Wang XingKun, Tian Long, Xu Qian, Pan Xin, Kong Lingjun, Zhao Hua
Department of Orthopaedics, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Lixia District, Jinan, Shandong, 250012, People's Republic of China.
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.
J Orthop Surg Res. 2025 Aug 21;20(1):784. doi: 10.1186/s13018-025-06218-9.
While pervious studies have identified metabolic imbalance as a key driver of intervertebral disc degeneration, few studies explored the relationship between metabolic and low back pain directly. We aimed to explore the relationships between two critical metabolic factors-insulin resistance and obesity-and low back pain (LBP), thereby providing novel insights for the integrated management of patients with LBP.
We enrolled 41663 participants from four NHANES survey cycles (1999-2004 and 2009-2010). The Metabolic Score for Insulin Resistance (METS-IR) and Body Roundness Index (BRI) were utilized to investigate the associations of insulin resistance and visceral obesity with LBP.Weighted logistic regression models were constructed to evaluate associations between MetS-IR/BRI and LBP, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Using Restricted Cubic Splines (RCS) to assess potential nonlinear relationships. ROC curve analysis quantified diagnostic performance through area under the curve (AUC) estimation. Subgroup analyses and interaction tests were conducted to ensure the robustness of the findings.
Multivariable regression analysis revealed significant positive associations between MetS-IR/BRI and LBP after adjusting for all potential confounders (MetS-IR: OR = 1.013, 95% CI: 1.008-1.018; BRI: OR = 1.072, 95% CI: 1.047-1.098) and these associations remained consistent across all subgroups. RCS analysis revealed no significant nonlinear associations between the METS-IR, BRI and LBP. In the ROC analysis, METS-IR showed the highest area under the ROC curve in females, followed by BRI and BMI.
In conclusion, within a nationally representative sample of U.S. adults with low back pain, we identified significant positive correlations between METS-IR/BRI and LBP. These findings underscore the importance of maintaining healthy metabolic status, providing valuable insights for further research.
虽然先前的研究已将代谢失衡确定为椎间盘退变的关键驱动因素，但很少有研究直接探讨代谢与腰痛之间的关系。我们旨在探讨两个关键代谢因素——胰岛素抵抗和肥胖——与腰痛（LBP）之间的关系，从而为腰痛患者的综合管理提供新的见解。
我们从四个国家健康与营养检查调查周期（1999 - 2004年和2009 - 2010年）中纳入了41663名参与者。使用胰岛素抵抗代谢评分（METS - IR）和身体圆度指数（BRI）来研究胰岛素抵抗和内脏肥胖与腰痛的关联。构建加权逻辑回归模型以评估Mets - IR/BRI与LBP之间的关联，结果以比值比（OR）和95%置信区间（CI）表示。使用限制立方样条（RCS）来评估潜在的非线性关系。ROC曲线分析通过曲线下面积（AUC）估计来量化诊断性能。进行亚组分析和交互检验以确保研究结果的稳健性。
多变量回归分析显示，在调整所有潜在混杂因素后，Mets - IR/BRI与LBP之间存在显著正相关（Mets - IR：OR = 1.013，95% CI：1.008 - 1.018；BRI：OR = 1.072，95% CI：1.047 - 1.098），并且这些关联在所有亚组中均保持一致。RCS分析显示METS - IR、BRI与LBP之间无显著非线性关联。在ROC分析中，METS - IR在女性中的ROC曲线下面积最高，其次是BRI和BMI。
总之，在具有全国代表性的美国腰痛成年样本中，我们发现METS - IR/BRI与LBP之间存在显著正相关。这些发现强调了维持健康代谢状态的重要性，为进一步研究提供了有价值的见解。
