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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 1/2019

Open Access 01-12-2019 | Back Pain | Research article

High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults

Authors: Sharmayne R. E. Brady, Donna M. Urquhart, Sultana Monira Hussain, Andrew Teichtahl, Yuanyuan Wang, Anita E. Wluka, Flavia Cicuttini

Published in: Arthritis Research & Therapy | Issue 1/2019

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Abstract

Objectives

Low back pain is the largest contributor to disability worldwide. The role of body composition as a risk factor for back pain remains unclear. Our aim was to examine the relationship between fat mass and fat distribution on back pain intensity and disability using validated tools over 3 years.

Methods

Participants (aged 25–60 years) were assessed at baseline using dual-energy X-ray absorptiometry (DXA) to measure body composition. All participants completed the Chronic Pain Grade Scale at baseline and 3-year follow-up. Of the 150 participants, 123 (82%) completed the follow-up.

Results

Higher baseline body mass index (BMI) and fat mass (total, trunk, upper limb, lower limb, android, and gynoid) were all associated with high intensity back pain at either baseline and/or follow-up (total fat mass: multivariable OR 1.05, 95% CI 1.01–1.09, p < 0.001). There were similar findings for all fat mass measures and high levels of back disability. A higher android to gynoid ratio was associated with high intensity back pain (multivariable OR 1.04, 95% CI 1.01–1.08, p = 0.009). There were no associations between lean mass and back pain.

