Very-low-calorie diets versus exercise alone for the treatement of hip osteoarthritis

1. In this randomized controlled trial, a very-low-calorie diet plus exercise was not superior to exercise alone in reducing hip pain severity among patients with hip osteoarthritis and overweight or obesity.

2. However, very-low-calorie diet was associated with improvement in a number of secondary outcomes, including health-related quality of life, body weight, and BMI.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Weight loss is thought to be a potential treatment to reduce joint pain in osteoarthritis with overweight or obesity, but there have been concerns about generalizing promising findings from knee osteoarthritis to those with involvement of the hip. Studies have suggested that a very-low-calorie diet (VLCD) can lead to considerable weight loss, including among individuals with osteoarthritis. This study aimed to assess whether adding VLCD to standard exercise could improve hip pain severity compared with exercise alone in patients with hip osteoarthritis and overweight or obesity. At six months, both VLCD with exercise and exercise alone were associated with reduced hip pain severity, although no significant difference was seen between the groups. Similar results were seen at one year, as well as in subgroup analyses investigating the effects of sex, radiographic disease density, and treatment expectation on outcomes. However, VLCD was associated with greater improvements in quality of life, body mass index, and visceral and total body fat mass. Although more VLCD-plus-exercise participants reported adverse events, no serious adverse events were seen across both groups. The generalizability of this study is limited by lack of blinding, gender imbalance among participants, and a relatively short follow-up period. Nevertheless, this study suggests that, although the addition of a VLCD may not noticeably improve hip pain severity in the short term compared to exercise alone, it may be beneficial in the overall management of hip osteoarthritis.

Click to read this study in AIM

Relevant Reading: Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis: A Randomized Trial

In-Depth [randomized controlled trial]: This randomized controlled trial aimed to assess whether VLCD plus exercise could reduce hip pain severity more than exercise alone among patients with hip osteoarthritis with overweight or obesity. A total of 101 participants were recruited from the community in Melbourne and Sydney, Australia. Inclusion criteria were age 50 years and older; hip pain for 3 or more months; hip pain of at least 4 on an 11-point numerical rating scale over the past week; radiographic evidence of osteoarthritis; and baseline body mass index (BMI) greater than 27 kg/m². The primary outcome was 6-month change in hip pain severity, while secondary outcomes included BMI, physical function, hip-related quality of life, and visceral and total body fat mass at baseline and 6 months. No significant difference in hip pain severity was seen between the treatment and control groups at 6 months (mean, -0.6 units [95% CI, -1.5 to 0.3]; p = 0.20). In contrast, secondary outcomes at 6 months showed significant differences in favor of VLCD plus exercise for hip-related QoL (8.6 units [95% CI, 0.3 to 16.8]), health-related QoL (0.06 units [95% CI, 0.01 to 0.12]), body weight (-8.8 kg [95% CI, -11.1 to -6.4 kg]), BMI (-3.2 kg/m² [95% CI, -4.0 to -2.3 kg/m²]), visceral fat mass (-402 g [95% CI, -539 to -266 g]), and total body fat mass (-7386 g [95% CI, -9239 to -5532 g]). At 12 months, significant differences in favor of VLCD plus exercise were seen for health-related QoL (0.06 units [95% CI, 0.01 to 0.11]), body weight (-5.4 kg [95% CI, -7.7 to -3.1 kg]), BMI (-1.9 kg/m² [95% CI, -2.8 to -1.1 kg/m²]), overall hip improvement (pain, 7.1 units [95% CI, 0.4 to 13.8], and physical function, 6.7 units [95% CI, 0.4 to 13.0]). The VLCD-plus-exercise group lost on average 8.5% more body weight than the exercise-only group; 82% of VLCD-plus-exercise group lost more than 5% of their total body weight as compared to only 16% of the exercise-only group. Overall, this study suggests that, while the addition of a VLCD to a standard exercise regimen may not be effective in reducing hip pain severity, it may have positive effects on BMI, body composition, and quality of life among patients with hip osteoarthritis and overweight or obesity.

Image: PD

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