Abstract
OBJECTIVES: To assess the risk of knee osteoarthritis (OA) attributable to obesity, and the interactions between obesity and other established causes of the disorder.
METHODS: We performed a population-based case–control study in three health districts of England (Southampton, Portsmouth and North Staffordshire). A total of 525 men and women aged 45 y and over, consecutively listed for surgical treatment of primary knee OA, were compared with 525 controls matched by age, sex and family practitioner.
RESULTS: Relative to a body mass index (BMI) of 24.0–24.9 kg/m2, the risk of knee OA increased progressively from 0.1 (95% CI 0.0–0.5) for a BMI<20 kg/m2 to 13.6 (95% CI 5.1–36.2) for a BMI of 36 kg/m2 or higher. If all overweight and obese people reduced their weight by 5 kg or until their BMI was within the recommended normal range, 24% of surgical cases of knee OA (95% CI 19–27%) might be avoided. As a risk factor for knee OA obesity interacted more than additively with each of Heberden's nodes, earlier knee injury and meniscectomy. In comparison with subjects of normal weight, without Heberden's nodes, and with no history of knee injury, people with a combination of obesity, definite Heberden's nodes and previous knee injury had a relative risk of 78 (95% CI 17–354).
CONCLUSIONS: Our findings give strong support to public health initiatives aimed at reducing the burden of knee OA by controlling obesity. People undergoing meniscectomy or with a history of knee injury might be a focus for targeted advice.
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Acknowledgements
This research was supported by a grant from the Arthritis Research Campaign and IR's post was funded by the Colt Foundation. We thank Syd Anstee, Trish Byng, Leslie Campbell, Gillian Latham and Gill Smith who carried out the fieldwork; Vanessa Cox and Graham Wield who supported the data handling and analysis; and Sue McIntosh who prepared the manuscript.
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Appendix 1
Appendix 1
The attributable proportion of cases due to an exposure is calculated as
where RRe is the relative risk of the exposed to the unexposed group (estimated by an odds ratio, ORe), Ce is the number of cases exposed and Ct is the total number of cases.
By using the function OR=(BMI/24)i where i=5.2 (4.2–6.3), we can calculate the individual OR for every subject for their actual weight vs their hypothetical reduced weight as:
where BMIak is the actual BMI for subject k and BMIrk is the reduced BMI for subject k made by reducing their weight. Then the attributable proportion of cases that might be eliminated by weight loss, using the above two equations is
That is the summation over all exposed (overweight or obese) cases.
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Coggon, D., Reading, I., Croft, P. et al. Knee osteoarthritis and obesity. Int J Obes 25, 622–627 (2001). https://doi.org/10.1038/sj.ijo.0801585
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DOI: https://doi.org/10.1038/sj.ijo.0801585
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