Association between monounsaturated fatty acids and low back pain and patient all-cause mortality: causal inferences based on NHANES epidemiology

doi:10.12307/2025.719

Abstract

Abstract: BACKGROUND: Monounsaturated fatty acids are mostly recognized as a fatty acid with beneficial effects on human health, and some studies have suggested that they may contribute to non-inflammatory pain at multiple sites in the body.
OBJECTIVE: To investigate the effect of monounsaturated fatty acids on the incidence of low back pain and all-cause mortality, thereby providing potential biomarkers and intervention strategies for low back pain management and prevention.
METHODS: A Mendelian randomization method was used to analyze the potential association of monounsaturated fatty acids on the incidence of low back pain and all-cause mortality in conjunction with large sample data from the National Health and Nutrition Examination Survey (NHANES) database. Results were validated and sensitivity analyzed using multiple statistical models (e.g., inverse variance weighting, MR-Egger regression, simple median, weighted median, and weighted median) to enhance the reliability of causal inferences. In the NHANES study, multivariate Cox proportional risk regression models were used to assess the independent predictive values of different fatty acid ratios and to control for confounders. Potential nonlinear relationships between monounsaturated fatty acids and all-cause mortality were assessed using Kaplan-Meier curves, log-rank tests, and restricted cubic spline curves.
RESULTS AND CONCLUSION: Elevated monounsaturated fatty acids have been found to be associated with a significantly higher risk of low back pain, suggesting an unfavorable effect of this fatty acid. Also, monounsaturated fatty acids may increase all-cause mortality in patients with low back pain. This provides new insights into the potential effects of monounsaturated fatty acids on low back pain and all-cause mortality, and provides a scientific basis for nutritional interventions for low back pain. The results support the use of dietary modification as one of the strategies for the prevention and management of low back pain in the European population, but further studies are needed to explore the specific biological mechanisms and potential for clinical application, thereby improving guidance for the prevention and treatment of diseases in China.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Mendelian randomization, monounsaturated fatty acids, NHANES, low back pain, all-cause mortality

CLC Number:

Tang Xiaochen, Yang Jingyan, Cheng Yupei, Hao Huatao, Li Hanyu, Yu Dong. Association between monounsaturated fatty acids and low back pain and patient all-cause mortality: causal inferences based on NHANES epidemiology[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(20): 4361-4368.

Figures/Tables 3

2.2 NHANES研究结果 2.2.1 研究人群的基线特征在NHANES数据库的研究中，共有1 405名参与者被纳入，其中腰痛人群有516人(见图3)。首先，根据疼痛与否对总样本、腰痛和无腰痛组的基线特征进行比较，结果显示腰痛和无腰痛的参与者在受教育程度、贫困收入比、吸烟情况等方面存在一定差异(P < 0.05)。相比之下，腰痛患者更容易是低学历、低收入以及吸烟人群。之后还描述了腰痛人群按性别划分的基线情况并观察到了若干具有统计学意义的差异。体质量指数(kg/m2)在男性(均值=27.85，标准差=5.05)与女性(均值=29.13，标准差=6.27)间存在显著差异(P=0.020)，男性的体质量指数普遍低于女性。吸烟行为在男性(32.77%)比女性(19.57%)更为常见，差异显著(P < 0.001)。饮酒习惯分析显示，男性中的重度饮酒者比例(23.83%)显著高于女性(12.46%，P < 0.001)。冠心病在男性中的发病率(8.09%)也显著高于女性(3.56%，P=0.026)。关于身体活动，从事繁重工作或负重活动的男性(14.04%)显著多于女性(2.14%，P < 0.001)。这些结果揭示了腰痛人群中生理健康指标和行为习惯上的性别差异。 2.2.2 单不饱和脂肪酸与腰痛患者全因死亡率的关联根据之前孟德尔随机化分析的结果，进一步探讨了单不饱和脂肪酸对腰痛患者全因死亡率的影响，为此按四分位数对单不饱和脂肪酸进行分类，并构建了多变量Cox回归模型(见表4)，模型结果显示，单不饱和脂肪酸的增加可能会增加腰痛患者的全因死亡率风险。在单不饱和脂肪酸的粗调整模型中，与最低四分位数的相比，最高四分位数的腰痛患者全因死亡率风险显著增加[风险比=2.80，95% CI (1.68，4.64)，P < 0.000 1]。在单不饱和脂肪酸的完全调整模型情况下，同样与最低四分位数的相比，最高四分位数的腰痛患者全因死亡率风险显著增加 [风险比=2.63，95%CI(1.35，5.13)，P=0.004 4]。并且趋势性检验均显著(P for trend < 0.05)。Kaplan-Meier生存曲线同样表明，较高的单不饱和脂肪酸与腰痛患者较高的全因死亡率相关(log rank P值<"

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