Glover Toni L, Goodin Burel R, King Christopher D, Sibille Kimberly T, Herbert Matthew S, Sotolongo Adriana S, Cruz-Almeida Yenisel, Bartley Emily J, Bulls Hailey W, Horgas Ann L, Redden David T, Riley Joseph L, Staud Roland, Fessler Barri J, Bradley Laurence A, Fillingim Roger B
*College of Nursing, Adult and Elderly Nursing Departments of ‡Community Dentistry and Behavioral Science, College of Dentistry §Aging and Geriatric Research, Institute on Aging **Medicine, University of Florida, Gainesville, FL Departments of †Psychology and Anesthesiology ∥Psychology ¶Medicine, Division of Clinical Immunology and Rheumatology #Biostatistics, University of Alabama at Birmingham ††Department of Clinical Immunology and Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Clin J Pain. 2015 Dec;31(12):1060-7. doi: 10.1097/AJP.0000000000000210.
The prevalence of knee osteoarthritis (OA) is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee OA pain and functional performance measures.
The sample consisted of 256 (63% female) racially diverse (55% black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high-performance liquid chromatography. Participants provided self-report regarding knee OA pain and underwent a lower extremity functional performance test.
Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee OA pain compared with participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels.
The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing through peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and nonobese individuals with knee OA warrants further study.
随着人口老龄化，膝关节骨关节炎（OA）的患病率不断上升，而肥胖老年人数量的增加又加剧了这一情况。通过血清25-羟基维生素D（25(OH)D）检测发现，老年人和肥胖个体中维生素D水平较低与多种负面健康状况相关，包括慢性疼痛。这项横断面研究旨在探讨25(OH)D水平和肥胖对膝关节OA疼痛及功能表现指标的交互影响。
样本包括256名（63%为女性）种族多样（55%为黑人/非裔美国人）的中老年人（平均年龄56.8岁）。采集血液，通过高效液相色谱法分析25(OH)D。参与者提供有关膝关节OA疼痛的自我报告，并接受下肢功能表现测试。
结果表明，肥胖与较低的25(OH)D水平相关。无论肥胖状况如何，25(OH)D水平充足的参与者报告的膝关节OA疼痛明显少于水平不足或缺乏的参与者。此外，在下肢功能表现方面，肥胖与25(OH)D水平之间存在显著交互作用，即25(OH)D水平充足的肥胖个体比25(OH)D水平不足或缺乏的肥胖参与者表现更好。
25(OH)D水平充足与疼痛严重程度减轻及功能改善相关的机制尚未完全阐明。可能是具有生物活性的25(OH)D的多效性作用通过外周和中枢机制影响疼痛及疼痛处理。或者，较高水平的疼痛可能导致户外活动减少，这可能同时导致肥胖和维生素D降低。因此，研究肥胖和非肥胖膝关节OA患者的维生素D状态值得进一步探讨。
