The Role of Nutrition in The Treatment of Chronic Musculoskeletal Diseases

Chronic musculoskeletal diseases demonstrate a high prevalence, especially amongst the older population [1]. Diet therapy might have several purposes in the treatment of chronic musculoskeletal diseases. It may play a role in the supression of chronic inflammation and pain. Nutrition might be an aid in improving bone, cartilage structure and function, and in immune modulation as well [2]. Foods, herbs, spices, marine species, and biologically-active compounds may have impacts on musculoskeletal health [3]. Vegetarian, Mediterranean diet, and fasting may help in the improvement of chronic musculoskeletal disease conditions [4,5]. Amongst elderly populations, the proper consumption of those nutriceuticals that play a role in musculoskeletal health and cognitive function is essential. Sixteen different micronutrients can be characterized as having evidence-based scientifically benefitial effects on musculoskeletal health and cognitive function in the elderly, such as beta-alanine, calcium, creatine, fluorides, leucine, magnesium, omega-3 fatty acids, potassium, vitamin B6, vitamin B9, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K2, and zinc [3]. Rheumatoid arthritis and osteoarthritis have a different nutritional approach, due to the variety of disease causalities [4,6,7]. Whereas diet therapy of degenerative joint diseases is based on targeting and maintaining normal Body Mass Index, in rheumatoid arthritis nutritional intervention focuses on reducing symptoms and preventing disease progression. Vegetables, fruits, polyunsatturated fatty acids (n-3, n-6, n-9), vegetarian, Mediterranean diet, and food-supplementation might be essential [8]. In the 19th century, Jonathan Hutchinson was amongst those doctors who advised lifestyle interventions and marine fish oil as a supplemental therapy for systemic lupus erythematosus (SLE) [9]. Nowadays, it has been scientifically proven that moderate energy intake, antioxidant rich diet, and the consumption of fish oil may help in the reduction of inflammation and the treatment of comorbidities that occur in SLE [10]. Regarding the delay of degenerative joint diseases, it is essential to target normal BMI (20-25kg/m2), although there are some cases where physical activity might be more important than body weight loss itself [11]. Alternate-day fasting (one day 25% of energy requirement, the following day 75-90% of total energy requirement, consumed) might be effective in weight reduction [12]. Instead of making drastic changes in diet, it is more effective to increase the consumption of fruits, vegetables, grains, and fish and reduce the consumption of meat, refined sugar, white flour, salt and saturated fatty acid [13,14]. In the delay or elimination of chronic inflammation, elimination diet, vegetarianism, and fasting might be effective [4,5,15]. Food supplementation with omega-3 fatty acids, glucosamine, and chondroitine sulphate may play a central role in the delay of osteoarthritis [16]. Evening primrose oil, borage oil, omega-3 fatty acid, gamma-linolenic acid, ginger, curcumin, bromelain (found in pineapple), and polyphenol compounds such as quercetine may improve musculoskeletal disease conditions [17,18]. There are vitamins, minerals and trace elements that have an impact on the improvement of musculoskeletal conditions: • Calcium (bone and teeth structure, bone mineralization, muscle contraction) [19,20] • Magnesium (bone structure, controlling muscle contraction) [21] • Vitamin-K2 (cofactor of structural and regulation proteins in bone tissue) [20, 22, 23] • Zinc (stimulation of osteoblast activity and promotion of bone mineralization) [24] • Vitamin-D (bone formation, maintaining bone mineralization, limiting factor of calcium absorption) [19, 25] • Copper (collagen and elastine formation, wound healing, immune competence) [17] • Vitamin-A (bone formation, immune competence) [20] • Selenium (immune modulation) [26] • Phosphorus (bone mineralization) [27,28] • Folic acid (protein sythesis, development of musculoskeletal system) [29] • Vitamin B1(collagen synthesis), Vitamin B2(prevention of fractures) [19], Vitamin B3(cell division, treatment of os-