Waist circumference, waist-hip ratio, body fat rate, total body fat mass and risk of low back pain: a systematic review and meta-analysis

Role of epidural fat in the local milieu: what we know and what we don't

PURPOSE

Traditionally, the epidural fat (EF) is known as a physical buffer for the dural sac against the force and a lubricant facilitating the relative motion of the latter on the osseous spine. Along with the development of the studies on EF, controversies still exist on vital questions, such as the underlying mechanism of the spinal epidural lipomatosis. Meanwhile, the scattered and fragmented researches hinder the global insight into the seemingly dispensable tissue.

METHODS

Herein, we reviewed literature on the EF and its derivatives to elucidate the dynamic change and complex function of EF in the local milieu, especially at the pathophysiological conditions. We start with an introduction to EF and the current pathogenic landscape, emphasizing the interlink between the EF and adjacent structures. We generally categorize the major pathological changes of the EF into hypertrophy, atrophy, and inflammation.

RESULTS AND CONCLUSIONS

It is acknowledged that not only the EF (or its cellular components) may be influenced by various endogenic/exogenic and focal/systematic stimuli, but the adjacent structures can also in turn be affected by the EF, which may be a hidden pathogenic clue for specific spinal disease. Meanwhile, the unrevealed sections, which are also the directions the future research, are proposed according to the objective result and rational inference. Further effort should be taken to reveal the underlying mechanism and develop novel therapeutic pathways for the relevant diseases.

Human metabolism and body composition: prospects for novel studies

CONTEXT

Most articles on gut microbiota argue the importance of body composition assessment in patients; however, body composition assessments are fragile (ie, with methodological limitations) in the most recent studies.

OBJECTIVE

To present two suggestions for further research using the human body composition assessment.

METHODS

The methods used in this study are based on a Pinto et al article published in Nutrition Reviews.

DATA EXTRACTION

On the basis of data.

obtained from the PubMed, SCOPUS, LILACS, and Web of Science databases, Pinto et al provided a current survey of intermittent fasting protocols and an understanding of the outcomes to date in terms of the profile of the intestinal microbiota in obese organisms.

DATA ANALYSIS

Of the 82 original articles identified from the databases, 35 were eliminated because of duplication and 32 were excluded for not meeting the inclusion criteria. Two additional articles found in a new search were added, yielding a total of 17 studies to be included in this review. Among the protocols, alternate-day fasting and time-restricted feeding were the most common, and they were shown to have different mechanisms of metabolic signaling. Time-restricted feeding influences body mass control and biochemical parameters by regulating the circadian system and improving satiety control systems by acting on leptin secretion. In contrast, alternate-day fasting leads to a reduction of ±75% of all energy consumption regardless of dietary composition, in addition to promoting hormonal adjustments that promote body mass control. Furthermore, both protocols could remodel the intestinal microbiota by changing the Firmicutes to Bacteroidetes ratio and increasing the abundance of strains such as Lactobacillus spp. and Akkermansia that have a protective effect on metabolism against the effects of body mass gain.

CONCLUSION

Changes in adipose tissue (eg, body mass loss, control, gain) should be interpreted via the sum of skinfolds in absolute values, waist perimeter, and patients' body proportionality, because fat is just a fraction of the adipocyte (lipid).

Causal relationship between leisure sedentary behaviors and low back pain risk: a Mendelian randomization study

PURPOSE

This study aims to assess the causal associations of leisure sedentary behaviors with low back pain (LBP).

METHODS

A Mendelian randomization (MR) study was carried out utilizing genetic instruments to determine whether leisure sedentary behaviors (including leisure television watching, leisure computer use, and driving) are causally associated with LBP. All instrumental variables were selected from publicly available genetic summary data. The inverse variance weighted (IVW) was used as the main method to conduct univariable MR analyses. Further sensitivity analyses were utilized to test the stability of the results. Moreover, multivariable MR was performed to evaluate the independent causal relationship between leisure sedentary behaviors and LBP when body mass index (BMI), waist circumference, smoking initiation, and vigorous physical activity were taken into account.

RESULTS

The MR analyses showed evidence that television watching increased the risk for LBP (OR: 1.97, 95% CI 1.45, 2.66; P = 1.19 × 10-5). Genetically determined computer use is causally associated with a decreased risk of LBP (OR: 0.53, 95% CI 0.41, 0.68; P = 4.79 × 10-7). However, no evidence was found of a causal relationship between driving and LBP (OR: 2.27, 95% CI 0.75, 6.81; P = 0.145). After adjusting for BMI, waist circumference, smoking initiation, and vigorous physical activity, only television maintained its causal effect on LBP.

CONCLUSIONS

This study indicated that genetically predicted television watching was a risk factor for LBP independent of BMI, waist circumference, smoking initiation, and vigorous physical activity. This finding may be helpful for the diagnosis and management of LBP.

