Abstract / Summary
Abstract Background Dietary patterns, adiposity, mechanical loading, metabolic factors, and reproductive history may influence knee symptoms in premenopausal women. However, few studies have examined dietary diversity, anthropometric indicators, and reproductive factors in premenopausal women. Objective This study aimed to examine the associations between dietary diversity, anthropometric indicators, reproductive history, and knee symptom severity among premenopausal women aged 40–50 years. Methods We conducted a cross-sectional analytical study of 276 premenopausal women aged 40–50 years who reported knee osteoarthritis-related symptoms. Dietary intake was assessed using a food-frequency questionnaire and dietary diversity score. Anthropometric assessments included body weight, height, body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Reproductive history was assessed using age at menarche, menstrual regularity, parity, number of live births, miscarriage or abortion history, breastfeeding history, oral contraceptive use, and age at first pregnancy. Knee symptom severity was assessed using the Likert-version Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Descriptive statistics, Pearson's correlation, and multiple linear regression were used. The study was reported according to the STROBE recommendations for cross-sectional studies (von Elm et al., 2007; Vandenbroucke et al., 2007). Results The mean age of the participants was 44.3 ± 2.8 years. The mean WOMAC total score was 53.4 ± 14.9, the mean dietary diversity score was 8.9 ± 1.5, and the mean BMI was 27.0 ± 4.2 kg/m². The mean waist circumference, hip circumference, WHR, and WHtR were 88.6 ± 9.4 cm, 101.8 ± 8.2 cm, 0.87 ± 0.07, and 0.56 ± 0.06, respectively. BMI showed a moderate positive correlation with WOMAC total score (r = 0.393, p < 0.001). Waist circumference (r = 0.365, p < 0.001), hip circumference (r = 0.214, p = 0.001), WHR (r = 0.337, p < 0.001), and WHtR (r = 0.354, p < 0.001) also showed positive correlations with WOMAC score. Dietary diversity showed a weak inverse correlation with WOMAC score (r = −0.136, p = 0.024). Age at menarche and parity were not significantly correlated with WOMAC score. In the BMI-adjusted regression model, BMI was positively associated with WOMAC score (B = 1.36, 95% CI: 0.77–1.95, p < 0.001), whereas dietary diversity showed a small inverse association (B = −1.09, 95% CI: −2.15 to −0.03, p = 0.045). In the WHR-adjusted model, WHR was positively associated with WOMAC score (B = 38.20, 95% CI: 18.91–57.49, p < 0.001), while the inverse association with dietary diversity was attenuated and was not statistically significant (B = −0.96, 95% CI: −2.00 to 0.08, p = 0.071).” Conclusion Higher general and central adiposity was associated with greater knee symptom burden, whereas greater dietary diversity showed a weak inverse association. The reproductive variables examined in the present analysis were not significantly associated with WOMAC scores. Because of the cross-sectional design and potential residual confounding, causal conclusions cannot be drawn.