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Epidemiology and Population Health

Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort

International Journal of Obesity (2023)Cite this article

Subjects

Abstract

Background/Objective

Knee pain is an important health problem due to its high prevalence, negative impact on daily activities and quality of life, and societal burden. While the link between excess weight and knee pain has been well-documented in the literature, many studies are limited to patients with osteoarthritis or use cross-sectional data. This longitudinal study investigated whether overweight and obesity were associated with the frequency and severity of frequent knee pain (FKP) episodes over 4 years in civil servants enrolled in the ELSA-Brasil MSK cohort.

Methods

Knee pain was assessed during baseline face-to-face interviews (2012–2014) and four yearly telephone follow-ups (2015–2019). Disabling FKP episodes or those of moderate to very severe intensity were classified as severe. Multinomial logistic regression models adjusted for confounders were used to test for associations in two participant groups: those with knee pain at baseline (prognosis cohort) and those without knee pain (incidence cohort).

Results

A total of 2644 participants were included: 54.2% female, mean age 55.8 (SD 8.8) years. In the incidence cohort (n = 1896), obesity increased the risk of one (OR: 1.63; 95% CI 1.13–2.37) and multiple FKP episodes (OR: 2.61; 95% CI 1.71–3.97), as well as the risk of non-severe (OR: 1.72; 95% CI 1.04–2.84) and severe FKP episodes (OR: 2.10; 95% CI 1.50–2.95). In the prognosis cohort (n = 748), obesity increased the risk of multiple (OR: 2.54; 95% CI 1.60–4.05) and severe FKP episodes (OR: 2.31; 95% CI 1.49–3.59). Overweight presented the same trends but fell short of significance.

Conclusions

These results provide further support that overweight and obesity are important contributors to the incidence and worsening of FKP, and that weight management must be prioritized in multidisciplinary knee pain prevention and treatment programs to reduce the burden of musculoskeletal disorders.

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Fig. 1: Flowchart of participants included in the analysis.
Fig. 2: Distribution of the number and severity of frequent knee pain episodes, ELSA-Brasil MSK (2015–2019). N = 2644.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–22. https://doi.org/10.1016/S0140-6736(20)30925-9.

    Article  Google Scholar 

  2. GBD 2019 Diseases and Injuries Collaborators. Musculoskeletal disorders-Level 2 cause. https://www.healthdata.org/results/gbd_summaries/2019/musculoskeletal-disorders-level-2-cause. Accessed 13 Feb 2023.

  3. Fernandes GS, Bhattacharya A, McWilliams DF, Ingham SL, Doherty M, Zhang W. Risk prediction model for knee pain in the Nottingham community: a Bayesian modelling approach. Arthritis Res Ther. 2017;19:59. https://doi.org/10.1186/s13075-017-1272-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ayis S, Dieppe P. The natural history of disability and its determinants in adults with lower limb musculoskeletal pain. J Rheumatol. 2009;36:583–91. https://doi.org/10.3899/jrheum.080455.

    Article  PubMed  Google Scholar 

  5. Leyland KM, Gates LS, Nevitt M, Felson D, Bierma-Zeinstra SM, Conaghan PG, et al. Harmonising measures of knee and hip osteoarthritis in population-based cohort studies: an international study. Osteoarthritis Cartilage. 2018;26:872–9. https://doi.org/10.1016/j.joca.2018.01.024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Bindawas SM, Vennu V. Longitudinal effects of physical inactivity and obesity on gait speed in older adults with frequent knee pain: data from the Osteoarthritis Initiative. Int J Environ Res. Public Health. 2015;12:1849–63. https://doi.org/10.3390/ijerph120201849.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15:288–98. https://doi.org/10.1038/s41574-019-0176-8.

    Article  PubMed  Google Scholar 

  8. Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: a systematic review. Int J Obes (Lond). 2020;44:969–79. https://doi.org/10.1038/s41366-019-0505-y.

    Article  PubMed  Google Scholar 

  9. Jinks C, Jordan K, Croft P. Disabling knee pain – another consequence of obesity: results from a prospective cohort study. BMC Public Health. 2006;6:258. https://doi.org/10.1186/1471-2458-6-258.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tanamas SK, Wluka AE, Davies-Tuck M, Wang Y, Strauss BJ, Proietto J, et al. Association of weight gain with incident knee pain, stiffness, and functional difficulties: a longitudinal study. Arthritis Care Res. (Hoboken). 2013;65:34–43. https://doi.org/10.1002/acr.21745.

