The Association of Low Back Pain with Obesity and Abdominal Obesity among Koreans Aged 50 Years or More

Eun Young Choi

doi:10.15384/kjhp.2018.18.3.119

Korean J Health Promot > Volume 18(3); 2018 > Article

Choi: The Association of Low Back Pain with Obesity and Abdominal Obesity among Koreans Aged 50 Years or More

Original Article

Korean Journal of Health Promotion 2018;18(3):119-126.

Published online: January 10, 2018

DOI: https://doi.org/10.15384/kjhp.2018.18.3.119

The Association of Low Back Pain with Obesity and Abdominal Obesity among Koreans Aged 50 Years or More

Eun Young Choi

Department of Family Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea

￭ Corresponding author: Eun Young Choi, MD, PhD Department of Family Medicine, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea
Tel: +82-41-550-3998, Fax: +82-41-550-3998 E-mail: choiey0410@gmail.com

Received May 18, 2018 Accepted September 11, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Both low back pain (LBP) and obesity are important public issues, but the association between them is controversial. This study was conducted to investigate the association of LBP with obesity and abdominal obesity among Koreans aged 50 years or more.

Methods

This cross-sectional study analyzed data from participants aged 50 years or more (n=11,941) who measured height, weight and waist circumference and answered the questions about low back pain in the Korean National Health and Nutrition Examination Survey 2010–2013. To investigate the association of LBP with obesity and abdominal obesity, weighted univariate and multivariate logistic regression analyses were done after adjusting for socioeconomic variables and lifestyle variables.

Results

The prevalence of LBP in men and women was 13.1% (standard error [SE], 0.6) and 31.0% (SE, 0.8), respectively, higher in women than men (P<0.001). For women only, abdominal obesity was significantly associated with an increased prevalence of LBP (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01–1.44) after adjustment of confounding variables, and the odds ratio of LBP in the highest quartile of waist circumference was higher compared to the lowest quartile of waist circumference (OR 1.30, 95% CI 1.02–1.66). For men abdominal obesity was not associated with an increased prevalence of LBP. There were no associations between obesity and LBP in both men and women.

Conclusions

This population-based, nationally representative study suggests that abdominal obesity increases the risk of LBP in women aged 50 years or more.

Keywords: Low back pain, Obesity, Obesity, abdominal, Nutrition surveys

Table 1.

Characteristics of participants according to the low back pain by gender

Variable	Men (5,075)			Women (6,866)
Variable	LBP (−)	LBP (+)	P	LBP (−)	LBP (+)	P
Proportion	86.9 (0.6)	13.1 (0.6)		69.0 (0.8)	31.0 (0.8)
Age	61.0±0.2	64.1±0.5	<0.001	61.3±0.2	66.9±0.3	<0.001
BMI (kg/m²)	23.9±0.1	23.5±0.1	<0.001	24.2±0.1	24.4±0.1	0.031
BMI group			0.006			0.092
<18.5	2.7 (3.5)	3.5 (0.7)		2.2 (0.3)	2.7 (0.5)
18.5–25	63.2 (0.9)	69.0 (2.2)		61.7 (0.9)	58.2 (1.3)
≥25	34.1 (0.9)	27.5 (2.0)		36.1 (0.9)	39.1 (1.3)
Waist circumference (cm)	85.1±0.2	85.0±0.3	0.787	81.3±0.2	83.3±0.3	<0.001
Abdominal obesity^a			0.678			<0.001
No	72.1 (0.8)	71.3 (2.0)		67.0 (0.9)	58.0 (1.3)
Yes	27.9 (0.8)	28.7 (2.0)		33.0 (0.9)	42.0 (1.3)
Education^b			<0.001			<0.001
Elementary	28.0 (0.9)	43.1 (2.3)		50.2 (1.0)	74.8 (1.2)
Middle	20.3 (0.8)	21.4 (1.9)		19.0 (0.7)	12.3 (0.9)
High	32.8 (1.0)	23.5 (2.0)		23.3 (0.8)	10.4 (0.8)
University	18.9 (0.8)	12.0 (1.6)		7.5 (0.5)	2.5 (0.4)
Physical activity^c			0.646			<0.001
1st quartile	28.7 (0.8)	29.9 (2.1)		29.2 (0.9)	37.0 (1.4)
2nd quartile	23.9 (0.7)	21.1 (1.9)		23.3 (0.8)	19.8 (1.1)
3rd quartile	23.0 (0.8)	23.7 (2.0)		24.1 (0.8)	19.0 (1.0)
4th quartile	24.4 (0.9)	25.2 (1.1)		23.4 (0.8)	24.2 (1.2)
Smoking			0.314			0.475
No	65.1 (0.9)	62.5 (2.3)		95.7 (0.4)	95.2 (0.6)
Yes	34.9 (0.9)	37.5 (2.3)		4.3 (0.4)	4.8 (0.6)
Monthly drinking			0.011			<0.001
No	29.8 (0.9)	35.4 (2.2)		71.1 (0.8)	77.3 (1.1)
Yes	70.2 (0.9)	64.6 (2.2)		28.9 (0.8)	22.7 (1.1)
Occupation			<0.001			<0.001
White collar	43.2 (1.1)	33.2 (2.3)		50.8 (1.1)	33.6 (1.4)
Blue collar	56.8 (1.1)	66.8 (2.3)		49.2 (1.1)	66.4 (1.4)

