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Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Knee osteoarthritis (OA) is a disabling condition\u2014characterized by pain, stiffness, and impaired quality of life\u2014that affects more females than males. Chronic systemic inflammation is a key feature of knee OA and can be modulated by diet. We evaluated the sex-specific relationship between the inflammatory potential of diet and health-related quality of life (HRQOL), sleep quality, energy and fatigue levels, and psychological distress in individuals with knee OA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study analyzed baseline data from 144 participants (64% female) aged 45\u201385 years with symptomatic knee OA enrolled in the FEAST (eFEct of an Anti-inflammatory diet for knee oSTeoarthritis) randomized controlled trial, which compared an anti-inflammatory dietary program to a standard low-fat dietary program. Dietary inflammatory potential was assessed using the dietary inflammatory index (DII<jats:sup>\u00ae<\/jats:sup>) and energy-adjusted DII (E-DII\u2122), calculated from 3-day food diaries. Higher scores reflect more proinflammatory diets. Outcomes were HRQOL (EQ-5D-5L utility score and 100 mm visual analogue scale [VAS]), self-reported sleep quality, energy and fatigue levels (100 mm VAS), and psychological distress (Kessler Scale). Linear regression with interaction terms assessed sex-specific associations between DII\/E-DII and outcomes, adjusting for age and body mass index (BMI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Male and female participants had a mean \u00b1 standard deviation BMI of 30.4 \u00b1 3.8 and 30.2 \u00b1 7.2 kg\/m<jats:sup>2<\/jats:sup>, respectively. Mean E-DII and DII were \u22120.35 \u00b1 1.34 and 0.72 \u00b1 1.49 (females), and \u22120.26 \u00b1 1.52 and 0.33 \u00b1 1.45 (males). Higher E-DII scores were associated with lower EQ-5D utility scores in females (unadjusted \u03b2 = \u22120.03, 95% CI \u22120.05 to \u22120.001), but not after adjustment. Higher DII scores were associated with lower energy levels in males (unadjusted \u03b2 = \u22124.34, 95% CI \u22128.44 to \u22120.23; adjusted \u03b2 = \u22124.01, 95% CI \u22127.91 to \u22120.30). No associations were found between DII and HRQOL, sleep, fatigue, or psychological distress in either sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>No associations were found between dietary inflammatory potential and sleep quality, fatigue, or psychological distress. A more proinflammatory diet was linked to lower energy levels in males with symptomatic knee OA. Findings from the FEAST trial will clarify whether reducing dietary inflammation improves these outcomes over time.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1624852","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T04:13:35Z","timestamp":1757909615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The inflammatory potential of diet in adults with knee osteoarthritis: sex-specific associations with quality of life, sleep, fatigue and mental health"],"prefix":"10.3389","volume":"12","author":[{"given":"Lynette","family":"Law","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua J.","family":"Heerey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke L.","family":"Devlin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Brukner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alysha M.","family":"De Livera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R.","family":"Hebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry","family":"Price","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan P.","family":"White","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam G.","family":"Culvenor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/BOR.0000000000000923","article-title":"Inflammation in osteoarthritis: the latest progress and ongoing challenges.","volume":"35","author":"Knights","year":"2023","journal-title":"Curr Opin Rheumatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.joca.2013.03.018","article-title":"The epidemiology and impact of pain in osteoarthritis.","volume":"21","author":"Neogi","year":"2013","journal-title":"Osteoarthritis Cartilage"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1111\/imj.15933","article-title":"Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia.","volume":"53","author":"Ackerman","year":"2023","journal-title":"Intern Med J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1111\/ggi.13879","article-title":"Knee osteoarthritis and its association with mental health and health-related quality of life: a nationwide cross-sectional study.","volume":"20","author":"Park","year":"2020","journal-title":"Geriatr Gerontol Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1002\/art.21584","article-title":"Pain as a mediator of sleep problems in arthritis and other chronic conditions.","volume":"53","author":"Power","year":"2005","journal-title":"Arthritis Rheum"},{"key":"B6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/1471-2474-9-63","article-title":"Fatigue in osteoarthritis: a qualitative study.","volume":"9","author":"Power","year":"2008","journal-title":"BMC Musculoskelet Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1002\/acr.22459","article-title":"Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms.","volume":"67","author":"Parmelee","year":"2015","journal-title":"Arthritis Care Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e079374","DOI":"10.1136\/bmjopen-2023-079374","article-title":"Effectiveness of an anti-inflammatory diet versus low-fat diet for knee osteoarthritis: the FEAST randomised controlled trial protocol.","volume":"14","author":"Law","year":"2024","journal-title":"BMJ Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3178","DOI":"10.3390\/jcm10143178","article-title":"Gender and sex are key determinants in osteoarthritis not only confounding variables. 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