Higher Polyphenol Intake Associated with Lower Risk of Severe Lumbar Spinal Stenosis

by | Feb 9, 2023 | 2022, Bone Health, Fruits and Vegetables, Polyphenols

Written by Taylor Woosley, Staff Writer. Univariate analysis (matched for age, sex, and physical activity) showed that a 1-SD increment in the total polyphenol eaten (281.0 mg/d) was associated with a decreased risk of LSS (OR=0.63; 95% CI 0.49-0.82). 

back painLumbar spinal stenosis (LSS) is a common degenerative disease of the lumbar vertebrae in elderly patients and is characterized by neurogenic intermittent claudication, leading to continuously shortened walking distances as the disease progresses and seriously affects patient quality of life1. LSS is a pathological process where bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, progressively compressing the neural and vascular elements in the spine canal2. It is associated with substantial functional limitation of walking, disability, and increased risk of falling3.

Polyphenols from fruits and vegetables play a protective role against LSS as they have antioxidant properties4. Furthermore, these phytochemicals act as reliable nutritional mediators with potent repressive impacts on oxidative stress and inflammation5. Polyphenols show protective roles due to their ability to effectively inhibit the apoptosis and senescence as well as promote autophagy of nucleus pulposus cells6.

Ruggiero et al. conducted a case-control analysis to examine whether diets rich in polyphenols may be useful for preventing LSS using data from the cohort of patients of the PREFACE Study. Patients (n=264) of the PREFACE Study were aged ≥35 years, with symptomatic LSS, who were enrolled in the study from 2016 to 2018. Study inclusion criteria consisted of being age ≥18 years, with a formal diagnosis of LSS based on neuroimaging scan, with little improvement after 6 months of conservative treatment, and classified as grade C or D on the Schiza’s scale, with a scheduled surgery. Anthropometric measurements and anamnestic and dietary questionnaires were completed before surgery. The final sample consisted of 156 subjects with LSS.

Matched-control participants (n=312) were included if they had no reported spine degenerative disease identified among the participants of the Moli-sani Study, a population-based cohort of men and women (aged ≥35 years) from the general population of the Molise region. For each LSS case, two controls were matched by sex, age, and physical activity level. For both groups of participants (LSS patients and control), data on food intake before enrollment was collected using the EPIC food frequency questionnaire (FFQ). The Phenol-Explorer database was used to estimate total intake of polyphenols and their classes and subclasses, including flavonoids, flavones, lignans, stilbenes, phenolic acids, and other polyphenols. Additionally, the total antioxidant capacity (TAC) of the diet was measured.

Multivariable conditional logistic regression analysis was utilized to quantify the association of dietary factors with LSS risk. The average intake of polyphenols in the diet of LSS cases was 595.3 mg/d (±274.1) and 677.8 mg/d (±218.0) in controls (p value = 0.0002). The LSS participants had lower intakes of flavonoids, stilbenes, and other polyphenols compared to matched controls. Significant findings of the study are as follows:

  • Univariate analysis (matched for age, sex, and physical activity) resulted in a 1-SD increment in the total polyphenol eaten (281.0 mg/d) was associated with a decreased risk of LSS (OR = 0.63; 95% CI 0.49-0.82). Results remained substantially unchanged in multivariable analyses (OR = 0.66; 95% CI 0.48-0.90).
  • Per 1-SD increment of total flavonoid (173.8 mg/d), the stilbenes (9.1 mg/d) and other polyphenols (23.9 mg/d) intakes were inversely associated with the risk of LSS (OR = 0.57, 95% CI 0.42-0.78; OR = 0.40, 95% CI 0.27-0.61; and OR = 0.30, 95% CI 0.20-0.47, respectively).

Results of the study show that a polyphenol-rich diet may be associated with a reduced risk of severe LSS, particularly flavonoids and stilbenes. Further research should continue to explore the effects of polyphenol consumption on inflammatory diseases and conditions. Study limitations include the potential for recall bias regarding dietary intake and polyphenol consumption and limitations on the generalizability of the study because the analysis focused solely on severe LSS.

Source: Ruggiero, Emilia, Simona Esposito, Simona Costanzo, Augusto Di Castelnuovo, Marianna Storto, Ettore Carpineta, Chiara Cerletti et al. “The Dietary Intake of Polyphenols Is Associated with a Lower Risk of Severe Lumbar Spinal Stenosis: A Case-Control Analysis from the PREFACE Study.” Nutrients 14, no. 24 (2022): 5229.

© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons
Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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Posted February 9, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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