Obesity and Knee Osteoarthritis: The Framingham Study
Abstract
Study objective To determine whether obesity preceded knee osteoarthritis and was thus a possible cause. Design Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years). Setting Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort. Methods For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level. Results In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the m…
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Cites
Statistical Aspects of the Analysis of Data From Retrospective Studies of Disease
(1959) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/22.4.719 · Cited by 14,689 · see citing works
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Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., Nadolsky, K., Pessah-Pollack, R., & Plodkowski, R. (2016) · Endocrine Practice · doi:10.4158/ep161365.gl · Cited by 1,914 · see citing works
Short Sleep Duration and Weight Gain: A Systematic Review
Patel, S. R., & Hu, F. B. (2008) · Obesity · doi:10.1038/oby.2007.118 · Cited by 1,505 · see citing works
Villareal, D. T., Apovian, C. M., Kushner, R. F., & Klein, S. (2005) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.5.923 · Cited by 880 · see citing works
Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., DeVita, P., Beavers, D. P., Hunter, D. J., Lyles, M. F., Eckstein, F., et al. (2013) · JAMA · doi:10.1001/jama.2013.277669 · Cited by 873 · see citing works
Villareal, D. T., Apovian, C. M., Kushner, R. F., & Klein, S. (2005) · Obesity Research · doi:10.1038/oby.2005.228 · Cited by 579 · see citing works
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(2013) · The Journal of Arthroplasty · doi:10.1016/j.arth.2013.02.011 · Cited by 373 · see citing works
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Klein, S., Wadden, T., & Sugerman, H. J. (2002) · Gastroenterology · doi:10.1053/gast.2002.35514 · Cited by 274 · see citing works
Petersen, K. K., Arendt-Nielsen, L., Simonsen, O., Wilder-Smith, O., & Laursen, M. B. (2015) · Pain · doi:10.1016/j.pain.0000000000000022 · Cited by 269 · see citing works
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Gurwitz, J. H. (1994) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1994.03520100043031 · Cited by 220 · see citing works
Lifetime health and economic benefits of weight loss among obese persons.
Oster, G., Thompson, D., Edelsberg, J., Bird, A. P., & Colditz, G. A. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.10.1536 · Cited by 193 · see citing works
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Cetin, D. C., & Nasr, G. (2014) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.81a.12165 · Cited by 94 · see citing works
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White, D. K., Keysor, J. J., Neogi, T., Felson, D. T., LaValley, M., Gross, K. D., Niu, J., Nevitt, M., Lewis, C. E., Torner, J., et al. (2012) · Arthritis Care & Research · doi:10.1002/acr.21694 · Cited by 52 · see citing works
Self-citationRISSANEN, A., & FOGELHOLM, M. (1999) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199911001-00024 · Cited by 49 · see citing works
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Browning, R. C., Reynolds, M. M., Board, W. J., Walters, K. A., & Reiser, R. F. (2013) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00765.2012 · Cited by 26 · see citing works
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Teichtahl, A. J., Wluka, A. E., Wang, Y., Wijethilake, P. N., Strauss, B., Proietto, J., Dixon, J. B., Jones, G., Forbes, A., & Cicuttini, F. M. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.04.021 · Cited by 5 · see citing works
- Authors
- Felson, D. T., Anderson, J. J., Naimark, A., Walker, A. M., & Meenan, R. F.
- Corresponding author
- Felson, David T.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1988-07-01
- Volume
- 109
- Issue
- 1
- Pages
- 18-24
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2034201007
- Cited by
- 1,080
- References
- 1
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 30 · 2023: 25 · 2022: 33 · 2021: 27 · 2020: 28 · 2019: 50 · 2018: 45 · 2017: 37 · 2016: 54 · 2015: 54 · 2014: 48 · 2013: 55 · 2012: 56
- FWCI
- 7.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p60am020613-08)
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- obesity, knee osteoarthritis, body weight, radiographic osteoarthritis, Framingham Heart Study, sex differences, uric acid, physical activity, overweight
- MeSH terms
- Activities of Daily Living, Adult, Age Factors, Epidemiologic Methods, Female, Humans, Knee Joint, Male, Middle Aged, Obesity, Osteoarthritis, Radiography, Risk Factors, Sex Factors, Uric Acid
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