Knee osteoarthritis risk in non-industrial societies undergoing an energy balance transition: evidence from the indigenous Tarahumara of Mexico

Abstract

Non-industrial societies with low energy balance levels are expected to be less vulnerable than industrial societies to diseases associated with obesity including knee osteoarthritis. However, as non-industrial societies undergo rapid lifestyle changes that promote positive energy balance, individuals whose metabolisms are adapted to energetic scarcity are encountering greater energy abundance, increasing their propensity to accumulate abdominal adipose tissue and thus potentially their sensitivity to obesity-related diseases.ObjectivesHere, we propose that knee osteoarthritis is one such disease for which susceptibility is amplified by this energy balance transition.MethodsSupport for our hypothesis comes from comparisons of knee radiographs, knee pain and anthropometry among men aged ≥40 years in two populations: Tarahumara subsistence farmers in Mexico undergoing the energy balance transition and urban Americans from Framingham, Massachusetts.ResultsWe show that despite having markedly lower obesity levels than the Americans, the Tarahumara appear predisposed to accrue greater abdominal adiposity (ie, larger abdomens) for a given body weight, and are more vulnerable to radiographic and symptomatic knee osteoarthritis at lower levels of body mass index. Also, proportionate increases in abdomen size in the two groups are associated with greater increases in radiographic knee osteoarthritis risk among the Tarahumara than the Americans, implying that the abdominal adipose tissue of the Tarahumara is a more potent stimulus for knee degeneration.ConclusionsHeightened vulnerability to knee osteoarthritis among non-industrial societies experiencing rapid lifestyle changes is a concern that warrants further investigation since such groups represent a large but understudied fraction of the global population.

Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study

“…Obesity creates an abnormal loading environment for weight-bearing joints and may contribute to the pathogenesis of KOA [48]. Alternatively, the increased risk of KOA may be caused by the positive energy balance and metaflammation associated with obesity [49].…”

“…Alternatively, the increased risk of KOA may be caused by the positive energy balance and metaflammation associated with obesity [49]. Although BMI has been illustrated as an important predictor of KOA [50], Wallace et al (2019) [48] reported that increased abdomen size is associated with a greater risk of radiographic KOA than high BMI. Further studies are required to determine whether BMI, waist circumference, or metabolic syndrome comprehensively influences KOA risk due to mechaflammation and metaflammation.…”

Development of a Model for Predicting the 4-year Risk of Symptomatic Knee Osteoarthritis in China: A Longitudinal Cohort Study

“…Obesity creates an abnormal loading environment for weight-bearing joints and may contribute to the pathogenesis of KOA [48]. Alternatively, the increased risk of KOA may be caused by the positive energy balance and meta ammation associated with obesity [49].…”

“…Alternatively, the increased risk of KOA may be caused by the positive energy balance and meta ammation associated with obesity [49]. Although BMI has been illustrated as an important predictor of KOA [50], Wallace et al (2019) [48] reported that increased abdomen size is associated with a greater risk of radiographic KOA than high BMI. Further studies are required to determine whether BMI, waist circumference, or metabolic syndrome comprehensively in uences KOA risk due to mecha ammation and meta ammation.…”

Development of A Model for Predicting The 4-Year Risk of Systematic Knee Osteoarthritis in China: A Longitudinal Cohort Study

“…Obesity may also contribute to the pathogenesis of KOA by promoting chronic low-grade systemic in ammation or inducing mechanical damage to joint tissues, which in turn may lead to local in ammation. Together, these factors may weaken and degrade joint tissues [35]. Alternatively, the increased risk of KOA may be caused by the positive energy balance and meta ammation associated with obesity [36].…”