{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:32:48Z","timestamp":1791210768680,"version":"4.1.0"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T00:00:00Z","timestamp":1558915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The link between fibromyalgia syndrome (FMS) and obesity has not been thoroughly investigated. The purpose of this study was to examine the relationships among body mass index (BMI) and body composition parameters, including fat mass, fat mass percentage, and visceral fat, as well as FMS features, such as tender point count (TPC), pain, disease activity, fatigue, sleep quality, and anxiety, in a population of FMS women and healthy controls. A total of seventy-three women with FMS and seventy-three healthy controls, matched on weight, were included in this cross-sectional study. We used a body composition analyzer to measure fat mass, fat mass percentage, and visceral fat. Tender point count (TPC) was measured by algometry pressure. The disease severity was measured with the Fibromyalgia Impact Questionnaire (FIQ-R) and self-reported global pain was evaluated with the visual analog scale (VAS). To measure the quality of sleep, fatigue, and anxiety we used the Pittsburgh Sleep Quality Questionnaire (PSQI), the Spanish version of the multidimensional fatigue inventory (MFI), and the Beck Anxiety Inventory (BAI), respectively. Of the women in this study, 38.4% and 31.5% were overweight and obese, respectively. Significant differences in FIQ-R.1 (16.82 \u00b1 6.86 vs. 20.66 \u00b1 4.71, p = 0.030), FIQ-R.3 (35.20 \u00b1 89.02 vs. 40.33 \u00b1 5.60, p = 0.033), and FIQ-R total score (63.87 \u00b1 19.12 vs. 75.94 \u00b1 12.25, p = 0.017) among normal-weight and overweight FMS were observed. Linear analysis regression revealed significant associations between FIQ-R.2 (\u03b2(95% CI) = 0.336, (0.027, 0.645), p = 0.034), FIQ-R.3 (\u03b2(95% CI) = 0.235, (0.017, 0.453), p = 0.035), and FIQ-R total score (\u03b2(95% CI) = 0.110, (0.010, 0.209), p = 0.032) and BMI in FMS women after adjusting for age and menopause status. Associations between sleep latency and fat mass percentage in FMS women (\u03b2(95% CI) = 1.910, (0.078, 3.742), p = 0.041) and sleep quality and visceral fat in healthy women (\u03b2(95% CI) = 2.614, (2.192, 3.036), p = 0.008) adjusted for covariates were also reported. The higher BMI values are associated with poor FIQ-R scores and overweight and obese women with FMS have higher symptom severity. The promotion of an optimal BMI might contribute to ameliorate some of the FMS symptoms.<\/jats:p>","DOI":"10.3390\/nu11051193","type":"journal-article","created":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T11:19:27Z","timestamp":1558955967000},"page":"1193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["The Association of Body Mass Index and Body Composition with Pain, Disease Activity, Fatigue, Sleep and Anxiety in Women with Fibromyalgia"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9165-4349","authenticated-orcid":false,"given":"Mar\u00eda","family":"Correa-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigaci\u00f3n Biosanitaria Granada (IBS Granada), 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"El Mansouri-Yachou","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Health Science, University of Granada (UGR), 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Casas-Barrag\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Health Science, University of Granada (UGR), 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Molina","sequence":"additional","affiliation":[{"name":"Department of Health Science, University of Ja\u00e9n, Paraje Las Lagunillas s\/n, 23071 Ja\u00e9n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0263-7000","authenticated-orcid":false,"given":"Blanca","family":"Rueda-Medina","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigaci\u00f3n Biosanitaria Granada (IBS Granada), 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Encarnaci\u00f3n","family":"Aguilar-Ferr\u00e1ndiz","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Health Science, University of Granada (UGR), Instituto de Investigaci\u00f3n Biosanitaria Granada (IBS. Granada), 18016 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,27]]},"reference":[{"key":"ref_1","first-page":"426130","article-title":"Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment","volume":"2012","author":"Bellato","year":"2012","journal-title":"Pain Res. Treat."},{"key":"ref_2","first-page":"S121","article-title":"Is fibromyalgia-related oxidative stress implicated in the decline of physical and mental health status?","volume":"31","author":"Rus","year":"2013","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.neuroscience.2016.06.006","article-title":"Neurobiology of fibromyalgia and chronic widespread pain","volume":"338","author":"Sluka","year":"2016","journal-title":"Neuroscience"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/10253890601130823","article-title":"The hypothalamo\u2013pituitary\u2013adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome","volume":"10","author":"Tanriverdi","year":"2007","journal-title":"Stress"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2174\/1573397111666150619094819","article-title":"Cytokine and immune system abnormalities in fibromyalgia and other central sensitivity syndromes","volume":"11","author":"Staud","year":"2015","journal-title":"Curr. Rheumatol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00296-011-1885-z","article-title":"Fibromyalgia and obesity: The hidden link","volume":"31","author":"Ursini","year":"2011","journal-title":"Rheumatol. