Abstract
Purpose
To clarify the relationship between body mass index (BMI) and spinal pathologies including spinal sagittal balance, back extensor strength (BES), paraspinal muscle mass, prevalent vertebral fracture, disc degeneration, Modic changes, low back pain, and quality of life (QOL) in community-dwelling older adults.
Methods
This study included 380 participants (age: ≥ 65 years, male/female: 152/228) from the Shiraniwa Study. Multivariate nonlinear regression analysis was used to investigate the relationship between BMI and sagittal vertical axis (SVA), BES, paraspinal muscle mass, visual analog scale (VAS) for low back pain, Oswestry Disability Index (ODI), and EuroQoL-5 Dimension (EQ5D) score after adjusting for sex, age, Hospital Anxiety and Depression Scale score, and Charlson Comorbidity Index. In addition, multiple logistic regression analysis was used to investigate the association between BMI and prevalent vertebral fracture, disc degeneration, and Modic changes.
Results
BMI was significantly correlated with SVA, BES, paraspinal muscle mass, VAS, ODI, and EQ5D score. The increase in BMI was associated with the deterioration of all outcomes, which accelerated when the BMI increased from approximately 22–23 kg/m2. Moreover, overweight/obesity was significantly correlated with disc degeneration and Modic changes.
Conclusion
Increased BMI is significantly associated with spinal pathologies such as SVA, BES, paraspinal muscle mass, VAS, QOL, disc degeneration, and Modic changes. The findings suggest that measures for controlling overweight and obesity among older adults can play an important role in the prevention and treatment of spinal pathologies.
Similar content being viewed by others
References
Cabinet Office homepage. International trends in population ageing. https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/s1_1_2.html Accessed 1 February, 2022
Marques A, Peralta M, Naia A, Loureiro N, de Matos MG (2018) Prevalence of adult overweight and obesity in 20 european countries, 2014. Eur J Public Health 28:295–300. https://doi.org/10.1093/eurpub/ckx143
Arterburn DE, Crane PK, Sullivan SD (2004) The coming epidemic of obesity in elderly americans. J Am Geriatr Soc 52:1907–1912. https://doi.org/10.1111/j.1532-5415.2004.52517.x
Schaap LA, Koster A, Visser M (2013) Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev 35:51–65. https://doi.org/10.1093/epirev/mxs006
Artaud F, Singh-Manoux A, Dugravot A, Tavernier B, Tzourio C, Elbaz A (2016) Body mass index trajectories and functional decline in older adults: three-city dijon cohort study. Eur J Epidemiol 31:73–83. https://doi.org/10.1007/s10654-015-0027-4
Moradi-Lakeh M, Forouzanfar MH, Vollset SE et al (2017) Burden of musculoskeletal disorders in the eastern mediterranean region, 1990–2013: findings from the global burden of disease study 2013. Ann Rheum Dis 76:1365–1373. https://doi.org/10.1136/annrheumdis-2016-210146
GilmartinThomas JF, Cicuttini FM, Owen AJ, Wolfe R, Ernst ME, Nelson MR, Lockery J, Woods RL, Britt C, Liew D, Murray A, Workman B, Ward SA, McNeil JJ, ASPREE Investigator Group (2020) Moderate or severe low back pain is associated with body mass index amongst community-dwelling older Australians. Arch Gerontol Geriatr 13(91):104231. https://doi.org/10.1016/j.archger.2020.104231
Schuller S, Charles YP, Steib JP (2011) Sagittal spinopelvic alignment and body mass index in patients with degenerative spondylolisthesis. Eur Spine J 20:713–719. https://doi.org/10.1007/s00586-010-1640-2
Knutsson B, Sandén B, Sjödén G, Järvholm B, Michaëlsson K (2015) Body mass index and risk for clinical lumbar spinal stenosis: a cohort study. Spine (Phila Pa 1976) 40(18):1451–1456. https://doi.org/10.1097/BRS.0000000000001038
World Health Organization, International Association for the Study of Obesity & International Obesity Task Force (2000) The asia-pacific perspective: redefining obesity and its treatment. Health Communications, Sydney
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029. https://doi.org/10.1097/01.brs.0000179086.30449.96
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915
Fortin M, Battié MC (2012) Quantitative paraspinal muscle measurements: inter-software reliability and agreement using osiriX and ImageJ. Phys Ther 92:853–864. https://doi.org/10.2522/ptj.20110380
