High-fat diet, adipokines and low-grade inflammation are associated with disrupted tendon healing: a systematic review of preclinical studies

Silvia Elli, Gabriele Schiaffini, Marina Macchi, Matteo Spezia, Emanuele Chisari, Nicola Maffulli


The aetiopathogenesis of tendinopathy is uncertain, but inflammation may play a role in the early phase of tendinopathy and in tendon healing response. We investigated the most up-to-date evidence about the association between obesity, high-fat diet and tendinopathy, focusing on the role of adipokines, inflammatory pathways and molecular changes.

Sources of data

A systematic review was performed searching PubMed, Embase and Cochrane Library databases following the PRISMA guidelines. We included studies of any level of evidence published in peer-reviewed journals. The risk of bias (SIRCLE) was assessed, as was the methodological quality (CAMARADES) of the included studies. We excluded all the articles with a high risk of bias and/or low quality after the assessment. After applying the inclusion and exclusion criteria, we included 14 studies of medium or high quality.

Areas of agreement

A high-fat diet negatively affects tendon quality, increasing the risk of rupture and tendinopathy.

Areas of controversy

Controversial evidence exists on both tendon fat infiltration secondary to a dysregulation of the lipid metabolism and of a molecular effect of inflammatory pathways.

Growing points

The secretion of adipokines is strictly related to fat ingestion and body composition and can potentially act on tendon physiology and injury.

Areas timely for developing research

Adipokines, low-grade inflammation and fat intake play a role in disrupting tendon healing and setting up tendinopathy. Further high-quality research is needed to better define the molecular pathways involved.


British Medical Bulletin
Review Article