Interaction of Dietary Patterns and Physical Activity with Low Back Pain in Pre- to Post-Menopause: A Cross-Sectional StudyDietary patterns, physical activity and their interaction in relation to low back pain among pre-, peri- and postmenopausal wom

BACKGROUND: Low back pain (LBP) in perimenopause and postmenopausal women is an important public health concern because of its high prevalence and associated social and economic burden. Dietary patterns and physical activity have attracted increasing attention as modifiable determinants of LBP, but the impact of their interaction, particularly across menopausal stages, has not been well characterized. METHODS: This cross-sectional analysis included 1530 adult women from the Ordos Resident Health White Paper Program. Dietary patterns were derived using principal components analysis of food frequency questionnaire data. Physical activity was assessed using the International Physical Activity Questionnair. LBP was defined as self-reported pain, ache or discomfort in the lumbosacral region (Verbal Rating Scale score 1-3). Logistic regression models were used to examine associations between dietary patterns, physical activity and LBP. Interaction between dietary patterns and physical activity was assessed overall and stratified by menopausal status. RESULTS: The prevalence of LBP was 12.6%. Three major dietary patterns were identified: a plant-based dietary pattern (PBDP), a northern pastoral dietary pattern (NPDP) and a northern traditional dietary pattern (NTDP). Only PBDP was significantly associated with LBP. Compared with women in the highest quartile of adherence to PBDP (Q4), those in the lowest quartile (Q1) had higher odds of LBP (adjusted OR = 2.879, 95% CI: 1.749-4.739). No significant association with LBP was observed for NPDP. In joint analyses, the highest odds of LBP were observed among women with higher-intensity physical activity and non-adherence to PBDP (Q1) (adjusted OR = 3.777, 95% CI: 1.991-7.166). In analyses stratified by menopausal status, the risk associated with higher-intensity physical activity and non-adherence to PBDP increased from perimenopausal to postmenopausal women, with adjusted ORs of 3.600 (95% CI: 1.029-12.592) and 5.752 (95% CI: 2.189-15.114), respectively. CONCLUSIONS: In this population of midlife women, higher-intensity physical activity was associated with increased risk of LBP, and this risk rose from perimenopause to postmenopause. Adherence to PBDP attenuated the LBP risk associated with higher-intensity physical activity, with the beneficial effect becoming more pronounced after menopause. These findings suggest that menopause-specific combinations of dietary improvement and appropriate physical activity may help mitigate the burden of LBP in perimenopausal and postmenopausal women.