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01-04-2016 | Original Article

Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins

Authors: Amabile B. Dario, Manuela L. Ferreira, Kathryn Refshauge, Juan F. Sánchez-Romera, Alejandro Luque-Suarez, John L. Hopper, Juan R. Ordoñana, Paulo H. Ferreira

Published in: European Spine Journal | Issue 4/2016

Abstract

Purpose

To investigate the relationship between different measures of obesity and chronic low back pain (LBP) using a within-pair twin case–control design that adjusts for genetics and early shared environment.

Methods

A cross-sectional association between lifetime prevalence of chronic LBP and different measures of obesity (body mass index-BMI; percent body fat; waist circumference; waist–hip ratio) was investigated in 1128 female twins in three stages: (i) total sample analysis; (ii) within-pair case–control analysis for monozygotic (MZ) and dizygotic (DZ) twins together; (iii) within-pair case–control analysis separated by DZ and MZ. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated.

Results

BMI (OR 1.12; 95 % CI 1.02–1.26) and percent body fat (OR 1.15; 95 % CI 1.01–1.32) were weakly associated with lifetime prevalence of chronic LBP in the total sample analysis but were absent when shared environment and genetic factors were adjusted for using the within-pair case–control analysis. Greater waist–hip ratios were associated with smaller prevalence estimates of chronic LBP in the within-pair case–control analysis with both MZ and DZ twins (OR 0.67; 95 % CI 0.47–0.94). However, this association did not remain after the full adjustment for genetic factors in the MZ within-pair case–control analysis.

Conclusions

BMI, percent of fat mass and greater depositions of fat and mass around the hips are associated with increases in chronic LBP prevalence in women but these associations are small and appear to be confounded by the effects of genetics and early shared environment. Therefore, our results do not support a causal direct relationship between obesity and chronic LBP.

Haslam DWJW (2005) Obesity. Lancet 336(1):1197–1209CrossRef

Vismara LMF, Zaina F, Galli M, Negrini S, Capodaglio P (2010) Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. J Neuroeng Rehabil 7(3):1–8. doi:10.1186/1743-0003-7-3

Guh DPZW, Bansback N, Amarsi Z, Birmingham CL, Anis AH (2009) The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9(88):1–20. doi:10.1186/1471-2458-9-88

Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223CrossRefPubMed

McBeth JJK (2007) Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 21(3):403–425. doi:10.1016/j.berh.2007.03.003 CrossRefPubMed

Leboeuf-Yde C (2000) Weight and low back pain a systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine 25(2):226–237CrossRefPubMed

Junqueira DR, Ferreira ML, Refshauge K, Maher CG, Hopper JL, Hancock M, Carvalho MG, Ferreira PH (2014) Heritability and lifestyle factors in chronic low back pain: results of the Australian Twin Low Back Pain Study (The AUTBACK study). Eur J Pain. doi:10.1002/ejp.506 PubMed

Mirtz TAGL (2005) Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question. Chiropr Osteopat 13(2):1–6. doi:10.1186/1746-1340-13-2

Shiri RKJ, Leino-Arjas P, Solovieva S, Viikari-Juntura E (2009) The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. doi:10.1093/aje/kwp356 PubMed

10.

Leboeuf-Yde CKK, Bruun NH (1999) Low back pain and life style. Part II—obesity. Spine 24(8):779–784CrossRefPubMed

11.

Tsuritani I, Honda R, Noborisaka Y, Ishida M, Ishizaki M, Yamada Y (2002) Impact of obesity on musculoskeletal pain and difficulty of daily movements in Japanese middle-aged women. Maturitas 42(1):23–30CrossRefPubMed

12.

Lee CY, Kratter R, Duvoisin N, Taskin A, Schilling J (2005) Cross-sectional view of factors associated with back pain. Int Arch Occup Environ Health 78(4):319–324. doi:10.1007/s00420-004-0589-z CrossRefPubMed

13.

Deere KCCJ, Holliday K, McBeth J, Crawley EM, Sayers A, Palmer SDR, Clark EM, Tobias JH (2012) Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort. Pain 123(2012):1932–1938. doi:10.1016/j.pain.2012.06.006 CrossRef

14.

Perry AC, Applegate EB, Allison MD, Jackson ML, Miller PC (1998) Clinical predictability of the waist-to-hip ratio in assessment of cardiovascular disease risk factors in overweight, premenopausal women. Am J Clin Nutr 68(5):1022–1027PubMed

15.

