The impact of nutrition on tendon health and tendinopathy: a systematic review.

Aveline Hijlkema, Caroline Roozenboom, Marco Mensink, Johannes Zwerver

Journal: Journal of the International Society of Sports Nutrition 2022;19(1):474-504

PMID: 35937777

Plain Language Summary

Tendinopathy, which involves persistent tendon pain and loss of function related to mechanical loading, is common in athletes as well as in the general population. The aim of this study was to evaluate the impact of nutrition on the prevention and treatment of tendinopathy in a general human population. This study is a systematic review of nineteen studies. The number of people included in these studies ranged from 50 to 80,106. Results show that: - there wasn’t an association between any of the dietary parameters and Achilles tendon thickness. - despite inconsistent findings on the risk and severity of tendinopathy in humans, there is evidence that alcohol may inhibit collagen synthesis through toxic effects. - collagen seems to be beneficial in the treatment of tendinopathy, but conclusions about optimal dosage, timing, duration, and type of collagen supplementation cannot be drawn yet. - many other nutrients may contribute to collagen synthesis or may have anti-inflammatory effects, so most dietary supplements used in the different studies contained multiple substances. Authors conclude it is impossible to draw definitive conclusions and formulate dietary recommendations on the prevention and treatment of tendinopathy.

Abstract

BACKGROUND

Tendinopathy is a painful condition that is prevalent in athletes as well as the general human population, and whose management is challenging.

OBJECTIVE

This systematic review aimed to evaluate the impact of nutrition on the prevention and treatment of tendinopathy.

METHODS

Searches were conducted in PubMed, EMBASE, Web of Science, and SPORTDiscus without restriction to year of publication. Studies examining the impact of exposure to nutrient intake in an adult human population on 1) prevalence/incidence of tendinopathy, 2) clinical outcomes of tendinopathy, 3) structural changes in the tendon by imaging modalities. Experimental and observational study designs written in English, Dutch, or German were eligible.

RESULTS

Nineteen studies met the inclusion criteria. The effects of the habitual diet were investigated in one study. Four studies examined the effects of exposure to alcohol. Alcohol consumption can be a potential risk factor associated with Achilles tendinopathy and rotator cuff tears, although findings were inconsistent. The use of dietary supplements was examined in fourteen studies. Among these, collagen-derived peptides were most often part of the supplements evaluated. Combining training and dietary supplements seems to induce better clinical and functional outcomes in tendinopathy.

CONCLUSION

This review demonstrates the paucity of high-quality studies and a wide variety among studies regarding nutrients, tendon location, study population, and reported outcome measures. Individual studies showed promising clinical implications for the use of dietary supplements, particularly those containing collagen-derived peptides. However, giving any definitive dietary recommendations on the prevention and treatment of tendinopathy remains elusive.

Address: Wageningen University and Research, Division of Human Nutrition and Health, Wageningen, The Netherlands.; Research Support Center, Hospital Gelderse Vallei, Ede, The Netherlands.; Hospital Gelderse Vallei, Sports Valley, Department of Sports Medicine, Ede, The Netherlands.; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.

DOI: 10.1080/15502783.2022.2104130