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s40273-014-0243-x","article-title":"The Epidemiology of Obesity: A Big Picture","volume":"33","author":"Hruby","year":"2015","journal-title":"Pharmacoeconomics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/j.jpain.2010.03.006","article-title":"Relationship between fibromyalgia and obesity in pain, function, mood, and sleep","volume":"11","author":"Okifuji","year":"2010","journal-title":"J. Pain Off. J. Am. Pain Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"399","DOI":"10.2147\/JPR.S55598","article-title":"The association between chronic pain and obesity","volume":"8","author":"Okifuji","year":"2015","journal-title":"J. Pain Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1038\/oby.2011.397","article-title":"Obesity and Pain Are Associated in the United States","volume":"20","author":"Stone","year":"2012","journal-title":"Obesity"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/MED.0b013e32832fa137","article-title":"Stress and obesity: The role of the hypothalamic-pituitary-adrenal axis in metabolic disease","volume":"16","author":"Bose","year":"2009","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.cellimm.2017.03.001","article-title":"Role of immune cells in obesity induced low grade inflammation and insulin resistance","volume":"315","author":"Asghar","year":"2017","journal-title":"Cell. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schmidt, F.M., Weschenfelder, J., Sander, C., Minkwitz, J., Thormann, J., Chittka, T., Mergl, R., Kirkby, K.C., Fa\u00dfhauer, M., and Stumvoll, M. (2015). Inflammatory Cytokines in General and Central Obesity and Modulating Effects of Physical Activity. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121971"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1177\/1099800415591035","article-title":"Nitric Oxide, Inflammation, Lipid Profile, and Cortisol in Normal- and Overweight Women with Fibromyalgia","volume":"18","author":"Rus","year":"2016","journal-title":"Biol. Res. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1007\/s10067-008-0966-1","article-title":"A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients","volume":"27","author":"Neumann","year":"2008","journal-title":"Clin. Rheumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1002\/acr.20653","article-title":"Association of body mass index with symptom severity and quality of life in patients with fibromyalgia","volume":"64","author":"Kim","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/RHU.0000000000000278","article-title":"Fibromyalgia and Obesity","volume":"21","author":"Gota","year":"2015","journal-title":"J. Clin. Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pmn.2011.06.002","article-title":"Fibromyalgia\u2019s Key Symptoms in Normal-Weight, Overweight, and Obese Female Patients","volume":"14","author":"Aparicio","year":"2013","journal-title":"Pain Manag. Nurs."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e4917","DOI":"10.7717\/peerj.4917","article-title":"The relationship between body mass index and pain, disease activity, depression and anxiety in women with fibromyalgia","volume":"6","author":"Okyay","year":"2018","journal-title":"PeerJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/030097402317255336","article-title":"Relationship between body mass index and fibromyalgia features","volume":"31","author":"Yunus","year":"2002","journal-title":"Scand. J. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s00296-012-2647-2","article-title":"Clinical symptoms in fibromyalgia are associated to overweight and lipid profile","volume":"34","author":"Cordero","year":"2014","journal-title":"Rheumatol. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/NOR.0b013e3182879c08","article-title":"Correlates of Body Mass Index in Women With Fibromyalgia","volume":"32","author":"Timmerman","year":"2013","journal-title":"Orthop. Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.pmrj.2014.02.007","article-title":"Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms","volume":"6","author":"Vincent","year":"2014","journal-title":"PM R"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1007\/s10067-012-2053-x","article-title":"Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: A randomized controlled trial","volume":"31","author":"Senna","year":"2012","journal-title":"Clin. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1002\/ejp.807","article-title":"The association of total and central body fat with pain, fatigue and the impact of fibromyalgia in women; role of physical fitness","volume":"20","year":"2016","journal-title":"Eur. J. Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00296-014-3091-2","article-title":"Obesity and sleepiness in women with fibromyalgia","volume":"35","author":"Mota","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.smrv.2014.09.001","article-title":"Sleep disturbances of adult women suffering from fibromyalgia: Asystematic review of observational studies","volume":"21","author":"Baldwin","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1038\/nrrheum.2015.56","article-title":"The role of sleep in pain and fibromyalgia","volume":"11","author":"Choy","year":"2015","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/j.1745-7599.2010.00547.x","article-title":"Subjective and objective sleep difficulties in women with fibromyalgia syndrome","volume":"22","author":"Stuifbergen","year":"2010","journal-title":"J. Am. Acad. Nurse Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/00006199-200305000-00002","article-title":"Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia","volume":"52","author":"Landis","year":"2003","journal-title":"Nurs. Res."