Rheumatology International

, Volume 39, Issue 2, pp 277–284 | Cite as

Dietary protein intake and upper leg muscle strength in subjects with knee osteoarthritis: data from the osteoarthritis initiative

  • A. H. de ZwartEmail author
  • M. van der Leeden
  • L. D. Roorda
  • M. Visser
  • M. van der Esch
  • W. F. Lems
  • J. Dekker
Observational Research


The aims of this study were (1) to describe dietary protein intake, and (2) to evaluate the association between dietary protein intake and upper leg muscle strength in subjects with knee osteoarthritis (OA). Baseline data from the OA was used, in a cross-sectional study. All subjects were diagnosed with symptomatic and radiographic knee OA. Daily dietary protein intake was measured with the Block Brief 2000 food frequency questionnaire (g/kg body weight). The sum of knee flexion and extension strength of the index knee (N/kg bodyweight) was assessed with the Good Strength chair test. Linear regression analysis was used to test the association between dietary protein intake and muscle strength, adjusting for relevant confounders. Data from 1316 subjects (mean age 61.4 ± SD 9.1 years, 57.0% female) were used. The mean daily protein intake was 0.72 ± SD 0.30 g/kg bodyweight, and 65.1% of the subjects had a protein intake lower than the recommended daily allowance of 0.8 g/kg bodyweight. The mean muscle strength was 5.4 ± SD 2.1 N/kg bodyweight. Lower protein intake was significantly associated with lower muscle strength (B = 0.583, 95% CI 0.230–0.936, p = 0.001). The majority of the subjects with knee OA had a dietary protein intake lower than the recommended daily allowance. Lower protein intake was associated with lower upper leg muscle strength. Longitudinal observational and interventional studies are needed to establish whether dietary protein intake has a causal effect on muscle strength in subjects with knee OA.


Knee joint Osteoarthritis Muscle strength Protein intake Nutrition 



The OAI is a public–private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.


This study was funded by the Dutch Arthritis Association (Grant number 13-1-401).

Compliance with ethical standards

Conflict of interest

AH de Zwart declares that he has no conflict of interest, M van der Leeden declares that she has no conflict of interest, LD Roorda declares that he has no conflict of interest, M Visser declares that she has no conflict of interest, M van der Esch declares that he has no conflict of interest, WF Lems declares that he has no conflict of interest, J Dekker declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Amsterdam Rehabilitation Research Center|ReadeAmsterdamThe Netherlands
  2. 2.Department of Rehabilitation Medicine, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Rehabilitation Medicine, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Internal Medicine, Section Nutrition and Dietetics, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
  5. 5.Amsterdam Rheumatology & Immunology CenterAmsterdamThe Netherlands
  6. 6.Department of Rheumatology, Amsterdam UMCVrije Universiteit Medical CenterAmsterdamThe Netherlands
  7. 7.Department of Psychiatry, Amsterdam UMCVrije Universiteit Medical Center AmsterdamAmsterdamThe Netherlands

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