Research Article| Volume 128, P53-59, October 2019

Modifiable factors associated with symptomatic knee osteoarthritis: The Murakami cohort study


      • This study thoroughly examined lifestyle factors associated with symptomatic knee osteoarthritis.
      • The association between lifestyle-related factors and symptomatic knee osteoarthritis differs by sex.
      • Age and body mass index are strong risk factors for symptomatic knee osteoarthritis.
      • Higher consumption of green tea is associated with a lower incidence of knee osteoarthritis in men.



      Modifiable risk factors for knee osteoarthritis (OA) have not been studied in detail. This study aimed to determine lifestyle-related modifiable factors of symptomatic knee osteoarthritis in an East Asian population.

      Study design

      This 5-year cohort study involved 11,091 individuals (age range 40–72 years) living in the Murakami region of Niigata, Japan, who did not have a history of knee OA. At baseline, information on sociodemographic characteristics, body size, lifestyle, and living condition was obtained using a self-administered questionnaire.

      Main outcome measures

      Incident symptomatic knee OA observed at hospitals and orthopaedic clinics in the five years to 2016. Clinical grades of knee OA were based on the Kellgren-Lawrence scale. P for trend was assessed to examine linear associations between predictors and the outcome in multiple logistic regression analysis.


      The mean age of participants was 58.1 (SD 9.3) years. The number of cases of grade 2 or more incident knee OA was 429. In men, older age (P for trend < 0.0001), higher BMI (P for trend < 0.0001), higher METs score (P for trend = 0.0150), less smoking (P for trend = 0.0249), and lower green tea consumption (P for trend = 0.0437) were associated with incident knee OA. In women, older age (P for trend < 0.0001), higher BMI (P for trend < 0.0001), and alcohol consumption (P = 0.0153) were associated with incident knee OA.


      Several lifestyle-related factors were found to be associated with incident knee OA and exhibited sex-dependent differences. In particular, higher consumption of green tea was associated with a lower incidence of knee OA in men.


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        • Sharma L.
        Epidemiology of osteoarthritis.
        in: Moskowitz R.W. Howell D.S. Altman R.D. Buckwalter J.A. Osteoarthritis. 3rd ed. W.B. Saunders Company, Philadelphia2001: 3-27
        • Health, Labour and Welfare Statistics Association
        Kokumin-Eisei-No-Doko 2017/2018.
        Health, Labour and Welfare Statistics Association, Tokyo2017
      1. Portal Site of Official Statistics of Japan (e-Stat): National Medical Costs. (Accessed 20 February 2019) (in Japanese).

