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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

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Abstract

The objective of this study is to investigate the association of clinical markers of obesity and weight trajectories with chronic musculoskeletal pain (CMP). This is a cross-sectional study using baseline data from ELSA-Brasil MSK cohort. CMP was evaluated at nine body sites (neck, shoulders, upper back, elbows, lower back, wrists/hands, hips/thighs, knees, ankles/feet), and defined as pain lasting > 6 months in the past year. General and abdominal obesity levels were classified according to accepted cut-offs for body mass index (BMI), waist circumference (WC) and waist–height ratio (WHtR). Binomial and multinomial logistic regressions tested for associations with CMP at any site, at ≥ 3 sites (multisite) and in upper + lower limbs + axial skeleton (generalized). A total of 2899 participants (mean age 56.0 ± 8.93) were included, 55.0% reported CMP, 19.1% had multisite, and 10.3% had generalized CMP. After adjustments for sex, age, education, physical activity and depressive symptoms, nearly all the investigated markers of obesity were associated with any CMP, multisite and generalized CMP, with strongest associations being observed for general obesity level II/III: OR 2.08 (95% CI 1.45–2.99), OR 3.19 (95% CI 2.06–4.94) and OR 3.65 (2.18–6.11), respectively. Having excess weight currently or both at age 20 and currently was also associated with all CMP presentations. Associations of greater magnitude were consistently observed at higher obesity levels and longer exposures to excess weight (dose–response). These results may support the contribution of obesity-derived mechanical and inflammatory mechanisms of CMP, and indicate a role for the accumulation of exposure to excess weight across the adult life course.

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Acknowledgements

We would like to thank the staff and participants of ELSA-Brasil MSK. We would also like to thank Douglas R.M. Azevedo for his support in building Venn diagrams.

Funding

ELSA-Brasil has been supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos and CNPq-BR), Grants 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ. ELSA-Brasil MSK has been supported by CAPES-BR (Grant pós-doc/SUS 054/2010), FAPEMIG-BR (Grant APQ-00921-16) and CNPq-BR (Grant 42358520169). The investigation was carried out while Dr. Luciana A.C. Machado was a Postdoctoral Fellow and MSc. Aline A.B. Costa was a PhD candidate, both supported by CAPES-BR (Finance Code 001). 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. Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena n. 190, Funcionários, Belo Horizonte, MG, 30130-100, Brazil

    Aline B. P. Costa, Rosa W. Telles & Sandhi M. Barreto

  2. Clinica Hospital, UFMG, Belo Horizonte, MG, Brazil

    Luciana A. C. Machado, Rosa W. Telles & Sandhi M. Barreto

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  1. Aline B. P. Costa
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  2. Luciana A. C. Machado
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Contributions

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

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Correspondence to Sandhi M. Barreto.

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Ethical approval

This study used data from ELSA-Brasil and its ancillary musculoskeletal cohort, ELSA-Brasil MSK. ELSA-Brasil was approved by the National Committee for Ethics in Research (Comissão Nacional de Ética em Pesquisa—CONEP), Brazil [protocol 976/2006]. ELSA-Brasil MSK was approved by the ethics and research committee of Universidade Federal de Minas Gerais (UFMG), Brazil [protocol COEP/UFMG, Etic 186/06; CEP 1.160.939; CAAE 0186.1.203.000-06]. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and all participants signed a written informed consent after they had been informed of details of the study.

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Electronic supplementary material

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296_2020_4557_MOESM1_ESM.docx

Supplementary file1 Online Resource 1 is a table describing the characteristics of included participants according to the presence, number of sites and spatial distribution of chronic musculoskeletal pain (CMP) (DOCX 30 kb)

296_2020_4557_MOESM2_ESM.docx

Supplementary file2 Online Resource 2 is a figure that illustrates the prevalence of different presentations of chronic musculoskeletal pain (at any site, at multisite and generalized pain) according to obesity clinical markers (DOCX 130 kb)

296_2020_4557_MOESM3_ESM.docx

Supplementary file3 Online Resource 3 is a figure that illustrates the frequency of chronic musculoskeletal pain according to body regions (upper limbs: shoulders, elbows and/or wrists/hands; lower limbs: knees, hips/thighs and/or ankles/feet; axial skeleton: neck, upper back and/or lower back) and markers of obesity/weight trajectories (DOCX 1445 kb)

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Costa, A.B.P., Machado, L.A.C., Telles, R.W. et al. 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 40, 881–891 (2020). https://doi.org/10.1007/s00296-020-04557-w

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