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sabeti, E., Gryak, J., Derksen, H., Biwer, C., Ansari, S., Isenstein, H., Kratz, A., Najarian, K., Sabeti, E., and Gryak, J. (2019). Learning Using Concave and Convex Kernels: Applications in Predicting Quality of Sleep and Level of Fatigue in Fibromyalgia. Entropy, 21.","DOI":"10.3390\/e21050442"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1089\/jwh.2017.6622","article-title":"Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study","volume":"27","author":"Arout","year":"2018","journal-title":"J. Women\u2019s Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1002\/acr.20301","article-title":"Mortality in fibromyalgia: A study of 8186 patients over thirty-five years","volume":"63","author":"Wolfe","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_34","first-page":"1164","article-title":"The epidemiology of tender points: A prospective study of 1520 patients","volume":"12","author":"Wolfe","year":"1985","journal-title":"J. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1053\/sarh.2000.8363","article-title":"Fibromyalgia syndrome in men","volume":"30","author":"Buskila","year":"2000","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/AJP.0b013e318154b6ae","article-title":"Interrater Reliability of Algometry in Measuring Pressure Pain Thresholds in Healthy Humans, Using Multiple Raters","volume":"23","author":"Chesterton","year":"2007","journal-title":"Clin. J. Pain"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1054\/math.1996.0276","article-title":"Pressure algometry in manual therapy","volume":"1","author":"Oostendorp","year":"1996","journal-title":"Man. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.jpain.2007.04.003","article-title":"Test-Retest Reliability of Pressure Pain Threshold Measurements of the Upper Limb and Torso in Young Healthy Women","volume":"8","author":"Jones","year":"2007","journal-title":"J. Pain"},{"key":"ref_39","first-page":"345","article-title":"Pain in fibromyalgia and discrimination power of the instruments: Visual Analog Scale, Dolorimetry and the McGill Pain Questionnaire","volume":"33","author":"Marques","year":"2008","journal-title":"Acta Reumatol. Port."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/1477-7525-11-132","article-title":"Validation of a Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR)","volume":"11","author":"Salgueiro","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s00296-014-2960-z","article-title":"Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia","volume":"34","author":"Garrido","year":"2014","journal-title":"Rheumatol. Int."},{"key":"ref_42","first-page":"94","article-title":"Multidimensional Fatigue Inventory: Spanish adaptation and psychometric properties for fibromyalgia patients. The Al-Andalus study","volume":"30","author":"Romero","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_43","first-page":"140","article-title":"The Impact of Fibromyalgia on Disability, Anxiety, Depression, Sleep Disturbance, and Quality of Life in Patients with Migraine","volume":"55","author":"Beyazal","year":"2018","journal-title":"Arch. Neuropsychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E76","DOI":"10.1017\/sjp.2014.76","article-title":"Beck Anxiety Inventory: Psychometric characteristics in a sample from the clinical Spanish population","volume":"17","author":"Zanin","year":"2014","journal-title":"Span. J. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"486","DOI":"10.5812\/ijem.3505","article-title":"Normality tests for statistical analysis: A guide for non-statisticians","volume":"10","author":"Ghasemi","year":"2012","journal-title":"Int. J. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.5395\/rde.2018.43.e43","article-title":"Statistical notes for clinical researchers: Analysis of covariance (ANCOVA)","volume":"43","author":"Kim","year":"2018","journal-title":"Restor. Dent. Endod."},{"key":"ref_47","unstructured":"Bennett, R.M., Jones, J., Turk, D.C., Russell, I.J., and Matallana, L. (2007). An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord., 8."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1002\/art.23828","article-title":"Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression","volume":"59","author":"Bigatti","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.annepidem.2015.05.001","article-title":"Association between actigraphic sleep metrics and body composition","volume":"25","author":"Wirth","year":"2015","journal-title":"Ann. Epidemiol."},{"key":"ref_50","first-page":"183","article-title":"Pain sensitivity in obesity","volume":"39","author":"Zych","year":"1988","journal-title":"Acta Physiol. Pol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1196\/annals.1367.023","article-title":"Obesity-Related Sleepiness and Fatigue: The Role of the Stress System and Cytokines","volume":"1083","author":"Vgontzas","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1080\/00140139.2015.1110622","article-title":"On the relationship between subjective and objective measures of fatigue","volume":"59","author":"Kirchner","year":"2016","journal-title":"Ergonomics"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e4849","DOI":"10.7717\/peerj.4849","article-title":"A survey on sleep assessment methods","volume":"6","author":"Silva","year":"2018","journal-title":"PeerJ"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/5\/1193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:53:54Z","timestamp":1760187234000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/5\/1193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,27]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["nu11051193"],"URL":"https:\/\/doi.org\/10.3390\/nu11051193","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,27]]}}}