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      Clustering of Lifestyle Factors and Its Association with Low Back Pain: A Cross-Sectional Study of Over 400,000 Japanese Adults

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          Although many studies have indicated the association between low back pain (LBP) and lifestyle factors, the combined effect of lifestyle factors on LBP has not been adequately investigated. We aimed to investigate the association between a cluster of unhealthy lifestyle behaviors and LBP using a large cohort of Japanese adults.


          We included 419,003 adults aged over 20 years who underwent an annual health checkup between April 2013 and March 2014 in Japan. Information on the following lifestyle factors was collected using the standardized questionnaire: smoking, alcohol intake, exercise, physical activity, walking speed, weight control, eating habits, and sleep. Each factor was evaluated as a dichotomous variable (1: health risk, 0: no health risk). A lifestyle risk score was calculated by summing the score of each lifestyle factor (range: 0–12) and was categorized into three groups (low, moderate, high). LBP was defined as self-reported LBP under treatment. Logistic regression analysis was conducted to calculate the odds ratio (OR) and 95% confidence interval (CI) for LBP.


          In multivariable logistic regression analysis, the OR for LBP was significantly higher in the moderate-risk score group (adjusted OR: 1.33 [95% CI: 1.23–1.44] in men; 1.40 [95% CI: 1.27–1.54] in women) and the high-risk score group (adjusted OR: 1.54 [95% CI: 1.43–1.67] in men; 1.83 [95% CI: 1.64–2.03] in women) than in the low-risk score group. A trend of higher risk of LBP associated with higher lifestyle risk score was observed in both sexes ( p for trend < 0.001). These results were similar even in subgroup analysis by age and body mass index (BMI).


          Clustering of unhealthy lifestyles was associated with increased risk of LBP regardless of age and BMI. These results may provide implications for better prevention and management of LBP, considering modifiable lifestyle factors.

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          Most cited references 31

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          The association between obesity and low back pain: a meta-analysis.

          This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.
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            Combined impact of lifestyle factors on mortality: prospective cohort study in US women

            Objective To evaluate the impact of combinations of lifestyle factors on mortality in middle aged women. Design Prospective cohort study. Setting Nurses’ health study, United States. Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980. Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score). Results 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate. Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.
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              Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan -2012 version.


                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                12 June 2020
                : 13
                : 1411-1419
                [1 ]Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine , Shinagawa-Ku, Tokyo, Japan
                [2 ]All Japan Labor Welfare Foundation , Shinagawa-Ku, Tokyo, Japan
                Author notes
                Correspondence: Takahiko Yoshimoto Email yoshimotot@med.showa-u.ac.jp
                © 2020 Yoshimoto et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Tables: 5, References: 44, Pages: 9
                Funded by: Grant-in-Aid for Young Scientists
                Funded by: Ministry of Education, Culture, Sports, Science, and Technology of Japan
                This study was supported in part by the Grant-in-Aid for Young Scientists (JP18K17979) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.
                Original Research

                Anesthesiology & Pain management

                health checkup, lifestyle, clustering, low back pain


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