Please wait a minute...
Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 53-56    DOI: 10.31083/j.ceog.2020.01.4996
Original Research Previous articles | Next articles
The association of body mass index with incidence, stage and recurrence of endometriosis: case-control study in Korean women
K.Y. Yun1, S.Y. Hwang1, H.J. Lee1, S.C. Kim1, J.K. Joo1, *(), D.S. Suh1, K.H. Kim1, K.S. Lee
1Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
Download:  PDF(461KB)  ( 234 ) Full text   ( 9 )
Export:  BibTeX | EndNote (RIS)      
Abstract  

Purpose: The aim of this study is to evaluate the association between body mass index (BMI) and endometriosis in Korean women. Materials and Methods: In a hospital-based case-control study, 134 endometriosis cases and 282 ovarian teratoma cases as controls were selected. All cases were histologically confirmed after laparotomy or laparoscopic surgery, and they were categorized by BMI, as < 18.5, 18.5-22.9, 23-24.9, and > 25 kg/m2, respectively, according to the World Health Organization (WHO) guidelines for Asia-Pacific populations. Diagnosis for recurrences evaluated mainly by ultrasound or surgery. The authors collected requisite patient information from medical records of seven years. Results: Development of endometriosis was not significantly related to varying BMI. However, when comparing overall median BMI values in endometriosis [21.43 (19.59, 23.61)] and teratoma [22.19 (20.41, 24.61)], BMI was significantly lower in endometriosis cases than in teratoma cases (p = 0.014). There was no significant relation between the BMI groups and American Fertility Society (AFS) stages (Spearman’s r = 0.06584, p = 0.4498). In both of endometriosis and ovarian teratoma patients, the patients with higher BMI than 23 kg/m2 showed elevated recurrence rates (p = 0.024, HR = 2.104 and p = 0.026, HR = 4.417, respectively). Yet, considering varying BMI groups and recurrence rates, recurrence rate had no association among 46 recurrent endometriosis and teratoma cases (p = 0.338). Conclusion: In this study, lower BMI was observed to be possibly associated with endometriosis in comparison to that of other benign disease. BMI did not affect disease severity, whereas obesity was related to the recurrence of endometriosis.

Key words:  Endometriosis      Body mass index (BMI)      Stage      Incidence      Recurrence     
Published:  15 February 2020     
*Corresponding Author(s):  J.K. Joo     E-mail:  hirosm@aichi-med-u.ac.jp

Cite this article: 

K.Y. Yun, S.Y. Hwang, H.J. Lee, S.C. Kim, J.K. Joo, D.S. Suh, K.H. Kim, K.S. Lee. The association of body mass index with incidence, stage and recurrence of endometriosis: case-control study in Korean women. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 53-56.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.01.4996     OR     https://ceog.imrpress.com/EN/Y2020/V47/I1/53

