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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



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.


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).


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.


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.


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


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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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).

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