The Relationship between Waist Circumference and Work-related Injury in Reference to the Fourth Korea National Health and Nutrition Examination Survey
© Kim et al.; licensee BioMed Central Ltd. 2013
Received: 1 November 2012
Accepted: 1 October 2013
Published: 1 November 2013
This study aims to investigate the relationship between waist circumference and work-related injury in reference to the fourth Korea National Health and Nutrition Examination Survey.
By analyzing data from the fourth Korea National Health and Nutrition Examination Survey conducted from 2007 to 2009, we estimated the rate of injury experience according to socioeconomic status, including occupational property, of 8,261 subjects. We performed logistic regression analysis with work-related injury experience rate as dependent variable and waist circumference as an independent variable, Odds ratios (OR) were calculated, which reflect the likelihood of work-related injury experience rate, and 95% confidence interval (95% CI) while controlling for relevant covariates with stratifying by sex, age, nature of injury, site of injury and occupational group.
Among 797 persons who had injury experience over the past 1 year, 293 persons (36.8%) had work-related injury experience. After adjusting the confounding variables, the work-related injury was related to abnormal waist circumference (OR = 1.35; 95% CI: 1.02 ~ 1.78). In subgroups, ORs were higher in men (OR = 1.42; 95% CI: 1.02 ~ 1.98), professional, manager, and administrator (OR = 2.41; 95% CI: 1.10 ~ 5.28). Higher rate of injuries were noted in back and waist (OR = 2.92; 95% CI: 1.49 ~ 5.73), and transport accident had increased risk (OR = 1.60; 95% CI: 1.13 ~ 2.28).
Work-related injury rate differed depending on the waist circumference. The abdominal obesity was associated with higher risk of work-related injury. This study would be useful in selecting appropriate priorities for work-related injury management in Korea.
Based on 2011 department of Korea statistics, generalized improvement in nutrient intake by Korean population has raised the rate of obesity. The rate was found to be higher in men (36.5%) than women (26.5%) . Obesity has a well-known association to raise the prevalence of cardiovascular disease or type 2 diabetes [2, 3]. Also, it is known that obese person is more likely to have sprain or dislocation injury than non-obese person , and risk of fracture is affected by the obesity. For a person with body mass index (BMI) between 25 and 29.9 kg/m2, the fracture risk is 1.29 times higher than a person with BMI of 29.9 kg/m2. People with BMI of between 30 and 34.9 kg/m2 and between 35 and 39.9 kg/m2 had increased risks of 1.67 and 1.94 times, respectively, revealing significant increase in fracture risk with higher BMI .
Injury is disability of body caused by external factors, and injuries originate during work is defined as work-related injury . In Korea, Industrial Accident Compensation Insurance Act states that occupational casualty is any injury, disease, disability, or death of a worker from causes originating or relating to his or her occupation . These casualties are attributed by accidents or noxious agents including physical factors, chemical materials, dusts, pathogens, works that put excessive strain to body. Conventionally, exposure to physical and chemical harmful agents and unsafe behavior are explained to be major sources of work-related injury [8, 9]. Occupation injury leads to pathologic condition, disability, and early mortality, and in turn, these losses translate into loss of life expectancy and increased cost in a society [10, 11]. Since 2001, applicant to occupational health and safety insurance had become widespread. The number of work places that had applied for the insurance has increased by 41.7% in 2009 from 2001, and 23.8% increase in full-time workers was noted during the same period. However, these years had shown steady increase of injured workers. For work-related accident, less mortality became evident in recent years, but the number of injured persons increased every year. Rate for work place accident momentarily had increased from 2003 to 2004, but in general, the figure has stagnated or decreased at around 0.7% . Injury is no longer recognized as random and unavoidable accident, but its perception has become preventable accident. Thus several nations are attempt in to set up an effectual policy for reduction of the injury, and collecting injury-related data to produce base reference in developing a policy is identified as an important agenda . It is known that work-related injury and disease originate through complex interaction of several risk factors [14–16].
Recently, some claimed that obesity function as a protective factor in injury , but obesity is generally considered as a risk factor . Body mass index (BMI) was used in several studies to define obesity. However, the index has been acknowledged inappropriate to reflect fluctuation of body fat distribution and different characteristics in obesity among individuals and population groups. In some cases, BMI is mainly attained from records that subjects had recorded for themselves rather than measuring the index for examination. This lowers validity of the data and showed inconsistency of outcomes [19, 20]. Because measuring abdominal fat is known to have more sensitivity in detecting individual differences than BMI, it is more useful to discover risk factors of obesity-related disease [19, 21].
