ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Association of the waist-to-weight index with low back pain: a mediation analysis involving accelerated biological ageing.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe precise contribution of visceral obesity to the pathogenesis of low back pain (LBP) is still uncertain. The aim of this study was to understand the relationship between central obesity determined using the waist-to-weight index (WWI) and LBP prevalence and how biological ageing acceleration (BAA) exerts an indirect effect in such an association.
methodsData were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and 2009-2010 databases, with 11,737 participants aged ≥ 18 years. The WWI was calculated as the ratio of waist circumference to the square root of weight, and BAA was assessed using the Klemera-Doubal method (KDM)-BAA, phenotypic age (PhenoAge) acceleration, and the allostatic load index (ALI).
resultsA greater WWI was significantly positively associated with greater odds of LBP (OR per 1-SD increase: 1.132; 95% CI: 1.082-1.185; p < 0.001). Mediation analysis revealed significant influences of BAA, where KDM-BAA, PhenoAge acceleration, and the ALI mediated 9.238%, 8.573%, and 8.046% of the associations, respectively (p < 0.001 for all). The indirect effects of BA on the association between the WWI and the odds of LBP were also nonnegligible in females, accounting for 8.762%, 19.171%, and 17.321% of the intermediary association mediated by KDM-BAA, PhenoAge acceleration, and the ALI, respectively.
conclusionsThis study provides evidence of the significant associations between the WWI and LBP prevalence and highlights the indirect effects of BAA in these associations.
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