Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne 3181, Australia.
Osteoarthritis Cartilage. 2020 Jan;28(1):45-52. doi: 10.1016/j.joca.2019.05.030. Epub 2019 Aug 5.
To examine the association of metabolic syndrome (MetS) and its components with knee pain severity trajectories.
Data from a population-based cohort study were utilised. Baseline blood pressure, glucose, triglycerides and high-density lipoprotein (HDL) cholesterol were measured. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. Radiographic knee osteoarthritis (ROA) was assessed by X-ray. Pain severity was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain questionnaire at each time-point. Group-based trajectory modelling was used to identify pain trajectories and multi-nominal logistic regression was used for analysis. Mediation analysis was performed to assess whether body mass index (BMI)/central obesity mediated the association between MetS, its components and pain trajectories.
Among 985 participants (Mean ± SD age: 62.9 ± 7.4, 50% female), 32% had MetS and 60% had ROA. Three pain trajectories were identified: 'Minimal pain' (52%), 'Mild pain' (33%) and 'Moderate pain' (15%). After adjustment for potential confounders, central obesity increased risk of belonging to both 'Mild pain' and 'Moderate pain' trajectories as compared to the 'Minimal pain' trajectory group, but MetS [relative risk ratio (RRR): 2.26, 95%CI 1.50-3.39], hypertriglyceridemia (RRR: 1.75, 95%CI 1.16-2.62) and low HDL (RRR: 1.67, 95%CI 1.10-2.52) were only associated with 'Moderate pain' trajectory. BMI/central obesity explained 37-70% of these associations. Results were similar in those with ROA.
MetS and its components are predominantly associated with worse pain trajectories through central obesity, suggesting that the development and maintenance of worse pain trajectories may be caused by MetS.
探讨代谢综合征（MetS）及其各组分与膝关节疼痛严重程度轨迹之间的关系。
利用一项基于人群的队列研究数据。在基线时测量血压、血糖、甘油三酯和高密度脂蛋白（HDL）胆固醇。MetS 按照美国国家胆固醇教育计划-成人治疗小组 III 标准进行定义。通过 X 射线评估放射学膝关节骨关节炎（ROA）。在每个时间点通过 Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）疼痛问卷评估疼痛严重程度。采用基于群组的轨迹建模来识别疼痛轨迹，并采用多分类逻辑回归进行分析。进行中介分析以评估体重指数（BMI）/中心型肥胖是否在 MetS、其组分与疼痛轨迹之间的关系中起中介作用。
在 985 名参与者中（平均年龄±标准差：62.9±7.4 岁，50%为女性），32%患有 MetS，60%患有 ROA。确定了三种疼痛轨迹：“轻度疼痛”（52%）、“中度疼痛”（33%）和“重度疼痛”（15%）。在调整了潜在混杂因素后，与“轻度疼痛”轨迹组相比，中心型肥胖增加了属于“中度疼痛”和“重度疼痛”轨迹的风险，但 MetS[相对风险比（RRR）：2.26，95%置信区间（CI）：1.50-3.39]、高三酰甘油血症（RRR：1.75，95%CI：1.16-2.62）和低 HDL（RRR：1.67，95%CI：1.10-2.52）仅与“中度疼痛”轨迹相关。BMI/中心型肥胖解释了这些关联的 37%-70%。在患有 ROA 的患者中，结果相似。
MetS 及其各组分主要通过中心型肥胖与更严重的疼痛轨迹相关，表明 MetS 可能导致更严重的疼痛轨迹的发展和维持。