There have been studies to identify obesity’s relationship to injury in a work environment, and they reported that obese persons have about 26 to 107% more incidence of injury during working than people with normal weight [14, 22–24]. They in addition noted that higher BMI showed increased frequency of acute traumatic injury at work [23, 25]. However, these studies used BMI only to investigate the relationship until now. As mentioned above, waist circumference has become recognized as a more useful index than BMI to study health problem associated with obesity [19, 21, 26], but few reports have been made about relationship between work-related injury and obesity using waist circumference. In addition, it is still unclear about abdominal obesity’s mechanism and extent to injury. Thus, it necessitates investigation and discussion about its role as a factor that incites injury .
In this study, its purpose is to determine relationship between waist circumference and work-related injury. The authors want to apply outcomes found in this study to manage obesity for prevention of injury at work.
Materials and methods
The Korea National Health and Nutrition Examination Survey has been performed to identify Korean health and nutrition state since 1998. The fourth Korea National Health and Nutrition Examination Survey was conducted for 3 years from 2007 to 2009 with rolling survey sampling method. Each rolling sample was extracted from the survey, and it was designed to have independent and identical properties among samples. Year-round survey (50 weeks per year) was conducted, and 200 to 250 subjects were surveyed in a week. In each year, probability samples reflecting the whole country were extracted through stratified sampling in 3 stages. First stage involved stratification of 29 strata with a reference to 11 areas’ population ratio by sex and age groups, and the samples were collected according to towns. Second stage extracted samples at district level, and final stage collected samples in family level. Number of participation to the survey was 23,632 (74.5%) among 31,705 national wide subjects . Final analysis was done to 8,261 adults between 20 and 65 years old who had an experience of injury in his or her job.
In this study, work-related injury was defined as an experience of injury for the past 1 year from the time of the fourth Korea National Health and Nutrition Examination Survey. Those who had answered yes to a question "have you received a treatment in a hospital or emergency room due to injury or intoxication?" were reviewed, and among them people who answered yes to "during work" in additional information section were finally defined as a work-related injury experiment .
As demographic and socioeconomic characteristics, age, sex, waist circumference, alcohol intake, smoking state, exercise level, marital status, annual household income, and educational level were identified. Also, mechanism of injury and injury site were noted. We organized occupations into 6 groups according to major categorizations of the '6th Korean Standard Classification of Occupations’; 'manager, professional, and administrator’, 'clerk’, 'service and sales worker’, 'skilled agricultural, forestry, and fishery worker’, 'craft, equipment, machine operating, and assembling worker’, and 'elementary worker’ . Abdominal obesity is termed for man with waist circumference of 90 cm or above and woman with the circumference of 85 cm or above .
In this study, injury rates were calculated according to demographic and occupational characteristics of study subjects. Also, injury experience was set as a dependent variable, and abdominal obesity was used as an independent variable. Using the variables, logistic regression analysis was performed to calculate corrected odds ratio (OR) of work-related injury experience to population and 95% confidence interval (CI). Stratified analysis was carried out for age, sex, injury mechanism, injury site, and occupational groups. SAS 9.2 program (SAS Inc., Cary, NC, USA) was used for statistical analysis, and statistical significance was determined at 0.05 or below.