    Article  PubMed  Google Scholar 

  11. Cooper L, Ryan CG, Ells LJ, Hamilton S, Atkinson G, Cooper K, et al. Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review. Obes Rev. 2018;19:989–1007. https://doi.org/10.1111/obr.12686.

    Article  CAS  PubMed  Google Scholar 

  12. Felisbino-Mendes MS, Cousin E, Malta DC, Machado ÍE, Ribeiro ALP, Duncan BB, et al. The burden of non-communicable diseases attributable to high BMI in Brazil, 1990–2017: findings from the Global Burden of Disease Study. Popul Health Metr. 2020;18:18. https://doi.org/10.1186/s12963-020-00219-y.

    Article  PubMed  PubMed Central  Google Scholar 

  13. IBGE. Pesquisa nacional de saúde: 2019: atenção primária à saúde e informações antropométricas: Brasil. Instituto Brasileiro de Geografia e Estatística, Coordenação de Trabalho e Rendimento. Rio de Janeiro: IBGE, 2020; https://biblioteca.ibge.gov.br/visualizacao/livros/liv101758.pdf.

  14. Costa ABP, Machado LAC, Telles RW, Barreto SM. Dose–response associations of clinical markers of obesity and duration of exposure to excess weight with chronic musculoskeletal pain: cross-sectional analysis at baseline of ELSA-Brasil Musculoskeletal cohort. Rheumatol Int. 2020;40:881–91. https://doi.org/10.1007/s00296-020-04557-w.

    Article  PubMed  Google Scholar 

  15. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23:507–15. https://doi.org/10.1016/j.joca.2014.11.019.

    Article  CAS  PubMed  Google Scholar 

  16. Aquino EM, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan BB, et al. Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175:315–24. https://doi.org/10.1093/aje/kwr294.

    Article  PubMed  Google Scholar 

  17. Telles RW, Machado LAC, Costa-Silva L, Barreto SM. Cohort profile update: the Brazilian longitudinal study of adult health musculoskeletal (ELSA-Brasil MSK) cohort. Int J Epidemiol. 2022;51:391. https://doi.org/10.1093/ije/dyac084.

    Article  Google Scholar 

  18. Schmidt MI, Griep RH, Passos VM, Luft VC, Goulart AC, Menezes GM, et al. Strategies and development of quality assurance and control in the ELSA-Brasil. Rev Saude Publica. 2013;47:105–12. https://doi.org/10.1590/s0034-8910.2013047003889.

    Article  PubMed  Google Scholar 

  19. World Health Organisation (WHO). Physical Status: the use and interpretation of anthropometry. WHO Technical Report Series 854, Geneva 1995.

  20. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90:139–47. https://doi.org/10.1016/j.mayocp.2014.09.010.

    Article  PubMed  Google Scholar 

  21. Larsson B, Bjork J, Borsbo B, Gerdle B. A systematic review of risk factors associated with transitioning from regional musculoskeletal pain to chronic widespread pain. Eur J Pain. 2012;16:1084–93.

    Article  CAS  PubMed  Google Scholar 

  22. World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report. 1997.

  23. Wei L, Wu B. Racial and ethnic differences in obesity and overweight as predictors of the onset of functional impairment. J Am Geriatr Soc. 2014;62:61–70. https://doi.org/10.1111/jgs.12605.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Autor DH, Levy F, Murnane RJ. The skill content of recent technological change: an empirical exploration. Q J Econ. 2003;118:1279–333.

    Article  Google Scholar 

  25. Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2001;6:5–18.

    Google Scholar 

  26. Nunes MA, Alves MGM, Chor D, Schmidt MI, Duncan BB. Adaptação transcultural do CIS-R (Clinical Interview Schedule- Revised version) para o português no Estudo Longitudinal de Saúde do Adulto (ELSA). Rev HCPA. 2011;31:515–8.

    Google Scholar 

  27. Haukka E, Ojajarvi A, Takala EP, Viikari-Juntura E, Leino-Arjas P. Physical workload, leisure-time physical activity, obesity and smoking as predictors of multisite musculoskeletal pain. A 2-year prospective study of kitchen workers. Occup Environ Med. 2012;69:485–92. https://doi.org/10.1136/oemed-2011-100453.

    Article  PubMed  Google Scholar 

  28. Mundal I, Grawe RW, Bjorngaard JH, Linaker OM, Fors EA. Psychosocial factors and risk of chronic widespread pain: an 11-year follow-up study–the HUNT study. Pain. 2014;155:1555–61. https://doi.org/10.1016/j.pain.2014.04.033.

