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Association Between Overweight and Low Back Pain: A Population-based Prospective Cohort Study of Adolescents

Mikkonen, Paula Hannele, MD*; Laitinen, Jaana, PhD; Remes, Jouko, MSc; Tammelin, Tuija, PhD§; Taimela, Simo, DMSc; Kaikkonen, Kaisu, MSc‖,**; Zitting, Paavo, MD; Korpelainen, Raija, PhD‖,**; Karppinen, Jaro, DMSc*,†

doi: 10.1097/BRS.0b013e3182843ac8

Study Design. A prospective cohort study in adolescents aged 7 to 19 years.

Objective. To evaluate whether persistent overweight increases the risk of low back pain (LBP) among adolescents.

Summary of Background Data. Overweight and LBP are common health problems in adolescents. Their relationship is still controversial among adolescents, as well as among adults.

Methods. The study population, the Oulu Back Study, was drawn from the Northern Finland Birth Cohort 1986. The final study sample included 1660 adolescents (56% females). The subcohort of 786 subjects (57% females) was used in the analysis of waist circumference. The association between the area under the curve of body mass index from 7 to 16 years, and from 16 to 18 years, and area under the curve of waist circumference from 16 to 19 years, and LBP during the past 6 months was evaluated separately for incident (reporting LBP at 18 or 19 yr but not at 16 yr) and persistent LBP (reporting LBP at 16 and 18 yr or 19 yr). Relative risks (RR) and their 95% confidence intervals (95% CI) were adjusted for smoking, leisure time physical activity, and family socioeconomic status at 16 years and stratified by sex.

Results. Body mass index from 16 to 18 years among girls and body mass index from 7 to 16 years among boys predicted incident LBP at 18 years (girls: RR, 1.09; 95% CI, 1.01–1.18; boys: RR, 1.15; 95% CI, 1.00–1.32). Among boys, waist circumference from 16 to 19 years was also associated with incident LBP (RR, 1.16; 95% CI, 1.02–1.32). Overweight was not associated with persistent LBP.

Conclusion. In this population-based cohort study, persistent overweight slightly increased the risk of incident LBP, but the time period during which overweight was related to incident LBP differed between sexes.

Level of Evidence: 2

In a birth-cohort based follow-up study of adolescents, persistent overweight seemed to be associated with incident LBP (LBP at 18 years, while no pain at 16) but not with persistent LBP (LBP at 16 and 18 years). However, there were dissimilarities between genders.

*Department of Physical and Rehabilitation Medicine, University of Oulu, Institute of Clinical Sciences, Oulu, Finland

Finnish Institute of Occupational Health, Oulu and Helsinki, Finland

Department of Statistical Services, Finnish Institute of Occupational Health, Oulu, Finland

§LIKES - Research Center for Sport and Health Sciences, Jyväskylä, Finland

Department of Public Health, University of Helsinki, Helsinki, Finland

Institute of Health Sciences, Unit of General Practice, University of Oulu and University Hospital of Oulu, Oulu, Finland; and

**Department of Sports and Exercise Medicine, Oulu Deaconess Institute, Oulu, Finland.

Address correspondence and reprint requests to Paula Mikkonen, MD, Institute of Clinical Sciences, Department of Physical and Rehabilitation Medicine, University of PO Box 21, 90029 Oulu, Finland; Email:

Acknowledgement date: July 2, 2012. First revision date: October 30, 2012. Second revision date: December 16, 2012. Acceptance date: December 19, 2012.

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

The Academy of Finland (No. 129504) and Yrjö Jahnsson foundation grant's funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lecture, stocks, payment for development of educational presentations.

© 2013 Lippincott Williams & Wilkins, Inc.