Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study.
BACKGROUND
Determining the association between body composition and low back pain (LBP) will improve our understanding of the mechanisms by which obesity affects LBP, and inform novel approaches to managing LBP. The aim of this study was t﻿o examine the relationship between body composition and LBP intensity and disability.


METHODS
A total of 5058 participants (44% men) of the Australian Diabetes, Obesity and Lifestyle Study were assessed for LBP intensity and disability using the Chronic Pain Grade Questionnaire (2013-2014). Body mass index (BMI) and waist circumference were directly obtained. Fat mass and percentage fat were estimated from bioelectrical impedance analysis at study inception (1999-2000).


RESULTS
Eighty-two percent of participants reported LBP, of whom 27% also reported LBP disability. BMI, waist circumference, percent fat, and fat mass were each positively associated with LBP intensity and disability at 12 years after adjustment for potential confounders. LBP intensity and disability showed significant dose-responses to sex-specific quartiles of BMI, waist circumference, percent fat and fat mass. For example, the adjusted OR for LBP intensity in women increased with increasing fat mass quartiles [Q1: 1, Q2: 1.05 (95%CI 0.84-1.32); Q3: 1.25 (1.00-1.57); and Q4: 1.78 (1.42-2.24); p < 0.001].


CONCLUSIONS
Fat mass and distribution are associated with LBP intensity and disability, suggesting systemic metabolic factors associated with adiposity play a major role in the pathogenesis of LBP. Clarifying the mechanisms will facilitate developing novel preventive and therapeutic approaches for LBP.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Sultana Monira
http://orcid.org/0000-0001-7894-2485
SM
Hussain
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Donna M
DM
Urquhart
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Yuanyuan
Y
Wang
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
Jonathan E
JE
Shaw
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.|Baker IDI Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
Dianna J
DJ
Magliano
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
Anita E
AE
Wluka
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia. flavia.cicuttini@monash.edu.
Flavia M
FM
Cicuttini
D000273:Adipose Tissue; D050154:Adiposity; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*
Body composition; Fat mass; Fat-free mass; Low back pain; Obesity