Published in IJCP August 2019
Clinical Study
Association of Musculoskeletal Pain with Body Composition Parameters
August 16, 2019 | Lokesh Agarwal, Mili Sengar, Sumit Saxena, Bhanu Pratap Singh, Dhruva Agarwal
     


Abstract

Musculoskeletal pain (MSP) is the most common chronic impairment in developed and developing countries as nearly 25% of adult subjects suffer from chronic MSP. Obesity leads to increased loading of the weight-bearing joint, which may be the most important mechanical contribution. Objectives: To study the magnitude of MSP among women and to assess relation between MSP and body composition parameters. Material and methods: A cross-sectional study was, conducted in the population around Rural Health Training Center (RHTC) and Urban Health Center (UHC), Barabanki district in 2015 among women in the age group of 25-65 years. Overall, 301 women from rural area and 52 from urban area were selected as study participants. Body composition parameters included weight, height (using a stadiometer), body mass index (BMI), waist circumference and hip circumference. Information regarding location (in the neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hip/buttocks, thighs, knees, lower legs and ankles) was recorded in separate datasheets for each individual. Results: The overall prevalence of MSP in Barabanki district was 45.33% (88.46% in urban population). Pain was absent in 54.67% of study subjects. There was significant association between high BMI with MSP. Conclusion: The study highlights the need to formulate a policy and device-specific intervention to alleviate suffering and reduce health care costs and lost productivity due to musculoskeletal problems.

Keywords: Musculoskeletal pain, BMI, body composition parameters

Musculoskeletal conditions affect more than 1.7 billion people worldwide and have the 4th greatest impact on the overall health of the world population, considering both death and disability. This burden has increased by 45% during the past 20 years and will continue to escalate unless action is taken. These cause considerable functional limitations in the adult population of most welfare states as compared to any other group of disorders. They are also a major cause of years lived with disability (YLDs) in all continents and economies. Estimates of people affected worldwide include: back pain 632 million, neck pain 332 million, osteoarthritis of the knee 251 million and other musculoskeletal (MS) conditions 561 million. As a group, MS disorders cause 21.3% of all YLDs, and are second only to mental/behavioral disorders that account for 22.7% of YLDs. Worldwide, low back pain is the leading cause of disability and contributes 10.7% of total YLDs. Low back pain (83.1 million YLDs), neck pain (33.6 million YLDs) and osteoarthritis (17.1 million YLDs) are chief causes of MS problems.

Human body composition changes with age, but the causes and consequences of these changes are unsatisfactorily understood. Studies have reported that fat mass increases with age, whereas lean mass, especially bone mass and muscle mass, decline. Changes in body composition with aging have been associated with increased morbidity and mortality, which predisposes to falls and osteoporotic fractures.

The concept that body size, shape and composition influence susceptibility and resistance to disease is truly ancient. Generally, women have more complex and stressful aging process as compared to men, due to hormonal changes that occur during menopausal transition. The onset of this physiological development not only marks the end of female reproductive function but also makes them more vulnerable to a new set of health problems like cardiovascular diseases, osteoporosis and so on. Body mass index (BMI) is a commonly used indicator for screening of body composition. It is widely used to predict ideal weight in relation to height and identify malnourished individuals and groups.

Objectives

  • To study the magnitude of musculoskeletal pain (MSP) among women.
  • To assess the relation between MSP and body composition parameters.

Material and Methods

A cross-sectional study was conducted in the population around Rural Health Training Center (RHTC) and Urban Health Center (UHC), Barabanki district between July and December 2015 among women in the age group of 25-65 years. The sample size was calculated to be 330 considering an expected prevalence rate of 31.3% (MSP among women), with absolute precision of 5%. Since 90% of population of Barabanki is rural, by Population Proportion Sampling, 297 (~301) women from rural area and 33 (~52) from urban area were selected as study participants. Multistage sampling was done to select participants - 301 in rural and 52 participants in urban areas.

