Research Original Research| Volume 118, ISSUE 9, P1673-1686.e2, September 2018

Download started.


Association between Dietary Glycemic Index and Knee Osteoarthritis: The Korean National Health and Nutrition Examination Survey 2010-2012

Published:February 07, 2018DOI:



      Obesity and metabolic abnormalities are important risk factors for knee osteoarthritis (KOA). Recent epidemiologic studies have found that a high glycemic index (GI) and glycemic load (GL) diet are associated with a higher risk for metabolic complications and cardiovascular mortality.


      We aimed to examine the association between dietary GI, dietary GL, and KOA among Korean adults.


      This was a cross-sectional study that analyzed data obtained from the Korean National Health and Nutrition Examination Survey 2010-2012.


      A total of 9,203 participants (5,275 women) aged ≥50 years were included.

      Main outcome measures

      KOA was defined as the presence of radiographic features of Kellgren-Lawrence grade ≥2. Chronic knee pain was defined as the presence of knee pain for more than 30 days during the past 3 months. Dietary information was collected using a single 24-hour recall method.

      Statistical analyses performed

      The association between the quintiles of dietary GI and dietary GL and knee conditions was analyzed using a multinomial logistic regression analysis adjusting for age, physical activity, obesity, hypertension and diabetes, serum low-density lipoprotein, and total energy intake.


      Among the women, the association between dietary GI and symptomatic KOA was: quintile 1: 1.00 (reference); quintile 2: 1.29 (95% CI 0.87 to 1.92); quintile 3: 1.59 (95% CI 1.11 to 2.28); quintile 4: 1.74 (95% CI 1.21 to 2.51); and quintile 5: 1.77 (95% CI 1.20 to 2.60) (P=0.001). Chronic knee pain without KOA was associated with dietary GI; however, this association was not linear across quintiles. There was no significant association between dietary GI and asymptomatic KOA. Among the men, no significant association was found between dietary GI and any knee conditions. There was no significant association between dietary GL and KOA in both men and women.


      There was a significant positive association between dietary GI and symptomatic KOA in women.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lee S.
        • Kim S.J.
        Prevalence of knee osteoarthritis, risk factors, and quality of life: The Fifth Korean National Health and Nutrition Examination Survey.
        Int J Rheum Dis. 2017; 20: 809-817
        • Roos E.M.
        • Arden N.K.
        Strategies for the prevention of knee osteoarthritis.
        Nat Rev Rheumatol. 2016; 12: 92-101
        • Hart D.J.
        • Doyle D.V.
        • Spector T.D.
        Association between metabolic factors and knee osteoarthritis in women: The Chingford Study.
        J Rheumatol. 1995; 22: 1118-1123
        • Yoshimura N.
        • Muraki S.
        • Oka H.
        • et al.
        Accumulation of metabolic risk factors such as overweight, hypertension, dyslipidaemia, and impaired glucose tolerance raises the risk of occurrence and progression of knee osteoarthritis: A 3-year follow-up of the ROAD study.
        Osteoarthritis Cartilage. 2012; 20: 1217-1226
        • Lee S.
        • Kim T.N.
        • Kim S.H.
        • et al.
        Obesity, metabolic abnormality, and knee osteoarthritis: A cross-sectional study in Korean women.
        Mod Rheumatol. 2015; 25: 292-297
        • Sowers M.
        • Karvonen-Gutierrez C.A.
        • Palmieri-Smith R.
        • Jacobson J.A.
        • Jiang Y.
        • Ashton-Miller J.A.
        Knee osteoarthritis in obese women with cardiometabolic clustering.
        Arthritis Rheum. 2009; 61: 1328-1336
        • Monira Hussain S.
        • Wang Y.
        • Cicuttini F.M.
        • et al.
        Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study.
        Semin Arthritis Rheum. 2014; 43: 429-436
        • Zhuo Q.
        • Yang W.
        • Chen J.
        • Wang Y.
        Metabolic syndrome meets osteoarthritis.
        Nat Rev Rheumatol. 2012; 8: 729-737
        • Wluka A.E.
        • Lombard C.B.
        • Cicuttini F.M.
        Tackling obesity in knee osteoarthritis.
        Nat Rev Rheumatol. 2013; 9: 225-235
        • Henriksen M.
        • Christensen R.
        • Danneskiold-Samsoe B.
        • Bliddal H.
        Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: A prospective cohort study.
        Arthritis Rheum. 2012; 64: 438-442
        • Ludwig D.S.
        • Friedman M.I.
        Increasing adiposity: consequence or cause of overeating?.
        JAMA. 2014; 311: 2167-2168
        • Jenkins D.J.
        • Wolever T.M.
        • Taylor R.H.
        • et al.
        Glycemic index of foods: A physiological basis for carbohydrate exchange.
        Am J Clin Nutr. 1981; 34: 362-366
        • Foster-Powell K.
        • Holt S.H.
        • Brand-Miller J.C.
        International table of glycemic index and glycemic load values: 2002.
        Am J Clin Nutr. 2002; 76: 5-56
        • Chew I.
        • Brand J.C.
        • Thorburn A.W.
        • Truswell A.S.
        Application of glycemic index to mixed meals.
        Am J Clin Nutr. 1988; 47: 53-56
        • Wolever T.M.
        • Jenkins D.J.
        The use of the glycemic index in predicting the blood glucose response to mixed meals.
        Am J Clin Nutr. 1986; 43: 167-172
        • Ludwig D.S.
        The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease.
        JAMA. 2002; 287: 2414-2423
        • Dehghan M.
        • Mente A.
        • Zhang X.
        • et al.
        Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): A prospective cohort study.
        The Lancet. 2017; 390: 2050-2062
      1. Kwon YJ, Lee HS, Lee JW. Association of carbohydrate and fat intake with metabolic syndrome [published online ahead of print July 4, 2017]. Clin Nutr.

