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2011 Young Investigator Award Winner: Increased Fat Mass Is Associated With High Levels of Low Back Pain Intensity and Disability

Urquhart, Donna M. PhD*; Berry, Patricia B BiomedSci (Hons)*; Wluka, Anita E. MBBS, FRACP, PhD*; Strauss, Boyd J. MBBS, FRACP, PhD; Wang, Yuanyuan MD, PhD*; Proietto, Joseph MBBS, FRACP, PhD; Jones, Graeme MD, MBBS, FRACP§; Dixon, John B. MBBS, FRACP, PhD; Cicuttini, Flavia M. MBBS, FRACP, PhD*

doi: 10.1097/BRS.0b013e3181f9fb66
Health Services Research

Study Design. A cross-sectional study.

Objective. To determine whether body composition is associated with low back pain intensity and/or disability.

Summary of Background Data. The relationship between obesity and low back pain and disability is unclear. No study has examined the role of body composition in low back pain and disability.

Methods. A total of 135 participants (25–62 years), with a range of body mass indices (18–55 kg/m2), were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed the Chronic Back Pain Grade Questionnaire, which examines individuals' levels of low back pain intensity and disability. Body composition was assessed using dual radiograph absorptiometry.

Results. Body mass index was associated with higher levels of back pain intensity (Odds ratio [OR] = 1.35; 95% confidence interval [CI] = 1.09, 1.67) and disability (OR = 1.66; 95% CI = 1.31, 2.09). Higher levels of pain intensity were positively associated with total body (OR = 1.19; 95% CI = 1.04, 1.38) and lower limb fat mass (OR = 1.51; 95% CI = 1.04, 2.20), independent of lean tissue mass. There were also positive associations between higher levels of low back disability and total body (OR = 1.41; 95% CI = 1.20, 1.67) and upper (OR = 1.67; 95% CI = 1.27, 2.19) and lower (OR = 2.29; 95% CI = 1.51, 3.49) limbs fat mass. Similar relationships were observed with trunk, android, and gynoid fat mass. After adjusting for confounders, no measures of lean tissue mass were associated with higher pain intensity or disability (P > 0.10).

Conclusion. Greater fat, but not lean tissue mass, was associated with high levels of low back pain intensity and disability. Longitudinal investigation is needed to determine whether fat mass is predictive of low back pain and disability, as this may have important implications for further prevention strategies. Understanding the mechanism for these relationships may provide novel approaches to managing low back pain.

The relationship between body composition and low back pain intensity and disability is evaluated. Increased fat mass is associated with high levels of low back pain intensity and disability.

* Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia

Body Composition Laboratory, Monash Medical Centre, Melbourne, Victoria 3168, Australia

Department of Medicine, University of Melbourne Austin Health, Victoria 3050, Australia

§ Menzies Research Institute, Private Bag 23, Hobart, Tasmania, Australia

Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, Victoria 3004, Australia

Address correspondence and reprint requests to Dr. Flavia Cicuttini, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia; E-mail:

D. M. U. and P. B. are co-first authors.

Acknowledgment date: April 14, 2010. First revision date: June 18, 2010. Acceptance date: August 2, 1010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Dr. Urquhart was supported by a NHMRC Public Health Capacity Building Grant 546248 and Monash Senior Fellowship. Patricia Berry is the recipient of an Australian Postgraduate Association Scholarship. Dr. Wluka is the recipient of an NHMRC Clinical Career Development Award (level 1, 545876) and Dr. Wang was supported by a NHMRC Public Health (Australia) Fellowship 465142.

© 2011 Lippincott Williams & Wilkins, Inc.