Association between body shape index and body mass index with knee osteoarthritis: a case control study
DOI:
https://doi.org/10.53638/phpma.2025.v13.i1.p04Keywords:
knee osteoarthritis, body mass index, body shape index, obesityAbstract
Background and purpose: Being overweight or obese, which can be determined using the
body mass index (BMI), is one of the risk factors for knee osteoarthritis (KOA).
Whilst, body shape index (BSI) is considered as more accurate indicator, hence,
this study aims to assess correlation of BSI and BMI with KOA.
Methods: This study employed a case control design conducted in Jenggawah
Village, East Java. Samples were randomly taken from the social service program
of the Faculty of Medicine, University of Jember which conducted on June 18,
2023, included 30 KOA patients and 30 non-KOA patients who met the inclusion
and exclusion criteria. The instruments used were Omni Calculator and KOA
clinical criteria sheet. The statistical analysis used the Spearman Rank
correlation test with a significance level of p<0.05.
Results: The statistical analysis revealed a significant, moderate, and direct
correlation between BSI and KOA (p=0.002; r=0.391). On the other hand, BMI
showed an insignificant, very weak, and inverse correlation with KOA (p=0.432;
r=-0.103). BSI values indicate low amount of skeletal muscle mass with increased
visceral or abdominal adiposity. BMI only assesses overweight, while BSI can
represent central adiposity, which also affects KOA.
Conclusion: The study concludes that BSI is related to the incidence of KOA, while
BMI is not related to the incidence of KOA in Jenggawah Village, Jember Regency.
Future research could use a cohort plan to validate whether BMI and BSI can
predict the incidence of KOA.
References
Liwang F, Yuswar PW, Wijaya E, Sanjaya NP. Kapita Selekta Kedokteran [Essentials of Medicine]. 5th Edition. Depok: Media Aesculapius; 2020.
WHO. Osteoarthritis. World Health Organization. 2023. [cited 2023 Sep 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M , et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204–22.
Hellmi RY, Najirman, Manuaba IARW, Rahmadi AR, Kurniari PK. Diagnosis dan Pengelolaan Osteoartritis (Lutut, Tangan, dan Panggul) [Diagnosis and Osteoarthritis Management (Knee, Hand and Hip)]. Perhimpunan Reumatologi Indonesia; 2021. 55 p.
Soeroso J, Isbagi H, Kalim H, Broto R, Pramudiyo R. Buku Ajar Ilmu Penyakit Dalam (Internal Medicine Textbook). 4th Edition. Setiati S, Alwi I, Sudoyo AW, K. MS, Setiyohadi B, Syam AF, editors. Jakarta Pusat: InternaPublishing; 2014.
Lefèvre-Colau MM, Nguyen C, Haddad R, Delamarche P, Paris G, Palazzo C, et al. Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis? Ann Phys Rehabil Med. 2016;59(3):196–206.
Wijaya S. Osteoartritis lutut [Knee osteoarthritis]. CDK. 2018;45(6):424–429.
Pamukoff DN, Vakula MN, Holmes SC, Shumski EJ, Garcia SA. Body mass index moderates the association between gait kinetics, body composition, and femoral knee cartilage characteristics. J Orthop Res. 2020;38(12):2685–95.
Nedunchezhiyan U, Varughese I, Sun ARJ, Wu X, Crawford R, Prasadam I. Obesity, Inflammation, and Immune System in Osteoarthritis. Front Immunol. 2022;13(July):1–19.
Tianshun F, Xianhao Z, Mingchao J, Jiangbo N, Xlongfeng L. Molecular Mechanisms of Mechanical Load-Induced Osteoarthritis. Int Orthop. 2021;45(5):1125.
Zhu J, Zhu Y, Xiao W, Hu Y, Li Y. Instability and excessive mechanical loading mediate subchondral bone changes to induce osteoarthritis. Ann Transl Med. 2020;8(6):350–350.
