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THE STATISTICS:
50% of adults have at least 1 chronic health condition (2014)[1]
25% of adults have 2 or more chronic health conditions (2016)[2]
Globally, 595 million people had osteoarthritis in 2020, equal to 7.6% of the global population, and an increase of 132.2% in total cases since 1990. [3]
About 10%-20% of the population has an autoimmune disease
Over half the US population is diabetic or prediabetic
>12% of the population will develop thyroid disease
About 1 in 3 moving to 1 in 2 people in the US will develop Cancer.
CDC: From 2021: For every 100,000 people, 439 new cancer cases were reported. [5]
Overall, the prevalence of inadequacy (% of population below estimated average requirement [EAR]) in four out of five key immune nutrients is substantial. Specifically, 45% of the U.S. population had a prevalence of inadequacy for vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc. [4]
An estimated 24–65% of surgical patients, ranging from young adults to the elderly undergoing major surgery, are malnourished or at risk of malnutrition [6]
Nutritional status is a strong predictor of postoperative outcomes. Malnourished patients have longer lengths of stay, higher readmission rates, a greater number of complications, and higher mortality risks [6]
BUT THE GOOD NEWS... ALL OF THESE CONDITIONS HAVE MODIFIABLE LEFESTYLE FACTORS THAT YOU CAN INFLUENCE!
"Nutrition is considered as one of the strongest and most adjustable environmental factors that could be used to reduce the burden of disease during an individual’s entire life. Appropriate and balanced nutrient’s intake and metabolism provide the substrates for the normal physiological functions of the human body." [13]
In 2022 only 69.9% of adults 18 and older are getting enough sleep [5]
Only 24.2% of adults aged 18 and over met the 2018 Physical Activity Guidelines for Americans for both aerobic and muscle-strengthening activities. [5]
Oral nutritional supplements have also been shown to reduce the net cost associated with hospitalization by an average of 12.2%, an average of about $180 in orthopedic patients. Cost savings are associated with reduced complications (−35%) and length of stay (−2 days). [6]
"An elimination diet, whether self-guided or with functional medicine health coaching support, may improve patient-reported health outcomes among relatively healthy healthcare professionals. While studies in more diverse samples are needed, functional medicine health coaching support appears to be superior to a self-guided approach with regard to both dietary compliance and improving health outcomes among those with greater symptomatology. " [7]
PT and Nutrition: Resources
Nutrition in Physical Therapist Practice: Setting the Stage for Taking Action
Patrick Berner, Janet R Bezner, David Morris, Donald H Lein, Nutrition in Physical Therapist Practice: Setting the Stage for Taking Action, Physical Therapy, Volume 101, Issue 5, May 2021, pzab062
Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition
Inoue T, Iida Y, Takahashi K, Shirado K, Nagano F, Miyazaki S, Takeuchi I, Yoshimura Y, Momosaki R, Maeda K, Wakabayashi H. Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication). JMA J. 2022 Apr 15;5(2):243-251. doi: 10.31662/jmaj.2021-0201. Epub 2022 Mar 4. PMID: 35611222; PMCID: PMC9090552.
