Life course body mass index and risk of knee osteoarthritis at the age of 53 years: evidence from the 1946 British birth cohort study

Abstract

Introduction: The authors examined how body mass index (BMI) across life is linked to the risk of midlife knee osteoarthritis (OA), testing whether prolonged exposure to high BMI or high BMI at a particular period has the greatest influence on the risk of knee OA.

Methods: A population-based British birth cohort of 3035 men and women underwent clinical examination for knee OA at age 53 years.Heights and weights were measured 10 times from 2 to 53 years. Analyses were stratified by gender and adjusted for occupation and activity levels.

Results: The prevalence of knee OA was higher in women than in men (12.9% (n=194) vs 7.4% (n=108)). In men, the association between BMI and later knee OA was evident at 20 years (p=0.038) and remained until 53 years (OR per z-score 1.38 (95% CI 1.11 to 1.71)). In women, there was evidence for an association at 15 years (p=0.003); at 53 years, the OR was 1.89 (95% CI 1.59 to 2.24) per z-score increase in BMI. Changes in BMI from childhood in women and from adolescence in men were also positively associated with knee OA. A structured modelling approach to disentange the way in which BMI is linked to knee OA suggested that prolonged exposure to high BMI throughout adulthood carried the highest risk and that there was no additional risk conferred from adolescence once adult BMI had been accounted for.

Conclusion: This study suggests that the risk of knee OA accumulates from exposure to a high BMI through adulthood.

Figure 1

Mean lifetime body mass index (BMI) z-score and 95% CI (shaded area) in men (A) and women (B) among those with knee osteoarthritis (OA; solid line) at age 53 years. The dashed line is the mean BMI pattern in individuals without knee OA at age 53 years.

Figure 2

Odds ratios (OR) for knee osteoarthritis in men (filled markers) and women (open markers) per z-score increase in body mass index (BMI) at each age (A) and per kg/m² increase in BMI (B). Adjusted for activity levels and occupation (manual/non-manual). Evidence for a sex interaction using BMI z-scores at ages 15 years (p=0.035) and 53 years (p=0.025) and weak evidence at ages 36 years (p=0.051) and 43 years (p=0.089). Evidence for sex interaction using nonstandardised BMI at age 15 years (p=0.043).

Figure 3

Association (OR) between conditional body mass index (BMI) change (per z-score increase) and knee osteoarthritis in infancy (2–7 years), childhood/adolescence (7–15 years), adolescence to young adulthood (15–20 years), early adulthood (20–36 years) and mid-adulthood (36–53 years) in men (filled markers) and women (open markers). Each period of BMI change is adjusted for BMI at the beginning of the interval. Adjusted for activity levels and occupation (manual/non-manual). Sex interactions: 7–15 years: p=0.088; 15–20 years: p=0.035; 20–36 years: p=0.012.