Association of general and central obesity, and their changes with risk of knee osteoarthritis: a nationwide population-based cohort study

Dojoon Park, Yong-Moon Park, Seung-Hyun Ko, Kang-Se Hyun, Youn-Ho Choi, Dong-Uk Min, Kyungdo Han, Hae-Seok Koh, Dojoon Park, Yong-Moon Park, Seung-Hyun Ko, Kang-Se Hyun, Youn-Ho Choi, Dong-Uk Min, Kyungdo Han, Hae-Seok Koh

Abstract

In this study, we aimed to evaluate the association between general and central obesity, and their changes with risk of knee osteoarthritis (OA) using retrospective cohort data collected from the Korean National Health Insurance Service. We studied 1,139,463 people aged 50 and over who received a health examination in 2009. To evaluate the association between general and/or central obesity and knee OA risk, a Cox proportional hazard models were used. Additionally, we investigate knee OA risk according to the change in obesity status over 2 years for subjects who had undergone health examinations for 2 consecutive years. General obesity without central obesity (HR 1.281, 95% CI 1.270-1.292) and central obesity without general obesity (HR 1.167, 95% CI 1.150-1.184) were associated with increased knee OA risk than the comparison group. Individuals with both general with central obesity had the highest risk (HR 1.418, 95% CI 1.406-1.429). This association was more pronounced in women and younger age group. Remarkably, the remission of general or central obesity over two years was associated with decreased knee OA risk (HR 0.884; 95% CI 0.867-0.902; HR 0.900; 95% CI 0.884-0.916, respectively). The present study found that both general and central obesity were associated with increased risk of knee OA and the risk was highest when the two types of obesity were accompanied. Changes in obesity status have been confirmed to alter the risk of knee OA.

Conflict of interest statement

The authors declare no competing interests.

© 2023. The Author(s).

Figures

Figure 1
Figure 1
Flow chart of the cohort selection.
Figure 2
Figure 2
Adjusted knee OA risk for general and/or central obesity composition, according to (a) age, (b) sex and (c) age and sex. aAdjusted for age, sex, income, smoking, alcohol intake, regular exercises, diabetes, hypertension, dyslipidemia, cancer, end-stage renal disease, chronic obstructive pulmonary disease, stroke, liver cirrhosis, hear failure, dementia and chronic kidney disease.

