Adiposity, lumbosacral lordosis and systemic inflammation in chronic low back pain: an analytical cross-sectional study
Keywords:
chronic low back pain, body mass index, adiposity, lumbosacral lordosis, erythrocyte sedimentation rate, Oswestry Disability IndexAbstract
Background and Aim: Chronic low back pain (cLBP) reflects both spinal mechanics and low-grade inflammation, into which excess body mass plausibly feeds, yet most studies treat body mass index (BMI) only as a baseline descriptor. We examined how adiposity related, within one cohort, to lumbosacral alignment, inflammatory markers, and pain and disability.
Methods: Forty-two adults with non-specific mechanical cLBP were assessed in one visit. BMI was recorded and the lumbosacral lordotic angle (LLA) measured on sagittal T2 MRI by the Cobb method. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and erythrocyte sedimentation rate (ESR) came from one venous sample. Pain used the Numerical Pain Rating Scale (NPRS) and disability the Indonesian Oswestry Disability Index (ODI). Spearman correlation was primary (Pearson reported alongside); subgroups (BMI <25 vs ≥25; men vs women) were compared with Mann–Whitney U.
Results: Mean BMI was 25.2 ± 4.4 kg/m²; 20 patients (47.6%) were normal weight, 16 (38.1%) overweight and 4 (9.5%) obese. BMI correlated positively with disability (Spearman r = 0.37, p = 0.016) and, on Pearson, with ESR (r = 0.38, p = 0.012); associations with pain and LLA were positive but non-significant. NLR and MLR were unrelated to body mass. Split at BMI 25, the heavier group showed higher median ODI, NPRS and ESR, none reaching significance. ESR differed sharply by sex, far higher in women than men (median 17 vs 8 mm/h; p = 0.002).
Conclusion: In this cross-sectional cohort, higher BMI tracked with greater self-reported disability and, less firmly, with higher ESR, leaving the inflammatory ratios untouched. Adiposity is best read as one inexpensive, modifiable correlate sitting alongside spinal alignment, not replacing it. The strong sex gradient in ESR warrants interpreting that marker against patient sex. Larger longitudinal work is needed before these associations can guide stratification. (www.actabiomedica.it)
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