Adiposity and Endometriosis Severity and Typology

Jiyoung Byun; C Matthew Peterson; Uba Backonja; Robert N Taylor; Joseph B Stanford; Kristina L Allen-Brady; Ken R Smith; Germaine M Buck Louis; Karen C Schliep

doi:10.1016/j.jmig.2020.01.002

Adiposity and Endometriosis Severity and Typology

Byun J, Peterson CM, Backonja U, Taylor RN, Stanford JB, Allen-Brady KL, Smith KR, Louis GMB, Schliep KC

Published January 14, 2020 Journal of Minimally Invasive Gynecology, 27(7), 1516-1523

DOI 10.1016/j.jmig.2020.01.002 PMID 31927045 PMC PMC7343585

RRM Academy Synopsis

More severe endometriosis types tend to show lower body fat

Women with endometriosis tended to have less body fat than women without it. The study included 473 women having surgery in Utah or California. The pattern held more by lesion type than by stage. Women with more severe disease, ovarian endometrioma or deep lesions, tended to have the lowest body fat. Women with superficial disease tended to have the most.

Key Findings

Among 473 women evaluated before gynecologic surgery, 190 were diagnosed with endometriosis: 112 had stage I disease, 27 stage II, 23 stage III, and 28 stage IV (rASRM staging).
Among 180 women whose lesion type could be classified, 101 had superficial endometriosis, 34 had deep infiltrating disease, 15 had ovarian endometrioma, and 30 had both ovarian and deep lesions.
After adjusting for age, race or ethnicity, and pregnancy history, body fat measures showed no clear differences by endometriosis stage or type, with wide, overlapping 95% confidence intervals.
Despite overlapping intervals, women with ovarian and/or deep infiltrating endometriosis tended to have the lowest body composition scores, while women with superficial lesions had the highest.

Interpretation

This cross-sectional study followed 473 women having surgery in Utah and California. Body fat was similar across endometriosis stages after accounting for age, race, and past pregnancies. A clearer pattern appeared by lesion type. Women with ovarian endometriomas or deep lesions had the lowest body fat. Women with surface lesions had the highest. One Korean study linked higher body mass index to milder disease. One Italian study linked higher body mass index to fewer deep lesions. The authors note group differences made comparison hard. The findings support larger studies on body fat and lesion type.

RRM Context

NaProTechnology finds and classifies endometriosis directly, through surgery, imaging, and a woman's cycle history. This study adds to a growing body of research linking body fat to endometriosis, sharpening the picture by lesion type beyond stage alone.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

Prior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.

Design

Cross-sectional study among women with no prior diagnosis of endometriosis.

Setting

Fourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.

Patients

A total of 495 women (of which 473 were analyzed), aged 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.

Interventions

Gynecologic laparoscopy/laparotomy regardless of clinical indication.

Measurements and Main Results

Participants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I-IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.

Conclusion

Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.

Jiyoung Byun, C Matthew Peterson, Uba Backonja, Robert N Taylor, Joseph B Stanford, Kristina L Allen-Brady, Ken R Smith, Germaine M Buck Louis, Karen C Schliep

J Byun, U Backonja, Bob Taylor, Rob Taylor, Bobby Taylor, R Taylor, Joe Stanford, Joey Stanford, J Stanford, K Allen-Brady, Kenneth Smith, K Smith, G Louis, K Schliep

PMID 31927045 31927045 DOI 10.1016/j.jmig.2020.01.002 10.1016/j.jmig.2020.01.002 Byun et al. 2020, Byun 2020

Adiposity and Endometriosis Severity and Typology

More severe endometriosis types tend to show lower body fat

Key Findings

Interpretation

RRM Context

Abstract

By this author

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