De Groote School of Medicine, McMaster University, Hamilton, Canada.
Inflammopharmacology. 2012 Apr;20(2):53-8. doi: 10.1007/s10787-011-0118-0. Epub 2012 Jan 12.
The association between obesity and knee osteoarthritis, and specifically the role of obesity as a risk factor for knee osteoarthritis has been well documented. A systematic review and meta-analysis by Blagojevic et al. in Osteoarthr Cartil 18(1):24-33, (2010) examined 36 papers reporting on BMI and found that all studies demonstrated obesity and being overweight to be risk factors for knee osteoarthritis. The effect size for obesity as a risk factor for knee OA was reported to be I² = 97%, and the random effects pooled odds ratio for obesity compared to normal weight was 2.63 with a 95% CI of 2.28-3.05.
This review summarises recent findings involving the association between knee osteoarthritis and obesity: the potential mechanisms of the link between the two disease states; and the potential benefits of weight loss on obese, knee osteoarthritis patients.
Studies for inclusion in our report were identified using: MEDLINE; EMBASE; PUBMED; Cochrane Central Register of Controlled Trials; CINAHL; and reference lists of relevant articles.
A number of recent studies involving the association between obesity and knee osteoarthritis have since been published. A large, population-based prospective study (n = 823) conducted by Toivanen et al. with a follow-up of 22 years found that the risk for knee osteoarthritis was 7 times greater for people with BMI ≥ 30 compared to the control of people with BMI <25. A prospective cohort study of the Norwegian population by Grotle et al. that followed 1,675 patients reported that BMI >30 was significantly associated with osteoarthritis of the knee, with odds ratio of 2.81, and 95% CI of 1.32-5.96. Lohmander et al. found that in a large cohort study of 27,960 patients from the Swedish population, the relative risk for knee osteoarthritis (fourth quartile compared to first quartile) was 8.1, with a 95% CI of 5.3-12.4. Finally, a case-control study from Holliday et al. with 1,042 knee osteoarthritis patients and 1,121 matched controls reported that the adjusted odds ratio for knee osteoarthritis in patients with BMI >30 was 7.48 with 95% CI of 5.45-10.27.
Recent prospective studies demonstrate obesity as a primary risk factor for incident knee osteoarthritis. The potential mechanisms to link obesity and knee osteoarthritis, as both a biomechanical and metabolic condition are strongly linked. It has been established that weight loss for obese patients with knee osteoarthritis is clinically beneficial, for pain reduction, and for improved function. The exact mechanism linking obesity and osteoarthritis is complex; however, it is our opinion that further evidence supporting the link between the two diseases will be useful in providing clinicians and researchers with targets for physical therapy and pharmacological management of obese patients with knee osteoarthritis.
肥胖与膝骨关节炎之间的关联，特别是肥胖作为膝骨关节炎的风险因素，已经得到了充分的证明。Blagojevic 等人在《骨关节炎与软骨》杂志 18(1):24-33 上发表的一项系统性回顾和荟萃分析研究了 36 篇报告 BMI 的论文，发现所有研究都表明肥胖和超重是膝骨关节炎的风险因素。肥胖作为膝骨关节炎风险因素的效应大小报告为 I²=97%，肥胖与正常体重相比的随机效应汇总优势比为 2.63，95%置信区间为 2.28-3.05。
本综述总结了肥胖与膝骨关节炎之间关联的最新发现：两种疾病状态之间联系的潜在机制；以及肥胖的膝骨关节炎患者减肥的潜在益处。
使用以下方法确定我们报告中纳入的研究：MEDLINE；EMBASE；PUBMED；Cochrane 对照试验中心注册；CINAHL；和相关文章的参考文献列表。
自那时以来，已经发表了一些涉及肥胖与膝骨关节炎之间关联的新研究。Toivanen 等人进行的一项大型、基于人群的前瞻性研究（n=823），随访 22 年，发现 BMI≥30 的人群患膝骨关节炎的风险是 BMI<25 的对照组的 7 倍。Grotle 等人对挪威人群进行的一项前瞻性队列研究报告称，BMI>30 与膝关节骨关节炎显著相关，优势比为 2.81，95%置信区间为 1.32-5.96。Lohmander 等人发现，在瑞典人群的一项大型队列研究中，对 27960 名患者进行研究，发现膝骨关节炎的相对风险（第四四分位数与第一四分位数相比）为 8.1，95%置信区间为 5.3-12.4。最后，Holliday 等人的一项病例对照研究纳入了 1042 名膝骨关节炎患者和 1121 名匹配的对照者，报告 BMI>30 的膝骨关节炎患者的调整比值比为 7.48，95%置信区间为 5.45-10.27。
最近的前瞻性研究表明肥胖是膝骨关节炎的主要危险因素。肥胖和膝骨关节炎之间的潜在联系机制，作为一种生物力学和代谢状况，紧密相连。已经确定，肥胖的膝骨关节炎患者减肥对减轻疼痛和改善功能有临床益处。肥胖与骨关节炎之间的联系机制非常复杂；然而，我们认为，进一步支持这两种疾病之间联系的证据将有助于为临床医生和研究人员提供针对肥胖的膝骨关节炎患者的物理治疗和药物治疗管理的目标。
