Epidemiology and Health

Original Articles

Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey: Minjun Kim, Joonwoong Kim, Inhwan Lee; Epidemiol Health. 2024;46:e2024027. Published online February 2, 2024; DOI: https://doi.org/10.4178/epih.e2024027

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.
METHODS
Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.
RESULTS
Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β, 0.005; 95% confidence interval [CI], 0.000 to 0.010) and WC and KL grade (β, 0.002; 95% CI, 0.001 to 0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.
CONCLUSIONS
The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.; Summary

Korean summary
본 연구는 한국의 50세 이상 여성들을 대상으로 비만 및 복부비만과 무릎골관절염의 관계에 대한 다리근육비율의 매개 효과를 분석한 결과, 다리근육비율은 비만의 진단하는 사용되는 체질량지수, 복부비만의 진단에 사용되는 허리둘레와 무릎 골관절염의 진단에 사용되는 KL등급의 관계를 부분적으로 매개하는 것으로 나타났다. 이러한 결과는 다리근육의 강화가 비만 및 복부비만으로 인한 무릎골관절염의 위험을 완화할 수 있음을 시사하며, 건강한 생활습관과 규칙적인 근력운동의 병행을 통해 다리 근육을 강화하는 것이 무릎 골관절염의 예방을 위한 전략으로 권장되어야 함을 시사한다.

Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in Korea women 50 years and older: a cross-sectional study: Dajeong Ham, Sanghyuk Bae; Epidemiol Health. 2023;45:e2023044. Published online April 13, 2023; DOI: https://doi.org/10.4178/epih.e2023044

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Osteoarthritis is the most common joint disease, with a higher prevalence among women than men. The present study aimed to examine the associations of breastfeeding duration and the total number of children breastfed with osteoarthritis in Korean women aged 50 years and older.
METHODS
In this cross-sectional study, we used representative data from the Korea National Health and Nutrition Examination Survey, phases 5 through 7 (2010-2018). Our analysis included 10,102 women aged ≥50 years. Osteoarthritis experience was defined as whether a physician had ever diagnosed osteoarthritis. Breastfeeding duration was categorized as 1-6 months, 7-24 months, and ≥25 months. The total number of children breastfed was categorized as 1-2, 3-4, and ≥5. The covariates were health behavior characteristics and risks of diseases (smoking, drinking, physical activity, body mass index, diabetes, hypertension, oral contraceptive use, and menopause) as well as socioeconomic characteristics (income, educational level, and occupation). A multiple logistic regression model was used to investigate associations between osteoarthritis and aspects of breastfeeding experience.
RESULTS
Compared to the non-breastfeeding group, the breastfeeding group had an odds ratio (OR) of 1.55 (95% confidence interval [CI], 1.18 to 2.03) for osteoarthritis. Those who reported breastfeeding for >25 months had an OR of 1.56 (95% CI, 1.19 to 2.06).
CONCLUSIONS
The advantages of breastfeeding are already well known, but the present study suggests that women who breastfeed children for a longer time may have a higher risk of osteoarthritis after middle age.; Summary

Korean summary
골관절염은 가장 흔한 관절 질환이며 유병률은 여성에서 더 높다. 본 연구는 국민건강영양조사의 50세 이상 여성 10,130명을 대상으로 모유수유경험과 골관절염의 유병율 사이의 연관성을 분석하였다. 모유 수유의 이점은 이미 잘 알려져 있지만, 모유 수유 기간이 길수록 골관절염에 걸릴 가능성이 더 높음을 관찰하였다.

Key Message
Osteoarthritis is one of the most common disorders in elderly women and identifying risk factors may contribute to screening and early treatment. In the present article, we analyzed the association of breastfeeding and related factors with prevalent osteoarthritis in Korea National Health and Nutrition Examination Survey. The advantages of breastfeeding are already well known, but we observed that the longer the breastfeeding duration was the more likely the woman has osteoarthritis.

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