articleSpinal pain and nutrition in adolescents-an exploratory cross-sectional study

Background: Spinal pain is an important health issue for adolescents resulting in functional limitations for many and increasing the risk of spinal pain in adulthood. Whilst human and animal studies suggest nutrition could influence spinal pain, this has not been investigated in adolescents. The objective of this exploratory cross sectional study was to evaluate associations between diet and adolescent spinal pain. Methods: This study surveyed the spinal pain (neck and back) and nutrition (specific nutrients, broad food groups, diet quality and dietary pattern) of 1424 male and female adolescents at 14 years of age, in Western Australia. Results: Back or neck pain were experienced by around half of the adolescents, with females more likely to experience spinal pain. Nutrition differed between sexes and deviated from optimal intakes. Vitamin B12, eggs, cereals and meat consumption were related to spinal pain in sex specific multivariate analyses including primary carer education level and adolescent waist girth and smoking. Conclusions: The findings of this study suggest that certain aspects of diet may have an association with spinal pain in adolescence. Background Spinal pain is a serious problem for adolescents, with over half having experienced some form of back or neck pain by mid adolescence[1,2] and a third experiencing a reduction in function [3]. Adolescent spinal pain also appears to be a precursor to adult spinal pain [4-6], which has well-documented personal and societal costs [7]. Identification of contributing factors is therefore warranted. Adolescent spinal pain has been shown to relate to physical factors such as obesity [8], psychosocial factors such as emotional problems [9] and lifestyle factors. Aspects of lifestyle such as very high or very low activity [10] or excessive computer use [11] have been shown to relate to adolescent spinal pain in cross-sectional studies. Moreover two longitudinal studies have shown links between adolescent spinal pain and aspects of lifestyle such as employment [12,13] and smoking [12]. However, another potentially important lifestyle factor, nutrition, has only been sparingly investigated. In the only studies to our knowledge concerning adolescent spinal pain and nutrition, Ghandour et al. [14] reported that back pain was related to high caffeine intake in adolescent girls, and Molcho et al. [15] documented that adolescents who reported going to bed hungry because there was insufficient food in the house were more likely to have back pain, even after adjustment for parental social class. Despite the dearth of information, it is likely that nutrition is an important factor relating to musculoskeletal health for adolescents, as healthy growth and development is nutrition dependent [16,17]. Furthermore, a possible link in adolescents is suggested by some adult evidence. Certain dietary patterns have been shown to reduce general pain sensitivity in adults, specifically greater intakes of sucrose [15-19] and omega 3 fatty acids [19], and lower intakes of saturated fats [19]. High post-prandial blood sucrose [20] and lipid concentrations [21] have also been linked to higher levels of proinflammatory factors. Conversely higher intakes of omega 3 fatty acids [22] are linked to lower levels of such factors, and it has been suggested that fruit and vegetables may reduce inflammatory processes through an anti* Correspondence: L.Straker@curtin.edu. au 1 School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth WA 6845, Perth, WA, Australia † Contributed equally Full list of author information is available at the end of the article © 2010 Perry et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Perry et al. BMC Musculoskeletal Disorders 2010, 11:138 http://www.biomedcentral. com/1471-2474/11/138 Page 2 of 9 oxidant effect [23]. Although such influences on inflammation are likely to be short-term in themselves, effects are likely to be continuous, as food intake is repeated [23]. There is evidence that adolescent diets deviate further from recommended dietary guidelines than adult diets [24] and so nutritional effects on spinal pain may possibly be more common in adolescents. Contemporary adolescent diet in the western world is below recommended standards, with high intakes of sugar [25,26] and fat [25], low intakes of fibre [25,27] and a steady reduction in fruit and vegetable consumption throughout adolescence [28]. Altogether these findings suggest that there may be links between spinal pain and nutrition in adolescents. Given the lack of prior research in this area, our study aims to be exploratory in nature, and to investigate the links between a range of nutritional and dietary factors and adolescent spinal pain. Based on the limited prior evidence, the first hypothesis was that low or high consumption of specific nutrients or food groups may be associated with spinal pain. As individual nutrients or foods may have a very small impact, our second hypothesis was that adolescents with spinal pain will have a poorer quality diet and dietary pattern. Methods Design This was a cross-sectional exploratory study conducted in Western Australia. Participants Data from 1424 adolescents (696 girls, 728 boys) of mean (SD) height 1.64 (0.08) m, weight 57.6 (13.1) kg and age 14.06 (0.20) yrs were collected as part of their participation in the Western Australian Pregnancy Cohort 'Raine' Study http://www.rainestudy. org.au. There were 2337 adolescents eligible for the 14 year follow-up, of which 1704 (72.9%) consented to some aspect of the follow-up and 1424 (60.9%) completed the data collection requirements for the analysis reported in this paper. The initial cohort over-represented socially disadvantaged groups and there has been greater attrition in these groups so the remaining participants more closely match the Australian adolescent population [29,30]. Informed consent to participate in the 14 year follow-up was obtained from the primary carer. The study was approved by the Human Research Ethics Committees of Curtin University of Technology and Princess Margaret Hospital.