Intermuscular adipose tissue and lean muscle mass assessed with MRI in people with chronic back pain in Germany: a retrospective observational study

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-05-14 DOI:10.1016/j.lanepe.2025.101323

Sebastian Ziegelmayer , Hartmut Häntze , Christian Mertens , Felix Busch , Tristan Lemke , Jakob Nikolas Kather , Daniel Truhn , Su Hwan Kim , Benedikt Wiestler , Markus Graf , Avan Kader , Fabian Bamberg , Christopher L. Schlett , Jakob B. Weiss , Jeanette Schulz-Menger , Steffen Ringhof , Elif Can , Tobias Pischon , Thoralf Niendorf , Jacqueline Lammert , Keno Bressem

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引用次数: 0

Abstract

Background

Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI).

Methods

This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site.

Findings

Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; median age 49 years IQR 41; 57), 21.8% (n = 6003; n = 2999/50.0% female, n = 3004/50% male; median age 53 years IQR 46; 60) reported CBP, compared to 78.2% (n = 21,515; n = 9194/42.7% female, n = 12,321/57.3% male; median age 48 years IQR 39; 56) who did not. CBP prevalence was highest in those with low (<500 MET min/week) or high (>5000 MET min/week) self-reported physical activity levels (24.6% (n = 10,892) and 22.0% (n = 3800), respectively) compared to moderate (500–5000 MET min/week) levels (19.4% (n = 12,826); p < 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13–1.30; p < 0.0001) was associated with an increased likelihood of chronic back pain (CBP), whereas higher lean muscle mass (LMM) (OR 0.87 per 2-unit Z-score; 95% CI 0.79–0.95; p = 0.003) was associated with a reduced likelihood of CBP. Stratified analyses confirmed these associations persisted in individuals with osteoarthritis (OA-CBP LMM: 22.9 cm³/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm³/kg/m; InterMAT: 6.96% both p < 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm³/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm³/kg/m; InterMAT: 7.9% p = 0.16 and p = 0.0019). Higher pain intensity (Pain Intensity Numerical Rating Scale ≥4) correlated with lower LMM (2-unit Z-score deviation = OR, 0.63; 95% CI, 0.57–0.70; p < 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13–1.30; p < 0.0001), independent of physical activity, osteoporosis and osteoarthritis.

Interpretation

This large, population-based study highlights the associations of InterMAT and LMM with CBP. Given the limitations of the cross-sectional design, our findings can be seen as an impetus for further causal investigations within a broader, multidisciplinary framework to guide future research toward improved prevention and treatment.

Funding

The NAKO is funded by the Federal Ministry of Education and Research (BMBF) [project funding reference numbers: 01ER1301A/B/C, 01ER1511D, 01ER1801A/B/C/D and 01ER2301A/B/C], federal states of Germany and the Helmholtz Association, the participating universities and the institutes of the Leibniz Association.

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用MRI评估德国慢性背痛患者的肌间脂肪组织和瘦肌肉质量：一项回顾性观察研究

在欧洲，慢性背痛（CBP）影响着8000多万人，造成了大量的医疗成本和残疾。了解可改变的危险因素，如肌肉成分，可能有助于预防和治疗。本研究利用无创全身磁共振成像（MRI）研究了瘦肌肉质量（LMM）和肌间脂肪组织（InterMAT）与CBP之间的关系。该横断面分析使用了2014年5月1日至2019年9月1日期间收集的来自德国国家队列（NAKO）的30,868名参与者的全身MRI数据。CBP定义为背痛持续3个月。使用经过验证的深度学习模型，通过基于mri的肌肉分割对LMM和InterMAT进行量化。使用混合逻辑回归分析相关性，调整年龄、性别、糖尿病、血脂异常、骨质疏松症、骨关节炎、体力活动和研究地点。在27,518名参与者中(n = 12,193/44.3%女性，n = 14,605/55.7%男性；中位年龄49岁IQR 41；57人),21.8% (n = 6003；N = 2999/50.0%女性，N = 3004/50%男性；中位年龄53岁IQR 46；60名)报称有美国海关入境，而78.2% (n = 21,515；N = 9194/42.7%女性，N = 12321 /57.3%男性；中位年龄48岁IQR 39；56)没有。与中度（500 - 5000 MET min/week）水平(19.4% （n = 12,826）相比，低（500 MET min/week）或高（5000 MET min/week）自我报告体力活动水平的人群（24.6% （n = 10,892）和22.0% (n = 3800)）的CBP患病率最高；p & lt;0.0001)。调整后的分析显示，较高的InterMAT (OR 1.22 / 2-unit Z-score)；95% ci 1.13-1.30；p & lt;0.0001)与慢性背痛（CBP）的可能性增加相关，而较高的瘦肌肉质量（LMM） (OR 0.87 / 2单位z评分；95% ci 0.79-0.95；p = 0.003)与CBP发生可能性降低相关。分层分析证实，这些关联在骨关节炎患者中持续存在(OA-CBP LMM: 22.9 cm3/kg/m；InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm3/kg/m；InterMAT: 6.96% both p <；0.0001)和骨质疏松症(OP-CBP LMM: 20.9 cm3/kg/m；InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm3/kg/m；InterMAT: 7.9% p = 0.16和p = 0.0019)。较高的疼痛强度（疼痛强度数值评定量表≥4）与较低的LMM相关(2单位Z-score偏差= OR, 0.63；95% ci, 0.57-0.70；p & lt;0.0001)和更高的InterMAT(2单位Z-score偏差= OR, 1.22；95% ci, 1.13-1.30；p & lt;0.0001)，与身体活动、骨质疏松和骨关节炎无关。这项基于人群的大型研究强调了InterMAT和LMM与CBP的关联。鉴于横断面设计的局限性，我们的研究结果可以被视为在更广泛的多学科框架内进一步进行因果调查的动力，以指导未来研究改进预防和治疗。NAKO由德国联邦教育和研究部（BMBF）[项目资助编号：01ER1301A/B/C， 01ER1511D， 01ER1801A/B/C/D和01ER2301A/B/C]，德国联邦各州和亥姆霍兹协会，参与的大学和莱布尼茨协会的研究所资助。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.