References

    1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet (London, England) 2019;393:1745–1759. doi: 10.1016/s0140-6736(19)30417-9.
    1. Buttgereit, F., Burmester, G. R. & Bijlsma, J. W. Non-surgical management of knee osteoarthritis: Where are we now and where do we need to go? RMD Open1, e000027. 10.1136/rmdopen-2014-000027 (2015).
    1. Cui, A. et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClin. Med.29–30, 100587. 10.1016/j.eclinm.2020.100587 (2020).
    1. Jiang L, et al. Body mass index and susceptibility to knee osteoarthritis: A systematic review and meta-analysis. Joint Bone Spine. 2012;79:291–297. doi: 10.1016/j.jbspin.2011.05.015.
    1. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England)388, 1545–1602. 10.1016/s0140-6736(16)31678-6 (2016).
    1. Statistics Korea, . Accessed 21 January 2022.
    1. Sowers MR, Karvonen-Gutierrez CA. The evolving role of obesity in knee osteoarthritis. Curr. Opin. Rheumatol. 2010;22:533–537. doi: 10.1097/BOR.0b013e32833b4682.
    1. Patterson RE, Frank LL, Kristal AR, White E. A comprehensive examination of health conditions associated with obesity in older adults. Am. J. Prev. Med. 2004;27:385–390. doi: 10.1016/j.amepre.2004.08.001.
    1. Yoon KH, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet (London, England) 2006;368:1681–1688. doi: 10.1016/s0140-6736(06)69703-1.
    1. Seidell JC. Waist circumference and waist/hip ratio in relation to all-cause mortality, cancer and sleep apnea. Eur. J. Clin. Nutr. 2010;64:35–41. doi: 10.1038/ejcn.2009.71.
    1. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am. J. Clin. Nutr. 2004;79:379–384. doi: 10.1093/ajcn/79.3.379.
    1. Mendy, V. L. et al. The association between individual and combined components of metabolic syndrome and chronic kidney disease among African Americans: The Jackson Heart Study. PloS One9, e101610. 10.1371/journal.pone.0101610 (2014).
    1. Farrell GC, Wong VW, Chitturi S. NAFLD in Asia—as common and important as in the West. Nat. Rev. Gastroenterol. Hepatol. 2013;10:307–318. doi: 10.1038/nrgastro.2013.34.
    1. Lim, U. et al. Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index. Nutr. Diab.1, e6. 10.1038/nutd.2011.2 (2011).
    1. Organization, W. H. Obesity: Preventing and managing the global epidemic (2000).
    1. Hu, L. et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PloS one12, e0183934. 10.1371/journal.pone.0183934 (2017).
    1. Zhou, Z. Y., Liu, Y. K., Chen, H. L. & Liu, F. Body mass index and knee osteoarthritis risk: A dose-response meta-analysis. Obesity (Silver Spring, Md.)22, 2180–2185. 10.1002/oby.20835 (2014).
    1. Holmberg S, Thelin A, Thelin N. Knee osteoarthritis and body mass index: A population-based case-control study. Scand. J. Rheumatol. 2005;34:59–64. doi: 10.1080/03009740510017922.
    1. Wills AK, et al. Life course body mass index and risk of knee osteoarthritis at the age of 53 years: Evidence from the 1946 British birth cohort study. Ann. Rheum. Dis. 2012;71:655–660. doi: 10.1136/ard.2011.154021.
    1. Lee SR, Choi EK, Han KD, Cha MJ, Oh S. Trends in the incidence and prevalence of atrial fibrillation and estimated thromboembolic risk using the CHA(2)DS(2)-VASc score in the entire Korean population. Int. J. Cardiol. 2017;236:226–231. doi: 10.1016/j.ijcard.2017.02.039.
    1. Kwon H, Han KD, Park CY. Weight change is significantly associated with risk of thyroid cancer: A nationwide population-based cohort study. Sci. Rep. 2019;9:1546. doi: 10.1038/s41598-018-38203-0.
    1. Yang HK, et al. Obesity, metabolic health, and mortality in adults: A nationwide population-based study in Korea. Sci. Rep. 2016;6:30329. doi: 10.1038/srep30329.
    1. Lee YH, Han K, Ko SH, Ko KS, Lee KU. Data analytic process of a nationwide population-based study using national health information database established by national health insurance service. Diabetes Metab. J. 2016;40:79–82. doi: 10.4093/dmj.2016.40.1.79.
    1. Lee, J., Lee, J. S., Park, S. H., Shin, S. A. & Kim, K. Cohort profile: The national health insurance service-national sample cohort (NHIS-NSC), South Korea. Int. J. Epidemiol.46, e15. 10.1093/ije/dyv319 (2017).
    1. Noh J, Han KD, Ko SH, Ko KS, Park CY. Trends in the pervasiveness of type 2 diabetes, impaired fasting glucose and co-morbidities during an 8-year-follow-up of nationwide Korean population. Sci. Rep. 2017;7:46656. doi: 10.1038/srep46656.
    1. Song SO, et al. Background and data configuration process of a nationwide population-based study using the Korean national health insurance system. Diabetes Metab. J. 2014;38:395–403. doi: 10.4093/dmj.2014.38.5.395.