Abbreviations: LBP, low back pain; BMI, body mass index; MET, metabolic equivalent. Values are presented as mean±standard error (SE) or % (SE). P-value by weighted chi-square test or t-test.

^a Defined by waist circumference ≥90 cm in male or ≥85 cm in female.

^b P_trend <0.001 for male.

^c Defined by sum of the MET-minutes/week=sum of walking+moderate physical activity+vigorous physical activity MET-minutes/week scores.

Table 2.

Factors associated with low back pain

Variable	Men		Women
Variable	OR (95% CI)	aOR^a (95% CI)	OR (95% CI)	aOR^a (95% CI)
Age (per year)	1.04 (1.03–1.05)^b	1.03 (1.02–1.04)^b	1.06 (1.06–1.07)^b	1.05 (1.04–1.05)^b
BMI group
<18.5 kg/m²	1	1	1	1
18.5–25 kg/m²	0.83 (0.53–1.30)	1.04 (0.67–1.61)	0.79 (0.50–1.23)	1.09 (0.68–1.76)
≥25 kg/m²	0.61 (0.39–0.95)^b	0.74 (0.45–1.21)	0.90 (0.58–1.41)	1.07 (0.65–1.76)
Abdominal obesity^c
Yes	1.04 (0.86–1.27)	1.30 (0.99–1.70)	1.47 (1.31–1.66)^b	1.20 (1.01–1.44)^b
Education
Elementary	1	1	1	1
Middle	0.68 (0.52–0.88)^b	0.82 (0.62–1.08)	0.43 (0.36–0.52)^b	0.64 (0.52–0.79)^b
High	0.46 (0.37–0.59)^b	0.58 (0.44–0.76)^b	0.30 (0.25–0.37)^b	0.53 (0.42–0.68)^b
University	0.41 (0.30–0.57)^b	0.56 (0.39–0.82)^b	0.22 (0.15–0.31)^b	0.46 (0.31–0.68)^b
Physical activity^d
1st quartile	1	1	1	1
2nd quartile	0.85 (0.64–1.11)	0.86 (0.66–1.11)	0.67 (0.60–0.80)^b	0.83 (0.69–1.00)^b
3rd quartile	0.99 (0.76–1.29)	0.79 (0.58–1.07)	0.62 (0.52–0.74)^b	0.68 (0.56–0.84)^b
4th quartile	0.99 (0.75–1.32)	0.86 (0.66–1.13)	0.81 (0.69–0.96)^b	0.69 (0.56–0.85)^b
Smoking
Yes	1.10 (0.89–1.37)	1.20 (0.96–1.51)	1.12 (0.82–1.53)	1.28 (0.92–1.78)
Monthly drinking
Yes	0.77 (0.63–0.94)	0.89 (0.72–1.10)	0.72 (0.62–0.84)	0.93 (0.79–1.10)
Occupation
White collar	1	1	1	1
Blue collar	1.54 (1.25–1.89)^b	1.16 (0.90–1.48)	2.04 (1.78–2.34)^b	1.30 (1.12–1.52)^b

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; MET, metabolic equivalent.

^a Calculated by multiple logistic regression analysis mutually adjusted for all variables shown.

^b P<0.05.

^c Defined by waist circumference ≥90 cm in male or ≥85 cm in female.

^d Defined by sum of the MET-minutes/week=sum of walking+moderate physical activity+vigorous physical activity MET-minutes/week scores.

Table 3.

Prevalence and adjusted odds ratio of low back pain according to the quartiles of waist circumference by gender

	Prevalence (%)	OR^a (95% CI)
Quartile of waist circumference in male (cm)
<79.8	13.5 (1.1)	1 (ref.)
79.8–85.3	13.8 (1.1)	1.22 (0.92–1.60)
85.4–90.7	11.8 (1.1)	1.14 (0.85–1.53)
>90.7	13.5 (1.1)	1.49 (1.05–2.12)
P	0.541	0.135
P_trend	0.533	0.061
Quartile of waist circumference in female (cm)
<75.7	27.4 (1.3)	1 (ref.)
75.7–81.7	27.2 (1.3)	0.93 (0.76–1.14)
81.8–87.9	31.9 (1.4)	1.15 (0.93–1.42)
>87.9	37.7 (1.4)	1.30 (1.02–1.66)
P	<0.001	0.043
P_trend	<0.001	0.019

Abbreviations: OR, odds ratio; CI, confidence interval; ref., reference.

