Investigating the role of nutrition and self-monitoring in osteoarthritis management: evidence from a cross-sectional study of UK adults

Investigating the role of nutrition and self-monitoring in osteoarthritis management: evidence from a cross-sectional study of UK adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the role of nutrition and self-monitoring in osteoarthritis management: evidence from a cross-sectional study of UK adults Mahmoud Al Ammouri, Maja Mazur, Janusz Jankowski, Qiling Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6239209/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Osteoarthritis (OA) is a prevalent, debilitating condition that significantly impacts global health. In addition to commonly recommended approaches (e.g., nonpharmacological, pharmacological and surgical therapy), the impact of nutrition on OA has become increasingly important, as supported by recent dietary randomized controlled trials on OA patients. However, very few studies have reported the attitudes, awareness and perceived barriers of community-dwelling adults in the UK with respect to nutrition and dietary intervention for OA. In addition, symptom tracking is proposed to stimulate engagement in self-management behaviours, including dietary modifications. Aim This study aims to investigate the prevailing attitudes, awareness, and perceived barriers to nutrition as a viable self-management approach to OA and maintaining joint health among community-dwelling adults in the UK. Methods This cross-sectional study employed an electronic survey. The survey, which was available online for three months, comprised 30 questions exploring attitudes, awareness and perceived barriers to adopting an anti-inflammatory diet for osteoarthritis management. Participants aged 18 years or older, with or without osteoarthritis, were recruited through various channels. Descriptive and inferential analyses were conducted, with a p value <0.05 considered significant. Results Among the 1,104 participants analysed, 53.3% were female, with the 36–45 years being the predominant age group (38.9%). Among those with OA (33.1%), 47.1% presented with tracked symptoms. The OA participants were more aware of treatment modalities and were more likely to seek nutritional information (45.9% vs. 23.8%, p < 0.001). They reported less frequent consumption of processed foods (p < 0.001), refined sugars (p = 0.010), trans fats (p < 0.001) and refined carbohydrates (p = 0.033). Uncertainty about the right diet was the main barrier to using food as medicine (78.5%, p < 0.01), followed by the cost of living (60.2%, p < 0.01). Symptom trackers demonstrated greater familiarity with dietary patterns exacerbating OA (adjusted relative risk ratio (aRRR): 2.43, 95% CI: 1.24--4.74, p = 0.01), were less likely to disagree about differences in their inflammatory diet (aRRR: 0.45, 95% CI: 0.25--0.82, p < 0.01) and were more likely to focus on diet during flare-ups (p < 0.001). Conclusion This study provides significant insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. While participants with OA showed increased awareness of treatment options and healthier dietary choices, uncertainty about the right diet was the primary barrier to using food as medicine. Symptom tracking was significantly associated with greater dietary knowledge and focus during flare-ups. Future research should develop personalized dietary interventions and evaluate the long-term effects of symptom tracking and dietary changes on OA outcomes. osteoarthritis nutrition dietary interventions dietary patterns awareness symptom tracking UK Figures Figure 1 Figure 2 Introduction Osteoarthritis (OA) is one of the most prevalent long-term conditions, significantly impairing physical function and causing a substantial burden on individuals. Its effects can extend across multiple joints, exacerbating functional limitations and restricting participation in daily activities. With no known cure, the prevalence of OA is increasing globally, with an estimated 28% of individuals over 60 years of age affected (1). The 2015 World Health Organization (WHO) Global Ageing and Health Report emphasized OA as a primary cause of disability among adults aged 60 and above (2). Furthermore, the 2023 Global Burden of Disease report indicated that OA affected 595 million people worldwide in 2020, comprising 7.6% of the global population and ranking as the most common form of arthritis. Among adults aged 70 and older, OA was listed as the seventh leading cause of disability (3). Given the trends of aging populations, escalating rates of obesity and increasing incidence of injuries, the prevalence of OA is projected to continue rising globally (4). The global impact of OA is substantial and represents a significant public health concern worldwide. Recognizing the profound implications of OA and similar conditions for functional ability and quality of life, the WHO designated 2021 to 2030 the "Decade of Healthy Ageing." This initiative highlights the importance of addressing diseases such as OA, which profoundly affect functional ability and quality of life, within the broader context of promoting health and well-being among ageing populations (5). The structural and clinical features of OA display significant variability among patients, posing challenges in identifying universally effective treatments. This heterogeneity emphasizes the complexity of OA management, acknowledging that a "one size fits all" approach may not be feasible and the ongoing quest for personalized therapeutic approaches (6, 7). The current OA management approaches include nonpharmacological pharmacological and surgical interventions in severe cases (8). Nonpharmacological therapies, including exercise programs, self-management educational programs, physical therapy, massage and acupuncture, are recommended for managing symptoms and/or delaying disease progression despite conflicting results (9, 10). Pharmacological management with nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics and topical therapies to alleviate symptoms is often more accessible, but these methods do not address the underlying cause of OA, and NSAIDs are not suitable for long-term use due to adverse events as well as relative contraindications with other concomitant medications (11). Surgical intervention is the option for severe OA patients, but access can be limited due to the long waiting list, and this option is extremely costly(12). The impact of nutrition on various chronic diseases, including OA, has become increasingly evident (13). Diets rich in trans and saturated fats increase OA risk and worsen existing symptoms (14). Recent research has highlighted the significant role of nutrition in the management of OA. In particular, several randomized controlled trial (RCT) studies have investigated the effects of dietary interventions on perceptual, functional and serum biomarkers in individuals with OA (15-17). A 16-week Mediterranean-type diet intervention was applied to knee OA patients. Researchers reported reductions in the proinflammatory cytokine interleukin-1α and the cartilage degradation marker cartilage oligomeric matrix protein, as well as improvements in knee and hip movement in the diet group compared with the control group (15). Another feasibility study reported that 46% of OA participants consumed less analgesic medication following a 9-week anti-inflammatory diet (16). Furthermore, another RCT showed that an anti-inflammatory diet combined with a low-calorie regimen resulted in greater weight loss and improvements in pain intensity, functional status, depression and anxiety(17). These findings collectively highlight the potential benefits of dietary interventions in managing OA symptoms and improving overall well-being. However, little is known about the attitudes, perceived barriers and awareness of community-dwelling adults in the UK about nutrition or dietary interventions for OA, which makes it difficult to evaluate the viability of nutritional interventions for OA management. In addition, self-management has been shown to effectively improve the health and well-being of OA patients while reducing healthcare system strain. OA patients in self-management programs with improved symptoms are less willing to undergo surgery, have decreased medication use, and take fewer sick leaves (18, 19). Furthermore, additional evidence supports the effectiveness of self-management, revealing that individuals with the highest levels of knowledge, skills and confidence in self-management had 19% fewer general practitioner (GP) appointments (20). Symptom tracking has emerged as a valuable self-management practice for OA patients. By systematically monitoring symptoms, individuals can gain better insight into their conditions, recognize patterns related to flare-ups, and make informed decisions about lifestyle adjustments, including diet adjustments (21). Research suggests that individuals who actively track their symptoms may have greater awareness of factors influencing their conditions and may be more likely to engage in self-management behaviours such as dietary modifications(22). Despite its potential benefits, the role of symptom tracking in OA management remains underexplored, particularly in relation to dietary interventions. The aim of this study was to investigate the prevailing attitudes, awareness and perceived barriers to nutrition as a viable self-management approach to OA and maintaining joint health among community-dwelling adults in the UK. The objectives include 1) investigating awareness, information-seeking behaviours and attitudes towards the dietary management of OA among individuals with and without OA. 2) To examine differences in dietary patterns between OA and non-OA participants, we identified perceived barriers to using food as medicine for OA symptom management. 3) To explore the relationship between symptom tracking and dietary knowledge related to OA and assess the likelihood of participants focusing on diet during OA flare-ups. Methods Study Design The study employed a cross-sectional research design, and this paper focuses on the quantitative findings derived from the electronic survey (eSurvey) component of the study. The survey was available online for three months, from 1 July 2024 to 1 October 2024. The participants accessed the survey via a link included in the recruitment materials distributed through various channels. The survey was administered via the secure Qualtrics platform, which ensures participant anonymity by disabling IP address collection and anonymising all responses. The survey instrument was developed for this study comprises 30 questions, which include multiple-choice questions, Likert-scale items and open-ended questions Supplementary material 1 . It was designed to investigate attitudes towards nutrition as a way of managing OA and maintaining joint health, evaluate awareness regarding the potential benefits of a personalized diet in alleviating OA symptoms and maintaining joint health beyond weight loss, including its anti-inflammatory effects. Additionally, it examined perceived barriers to adopting nutrition as a self-care method for osteoarthritis patients. The participants had the opportunity to review and change their responses before the final submission. The questions were developed and piloted by a team of researchers to ensure clarity, relevance and cultural sensitivity. The survey was structured to align with the Checklist for Reporting Results of internet E-Surveys (CHERRIES) to ensure comprehensive and transparent reporting (23) Supplementary material 2 , ensuring adherence to best practices in online survey research. Study population and data collection Individuals aged 18 years or older with or without OA were invited to participate in the study. Detailed information about the study, including the participant information sheet (PIS), is provided in the introductory section of the survey. The PIS outlined the study's objectives, data protection measures, participant rights and the voluntary nature of participation. The anonymised electronic survey was hosted on the Qualtrics platform. Recruitment strategies included social media advertisements, outreach through healthcare networks, email invitations and direct recruitment at community health events. Informed consent was obtained from all participants, and the data collected were anonymised and securely stored in an institutional database accessible only to the research team. Data analysis Descriptive analyses were conducted to summarize participant characteristics and survey responses, reporting frequencies and percentages. Inferential analyses were performed to identify differences in awareness and perceptions across various demographic groups via chi-square tests and Fisher's exact tests. Multinomial logistic regression models were used to examine the influence of diet on OA among individuals whose OA symptoms were tracked in comparison to those whose symptoms were not tracked. A p value of less than 0.05 was considered statistically significant. All analyses were performed via STATA, version 17 (StataCorp LP, College Station, TX, USA). Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The study received ethical approval from the Imperial College Research Ethics Committee (ICREC #7128007) on 27 June 2024. Informed consent was obtained from all participants, and the data were handled in accordance with ethical guidelines to ensure confidentiality and data integrity. Results Demographic profile of the participants Among the 1,400 individuals who were invited to participate, 1,206 participants accessed the survey (participation rate of 86.1%). A total of 1,104 respondents completed the survey, with a completion rate of 91.5% and a response rate of 78.9%. Six individuals who did not consent, 30 who consented but did not answer any questions and 66 who provided insufficient data by answering fewer than three questions were excluded. The study sample consisted of a diverse range of demographic and health characteristics ( Table 1) . A detailed stratification of demographic characteristics on the basis of OA status is presented in Supplementary material 3 . The results of the survey are available in Supplementary material 4 . The age distribution revealed a predominance of middle-aged adults, with the 36–45 years age group representing the largest proportion (38.9%, n=429), followed by the 26–35 years and 46–55 years age groups, each accounting for 23.5% (n=259) of the total population ( Table 1) . There was a nearly equal distribution of gender, with a female majority (53.3%, n=588) and a male majority (44.6%, n=492). The sample was predominantly White (90.9%, n=1,004), with other ethnic groups represented in smaller proportions. Nearly half (49.0%, n=541) reported a university degree or higher. A third of the respondents (33.6%, n=371) had full-time employment, followed by retirement (27.0%, n=298) and part-time employment (21.1%, n=233). More than one-third (35.0%, n=386) reported an annual household income within the £20,000--£38,000 range. A third (33.1%, n=366) of the respondents reported having osteoarthritis. Chronic joint conditions were prevalent, with 69.3% reporting at least one condition, the most common being chronic lower back pain (21.5%, n=304). Similarly, 66.7% of the participants reported at least one chronic medical condition, with mental health conditions being the most prevalent (16.6%, n=251), followed by a history of cardiovascular diseases (14.9%, n=226) and diabetes (11.7%, n=177) ( Table 1) . Table 1: Participant characteristics (n=1,104) Characteristic N (%)* Age 18-25 79 7.2% 26-35 259 23.5% 36-45 429 38.9% 46-55 259 23.5% 56 and above 60 5.4% Missing 18 1.6% Gender Female 588 53.3% Male 492 44.6% Other 2 0.2% Prefer not to say 4 0.4% Missing 18 1.6% Ethnicity White 1,004 90.9% Asian, or Asian British 30 2.7% Black, Black British, Caribbean or African 21 1.9% Mixed or Multiple ethnic groups 21 1.9% Other ethnic groups 6 0.5% Prefer not to say 4 0.4% Missing 18 1.6% Highest level of Education Primary/Secondary school 208 18.8% A levels/College 337 30.5% University degree or higher 541 49.0% Missing 18 1.6% Employment Employed full-time 371 33.6% Employed part-time 233 21.1% Retired 298 27.0% Student 15 1.4% Unemployed 130 11.8% Prefer not to say 39 3.5% Missing 18 1.6% Annual Household Income £100,000 47 4.3% Missing 18 1.6% Having osteoarthritis Yes 366 33.2% No 738 66.8% Chronic Joint Conditions † Rheumatoid arthritis 158 14.3% Fibromyalgia 102 9.2% Osteoporosis 151 13.7% Gout 47 4.3% Chronic lower back pain 304 27.5% Other 191 17.3% None of above 434 39.3% Prefer not to say 25 2.3% Chronic Medical Conditions † History of cardiovascular diseases 226 20.5% Chronic kidney disease 35 3.2% Chronic liver disease 18 1.6% Diabetes 177 16.0% History of cancer 95 8.6% History of extreme allergies 40 3.6% History of eating disorders 32 2.9% Coeliac disease 25 2.3% Gluten intolerance 39 3.5% Lactose intolerance 38 3.4% Dementia 4 0.4% Mental health condition 251 22.7% Other 154 13.9% None of above 368 33.3% Prefer not to say 13 1.2% †: Multiple response question (any unit of interest is number of answers not number of participants *: Percentages have been rounded and may not total to 100% Awareness, information-seeking behaviour and attitudes towards the dietary management of osteoarthritis There were significant disparities in awareness, information-seeking behaviours and attitudes towards OA management between participants with and without OA ( Table 2 ). Compared with those without OA, participants with OA demonstrated significantly greater awareness of several treatment modalities, including exercise and physical activity (88.3% vs. 77.2%, p < 0.001), weight management (81.4% vs. 64.2%, p < 0.001), physiotherapy (71.9% vs. 58.8%, p < 0.001), and dietary supplements (58.5% vs. 41.1%, p < 0.001). Additionally, those with OA showed greater awareness of over-the-counter medications (OTC, 55.2% vs. 30.2%, p < 0.001) and surgical options (57.9% vs. 32.8%, p < 0.001). However, there was no significant difference in awareness of prescription medications (75.7% vs. 75.5%, p = 0.939) or nutrition as medicine (43.7% vs. 40.2%, p = 0.270) between the two groups. A small but statistically significant difference was observed in the awareness of herbal treatments (10.7% vs. 6.5%, p = 0.016). Information-seeking behaviours differed markedly between groups, with OA participants being more likely to seek nutritional information for symptom management than non-OA participants seeking information for general joint health (45.9% vs. 23.8%, p < 0.001). Among information seekers, OA participants were significantly more likely to consult NHS doctors (51.8% vs. 33.5%, p = 0.020). Other information sources were not significantly different between the groups. Familiarity with dietary patterns potentially impacting OA symptoms was significantly greater among OA participants (p < 0.001 for improvement patterns; p = 0.001 for exacerbation patterns). Additionally, OA participants exhibited a significantly greater commitment to learning about healthy/anti-inflammatory diets (89.3% vs. 78.8%, p < 0.001). Table 2: Awareness, information-seeking behaviour and attitudes towards the dietary management of osteoarthritis Without OA (N=738) With OA (N=366) Total (N=1104) p value* What treatments for osteoarthritis are you aware of? † Exercise & physical activity 570.0 (77.24%) 323.0 (88.25%) 893.0 (80.89%) < 0.001 Weight management 474.0 (64.23%) 298.0 (81.42%) 772.0 (69.93%) < 0.001 Medication (prescription only) 557.0 (75.47%) 277.0 (75.68%) 834.0 (75.54%) 0.939 Medication (OTC) 223.0 (30.22%) 202.0 (55.19%) 425.0 (38.50%) < 0.001 Physiotherapy 434.0 (58.81%) 263.0 (71.86%) 697.0 (63.13%) < 0.001 Nutrition as medicine (anti-inflammatory diet) 297.0 (40.24%) 160.0 (43.72%) 457.0 (41.39%) 0.270 Supplements (e.g., Chondroitin, Glucosamine) 303.0 (41.06%) 214.0 (58.47%) 517.0 (46.83%) < 0.001 Herbs 48.0 (6.50%) 39.0 (10.66%) 87.0 (7.88%) 0.016 Surgery 242.0 (32.79%) 212.0 (57.92%) 454.0 (41.12%) < 0.001 None of the above 36.0 (4.88%) 3.0 (0.82%) 39.0 (3.53%) 0.001 Seeking information about healthy nutrition/diet to manage the symptoms of Osteoarthritis (if OA diagnosed) or to promote joint health (If OA free) < 0.001 No 562.0 (76.2%) 198.0 (54.1%) 760.0 (68.8%) Yes 176.0 (23.8%) 168.0 (45.9%) 344.0 (31.2%) What are the resources you have sought?** † NHS (website) 132 (75.0%) 131 (77.98%) 263 (76.45%) 0.951 NHS (doctor's advice) 59 (33.52%) 87 (51.79%) 146 (42.44%) 0.020 BBC Food (website) 21 (11.93%) 30 (17.86%) 51 (14.83%) 0.208 Magazines 31 (17.61%) 26 (15.48%) 57 (16.57%) 0.508 Blogs 45 (25.57%) 34 (20.24%) 79 (22.97%) 0.216 Dietitian/Nutritionist 38 (21.59%) 43 (25.6%) 81 (23.55%) 0.579 Charities 50 (28.41%) 64 (38.1%) 114 (33.14%) 0.190 Other 40 (22.73%) 25 (14.88%) 65 (18.9%) 0.063 I'm familiar with dietary patterns that may improve Osteoarthritis symptoms < 0.001 Strongly Disagree 127.0 (17.3%) 37.0 (10.2%) 164.0 (14.9%) Disagree 279.0 (38.0%) 119.0 (32.8%) 398.0 (36.2%) Neither agree nor disagree 129.0 (17.6%) 73.0 (20.1%) 202.0 (18.4%) Agree 185.0 (25.2%) 118.0 (32.5%) 303.0 (27.6%) Strongly Agree 15.0 (2.0%) 16.0 (4.4%) 31.0 (2.8%) I'm familiar with dietary patterns that may exacerbate Osteoarthritis symptoms 0.001 Strongly Disagree 144.0 (19.6%) 43.0 (11.8%) 187.0 (17.0%) Disagree 292.0 (39.7%) 135.0 (37.2%) 427.0 (38.9%) Neither agree nor disagree 114.0 (15.5%) 63.0 (17.4%) 177.0 (16.1%) Agree 172.0 (23.4%) 107.0 (29.5%) 279.0 (25.4%) Strongly Agree 13.0 (1.8%) 15.0 (4.1%) 28.0 (2.6%) I know the differences between an inflammatory & noninflammatory diet osteoarthritis management 0.037 Strongly Disagree 129.0 (17.6%) 44.0 (12.2%) 173.0 (15.8%) Disagree 253.0 (34.4%) 135.0 (37.5%) 388.0 (35.4%) Neither agree nor disagree 118.0 (16.1%) 78.0 (21.7%) 196.0 (17.9%) Agree 204.0 (27.8%) 88.0 (24.4%) 292.0 (26.7%) Strongly Agree 31.0 (4.2%) 15.0 (4.2%) 46.0 (4.2%) Commitment to learning more about healthy/anti-inflammatory diets < 0.0011 No 156.0 (21.2%) 39.0 (10.7%) 195.0 (17.7%) Yes 579.0 (78.8%) 325.0 (89.3%) 904.0 (82.3%) Values are presented as frequencies (percentages) within each group * : Statistical comparisons were performed using Pearson’s Chi-squared test or Fisher’s exact test, with p values indicating significance † : Multiple response question (any unit of interest is number of answers not number of participants ** : Follow up if “Seeking information about healthy nutrition/diet...” = Yes Frequency of consumption of various food categories There were significant differences in dietary patterns between participants with and without OA ( Table 3 ). Compared with those without OA, participants with OA reported less frequent consumption of processed foods (p < 0.001), refined sugars (p = 0.010), trans fats (p < 0.001) and refined carbohydrates (p = 0.033). Notably, 23.3% of the OA participants rarely consumed processed foods, whereas 14.7% of the non-OA participants did. Healthy fat consumption patterns also differed significantly (p = 0.011), with a greater proportion of OA participants (8.1%) reporting never consuming healthy fats than non-OA participants did (3.7%). Herb consumption also varied (p = 0.002), with lower daily use among OA participants (10.4% vs 14.0% in non-OA participants). No significant differences were observed in the consumption of high- omega-6 fatty acid foods, fruits and vegetables, whole grains, high-omega-3 fatty acid foods, or white meat. Table 3: Frequencies of various food categories consumed by participants with and without osteoarthritis Food Category Without OA (N=728) With OA (N=356) Total (N=1084) p value* Processed foods < 0.001 Daily 91.0 (12.5%) 42.0 (11.8%) 133.0 (12.3%) Several times a week 284.0 (39.0%) 96.0 (27.0%) 380.0 (35.1%) Occasionally 239.0 (32.8%) 133.0 (37.4%) 372.0 (34.3%) Rarely 107.0 (14.7%) 83.0 (23.3%) 190.0 (17.5%) Never 7.0 (1.0%) 2.0 (0.6%) 9.0 (0.8%) Refined sugars 0.010 Daily 83.0 (11.4%) 30.0 (8.4%) 113.0 (10.4%) Several times a week 175.0 (24.0%) 71.0 (19.9%) 246.0 (22.7%) Occasionally 267.0 (36.7%) 118.0 (33.1%) 385.0 (35.5%) Rarely 168.0 (23.1%) 111.0 (31.2%) 279.0 (25.7%) Never 35.0 (4.8%) 26.0 (7.3%) 61.0 (5.6%) Trans fats < 0.001 Daily 9.0 (1.2%) 4.0 (1.1%) 13.0 (1.2%) Several times a week 132.0 (18.1%) 42.0 (11.8%) 174.0 (16.1%) Occasionally 355.0 (48.8%) 147.0 (41.3%) 502.0 (46.3%) Rarely 204.0 (28.0%) 142.0 (39.9%) 346.0 (31.9%) Never 28.0 (3.8%) 21.0 (5.9%) 49.0 (4.5%) High omega-6 fatty acid foods 0.163 Daily 38.0 (5.2%) 24.0 (6.7%) 62.0 (5.7%) Several times a week 273.0 (37.5%) 115.0 (32.3%) 388.0 (35.8%) Occasionally 277.0 (38.0%) 131.0 (36.8%) 408.0 (37.6%) Rarely 126.0 (17.3%) 74.0 (20.8%) 200.0 (18.5%) Never 14.0 (1.9%) 12.0 (3.4%) 26.0 (2.4%) Refined carbohydrates 0.033 Daily 102.0 (14.0%) 35.0 (9.8%) 137.0 (12.6%) Several times a week 272.0 (37.4%) 114.0 (32.0%) 386.0 (35.6%) Occasionally 232.0 (31.9%) 129.0 (36.2%) 361.0 (33.3%) Rarely 99.0 (13.6%) 66.0 (18.5%) 165.0 (15.2%) Never 23.0 (3.2%) 12.0 (3.4%) 35.0 (3.2%) Fruits & vegetables 0.486 Daily 439.0 (60.3%) 201.0 (56.5%) 640.0 (59.0%) Several times a week 229.0 (31.5%) 116.0 (32.6%) 345.0 (31.8%) Occasionally 47.0 (6.5%) 30.0 (8.4%) 77.0 (7.1%) Rarely 12.0 (1.6%) 9.0 (2.5%) 21.0 (1.9%) Never 1.0 (0.1%) 0.0 (0.0%) 1.0 (0.1%) Whole grains 0.087 Daily 87.0 (12.0%) 34.0 (9.6%) 121.0 (11.2%) Several times a week 221.0 (30.4%) 93.0 (26.1%) 314.0 (29.0%) Occasionally 234.0 (32.1%) 118.0 (33.1%) 352.0 (32.5%) Rarely 156.0 (21.4%) 85.0 (23.9%) 241.0 (22.2%) Never 30.0 (4.1%) 26.0 (7.3%) 56.0 (5.2%) High omega-3 fatty acid foods 0.054 Daily 79.0 (10.9%) 39.0 (11.0%) 118.0 (10.9%) Several times a week 175.0 (24.0%) 66.0 (18.5%) 241.0 (22.2%) Occasionally 245.0 (33.7%) 114.0 (32.0%) 359.0 (33.1%) Rarely 178.0 (24.5%) 97.0 (27.2%) 275.0 (25.4%) Never 51.0 (7.0%) 40.0 (11.2%) 91.0 (8.4%) White meat 0.949 Daily 34.0 (4.7%) 19.0 (5.3%) 53.0 (4.9%) Several times a week 323.0 (44.4%) 152.0 (42.7%) 475.0 (43.8%) Occasionally 238.0 (32.7%) 123.0 (34.6%) 361.0 (33.3%) Rarely 65.0 (8.9%) 30.0 (8.4%) 95.0 (8.8%) Never 68.0 (9.3%) 32.0 (9.0%) 100.0 (9.2%) Healthy fats 0.011 Daily 87.0 (12.0%) 47.0 (13.2%) 134.0 (12.4%) Several times a week 237.0 (32.6%) 102.0 (28.7%) 339.0 (31.3%) Occasionally 237.0 (32.6%) 100.0 (28.1%) 337.0 (31.1%) Rarely 140.0 (19.2%) 78.0 (21.9%) 218.0 (20.1%) Never 27.0 (3.7%) 29.0 (8.1%) 56.0 (5.2%) Herbs 0.002 Daily 102.0 (14.0%) 37.0 (10.4%) 139.0 (12.8%) Several times a week 264.0 (36.3%) 126.0 (35.4%) 390.0 (36.0%) Occasionally 241.0 (33.1%) 103.0 (28.9%) 344.0 (31.7%) Rarely 105.0 (14.4%) 69.0 (19.4%) 174.0 (16.1%) Never 16.0 (2.2%) 21.0 (5.9%) 37.0 (3.4%) Values are presented as frequencies (percentages) within each group * : Statistical comparisons were performed using Pearson’s Chi-squared test with p values indicating significance Perceived barriers to using food as medicine In terms of perceived barriers to using food as medicine for OA symptoms, uncertainty about the right diet was the most prominent concern, with 78.5% of participants viewing it as a likely or very likely obstacle (p < 0.01) ( Supplementary material 5) . The cost of living (60.2%, p < 0.01) and time constraints for meal preparation (47.6%, p < 0.01) were also significant barriers ( Figure 1) . Social factors, such as eating with family or friends, posed a challenge for 41.5% of the participants (p < 0.01). Interestingly, job-related difficulties (12.5%, p < 0.01) and the perception of healthy eating as boring (22.6%, p < 0.01) were not considered major barriers. Focusing on diet to manage osteoarthritis symptoms during flare-ups Regarding the likelihood of participants focusing on their diet to manage OA symptoms during flare-ups, the results revealed a significant difference between those who tracked symptoms and those who did not (p < 0.001) ( Supplementary material 6) . Among those not tracking symptoms (n=191), 65.1% were unlikely or very unlikely to focus on their diet during flare-ups, with only 15.8% likely or very likely to do so. In contrast, among those tracking symptoms (n=170), 41.3% were unlikely or very unlikely to focus on their diet, whereas 38.3% were likely or very likely to do so. Interest level in coaching methods for osteoarthritis management The study also examined interest in various coaching methods for managing OA symptoms among participants who tracked and did not track their symptoms. Significant differences were observed in preferences for online (p=0.019), face-to-face (p=0.044), and hybrid coaching (p=0.010) between the two groups ( Supplementary material 7) . For online coaching, 57.2% of nontrackers and 60.3% of trackers were interested or very interested, with more trackers not at all interested (4.2% vs 12.0%). Face-to-face coaching showed similar interest levels (46.6% vs 49.4% interested or very interested), but with more trackers not at all interested (18.1% vs 11.6%). Hybrid coaching revealed the most significant difference, with nontrackers showing greater interest (17.5% vs. 6.6%) and very high interest (14.3% vs. 9.6%). No significant differences were found for mobile app-based (p=0.437) or telephone coaching (p=0.560) preferences. Symptom tracking and knowledge of dietary influences on osteoarthritis This study also examined the relationship between symptom tracking and knowledge of dietary influences on OA (Table 4) . For example, individuals who track their OA symptoms are more familiar with dietary patterns that improve symptoms than are those who do not track them. In the crude model, they were 1.89 times more likely to agree with this statement (95% CI: 1.06–3.36, p = 0.03) ( Figure 2) . This association was insignificant after adjusting for confounding factors in the adjusted model (aRRR: 1.79, 95% CI: 0.95–3.40, p = 0.07). Symptom trackers also demonstrated greater familiarity with dietary patterns that exacerbate OA symptoms. They were 2.56 times more likely to agree with this statement in the crude model (95% CI: 1.38–4.75, p < 0.01), with the association remaining significant in the adjusted model (RRR: 2.43, 95% CI: 1.24–4.74, p = 0.01). With respect to knowledge of differences between inflammatory and noninflammatory diets, those who tracked their symptoms were less likely to disagree than nontrackers were. This was consistent in both the crude (RRR: 0.47, 95% CI: 0.27–0.81, p < 0.01) and adjusted models (RRR: 0.45, 95% CI: 0.25–0.82, p < 0.01). Table 4: Knowledge of the influence of diet on osteoarthritis symptoms and management among individuals who actively track osteoarthritis symptoms in comparison to those who do not Level of agreement Crude Model ¶ Adjusted Model § RRR † 95% CI P value* RRR † 95% CI P value* Familiarity with dietary patterns that improve OA symptoms Neutral (Ref) - - (Ref) - - Disagree 0.72 0.41 - 1.27 0.26 0.69 0.37 - 1.30 0.25 Agree 1.89 1.06 - 3.36 0.03 1.79 0.95 - 3.40 0.07 Familiarity with dietary patterns that exacerbate OA symptoms Neutral (Ref) - - (Ref) - - Disagree 0.94 0.53 - 1.69 0.85 0.85 0.45 - 1.60 0.61 Agree 2.56 1.38 - 4.75 <0.01 2.43 1.24 - 4.74 0.01 Knowing the differences between inflammatory & noninflammatory diet on OA management Neutral (Ref) - - (Ref) - - Disagree 0.47 0.27 - 0.81 <0.01 0.45 0.25 - 0.82 <0.01 Agree 1.32 0.73 - 2.41 0.36 1.36 0.70 - 2.64 0.37 ¶ : Crude multinomial logistic regression model. § : Multinomial logistic regression model adjusted for age, gender, ethnicity, education, employment and annual income. † : Relative risk ratios (RRR) are exponentiated coefficients from a multinomial logistic regression model. *: Significance level, with values <0.05 considered statistically significant. Discussion Summary of principal findings This cross-sectional study provides valuable insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. Notably, participants with OA demonstrated significantly greater awareness of various treatment modalities, including exercise, weight management, physiotherapy, OTC, surgical options, herbs and dietary supplements (e.g., chondroitin, glucosamine), than did those without OA (p < 0.001). This heightened awareness was accompanied by a greater likelihood of seeking nutritional information for symptom management among OA participants (46% vs. 24%, p < 0.001). Furthermore, OA participants reported less frequent consumption of processed foods (p = 0.001), refined sugars (p = 0.010), trans fats (p < 0.001) and refined carbohydrates (p = 0.033), suggesting a potential shift towards healthier dietary patterns in response to their condition. Despite this increased awareness and apparent dietary modifications, our study revealed that uncertainty about the right diet remains a primary barrier to using food as medicine for OA management, with 79% of participants expressing this concern (p < 0.01). This was followed by cost-of-living concerns (60%, p < 0.01) and time constraints for meal preparation (48%, p < 0.01), highlighting the complex challenges faced by individuals attempting to implement dietary changes. Interestingly, our analysis revealed a significant association between symptom tracking and greater familiarity with dietary patterns affecting OA symptoms. The participants who tracked their symptoms were 2.4 times more likely to agree with being familiar with exacerbating dietary patterns (aRRR: 2.43, 95% CI: 1.24--4.74, p = 0.01) and were less likely to disagree about knowing inflammatory diet differences (aRRR: 0.45, 95% CI: 0.25--0.82, p < 0.01). In addition, symptom trackers were significantly more likely to focus on their diet during OA flare-ups (p < 0.001), with 38% of trackers likely or very likely to do so, compared with only 16% of nontrackers. These findings highlight the potential importance of self-monitoring practices in enhancing dietary awareness and management strategies among individuals with OA. Comparison with literature Our study findings align with and expand upon prior research examining the role of nutrition and self-monitoring in OA management. Previous studies have consistently demonstrated that dietary interventions, particularly those focused on anti-inflammatory foods, can alleviate OA symptoms and improve functional outcomes (14, 15). The present study builds on this literature by further establishing a link between symptom tracking and dietary adherence, suggesting that individuals who actively monitor their symptoms are more likely to engage in evidence-based dietary practices (22, 24). Research has identified dietary components such as processed foods, trans fats, and refined sugars as contributors to increased inflammation and OA symptom severity (20). Our findings support this evidence, demonstrating that OA participants who tracked their symptoms reported significantly lower consumption of these proinflammatory foods than nontrackers did. This finding is consistent with those of prior studies (13, 16), which revealed that adherence to an anti-inflammatory diet led to improved pain management and mobility in OA patients. Additionally, our study contributes to the broader self-management literature by emphasizing the role of symptom tracking in facilitating proactive dietary choices. Previous studies highlighted the benefits of self-management programs for chronic conditions, showing that structured monitoring leads to better health outcomes and reduced reliance on pharmacological treatments (18, 19). We extend this understanding by highlighting a direct association between symptom tracking and increased awareness of dietary triggers, highlighting its potential as a behavioural intervention in OA management, which should be reinforced by the promotion of health literacy, the adoption of risk mitigation strategies and the application of the ‘food as medicine’ Healthy Eating Pillar of self-care (25). Despite these parallels with the literature, our study also highlights critical gaps that warrant further exploration. Notably, the high level of uncertainty regarding appropriate dietary choices for OA remains a major barrier, as observed in similar studies (16, 26). This suggests a need for more targeted educational interventions aimed at increasing patient confidence in making dietary adjustments. Furthermore, while prior studies have established the efficacy of dietary interventions in controlled settings, real-world adherence remains a challenge. Our findings indicate that symptom tracking could facilitate sustained dietary modifications, an area that requires further longitudinal investigation. Our study contributes valuable insights to the growing body of evidence supporting the role of nutrition and self-monitoring in OA management. By demonstrating a clear link between symptom tracking and dietary behaviour, this research lays the groundwork for future interventions aimed at integrating digital health tools, dietary counselling, and self-monitoring strategies to enhance long-term outcomes for individuals with OA. Strengths and limitations This cross-sectional study's primary strength lies in its large sample size of 1,104 participants, providing robust statistical power for analyses. The comprehensive survey covered a wide range of topics related to OA management, dietary patterns and attitudes. This breadth, combined with a structured analysis approach, allowed for a detailed assessment of behaviours and attitudes surrounding the influence of diet on OA symptoms and management. Additionally, the study enabled comparisons between participants who tracked their OA symptoms and those who did not, offering valuable insights into the potential benefits of symptom monitoring in OA management. The primary limitation of this study is its cross-sectional design, which limits the ability to establish causal relationships between variables. We also acknowledge that our reliance on self-reported data may introduce recall bias and social desirability bias. The electronic survey distribution potentially excluded individuals with limited digital access. Finally, although our sample is diverse, the demographic profile of the study participants largely consisted of White (91%) and university-educated adults, which may not be representative of the wider UK population. Implications for research and practice Our findings have several important implications for OA management and research. The high level of uncertainty regarding appropriate diets for OA emphasizes the need for targeted nutritional education programmes, with healthcare providers prioritizing clear, evidence-based dietary guidance. The positive association between symptom tracking and dietary knowledge suggests that incorporating tracking tools into OA management strategies could enhance patient engagement and outcomes. The observed differences in dietary patterns between OA and non-OA participants highlight the potential for tailored dietary interventions. Addressing identified barriers may improve adherence to dietary recommendations. Given the significant interest in dietary interventions among OA participants, healthcare systems should consider integrating nutritional counselling as a standard component of OA care, involving collaboration between rheumatologists, dietitians and primary care providers. Additionally, the high interest in online tools for symptom tracking (85.2% of OA participants) presents an opportunity for developing technology-enabled self-driven healthcare solutions (27) that could promote the adoption of health-seeking self-care behaviours. Future research should focus on creating and evaluating mobile applications that combine symptom tracking, dietary monitoring and personalized recommendations. Conclusion This study provides significant insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. Despite the heightened awareness of treatment modalities among OA participants and their more health-conscious dietary choices, uncertainty about the right diet was the primary barrier to using food as medicine. The study highlights a clear association between symptom tracking and greater dietary knowledge, as well as an increased likelihood of focusing on diet during flare-ups. Collectively, these findings suggest the need for a whole-person approach to OA management, integrating tailored nutritional education, promoting self-monitoring practices and addressing practical barriers to implementing dietary changes. Future research should focus on developing and evaluating personalized, evidence-based dietary interventions for OA, as well as exploring the long-term impact of symptom tracking and dietary modifications on disease progression and quality of life. Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. The study received ethical approval from the Imperial College Research Ethics Committee (ICREC #7128007) on 27 June 2024. Informed consent was obtained from all participants, and the data were handled in accordance with ethical guidelines to ensure confidentiality and data integrity. Consent for publication Not applicable. Availability of data and materials All the data generated or analysed during this study are included in this published article and its supplementary materials. Competing interests JJ is the Chief Scientific Officer for Healthnix and the author of a dietary advice book called Holistic Health. MM is the CEO for Healthnix & QC is the Lead Scientist for Healthnix Ltd. MA and AEO report no conflicts of interest. Funding This research received a small unrestricted medical education grant from Healthnix Ltd. The funder did not partake in data collection, analysis or study interpretation. Author Contribution All authors provided substantial contributions to the conception (MA, JJ, MM, AEO), design (AEO, MA, JJ, MM), acquisition (MA, MM, AEO) and interpretation (MA, AEO) of the study data. AEO took the lead in planning the study with support from coauthors. MA carried out the data analysis and developed the manuscript, which was later revised and approved by the coauthors. AEO is the guarantor. Acknowledgements None. Twitter: @austenelosta @ImperialSCARU References Swain S, Sarmanova A, Mallen C, Kuo CF, Coupland C, Doherty M, Zhang W. Trends in incidence and prevalence of osteoarthritis in the United Kingdom: findings from the Clinical Practice Research Datalink (CPRD). Osteoarthritis Cartilage. 2020;28(6):792-801. Beard JR, Officer AM, Cassels AK. The World Report on Ageing and Health. Gerontologist. 2016;56 Suppl 2:S163-6. Collaborators GBDO. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e22. (WHO) WHO. Osteoarthritis 2023 [Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis#:~:text=344%20million%20people%20living%20with,to%20continue%20to%20increase%20globally. Keating N. A research framework for the United Nations Decade of Healthy Ageing (2021-2030). Eur J Ageing. 2022;19(3):775-87. Deveza LA, Nelson AE, Loeser RF. Phenotypes of osteoarthritis: current state and future implications. Clin Exp Rheumatol. 2019;37 Suppl 120(5):64-72. Felson DT. Identifying different osteoarthritis phenotypes through epidemiology. Osteoarthritis Cartilage. 2010;18(5):601-4. Maqbool M, Fekadu G, Jiang X, Bekele F, Tolossa T, Turi E, et al. An up to date on clinical prospects and management of osteoarthritis. Ann Med Surg (Lond). 2021;72:103077. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014;43(6):701-12. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020;72(2):220-33. Salis Z, Sainsbury A. Association of long-term use of nonsteroidal anti-inflammatory drugs with knee osteoarthritis: a prospective multicohort study over 4-to-5 years. Scientific Reports. 2024;14(1):6593. Dawson E, Neufeld ME, Schemitsch E, John-Baptiste A. The impact of wait time on patient outcomes in knee and hip replacement surgery: a scoping review protocol. Syst Rev. 2022;11(1):38. Lopez HL. Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM R. 2012;4(5 Suppl):S145-54. Jungmann PM, Kraus MS, Alizai H, Nardo L, Baum T, Nevitt MC, et al. Association of metabolic risk factors with cartilage degradation assessed by T2 relaxation time at the knee: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2013;65(12):1942-50. Dyer J, Davison G, Marcora SM, Mauger AR. Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis. J Nutr Health Aging. 2017;21(5):562-6. Cooper I, Brukner P, Devlin BL, Reddy AJ, Fulton M, Kemp JL, Culvenor AG. An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study. BMC Musculoskelet Disord. 2022;23(1):47. Dolatkhah N, Toopchizadeh V, Barmaki S, Salekzamani Y, Najjari A, Farshbaf-Khalili A, Dolati S. The effect of an anti-inflammatory in comparison with a low caloric diet on physical and mental health in overweight and obese women with knee osteoarthritis: a randomized clinical trial. Eur J Nutr. 2023;62(2):659-72. Uritani D, Koda H, Sugita S. Effects of self-management education programmes on self-efficacy for osteoarthritis of the knee: a systematic review of randomized controlled trials. BMC Musculoskelet Disord. 2021;22(1):515. Jönsson T. A Supported Osteoarthritis Self-Management Program for People with Knee and/or Osteoarthritis. Outcomes and factors associated with response. Lund: Lund University; 2020. Barker I, Steventon A, Deeny S. Patient activation is associated with fewer visits to both general practice and emergency departments: a cross-sectional study of patients with long-term conditions. Clin Med (Lond). 2017;17(Suppl 3):s15. Battista S, Giardulli B, Sieiro Santos C, Aharonov O, Puttaswamy D, Russell A, Gupta L. Digital Health and Self-Management in Idiopathic Inflammatory Myopathies: A Missed Opportunity? Curr Rheumatol Rep. 2024;26(11):383-91. Figueiredo M, Caldeira C, Chen Y, Zheng K. Routine self-tracking of health: reasons, facilitating factors, and the potential impact on health management practices. AMIA Annu Symp Proc. 2017;2017:706-14. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of internet E-Surveys (CHERRIES). J Med internet Res. 2004;6(3):e34. Filzmoser N, Webber I, Kerr G, Alaa A, El Asmar MI, Karki M, et al. Exploring the link between self-management of migraine and emotional wellbeing: a cross-sectional study of community-dwelling migraine sufferers. BMC neurology. 2024;24(1):47. El-Osta A, Webber D, Gnani S, Banarsee R, Mummery D, Majeed A, Smith P. The Self-Care Matrix: a unifying framework for self-care. Self-Care. 2019;10:38-56. Buck AN, Shultz SP, Huffman KF, Vincent HK, Batsis JA, Newman CB, et al. Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis. Curr Dev Nutr. 2022;6(6):nzac084. El-Osta A, Rowe C, Majeed A. Developing a shared definition of self-driven healthcare to enhance the current healthcare delivery paradigm. Journal of the Royal Society of Medicine. 2022;115(11):424-8. Additional Declarations Competing interest reported. JJ is the Chief Scientific Officer for Healthnix and the author of a dietary advice book called Holistic Health. MM is the CEO for Healthnix & QC is the Lead Scientist for Healthnix Ltd. MA and AEO report no conflicts of interest. Supplementary Files AnonymisedDataset.xlsx SupplementaryFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Jun, 2025 Reviews received at journal 12 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviews received at journal 25 Mar, 2025 Reviewers agreed at journal 24 Mar, 2025 Reviewers agreed at journal 22 Mar, 2025 Reviewers agreed at journal 20 Mar, 2025 Reviewers invited by journal 20 Mar, 2025 Editor assigned by journal 20 Mar, 2025 Editor invited by journal 20 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6239209","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":435865263,"identity":"144b05af-d8ea-4390-9ef0-007d60a923f0","order_by":0,"name":"Mahmoud Al 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2","display":"","copyAsset":false,"role":"figure","size":315640,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot showing crude (blue) and adjusted (red) relative risk ratios (RRRs) with 95% confidence intervals for the association between knowledge of dietary influence on osteoarthritis (OA) symptoms and management among individuals who actively track OA symptoms\u003c/strong\u003e \u003cstrong\u003eversus those who do not.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6239209/v1/86d3495393ccc73a745e3e85.png"},{"id":79650400,"identity":"235da8fb-8ed7-4cc9-b98e-daeed46fc56d","added_by":"auto","created_at":"2025-04-01 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JJ is the Chief Scientific Officer for Healthnix and the author of a dietary advice book called Holistic Health. MM is the CEO for Healthnix \u0026 QC is the Lead Scientist for Healthnix Ltd. MA and AEO report no conflicts of interest.","formattedTitle":"Investigating the role of nutrition and self-monitoring in osteoarthritis management: evidence from a cross-sectional study of UK adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoarthritis (OA) is one of the most prevalent long-term conditions, significantly impairing physical function and causing a substantial burden on individuals. Its effects can extend across multiple joints, exacerbating functional limitations and restricting participation in daily activities. With no known cure, the prevalence of OA is increasing globally, with an estimated 28% of individuals over 60 years of age affected (1).\u003c/p\u003e\n\u003cp\u003eThe 2015 World Health Organization (WHO) Global Ageing and Health Report emphasized OA as a primary cause of disability among adults aged 60 and above (2). Furthermore, the 2023 Global Burden of Disease report indicated that OA affected 595 million people worldwide in 2020, comprising 7.6% of the global population and ranking as the most common form of arthritis. Among adults aged 70 and older, OA was listed as the seventh leading cause of disability (3). Given the trends of aging populations, escalating rates of obesity and increasing incidence of injuries, the prevalence of OA is projected to continue rising globally (4). The global impact of OA is substantial and represents a significant public health concern worldwide. Recognizing the profound implications of OA and similar conditions for functional ability and quality of life, the WHO designated 2021 to 2030 the \"Decade of Healthy Ageing.\" This initiative highlights the importance of addressing diseases such as OA, which profoundly affect functional ability and quality of life, within the broader context of promoting health and well-being among ageing populations (5).\u003c/p\u003e\n\u003cp\u003eThe structural and clinical features of OA display significant variability among patients, posing challenges in identifying universally effective treatments. This heterogeneity emphasizes the complexity of OA management, acknowledging that a \"one size fits all\" approach may not be feasible and the ongoing quest for personalized therapeutic approaches (6, 7). The current OA management approaches include nonpharmacological pharmacological and surgical interventions in severe cases (8). Nonpharmacological therapies, including exercise programs, self-management educational programs, physical therapy, massage and acupuncture, are recommended for managing symptoms and/or delaying disease progression despite conflicting results (9, 10). Pharmacological management with nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics and topical therapies to alleviate symptoms is often more accessible, but these methods do not address the underlying cause of OA, and NSAIDs are not suitable for long-term use due to adverse events as well as relative contraindications with other concomitant medications (11). Surgical intervention is the option for severe OA patients, but access can be limited due to the long waiting list, and this option is extremely costly(12).\u003c/p\u003e\n\u003cp\u003eThe impact of nutrition on various chronic diseases, including OA, has become increasingly evident (13). Diets rich in trans and saturated fats increase OA risk and worsen existing symptoms (14). Recent research has highlighted the significant role of nutrition in the management of OA. In particular, several randomized controlled trial (RCT) studies have investigated the effects of dietary interventions on perceptual, functional and serum biomarkers in individuals with OA (15-17). A 16-week Mediterranean-type diet intervention was applied to knee OA patients. Researchers reported reductions in the proinflammatory cytokine interleukin-1α and the cartilage degradation marker cartilage oligomeric matrix protein, as well as improvements in knee and hip movement in the diet group compared with the control group (15). Another feasibility study reported that 46% of OA participants consumed less analgesic medication following a 9-week anti-inflammatory diet (16). Furthermore, another RCT showed that an anti-inflammatory diet combined with a low-calorie regimen resulted in greater weight loss and improvements in pain intensity, functional status, depression and anxiety(17). These findings collectively highlight the potential benefits of dietary interventions in managing OA symptoms and improving overall well-being. However, little is known about the attitudes, perceived barriers and awareness of community-dwelling adults in the UK about nutrition or dietary interventions for OA, which makes it difficult to evaluate the viability of nutritional interventions for OA management.\u003c/p\u003e\n\u003cp\u003eIn addition, self-management has been shown to effectively improve the health and well-being of OA patients while reducing healthcare system strain. OA patients in self-management programs with improved symptoms are less willing to undergo surgery, have decreased medication use, and take fewer sick leaves (18, 19). Furthermore, additional evidence supports the effectiveness of self-management, revealing that individuals with the highest levels of knowledge, skills and confidence in self-management had 19% fewer general practitioner (GP) appointments (20). Symptom tracking has emerged as a valuable self-management practice for OA patients. By systematically monitoring symptoms, individuals can gain better insight into their conditions, recognize patterns related to flare-ups, and make informed decisions about lifestyle adjustments, including diet adjustments (21). Research suggests that individuals who actively track their symptoms may have greater awareness of factors influencing their conditions and may be more likely to engage in self-management behaviours such as dietary modifications(22). Despite its potential benefits, the role of symptom tracking in OA management remains underexplored, particularly in relation to dietary interventions.\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to investigate the prevailing attitudes, awareness and perceived barriers to nutrition as a viable self-management approach to OA and maintaining joint health among community-dwelling adults in the UK. The objectives include 1) investigating awareness, information-seeking behaviours and attitudes towards the dietary management of OA among individuals with and without OA. 2) To examine differences in dietary patterns between OA and non-OA participants, we identified perceived barriers to using food as medicine for OA symptom management. 3) To explore the relationship between symptom tracking and dietary knowledge related to OA and assess the likelihood of participants focusing on diet during OA flare-ups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study employed a cross-sectional research design, and this paper focuses on the quantitative findings derived from the electronic survey (eSurvey) component of the study.\u003c/p\u003e\n\u003cp\u003eThe survey was available online for three months, from 1 July 2024 to 1 October 2024. The participants accessed the survey via a link included in the recruitment materials distributed through various channels. The survey was administered via the secure Qualtrics platform, which ensures participant anonymity by disabling IP address collection and anonymising all responses. The survey instrument was developed for this study comprises 30 questions, which include multiple-choice questions, Likert-scale items and open-ended questions \u003cstrong\u003eSupplementary material 1\u003c/strong\u003e. It was designed to investigate attitudes towards nutrition as a way of managing OA and maintaining joint health, evaluate awareness regarding the potential benefits of a personalized diet in alleviating OA symptoms and maintaining joint health beyond weight loss, including its anti-inflammatory effects. Additionally, it examined perceived barriers to adopting nutrition as a self-care method for osteoarthritis patients. The participants had the opportunity to review and change their responses before the final submission.\u003c/p\u003e\n\u003cp\u003eThe questions were developed and piloted by a team of researchers to ensure clarity, relevance and cultural sensitivity. The survey was structured to align with the Checklist for Reporting Results of internet E-Surveys (CHERRIES) to ensure comprehensive and transparent reporting (23)\u003cstrong\u003e\u0026nbsp;Supplementary material 2\u003c/strong\u003e, ensuring adherence to best practices in online survey research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals aged 18 years or older with or without OA were invited to participate in the study. Detailed information about the study, including the participant information sheet (PIS), is provided in the introductory section of the survey. The PIS outlined the study's objectives, data protection measures, participant rights and the voluntary nature of participation. The anonymised electronic survey was hosted on the Qualtrics platform. Recruitment strategies included social media advertisements, outreach through healthcare networks, email invitations and direct recruitment at community health events. Informed consent was obtained from all participants, and the data collected were anonymised and securely stored in an institutional database accessible only to the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive analyses were conducted to summarize participant characteristics and survey responses, reporting frequencies and percentages. Inferential analyses were performed to identify differences in awareness and perceptions across various demographic groups via chi-square tests and Fisher's exact tests. Multinomial logistic regression models were used to examine the influence of diet on OA among individuals whose OA symptoms were tracked in comparison to those whose symptoms were not tracked. A p value of less than 0.05 was considered statistically significant. All analyses were performed via STATA, version 17 (StataCorp LP, College Station, TX, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. The study received ethical approval from the Imperial College Research Ethics Committee (ICREC #7128007) on 27 June 2024. Informed consent was obtained from all participants, and the data were handled in accordance with ethical guidelines to ensure confidentiality and data integrity.