European Spine Journal

, Volume 28, Issue 2, pp 224–233 | Cite as

Contributions of birthweight, annualised weight gain and BMI to back pain in adults: a population-based co-twin control study of 2754 Australian twins

  • Hercules R. LeiteEmail author
  • Amabile B. Dario
  • Alison R. Harmer
  • Vinicius C. Oliveira
  • Manuela L. Ferreira
  • Lucas Calais-Ferreira
  • Paulo H. Ferreira
Original Article



To investigate associations between anthropometric measures (birthweight, weight gain and current BMI) and back pain; and to determine whether these associations differ between those born with low or full birthweight.


The cross-sectional associations between the lifetime prevalence of back pain and anthropometric measures (birthweight, weight gain and current BMI) among 2754 adult twins were investigated in three stages: total sample; within-pair case–control for monozygotic and dizygotic twins together; and within-pair case–control analysis separated by dizygotic and monozygotic. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI).


Birthweight was not associated with back pain (OR 0.99; 95% CI 0.99–1.00), but a weak association was found between weight gain (OR 1.01; CI 1.00–1.01) or current BMI (OR 1.02; 95% CI 1.00–1.05) and back pain in the total sample analysis. These associations did not remain significant after adjusting for genetics. The associations did not differ between those whose were born with low or full birthweight.


Birthweight was not associated with prevalence of back pain in adulthood. Weight gain and current BMI were weakly associated with back pain prevalence in the total sample analysis but did not differ between those born with low or full birthweight. However, the small-magnitude association only just achieved significance and appeared to be confounded by genetics and the early shared environment. Our results suggest that a direct link between these predictors and back pain in adults is unlikely.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Birthweight BMI Twins Back pain Genetics 



HRL and LCF were supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Foundation, Ministry of Education, Brazil. MLF holds a National Health and Medical Research Council Research Fellowship and is a Sydney Medical Foundation Fellow. PHF is a National Health and Medical Research Council Fellow. This research was facilitated through access to Twins Research Australia, a national resource supported by a Centre of Research Excellence Grant (ID: 1079102), from the National Health and Medical Research Council, Australia.

Compliance with ethical standards

Conflict of interest


Supplementary material

586_2018_5850_MOESM1_ESM.pptx (150 kb)
Supplementary material 1 (PPTX 150 kb)


