Body composition, functional limitations, and pain in patients with knee osteoarthritis and low back pain
DOI:
https://doi.org/10.11606/issn.2317-0190.v32i3a240496Keywords:
Musculoskeletal Diseases, Osteoarthritis, Knee, Low Back Pain, Body Weight, Body Mass Index, Physical Functional PerformanceAbstract
Objective: To verify the association between body composition (lean mass, fat mass, and body mass index – BMI), functional capacity, and pain perception in individuals with knee osteoarthritis (OA), chronic low back pain, or both. Method: Cross-sectional study with 113 participants recruited from a university outpatient clinic, divided into groups: low back pain (n= 42), OA (n= 33), and low back pain + OA (n= 38). Body composition (BMI, bioelectrical impedance), functional mobility (Timed Up and Go – TUG), pain, stiffness and function (WOMAC), lumbar functionality (Roland Morris), and pain intensity (Visual Analog Scale – VAS) were assessed. Statistical analysis was performed using Pearson correlation with p ≤ 0.05. Results: Mean values for pain, BMI, body composition, and functionality were similar between groups. In the OA group, a weak association was found between BMI and Roland Morris. In the low back pain group, there was a moderate correlation between BMI and WOMAC stiffness and a weak correlation between lean mass and TUG. Fat mass showed a moderate correlation with Roland Morris. In the low back pain + OA group, weak correlations were observed between BMI and VAS/WOMAC stiffness, and moderate correlations between BMI and WOMAC physical activity/total and TUG. Conclusion: Increased BMI and fat mass are associated with worse functionality and mobility, especially in individuals with both clinical conditions.
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff- Ferrari HA, Boonen A, et al. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open. 2022;8(1):e002168. Doi: https://doi.org/10.1136/rmdo-pen-2021-002168
Zeddou M. Osteoarthritis Is a Low-Grade Inflammatory Disease: Obesity's Involvement and Herbal Treatment. Evid Based Complement Alternat Med. 2019;2019:2037484. Doi: https://doi.org/10.1155/2019/2037484
BD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329. Doi: https://doi.org/10.1016/S2665-9913(23)00098-X
Nopsopon T, Suputtitada A, Lertparinyaphorn I, Pongpirul K. Nonoperative treatment for pain sensitization in patients with low back pain: protocol for a systematic review. Syst Rev. 2022;11(1):59. Doi: https://doi.org/10.1186/s13643-022-01927-2
Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. Doi: https://doi.org/10.1002/14651858.CD009790.pub2
Joaquim AF, Helvie P, Patel AA. Bariatric Surgery and Low Back Pain: A Systematic Literature Review. Global Spine J. 2020;10(1):102-110. Doi: https://doi.org/10.1177/2192568219826935
Verdú E, Homs J, Boadas-Vaello P. Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle- Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise. Int J Environ Res Public Health. 2021;18(24):13333. Doi: https://doi.org/10.3390/ijerph182413333
GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. Doi: https://doi.org/10.1016/S2665-9913(23)00163-7
Alfieri FM, Silva NCOVE, Battistella LR. Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis. Einstein (Sao Paulo). 2017;15(3):307-312. Doi: https://doi.org/10.1590/S1679-45082017AO4082
Chen LH, Weber K, Mehrabkhani S, Baskaran S, Abbass T, Macedo LG. The effectiveness of weight loss programs for low back pain: a systematic review. BMC Musculoskelet Disord. 2022;23(1):488. Doi: https://doi.org/10.1186/s12891-022-05391-w
Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol. 2021;320(3):C375-C391. Doi: https://doi.org/10.1152/aj-pcell.00379.2020
Holmes CJ, Racette SB. The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology. Nutrients. 2021;13(8):2493. Doi: https://doi.org/10.3390/nu13082493
Chapman CR, Syrjala KL. Measurement of pain. In: Bonica JJ, ed. The Management of Pain. 2nd ed. London: Lea & Febiger; 1990:580–594.
Ward LC, Brantlov S. Bioimpedance basics and phase angle fundamentals. Rev Endocr Metab Disord. 2023;24(3):381-391. Doi: https://doi.org/10.1007/s11154-022-09780-3
Campa F, Toselli S, Mazzilli M, Gobbo LA, Coratella G. Assessment of Body Composition in Athletes: A Narrative Review of Available Methods with Special Reference to Quantitative and Qualitative Bioimpedance Analysis. Nutrients. 2021;13(5):1620. Doi: https://doi.org/10.3390/nu13051620
Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. Doi: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-40.
