Collagen peptides combined with type II in joint pain of the elderly

LIMA, Rafaela Batista de. AMARAL, Camilla Lais. MINATTI, Jaqueline. Collagen peptides combined with type II in joint pain of the elderly. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 08, Vol. 07, pp. 115-127. August 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/nutrition/collagen-peptides, DOI: 10.32749/nucleodoconhecimento.com.br/nutrition/collagen-peptides

The research had the following exclusion criteria: participants who were using chondroitin and/or glucosamine, non-steroidal anti-inflammatory drugs (AINEs) and corticosteroids, but those who had been using these same drugs for more than 30 days and still felt pain were included. Participants who did not comply with the protocol or who modified eating and/or physical habits during the intervention could be excluded from the study. Those who had surgeries, intra-articular medication injections, or who had modified oral medication in the month prior to the beginning of the study would also be excluded. Participants with synovite and effusion in the knee, severe concomitant systemic diseases, peripheral or central neurological disorder, heart, renal, hepatic, or severe hematological disease were not accepted in the study. In addition to those who included medications such as chondroitin and/or glucosamine (AINEs) and corticosteroids during the study, they would also be excluded.
Data were collected at time 0, after 30, 60 and 90 days of intervention.

METHODOLOGICAL DESIGN
To trace the profile of the sample, the questionnaire adapted with variables such as age, gender, level of physical activity and anthropometric measurements was used (MOTA, 2017). To investigate the effect of supplementation on symptoms related to sarcopenia, the SARC-F + CP score (calf circumference) was applied, which contain 5 components that signify the letters of the name of this questionnaire in English, Strength, Walking Assistance, Get up from a chair, Climb stairs and Falls, and scores range from 0 to 10 for CP and from 0 to 2 points for each component that makes up the questionnaire. The score equal to or greater than 4 was predictive of sarcopenia (MALMSTROM et al., 2016).
To measure the calf circumference, a measuring tape of the TBW brand ® flexible plastic, inelastic, auto retractable and graduated from 0 to 150 cm, measured in the most protuberant part, was used while the patient was seated, with the leg folded at an angle of 90 degrees. Calf circumference is a good parameter for evaluating muscle mass in the elderly and should be considered adequate to circumference equal to or greater than 31 cm for men and women (BRASIL, 2017).
The HAQ (Health Assessment Questionnaire) score assesses eight areas of habitual functional activities, with 20 questions about the patient's daily life. The patients answered the questions each with four possibilities of answers, being: no difficulty (score 0), with some difficulty (score 1), with great difficulty (score 2) and unable to perform (score 3). The arithmetic mean of the highest score of each of the eight areas evaluated was calculated and the final result was the HAQ score (FERNANDES, 2003).