General and occupational characteristics of study subjects
General characteristics of participants
20 ~ 40y
41 ~ 65y
Male < 90 cm
Male ≥ 90 cm
Female < 85 cm
Female ≥ 85 cm
Alcohol consumption (frequency)
<1 per month
1 ~ 4 per month
≥2 per week
Present smoking status
Family income (quartile)
Types of occupation
Manager, professional and administrator
Service and sales worker
Skilled agricultural, forestry, and fishery worker
Craft, equipment, machine operating, and assembling worker
Work-related injury experience
Mechanisms of work-related injury
Fall down, slip down, and collision
Laceration, amputation, stab, and machinery accident
Burn and poisoning
Location of injury
Face, neck, and head
Back and waist
Risk of work-related injury regarding to waist circumference
Associations between waist circumference and any work-related injury
Crude abdominal obesity (95% CI†)
Adjusted‡ abdominal obesity (95% CI)
1.49(1.16 ~ 1.92)
1.35(1.02 ~ 1.78)
Factors related to work-related injury in abnormal waist circumference group
Associations between abnormal waist circumference and work-related injury of subgroups
OR* (95% CI)†
1.42 (1.02 ~ 1.98)
1.16 (0.68 ~ 1.97)
20 ~ 40 yr
1.52 (0.90 ~ 2.57)
41 ~ 65 yr
1.26 (0.91 ~ 1.74)
Types of occupation
Manager, professional, and administrator
2.41 (1.10 ~ 5.28)
0.95 (0.29 ~ 3.10)
Service and sales worker
1.15 (0.32 ~ 2.09)
Skilled agricultural, forestry,
1.31 (0.67 ~ 2.55)
and fishery worker
Craft, equipment, machine operating, and assembling worker
1.57 (0.99 ~ 2.43)
0.72 (0.31 ~ 1.67)
Sites of injury
0.49 (0.11 ~ 2.27)
1.29 (0.31 ~ 5.33)
1.39 (0.64 ~ 3.00)
Back and waist
2.92 (1.49 ~ 5.73)
1.79 (0.49 ~ 6.63)
0.61 (0.61 ~ 6.08)
1.62 (0.96 ~ 2.73)
1.02 (0.52 ~ 2.00)
0.37 (0.05 ~ 3.10)
Mechanisms of injury
1.60 (1.13 ~ 2.28)
Fall down, slip down, and collision
1.41 (0.97 ~ 2.05)
1.19 (0.70 ~ 2.02)
This study investigated relationship between work-related injury and waist circumference. Subjects were selected using the 4th Korea National Health and Nutrition Examination Survey, and those who had experienced an injury over 1 year period were accounted for the study. There were 7.2% of patients who suffered injury over 1 year, and injuries that were related to work was 3.3% of the population. Waist circumference was measured to each subject to evaluate obesity, 74.1% were found to be within normal range. There were 27.7% of male population who had abnormal waist circumference, and 24.7% of female subjects had abdominal obesity.
Young age, short work experience, male, improper education about health and safety, insomnia, and work stress are known to have significant relationship with work-related injury [14, 17, 31, 32]. Recently, obesity has been recognized as a risk factor of injury [14, 33]. In this study, multiple logistic regression analysis showed that age, sex, exercise, smoking, alcohol intake, marital status, and occupations had 1.35 times higher risk of work-related injury (95% CI: 1.02 ~ 1.78). Also, in the group who are male, who had abnormal waist circumference, motor vehicle accidents, and managerial and professional jobs, and whose injury sites were back and waist illustrated significant relationship with work-related injury.
This study used waist circumference instead of BMI to determine obesity, because waist circumference is suggested by several studies to more indicative of obesity than BMI . However, previous studies that studied relationship between obesity and work-related injury had used BMI as index for obesity [14, 33].
In addition, reports were published concerning obesity as both hazard and protective factor in work-related injury . It is considered as a risk factor because over-weight affects a person’s gait and balance. These people are likely on multiple medications, and their psychotropic effects may give additional risk for injury. Also, increased prevalence of sleep apnea syndrome in obese people may cause excessive sleepiness and fatigue. For a protective factor, obesity acts as a cushion during slip down, and increased bone density in obesity reduces fracture risk . However, although positive correlation was present between bone density and BMI in a study on menopausal women, the study found that visceral fat and waist circumference had a negative correlation which led to increased risk of spine fracture .
In this study, people with abnormal waist circumference had 1.35 time higher risk for work-related injury. When subgroups were studied, male (OR: 1.42, 95% CI: 1.02-1.98) and 'Manager, professional, and administrator’ groups (OR: 2.41, 95% CI: 1.10-5.28) showed significant relationship. Like previous studies that determined relationship between BMI and work-related injury , some subgroups in our study did not show any close relationship. The reason for partial relation is believed that obesity’s biophysical risk factor had worked differently in accordance to each of subgroups.
In 2011, Canadian study on relationship between obesity and work-related injury noted that sprain, back and waist, lower extremity, and fall showed correlation to injury prevalence . In one study, sprain, strain, and dislocation were significantly more in obesity diagnosed people, and fall and physical overuse were identified as causes for injury . In other study, BMI and work-related injury had significant relationship, and particularly, prevalence of injury in knee and lower body were higher in obese group . In addition, senile with obesity had a higher risk of fracture in one study .