Fernandes MI. Tradução e validação do questionário de QV específico para osteoartrose WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index – para a língua portuguesa [Dissertação]. São Paulo: Universidade Federal de São Paulo; 2002.
Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976). 1983;8(2):141-4. Doi: https://doi.org/10.1097/00007632-198303000-00004
Júnior JJS, Nicholas MK, Pimenta CAM, Asghari A, Thieme AL. Validação do Questionário de Incapacidade Roland Morris para dor em geral. Rev Dor. 2010;11(1):28-36.
Saludes R, Acevedo P, García IZ, Gómez Carrión Á, Martínez Sebastián C, Núñez Fernández A, et al. Abdominal adiposity increases lordosis and doubles the risk of low back pain. Appl Sci. 2022;12(15):7616. Doi: https://doi.org/10.3390/app12157616
Sampath SJP, Venkatesan V, Ghosh S, Kotikalapudi N. Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review. Curr Obes Rep. 2023;12(3):308-331. Doi: https://doi.org/10.1007/s13679-023-00520-5
Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005;17(2):134-40. Doi: https://doi.org/10.1097/01.bor.0000154215.08986.06
Nitecki M, Shapiro G, Orr O, Levitin E, Sharshevsky H, Tzur D, et al. Association Between Body Mass Index and Nonspecific Recurrent Low Back Pain in Over 600,000 Healthy Young Adults. Am J Epidemiol. 2023;192(8):1371-1378. Doi: https://doi.org/10.1093/aje/kwad102
Browne W, Nair BKR. The Timed Up and Go test. Med J Aust. 2019;210(1):13-14.e1. Doi: https://doi.org/10.5694/mja2.12045
Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther. 2006;29(2):64-8. Doi: https://doi.org/10.1519/00139143-200608000-00004
Gomes-Neto M, Araujo AD, Junqueira ID, Oliveira D, Brasileiro A, Arcanjo FL. Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoarthritis. Rev Bras Reumatol Engl Ed. 2016;56(2):126-30. Doi: https://doi.org/10.1016/j.rbre.2015.08.014
Johnson AJ, Peterson JA, Vincent HK, Manini T, Cruz-Almeida Y. Body composition and body mass index are independently associated with widespread pain and experimental pain sensitivity in older adults: a pilot investigation. Front Pain Res (Lausanne). 2024;5:1386573. Doi: https://doi.org/10.3389/fpain.2024.1386573
Moonen HPFX, Van Zanten ARH. Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness. Curr Opin Crit Care. 2021;27(4):344-353. Doi: https://doi.org/10.1097/MCC.0000000000000840
Prokopidis K, Giannos P, Katsikas Triantafyllidis K, Kechagias KS, Mesinovic J, Witard OC, et al. Effect of vitamin D monotherapy on indices of sarcopenia in community-dwelling older adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(3):1642-1652. Doi: https://doi.org/10.1002/jcsm.12976
Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly. Rev Bras Fisioter. 2012;16(5):381- 8. Doi: https://doi.org/10.1590/s1413-35552012005000041
Brady SRE, Urquhart DM, Hussain SM, Teichtahl A, Wang Y, Wluka AE, et al. High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults. Arthritis Res Ther. 2019;21(1):165. Doi: https://doi.org/10.1186/s13075-019-1953-4
Weir CB, Jan A. BMI Classification Percentile and Cut Off Points. StatPearls [monograph on the Internet]. Treasure Island (FL): StatPearls; 2024 [cited 2025 Jun 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/
Walsh TP, Arnold JB, Evans AM, Yaxley A, Damarell RA, Shanahan EM. The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19(1):233. Doi: https://doi.org/10.1186/s12891-018-2137-0
Larsson SC, Burgess S. Causal role of high body mass index in multiple chronic diseases: a systematic review and meta-analysis of Mendelian randomization studies. BMC Med. 2021;19(1):320. Doi: https://doi.org/10.1186/s12916-021-02188-x
Hirano K, Imagama S, Hasegawa Y, Ito Z, Muramoto A, Ishiguro N. Impact of low back pain, knee pain, and timed up-and-go test on quality of life in community-living people. J Orthop Sci. 2014;19(1):164-71. Doi: https://doi.org/10.1007/s00776-013-0476-0
Ward SJ, Coates AM, Carter S, Baldock KL, Berryman C, Stanton TR, et al. Effects of weight loss through dietary intervention on pain characteristics, functional mobility, and inflammation in adults with elevated adiposity. Front Nutr. 2024;11:1274356. Doi: https://doi.org/10.3389/fnut.2024.1274356
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