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic profile of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 1,400 individuals who were invited to participate, 1,206 participants accessed the survey (participation rate of 86.1%). A total of 1,104 respondents completed the survey, with a completion rate of 91.5% and a response rate of 78.9%. Six individuals who did not consent, 30 who consented but did not answer any questions and 66 who provided insufficient data by answering fewer than three questions were excluded. The study sample consisted of a diverse range of demographic and health characteristics (\u003cstrong\u003eTable 1)\u003c/strong\u003e. A detailed stratification of demographic characteristics on the basis of OA status is presented in\u003cstrong\u003e\u0026nbsp;Supplementary material 3\u003c/strong\u003e. The results of the survey are available in \u003cstrong\u003eSupplementary material 4\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe age distribution revealed a predominance of middle-aged adults, with the 36\u0026ndash;45 years age group representing the largest proportion (38.9%, n=429), followed by the 26\u0026ndash;35 years and 46\u0026ndash;55 years age groups, each accounting for 23.5% (n=259) of the total population (\u003cstrong\u003eTable 1)\u003c/strong\u003e. There was a nearly equal distribution of gender, with a female majority (53.3%, n=588) and a male majority (44.6%, n=492). The sample was predominantly White (90.9%, n=1,004), with other ethnic groups represented in smaller proportions. Nearly half (49.0%, n=541) reported a university degree or higher. A third of the respondents (33.6%, n=371) had full-time employment, followed by retirement (27.0%, n=298) and part-time employment (21.1%, n=233). More than one-third (35.0%, n=386) reported an annual household income within the \u0026pound;20,000--\u0026pound;38,000 range. A third (33.1%, n=366) of the respondents reported having osteoarthritis. Chronic joint conditions were prevalent, with 69.3% reporting at least one condition, the most common being chronic lower back pain (21.5%, n=304). Similarly, 66.7% of the participants reported at least one chronic medical condition, with mental health conditions being the most prevalent (16.6%, n=251), followed by a history of cardiovascular diseases (14.9%, n=226) and diabetes (11.7%, n=177) (\u003cstrong\u003eTable 1)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Participant characteristics (n=1,104)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e23.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e36-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e38.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e46-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e23.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e56 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e53.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e44.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1,004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e90.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eAsian, or Asian British\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eBlack, Black British, Caribbean or African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMixed or Multiple ethnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eOther ethnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest level of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrimary/Secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eA levels/College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e30.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eUniversity degree or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e49.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eEmployed full-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eEmployed part-time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e21.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e27.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e11.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual Household Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026lt; \u0026pound;20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e22.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026pound;20,000 - \u0026pound;38,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e35.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026pound;38,000 - \u0026pound;60,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026pound;60,000 - \u0026pound;100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026gt; \u0026pound;100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving osteoarthritis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e66.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Joint Conditions \u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eRheumatoid arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eFibromyalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eOsteoporosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e13.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eGout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eChronic lower back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e27.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e17.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNone of above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Medical Conditions \u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eHistory of cardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eChronic liver disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e16.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eHistory of cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e8.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eHistory of extreme allergies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eHistory of eating disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eCoeliac disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eGluten intolerance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eLactose intolerance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eDementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eMental health condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e22.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e13.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eNone of above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026dagger;: Multiple response question (any unit of interest is number of answers not number of participants\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e*: Percentages have been rounded and may not total to 100%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness, information-seeking behaviour and attitudes towards the dietary management of osteoarthritis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were significant disparities in awareness, information-seeking behaviours and attitudes towards OA management between participants with and without OA (\u003cstrong\u003eTable 2\u003c/strong\u003e). Compared with those without OA, participants with OA demonstrated significantly greater awareness of several treatment modalities, including exercise and physical activity (88.3% vs. 77.2%, p \u0026lt; 0.001), weight management (81.4% vs. 64.2%, p \u0026lt; 0.001), physiotherapy (71.9% vs. 58.8%, p \u0026lt; 0.001), and dietary supplements (58.5% vs. 41.1%, p \u0026lt; 0.001). Additionally, those with OA showed greater awareness of over-the-counter medications (OTC, 55.2% vs. 30.2%, p \u0026lt; 0.001) and surgical options (57.9% vs. 32.8%, p \u0026lt; 0.001). However, there was no significant difference in awareness of prescription medications (75.7% vs. 75.5%, p = 0.939) or nutrition as medicine (43.7% vs. 40.2%, p = 0.270) between the two groups. A small but statistically significant difference was observed in the awareness of herbal treatments (10.7% vs. 6.5%, p = 0.016).\u003c/p\u003e\n\u003cp\u003eInformation-seeking behaviours differed markedly between groups, with OA participants being more likely to seek nutritional information for symptom management than non-OA participants seeking information for general joint health (45.9% vs. 23.8%, p \u0026lt; 0.001). Among information seekers, OA participants were significantly more likely to consult NHS doctors (51.8% vs. 33.5%, p = 0.020). Other information sources were not significantly different between the groups.\u003c/p\u003e\n\u003cp\u003eFamiliarity with dietary patterns potentially impacting OA symptoms was significantly greater among OA participants (p \u0026lt; 0.001 for improvement patterns; p = 0.001 for exacerbation patterns). Additionally, OA participants exhibited a significantly greater commitment to learning about healthy/anti-inflammatory diets (89.3% vs. 78.8%, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Awareness, information-seeking behaviour and attitudes towards the dietary management of osteoarthritis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout OA (N=738)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith OA (N=366)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=1104)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat treatments for osteoarthritis are you aware of? \u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eExercise \u0026amp; physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e570.0 (77.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e323.0 (88.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e893.0 (80.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eWeight management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e474.0 (64.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e298.0 (81.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e772.0 (69.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMedication (prescription only)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e557.0 (75.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e277.0 (75.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e834.0 (75.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMedication (OTC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e223.0 (30.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e202.0 (55.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e425.0 (38.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePhysiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e434.0 (58.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e263.0 (71.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e697.0 (63.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNutrition as medicine (anti-inflammatory diet)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e297.0 (40.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e160.0 (43.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e457.0 (41.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSupplements (e.g., Chondroitin, Glucosamine)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e303.0 (41.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e214.0 (58.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e517.0 (46.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eHerbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e48.0 (6.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e39.0 (10.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e87.0 (7.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e242.0 (32.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e212.0 (57.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e454.0 (41.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNone of the above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e36.0 (4.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3.0 (0.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e39.0 (3.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeeking information about healthy nutrition/diet to manage the symptoms of Osteoarthritis (if OA diagnosed) or to promote joint health (If OA free)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e562.0 (76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e198.0 (54.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e760.0 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e176.0 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e168.0 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e344.0 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat are the resources you have sought?** \u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNHS (website)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e132 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e131 (77.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e263 (76.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNHS (doctor\u0026apos;s advice)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e59 (33.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e87 (51.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e146 (42.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eBBC Food (website)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e21 (11.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30 (17.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e51 (14.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eMagazines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e31 (17.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e26 (15.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e57 (16.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eBlogs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e45 (25.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e34 (20.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e79 (22.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eDietitian/Nutritionist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e38 (21.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e43 (25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e81 (23.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCharities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e50 (28.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e64 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e114 (33.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e40 (22.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e25 (14.