kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2018.18.3.119 kjhp-18-119 Original Article The Association of Low Back Pain with Obesity and Abdominal Obesity among Koreans Aged 50 Years or More ChoiEun Young Department of Family Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea ￭ Corresponding author: Eun Young Choi, MD, PhD Department of Family Medicine, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: +82-41-550-3998, Fax: +82-41-550-3998 E-mail: choiey0410@gmail.com 01 2018 10 01 2018 18 3 119 126 18052018 11092018 Copyright © 2018 The Korean Society of Health Promotion and Disease Prevention 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Both low back pain (LBP) and obesity are important public issues, but the association between them is controversial. This study was conducted to investigate the association of LBP with obesity and abdominal obesity among Koreans aged 50 years or more.

 Methods

This cross-sectional study analyzed data from participants aged 50 years or more (n=11,941) who measured height, weight and waist circumference and answered the questions about low back pain in the Korean National Health and Nutrition Examination Survey 2010–2013. To investigate the association of LBP with obesity and abdominal obesity, weighted univariate and multivariate logistic regression analyses were done after adjusting for socioeconomic variables and lifestyle variables.

 Results

The prevalence of LBP in men and women was 13.1% (standard error [SE], 0.6) and 31.0% (SE, 0.8), respectively, higher in women than men (P<0.001). For women only, abdominal obesity was significantly associated with an increased prevalence of LBP (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01–1.44) after adjustment of confounding variables, and the odds ratio of LBP in the highest quartile of waist circumference was higher compared to the lowest quartile of waist circumference (OR 1.30, 95% CI 1.02–1.66). For men abdominal obesity was not associated with an increased prevalence of LBP. There were no associations between obesity and LBP in both men and women.

 Conclusions

This population-based, nationally representative study suggests that abdominal obesity increases the risk of LBP in women aged 50 years or more.

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Characteristics of participants according to the low back pain by gender

Variable Men (5,075) Women (6,866)
LBP (−) LBP (+) P LBP (−) LBP (+) P
Proportion 86.9 (0.6) 13.1 (0.6)   69.0 (0.8) 31.0 (0.8)  
Age 61.0±0.2 64.1±0.5 <0.001 61.3±0.2 66.9±0.3 <0.001
BMI (kg/m2) 23.9±0.1 23.5±0.1 <0.001 24.2±0.1 24.4±0.1 0.031
BMI group     0.006     0.092
   <18.5 2.7 (3.5) 3.5 (0.7)   2.2 (0.3) 2.7 (0.5)  
   18.5–25 63.2 (0.9) 69.0 (2.2)   61.7 (0.9) 58.2 (1.3)  
   ≥25 34.1 (0.9) 27.5 (2.0)   36.1 (0.9) 39.1 (1.3)  
Waist circumference (cm) 85.1±0.2 85.0±0.3 0.787 81.3±0.2 83.3±0.3 <0.001
Abdominal obesitya     0.678     <0.001
   No 72.1 (0.8) 71.3 (2.0)   67.0 (0.9) 58.0 (1.3)  
   Yes 27.9 (0.8) 28.7 (2.0)   33.0 (0.9) 42.0 (1.3)  
Educationb     <0.001     <0.001
   Elementary 28.0 (0.9) 43.1 (2.3)   50.2 (1.0) 74.8 (1.2)  
   Middle 20.3 (0.8) 21.4 (1.9)   19.0 (0.7) 12.3 (0.9)  
   High 32.8 (1.0) 23.5 (2.0)   23.3 (0.8) 10.4 (0.8)  
   University 18.9 (0.8) 12.0 (1.6)   7.5 (0.5) 2.5 (0.4)  
Physical activityc     0.646     <0.001
   1st quartile 28.7 (0.8) 29.9 (2.1)   29.2 (0.9) 37.0 (1.4)  
   2nd quartile 23.9 (0.7) 21.1 (1.9)   23.3 (0.8) 19.8 (1.1)  
   3rd quartile 23.0 (0.8) 23.7 (2.0)   24.1 (0.8) 19.0 (1.0)  
   4th quartile 24.4 (0.9) 25.2 (1.1)   23.4 (0.8) 24.2 (1.2)  
Smoking     0.314     0.475
   No 65.1 (0.9) 62.5 (2.3)   95.7 (0.4) 95.2 (0.6)  
   Yes 34.9 (0.9) 37.5 (2.3)   4.3 (0.4) 4.8 (0.6)  
Monthly drinking     0.011     <0.001
   No 29.8 (0.9) 35.4 (2.2)   71.1 (0.8) 77.3 (1.1)  
   Yes 70.2 (0.9) 64.6 (2.2)   28.9 (0.8) 22.7 (1.1)  
Occupation     <0.001     <0.001
   White collar 43.2 (1.1) 33.2 (2.3)   50.8 (1.1) 33.6 (1.4)  
   Blue collar 56.8 (1.1) 66.8 (2.3)   49.2 (1.1) 66.4 (1.4)  

Abbreviations: LBP, low back pain; BMI, body mass index; MET, metabolic equivalent. Values are presented as mean±standard error (SE) or % (SE). P-value by weighted chi-square test or t-test.