^a Assessed by multiple logistic regression analysis adjusted for age, education, physical activity, smoking, monthly dinking, job, obesity group.

References

1. The Korean Academy of Family Medicine. Textbook of Family Medicine. 4th ed.. Seoul: Jin Plan; 2013. p. 626..

2. Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine (Phila Pa 1976) 2000;25(2):226-37.

3. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a metaanalysis. Am J Epidemiol 2010;171(2):135-54.

4. Heuch I, Hagen K, Heuch I, Nygaard Ø, Zwart JA. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976) 2010;35(7):764-8.

5. Adera T, Deyo RA, Donatelle RJ. Premature menopause and low back pain. A population-based study. Ann Epidemiol 1994;4(5):416-22.

6. Croft PR, Rigby AS. Socioeconomic influences on back problems in the community in Britain. J Epidemiol Community Health 1994;48(2):166-70.

7. Schneider S, Randoll D, Buchner M. Why do women have back pain more than men? A representative prevalence study in the federal republic of Germany. Clin J Pain 2006;22(8):738-47.

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

9. Toda Y, Segal N, Toda T, Morimoto T, Ogawa R. Lean body mass and body fat distribution in participants with chronic low back pain. Arch Intern Med 2000;160(21):3265-9.

10. Yoon YS, Oh SW. Optimal waist circumference cutoff values for the diagnosis of abdominal obesity in korean adults. Endocrinol Metab (Seoul) 2014;29(4):418-26.

11. Hallal PC, Victora CG. Reliability and validity of the International Physical Activity Questionnaire (IPAQ). Med Sci Sports Exerc 2004;36(3):556.

12. Shiri R, Solovieva S, Husgafvel-Pursiainen K, Taimela S, Saarikoski LA, Huupponen R, 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.

13. McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2007;21(3):403-25.

14. Cooper RG, Holli S, Jayson MI. Gender variation of human spinal and paraspinal structures. Clin Biomech (Bristol, Avon) 1992;7(2):120-4.

15. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009;10(5):447-85.

16. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev 2015;(9):CD001139.

17. Heliövaara M, Mäkelä M, Knekt P, Impivaara O, Aromaa A. Determinants of sciatica and low-back pain. Spine (Phila Pa 1976) 1991;16(6):608-14.

18. Lee CY, Kratter R, Duvoisin N, Taskin A, Schilling J. Cross-sectional view of factors associated with back pain. Int Arch Occup Environ Health 2005;78(4):319-24.

19. 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.

20. Urquhart DM, Berry P, Wluka AE, Strauss BJ, Wang Y, Proietto J, et al. 2011 young investigator award winner: increased fat mass is associated with high levels of low back pain intensity and disability. Spine (Phila Pa 1976) 2011;36(16):1320-5.

21. Brady SR, Mamuaya BB, Cicuttini F, Wluka AE, Wang Y, Hussain SM, et al. Body composition is associated with multisite lower body musculoskeletal pain in a community-based study. J Pain 2015;16(8):700-6.

22. Iizuka Y, Iizuka H, Mieda T, Tajika T, Yamamoto A, Ohsawa T, et al. Association between neck and shoulder pain, back pain, low back pain and body composition parameters among the Japanese general population. BMC Musculoskelet Disord 2015;16:333.

23. Yip YB, Ho SC, Chan SG. Tall stature, overweight and the prevalence of low back pain in Chinese middle-aged women. Int J Obes Relat Metab Disord 2001;25(6):887-92.

24. Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin Biomech (Bristol, Avon) 2001;16(1):28-37.

25. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev 2010;11(1):11-8.

26. Igarashi A, Kikuchi S, Konno S, Olmarker K. Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine (Phila Pa 1976) 2004;29(19):2091-5.

27. Brooks C, Siegler JC, Marshall PW. Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study. BMC Public Health 2016;16:700.

28. Jia WP, Lu JX, Xiang KS, Bao YQ, Lu HJ, Chen L. Prediction of abdominal visceral obesity from body mass index, waist circumference and waist-hip ratio in Chinese adults: receiver operating characteristic curves analysis. Biomed Environ Sci 2003;16(3):206-11.

29. Onat A, Avci GS, Barlan MM, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. Int J Obes Relat Metab Disord 2004;28(8):1018-25.

30. Jimenez-Garcia R, Del Barrio JL, Hernandez-Barrera V, de Miguel-Díez J, Jimenez-Trujillo I, Martinez-Huedo MA, et al. Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study. J Pain Res 2018;11:1005-15.