        • Jordan J.M.
        • Helmick C.G.
        • Renner J.B.
        • Luta G.
        • Dragomir A.D.
        • Woodard J.
        • Fang F.
        • Schwartz T.A.
        • Abbate L.M.
        • Callahan L.F.
        • Kalsbeek W.D.
        • Hochberg M.C.
        Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project.
        J. Rheumatol. 2007; 34: 172-180
        • Litwic A.
        • Edwards M.H.
        • Dennison E.M.
        • Cooper C.
        Epidemiology and burden of osteoarthritis.
        Br. Med. Bull. 2013; 105: 185-199
        • Silverwood V.
        • Blagojevic-Bucknall M.
        • Jinks C.
        • Jordan J.L.
        • Protheroe J.
        • Jordan K.P.
        Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis.
        Osteoarthr. Cartil. 2015; 23: 507-515
        • McWilliams D.F.
        • Leeb B.F.
        • Muthuri S.G.
        • Doherty M.
        • Zhang W.
        Occupational risk factors for osteoarthritis of the knee: a meta-analysis.
        Osteoarthr. Cartil. 2011; 19: 829-839
        • Nakamura K.
        • Takachi R.
        • Kitamura K.
        • Saito T.
        • Kobayashi R.
        • Oshiki R.
        • Watanabe Y.
        • Kabasawa K.
        • Takahashi A.
        • Tsugane S.
        • Iki M.
        • Sasaki A.
        • Yamazaki O.
        The Murakami cohort study of vitamin D for the prevention of musculoskeletal and other age-related diseases: a study protocol.
        Environ. Health Prev. Med. 2018; 23: 28
        • Fujii H.
        • Yamamoto S.
        • Takeda-Imai F.
        • Inoue M.
        • Tsugane S.
        • Kadowaki T.
        • Noda M.
        Validity and applicability of a simple questionnaire for the estimation of total and domain-specific physical activity.
        Diabetol. Int. 2011; 2: 47-54
        • Inoue M.
        • Tsugane S.
        Impact of alcohol drinking on total cancer risk: data from a large-scale population-based cohort study in Japan.
        Br. J. Cancer. 2005; 92: 182-187
        • Nakamura K.
        • Kitamura K.
        • Takachi R.
        • Saito T.
        • Kobayashi R.
        • Oshiki R.
        • Watanabe Y.
        • Tsugane S.
        • Sasaki A.
        • Yamazaki O.
        Impact of demographic, environmental, and lifestyle factors on vitamin D sufficiency in 9,084 Japanese adults.
        Bone. 2015; 74: 10-17
        • Kulkarni K.
        • Karssiens T.
        • Kumar V.
        • Pandit H.
        Obesity and osteoarthritis.
        Maturitas. 2016; 89: 22-28
        • Johnson R.
        • Bryant S.
        • Huntley A.L.
        Green tea and green tea catechin extracts: an overview of the clinical evidence.
        Maturitas. 2012; 73: 280-287
        • Vuong Q.V.
        Epidemiological evidence linking tea consumption to human health: a review.
        Crit. Rev. Food Sci. Nutr. 2014; 54: 523-536
        • Herrero-Beaumont G.
        • Roman-Blas J.A.
        • Bruyère O.
        • Cooper C.
        • Kanis J.
        • Maggi S.
        • Rizzoli R.
        • Reginster J.Y.
        Clinical settings in knee osteoarthritis: pathophysiology guides treatment.
        Maturitas. 2017; 96: 54-57
        • Shen C.L.
        • Smith B.J.
        • Lo D.F.
        • Chyu M.C.
        • Dunn D.M.
        • Chen C.H.
        • Kwun I.S.
        Dietary polyphenols and mechanisms of osteoarthritis.
        J. Nutr. Biochem. 2012; 23: 1367-1377
        • Grover A.K.
        • Samson S.E.
        Benefits of antioxidant supplements for knee osteoarthritis: rationale and reality.
        Nutr. J. 2016; 15: 1
        • Keske M.A.
        • Ng H.L.
        • Premilovac D.
        • Rattigan S.
        • Kim J.A.
        • Munir K.
        • Yang P.
        • Quon M.J.
        Vascular and metabolic actions of the green tea polyphenol epigallocatechin gallate.
        Curr. Med. Chem. 2015; 22: 59-69
        • Chen X.Q.
        • Hu T.
        • Han Y.
        • Huang W.
        • Yuan H.B.
        • Zhang Y.T.
        • Du Y.
        • Jiang Y.W.
        Preventive effects of catechins on cardiovascular disease.
        Molecules. 2016; 21: 1-7
        • Hursel R.
        • Westerterp-plantenga M.S.
        Catechin- and caffeine-rich teas for control of body weight in humans.
        Am. J. Clin. Nutr. 2013; 98: 1682S-1693S
        • Bereshchenko O.
        • Bruscoli S.
        • Riccardi C.
        Glucocorticoids, sex hormones, and immunity.
        Front. Immunol. 2018; 9: 1332
        • Jin X.
        • Wang B.H.
        • Wang X.
        • Antony B.
        • Zhu Z.
        • Han W.
        • Cicuttini F.
        • Wluka A.E.
        • Winzenberg T.
        • Blizzard L.
        • Jones G.
        • Ding C.
        Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis.
        Osteoarthr. Cartil. 2017; 25: 1100-1106
        • Lefèvre-Colau M.M.
        • Nguyen C.
        • Haddad R.
        • Delamarche P.
        • Paris G.
        • Palazzo C.
        • Poiraudeau S.
        • Rannou F.
        • Roren A.
        Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?.
        Ann. Phys. Rehabil. Med. 2016; 59: 196-206
        • Belbasis L.
        • Dosis V.
        • Evangelou E.
        Elucidating the environmental risk factors for rheumatic diseases: an umbrella review of meta-analyses.
        Int. J. Rheum. Dis. 2018; 21: 1514-1524
        • Muthuri S.G.
        • Zhang W.
        • Maciewicz R.A.
        • Muir K.
        • Doherty M.
        Beer and wine consumption and risk of knee or hip osteoarthritis: a case control study.
        Arthritis Res. Ther. 2015; 17: 23
        • Haugen I.K.
        • Magnusson K.
        • Turkiewicz A.
        • Englund M.
        The prevalence, incidence, and progression of hand osteoarthritis in relation to body mass index, smoking, and alcohol consumption.
        J. Rheumatol. 2017; 44: 1402-1409
        • Kong L.
        • Wang L.
        • Meng F.
        • Cao J.
        • Shen Y.
        Association between smoking and risk of knee osteoarthritis: a systematic review and meta-analysis.
        Osteoarthr. Cartil. 2017; 25: 809-816
        • Felson D.T.
        • Zhang Y.
        Smoking and osteoarthritis: a review of the evidence and its implications.
        Osteoarthr. Cartil. 2015; 23: 331-333