        • Hodge A.M.
        • English D.R.
        • O'Dea K.
        • Giles G.G.
        Glycemic index and dietary fiber and the risk of type 2 diabetes.
        Diabetes Care. 2004; 27: 2701-2706
        • Villegas R.
        • Liu S.
        • Gao Y.T.
        • et al.
        Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women.
        Arch Intern Med. 2007; 167: 2310-2316
        • Mirrahimi A.
        • de Souza R.J.
        • Chiavaroli L.
        • et al.
        Associations of glycemic index and load with coronary heart disease events: A systematic review and meta-analysis of prospective cohorts.
        J Am Heart Assoc. 2012; 1: e000752
        • Dong J.Y.
        • Zhang Y.H.
        • Wang P.
        • Qin L.Q.
        Meta-analysis of dietary glycemic load and glycemic index in relation to risk of coronary heart disease.
        Am J Cardiol. 2012; 109: 1608-1613
        • Oba S.
        • Nagata C.
        • Nakamura K.
        • et al.
        Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women.
        Metabolism. 2010; 59: 1574-1582
        • Baer H.J.
        • Glynn R.J.
        • Hu F.B.
        • et al.
        Risk factors for mortality in the nurses' health study: A competing risks analysis.
        Am J Epidemiol. 2011; 173: 319-329
        • Castro-Quezada I.
        • Sanchez-Villegas A.
        • Estruch R.
        • et al.
        A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk.
        PLoS One. 2014; 9: e107968
        • Choi K.W.
        • Somers T.J.
        • Babyak M.A.
        • Sikkema K.J.
        • Blumenthal J.A.
        • Keefe F.J.
        The relationship between pain and eating among overweight and obese individuals with osteoarthritis: An ecological momentary study.
        Pain Res Manag. 2014; 19: e159-e163
        • Dore D.
        • de Hoog J.
        • Giles G.
        • Ding C.
        • Cicuttini F.
        • Jones G.
        A longitudinal study of the association between dietary factors, serum lipids, and bone marrow lesions of the knee.
        Arthritis Res Ther. 2012; 14: R13
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
      2. National Agricultural Resources Development Institute. Food Composition Table. 7th ed. Jeonju, South Korea: Rural Development Administration; 2006.