The WOMAC score (Westerm Ontario and McMaster Universities) is divided by sections that
question the intensity of pain in knee arthrosis, intensity of joint stiffness in the knee and ability to get around and to take care of themselves in daily physical activities, in which the responses can be "none", "mild", "moderate", "strong", "very strong". To analyze the data, these levels were transformed respectively into 0, 25, 50, 75 and 100. Therefore, used to analyze the efficacy of supplementation in joint recovery (FERNANDES, 2003).
The Lequesne score was also used to analyze the joints and according to Marx et al. (2006), investigates whether the person feels pain, discomfort or does not feel pain during daily activities. It is a way to evaluate the functional improvement of a patient with osteoarthritis, where the subject reports his difficulties. Scores range from zero (without involvement) to two (incapable) and the sum of the score ranges from 1 to 4 (little involvement), 5 to 7 (moderate), 8 to 10 (severe), 11 to 13 (very severe), equal to or greater than 14 (extremely severe Of the elderly analyzed, the majority were female (72%). The mean age was 67 ± 5.2 years, with no significant difference between the sexes, with a mean of 67 ± 4.9 years in women and mean of 67 ± 6.3 years in men. The mean height of the volunteers was 1.61 ± 0.096 m and the average weight was 71 ± 12.7kg. Regarding the type of physical activity of the participants, 16% practiced gymnastics, 36% volleyball, 24% multifunctional training and 24% pilates. All participants remained physically active during the study and did not change their medications and/or diet.
The assessment of nutritional status (EN) of the participants showed that 16% were underweight, the largest share (58%) had normal weight, 12% were overweight and 14% were obese. The participants maintained the same EN until the end of the study.
In relation to EN, high weight (26% of participants), added to the natural processes and wear iness of aging, can interfere in the maintenance of health with the increase of joint pain, negatively influencing quality of life and morbidity and mortality (CHUMLEA, 1989).
Another common complaint observed in the sample studied was regarding the health of the skin, nails and hair. It is known that the reduction of collagen, a common situation in senectude, not only worsens the health of osteoarticular structures, but is also shown in aesthetic issues. Regarding the evaluation of skin, nails and hair characteristics, there was a partial improvement of the nails in 32% of those analyzed; partial improvement of nails and hair (26%); partial improvement of skin and nail (4%); total hair improvement (10%); total improvement of hair, skin and nail (6%); and reported indifference (22%) of those studied. As age increases, there are changes that lead to a decrease in collagen in the general population, which are not yet fully understood. Aging can vary from person to person, lifestyle, current and established diseases, genetic and environmental influences (YAAR et al., 2002), and the replacement of collagen peptides seems to bring beneficial results regardless of external factors, in the present study, seen in 78% of those analyzed.
To evaluate sarcopenia through the SARC-F + CP protocol, it was evidenced that 16% of the elderly started in t0 with sarcopenia, while in t30 they became 14% and at the end of the study it increased to 12%. Although supplementation did not have the main objective aimed Collagen peptides combined with type II in joint pain of the elderly www.nucleodoconhecimento.com.br at improving lean mass, 4% of the participants showed these beneficial results at the end of the study. There were no new cases of sarcopenia during the research. The study by Zdzieblik (2015) was able to prove that individuals supplemented with collagen presented a greater increase in lean mass and muscle strength, which corroborates the results in question.
In addition to the analysis of lean mass, the functional status evaluated was performed by means of HAQ, where more than half (60%) they presented in the classification of mild deficiency, that is, that they are able to perform activities of daily living, however, there was a prevalence of 47% who reported pain or discomfort in the shoulder joint, and that according to Figure 1, performance is observed along t30 (p = 0.0003), t60 (p < 0.0001) and t90 (p < 0.0001) when compared to t0. Lately, collagen peptides have been vividly discussed as a symptom-modifying agent for osteoarthritis. Based on their application in functional foods as bioactive ingredients, they are thought to act in a phase before the disease, helping to prevent or delay the manifestation of osteoarthritis (VIJVEN et al. 2012), as in already established situations, bringing improvements. during study times with collagen mix supplementation.
In the evaluation of the WOMAC protocol, it was observed that 58% of the volunteers had osteoarthritis in the knee or felt some discomfort related to symptoms. For the participants who answered this protocol, an improvement was obtained in the first month of treatment, as shown in Figure 2, with the improvement of functional capacity in t30 (p=0.0001), t60 (p<0.0001) and t90 (p<0.0001). These results corroborate the findings in the study Crowley et al . (2009) with the demonstration of the efficacy of treatment with type II collagen and reduction of the WOMAC score by 33% related to difficulties in the daily activities of individuals. Collagen peptides combined with type II in joint pain of the elderly www.nucleodoconhecimento.com.br Source: primary data (2018). Legend: *p < 0.05 when compared to t0.
According to Lugo et al. (2015), also showed that individuals who consumed type II collagen showed better clinical results compared to those supplemented with placebo in this study. The analysis of WOMAC subscales showed that there were reductions in the three WOMAC subscales contributing to the improvement in the overall WOMAC score observed in individuals supplemented with type II collagen It is known that with advancing aging, there is loss of trabecular bone. However, according to the study by Oftadeh et al. (2015), trabecular microarchitecture was improved after treatment with PC. This result clearly suggests that PCs are effective in improving the capacity of the trabecular network.
Regarding the pain classification of the Lequesne score, most males (71%) mean age 65 ± 5.2 years presented some difficulty in daily activity in relation to the knee and hip, and 30% were obese according to BMI, which may influence this result aggravating the injuries.
According to figures 3, there was a reduction in pain/disonform in the hip in t30 (p<0.0001), t60 (p<0.0001) and t90 (p<0.0001) and knee in t30 (p<0.0001), t60 (p<0.0001) and t90 (p<0.0001). The use of collagen can be used in the prevention and/or treatment of osteoarthritis and osteoporosis. A clinical study showed efficiency in reducing joint pain and improving patient mobilization when supplemented (ZIEGLER and SGARBIERI, 2009).
Figure 3a -Comparison of hip pain/discomfort measured by Lequesne (Mean ± DP) during study times with collagen mix supplementation.
Collagen peptides combined with type II in joint pain of the elderly www.nucleodoconhecimento.com.br Source: primary data (2018). Legend: *p < 0.05 when compared to t0.

FINAL CONSIDERATIONS
The protocols used in this study were effective with results such as: improvement of muscle strength, reduction of pain and improvement of daily activities of patients with pain or some discomfort in the joints. It was observed that collagen mix can be a good alternative for joint problems for physically active elderly.
Based on the results obtained, it is concluded that the collagen mix supplement composed of bioactive peptides of hydrolyzed collagen, intact type II collagen, silicon and nutrients involved in joint bone metabolism (Duo flex ® -Brand Snella) demonstrated efficacy in joint manifestations evidencing to be a good nutraceutical for the active elderly.