  1. 1.
    Rossi M, Pasanen K, Heinonen A, Myklebust G, Kannus P, Kujala U, Tokola K, Parkkari J (2018) Incidence and risk factors for back pain in young floorball and basketball players: a prospective study. Scand J Med Sci Sports 28:2407–2415Google Scholar
  2. 2.
    AIWH (2016) Australian Institute of Health and WelfareGoogle Scholar
  3. 3.
    Kirby ER, Broom AF, Sibbritt DW, Refshauge KM, Adams J (2013) Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women. PLoS ONE 8(12):e83559Google Scholar
  4. 4.
    Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J (2018) What low back pain is and why we need to pay attention. Lancet 391:2356–2367Google Scholar
  5. 5.
    Iversen J, Hoftun G, Romundstad P, Rygg M (2015) Adolescent chronic pain and association to perinatal factors: linkage of Birth Registry data with the Young-HUNT Study. Eur J Pain 19(4):567–575Google Scholar
  6. 6.
    Iversen JM, Indredavik MS, Evensen KA, Romundstad PR, Rygg M (2017) Self-reported chronic pain in young adults with a low birth weight. Clin J Pain 33(4):348Google Scholar
  7. 7.
    Oostroml SH, Verschurenl W, Vetl HC, Picavetl HSJ (2011) Ten year course of low back pain in an adult population-based cohort—the Doetinchem cohort study. Eur J Pain 15(9):993–998Google Scholar
  8. 8.
    Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. Lancet 379(9814):482–491Google Scholar
  9. 9.
    Tanamas SK, Wluka AE, Davies-Tuck M, Wang Y, Strauss BJ, Proietto J, Dixon JB, Jones G, Forbes A, Cicuttini FM (2013) Association of weight gain with incident knee pain, stiffness, and functional difficulties: a longitudinal study. Arthritis Care Res 65(1):34–43Google Scholar
  10. 10.
    Andersen RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR (2003) Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obesity 11(10):1159–1162Google Scholar
  11. 11.
    Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA (2009) Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 12(4):E35–70Google Scholar
  12. 12.
    Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA (2014) Epidemiology of low back pain in adults. Neuromodul Technol Neural Interface 17(S2):3–10Google Scholar
  13. 13.
    Garzillo M, Garzillo T (1994) Does obesity cause low back pain? J Manip Physiol Ther 17(9):601–604Google Scholar
  14. 14.
    Leboeuf-Yde C (2000) Body weight and low back pain: a systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine 25(2):226Google Scholar
  15. 15.
    Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E (2013) The role of obesity and physical activity in non-specific and radiating low back pain: the Young Finns study. In: Seminars in arthritis and rheumatism, vol 6. Elsevier, pp 640–650Google Scholar
  16. 16.
    Dario AB, Ferreira ML, Refshauge KM, Lima TS, Ordoñana JR, Ferreira PH (2015) The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J 15(5):1106–1117Google Scholar
  17. 17.
    Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C (2003) Is low back pain in youth associated with weight at birth? A cohort study of 8000 Danish adolescents. Dan Med Bull 50(2):181–185Google Scholar
  18. 18.
    Hestbaek L, Iachine IA, Leboeuf-Yde C, Kyvik KO, Manniche C (2004) Heredity of low back pain in a young population: a classical twin study. Twin Res Hum Genet 7(1):16–26Google Scholar
  19. 19.
    El-Metwally A, Mikkelsson M, Ståhl M, Macfarlane GJ, Jones GT, Pulkkinen L, Rose RJ, Kaprio J (2008) Genetic and environmental influences on non-specific low back pain in children: a twin study. Eur Spine J 17(4):502–508Google Scholar
  20. 20.
    Dario AB, Ferreira ML, Refshauge K, Luque-Suarez A, Ordoñana JR, Ferreira PH (2017) Obesity does not increase the risk of chronic low back pain when genetics are considered: a prospective study of Spanish adult twins. Spine J 17(2):282–290Google Scholar
  21. 21.
    Calais-Ferreira L, Oliveira VC, Craig JM, Flander LB, Hopper JL, Teixeira-Salmella L, Ferreira PH (2017) Twin studies for the prognosis, prevention and treatment of musculoskeletal conditions. Braz J Phys Ther 22:184–189Google Scholar
  22. 22.
    Onyiriuka A (2010) Incidence of delivery of low birthweight infants in twin gestations. Niger J Clin Pract 13(4):365–370Google Scholar
  23. 23.
    Yokoyama Y, Jelenkovic A, Sund R, Sung J, Hopper JL, Ooki S, Heikkilä K, Aaltonen S, Tarnoki AD, Tarnoki DL (2016) Twin’s birth-order differences in height and body mass index from birth to old age: a pooled study of 26 twin cohorts participating in the CODATwins project. Twin Res Hum Genet 19(2):112–124Google Scholar
  24. 24.
    Organization WH (2014) Comprehensive implementation plan on maternal, infant and young child nutritionGoogle Scholar
  25. 25.
    Hopper JL, Foley DL, White PA, Pollaers V (2013) Australian Twin Registry: 30 years of progress. Twin Res Hum Genet 16(1):34–42Google Scholar
  26. 26.
    Nilsen TS, Kutschke J, Brandt I, Harris JR (2017) Validity of self-reported birth weight: results from a Norwegian twin sample. Twin Res Hum Genet 20(5):406–413Google Scholar
  27. 27.
    Peeters A, Magliano DJ, Backholer K, Zimmet P, Shaw JE (2014) Changes in the rates of weight and waist circumference gain in Australian adults over time: a longitudinal cohort study. BMJ Open 4(1):e003667Google Scholar
  28. 28.
    Kessler R, Mroczek D (1994) Final versions of our non-specific psychological distress scale. Memo dated March 10:1994Google Scholar
  29. 29.
    Mallen CD, Peat G, Thomas E, Croft PR (2006) Is chronic musculoskeletal pain in adulthood related to factors at birth? A population-based case-control study of young adults. Eur J Epidemiol 21(3):237–243. Google Scholar
  30. 30.
    Littlejohn C, Pang D, Power C, Macfarlane GJ, Jones GT (2012) Is there an association between preterm birth or low birthweight and chronic widespread pain? Results from the 1958 Birth Cohort Study. Eur J Pain 16(1):134–139. Google Scholar
  31. 31.
    Brady S, Hussain S, Brown WJ, Heritier S, Wang Y, Teede H, Urquhart DM, Cicuttini FM (2018) The course and contributors to back pain in middle-aged women over nine years: data from the Australian longitudinal study of women’s health. Osteoarthr Cartil 26:S418Google Scholar
  32. 32.
    Badley EM, Millstone DB, Perruccio AV (2018) Back pain and co-occurring conditions: findings from a nationally representative sample. Spine 43:E935–E941Google Scholar
  33. 33.
    Deyo RA, Mirza SK, Martin BI (2006) Back pain prevalence and visit rates: estimates from US national surveys, 2002. Spine 31(23):2724–2727Google Scholar
  34. 34.
    Dario AB, Ferreira ML, Refshauge K, Sánchez-Romera JF, Luque-Suarez A, Hopper JL, Ordoñana JR, Ferreira PH (2016) Are obesity and body fat distribution associated with low back pain in women? A population-based study of 1128 Spanish twins. Eur Spine J 25(4):1188–1195Google Scholar
  35. 35.
    Loos R, Beunen G, Fagard R, Derom C, Vlietinck R (2001) Birth weight and body composition in young adult men—a prospective twin study. Int J Obes 25(10):1537Google Scholar
  36. 36.
    Gorber SC, Tremblay M, Moher D, Gorber B (2007) A comparison of direct vs self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8(4):307–326Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hercules R. Leite
    • 1
    • 2
    Email author
  • Amabile B. Dario
    • 2
  • Alison R. Harmer
    • 2
  • Vinicius C. Oliveira
    • 1
  • Manuela L. Ferreira
    • 3
  • Lucas Calais-Ferreira
    • 4
  • Paulo H. Ferreira
    • 2
  1. 1.Programa de Pós-Graduação em Reabilitação e Desempenho FuncionalUniversidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM)DiamantinaBrazil
  2. 2.Musculoskeletal Health Research Group, Faculty of Health SciencesThe University of SydneyLidcombe, SydneyAustralia
  3. 3.Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical SchoolThe University of SydneySydneyAustralia
  4. 4.Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia

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