The association between body fat and musculoskeletal pain: a systematic review and meta-analysis

Abstract

BackgroundObesity and musculoskeletal pain are strongly related, but there is emerging evidence that body fat, not body weight, may be a better indicator of risk. There is, therefore, a need to determine if body fat is associated with musculoskeletal pain as it may improve management strategies. The aim of this systematic review was to investigate the association between body fat and musculoskeletal pain.MethodsSeven electronic databases were searched from inception to 8th January 2018. Cross-sectional and longitudinal studies investigating the association between measures of body fat and musculoskeletal pain were included. All included articles were assessed for methodological rigour using the Epidemiology Appraisal Instrument. Standardised mean differences (SMDs) and effect estimates were pooled for meta-analysis.ResultsA total of 10,221 citations were identified through the database searching, which after abstract and full-text review, yielded 28 unique articles. Fourteen studies were included in the meta-analyses, which found significant cross-sectional associations between total body fat mass and widespread pain (SMD 0.49, 95% CI 0.37–0.61, p < 0.001). Individuals with low-back pain and knee pain had a higher body fat percentage than asymptomatic controls (SMD 0.34, 95% CI 0.17–0.52, p < 0.001 and SMD 0.18, 95% CI 0.05–0.32, p = 0.009, respectively). Fat mass index was significantly, albeit weakly, associated with foot pain (SMD 0.05, 95% CI 0.03–0.06, p < 0.001). Longitudinal studies (n = 8) were unsuitable for meta-analysis, but were largely indicative of elevated body fat increasing the risk of incident and worsening joint pain. There was conflicting evidence for an association between body fat percentage and incident low-back pain (3 studies, follow-up 4–20 years). Increasing knee pain (1 study) and incident foot pain (2 studies) were positively associated with body fat percentage and fat mass index. The percentage of items in the EAI graded as ‘yes’ for each study ranged from 23 to 85%, indicating variable methodological quality of the included studies.ConclusionsThis systematic review and meta-analysis identified positive cross-sectional associations between increased body fat and widespread and single-site joint pain in the low-back, knee and foot. Longitudinal studies suggest elevated body fat may infer increased risk of incident and worsening joint pain, although further high-quality studies are required.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2137-0) contains supplementary material, which is available to authorized users.

PROMIS Physical and Emotional Health Scores Are Worse in Musculoskeletal Patients Presenting to Physiatrists than to Other Orthopedic Specialists

“…For these patients, we believe the next level of care should be a multidisciplinary approach including services such as a refocused course of physical therapy with a subspecialist, acupuncture, myofascial massage, nutrition optimization, smoking cessation counseling, and/or cognitive behavioral therapy. All these services have a growing body of evidence to support their efficacy in addressing contributors of musculoskeletal pain . Our study results also support that patient complexity is influenced not only by clinical diagnosis but also by symptom burden and response to treatment, and equitable reimbursement based on patient complexity is essential so that providers can dedicate the time‐intensive expertise these patients require and deserve.…”

Circulating Levels of Visceral Adipose Tissue-Derived Serine Protease Inhibitor (Vaspin) Appear as a Marker of Musculoskeletal Pain Disability

“…Association of MSP manifestations with body composition characteristics were also repeatedly reported [ 30 , 31 , 32 , 33 ]. Body mass index (BMI) and other anthropometric measures of obesity were found to be associated with LBP intensity in both men and women [ 34 , 35 , 36 ], suggesting the involvement of AT in LBP pathogenesis.…”

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

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