Nakai K, Tanaka H, Yamanaka K, Takahashi Y, Murakami F, Matsuike R, et al. Effects of C-reactive protein on the expression of matrix metalloproteinases and their inhibitors via Fcγ receptors on 3T3-L1 adipocytes. Int J Med Sci. 2017;14(5):484–93.
Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: Pathophysiology and current treatment modalities. J Pain Res. 2018;11:2189–96.
Farshid G. Biomechanical factors in osteoarthritis. Best Practice & Research Clinical Rheumatology. 2011;23(1):1–7.
Cho KW, Morris DL, delProposto JL, Geletka L, Zamarron B, Martinez-Santibanez G, et al. An MHC II-dependent activation loop between adipose tissue macrophages and CD4+ T cells controls obesity-induced inflammation. Cell Rep. 2014;9(2):605–17.
Drake RL, Vogi W, Mitchell AWM. Gray’s Basic Anatomy. Singapore: Elsevier Inc.; 2014.
Gleneagles Hospital. Artritis Lutut [Knee Arthritis]. Gleneagles Hospital Singapore. 2022. cited 2023 Nov 5]. Available from: https://www.gleneagles.com.sg/id/conditions-diseases/knee-arthritis/symptoms-causes
Batsis JA, Mackenzie TA, Bartels SJ, Sahakyan KR, Somers VK, Lopez-Jimenez F. Diagnostic Accuracy of Body Mass Index to Identify Obesity in Older Adults: NHANES 1999–2004. International Journal of Obesity. 2015;176(1):100–106.
Sampson K. What is the Gold Standard for determining Body Fat? Obesity Medicine Association. 2023. [cited 2023 Nov 8]. Available from: https://obesitymedicine.org/blog/what-is-the-gold-standard-for-determining-body-fat/
Khanna D, Peltzer C, Kahar P, Parmar MS. Body Mass Index (BMI): A Screening Tool Analysis. Cureus. 2022;14(1994):1–6.
Krakauer NY, Krakauer JC. The New Anthropometrics and Abdominal Obesity: A Body Shape Index, Hip Index, and Anthropometric Risk Index. Nutr Prev Treat Abdom Obes. 2019;19–27.
Malara M, Kȩska A, Tkaczyk J, Lutoslawska G. Body shape index versus body mass index as correlates of health risk in young healthy sedentary men. J Transl Med. 2015;13(1):1–5.
Gomez-Peralta F, Abreu C, Cruz-Bravo M, Alcarria E, Gutierrez-Buey G, Krakauer NY, et al. Relationship between “a body shape index (ABSI)” and body composition in obese patients with type 2 diabetes. Diabetol Metab Syndr. 2018;10(1):1–8.
Syapitri H, Amila, Aritonang J. Buku Ajar Metodologi Penelitian Kesehatan. Malang: Ahlimedia Press; 2021. 1–187 p.
Koolhaas CM, Dhana K, Golubic R, Schoufour JD, Hofman A, Van Rooij FJA, et al. Physical Activity Types and Coronary Heart Disease Risk in Middle-Aged and Elderly Persons: The Rotterdam Study. Am J Epidemiol. 2016;183(8):729–38.
Driban JB, Hootman JM, Sitler MR, Harris KP, Cattano NM. Is participation in certain sports associated with knee osteoarthritis? A systematic review. J Athl Train. 2017;52(6):497–506.
Szilagyi IA, Waarsing JH, Van Meurs JBJ, Bierma-Zeinstra SMA, Schiphof D. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatol (Oxford). 2023;62(6):2037–47.
Shamsi M, Safari A, Soroush A, Safari Y. The Survey of Knee Osteoarthritis in the Population over Age 50 Visited in the Health Bus in Kermanshah, Iran. J Aging Res. 2021:9809565.
Li D, Li S, Chen Q, Xie X. The Prevalence of Symptomatic Knee Osteoarthritis in Relation to Age, Sex, Area, Region, and Body Mass Index in China: A Systematic Review and Meta-Analysis. Front Med. 2020;7(July):1–12.
