Abstract
Osteoarthritis (OA) is the main degenerative joint disease affecting nearly 7% of world population. OA is a multifactorial pathology due to environmental, inflammatory and genetic causes. Recently, the diet and consumption of specific foods have been associated to onset and progression of OA. Dietary patterns, macronutrients, micronutrients, and bioactive compounds can influence inflammatory pathways, oxidative stress, and cartilage metabolism. These effects are mediated not only by structural support but also through the modulation of gene expression and cellular signaling pathways. The emerging fields of nutrigenomics and nutrigenetics provide a mechanistic framework to explain interindividual variability in dietary responses. Nutrigenomics investigates how nutrients influence gene expression and molecular pathways involved in OA pathophysiology, whereas nutrigenetics examines how genetic polymorphisms affect nutrient metabolism, bioavailability, and biological efficacy. This narrative review critically examines current evidence on the interaction between diet, nutraceuticals, and common non-pathological genetic variants in OA. We discuss whether specific dietary patterns exert genotype-independent effects or require personalized approaches to optimize outcomes. By integrating genetic, metabolic, and nutritional perspectives, this review aims to clarify inconsistent findings in the literature and to outline the potential of precision nutrition as a complementary strategy for OA prevention and management. The integration of these approaches enables the development of personalized nutritional strategies tailored to an individual's genetic background, metabolic profile, and comorbid conditions such as obesity, cardiovascular disease, and diabetes.