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Background <p>The precise contribution of visceral obesity to the pathogenesis of low back pain (LBP) is still uncertain. The aim of this study was to understand the relationship between central obesity determined using the waist-to-weight index (WWI) and LBP prevalence and how biological ageing acceleration (BAA) exerts an indirect effect in such an association.</p> Methods <p>Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 and 2009–2010 databases, with 11,737 participants aged ≥ 18 years. The WWI was calculated as the ratio of waist circumference to the square root of weight, and BAA was assessed using the Klemera–Doubal method (KDM)-BAA, phenotypic age (PhenoAge) acceleration, and the allostatic load index (ALI).</p> Results <p>A greater WWI was significantly positively associated with greater odds of LBP (OR per 1-SD increase: 1.132; 95% CI: 1.082–1.185; <i>p</i> &lt; 0.001). Mediation analysis revealed significant influences of BAA, where KDM-BAA, PhenoAge acceleration, and the ALI mediated 9.238%, 8.573%, and 8.046% of the associations, respectively (<i>p</i> &lt; 0.001 for all). The indirect effects of BA on the association between the WWI and the odds of LBP were also nonnegligible in females, accounting for 8.762%, 19.171%, and 17.321% of the intermediary association mediated by KDM-BAA, PhenoAge acceleration, and the ALI, respectively.</p> Conclusions <p>This study provides evidence of the significant associations between the WWI and LBP prevalence and highlights the indirect effects of BAA in these associations.</p>

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Association of the waist-to-weight index with low back pain: a mediation analysis involving accelerated biological ageing

  • 期刊论文

  • 发表日期：

    2026年6月2日

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  • Yufeng Yin,
  • Erye Zhou,
  • Mingjun Wang,
  • Jian Wu,
  • Weichang Chen,
  • Tian Ren

摘要

Background

The precise contribution of visceral obesity to the pathogenesis of low back pain (LBP) is still uncertain. The aim of this study was to understand the relationship between central obesity determined using the waist-to-weight index (WWI) and LBP prevalence and how biological ageing acceleration (BAA) exerts an indirect effect in such an association.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 and 2009–2010 databases, with 11,737 participants aged ≥ 18 years. The WWI was calculated as the ratio of waist circumference to the square root of weight, and BAA was assessed using the Klemera–Doubal method (KDM)-BAA, phenotypic age (PhenoAge) acceleration, and the allostatic load index (ALI).

Results

A greater WWI was significantly positively associated with greater odds of LBP (OR per 1-SD increase: 1.132; 95% CI: 1.082–1.185; p < 0.001). Mediation analysis revealed significant influences of BAA, where KDM-BAA, PhenoAge acceleration, and the ALI mediated 9.238%, 8.573%, and 8.046% of the associations, respectively (p < 0.001 for all). The indirect effects of BA on the association between the WWI and the odds of LBP were also nonnegligible in females, accounting for 8.762%, 19.171%, and 17.321% of the intermediary association mediated by KDM-BAA, PhenoAge acceleration, and the ALI, respectively.

Conclusions

This study provides evidence of the significant associations between the WWI and LBP prevalence and highlights the indirect effects of BAA in these associations.