This study showed that male with abdominal obesity had a higher injury risk than female. This supports previous studies which male with obesity had higher risks for motor vehicle accident and injury than female, and in turn the result reflects that obesity works differently to development of injury according to sex [35, 36]. Motor vehicle accident and injury site such as body parts above pelvic bone are already known as a risk factor for injury in obese patients. Boulanger et al. performed a cohort study on patients with blunt injury, and they found high incidence of injury due to traffic accident in people whose BMI is 30 kg/m2 and above. They also found that frequently involved injuries were rib fracture, lung contusion, pelvic bone fracture, and fractures in extremities . Mock et al. reported that people with obesity had increased risk for mortality and severity of injury from motor vehicle accident and injury to chest . Although this study was not able to reproduce relationship between obesity and lower body injury that showed significant relationship in other studies , our study revealed that work-related injury in back area increased in a group that had abnormal waist circumference by 2.92 times. This outcome reflects abdominal obesity has a possible correlation to development of back injury. Obesity-related chronic inflammatory diseases such as hypertension, diabetes, and dyslipidemia induce atherosclerotic change in spinal vessels , and this led to degeneration to spine , affecting raised susceptibility to injury . Because abdominal obesity is an index that reflects obesity associated risk factors and chronic inflammatory state well [19–21], it implies that measuring waist circumference can be an useful tool to predict the injury.
Meanwhile, not all occupational groups showed significant correlation between abnormal waist circumference and work-related injury. Only 'Manager, professional, and administrator’ group showed significant increase of work-related injury risk by 2.41 times, and this suggests that injury is affected by waist circumference found in a specific occupational group. Like previous studies that discovered significant relationship between obesity and work-related injury in office workers , our result had an identical evidence that white collar workers were found to have significant relationship between abnormal waist circumference and work-related injury. It is possible that high incidence of sprain in white collar group may be the reason for increased number of injury .
One limitation in this study is that we were not able to remove recall bias, because the study is based on memory of subjects who answered the questionnaire about their experiences of work-related injury. In addition, thought a subject suffered from an injury, the subject may have been absent because he or she was admitted to a hospital during a visit by a surveyor for an interview. Other limitations include that occupational groups, injury mechanism, and site were not classified in detail and several variables are mixed together, limiting the recognition of injury’s risk factors. Also, waist circumference was divided simply into normal and abnormal, and this simplification did not allow dose-reaction relationship. Further study that verifies distribution of injury risk in accordance with each waist circumference as continuous variable is required to determine clearer relationship. In addition, the study is insufficient to prove causal relationship between the circumference and injury because it was a cross-sectional study. Therefore, a prospective cohort study with a method that can verify risk factors in detail is needed for determining causal relationship between work-related injury and abdominal obesity, and with the study, it would be able to identify risk factors such as influence of chronic diseases, sleepiness and fatigue, and physical limitations that are suggested in previous studies .
Despite of limitations present in this study, it again showed possible connection of abdominal obesity to work-related injury. This study is significant that waist circumference rather than BMI is presented as a predictive index to work-related injury. However, additional studies are needed to identify factors in waist circumference that affect work-related injury more clearly. With further refinement and learning about the risk factors, it would be possible to raise the need for obesity management to reduce occurrence of work-related injury in a corporation or a nation.
This work was carried out with the support of "Cooperative Research Program for Agriculture Science & Technology Development (PJ0064222012)" Rural Development Administration, Republic of Korea.