Ji S, Liu L, Li J, Zhao G, Cai Y, Dong Y, et al. Prevalence and factors associated with knee osteoarthritis among middle-aged and elderly individuals in rural Tianjin: a population-based cross-sectional study. J Orthop Surg Res. 2023;18(1):1–8.
Dong Y, Yan Y, Zhou J, Zhou Q, Wei H. Evidence on risk factors for knee osteoarthritis in middle-older aged: a systematic review and meta analysis. J Orthop Surg Res. 2023;18(1):1–16.
Loeser RF, Collins JA, Diekman BO. Ageing and the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(7):412–20.
Greene MA, Loeser RF. Aging-related Inflammation in Osteoarthritis. Osteoarthr Cart. 2015;11(23):1966–1971.
Christakoudi S, Tsilidis KK, Muller DC, Freisling H, Weiderpass E, Overvad K, et al. A Body Shape Index ( ABSI ) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort National Health and Nutrition Examination Survey. Sci Rep. 2020;1–15.
Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16(3):177–89.
Wang YF, Tang Z, Guo J, Tao LX, Liu L, Li H Bin, et al. BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing: a 20-year Cohort Study. Biomed Environ Sci. 2017;30(2):79–87.
Krakauer NY, Krakauer JC. A new body shape index predicts mortality hazard independently of body mass index. PLoS One. 2012;7(7).
Krakauer NY, Krakauer JC. Dynamic association of mortality hazard with body shape. PLoS One. 2014;9(2):1–7.
Park D, Park YM, Ko SH, Hyun KS. Association of general and central obesity, and their changes with risk of knee osteoarthritis _ a nationwide population‑based cohort study.pdf. Sci Rep. 2023;13(1):3796.
Fatrcová-šramková K, Schwarzová M, Tvrdá E, Kačániová M. A Body Shape Index - ABSI In Relation to The Prevention of Civilization Diseases in Females. J Hyg Eng Des. 2016;875:167–75.
Nagayama D, Fujishiro K, Watanabe Y, Yamaguchi T, Suzuki K, Saiki A, et al. A Body Shape Index (ABSI) as a Variant of Conicity Index Not Affected by the Obesity Paradox: A Cross-Sectional Study Using Arterial Stiffness Parameter. J Pers Med. 2022;
Chen L, Zheng JJY, Li G, Yuan J, Ebert JR, Li H, et al. Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. J Orthop Transl. 2020;24(May):66–75.
Lyu L, Cai Y, Xiao M, Liang J, Zhang G, Jing Z, et al. Causal Relationships of General and Abdominal Adiposity on Osteoarthritis: A Two-Sample Mendelian Randomization Study. J Clin Med. 2022;12(1).
Aoki KC, Mayrovitz HN. Utility of a Body Shape Index Parameter in Predicting Cardiovascular Disease Risks. Cureus. 2022;14(4):2017–8.
Bertoli S, Leone A, Krakauer NY, Bedogni G, Vanzulli A, Redaelli VI, et al. Association of Body Shape Index (ABSI) with cardio-metabolic risk factors: A cross-sectional study of 6081 Caucasian adults. PLoS One. 2017;12(9):1–15.
Centers of Disease Control. Body mass index: Considerations for practitioners. Centers of Disease Control. 2023. p.4.
Paterson G, April KT, Backman C, Tugwell P. OA go away: Development and preliminary validation of a self-management tool to promote adherence to exercise and physical activity for people with osteoarthritis of the hip or knee. Physiother Canada. 2016;68(2):124–32.
Sananta P, Pratama WF, Widasmara D, Fuzianingsih EN. Body Mass Index and Knee Osteoarthritis: A Retrospective Cross-Sectional Study in Baptis Hospital, Batu City. J Ilm Kedokt Wijaya Kusuma. 2023;12(1):84.
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