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

Article information

Korean J Health Promot. 2018;18(3):119-126

Publication date (electronic) : 2018 January 10

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

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 2018 May 18; Accepted 2018 September 11.

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

Table 2.

Factors associated with low back pain

Table 3.

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

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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.

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

P_trend <0.001 for male.

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.

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

P<0.05.

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

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.

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