- Seok HH, Kim DS, Chang DJ, Park SN, Shim SJ: Korean Social Trend 2010. Daejeon: Statistics Korea Statistical Research Institute; 2011.Google Scholar
- Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the, American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 1997,2006(113):898–918.Google Scholar
- Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS: Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003, 289: 76–79. 10.1001/jama.289.1.76View ArticlePubMedGoogle Scholar
- Matter KC, Sinclair SA, Hostetler SG, Xiang H: A comparison of the characteristics of injuries between obese and non-obese inpatients. Obesity 2007, 15: 2384–2390. 10.1038/oby.2007.283View ArticlePubMedGoogle Scholar
- Nielson CM, Marshall LM, Adams AL, LeBlanc ES, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES: BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 2011, 26: 496–502. 10.1002/jbmr.235PubMed CentralView ArticlePubMedGoogle Scholar
- Karjalainen A: International statistical classification of diseases and related health problems (ICD-10) in occupational health. Geneva: World Health Organization, Sustainable Development and Healthy Environments, Protection of the Human Environment; 1999.Google Scholar
- Occupational Safety and Health Research Institute: Analysis of causes of industrial accidents stagnation in Korea (translated by Kim SK). Incheon: Occupational Safety and Health Research Institute; 2010. pp 33Google Scholar
- Heinrich HW: Industrial Accident prevention. 5th edition. New York: McGraw-Hill; 1980.Google Scholar
- Petersen D: Techniques of safety Management: A system Approach. 3rd edition. New York: Aloray; 1989.Google Scholar
- Rivara FP, Grossman DC, Cummings P: Injury prevention. Second of two parts. N Engl J Med 1997, 337: 613–618. 10.1056/NEJM199708283370907View ArticlePubMedGoogle Scholar
- Rivara FP, Grossman DC, Cummings P: Injury prevention. First of two parts. N Engl J Med 1997, 337: 543–548. 10.1056/NEJM199708213370807View ArticlePubMedGoogle Scholar
- Industrial Accident Compensation Insurance Act. http://www.law.go.kr/lsInfoP.do?lsiSeq=130845&efYd=20121218#0000
- Lee EJ, Lee JS, Kim Y, Park K, Eun SJ, Suh SK, Kim YI: Patterns of unintentional domestic injuries in Korea. J Prev Med Public Health 2010, 43: 84–92. 10.3961/jpmph.2010.43.1.84View ArticlePubMedGoogle Scholar
- Bhattacherjee A, Chau N, Sierra CO, Legras B, Benamghar L, Michaely JP, Ghosh AK, Guillemin F, Ravaud JF, Mur JM: Relationships of job and some individual characteristics to occupational injuries in employed people: a community-based study. J Occup Health 2003, 45: 382–391. 10.1539/joh.45.382View ArticlePubMedGoogle Scholar
- Dembe AE, Erickson JB, Delbos R: Predictors of work-related injuries and illnesses: national survey findings. J Occup Environ Hyg 2004, 1: 542–550. 10.1080/15459620490478376View ArticlePubMedGoogle Scholar
- Wilkins K, Mackenzie SG: Work injuries. Health Rep 2007, 18: 25–42.PubMedGoogle Scholar
- Salminen S, Oksanen T, Vahtera J, Sallinen M, HÄRmÄ M, Salo P, Virtanen M, KivimÄKi M: Sleep disturbances as a predictor of occupational injuries among public sector workers. J Sleep Res 2010, 19: 207–213. 10.1111/j.1365-2869.2009.00780.xView ArticlePubMedGoogle Scholar
- van der Zwaag D, Pointer S, Harrison J: Obesity and injury in the National Hospital Morbidity Database. Canberra: Australian Institute of Health and Welfare; 2010.Google Scholar
- WHO Health Organization: Obesity: Preventing and managing the global epidemic. Geneva: WHO Technical Report Series no 894; 2000.Google Scholar
- Michels KB, Greenland S, Rosner BA: Does body mass index adequately capture the relation of body composition and body size to health outcomes? Am J Epidemiol 1998, 147: 167–172. 10.1093/oxfordjournals.aje.a009430View ArticlePubMedGoogle Scholar
- Zhu S, Wang Z, Heshka S, Heo M, Faith MS, Heymsfield SB: Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. Am J Clin Nutr 2002, 76: 743.PubMedGoogle Scholar
- Craig BN, Congleton JJ, Kerk CJ, Amendola AA, Gaines WG: Personal and non-occupational risk factors and occupational injury/illness. Am J Ind Med 2006, 49: 249–260. 10.1002/ajim.20290View ArticlePubMedGoogle Scholar