Conclusions

This cohort study provides evidence for the important role of fat mass, specifically android fat relative to gynoid fat, on back pain and disability.
Literature
1.
Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.PubMedCrossRef
2.
Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manip Physiol Ther. 2004;27(4):238–44.CrossRef
3.
Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88(Suppl 2):21–4.PubMed
4.
Engel CC, von Korff M, Katon WJ. Back pain in primary care: predictors of high health-care costs. Pain. 1996;65(2–3):197–204.PubMedCrossRef
5.
Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. Int J Obes. 2007;32:211.CrossRef
6.
Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine. 2000;25(2):226–37.PubMedCrossRef
7.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135–54.PubMedCrossRef
8.
Sandell LJ. Obesity and osteoarthritis: is leptin the link? Arthritis Rheum. 2009;60(10):2858–60.PubMedCrossRef
9.
Teichtahl AJ, Urquhart DM, Wang Y, et al. Modic changes in the lumbar spine and their association with body composition, fat distribution and intervertebral disc height - a 3.0 T-MRI study. BMC Musculoskelet Disord. 2016;17:92.PubMedPubMedCentralCrossRef
10.
Urquhart DM, Berry P, Wluka AE, et al. 2011 Young Investigator Award winner: increased fat mass is associated with high levels of low back pain intensity and disability. Spine. 2011;36(16):1320–5.PubMedCrossRef
11.
Chou L, Brady SR, Urquhart DM, et al. The association between obesity and low back pain and disability is affected by mood disorders: a population-based, cross-sectional study of men. Medicine. 2016;95(15):e3367.PubMedPubMedCentralCrossRef
12.
13.
Oliver JM, Lambert BS, Martin SE, et al. Predicting body fat to the accuracy of DEXA using standard anthropometric measures. J Strength Cond Res. 2011;25:S38–9.CrossRef
14.
Glickman SG, Marn CS, Supiano MA, Dengel DR. Validity and reliability of dual-energy X-ray absorptiometry for the assessment of abdominal adiposity. J Appl Physiol (1985). 2004;97(2):509–14.CrossRef
15.
Clasey JL, Hartman ML, Kanaley J, et al. Body composition by DEXA in older adults: accuracy and influence of scan mode. Med Sci Sports Exerc. 1997;29(4):560–7.PubMedCrossRef
16.
17.
Hussain SM, Urquhart DM, Wang Y, et al. Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study. Arthritis Res Ther. 2017;19(1):26.PubMedPubMedCentralCrossRef
18.
Selkow NM, Pietrosimone BG, Saliba SA. Subcutaneous thigh fat assessment: a comparison of skinfold calipers and ultrasound imaging. J Athl Train. 2011;46(1):50–4.PubMedPubMedCentralCrossRef
19.
20.
Walsh TP, Arnold JB, Evans AM, Yaxley A, Damarell RA, Shanahan EM. The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19(1):233.PubMedPubMedCentralCrossRef
21.
Pan F, Laslett L, Blizzard L, et al. Associations between fat mass and multisite pain: a five-year longitudinal study. Arthritis Care Res. 2017;69(4):509–16.CrossRef
22.
Dario AB, Loureiro Ferreira M, Refshauge K, Luque-Suarez A, Ordonana JR, Ferreira PH. Obesity does not increase the risk of chronic low back pain when genetics are considered. A prospective study of Spanish adult twins. Spine J. 2017;17(2):282–90.PubMedCrossRef
23.
Hashimoto Y, Matsudaira K, Sawada SS, et al. Obesity and low back pain: a retrospective cohort study of Japanese males. J Phys Ther Sci. 2017;29(6):978–83.PubMedPubMedCentralCrossRef
24.
Despres JP. Cardiovascular disease under the influence of excess visceral fat. Crit Pathw Cardiol. 2007;6(2):51–9.PubMedCrossRef
25.
Berry PA, Wluka AE, Davies-Tuck ML, et al. The relationship between body composition and structural changes at the knee. Rheumatology. 2010;49(12):2362–9.PubMedCrossRef
26.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRef
27.
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.CrossRef
28.
Heuch I, Heuch I, Hagen K, Zwart JA. Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trondelag Health Study. Spine. 2013;38(2):133–9.PubMedCrossRef
29.
Lake JK, Power C, Cole TJ. Back pain and obesity in the 1958 British birth cohort: cause or effect? J Clin Epidemiol. 2000;53(3):245–50.PubMedCrossRef
30.
Nilsen TI, Holtermann A, Mork PJ. Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study. Am J Epidemiol. 2011;174(3):267–73.PubMedCrossRef
31.
Power C, Frank J, Hertzman C, Schierhout G, Li L. Predictors of low back pain onset in a prospective British study. Am J Public Health. 2001;91(10):1671–8.PubMedPubMedCentralCrossRef
32.
Shiri R, Solovieva S, Husgafvel-Pursiainen K, et al. The role of obesity and physical activity in non-specific and radiating low back pain: the Young Finns study. Semin Arthritis Rheum. 2013;42(6):640–50.PubMedCrossRef
33.
Hestbaek L, Leboeuf-Yde C, Kyvik KO. Are lifestyle-factors in adolescence predictors for adult low back pain? A cross-sectional and prospective study of young twins. BMC Musculoskelet Disord. 2006;7:27.PubMedPubMedCentralCrossRef
34.
Leino-Arjas P, Solovieva S, Kirjonen J, Reunanen A, Riihimaki H. Cardiovascular risk factors and low-back pain in a long-term follow-up of industrial employees. Scand J Work Environ Health. 2006;32(1):12–9.PubMedCrossRef
35.
Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. Arthritis Rheum. 2007;56(4):1355–64.PubMedCrossRef
36.
Miranda H, Viikari-Juntura E, Punnett L, Riihimaki H. Occupational loading, health behavior and sleep disturbance as predictors of low-back pain. Scand J Work Environ Health. 2008;34(6):411–9.PubMedCrossRef
37.
Elders LA, Burdorf A. Prevalence, incidence, and recurrence of low back pain in scaffolders during a 3-year follow-up study. Spine. 2004;29(6):E101–6.PubMedCrossRef
38.
Van Nieuwenhuyse A, Crombez G, Burdorf A, et al. Physical characteristics of the back are not predictive of low back pain in healthy workers: a prospective study. BMC Musculoskelet Disord. 2009;10:2–2.PubMedPubMedCentralCrossRef
39.
Heuch I, Heuch I, Hagen K, Zwart JA. A comparison of anthropometric measures for assessing the association between body size and risk of chronic low back pain: the HUNT study. PLoS One. 2015;10(10):e0141268.PubMedPubMedCentralCrossRef
40.
41.
Van Gaal LF, Vansant GA, De Leeuw IH. Upper body adiposity and the risk for atherosclerosis. J Am Coll Nutr. 1989;8(6):504–14.PubMedCrossRef
42.
Misra A, Vikram NK. Clinical and pathophysiological consequences of abdominal adiposity and abdominal adipose tissue depots. Nutrition. 2003;19(5):457–66.PubMedCrossRef
43.
Tanamas SK, Wluka AE, Berry P, et al. Relationship between obesity and foot pain and its association with fat mass, fat distribution, and muscle mass. Arthritis Care Res. 2012;64(2):262–8.CrossRef
44.
Fillipas S, Tanamas SK, Davies-Tuck ML, et al. The relationship between body composition and knee structure in patients with human immunodeficiency virus. Int J STD AIDS. 2015;26(2):133–8.PubMedCrossRef
45.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193–9.PubMedCrossRef
46.
Kuisma M, Karppinen J, Niinimaki J, et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine. 2007;32(10):1116–22.PubMedCrossRef
47.
Brady SR, Mamuaya BB, Cicuttini F, et al. Body composition is associated with multisite lower body musculoskeletal pain in a community-based study. J Pain. 2015;16(8):700–6.PubMedCrossRef
48.
49.
Vuolteenaho K, Koskinen A, Moilanen E. Leptin - a link between obesity and osteoarthritis. Applications for prevention and treatment. Basic Clin Pharmacol Toxicol. 2014;114(1):103–8.PubMedCrossRef
50.
Martel-Pelletier J, Raynauld JP, Dorais M, Abram F, Pelletier JP. The levels of the adipokines adipsin and leptin are associated with knee osteoarthritis progression as assessed by MRI and incidence of total knee replacement in symptomatic osteoarthritis patients: a post hoc analysis. Rheumatology (Oxford). 2016;55(4):680–8.CrossRef
51.
Dumond H, Presle N, Terlain B, et al. Evidence for a key role of leptin in osteoarthritis. Arthritis Rheum. 2003;48(11):3118–29.PubMedCrossRef
52.
53.
Shiri R, Solovieva S, Husgafvel-Pursiainen K, et al. The association between obesity and the prevalence of low back pain in young adults: the Cardiovascular Risk in Young Finns Study. Am J Epidemiol. 2008;167(9):1110–9.PubMedCrossRef
54.
Brady SRE, Mousa A, Naderpoor N, de Courten MPJ, Cicuttini F, de Courten B. Adipsin concentrations are associated with back pain independently of adiposity in overweight or obese adults. Front Physiol. 2018;9:93.PubMedPubMedCentralCrossRef
55.
Walsh TL, Homa K, Hanscom B, Lurie J, Sepulveda MG, Abdu W. Screening for depressive symptoms in patients with chronic spinal pain using the SF-36 Health Survey. Spine J. 2006;6(3):316–20.PubMedCrossRef
56.
Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH Task Force on research standards for chronic low back pain. J Pain. 2014;15(6):569–85.
57.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. The Lancet. 2017;389(10070):736–47.CrossRef
Metadata
Title
High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults
Authors
Sharmayne R. E. Brady
Donna M. Urquhart
Sultana Monira Hussain
Andrew Teichtahl
Yuanyuan Wang
Anita E. Wluka
Flavia Cicuttini
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 1/2019
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/s13075-019-1953-4

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