Abstract
BackgroundAdiposity is a modifiable factor that has been implicated in tendinopathy. As tendon pain reduces physical activity levels and can lead to weight gain, associations between tendon pathology and adiposity must be studied in individuals without tendon pain. Therefore, the purpose of this study was to determine whether fat distribution was associated with asymptomatic Achilles tendon pathology.MethodsThe Achilles tendons of 298 individuals were categorised as normal or pathological using diagnostic ultrasound. Fat distribution was determined using anthropometry (waist circumference, waist hip ratio [WHR]) and dual-energy x-ray absorptiometry.ResultsAsymptomatic Achilles tendon pathology was more evident in men (13%) than women (5%) (p = 0.007). Men with tendon pathology were older (50.9 ± 10.4, 36.3 ± 11.3, p < 0.001), had greater WHR (0.926 ± 0.091, 0.875 ± 0.065, p = 0.039), higher android/gynoid fat mass ratio (0.616 ± 0.186, 0.519 ± 0.142, p = 0.014) and higher upper-body/lower body fat mass ratio (2.346 ± 0.630, 2.022 ± 0.467, p = 0.013). Men older than 40 years with a waist circumference >83 cm had the greatest prevalence of tendon pathology (33%). Women with tendon pathology were older (47.4 ± 10.0, 36.0 ± 10.3, p = 0.008), had less total fat (17196 ± 3173 g, 21626 ± 7882 g, p = 0.009), trunk fat (7367 ± 1662 g, 10087 ± 4152 g, p = 0.003) and android fat (1117 ± 324 g, 1616 ± 811 g, p = 0.005). They had lower central/peripheral fat mass ratios (0.711 ± 0.321 g, 0.922 ± 0.194 g, p = 0.004) than women with normal tendons. Women with tendon pathology were more often menopausal (63%, 13%, p = 0.002).ConclusionsMen with Achilles tendon pathology were older and had a central fat distribution. Women with tendon pathology were older and had a peripheral fat distribution. An interaction between age and waist circumference was observed among men.
Highlights
Adiposity is a modifiable factor that has been implicated in tendinopathy
Our findings show that 40% of patients with Achilles tendinopathy report gaining weight since their tendon first became painful, and among this group their average estimated weight gain was 5 kg (Gaida et al unpublished data)
Asymptomatic Achilles tendon pathology was evident in more men (17/127, 13%) than women (8/171, 5%) (c2 = 7.189, df = 1, p = 0.007)
Summary
As tendon pain reduces physical activity levels and can lead to weight gain, associations between tendon pathology and adiposity must be studied in individuals without tendon pain. The purpose of this study was to determine whether fat distribution was associated with asymptomatic Achilles tendon pathology. The condition is most common among those with high levels of tendon loading – 1 in every 2 runners will experience Achilles tendinopathy before the age of 45 [2]. Identification of risk factors is a critical first step in developing prevention programmes. Recent evidence suggests that the amount and distribution of adiposity may be a risk factor for tendinopathy [4,5]. As greater adiposity is amenable to change through diet and exercise interventions, this factor could potentially be incorporated into prevention programmes
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