The Impact of Adhering to a Mediterranean Diet on the Severity of Overuse Tendinopathy Symptoms

Abstract

Aim: The Mediterranean diet’s high carbohydrate content and antioxidant and anti-inflammatory properties make it appealing to athletes. Tendinopathy etiology is influenced by nutrition. Athletes with high adherence to the Mediterranean diet may have a lower severity of tendinopathy. This study aimed to investigate the effect of adherence to the Mediterranean diet on tendinopathy severity. Material and Methods: Exercise habits, physical activity level, body region, stage of the injury, age, body mass index, gender, smoking status, and presence of chronic diseases of individuals older than 18 years of age and who were diagnosed with tendinopathy in the sports medicine clinic were recorded in this cross-sectional study. The Revised Oslo Sports Trauma Research Centre Overuse Injury and Health Problems Questionnaires and the Mediterranean diet adherence screener were applied to participants. Results: A total of 152 participants, 52% (n=79) of whom were female, with lateral epicondylopathy (n=71), Achilles tendinopathy (n=25), plantar fasciitis (n=23), patellar tendinopathy (n=13), and other tendinopathies were included in the study. Upon examination of the relationship between the level of adherence to the Mediterranean diet and the severity of complaints due to overuse, no significant differences were found between groups (p=0.935, and p=0.927, respectively). A weak negative correlation was found between weekly exercise duration and adherence to the Mediterranean diet (rs=-0.237; p=0.016). Conclusion: No evidence was found that adherence to the Mediterranean diet was associated with differences in the severity of tendinopathy complaints. Athletes with high weekly exercise durations do not adopt the Mediterranean diet as an optimal dietary approach.

Keywords

• Mediterranean diet
• athletes
• tendinopathy
• diet patterns

Akdeniz Diyetine Bağlılığın Aşırı Kullanıma Bağlı Tendinopati Yakınmalarının Ciddiyetine Etkisi

Abstract

Amaç: Akdeniz diyetinin yüksek karbonhidrat içeriği ve antioksidan ve anti-inflamatuvar özellikleri bu diyeti sporcular için cazip kılmaktadır. Tendinopati etiyolojisi beslenmeden etkilenmektedir. Akdeniz diyetine bağlılığı yüksek olan sporcularda tendinopati şiddeti daha düşük olabilir. Bu çalışmanın amacı Akdeniz diyetine bağlılığın tendinopati şiddeti üzerindeki etkisini araştırmaktır. Gereç ve Yöntemler: Bu kesitsel çalışmada spor hekimliği kliniğinde tendinopati tanısı almış olan 18 yaş üstü bireylerin egzersiz alışkanlıkları, fiziksel aktivite düzeyi, vücut bölgesi, yaralanma evresi, yaş, vücut kitle indeksi, cinsiyet, sigara içme durumu ve kronik hastalık varlık durumları kayıt edildi. Katılımcılara Revize Edilmiş Oslo Spor Travması Araştırma Merkezi Aşırı Kullanım Yaralanması ve Sağlık Sorunları Anketleri yanı sıra Akdeniz diyetine uyum tarama aracı uygulandı. Bulgular: Lateral epikondilopati (n=71), Aşil tendinopatisi (n=25), plantar fasiit (n=23), patellar tendinopati (n=13) ve diğer tendinopatileri olan, %52’si (n=79) kadın olmak üzere toplam 152 katılımcı bu çalışmaya dahil edildi. Akdeniz diyetine uyum düzeyi ile şikâyetlerin şiddeti arasında ilişki olup olmadığı incelendiğinde, gruplar arasında anlamlı bir fark olmadığı bulundu (sırasıyla p=0,935 ve p=0,927). Haftalık egzersiz süresi ile Akdeniz diyetine bağlılık düzeyi arasında zayıf düzeyde negatif bir korelasyon olduğu bulundu (rs=-0,237; p=0,016). Sonuç: Akdeniz diyetine uyumun tendinopati şikâyetlerinin şiddetindeki farklılıklarla ilişkili olduğuna dair bir kanıt bulunamadı. Haftalık egzersiz süreleri yüksek olan sporcular, Akdeniz diyetini en uygun bir beslenme yaklaşımı olarak benimsememektedir.