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e65 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u0026apos;m familiar with dietary patterns that may improve Osteoarthritis symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e127.0 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e37.0 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e164.0 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e279.0 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e119.0 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e398.0 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Neither agree nor disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e129.0 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e73.0 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e202.0 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e185.0 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e118.0 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e303.0 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e15.0 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16.0 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e31.0 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u0026apos;m familiar with dietary patterns that may exacerbate Osteoarthritis symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e144.0 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e43.0 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e187.0 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e292.0 (39.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e135.0 (37.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e427.0 (38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Neither agree nor disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e114.0 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e63.0 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e177.0 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e172.0 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e107.0 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e279.0 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e13.0 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e15.0 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28.0 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI know the differences between an inflammatory \u0026amp; noninflammatory diet osteoarthritis management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e129.0 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e44.0 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e173.0 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e253.0 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e135.0 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e388.0 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Neither agree nor disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e118.0 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e78.0 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e196.0 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e204.0 (27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e88.0 (24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e292.0 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e31.0 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e15.0 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e46.0 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 529px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommitment to learning more about healthy/anti-inflammatory diets\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.0011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e156.0 (21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39.0 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e195.0 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e579.0 (78.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e325.0 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e904.0 (82.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cem\u003eValues are presented as frequencies (percentages) within each group\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e*\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Statistical comparisons were performed using Pearson\u0026rsquo;s Chi-squared test or Fisher\u0026rsquo;s exact test, with p values indicating significance\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026dagger;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Multiple response question (any unit of interest is number of answers not number of participants\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e**\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Follow up if \u0026ldquo;Seeking information about healthy nutrition/diet...\u0026rdquo; = Yes\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency of consumption of various food categories\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were significant differences in dietary patterns between participants with and without OA (\u003cstrong\u003eTable 3\u003c/strong\u003e). Compared with those without OA, participants with OA reported less frequent consumption of processed foods (p \u0026lt; 0.001), refined sugars (p = 0.010), trans fats (p \u0026lt; 0.001) and refined carbohydrates (p = 0.033). Notably, 23.3% of the OA participants rarely consumed processed foods, whereas 14.7% of the non-OA participants did.\u003c/p\u003e\n\u003cp\u003eHealthy fat consumption patterns also differed significantly (p = 0.011), with a greater proportion of OA participants (8.1%) reporting never consuming healthy fats than non-OA participants did (3.7%). Herb consumption also varied (p = 0.002), with lower daily use among OA participants (10.4% vs 14.0% in non-OA participants). No significant differences were observed in the consumption of high- omega-6 fatty acid foods, fruits and vegetables, whole grains, high-omega-3 fatty acid foods, or white meat.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Frequencies of various food categories consumed by participants with and without osteoarthritis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout OA (N=728)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith OA (N=356)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=1084)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProcessed foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e91.0 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e42.0 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e133.0 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e284.0 (39.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e96.0 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e380.0 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e239.0 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e133.0 (37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e372.0 (34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e107.0 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e83.0 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e190.0 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7.0 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2.0 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.0 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRefined sugars\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e83.0 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e30.0 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e113.0 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e175.0 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e71.0 (19.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e246.0 (22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e267.0 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e118.0 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e385.0 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e168.0 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e111.0 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e279.0 (25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e35.0 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26.0 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e61.0 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrans fats\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e9.0 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4.0 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e13.0 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e132.0 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e42.0 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e174.0 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e355.0 (48.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e147.0 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e502.0 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e204.0 (28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e142.0 (39.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e346.0 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e28.0 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e21.0 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e49.0 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh omega-6 fatty acid foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e38.0 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e24.0 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e62.0 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e273.0 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e115.0 (32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e388.0 (35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e277.0 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e131.0 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e408.0 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e126.0 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e74.0 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e200.0 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e14.0 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12.0 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e26.0 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRefined carbohydrates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e102.0 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e35.0 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e137.0 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e272.0 (37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e114.0 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e386.0 (35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e232.0 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e129.0 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e361.0 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e99.0 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e66.0 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e165.0 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e23.0 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12.0 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e35.0 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFruits \u0026amp; vegetables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e439.0 (60.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e201.0 (56.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e640.0 (59.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e229.0 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e116.0 (32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e345.0 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e47.0 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e30.0 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e77.0 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e12.0 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e9.0 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e21.0 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1.0 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.0 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhole grains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e87.0 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e34.0 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e121.0 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e221.0 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e93.0 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e314.0 (29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e234.0 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e118.0 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e352.0 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e156.0 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e85.0 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e241.0 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e30.0 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26.0 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e56.0 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh omega-3 fatty acid foods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e79.0 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e39.0 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e118.0 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e175.0 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e66.0 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e241.0 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e245.0 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e114.0 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e359.0 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e178.0 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e97.0 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e275.0 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e51.0 (7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e40.0 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e91.0 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite meat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e34.0 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e19.0 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e53.0 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e323.0 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e152.0 (42.