Griffith JF, Wang YX, Antonio GE, Choi KC, Alfred Yu, Ahuja AT, Leung PC (2007) Modified pfirrmann grading system for lumbar intervertebral disc degeneration. Spine 32(24):E708–E712. https://doi.org/10.1097/BRS.0b013e31815a59a0
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199. https://doi.org/10.1148/radiology.166.1.3336678
Toyoda H, Hoshino M, Ohyama S, Terai H, Suzuki A, Yamada K, Takahashi S, Hayashi K, Tamai K, Hori Y, Nakamura H (2019) The association of back muscle strength and sarcopenia-related parameters in the patients with spinal disorders. Eur Spine J 28:241–249. https://doi.org/10.1007/s00586-018-5858-8
Salimi H, Ohyama S, Terai H, Hori Y, Takahashi S, Hoshino M, Yabu A, Habibi H, Kobayashi A, Tsujio T, Kotake S, Nakamura H (2021) Trunk muscle mass measured by bioelectrical impedance analysis reflecting the cross-sectional area of the paravertebral muscles and back muscle strength: a cross-sectional analysis of a prospective cohort study of elderly population. J Clin Med 10:1187. https://doi.org/10.3390/jcm10061187
Xu X, Li X, Wu W (2015) Association between overweight or obesity and lumbar disk diseases: a meta-analysis. J Spinal Disord Tech 28:370–376. https://doi.org/10.1097/BSD.0000000000000235
Peng X, Li X, Xu Z, Wang L, Cai W, Yang S, Liao W, Cheng X (2020) Age-related fatty infiltration of lumbar paraspinal muscles: a normative reference database study in 516 chinese females. Quant Imaging Med Surg 10:1590–1601
Keller A, Johansen JG, Hellesnes J, Brox JI (1999) Predictors of isokinetic back muscle strength in patients with low back pain. Spine (Phila Pa 1976) 24:275–280. https://doi.org/10.1097/00007632-199902010-00016
Rodriguez-Martinez NG, Perez-Orribo L, Kalb S, Reyes PM, Newcomb AG, Hughes J, Theodore N, Crawford NR (2016) The role of obesity in the biomechanics and radiological changes of the spine: an in vitro study. J Neurosurg Spine 24:61–623. https://doi.org/10.3171/2015.7.SPINE141306
Konno S, Kikuchi S, Nagaosa Y (1994) The relationship between intramuscular pressure of the paraspinal muscles and low back pain. Spine (Phila Pa 1976) 19:2186–2189. https://doi.org/10.1097/00007632-199410000-00011
Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study Group (ISSG) (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812. https://doi.org/10.1097/BRS.0b013e318292b7b9
Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581. https://doi.org/10.1007/s00330-004-2314-4
WHO Expert Consultation (2004) Appropriate body-mass index for asian populations and its implications for policy and intervention strategies. Lancet 363:157–163. https://doi.org/10.1016/S0140-6736(03)15268-3
Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O (2005) Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 29:1011–1029. https://doi.org/10.1038/sj.ijo.0803005
Xu W, Zhang H, Paillard-Borg S, Zhu H, Qi X, Rizzuto D (2016) Prevalence of overweight and obesity among chinese adults: role of adiposity indicators and age. Obes Facts 9:17–28. https://doi.org/10.1159/000443003
Dunlevy C, MacLellan GA, O’Malley E, Blake C, Breen C, Gaynor K, Wallace N, Yoder R, Casey D, Mehegan J, Fullen BM, O’Shea D (2019) Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service. Eur J Pain 23:1403–1415. https://doi.org/10.1002/ejp.1397
Hageman PA, Mroz JE, Yoerger MA, Pullen CH (2019) Weight loss is associated with improved quality of life among rural women completers of a web-based lifestyle intervention. Plos One 14:e0225446. https://doi.org/10.1371/journal.pone.0225446
Acknowledgements
The authors thank Satomi Kawabata for assisting with data collection and conducting interviews with participants. The authors also express sincere thanks to the staff of Shiraniwa Hospital for their help in conducting the Shiraniwa Study.
Funding
This study was financially supported by a Japanese Orthopaedic Association Research Grant (2017–1).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
The study protocol was approved by the Osaka City University Ethics Committee (approval no. 3484). All participants provided written informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Takeuchi, Y., Takahashi, S., Ohyama, S. et al. Relationship between body mass index and spinal pathology in community-dwelling older adults. Eur Spine J 32, 428–435 (2023). https://doi.org/10.1007/s00586-022-07495-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-022-07495-2