        • Song S.
        • Choi H.
        • Lee S.
        • et al.
        Establishing a table of glycemic index values for common Korean Foods and an evaluation of the dietary glycemic index among the Korean adult population.
        Korean J Nutr. 2012; 45: 80
        • Atkinson F.S.
        • Foster-Powell K.
        • Brand-Miller J.C.
        International tables of glycemic index and glycemic load values: 2008.
        Diabetes Care. 2008; 31: 2281-2283
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
      3. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health.
        Obes Res. 1998; 6: 51s-209s
        • Zheng W.
        • McLerran D.F.
        • Rolland B.
        • et al.
        Association between body-mass index and risk of death in more than 1 million Asians.
        N Engl J Med. 2011; 364: 719-729
        • O'Brien E.
        • Mee F.
        • Tan K.S.
        • Atkins N.
        • O'Malley K.
        Training and assessment of observers for blood pressure measurement in hypertension research.
        J Hum Hypertens. 1991; 5: 7-10
        • Graciani A.
        • Banegas J.R.
        • Lopez-Garcia E.
        • Diez-Ganan L.
        • Rodriguez-Artalejo F.
        Assessment of a blood pressure measurement training programme for lay observers.
        Blood Press Monit. 2002; 7: 251-257
        • Willett W.C.
        • Howe G.R.
        • Kushi L.H.
        Adjustment for total energy intake in epidemiologic studies.
        Am J Clin Nutr. 1997; 65: 1220S-1228S
      4. SPSS [computer program]. Version 21.0. Armonk, NY: IBM Corp; 2015.

