Diet Interventions, by Race, Evaluated as Complementary Treatments for Pain (DIRECTPain)

饮食干预，由种族评估，作为疼痛的补充治疗(DIRECTPain) 项目摘要 膝骨性关节炎(OA)是美国最常见的关节炎形式，也是导致残疾的重要原因 种族是导致糟糕结果的一个风险因素。非西班牙裔黑人个人(NHB)报告更多与OA相关的残疾 与非西班牙裔白人(NHW)相比，他们的疼痛程度更高。这些差异被强化了 通过社会和生物机制，最终导致疼痛体验的显著种族差异 以及相关的生活质量。目前各国减少止痛药使用的努力突出表明，迫切需要 为服务不足/高危人群提供安全有效的止痛替代方案。低碳水化合物饮食(LCD) 减少炎症和疼痛，与减肥无关，表明饮食干预提供了一种 药理互补疗法。然而，新陈代谢方面存在罕见的种族差异。 在饮食干预中解决。高血压病患者胰岛素敏感度较低，罹患该病的风险较大。 代谢紊乱，表明碳水化合物反应改变。因此，LCD可能会有更大的痛苦- 减少NHBs的影响，并为疼痛提供补充(或替代)治疗。在这里，我们将招募 男性和女性NHB(n=100)和NHW(n=100)膝关节骨性关节炎成人完成我们的两阶段方案。 第一阶段将包括为期3周的饮食增加，这将允许量化疼痛措施，心理社会 变量(社会经济状况、营养知识、离杂货店近、食品不安全)和饮食 质量，以提供比较的基线。第二阶段是为期6周的饮食干预(LCD或USDA饮食) 在研究人员的指导下和参与者的投入下，两组都将得到所有的食物。 将每隔3天评估一次诱发疼痛、疼痛残疾、严重程度、灾难和干预措施。 除了生活质量、情绪和抑郁之外的几周。生理变量将通过以下方式评估 抽血(炎症特征)和双能X射线吸收扫描(DXA；身体成分， 内脏脂肪)。这将是第一次研究这些饮食对 通过强调种族和与生物心理社会变量的相互作用来减少膝骨性关节炎的疼痛。所有方面的变化 第二阶段后的疼痛措施将根据已发表的具有临床意义的措施进行评估 在疼痛和残疾方面的差异，以及统计意义。中心假设是LCD将 改善膝骨性关节炎患者的疼痛和生活质量，NHBs的效果比NHWs更大。

Diet Interventions, by Race, Evaluated as Complementary Treatments for Pain (DIRECTPain) Project Summary Knee osteoarthritis (OA) is the most prevalent form of arthritis and a significant cause of disability in the U.S. and race is a risk factor for poor outcomes. Non-Hispanic Black individuals (NHB) report greater OA-related disability and pain severity compared to their Non-Hispanic White (NHW) counterparts. These disparities are reinforced through social and biological mechanisms, ultimately resulting in dramatic racial disparities in pain experience and associated quality of life. Current national efforts to reduce analgesic utilization highlight the critical need for safe and effective alternatives for pain relief for underserved/at-risk populations. Low-carbohydrate diets (LCDs) reduce inflammation and pain independent of weight loss, indicating that diet interventions offer a non- pharmacological complementary treatment. However, racial differences exist in metabolism that are rarely addressed in diet interventions. NHBs tend to have low insulin sensitivity and are at greater risk for developing metabolic disorders, suggesting altered carbohydrate responses. Therefore, a LCD may have greater pain- reducing effects in NHBs and provide a complementary (or alternative) treatment for pain. Here, we will recruit male and female NHB (n=100) and NHW (n=100) adults with knee OA to complete our two-phase protocol. Phase 1 will involve a 3-week diet run-up that will allow for quantification of pain measures, psychosocial variables (socioeconomic status, nutritional knowledge, proximity to grocery stores, food insecurity), and diet quality to provide a baseline for comparison. Phase 2 will be a 6-week diet intervention (LCD or USDA diet) in which both groups will be provided with all meals at the direction of study personnel and input from participants. Evoked pain, measures of pain disability, severity, catastrophizing, and interference will be assessed every 3 weeks in addition to QOL measures, mood, and depression. Physiological variables will be assessed through blood draws (inflammatory profile) and dual-energy X-ray absorptiometry scans (DXA; body composition, visceral fat) at the end of Phases 1 and 2. This will be the first study to examine the efficacy of these diets to reduce knee OA pain with an emphasis on race and interactions with biopsychosocial variables. Changes in all pain measures following Phase 2 will be assessed with respect to published measures of clinically-meaningful differences in pain and disability, as well as for statistical significance. The central hypothesis is that the LCD will improve pain and QOL in participants with knee OA with a greater effect in NHBs than NHWs.