Keywords

• Akdeniz diyeti
• sporcular
• tendinopati
• diyet kalıpları

References

1. Urquiaga I, Echeverría G, Dussaillant C, Rigotti A. Origin, components and mechanisms of action of the Mediterranean diet. Rev Med Chile. 2017;145(1):85-95. Spanish.
2. Griffiths A, Matu J, Whyte E, Akin-Nibosun P, Clifford T, Stevenson E, et al. The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review. Br J Nutr. 2022;128(7):1285-98.
3. Nani A, Murtaza B, Sayed Khan A, Khan NA, Hichami A. Antioxidant and anti-inflammatory potential of polyphenols contained in Mediterranean diet in obesity: molecular mechanisms. Molecules. 2021;26(4):985.
4. Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, et al. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Sports Med. 2020;54(5):260-2.
5. Lipman K, Wang C, Ting K, Soo C, Zheng Z. Tendinopathy: injury, repair, and current exploration. Drug Des Devel Ther. 2018;12:591-603.
6. Kaya İ, Örsçelik A, Solmaz İ, Karaaslan B, Şafak Yılmaz E. Neutrophil to lymphocyte ratio may be used as a predictor in tendinopathy. Eur Res J. 2023;9(4):645-51.
7. Andarawis‐Puri N, Flatow EL, Soslowsky LJ. Tendon basic science: Development, repair, regeneration, and healing. J Orthop Res. 2015;33(6):780-4.
8. Bifulco M, Cerullo G, Abate M. Is the Mediterranean diet pattern a good choice for athletes? Nutr Today. 2019;54(3):121-3.

9. Curtis L. Nutritional research may be useful in treating tendon injuries. Nutrition. 2016;32(6):617-9.
10. Loiacono C, Palermi S, Massa B, Belviso I, Romano V, Di Gregorio A, et al. Tendinopathy: pathophysiology, therapeutic options, and role of nutraceutics. A narrative literature review. Medicina (Kaunas). 2019;55(8):447.
11. Wonders J. Lifestyle factors as risk factors and treatment options in tendinopathy. Arch Med. 2021;13(5):22.
12. Baker RT, Burton D, Pickering MA, Start A. Confirmatory factor analysis of the disablement in the physically active scale and preliminary testing of short-form versions: A calibration and validation study. J Athl Train. 2019;54(3):302-18.
13. Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. Br J Sports Med. 2013;47(8):495-502.
14. Clarsen B, Bahr R, Myklebust G, Andersson SH, Docking SI, Drew M, et al. Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sports Trauma Research Center questionnaires. Br J Sports Med. 2020;54(7):390-6.
15. Schröder H, Fitó M, Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141(6):1140-5.
16. Özkan Pehlivanoğlu EF, Balcıoğlu H, Ünlüoğlu İ. Turkish validation and reliability of Mediterranean diet adherence screener. Osmangazi J Med. 2020;42(2):160-4. Turkish.
17. Dominguez LJ, Di Bella G, Veronese N, Barbagallo M. Impact of Mediterranean diet on chronic non-communicable diseases and longevity. Nutrients. 2021;13(6):2028.
18. Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30-43.
19. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34.
20. Bonaccio M, Di Castelnuovo A, Costanzo S, Gialluisi A, Persichillo M, Cerletti C, et al. Mediterranean diet and mortality in the elderly: a prospective cohort study and a meta-analysis. Br J Nutr. 2018;120(8):841-54.
21. Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health. Circ Res. 2019;124(5):779-98.
22. Dominguez LJ, Barbagallo M. Dietary approaches and supplements in the prevention of cognitive decline and Alzheimer’s disease. Curr Pharm Des. 2016;22(6):688-700.
23. Norde MM, Collese TS, Giovannucci E, Rogero MM. A posteriori dietary patterns and their association with systemic low-grade inflammation in adults: a systematic review and meta-analysis. Nutr Rev. 2021;79(3):331-50.
24. Hébert JR, Shivappa N, Wirth MD, Hussey JR, Hurley TG. Perspective: the dietary inflammatory index (DII)-lessons learned, improvements made, and future directions. Adv Nutr. 2019;10(2):185-95.
25. Rubio-Arias JÁ, Ramos Campo DJ, Ruiloba Nuñez JM, Carrasco Poyatos M, Alcaraz Ramón PE, Jiménez Díaz FJ. Adherence to a Mediterranean diet and sport performance in a elite female athletes futsal population. Nutr Hosp. 2015;31(5):2276-82. Spanish.
26. Muros JJ, Zabala M. Differences in Mediterranean diet adherence between cyclists and triathletes in a sample of Spanish athletes. Nutrients. 2018;10(10):1480.
27. Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6(5):262-8.
28. Hijlkema A, Roozenboom C, Mensink M, Zwerver J. The impact of nutrition on tendon health and tendinopathy: a systematic review. J Int Soc Sports Nutr. 2022;19(1):474-504.