    Article  PubMed  Google Scholar 

  29. Bindawas SM. Relationship between frequent knee pain, obesity, and gait speed in older adults: data from the Osteoarthritis Initiative. Clin Interv Aging. 2016;11:237–44. https://doi.org/10.2147/cia.s100546.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Choi HK, Nguyen US, Niu J, Danaei G, Zhang Y. Selection bias in rheumatic disease research. Nat Rev Rheumatol. 2014;10:403–12. https://doi.org/10.1038/nrrheum.2014.36.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bonakdar RA. Obesity-related pain: time for a new approach that targets systemic inflammation. J Fam Pract. 2013;62:S22–9.

    PubMed  Google Scholar 

  32. Walsh TP, Arnold JB, Evans AM, Yaxley A, Damarell RA, Shanahan M. The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19:949. https://doi.org/10.1186/s12891-018-2137-0.

    Article  Google Scholar 

  33. Marchand F, Perreti M, Macmahon SB. Role of the immune system in chronic pain. Nat Rev Neurosci. 2005;6:521–32. https://doi.org/10.1038/nrn1700.

    Article  CAS  PubMed  Google Scholar 

  34. Harte SE, Harris RE, Clauw DJ. The neurobiology of central sensitization. J Appl Behav Res. 2018;23:S53. https://doi.org/10.1111/jabr.12137.

    Article  Google Scholar 

  35. Stefanik JJ, Felson DT, Apovian CM, Niu J, Margaret Clancy M, LaValley MP, et al. Changes in pain sensitization after bariatric surgery. Arthritis Care Res (Hoboken). 2018;70:1525–8. https://doi.org/10.1002/acr.23513.

    Article  PubMed  Google Scholar 

  36. Li JS, Tsai TY, Clancy MM, Li G, Lewis CL, Felson DT. Weight loss changed gait kinematics in individuals with obesity and knee pain. Gait Posture. 2019;68:461–5. https://doi.org/10.1016/j.gaitpost.2018.12.031.

    Article  PubMed  Google Scholar 

  37. Richiardi L, Pizzi C, Pearce N. Commentary: representativeness is usually not necessary and often should be avoided. Int J Epidemiol. 2013;42:1018e22. https://doi.org/10.1093/ije/dyt103.

    Article  Google Scholar 

  38. Rothman KJ, Gallacher JEJ, Hatch E. Why representativeness should be avoided. Int J Epidemiol. 2013;42:1012e4. https://doi.org/10.1093/ije/dys223.

    Article  Google Scholar 

  39. Machado LAC, Telles RW, Benseñor IM, Barreto SM. Prevalence of pain and associated factors in Brazilian civil servants: an introductory analysis using baseline data from the ELSA-Brasil cohort. Pain Rep. 2019;4:797 https://doi.org/10.1097/pr9.0000000000000797.

    Article  Google Scholar 

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Acknowledgements

We would like to thank the staff and participants of ELSA-Brasil MSK.

Funding

ELSA-Brasil was supported by Ministério da Saúde Brasil (BR), Secretaria de Ciência Tecnologia e Insumos Estratégicos (BR), Ministério da Ciência e Tecnologia (BR), Departamento de Ciência e Tecnologia (Decit-BR), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq-BR), Financiadora de Estudos e Projetos (FINEP-BR) and by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-BR). ELSA-Brasil MSK was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-BR), Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) (APQ-00921-16 and APQ-00549-22) and CNPq-BR (423585/2016-9 and 404728/2021-9). Dr Sandhi M. Barreto is a research fellow of CNPq-BR and of FAPEMIG. Aline A.B. Costa was a PhD candidate, both supported by CAPES-BR (Finance Code 001). The authors are solely responsible for the content of the manuscript and the decision to submit for publication. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Post-graduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Aline Bárbara Pereira Costa

  2. Hospital das Clínicas/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Luciana A. C. Machado & Sandhi Maria Barreto

  3. Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Rosa Weiss Telles

  4. Rheumatology Service, Hospital das Clínicas/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Rosa Weiss Telles

  5. Department of Preventive Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Sandhi Maria Barreto

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  1. Aline Bárbara Pereira Costa
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Contributions

ABPC, LACM, RWT and SMB contributed to the study conception and design; ABPC, RWT and SMB contributed to the analysis and interpretation of data; ABPC drafted the first version of the article; LACM, RWT and SMB revised critically the article content. All authors approved of the final version of the manuscript.

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Correspondence to Sandhi Maria Barreto.

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Costa, A.B.P., Machado, L.A.C., Telles, R.W. et al. Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort. Int J Obes (2023). https://doi.org/10.1038/s41366-023-01383-5

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