- Pollack KM, Sorock GS, Slade MD, Cantley L, Sircar K, Taiwo O, Cullen MR: Association between body mass index and acute traumatic workplace injury in hourly manufacturing employees. Am J Epidemiol 2007, 166: 204–211. 10.1093/aje/kwm058View ArticlePubMedGoogle Scholar
- Soteriades ES, Hauser R, Kawachi I, Christiani DC, Kales SN: Obesity and risk of job disability in male firefighters. Occup Med 2008, 58: 245–250. 10.1093/occmed/kqm153View ArticleGoogle Scholar
- Pollack KM, Cheskin LJ: Obesity and workplace traumatic injury: does the science support the link? Inj Prev 2007, 13: 297–302. 10.1136/ip.2006.014787PubMed CentralView ArticlePubMedGoogle Scholar
- Janssen I, Katzmarzyk PT, Ross R: Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004, 79: 379–384.PubMedGoogle Scholar
- Norton K, Norton L: Pre-exercise Screening. Exercise and Sports Science Australia, Fitness Australia and Sports Medicine Australia; 2011. http://www.fitcollege.com.au/adminnew/resources/resourcefiles/Learning_Material_2012727_pre_exercise_screening_textbook_2012.pdf Google Scholar
- Korea Centers for Disease Control and Prevention: Guide to the utilization of the data from the forth Korea National Health and Nutrition Examination Survey. Seoul: Korea Centers for Disease Control and Prevention; 2010.Google Scholar
- Jung DY, Kim HC, Leem JH, Park SG, Lee DH, Lee SJ, Kim GW: Estimated occupational injury rate and work related factors based on data from the fourth Korea National Health and Nutrition Examination Survey. Korean J Occup Environ Med 2011, 23: 149–163.Google Scholar
- Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, et al.: Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007, 75: 72–80. 10.1016/j.diabres.2006.04.013View ArticlePubMedGoogle Scholar
- Saha A, Kumar S, Vasudevan DM: Factors of occupational injury: a survey in a chemical company. Ind Health 2008, 46: 152–157. 10.2486/indhealth.46.152View ArticlePubMedGoogle Scholar
- Aderaw Z, Engdaw D, Tadesse T: Determinants of occupational injury: a case control study among textile factory workers in Amhara Regional State, Ethiopia. J Trop Med 2011, 2011: 657275.PubMed CentralView ArticlePubMedGoogle Scholar
- Fawzy T, Muttappallymyalil J, Sreedharan J, Ahmed A, Alshamsi SOS, Al Ali MSSHBB, Al Balsooshi KA: Association between body mass index and bone mineral density in patients referred for dual-energy X-Ray absorptiometry scan in Ajman, UAE. J Osteoporos 2011,2011(Article ID 876309):4.Google Scholar
- Kim KC, Shin DH, Lee SY, Im JA, Lee DC: Relation between obesity and bone mineral density and vertebral fractures in Korean postmenopausal women. Yonsei Med J 2010, 51: 857–863. 10.3349/ymj.2010.51.6.857PubMed CentralView ArticlePubMedGoogle Scholar
- Zhu SK, Layde PM, Guse CE, Laud PW, Pintar F, Nirula R, Hargarten S: Obesity and risk for death due to motor vehicle crashes. Am J Pub Health 2006, 96: 734–739. 10.2105/AJPH.2004.058156View ArticleGoogle Scholar
- Ma X, Laud PW, Pintar F, Kim JE, Shih A, Shen W, Heymsfield SB, Allison DB, Zhu S: Obesity and non-fatal motor vehicle crash injuries: sex difference effects. Int J Obes 2011, 35: 1216–1224. 10.1038/ijo.2010.270View ArticleGoogle Scholar
- Boulanger BR, Milzman D, Mitchell K, Rodriguez A: Body habitus as a predictor of injury pattern after blunt trauma. J Trauma 1992, 33: 228–232. 10.1097/00005373-199208000-00011View ArticlePubMedGoogle Scholar
- Mock CN, Grossman DC, Kaufman RP, Mack CD, Rivara FP: The relationship between body weight and risk of death and serious injury in motor vehicle crashes. Accid Anal Prev 2002, 34: 221–228. 10.1016/S0001-4575(01)00017-3View ArticlePubMedGoogle Scholar
- Poirier P, Eckel RH: Obesity and cardiovascular disease. Curr Atherosclerosis Rep 2002, 4: 448–453. 10.1007/s11883-002-0049-8View ArticleGoogle Scholar
- Liuke M, Solovieva S, Lamminen A, Luoma K, Leino-Arjas P, Luukkonen R, Riihimäki H: Disc degeneration of the lumbar spine in relation to overweight. Int J Obes 2005, 29: 903–908. 10.1038/sj.ijo.0802974View ArticleGoogle Scholar
- McIlwraith CW: Current concepts in equine degenerative joint disease. J Am Vet Med Assoc 1982, 180: 239.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.