Sharmayne R.E. Brady

The Role of Traditional Cardiovascular Risk Factors Among Patients with Rheumatoid Arthritis

Objective People with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) compared with the general population. We investigated the relative contribution of traditional cardiovascular risk factors to this elevated risk. Methods Fifty RA subjects and 150 age and sex matched controls attended a cardiovascular risk assessment clinic betweenMarch and July 2006. Traditional cardiovascular risk factors and the absolute risks of CVD (calculated from application of a Framingham risk equation) were compared between the 2 groups. Results Compared with the controls, RA subjects were more likely to smoke (p < 0.001), be physically inactive (p = 0.006), and have higher mean measurements of body mass index (p = 0.040) and waist circumference (p = 0.049). No significant differences were found in mean levels of plasma lipid or glucose, or in the prevalences of diabetes and hypertension. Overall, the mean absolute risk of CVD was higher in the RA group, even after excluding smokers (p = 0.036). Conclusion Smoking and physical inactivity are important risk factors in the management of cardiovascular risk among patients with RA. Subjects with RA seem to have higher absolute risks of CVD compared with controls, even independently of smoking. This highlights the importance of treating all modifiable risk factors in those with RA although, individually, few may be conspicuous.

The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men

AbstractLow back pain (LBP) and obesity are major public health problems; however, the relationship between body composition and low back pain in men is unknown. This study aims to examine the association between body composition and LBP and disability in a population-based sample of men, as well as the factors that may affect this relationship.Nine hundred seventy-eight male participants from the Geelong Osteoporosis Study were invited to participate in a follow-up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of an emotional disorder was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry.Of the 820 respondents (84% response rate), 124 (15%) had high-intensity low back pain and/or disability (back pain). Low back pain was associated with higher body mass index (28.7 ± 0.4 vs 27.3 ± 0.2 kg/m2, P = 0.02) and waist–hip ratio (0.97 ± 0.006 vs 0.96 ± 0.006, P = 0.04), with increased tendency toward having a higher fat mass index (8.0 vs 7.6 kg/m2, P = 0.08), but not fat-free mass index (P = 0.68). The associations between back pain and measures of obesity were stronger in those with an emotional disorder, particularly for waist–hip ratio (P = 0.05 for interaction) and fat mass index (P = 0.06 for interaction).In a population-based sample of men, high-intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with an emotional disorder. This provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain.

Predictors of Back Pain in Middle Aged Women: Data from the Australian Longitudinal Study on Women's Health.

Back pain causes greater disability worldwide than any other condition, with women more likely to experience back pain than men. Our aim was to identify modifiable risk factors for back pain in middle‐aged women.Background: Back pain causes greater disability worldwide than any other condition, with women more likely to suffer from back pain than men. Our aim was to identify modifiable risk factors for back pain in middle-aged women. Methods: Women born between 1946 and 1951 were randomly selected from the national health insurance scheme database to participate in The Australian Longitudinal Study of Womens Health. Self-reported data on back pain in the last 12 months, weight, physical activity and other socio-demographic factors were collected in 1998, 2001, 2004, 2007, 2010 and 2013. In 1998, 12,338 women completed the survey and 10,011 (74%) completed the 2013 survey. Results: At baseline, median (range) age was 49.5 (44.6 – 53.5) years and 54% reported back pain. In multivariate analysis, baseline weight and depression were positive predictors of back pain over each 3 year survey interval and over the following 15 years, whereas participation in vigorous physical activity was protective. The effects of weight on back pain were most marked in women with a BMI ≥25. Conclusions: Back pain is common in middle-aged women. Increased weight, weight gain and depression were independent predictors of back pain over 15 years, whereas participation in vigorous physical activity was protective. Targeting these lifestyle factors is an important area for future research on reducing the burden of back pain in middle-aged women. This article is protected by copyright. All rights reserved.

Relationships Between Weight, Physical Activity, and Back Pain in Young Adult Women.