Table 1  — Patients characteristics of endometriosis and teratoma groups.
Endometriosis (n=134) Teratoma (n=282) p-value
Age (years) 34.23 ± 8.08 32.44 ± 13.91 0.990
Parity 0.43 ± 0.81 0.61 ± 1.11 0.550
Age at menarche (years) 14.05 ± 1.45 13.91 ± 1.83 0.489
BMI* 21.43 [19.59, 23.61] 22.19 [20.41, 24.61] 0.014
BMI group** 0.203
<18.5 18 (13.4) 24 (8.5)
18.5 - 22.9 76 (56.7) 148 (52.5)
23 - 24.9 16 (11.9) 47 (16.7)
>25 24 (17.9) 63 (22.3)
Table 2  — AFS stages of endometriosis in relation to BMI.
AFS stage BMI category
<18.5 (n=18) 18.5 - 22.9 (n=76) 23 - 24.9 (n=16) >25 (n=24) p-value
1 1 (5.6) 5 (6.6) 0 (0.0) 0 (0.0) 0.605
2 1 (5.6) 1 (1.3) 1 (6.2) 2 (8.3)
3 6 (33.3) 29 (38.2) 5 (31.2) 7 (29.2)
4 10 (55.6) 41 (53.9) 10 (62.5) 15 (62.5)
Table 3  — Comparison of recurrence rate by BMI groups in endometriosis and ovarian teratoma.
log-rank test Cox PH regression analysis
BMI category N p-value HR [95% CI] p-value
Endometriosis <18.5 2 0.151 0.652 [0.150, 2.836] 0.569
18.5 - 22.9 18 1
23 - 24.9 3 2.035 [0.582, 7.110] 0.266
>25 12 1.983 [0.945, 4.159] 0.070
<23 20 0.024 1
>23 15 2.104 [1.066, 4.154] 0.032
Teratoma <18.5 1 0.082 1.929 [0.168, 22.122] 0.597
18.5 - 22.9 4 1
23 - 24.9 3 10.092 [1.323, 76.992] 0.026
>25 3 3.902 [0.627, 24.297] 0.145
<23 5 0.026 1
>23 6 4.417 [1.030, 18.954] 0.046
[1] Yamamoto A., Johnstone E.B., Bloom M.S., Huddleston H.G., Fujimoto V.Y.: “A higher prevalence of endometriosis among Asian women does not contribute to poorer IVF outcomes”. J. Assist. Reprod. Genet., 2017, 34, 765.
[2] Eskenazi B., Warner M.L.: “Epidemiology of endometriosis”. Obstet. Gynecol. Clin. N. Am., 1997, 24, 235.
[3] ASRM: “Revised American Society for Reproductive Medicine classification of endometriosis: 1996 ”. Fertil. Steril., 1997, 67, 817.
[4] Lafay Pillet M.C., Schneider A., Borghese B., Santulli P., Souza C., Streuli I., et al.: “Deep infiltrating endometriosis is associated with markedly lower body mass index: a 476 case-control study”. Hum. Reprod., 2012, 27, 265.
[5] WHO Expert Consultation: “Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies”. Lancet, 2004, 363, 157.
[6] Shah D.K., Correia K.F., Vitonis A.F., Missmer S.A.: “Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort”. Hum. Reprod., 2013, 28, 1783.
[7] Liu Y., Zhang W.: “Association between body mass index and endometriosis risk: a meta-analysis”. Oncotarge., 2017, 8, 46928.
[8] Ashrafi M., Sadatmahalleh S.J., Akhoond M.R., Talebi M.: “Evaluation of risk factors associated with endometriosis in infertile women”. Int. J. Fertil. Steril., 2016, 10, 11.
[9] Ferrero S., Anserini P., Remorgida V., Ragni N.: “Body mass index in endometriosis”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2005, 121, 94.
[10] Burghaus S., Klingsiek P., Fasching P.A., Engel A., Haberle L., Strissel P.L., et al.: “Risk factors for endometriosis in a German casecontrol study”. Geburtshilfe und Frauenheilkunde., 2011, 71, 1073.
[11] Ianieri M.M., Mautone D., Ceccaroni M.: “Recurrence in deep infiltrating endometriosis: a systematic review of the literature”. J. Minim. Invasive Gynecol., 2018, 25, 786.
[12] Yi K.W., Shin J.H., Park M.S., Kim T., Kim S.H., Hur J.Y.: “Association of body mass index with severity of endometriosis in Korean women”. Int. J. Gynaecol. Obstet., 2009, 105, 39.
[13] Mais V., Guerriero S., Ajossa S., Angiolucci M., Paoletti A.M., Melis G.B.: “The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma”. Fertil. Steril., 1993, 60, 776.
[14] Shahbazi S., Shahrabi-Farahani M.: “Evaluation of the correlation between body mass index and endometriosis among Iranian fertile women”. Gynecol. Endocrinol., 2016, 32, 157.
[15] Vitonis A.F., Baer H.J., Hankinson S.E., Laufer M.R., Missmer S.A.: “A prospective study of body size during childhood and early adulthood and the incidence of endometriosis”. Hum. Reprod., 2010, 25, 1325.
[16] Hediger M.L., Hartnett H.J., Louis G.M.: “Association of endometriosis with body size and figure”. Fertil. Steril., 2005, 84, 1366.
[17] Parazzini F., La Vecchia C., Negri E., Moroni S., Villa A.: “Risk factors for benign ovarian teratomas”. Br. J. Cancer., 1995, 71, 644.