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e475.0 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e238.0 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e123.0 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e361.0 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e65.0 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e30.0 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e95.0 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e68.0 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e32.0 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy fats\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e87.0 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e47.0 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e134.0 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e237.0 (32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e102.0 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e339.0 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e237.0 (32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e100.0 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e337.0 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e140.0 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e78.0 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e218.0 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e27.0 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e29.0 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e56.0 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e102.0 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e37.0 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e139.0 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSeveral times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e264.0 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e126.0 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e390.0 (36.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e241.0 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e103.0 (28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e344.0 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e105.0 (14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e69.0 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e174.0 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e16.0 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e21.0 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e37.0 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eValues are presented as frequencies (percentages) within each group\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e*\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Statistical comparisons were performed using Pearson\u0026rsquo;s Chi-squared test with p values indicating significance\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived barriers to using food as medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn terms of perceived barriers to using food as medicine for OA symptoms, uncertainty about the right diet was the most prominent concern, with 78.5% of participants viewing it as a likely or very likely obstacle (p \u0026lt; 0.01) (\u003cstrong\u003eSupplementary material 5)\u003c/strong\u003e. The cost of living (60.2%, p \u0026lt; 0.01) and time constraints for meal preparation (47.6%, p \u0026lt; 0.01) were also significant barriers (\u003cstrong\u003eFigure 1)\u003c/strong\u003e. Social factors, such as eating with family or friends, posed a challenge for 41.5% of the participants (p \u0026lt; 0.01). Interestingly, job-related difficulties (12.5%, p \u0026lt; 0.01) and the perception of healthy eating as boring (22.6%, p \u0026lt; 0.01) were not considered major barriers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocusing on diet to manage osteoarthritis symptoms during flare-ups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding the likelihood of participants focusing on their diet to manage OA symptoms during flare-ups,\u0026nbsp;the results revealed a significant difference between those who tracked symptoms and those who did not (p \u0026lt; 0.001) (\u003cstrong\u003eSupplementary material 6)\u003c/strong\u003e. Among those not tracking symptoms (n=191), 65.1% were unlikely or very unlikely to focus on their diet during flare-ups, with only 15.8% likely or very likely to do so. In contrast, among those tracking symptoms (n=170), 41.3% were unlikely or very unlikely to focus on their diet, whereas 38.3% were likely or very likely to do so.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterest level in coaching methods for osteoarthritis management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study also examined interest in various coaching methods for managing OA symptoms among participants who tracked and did not track their symptoms. Significant differences were observed in preferences for online (p=0.019), face-to-face (p=0.044), and hybrid coaching (p=0.010) between the two groups (\u003cstrong\u003eSupplementary material 7)\u003c/strong\u003e. For online coaching, 57.2% of nontrackers and 60.3% of trackers were interested or very interested, with more trackers not at all interested (4.2% vs 12.0%). Face-to-face coaching showed similar interest levels (46.6% vs 49.4% interested or very interested), but with more trackers not at all interested (18.1% vs 11.6%). Hybrid coaching revealed the most significant difference, with nontrackers showing greater interest (17.5% vs. 6.6%) and very high interest (14.3% vs. 9.6%). No significant differences were found for mobile app-based (p=0.437) or telephone coaching (p=0.560) preferences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSymptom tracking and knowledge of dietary influences on osteoarthritis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study also examined the relationship between symptom tracking and knowledge of dietary influences on OA\u003cstrong\u003e\u0026nbsp;(Table 4)\u003c/strong\u003e. For example, individuals who track their OA symptoms are more familiar with dietary patterns that improve symptoms than are those who do not track them. In the crude model, they were 1.89 times more likely to agree with this statement (95% CI: 1.06\u0026ndash;3.36, p = 0.03) (\u003cstrong\u003eFigure 2)\u003c/strong\u003e. This association was insignificant after adjusting for confounding factors in the adjusted model (aRRR: 1.79, 95% CI: 0.95\u0026ndash;3.40, p = 0.07). Symptom trackers also demonstrated greater familiarity with dietary patterns that exacerbate OA symptoms. They were 2.56 times more likely to agree with this statement in the crude model (95% CI: 1.38\u0026ndash;4.75, p \u0026lt; 0.01), with the association remaining significant in the adjusted model (RRR: 2.43, 95% CI: 1.24\u0026ndash;4.74, p = 0.01). With respect to knowledge of differences between inflammatory and noninflammatory diets, those who tracked their symptoms were less likely to disagree than nontrackers were. This was consistent in both the crude (RRR: 0.47, 95% CI: 0.27\u0026ndash;0.81, p \u0026lt; 0.01) and adjusted models (RRR: 0.45, 95% CI: 0.25\u0026ndash;0.82, p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Knowledge of the influence of diet on osteoarthritis symptoms and management among individuals who actively track osteoarthritis symptoms in comparison to those who do not\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of agreement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Model\u003c/strong\u003e \u003cstrong\u003e\u0026para;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Model\u003c/strong\u003e \u003cstrong\u003e\u0026sect;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRRR\u003c/strong\u003e \u003cstrong\u003e\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRRR\u003c/strong\u003e \u003cstrong\u003e\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamiliarity with dietary patterns that improve OA symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.41 - 1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.37 - 1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.06 - 3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.95 - 3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamiliarity with dietary patterns that exacerbate OA symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.53 - 1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.45 - 1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.38 - 4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.24 - 4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowing the differences between inflammatory \u0026amp; noninflammatory diet on OA management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.27 - 0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.25 - 0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.73 - 2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.70 - 2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026para;\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eCrude multinomial logistic regression model.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026sect;\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eMultinomial logistic regression model adjusted for age, gender, ethnicity, education, employment and annual income.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026dagger;\u003c/strong\u003e: Relative risk ratios (RRR) are exponentiated coefficients from a multinomial logistic regression model.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e*:\u0026nbsp;\u003c/strong\u003eSignificance level, with values \u0026lt;0.05 considered statistically significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eSummary of principal findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study provides valuable insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. Notably, participants with OA demonstrated significantly greater awareness of various treatment modalities, including exercise, weight management, physiotherapy, OTC, surgical options, herbs and dietary supplements (e.g., chondroitin, glucosamine), than did those without OA (p \u0026lt; 0.001). This heightened awareness was accompanied by a greater likelihood of seeking nutritional information for symptom management among OA participants (46% vs. 24%, p \u0026lt; 0.001). Furthermore, OA participants reported less frequent consumption of processed foods (p = 0.001), refined sugars (p = 0.010), trans fats (p \u0026lt; 0.001) and refined carbohydrates (p = 0.033), suggesting a potential shift towards healthier dietary patterns in response to their condition.\u003c/p\u003e\n\u003cp\u003eDespite this increased awareness and apparent dietary modifications, our study revealed that uncertainty about the right diet remains a primary barrier to using food as medicine for OA management, with 79% of participants expressing this concern (p \u0026lt; 0.01). This was followed by cost-of-living concerns (60%, p \u0026lt; 0.01) and time constraints for meal preparation (48%, p \u0026lt; 0.01), highlighting the complex challenges faced by individuals attempting to implement dietary changes. Interestingly, our analysis revealed a significant association between symptom tracking and greater familiarity with dietary patterns affecting OA symptoms. The participants who tracked their symptoms were 2.4 times more likely to agree with being familiar with exacerbating dietary patterns (aRRR: 2.43, 95% CI: 1.24--4.74, p = 0.01) and were less likely to disagree about knowing inflammatory diet differences (aRRR: 0.45, 95% CI: 0.25--0.82, p \u0026lt; 0.01). In addition, symptom trackers were significantly more likely to focus on their diet during OA flare-ups (p \u0026lt; 0.001), with 38% of trackers likely or very likely to do so, compared with only 16% of nontrackers. These findings highlight the potential importance of self-monitoring practices in enhancing dietary awareness and management strategies among individuals with OA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison with literature\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study findings align with and expand upon prior research examining the role of nutrition and self-monitoring in OA management. Previous studies have consistently demonstrated that dietary interventions, particularly those focused on anti-inflammatory foods, can alleviate OA symptoms and improve functional outcomes (14, 15). The present study builds on this literature by further establishing a link between symptom tracking and dietary adherence, suggesting that individuals who actively monitor their symptoms are more likely to engage in evidence-based dietary practices (22, 24).\u003c/p\u003e\n\u003cp\u003eResearch has identified dietary components such as processed foods, trans fats, and refined sugars as contributors to increased inflammation and OA symptom severity (20). Our findings support this evidence, demonstrating that OA participants who tracked their symptoms reported significantly lower consumption of these proinflammatory foods than nontrackers did. This finding is consistent with those of prior studies (13, 16), which revealed that adherence to an anti-inflammatory diet led to improved pain management and mobility in OA patients.\u003c/p\u003e\n\u003cp\u003eAdditionally, our study contributes to the broader self-management literature by emphasizing the role of symptom tracking in facilitating proactive dietary choices. Previous studies highlighted the benefits of self-management programs for chronic conditions, showing that structured monitoring leads to better health outcomes and reduced reliance on pharmacological treatments (18, 19). We extend this understanding by highlighting a direct association between symptom tracking and increased awareness of dietary triggers, highlighting its potential as a behavioural intervention in OA management, which should be reinforced by the promotion of health literacy, the adoption of risk mitigation strategies and the application of the ‘food as medicine’ Healthy Eating Pillar of self-care (25).\u003c/p\u003e\n\u003cp\u003eDespite these parallels with the literature, our study also highlights critical gaps that warrant further exploration. Notably, the high level of uncertainty regarding appropriate dietary choices for OA remains a major barrier, as observed in similar studies (16, 26). This suggests a need for more targeted educational interventions aimed at increasing patient confidence in making dietary adjustments. Furthermore, while prior studies have established the efficacy of dietary interventions in controlled settings, real-world adherence remains a challenge. Our findings indicate that symptom tracking could facilitate sustained dietary modifications, an area that requires further longitudinal investigation.