Longitudinal associations of body mass index and abdominal circumference with back pain among community-dwelling adults: data from the Osteoarthritis Initiative

BACKGROUND CONTEXT

Back pain is the most common musculoskeletal problem in both developed and developing countries. The prevalence and burden of back pain increases with age, and the management of back pain becomes increasingly important in the context of global aging. There is increasing evidence that obesity is a modifiable risk factor for musculoskeletal pain in different locations. Understanding the role of obesity in back pain holds great potential for improving understanding of the mechanisms of back pain and for developing new preventive and therapeutic approaches.

PURPOSE

To evaluate the role of weight, body mass index (BMI) and abdominal circumference (AC) in risk of back pain over 96 months.

DESIGN

Prospective cohort study.

PATIENT SAMPLE

The sample was from 4,793 adults in the Osteoarthritis Initiative (OAI) database who had or were at increased risk for knee Osteoarthritis.

OUTCOME MEASURES

Outcome variables included the presence, severity, and frequency of back pain, using the past 30 days as the time frame.

METHODS

Longitudinal analysis of data from 4,793 participants enrolled in the Osteoarthritis Initiative, assessed every 12 or 24 months for weight, BMI (kg/m2), AC (cm), and presence, severity (none, mild, moderate, severe), and frequency (none, rarely, sometimes, often, always) of back pain. BMI and AC were decomposed into between-person and with-person components. Data analyses were performed using mixed-effects logistic (for presence of back pain) or ordered logistic regression (for severity and frequency of back pain) models.

RESULTS

Back pain was reported in 58% of participants at baseline; 70% of those without back pain had incident back pain over 96 months. Both between-person (average value across a participant's all measurements) and within-person (deviations from the participant's average) effects of weight and BMI increased risk of presence, severity, and frequency of back pain (Odds radios (OR) per kg/m2: 1.010-1.046, p<.05) in females but not males, with statistically significant weight*sex and BMI*sex interactions. Similar findings were observed for between-person effects of AC on back pain, and the within-person effect of AC was only associated with back pain severity (OR per cm: 1.009, 95% confidence interval 1.002-1.017, p=.019) in females.

CONCLUSIONS

Greater average weight and BMI and increases in them increased odds of presence, severity, and frequency of back pain over 96 months in middle aged and older women but not men. Only average AC increased odds of back pain over time, in women. These findings suggest that preventing obesity and slowing weight gain is important for the management of back pain.

The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions

BACKGROUND

There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness.

METHODS

Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health.

RESULTS

Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health.

CONCLUSIONS

Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.

Dose-response relationship between daily screen time and the risk of low back pain among children and adolescents: a meta-analysis of 57831 participants

BACKGROUND

The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

METHODS

PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

RESULTS

The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05-1.60), daily mobile phone time (OR = 1.32, 1.00-1.64), daily TV watching (OR = 1.07, 1.04-1.09) and the risk of low back pain, separately. The dose-response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

CONCLUSIONS

Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.

Role of central obesity on pain onset and its association with cardiovascular disease: a retrospective study of a hospital cohort of patients with osteoarthritis

OBJECTIVES

To determine the role of central obesity (CO) in the onset and severity of joint pain and in predicting cardiovascular disease (CVD) in subjects affected with osteoarthritis (OA).

DESIGN

Retrospective analysis on the onset of OA joint pain and CO. Waist circumference (WC), Waist-to-height ratio andwaist-to-hip ratio (WHR) were measured at the interview and defined according to the WHO criteria. Cross-sectional analyses on the association of comorbidities, including CVD, pain severity (number of joints and pain score) and CO.

SETTINGS AND PARTICIPANTS

Medical records and interviews of a hospital cohort study of 609 patients with OA. Analyses included analysis of variance, mean differences (MDs), SE and logistic regression. Areas under the receiver operating characteristic curve (AUROC) compared the predictive value of the sex-specific CVD models.

OUTCOME MEASURES

Onset of OA joint pain (years) and severity according to body mass index (BMI) and WC categories. Predictive value of WC for CVD by sex. Education level, disability, smoking and alcohol use were used to adjust the analysis.

RESULTS

Subjects with OA and CO by WHR started 2 years earlier with pain symptoms and had more joints affected than those without CO (MD=1.96 years, SE=0.95, p=0.04 and MD=0.32, SE=0.15 and p=0.04, respectively). Age and hypertension were associated with CVD in both genders, and NSAIDs use only in males. In addition, respiratory disease, hypercholesterolaemia, stairs difficulty, a wider WC and obesity were significant risk factors in females, improving 12.7% in the prediction of CVD cases, compared with only age and BMI (AUROCC=0.793 and 0.666, respectively, p=0.03 for the difference between AUROCs).

CONCLUSION

CO is associated with the onset of joint pain, and all pain analysed variables. CO has a role in CVD in women affected with OA and might help predict CVD cases.

Computational modeling of posteroanterior lumbar traction by an automated massage bed: predicting intervertebral disc stresses and deformation

Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.