# Abdominal Adiposity Increases Lordosis and Doubles the Risk of Low Back Pain
## 2 Subjects and Methods
### Measurements
#### Anthropometric measurements and body composition indexes  
Weight (kg) was measured using a Tanita(r) BF 350 scale (Madrid, Spain). Height (cm) was measured with the subject in a standing position and with the heels placed together, while the head position was maintained in the Frankfurt plane. Waist and hip circumferences were measured using a Seca(r) (Hamburg, Germany) brand tape measure. The waist circumference (WC) was measured at the midpoint between the lower border of the last palpable rib and the upper portion of the iliac crest. The hip circumference was measured at the trochanter level according to the criteria established by the World Health Organization [14]. In order to evaluate the percentage of body fat (BF%), subcutaneous, tricipital, bicipital, subscapular, and supra-iliac fat folds (mm) were measured on the left side of the body by using a Holtaincaliper, in accordance with Lohman standards [15]. Based upon these measurements, the indicators of general obesity (namely, BMI and BF%) and abdominal obesity (WC, WHR, and W/HT) were readily calculated. The subjects were classified according to BMI (weight -kg-/height -m\({}^{2}\)-), and the values of normal weight were considered to be <24.99 kg/m\({}^{2}\), while overweight was >25 and <29.99 kg/m\({}^{2}\) while obesity was classified at >30 kg/m\({}^{2}\)[16]. The BF% was calculated from subcutaneous fat folds using the body density formula and the Siri equation [17; 18]. The following limitation cut-off points were used: 21-25% in men and 31-33% in women, while values for obesity were: >25.01% in men and >33.01% in women [19]. Abdominal obesity was defined with WC values > 88 cm for women and >102 cm for men [16]. The WHR risk values for obesity were >1 for men and >0.85 for women [20]. The risk category of the W/HT was considered at values >0.51 for both sexes [21]. _Angular quantification of vertebral curvatures_: A Unilevel inclinometer (ISOMED, Inc., Portland, OR, USA) was used after identifying the position of the cervical, thoracic, and lumbar angle postural markers as described by [PERSON] [22]. This procedure presents a simple, noninvasive, objective, and low-cost methodology that correlates well with magnetic X-rays for evaluation of the spine [23]. For the results to be valid and reproducible, it was necessary to perform the subjects' measurements in a standardized anatomical position (Figure 1). The points of reference were P1: the inclination of the cervical section,  
Figure 1: Vertebral curve quantification in the sagittal plane using an inclinometer. P1: Inclination of the cervical section, P2: Maximum kyphosis of the thoracic section, P3: Sacral inclination. P2: maximum kyphosis of the thoracic section, and P3: sacral inclination. The inclinometer was reset to 0\({}^{\circ}\), and the inclinometer is supported on the seventh cervical vertebra, which corresponds to the cervical angle. From P1, with the device at 0\({}^{\circ}\), it slides caudally to the point of greatest inclination, which is P2. In order to measure lumbar lordosis, the inclinometer was reset to 0\({}^{\circ}\) from P2 and slid caudally to P3, which corresponds to the second vertebra of the sacrum. Normal values for dorsal curvature fall within the range of 20\({}^{\circ}\) to 45\({}^{\circ}\), and for cervical and lumbar curvature, they are in the range of 20\({}^{\circ}\) to 40\({}^{\circ}\) (for measurements made with an inclinometer) [24]. _Assessment of back pain:_ The self-perception of cervical, dorsal, and lumbar vertebral pain (yes/no) was collected over the last year, including both radicular and non-radicular pain, even if such pain occurred intermittently. _Covariates_: Participants' sex, age, educational level, and physical activity. The educational levels were coded as either low (complete or incomplete elementary studies) or high (secondary studies or higher).