AbstractBack pain causes enormous financial and disability burden worldwide, which could potentially be reduced by understanding its determinants to develop effective prevention strategies. Our aim was to identify whether modifiable risk factors, weight and physical activity, are predictive of back pain in young adult women.Women born between 1973 and 1978 were randomly selected from the national health insurance scheme database to participate in The Australian Longitudinal Study of Womens Health. Self-reported data on back pain in the last 12 months, weight, height, age, education status, physical activity, and depression were collected in 2000, 2003, 2006, 2009, and 2012. In 2000, 9688 women completed the questionnaire and 83% completed follow-up 12 years later.At baseline, median age was 24.6 years and 41% had self-reported back pain. For every 5 kg higher weight at baseline, there was a 5% (95% confidence interval [CI] 4%–6%) increased risk of back pain over the next 12 years. Higher weight at each survey also predicted back pain risk 3 years later (P < 0.001). The effects of weight on back pain were most significant in those with BMI ≥25 kg/m2 and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both P < 0.001), after adjusting for age, weight, height, and education status.Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity, and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young women and suggest potential opportunities for future prevention.

Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults

Back pain is currently the greatest cause of disability worldwide, and there are very limited therapeutic options available. Vitamin D deficiency and obesity are both risk factors for back pain. The few randomised controlled trials examining the effects of vitamin D supplementation on back pain have methodological limitations and largely include non-vitamin D deficient participants. Thus, the aim of this study was to determine whether vitamin D supplementation improves back pain symptoms in vitamin D deficient and overweight or obese, otherwise healthy adults. Sixty-five overweight or obese adults (BMI ≥ 25 kg/m2) with vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] concentrations ≤50 nmol/L) were randomised to a bolus oral dose of 100,000 IU followed by 4000 IU cholecalciferol/day or matching placebo for 16 weeks. We measured 25(OH)D concentrations (chemiluminescent immunoassays) and self-reported back pain (Chronic Pain Grade Questionnaire) before and after the intervention. Lifestyle habits including sun exposure, physical activity, and diet were collected using questionnaires. Fifty-four participants completed the study, of which 49 had complete data for back pain and were included in the present analyses (31 M/18 F; mean ± SD age: 31.8 ± 8.9 years; BMI: 31.1 ± 4.5 kg/m2). After the 16-week intervention, 25(OH)D levels increased significantly with vitamin D supplementation compared with placebo (55.7 ± 20.9 versus 3.9 ± 14.4 nmol/L, respectively, p < 0.001). There were no significant differences between vitamin D and placebo groups in change in back pain intensity or disability scores (all p > 0.05). However, in those with 25(OH)D concentrations <30 nmol/L at baseline (n = 20), there was a significantly greater reduction in back pain disability scores in the vitamin D group compared with placebo, after adjusting for important covariates known to affect vitamin D status and/or back pain (b [95%CI] = -11.6 [-22.4, -0.8], p = 0.04). Our findings suggest that vitamin D supplementation in overweight or obese and markedly vitamin D deficient adults (25(OH)D <30 nmol/L) may improve back pain disability. Although treating severe vitamin D deficiency is recommended for optimising bone health, this study suggests it may also improve back pain. Hence, testing for vitamin D deficiency in those with back pain who are overweight or obese may be warranted.

Adipsin concentrations are associated with back pain independently of adiposity in overweight or obese adults

