritis, 2015, 26, pp
1-9.
6. Barbara R, Carol V, Bridget Z M, Nicole P B,
Annuziate A, Kathleen S, Mechnical Hyperalgesia and Reduced Quality of Life
Occur in people with mild Knee Osteoarthritis Pain, The Clinical Journal of
Pain, 2015, 31(4) pp, 315-322.
7. Kim H J, Lee J Y, Kim T J, Lee J W,
Association between serum vitamin D status and health related quality of
life(HROOL) in an older Korean population with raditgraphy knee
osteroarthritis: data from the Korea national health and nutrition examination
surver(2010-2011), Health and Quality of Life Outcomes, 2015, 13(48), pp1-9.
8. Lluch E, Torres R,Nijs J, Oosterwijck V,
Evidence for central senstitization in patients with oseroarthritis pain : A
sustematic literature review, European Journal of Pain, 2014, 18(10, pp
1367-1375.
9. Silverwood V, Bucknall M B, Jordan J J L,
Protheroe F, Jordan K P, Current evidence on risk factors for knee
osteoarthritis in older adults: a systematic review and meta analysis,
Osteoarthritis and Cartilage, 2015, 23(4), pp 507-515.
10. Esposito K, Marfella R, Ciotola M, Effect of
a Mediterranean-style diet on endothelial dysfunction and markers of vascular
inflammation in the metabolic syndrome:a randomized trial, JAMA, 2004, 292(12),
pp1440-1446.
11. Messier S P, Mihalko S, Legault C, Miller G
D, Nicklas B J, DeVita P, Beavers D P, Hunter D J, Lyles M, Eckstein F,
Williamson J D, Carr J J, Guermazi, A, Loeser R F, Effects of intensive diet
and exercise on knee joint loads, inflammation and clinical outcomes among
overweight and obese adults with knee osteoarthritis, Intensive Diet and
Exercise and Knee Osteoarthritis, JAMA, 2013, 310(12), 1263-1273.