Defined by waist circumference ≥90 cm in male or ≥85 cm in female.

Ptrend <0.001 for male.

Defined by sum of the MET-minutes/week=sum of walking+moderate physical activity+vigorous physical activity MET-minutes/week scores.

Factors associated with low back pain

Variable Men Women
OR (95% CI) aORa (95% CI) OR (95% CI) aORa (95% CI)
Age (per year) 1.04 (1.03–1.05)b 1.03 (1.02–1.04)b 1.06 (1.06–1.07)b 1.05 (1.04–1.05)b
BMI group        
   <18.5 kg/m2 1 1 1 1
   18.5–25 kg/m2 0.83 (0.53–1.30) 1.04 (0.67–1.61) 0.79 (0.50–1.23) 1.09 (0.68–1.76)
   ≥25 kg/m2 0.61 (0.39–0.95)b 0.74 (0.45–1.21) 0.90 (0.58–1.41) 1.07 (0.65–1.76)
Abdominal obesityc        
   Yes 1.04 (0.86–1.27) 1.30 (0.99–1.70) 1.47 (1.31–1.66)b 1.20 (1.01–1.44)b
Education        
   Elementary 1 1 1 1
   Middle 0.68 (0.52–0.88)b 0.82 (0.62–1.08) 0.43 (0.36–0.52)b 0.64 (0.52–0.79)b
   High 0.46 (0.37–0.59)b 0.58 (0.44–0.76)b 0.30 (0.25–0.37)b 0.53 (0.42–0.68)b
   University 0.41 (0.30–0.57)b 0.56 (0.39–0.82)b 0.22 (0.15–0.31)b 0.46 (0.31–0.68)b
Physical activityd        
   1st quartile 1 1 1 1
   2nd quartile 0.85 (0.64–1.11) 0.86 (0.66–1.11) 0.67 (0.60–0.80)b 0.83 (0.69–1.00)b
   3rd quartile 0.99 (0.76–1.29) 0.79 (0.58–1.07) 0.62 (0.52–0.74)b 0.68 (0.56–0.84)b
   4th quartile 0.99 (0.75–1.32) 0.86 (0.66–1.13) 0.81 (0.69–0.96)b 0.69 (0.56–0.85)b
Smoking        
   Yes 1.10 (0.89–1.37) 1.20 (0.96–1.51) 1.12 (0.82–1.53) 1.28 (0.92–1.78)
Monthly drinking        
   Yes 0.77 (0.63–0.94) 0.89 (0.72–1.10) 0.72 (0.62–0.84) 0.93 (0.79–1.10)
Occupation        
   White collar 1 1 1 1
   Blue collar 1.54 (1.25–1.89)b 1.16 (0.90–1.48) 2.04 (1.78–2.34)b 1.30 (1.12–1.52)b

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index; MET, metabolic equivalent.

Calculated by multiple logistic regression analysis mutually adjusted for all variables shown.

P<0.05.

Defined by waist circumference ≥90 cm in male or ≥85 cm in female.

Defined by sum of the MET-minutes/week=sum of walking+moderate physical activity+vigorous physical activity MET-minutes/week scores.

Prevalence and adjusted odds ratio of low back pain according to the quartiles of waist circumference by gender

  Prevalence (%) ORa (95% CI)
Quartile of waist circumference in male (cm)    
   <79.8 13.5 (1.1) 1 (ref.)
   79.8–85.3 13.8 (1.1) 1.22 (0.92–1.60)
   85.4–90.7 11.8 (1.1) 1.14 (0.85–1.53)
   >90.7 13.5 (1.1) 1.49 (1.05–2.12)
   P 0.541 0.135
   Ptrend 0.533 0.061
Quartile of waist circumference in female (cm)    
   <75.7 27.4 (1.3) 1 (ref.)
   75.7–81.7 27.2 (1.3) 0.93 (0.76–1.14)
   81.8–87.9 31.9 (1.4) 1.15 (0.93–1.42)
   >87.9 37.7 (1.4) 1.30 (1.02–1.66)
   P <0.001 0.043
   Ptrend <0.001 0.019

Abbreviations: OR, odds ratio; CI, confidence interval; ref., reference.

Assessed by multiple logistic regression analysis adjusted for age, education, physical activity, smoking, monthly dinking, job, obesity group.