Toda YSNTTMTOR (2000) Lean body mass and body fat distribution in participants with chronic low back pain. Arch Intern Med 160(21):3265–3269. doi:10.1001/archinte.160.21.3265 CrossRefPubMed

16.

Han TS, Schouten JS, Lean ME, Seidell JC (1997) The prevalence of low back pain and associations with body fatness, fat distribution and height. Int J Obes Relat Metab Disord 21(7):600–607CrossRefPubMed

17.

Leboeuf-Yde C, Nielsen J, Kyvik K, Fejer R, Hartvigsen J (2009) Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskelet Disord 10(1):1–12. doi:10.1186/1471-2474-10-39 CrossRef

18.

Weimer MB, Macey TA, Nicolaidis C, Dobscha SK, Duckart JP, Morasco BJ (2013) Sex differences in the medical care of va patients with chronic non-cancer pain. Pain Med. doi:10.1111/pme.12177 PubMedPubMedCentral

19.

Ordonana JR, Rebollo-Mesa I, Carrillo E, Colodro-Conde L, Garcia-Palomo FJ, Gonzalez-Javier F, Sanchez-Romera JF, Aznar Oviedo JM, de Pancorbo MM, Perez-Riquelme F (2013) The Murcia Twin Registry: a population-based registry of adult multiples in Spain. Twin Res Hum Genet 16(1):302–306. doi:10.1017/thg.2012.66 CrossRefPubMed

20.

Brian S. Everitt DH (2005) Encyclopedia of statistics in behavioral science, vol 1, 1st edn. Wiley

21.

Hestbaek L, Leboeuf-Yde C, Kyvik KO (2006) Are lifestyle-factors in adolescence predictors for adult low back pain? A cross-sectional and prospective study of young twins. BMC Musculoskelet Disord. doi:10.1186/1471-2474-7-27

22.

Leboeuf-Yde C, Kyvik KO, Bruun NH (1999) Low back pain and lifestyle. Part II—obesity. Information from a population-based sample of 29,424 twin subjects. Spine 24(8):779–783 (Discussion 783–774) CrossRefPubMed

23.

Livshits G, Popham M, Malkin I, Sambrook PN, MacGregor AJ, Spector T, Williams FMK (2011) Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK Twin Spine Study. Ann Rheum Dis 70(10):1740–1745. doi:10.1136/ard.2010.137836 CrossRefPubMedPubMedCentral

24.

Chaput JP, Perusse L, Despres JP, Tremblay A, Bouchard C (2014) Findings from the Quebec Family Study on the etiology of obesity: genetics and environmental highlights. Curr Obes Rep 3:54–66. doi:10.1007/s13679-013-0086-3 CrossRefPubMedPubMedCentral

25.

Ferreira PHBP, Maher CG, Hopper JL, Ferreira ML (2013) Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. Eur J Pain 1(1):1–15. doi:10.1002/j.1532-2149.2012.00277

26.

Yip YB, Ho SC, Chan SG (2001) Tall stature, overweight and the prevalence of low back pain in Chinese middle-aged women. Int J Obes 25(6):887–892. doi:10.1038/sj.ijo.0801557 CrossRef

27.

O’Sullivan PB (2000) Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management. Man Ther 5(1):2–12. doi:10.1054/math.1999.0213 CrossRefPubMed

28.

Gorber SC, Tremblay M, Moher D, Gorber B (2007) A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8(4):307–326. doi:10.1111/j.1467-789X.2007.00347.x CrossRefPubMed

29.

Talma H, Chinapaw MJ, Bakker B, HiraSing RA, Terwee CB, Altenburg TM (2013) Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error. Obes Rev Off J Int Assoc Study Obes 14(11):895–905. doi:10.1111/obr.12061 CrossRef

30.

Dario AB, Ferreira ML, Refshauge K, Lima T, Ordonana JR, Ferreira PH (2015) The relationship between obesity, low back pain and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J. doi:10.1016/j.spinee.2015.02.001 PubMed

Title: Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins
Authors: Amabile B. Dario
Manuela L. Ferreira
Kathryn Refshauge
Juan F. Sánchez-Romera
Alejandro Luque-Suarez
John L. Hopper
Juan R. Ordoñana
Paulo H. Ferreira
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4055-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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