        • Bhupathiraju S.N.
        • Tobias D.K.
        • Malik V.S.
        • et al.
        Glycemic index, glycemic load, and risk of type 2 diabetes: Results from 3 large US cohorts and an updated meta-analysis.
        Am J Clin Nutr. 2014; 100: 218-232
        • Thomas D.E.
        • Elliott E.J.
        • Baur L.
        Low glycaemic index or low glycaemic load diets for overweight and obesity.
        Cochrane Database Syst Rev. 2007 Jul 18; : Cd005105
        • Sacks F.M.
        • Carey V.J.
        • Anderson C.A.
        • et al.
        Effects of high vs low glycemic index of dietary carbohydrate on cardiovascular disease risk factors and insulin sensitivity: The OmniCarb randomized clinical trial.
        JAMA. 2014; 312: 2531-2541
        • Levitan E.B.
        • Mittleman M.A.
        • Wolk A.
        Dietary glycemic index, dietary glycemic load and mortality among men with established cardiovascular disease.
        Eur J Clin Nutr. 2009; 63: 552-557
        • Murakami K.
        • Livingstone M.B.
        Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012.
        Br J Nutr. 2015; 114: 1294-1303
        • Reardon M.F.
        • Nestel P.J.
        • Craig I.H.
        • Harper R.W.
        Lipoprotein predictors of the severity of coronary artery disease in men and women.
        Circulation. 1985; 71: 881-888
        • Hardin J.A.
        • Cobelli N.
        • Santambrogio L.
        Consequences of metabolic and oxidative modifications of cartilage tissue.
        Nat Rev Rheumatol. 2015; 11: 521-529
        • Henrotin Y.E.
        • Bruckner P.
        • Pujol J.P.
        The role of reactive oxygen species in homeostasis and degradation of cartilage.
        Osteoarthritis Cartilage. 2003; 11: 747-755
        • Alvarez-Garcia O.
        • Rogers N.H.
        • Smith R.G.
        • Lotz M.K.
        Palmitate has proapoptotic and proinflammatory effects on articular cartilage and synergizes with interleukin-1.
        Arthritis Rheumatol. 2014; 66: 1779-1788
        • Wang Y.
        • Wluka A.E.
        • Hodge A.M.
        • et al.
        Effect of fatty acids on bone marrow lesions and knee cartilage in healthy, middle-aged subjects without clinical knee osteoarthritis.
        Osteoarthritis Cartilage. 2008; 16: 579-583
        • Baker K.R.
        • Matthan N.R.
        • Lichtenstein A.H.
        • et al.
        Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: The MOST study.
        Osteoarthritis Cartilage. 2012; 20: 382-387
        • Goletzke J.
        • Buyken A.E.
        • Joslowski G.
        • et al.
        Increased intake of carbohydrates from sources with a higher glycemic index and lower consumption of whole grains during puberty are prospectively associated with higher IL-6 concentrations in younger adulthood among healthy individuals.
        J Nutr. 2014; 144: 1586-1593
        • Livshits G.
        • Zhai G.
        • Hart D.J.
        • et al.
        Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: The Chingford Study.
        Arthritis Rheum. 2009; 60: 2037-2045
        • Stannus O.
        • Jones G.
        • Cicuttini F.
        • et al.
        Circulating levels of IL-6 and TNF-alpha are associated with knee radiographic osteoarthritis and knee cartilage loss in older adults.
        Osteoarthritis Cartilage. 2010; 18: 1441-1447
        • Stannus O.P.
        • Jones G.
        • Blizzard L.
        • Cicuttini F.M.
        • Ding C.
        Associations between serum levels of inflammatory markers and change in knee pain over 5 years in older adults: A prospective cohort study.
        Ann Rheum Dis. 2013; 72: 535-540
        • Ding C.
        • Parameswaran V.
        • Cicuttini F.
        • et al.
        Association between leptin, body composition, sex and knee cartilage morphology in older adults: The Tasmanian older adult cohort (TASOAC) study.
        Ann Rheum Dis. 2008; 67: 1256-1261
        • Stannus O.P.
        • Cao Y.
        • Antony B.
        • et al.
        Cross-sectional and longitudinal associations between circulating leptin and knee cartilage thickness in older adults.
        Ann Rheum Dis. 2015; 74: 82-88
        • Becker G.F.
        • Passos E.P.
        • Moulin C.C.
        Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: A randomized controlled trial.
        Am J Clin Nutr. 2015; 102: 1365-1372
        • Shin D.
        Association between metabolic syndrome, radiographic knee osteoarthritis, and intensity of knee pain: Results of a national survey.
        J Clin Endocrinol Metab. 2014; 99: 3177-3183
        • Gandhi R.
        • Takahashi M.
        • Smith H.
        • Rizek R.
        • Mahomed N.N.
        The synovial fluid adiponectin-leptin ratio predicts pain with knee osteoarthritis.
        Clin Rheumatol. 2010; 29: 1223-1228
        • Mercer M.E.
        • Holder M.D.
        Antinociceptive effects of palatable sweet ingesta on human responsivity to pressure pain.
        Physiol Behav. 1997; 61: 311-318
        • Tooze J.A.
        • Kipnis V.
        • Buckman D.W.
        • et al.
        A mixed-effects model approach for estimating the distribution of usual intake of nutrients: The NCI method.
        Stat Med. 2010; 29: 2857-2868
        • Hatonen K.A.
        • Virtamo J.
        • Eriksson J.G.
        • Sinkko H.K.
        • Sundvall J.E.
        • Valsta L.M.
        Protein and fat modify the glycaemic and insulinaemic responses to a mashed potato-based meal.
        Br J Nutr. 2011; 106: 248-253
        • Flint A.
        • Moller B.K.
        • Raben A.
        • et al.
        The use of glycaemic index tables to predict glycaemic index of composite breakfast meals.
        Br J Nutr. 2004; 91: 979-989
        • Dodd H.
        • Williams S.
        • Brown R.
        • Venn B.
        Calculating meal glycemic index by using measured and published food values compared with directly measured meal glycemic index.
        Am J Clin Nutr. 2011; 94: 992-996
        • Sharma L.
        • Chmiel J.S.
        • Almagor O.
        • et al.
        Significance of preradiographic magnetic resonance imaging lesions in persons at increased risk of knee osteoarthritis.
        Arthritis Rheumatol. 2014; 66: 1811-1819
        • Riddle D.L.
        • Jiranek W.A.
        • Hayes C.W.
        Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: A multicenter longitudinal cohort study.
        Arthritis Rheumatol. 2014; 66: 2134-2143
        • Van Spil W.E.
        • Welsing P.M.
        • Kloppenburg M.
        • et al.
        Cross-sectional and predictive associations between plasma adipokines and radiographic signs of early-stage knee osteoarthritis: Data from CHECK.
        Osteoarthritis Cartilage. 2012; 20: 1278-1285
        • National Center for Health Statistics
        Health, United States, 2016: With Chartbook on Long-Term Trends in Health.
        National Center for Health Statistics, Hyattsville, MD2017


      M. W. So is an assistant professor, Department of Internal Medicine, Pusan National University Yangsan Hospital, Gyeongnam.


      S. Lee is an assistant professor, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.


      S.-H. Kim is a professor, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.