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Pediatrics

Obesity and overweight as risk factors for low back pain in children and adolescents: a meta-analysis

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Background

Childhood obesity and overweight are associated with musculoskeletal pain, but the association between low back pain (LBP) and overweight/obesity in this population needs clarification. The objective of this meta-analysis is to ascertain the relationship between LBP and obesity/overweight in children and adolescents.

Methods

Various databases and specialized journals were queried from inception to October 2022. Encompassed were all studies examining the association between overweight or obesity and LBP among participants aged 6 to 18 years. The ROBINS-E tool was employed to assess bias. Random-effects models were used to pool results across studies, with location-scale models used to search for moderator variables where evidence of heterogeneity was found.

Results

In total, 34 studies were incorporated. Four studies had a low risk of bias, while the remaining studies had some concerns. Nine studies evinced an association between overweight and LBP, in contrast to normal weight, yielding an OR of 1.13 (95% CI 1.10–1.16) and no heterogeneity. Eight studies demonstrated a similar association between obesity and LBP compared to normal weight, with an OR of 1.27 (95% CI 1.20–1.34) and no heterogeneity. Ten studies established an association between overweight/obesity and LBP compared to normal weight, yielding an OR of 1.18 (95% CI 1.14–1.23) and no heterogeneity. Finally, nineteen studies showcased an association between body mass index (BMI) and LBP, with an OR of 1.19 (95% CI 1.03–1.39) with evidence of heterogeneity. For this last analysis, we compared the mean BMI in groups and transformed results to log OR, and then retransformed to OR.

Conclusion

Overweight and obesity may be risk factors for LBP in children and adolescents. The association between LBP and obesity appears to be stronger than with overweight. However, the analysis revealed considerable heterogeneity and risk of bias across studies.

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Fig. 1: PRISMA flow diagram.
Fig. 2: Overweight and LBP association forest plot and funnel plot.
Fig. 3: Obese and LBP association forest plot and funnel plot.
Fig. 4: Overweight-obesity and LBP association forest plot and funnel plot.
Fig. 5: BMI and LBP association forest plot and funnel plot.

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Funding

Funding

This work was supported by Agencia Estatal de Investigación (Government of Spain; PID2019-104033GA-I00/MCIN/AEI/10.13039/50110 00110 33) and by the Regional Program for the Promotion of Scientific and Technical Research of Excellence (Action Plan 2022) of the Seneca Foundation - Science and Technology Agency of the Region of Murcia (grant no. 22064/PI/22).

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Authors and Affiliations

  1. International School of Doctoral Studies, University of Murcia, Murcia, Spain

    José Manuel García-Moreno

  2. Dept. of Physiotherapy, UCAM Catholic University of Murcia, Murcia, Spain

    Inmaculada Calvo-Muñoz

  3. Research Group Research Methods and Evaluation in Social Sciences. Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, Spain

    Antonia Gómez-Conesa & José Antonio López-López

  4. Dept. of Basic Psychology and Methodology, University of Murcia, Murcia, Spain

    José Antonio López-López

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Contributions

All authors contributed to the conception and design, acquisition, analysis and interpretation of data and drafting of the manuscript. JGM, ICM and AGC carried out the systematic review. JGM and JLL performed the statistical analyses. JGM wrote a first full draft of the manuscript. All authors participated in the critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to José Manuel García-Moreno.

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García-Moreno, J.M., Calvo-Muñoz, I., Gómez-Conesa, A. et al. Obesity and overweight as risk factors for low back pain in children and adolescents: a meta-analysis. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01475-w

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