[18] Sait K., Simpson C.: “Ovarian teratoma diagnosis and management: case presentations”. J. Obstet. Gynaecol. Can., 2004, 26, 137.
[19] Burney R.O., Giudice L.C.: “Pathogenesis and pathophysiology of endometriosis”. Fertil. Steril., 2012, 98, 511.
[20] Okifuji A., Hare B.D.: “The association between chronic pain and obesity”. J. Pain Res., 2015, 8, 399.
[21] Rand C.S., Kuldau J.M., Yost R.L.: “Obesity and post-operative pain”. J. Psychosom. Res., 1985, 29, 43.
[22] Cramer D.W., Missmer S.A.: “The epidemiology of endometriosis”. Ann. N. Y. Acad. Sci., 2002, 955, 11.
[1] Y.A. Kim. Mature cystic teratoma of the uterus presenting as an endometrial polyp in a patient with a history of ovarian mature cystic teratoma with gliomatosis peritonei and ovarian endometriosis: a case report[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 800-804.
[2] H. Takagi, S. Yamada, J. Sakamoto, S. Fujita, T. Sasagawa. Hemostatic effects of kyukikyogaito in dienogest treatment[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 560-564.
[3] K. Chmaj-Wierzchowska, M. Wojciechowska, I. Parda, K. Plagens-Rotman, P. Rzymski, M. Wilczak. How do health problems affect the quality and everyday life of patients with endometriomas?[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 571-575.
[4] X.J. Shi, L.B. Shi, S.Y. Zhang. Mechanistic study of vitamin C attenuation of endometriotic fibrosis[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 383-390.
[5] M. Ζafrakas, Κ. Κοtronis, P. Papasozomenou, P. Eskitzis, G. Grimbizis. Extracellular matrix metalloproteinases in the etiopathogenesis of endometriosis: a systematic review and critical appraisal[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 147-153.
[6] Hue HJ, Kim SK, Choi JY, Suh DH, Kim KD, No JH, Lee JR, Jee BC, Kim YB, Jeon HW. Previous ovarian surgery increases the risk of tubal factor infertility[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 84-88.
[7] H.-H. Lee, M.-J. Mun, T.-H. Kim, Y.-S. Kim, W.-C. Jang, J.-Y. Hwang. Relationships between vitamin D receptor genetic polymorphisms and endometriosis in Korean women[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 876-880.
[8] A. Vitagliano, A. Andrisani, F. Dessole, G. Virdis, R. Cappadona, L. Marin, G. Capobianco, S. Dessole, G. Ambrosini. Rectovaginal endometriosis: head to head comparison between sonovaginography and magnetic resonance imaging[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 888-891.
[9] C. Hayashi, K. Matsumoto, K. Shinya, T. Nakajima, T. Nakao, A. Komatsu, F. Chishima, K. Kawana. The expression of angiotensin II receptors mRNA in granulosa-lutein cells in endometriosis patients who underwent ovarian surgery before in vitro fertilization[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 910-913.
[10] Songping Liu, Xin Tian, Hongyan Cui, Qiong Zhang, Keqin Hua. Feasibility of serum-free culture in isolating endometriotic stem cells[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 920-923.
[11] M. Paliga, S. Horák. Relationship between endometriosis and vitamin D status – a review[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(5): 674-678.
[12] R. T. Ratner, A. Harris, J. Tsaltas, N. Goyal, M. Davies-Tuck, H. Najjar, O. Barel. An eight-year retrospective analysis of laparoscopic surgery for endometriosis, outcomes and complications in a large multicenter unit[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(5): 699-703.
[13] Y.-S. Kim, J.-Y. Hwang, T.-H. Kim, E.-G. Lee, H.-H. Lee. Genome-wide association study of recurrent endometriosis related with ovarian cancer[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(4): 553-559.
[14] K. Nakamura, K. Nakayama, T. Minamoto, T. Ishibashi, K. Sanuki, H. Yamashita, R. Ono, H. Sasamori, S. Razia, M.M. Hossain, S. Kamrunnahar, M. Ishikawa, S. Kyo. A novel retrograde approach for total laparoscopic hysterectomy in patients with severe adhesion in the cul-de-sac[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(4): 565-569.
[15] H. Takagi, J. Sakamoto, T. Sasagawa. Long-term treatment of endometriosis with dienogest for up to five years[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(3): 398-402.
No Suggested Reading articles found!