Musculoskeletal Related Research:
"Central obesity, glucose intolerance (insulin resistance), dyslipidaemia and hypertension embody the MetS [26]. OA has been suggested to be a fifth component with shared mechanisms of inflammation and oxidative stress" [8]
"Hyperglycaemia prompts local accumulation of advanced-glycation end products, impairing subchondral bone and chondrocyte function [27]. In a German cohort study, type-2 diabetes was identified as an independent risk factor for severe OA and a predictor for knee/hip replacement [30]. In a French study of patients with knee OA assessed over 3 years, type-2 diabetes was a significant predictor of joint-space-width reduction in men" [8]
"Physical activity generates changes in white adipose tissue, including increased mitochondrial biogenesis and an altered adipokine profile [40], and hence weight reduction programmes that combine diet and exercise have the most benefit on functional status, joint imaging and visual analogue scale pain" [8]
"During rehabilitation, simultaneous carbohydrates and protein intake can inhibit muscle breakdown and muscle atrophy. The long-term intake of omega-3 fatty acids enhances anabolic sensitivity to amino acids; thus, it may be beneficial to the injured athlete. Adequate intakes of macronutrients can play a major role supporting athletes’ anabolism" [9]
"The hospitalization of patients undergoing elective hip, knee, and spine surgery is short, with perioperative processes focusing on the principles of enhanced recovery after surgery (ERAS). There is a growing interest in prehabilitation techniques, and nutrition is one of the three pillars of this concept. There is a clinical acknowledgement that the promotion of healthy eating should be championed by all members of the multidisciplinary team along with the fact that patients who follow a healthy diet are more likely to have an enhanced recovery than patients who eat poorly." [10]
"Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality." [11]
"Although difficult to visualize, compared with a an injury or infection, the body responds in a similar fashion to “non-overtly injurious” homeostatic challenges. Reduced sleep, stress, sedentary living, and high glycemic index foods, promotes cellular release of inflammatory mediators, most notably are the pro-inflammatory cytokines such as interleukin-1β (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF). In other words, immune cells release the same mediators whether there is overt tissue injury or noxious homeostatic challenges, such as inadequate sleep, stress, and a high glycemic meal" [12]
"The anatomy, and thus, the integrity of the musculoskeletal system is known to be changed by adiposity, perhaps rendering it more susceptible to injury during mechanical loading." [12]
1 ward et al. Prev Chronic Dis. 2014; 11:130389.
2 Wang et al. Lancet.2016;388(10053):1459-544.
3 GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Aug 21;5(9):e508-e522. doi: 10.1016/S2665-9913(23)00163-7. PMID: 37675071; PMCID: PMC10477960.
4 Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients. 2020 Jun 10;12(6):1735. doi: 10.3390/nu12061735. PMID: 32531972; PMCID: PMC7352522.
5 CDC's National Center For Health Statistics
6 Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients. 2021 May 15;13(5):1675. doi: 10.3390/nu13051675. PMID: 34063333; PMCID: PMC8156786.
7 D’Adamo, Christopher R. PhDa,*; Kaplan, Michael B. NDb; Campbell, Patricia S. MSc; McLaughlin, Kerri BAc; Swartz, Jordan S. MAScc; Wattles, Kalea R. NDb; Lukaczer, Dan NDb; Scheinbaum, Sandra PhDc. Functional medicine health coaching improved elimination diet compliance and patient-reported health outcomes: Results from a randomized controlled trial. Medicine 103(8):p e37148, February 23, 2024. | DOI: 10.1097/MD.0000000000037148
8 Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford). 2018 May 1;57(suppl_4):iv61-iv74. doi: 10.1093/rheumatology/key011. PMID: 29684218; PMCID: PMC5905611.
9. Papadopoulou SK. Rehabilitation Nutrition for Injury Recovery of Athletes: The Role of Macronutrient Intake. Nutrients. 2020 Aug 14;12(8):2449. doi: 10.3390/nu12082449. PMID: 32824034; PMCID: PMC7468744.
10. Briguglio M, Wainwright TW, Southern K, Riso P, Porrini M, Middleton RG. Healthy Eating for Elective Major Orthopedic Surgery: Quality, Quantity, and Timing. J Multidiscip Healthc. 2023 Jul 24;16:2081-2090. doi: 10.2147/JMDH.S415116. PMID: 37521366; PMCID: PMC10377616.
11 Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients. 2021 May 15;13(5):1675. doi: 10.3390/nu13051675. PMID: 34063333; PMCID: PMC8156786.
12 Seaman DR. Body mass index and musculoskeletal pain: is there a connection? Chiropr Man Therap. 2013 May 20;21(1):15. doi: 10.1186/2045-709X-21-15. PMID: 23687943; PMCID: PMC3665675.
13 Kiani AK, Dhuli K, Donato K, Aquilanti B, Velluti V, Matera G, Iaconelli A, Connelly ST, Bellinato F, Gisondi P, Bertelli M. Main nutritional deficiencies. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E93-E101. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2752. PMID: 36479498; PMCID: PMC9710417.
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