Association Between Low Back Pain and Body Mass Index in Adult Twins: An analysis of monozygotic and dizygotic twins of the Washington State Twin Registry

Liechty A, Tsang S, Turkheimer E, Duncan GE.

Background Context

LBP is a common and significant cause of disability worldwide, however; questions about cause still remain.

Purpose

To investigate the association between low back pain (LBP), body mass index (BMI), and moderate to vigorous physical activity (MVPA) in a twin sample.

Study Design

Cross sectional study of monozygotic (MZ) and dizygotic (DZ) twins from the Washington State Twin Registry.

Patient Sample

Monozygotic and dizygotic twins from the Washington State Twin Registry

Outcome Measures

Self-report measures: Low back pain, body mass index, duration and intensity of exercise

Methods

The sample included 5,183 same-sex pairs (69% MZ). The outcome was self-reported diagnosis of LBP from a health care provider. A phenotypic model tested the association between BMI and LBP without including genetic or shared environmental confounds. We then re-estimated the association using a quasi-causal model which controls for those confounds. Finally, we used a mediation model to investigate if the association between LBP and MVPA was mediated by BMI.

Results

In the phenotypic regression of LBP on BMI, there was a ∼4-fold increase in the odds of having LBP with every one-unit increase in BMI (OR =3.83; 95% CI =3.28, 4.46). However, quasi-causal regression of LBP on BMI was reduced to zero (OR =0.95; 95% CI =0.60, 1.49). A significant genetic background to BMI and LBP was present (bA =1.66; p <0.001), even after controlling for confounders. In another analysis there was a significant direct effect between MVPA and LBP (bp =-.092, SE =.017, p<.001). In mediation analysis, the effect of MVPA on LBP was partially mediated through MVPA effects on BMI (bPMVPA=-0.043, SE=0.003, p<0.001) and BMI effects on LBP (bPBMI=1.281, SE=0.079, OR=3.6, p<0.001), however shared environmental factors confounded this relationship.

Conclusions

BMI was not associated with LBP, despite sharing a phenotypic association, but they may share a genetic influence. The effect of MVPA on LBP is, in part, mediated by BMI but shared environment confounds this relationship.

Association Between Low Back Pain and Body Mass Index in Adult Twins: An analysis of monozygotic and dizygotic twins of the Washington State Twin Registry. The Spine Journal.  2020 Jun 29; Epub ahead of print.