Objective: To compare cardiometabolic risk factors including cytokine and adipokine concentrations between individuals with and without back pain. Methods: In 62 overweight/obese adults (BMI ≥ 25 kg/m2; 23F/39M), we collected data on: self-reported back pain; anthropometry [BMI, waist circumference, body composition (dual energy X-ray absorptiometry—DEXA)]; metabolic parameters [fasting glucose; insulin sensitivity (hyperinsulinaemic-euglycaemic clamps)]; cardiovascular parameters (blood pressure, lipids); serum inflammation markers [high-sensitivity C-reactive protein (hsCRP; immunoturbidimetric-assay), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-10 (multiplex-assay)]; and adipokines [leptin, adipsin, resistin, and adiponectin (multiplex-assay)]. Results: Participants who reported having back pain in the past month (n = 24; 39%) had higher BMI (mean ± SD = 33.8 ± 6.3 vs. 30.2 ± 4.1 kg/m2, p = 0.008), fat-mass (39.9 ± 12.3 vs. 33.9 ± 9.8%, p = 0.04), and waist circumference (109.6 ± 16.8 vs. 101.0 ± 9.3 cm, p = 0.01) compared to those without back pain (n = 38; 61%). No differences were observed in cardiometabolic parameters, inflammatory markers, or adiponectin or resistin concentrations. Those reporting back pain had higher adipsin concentrations compared to those without back pain [median (IQR) = 744 (472–2,804) vs. 721 (515–867) ng/ml, p = 0.03], with a trend for higher leptin [5.5 (1.5–24.3) vs. 2.3 (1.5–6.7) ng/ml, p = 0.05], both of which persisted after adjustment for age and sex. Adipsin remained associated with back pain independently of adiposity (BMI, waist, fat-mass, or total %body fat; all p ≤ 0.03). Conclusions: Greater obesity, and higher adipsin and leptin concentrations were observed in those who reported back pain in the past month compared to those without back pain, and adipsin was associated with back pain independently of adiposity. Larger studies are needed to determine if adipsin could be a novel therapeutic target for prevention and/or treatment of back pain.

SAT0519 The Association between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders – A Population-Based, Cross-Sectional Study of Men

Background Low back pain (LBP) and obesity are both major public health problems. Obesity has been linked with LBP, with recent studies reporting that increased fat but not lean tissue mass is associated with LBP, however previous studies predominantly examined women. The relationship between body composition and LBP in men is unknown. Objectives The aim of this study was to examine the relationship between body composition and LBP and disability in a population-based sample of men. Methods 978 male participants from the Geelong Osteoporosis Study (GOS), a population-based Australian study designed to investigate the epidemiology of osteoporosis among adults, were invited to participate in a follow up study in 2006. Participants completed questionnaires on sociodemographics and health status. LBP was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of mood disorders was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Independent samples t-tests and chi-square tests were used to compare the baseline characteristics of men with and without LBP and/or disability. Estimated marginal means were used to examine the relationships between obesity measures and body composition in participants with high intensity pain and disability compared to those with no or low pain and disability. Multivariate analyses included adjustments for age, mood disorder, education, mobility and body mass index (BMI). To examine the multivariate associations between body composition and back pain, adjustment was also made for the alternate body composition measure. Interactions between risk factors for LBP and measures of obesity, including measures of body composition were examined. Results Of the 820 respondents (84% response rate), 124 (15%) had high intensity LBP and/or disability. Participants with high intensity pain and/or disability were older, more likely to have a mood disorder, less likely to have completed secondary school and more likely to have poor mobility than those with no or LBP and disability (p<0.002 for all). LBP was associated with higher BMI (28.7±0.4 vs 27.3±0.2 kg/m2, p=0.02) and waist-hip ratio (0.97±0.006 vs 0.96±0.006, p=0.04), with increased tendency towards having a higher fat mass index (8.0 vs 7.6 kg/m2, p=0.08), but not fat-free mass index (p=0.68). The associations between LBP and measures of obesity were stronger in those with a mood disorder, particularly for waist-hip ratio (p=0.05 for interaction) and fat mass index (p=0.06 for interaction). Conclusions In a population-based sample of men, high intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with mood disorders. This provides evidence to support a biopsychosocial interaction between mood disorders and obesity with LBP. Acknowledgement S.B: NHMRC Postgraduate Scholarship, S.BO: Alfred Deakin Postdoctoral Fellowship, D.M.U & A.E.W: NHMRC Career Development Fellowships, A.T: NHMRC Early Career Fellowship, JP: NHMRC grants, GOS: NHMRC grants. Disclosure of Interest None declared