Central and General Obesity Linked to Increased Risk of Pelvic Organ Prolapse: Study Reveals

Pelvic organ prolapse occurs when the pelvic floor muscles and tissues weaken, leading to the descent of pelvic organs into or outside the vaginal canal. This condition is commonly linked to factors like childbirth, aging, and hormonal changes, but the role of body weight and fat distribution has remained a key area of exploration. Guizhu Wu, Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China, and colleagues aimed to Investigate the relationship between combined measures of central and general obesity and the risk of pelvic organ prolapse.

For this purpose, the researchers analyzed data from 251,143 participants aged 39–71 years without pre-existing pelvic organ prolapse (POP) at the time of enrollment in the UK Biobank between 2006 and 2010. They collected waist-to-height ratio and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) for these participants. The cohort was followed until December 19, 2022, with incident cases of POP identified through International Classification of Diseases, Tenth Revision (ICD-10) codes and operating procedure codes recorded in medical records.

To evaluate the link between obesity measures and the risk of developing POP, the researchers utilized a Cox proportional hazards model. Additionally, population-attributable fractions were calculated to determine the proportion of POP cases that could be attributed to obesity-related measures.

The study led to the following findings:

• Over a median follow-up of 13.8 years, 9,781 cases of POP were recorded.
• Central obesity, a waist-to-height ratio of 0.5 or greater, was linked to a 48% increased risk of POP regardless of BMI (hazard ratio [HR] 1.48).
• Central obesity accounted for approximately 21.7% of all POP cases.
• Overweight individuals without central obesity (BMI 25–29.9 and waist-to-height ratio less than 0.5) had a 23% higher risk of developing POP (HR 1.23), contributing to 2.0% of all cases.
• The increased risk of POP associated with central obesity varied by age, with a 57% higher risk in those younger than 60 years compared to a 39% increase in those aged 60 years or older.
• The risk also differed based on hysterectomy history, with a 54% increased risk in women without a history of hysterectomy compared to a 27% increase in those with such a history.

The findings revealed that individuals with central obesity, marked by excess abdominal fat, face a higher risk of developing pelvic organ prolapse, especially those under 60 years of age or without a history of hysterectomy. Additionally, women who are overweight but do not exhibit CO are also at an increased risk of POP.

"We found that combining waist-to-height ratio with BMI provides a more precise way to differentiate individuals with varying risks of pelvic organ prolapse. Within the same BMI category, waist-to-height ratios can differ, with higher ratios being linked to an elevated risk of POP compared to normal ratios," the researchers wrote.

They emphasized that relying on a single measure of obesity is insufficient and that this combined approach can identify more individuals at high risk for POP than using either measure alone.

Reference:

Si, Keyi PhD; Yang, Yingying PhD; Liu, Qianqian MD; Wang, Qin MPH; Yin, Shaohua PhD; Dai, Qingqiang MD; Yao, Yuting MD; Yuan, Lei MPH; Wu, Guizhu PhD. Association of Central and General Obesity Measures With Pelvic Organ Prolapse. Obstetrics & Gynecology ():10.1097/AOG.0000000000005758, October 24, 2024. | DOI: 10.1097/AOG.0000000000005758