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Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review
  1. Alex Scott1,2,
  2. Johannes Zwerver3,
  3. Navi Grewal1,2,
  4. Agnetha de Sa1,2,
  5. Thuraya Alktebi1,2,
  6. David J Granville4,
  7. David A Hart5
  1. 1Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Vancouver Coastal Health Research Institute, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
  3. 3University of Groningen, University Medical Center Groningen, Center for Sports Medicine, Groningen, The Netherlands
  4. 4UBC James Hogg Research Centre, Institute for Heart + Lung Health, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
  5. 5University of Calgary, McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
  1. Correspondence to Dr Alex Scott, Department of Physical Therapy, University of British Columbia, Vancouver, 2177 Wesbrook Mall British Columbia, Canada V6T 1Z3 ascott{at}


Being overweight or obese is associated with an elevated risk of tendon pathology. However, for sportspeople the epidemiological data linking weight or adiposity on one hand, and risk of tendon pathology on the other, are less consistent. Indeed, the mechanistic links between diet, adiposity and tendon pathology remain largely unexamined. Recent studies have begun to examine the effects of dietary interventions on outcomes such as tendon biomechanics or pain. Oxidised low-density lipoprotein has been shown to (A) accumulate in the tendon tissues of mice that eat a fatty diet and (B) induce a pathological phenotype in human tendon cells. This paper addresses the current debate: is excessive body mass index (causing increased load and strain on tendon tissue) per se the underlying mechanism? Or do local or systemic influences of fat on tendons predispose to tendon pathology? This narrative review argues that excessive blood lipids may be an important avenue for clinical investigations.

  • Tendon
  • Body composition
  • Fat
  • Injury
  • Overuse
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