\u003c/p\u003e\n\u003cp\u003eOur study contributes valuable insights to the growing body of evidence supporting the role of nutrition and self-monitoring in OA management. By demonstrating a clear link between symptom tracking and dietary behaviour, this research lays the groundwork for future interventions aimed at integrating digital health tools, dietary counselling, and self-monitoring strategies to enhance long-term outcomes for individuals with OA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study's primary strength lies in its large sample size of 1,104 participants, providing robust statistical power for analyses. The comprehensive survey covered a wide range of topics related to OA management, dietary patterns and attitudes. This breadth, combined with a structured analysis approach, allowed for a detailed assessment of behaviours and attitudes surrounding the influence of diet on OA symptoms and management. Additionally, the study enabled comparisons between participants who tracked their OA symptoms and those who did not, offering valuable insights into the potential benefits of symptom monitoring in OA management.\u003c/p\u003e\n\u003cp\u003eThe primary limitation of this study is its cross-sectional design, which limits the ability to establish causal relationships between variables. We also acknowledge that our reliance on self-reported data may introduce recall bias and social desirability bias. The electronic survey distribution potentially excluded individuals with limited digital access. Finally, although our sample is diverse, the demographic profile of the study participants largely consisted of White (91%) and university-educated adults, which may not be representative of the wider UK population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for research and practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings have several important implications for OA management and research. The high level of uncertainty regarding appropriate diets for OA emphasizes the need for targeted nutritional education programmes, with healthcare providers prioritizing clear, evidence-based dietary guidance. The positive association between symptom tracking and dietary knowledge suggests that incorporating tracking tools into OA management strategies could enhance patient engagement and outcomes. The observed differences in dietary patterns between OA and non-OA participants highlight the potential for tailored dietary interventions. Addressing identified barriers may improve adherence to dietary recommendations.\u003c/p\u003e\n\u003cp\u003eGiven the significant interest in dietary interventions among OA participants, healthcare systems should consider integrating nutritional counselling as a standard component of OA care, involving collaboration between rheumatologists, dietitians and primary care providers. Additionally, the high interest in online tools for symptom tracking (85.2% of OA participants) presents an opportunity for developing technology-enabled self-driven healthcare solutions (27) that could promote the adoption of health-seeking self-care behaviours. Future research should focus on creating and evaluating mobile applications that combine symptom tracking, dietary monitoring and personalized recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study provides significant insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. Despite the heightened awareness of treatment modalities among OA participants and their more health-conscious dietary choices, uncertainty about the right diet was the primary barrier to using food as medicine. The study highlights a clear association between symptom tracking and greater dietary knowledge, as well as an increased likelihood of focusing on diet during flare-ups. Collectively, these findings suggest the need for a whole-person approach to OA management, integrating tailored nutritional education, promoting self-monitoring practices and addressing practical barriers to implementing dietary changes. Future research should focus on developing and evaluating personalized, evidence-based dietary interventions for OA, as well as exploring the long-term impact of symptom tracking and dietary modifications on disease progression and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki.\u0026nbsp;The study received ethical approval from the Imperial College Research Ethics Committee (ICREC #7128007) on 27 June 2024. Informed consent was obtained from all participants, and the data were handled in accordance with ethical guidelines to ensure confidentiality and data integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data generated or analysed during this study are included in this published article and its supplementary materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJJ is the Chief Scientific Officer for Healthnix and the author of a dietary advice book called Holistic Health. MM is the CEO for Healthnix \u0026amp; QC is the Lead Scientist for Healthnix Ltd. MA and AEO report no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received a small unrestricted medical education grant from Healthnix Ltd. The funder did not partake in data collection, analysis or study interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors provided substantial contributions to the conception (MA, JJ, MM, AEO), design (AEO, MA, JJ, MM), acquisition (MA, MM, AEO) and interpretation (MA, AEO) of the study data. AEO took the lead in planning the study with support from coauthors. MA carried out the data analysis and developed the manuscript, which was later revised and approved by the coauthors. AEO is the guarantor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTwitter:\u0026nbsp;\u003c/strong\u003e@austenelosta @ImperialSCARU\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSwain S, Sarmanova A, Mallen C, Kuo CF, Coupland C, Doherty M, Zhang W. Trends in incidence and prevalence of osteoarthritis in the United Kingdom: findings from the Clinical Practice Research Datalink (CPRD). Osteoarthritis Cartilage. 2020;28(6):792-801.\u003c/li\u003e\n\u003cli\u003eBeard JR, Officer AM, Cassels AK. The World Report on Ageing and Health. Gerontologist. 2016;56 Suppl 2:S163-6.\u003c/li\u003e\n\u003cli\u003eCollaborators GBDO. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. 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The impact of wait time on patient outcomes in knee and hip replacement surgery: a scoping review protocol. Syst Rev. 2022;11(1):38.\u003c/li\u003e\n\u003cli\u003eLopez HL. Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients. PM R. 2012;4(5 Suppl):S145-54.\u003c/li\u003e\n\u003cli\u003eJungmann PM, Kraus MS, Alizai H, Nardo L, Baum T, Nevitt MC, et al. Association of metabolic risk factors with cartilage degradation assessed by T2 relaxation time at the knee: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2013;65(12):1942-50.\u003c/li\u003e\n\u003cli\u003eDyer J, Davison G, Marcora SM, Mauger AR. Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis. J Nutr Health Aging. 2017;21(5):562-6.\u003c/li\u003e\n\u003cli\u003eCooper I, Brukner P, Devlin BL, Reddy AJ, Fulton M, Kemp JL, Culvenor AG. An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study. BMC Musculoskelet Disord. 2022;23(1):47.\u003c/li\u003e\n\u003cli\u003eDolatkhah N, Toopchizadeh V, Barmaki S, Salekzamani Y, Najjari A, Farshbaf-Khalili A, Dolati S. The effect of an anti-inflammatory in comparison with a low caloric diet on physical and mental health in overweight and obese women with knee osteoarthritis: a randomized clinical trial. Eur J Nutr. 2023;62(2):659-72.\u003c/li\u003e\n\u003cli\u003eUritani D, Koda H, Sugita S. Effects of self-management education programmes on self-efficacy for osteoarthritis of the knee: a systematic review of randomized controlled trials. BMC Musculoskelet Disord. 2021;22(1):515.\u003c/li\u003e\n\u003cli\u003eJ\u0026ouml;nsson T. A Supported Osteoarthritis Self-Management Program for People with Knee and/or Osteoarthritis. Outcomes and factors associated with response. Lund: Lund University; 2020.\u003c/li\u003e\n\u003cli\u003eBarker I, Steventon A, Deeny S. Patient activation is associated with fewer visits to both general practice and emergency departments: a cross-sectional study of patients with long-term conditions. Clin Med (Lond). 2017;17(Suppl 3):s15.\u003c/li\u003e\n\u003cli\u003eBattista S, Giardulli B, Sieiro Santos C, Aharonov O, Puttaswamy D, Russell A, Gupta L. Digital Health and Self-Management in Idiopathic Inflammatory Myopathies: A Missed Opportunity? Curr Rheumatol Rep. 2024;26(11):383-91.\u003c/li\u003e\n\u003cli\u003eFigueiredo M, Caldeira C, Chen Y, Zheng K. Routine self-tracking of health: reasons, facilitating factors, and the potential impact on health management practices. AMIA Annu Symp Proc. 2017;2017:706-14.\u003c/li\u003e\n\u003cli\u003eEysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of internet E-Surveys (CHERRIES). J Med internet Res. 2004;6(3):e34.\u003c/li\u003e\n\u003cli\u003eFilzmoser N, Webber I, Kerr G, Alaa A, El Asmar MI, Karki M, et al. Exploring the link between self-management of migraine and emotional wellbeing: a cross-sectional study of community-dwelling migraine sufferers. BMC neurology. 2024;24(1):47.\u003c/li\u003e\n\u003cli\u003eEl-Osta A, Webber D, Gnani S, Banarsee R, Mummery D, Majeed A, Smith P. The Self-Care Matrix: a unifying framework for self-care. Self-Care. 2019;10:38-56.\u003c/li\u003e\n\u003cli\u003eBuck AN, Shultz SP, Huffman KF, Vincent HK, Batsis JA, Newman CB, et al. Mind the Gap: Exploring Nutritional Health Compared With Weight Management Interests of Individuals with Osteoarthritis. Curr Dev Nutr. 2022;6(6):nzac084.\u003c/li\u003e\n\u003cli\u003eEl-Osta A, Rowe C, Majeed A. Developing a shared definition of self-driven healthcare to enhance the current healthcare delivery paradigm. Journal of the Royal Society of Medicine. 2022;115(11):424-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"osteoarthritis, nutrition, dietary interventions, dietary patterns, awareness, symptom tracking, UK","lastPublishedDoi":"10.21203/rs.3.rs-6239209/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6239209/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOsteoarthritis (OA) is a prevalent, debilitating condition that significantly impacts global health. In addition to commonly recommended approaches (e.g., nonpharmacological, pharmacological and surgical therapy), the impact of nutrition on OA has become increasingly important, as supported by recent dietary randomized controlled trials on OA patients. However, very few studies have reported the attitudes, awareness and perceived barriers of community-dwelling adults in the UK with respect to nutrition and dietary intervention for OA. In addition, symptom tracking is proposed to stimulate engagement in self-management behaviours, including dietary modifications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to investigate the prevailing attitudes, awareness, and perceived barriers to nutrition as a viable self-management approach to OA and maintaining joint health among community-dwelling adults in the UK.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study employed an electronic survey. The survey, which was available online for three months, comprised 30 questions exploring attitudes, awareness and perceived barriers to adopting an anti-inflammatory diet for osteoarthritis management. Participants aged 18 years or older, with or without osteoarthritis, were recruited through various channels. Descriptive and inferential analyses were conducted, with a p value \u0026lt;0.05 considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 1,104 participants analysed, 53.3% were female, with the 36–45 years being the predominant age group (38.9%). Among those with OA (33.1%), 47.1% presented with tracked symptoms. The OA participants were more aware of treatment modalities and were more likely to seek nutritional information (45.9% vs. 23.8%, p \u0026lt; 0.001). They reported less frequent consumption of processed foods (p \u0026lt; 0.001), refined sugars (p = 0.010), trans fats (p \u0026lt; 0.001) and refined carbohydrates (p = 0.033). Uncertainty about the right diet was the main barrier to using food as medicine (78.5%, p \u0026lt; 0.01), followed by the cost of living (60.2%, p \u0026lt; 0.01). Symptom trackers demonstrated greater familiarity with dietary patterns exacerbating OA (adjusted relative risk ratio (aRRR): 2.43, 95% CI: 1.24--4.74, p = 0.01), were less likely to disagree about differences in their inflammatory diet (aRRR: 0.45, 95% CI: 0.25--0.82, p \u0026lt; 0.01) and were more likely to focus on diet during flare-ups (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study provides significant insights into the awareness, attitudes and dietary behaviours related to OA management among UK adults. While participants with OA showed increased awareness of treatment options and healthier dietary choices, uncertainty about the right diet was the primary barrier to using food as medicine. Symptom tracking was significantly associated with greater dietary knowledge and focus during flare-ups. Future research should develop personalized dietary interventions and evaluate the long-term effects of symptom tracking and dietary changes on OA outcomes.\u003c/p\u003e","manuscriptTitle":"Investigating the role of nutrition and self-monitoring in osteoarthritis management: evidence from a cross-sectional study of UK adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-01 07:24:42","doi":"10.21203/rs.3.rs-6239209/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-13T08:10:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T21:59:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296177440222709412163868424652750864196","date":"2025-06-05T14:56:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246570528637371940998972841911757939284","date":"2025-06-03T08:37:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T11:43:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306922141782150823883977486976648320493","date":"2025-03-24T04:07:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96954403345678958384156053768714205095","date":"2025-03-22T07:57:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56150612961223710209276542643475339707","date":"2025-03-20T22:33:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-20T07:47:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-20T07:43:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-20T07:38:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T12:15:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-19T12:14:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d935e63-f99e-42dc-a074-491adfd9fcb4","owner":[],"postedDate":"April 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T01:53:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-01 07:24:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6239209","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6239209","identity":"rs-6239209","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}