Methodology

Body composition parameters included weight, height (using a stadiometer), BMI, waist circumference and hip circumference. Personal, social and occupational details of each subject were collected through a pretested questionnaire. Information regarding location (in the neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hip/buttocks, thighs, knees, lower legs and ankles) was recorded in separate datasheets for each individual. The BMI of the subjects was classified into normal, overweight and obese based on World Health Organization (WHO) classification.

Statistical Methods

All data was compiled on MS Excel with subsequent clean up and proper checks. Chi-square test was used to test the associations between the different variables. A p value <0.05 was considered significant. The results were interpreted on the basis of significance and association found among all the variables.

Results

The mean age of rural women was 41.69 ± 11.86 and of urban women was 35.10 ± 7.66. Majority of women were of Hindu religion (96.67% in rural and 92.6% in urban) and OBC caste (85.22% in rural and 79.17% in urban). More than half of the individuals (61.8%) in rural area lived in joint families, whereas 82.69% in urban area belonged to nuclear families. Most of the females were married (94% in rural and 84.62% in urban) and only 2.7% in rural area and 3.84% in urban area were widows. Over 40% females belonged to lower and lower middle class. Nearly 51.3% of the females in rural area were illiterate and 55.77% in urban area had education up to intermediate. Eighty-nine percent of females in rural area were housewives, 5% were farmers and 2% were government employees. Most common occupation in urban area was private service (34.62%) followed by government employee (28.85%) and 21.15% were housewives.

Table 1 shows the prevalence of high waist-hip ratio was 43.34%. High BMI (overweight and obese) was found in 28.33%. More than 50% study subjects had normal BMI, waist circumference and waist-hip ratio.

Table 1. Classification of Body Composition Parameters Among Study Subjects

Body composition parameters

Low

Normal

High

Waist circumference

-

243

(68.8%)

110

(31.2%)

Waist-Hip ratio

-

200

(56.66%)

153

(43.34%)

BMI

69

(19.55%)

184

(52.12%)

100

(28.33%)

Table 2 shows that the overall prevalence of MSP in Barabanki district was 45.33% (88.46% in urban and 37.87% in rural). MSP was absent in 54.67% of study subjects.

Table 2. Prevalence of MSP

MSP

Rural
(n = 301)

Urban
(n = 52)

Total
(n = 353)

MSP present

114
(37.87%)

46
(88.46%)

160
(45.33%)

MSP absent

187
(62.13%)

6
(11.54%)

193
(54.67%)

Table 3 shows that there was significant association between high BMI with MSP. The risk of MSP is 5 times higher in BMI ≥25 than in women with BMI <25. Figure 1 shows the prevalence of MSP in women with BMI >24.9.

Table 3. Association Between MSP and Body Composition Parameters

MSP

+/-

BMI

<25

≥25

MSP

86

74

No MSP

167

26

Total

253

100

OR = 5.53; CI = 3.304-9.242; p value <0.05.

Figure 1. MSP among women with BMI >24.9.

*Either the neck, hand, shoulder, upper back, lower back, thigh, knee or ankle.

Discussion

Similar to the present study, a significantly higher BMI was found in subjects with MSP as compared to those who had no MSP in another study. There was a positive correlation between age and MSP. MSP was more common among females. Significant association of pain has been found with obesity. Being overweight or obese puts extra weight on human muscles and thus increases the risk of MSP. A study showed that overweight and obesity increased the risk of widespread chronic MSP during 11-year follow-up.

Several studies have reported that there is higher prevalence of low back pain in menopausal middle-aged women. Increase in BMI, was observed among housewives with MSP as compared to no MSP group. This is similar to a study done in National Capital Region in India. MSP is also one of the most common reasons for seeking medical advice in Western
societies.

Conclusion

A weight-for-height measure such as BMI is a simple inexpensive method of determining overall fatness. Awareness based on the present findings and combined with suitable fitness regimes can form the basis of a strategy for reducing the burden of MSP globally.

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