Mediterranean Diet Adherence and Its Association With Pain and Functional Status in Knee Osteoarthritis: A Cross-Sectional Study.

BACKGROUND

Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability worldwide, with metabolic and inflammatory mechanisms increasingly recognized in its pathophysiology. The Mediterranean diet (MD) has anti-inflammatory and cardiometabolic effects, but evidence regarding its association with pain and functional outcomes in KOA remains limited, particularly in North African populations.

OBJECTIVE

The aim of our study was to assess the association between MD adherence and pain intensity in patients with primary KOA and to evaluate its relationship with functional impairment and clinical predictors of worse outcomes.

METHODS

This single-center cross-sectional study included patients with primary KOA and was conducted at the Rheumatology Department A, El Ayachi Hospital, affiliated with the Ibn Sina University Hospital Center (CHU Ibn Sina), Rabat-Salé, Morocco. MD adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS) and classified into low (≤7) and high (>7) adherence groups. Pain was measured using the Visual Analog Scale (VAS) and functional impairment using the Lequesne index. Associations between dietary adherence and outcomes were analyzed using multivariate linear regression adjusted for key clinical and lifestyle confounders.

RESULTS

A total of 103 patients were included (mean age 61.0 ± 9.97 years; 88.3% female). Higher MEDAS scores were independently associated with lower pain intensity (β = -0.947, p < 0.001) and better functional outcomes (Lequesne index: β = -1.967, p < 0.001). By contrast, higher BMI and advanced radiographic stages were significantly associated with increased pain and disability. Age, disease duration, and physical activity were not independently associated with outcomes.

CONCLUSION

Greater adherence to the MD is independently associated with reduced pain and improved functional status in patients with KOA. These findings support the potential role of dietary patterns as a complementary, non-pharmacological strategy in osteoarthritis (OA) management.