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This study was undertaken to examine whether visceral fat, a major source of inflammatory cytokines and adipokines, is associated with an increased risk of knee <jats:styled-content style=\"fixed-case\">OA<\/jats:styled-content> or musculoskeletal pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Subjects in the Multicenter Osteoarthritis Study cohort, who were age 50\u201379 years and had or were at high risk of knee <jats:styled-content style=\"fixed-case\">OA<\/jats:styled-content>, underwent whole\u2010body dual x\u2010ray absorptiometry (<jats:styled-content style=\"fixed-case\">DXA<\/jats:styled-content>) at baseline. At baseline, 30 months, and 60 months radiographs and magnetic resonance images (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>s) of the knees were obtained, and patients were asked to score the severity of their knee pain and to identify sites of joint pain using a body homunculus. Baseline <jats:styled-content style=\"fixed-case\">DXA<\/jats:styled-content> scans were used to measure total body fat and visceral and subcutaneous fat in the torso. The association of fat depot size with structural outcomes (incident radiographic <jats:styled-content style=\"fixed-case\">OA<\/jats:styled-content> and cartilage loss and synovitis on <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) and with pain outcomes (worsening knee pain, number of painful joints, and widespread pain) was assessed. Regression analyses were adjusted for age, sex, race, education level, smoking status, physical activity, body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>), and depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2,961 participants at baseline, 60.7% were women. The mean age was 62.5 years and mean <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> was 30.5 kg\/m<jats:sup>2<\/jats:sup>. After adjustment for covariates, no fat measures were associated with any structural outcomes. However, total and visceral, but not subcutaneous, fat were positively associated with worsening knee pain (<jats:italic>P<\/jats:italic> = 0.0005 for total fat and <jats:italic>P<\/jats:italic> = 0.007 for visceral fat) and widespread pain (<jats:italic>P<\/jats:italic> = 0.001 for total fat and <jats:italic>P<\/jats:italic> = 0.02 for visceral fat), and the amount of visceral fat was associated with the number of painful joints (<jats:italic>P<\/jats:italic> = 0.07).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings indicate that visceral fat is associated with an increased risk of musculoskeletal and widespread pain.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.41222","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T07:28:38Z","timestamp":1581319718000},"page":"1103-1110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Association of 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