    1. Lee SR, Han KD, Choi EK, Oh S, Lip GYH. Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index: A nationwide population-based study. Sci. Rep. 2021;11:3737. doi: 10.1038/s41598-021-83367-x.
    1. Lee KR, Hwang IC, Han KD, Jung J, Seo MH. Waist circumference and risk of breast cancer in Korean women: A nationwide cohort study. Int. J. Cancer. 2018;142:1554–1559. doi: 10.1002/ijc.31180.
    1. Kang SH, et al. Underweight is a risk factor for atrial fibrillation: A nationwide population-based study. Int. J. Cardiol. 2016;215:449–456. doi: 10.1016/j.ijcard.2016.04.036.
    1. Choi YJ, et al. Temporal trends of the prevalence and incidence of atrial fibrillation and stroke among Asian patients with hypertrophic cardiomyopathy: A nationwide population-based study. Int. J. Cardiol. 2018;273:130–135. doi: 10.1016/j.ijcard.2018.08.038.
    1. Choi YJ, et al. Reconsidering the cut-off diastolic blood pressure for predicting cardiovascular events: A nationwide population-based study from Korea. Eur. Heart J. 2019;40:724–731. doi: 10.1093/eurheartj/ehy801.
    1. Organization, W. H. The Asia-Pacific perspective: Redefining obesity and its treatment (2000).
    1. Lee SY, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res. Clin. Pract. 2007;75:72–80. doi: 10.1016/j.diabres.2006.04.013.
    1. Park HR, et al. Validation of algorithms to identify knee osteoarthritis patients in the claims database. Int. J. Rheum. Dis. 2019;22:890–896. doi: 10.1111/1756-185x.13470.
    1. Felson DT. Weight and osteoarthritis. J. Rheumatol. Suppl. 1995;43:7–9.
    1. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: A systematic review and meta-analysis. Osteoarth. Cartil. 2010;18:24–33. doi: 10.1016/j.joca.2009.08.010.
    1. Leyland, K. M. et al. Obesity and the relative risk of knee replacement surgery in patients with knee osteoarthritis: A prospective cohort study. Arthritis Rheumatol. (Hoboken, N.J.)68, 817–825. 10.1002/art.39486 (2016).
    1. Yusuf E, et al. Association between weight or body mass index and hand osteoarthritis: A systematic review. Ann. Rheum. Dis. 2010;69:761–765. doi: 10.1136/ard.2008.106930.
    1. Coppari R, Bjørbæk C. Leptin revisited: its mechanism of action and potential for treating diabetes. Nat. Rev. Drug Discovery. 2012;11:692–708. doi: 10.1038/nrd3757.
    1. Gualillo O. Further evidence for leptin involvement in cartilage homeostases. Osteoarth. Cartil. 2007;15:857–860. doi: 10.1016/j.joca.2007.04.015.
    1. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat. Rev. Immunol. 2011;11:85–97. doi: 10.1038/nri2921.
    1. Scotece M, et al. Adipokines as drug targets in joint and bone disease. Drug Discov. Today. 2014;19:241–258. doi: 10.1016/j.drudis.2013.07.012.
    1. Scotece M, Mobasheri A. Leptin in osteoarthritis: Focus on articular cartilage and chondrocytes. Life Sci. 2015;140:75–78. doi: 10.1016/j.lfs.2015.05.025.
    1. Thijssen E, van Caam A, van der Kraan PM. Obesity and osteoarthritis, more than just wear and tear: pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatology (Oxford) 2015;54:588–600. doi: 10.1093/rheumatology/keu464.
    1. Hanna, F. S. et al. Women have increased rates of cartilage loss and progression of cartilage defects at the knee than men: A gender study of adults without clinical knee osteoarthritis. Menopause (New York, N.Y.)16, 666–670. 10.1097/gme.0b013e318198e30e (2009).
    1. Hame SL, Alexander RA. Knee osteoarthritis in women. Curr. Rev. Musculoskelet. Med. 2013;6:182–187. doi: 10.1007/s12178-013-9164-0.
    1. Richmond RS, Carlson CS, Register TC, Shanker G, Loeser RF. Functional estrogen receptors in adult articular cartilage: estrogen replacement therapy increases chondrocyte synthesis of proteoglycans and insulin-like growth factor binding protein 2. Arthritis Rheum. 2000;43:2081–2090. doi: 10.1002/1529-0131(200009)43:9<2081::aid-anr20>;2-i.
    1. Lyu L, et al. Causal relationships of general and abdominal adiposity on osteoarthritis: A two-sample Mendelian randomization study. J. Clin. Med. 2022;12:1. doi: 10.3390/jcm12010320.
    1. Janssen I, Mark AE. Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis. Int. J. Obes. (Lond) 2006;30:1223–1228. doi: 10.1038/sj.ijo.0803287.
    1. Gelber AC, et al. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am. J. Med. 1999;107:542–548. doi: 10.1016/s0002-9343(99)00292-2.
    1. Hochberg MC, et al. The association of body weight, body fatness and body fat distribution with osteoarthritis of the knee: Data from the Baltimore Longitudinal Study of Aging. J. Rheumatol. 1995;22:488–493.
    1. van Saase JL, Vandenbroucke JP, van Romunde LK, Valkenburg HA. Osteoarthritis and obesity in the general population: A relationship calling for an explanation. J. Rheumatol. 1988;15:1152–1158.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever