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Salmeri N, Viganò P, Cavoretto P, Marci R, Candiani M. The kisspeptin system in and beyond reproduction: exploring intricate pathways and potential links between endometriosis and polycystic ovary syndrome. Rev Endocr Metab Disord 2024; 25:239-257. [PMID: 37505370 DOI: 10.1007/s11154-023-09826-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Endometriosis and polycystic ovary syndrome (PCOS) are two common female reproductive disorders with a significant impact on the health and quality of life of women affected. A novel hypothesis by evolutionary biologists suggested that these two diseases are inversely related to one another, representing a pair of diametrical diseases in terms of opposite alterations in reproductive physiological processes but also contrasting phenotypic traits. However, to fully explain the phenotypic features observed in women with these conditions, we need to establish a potential nexus system between the reproductive system and general biological functions. The recent discovery of kisspeptin as pivotal mediator of internal and external inputs on the hypothalamic-pituitary-gonadal axis has led to a new understanding of the neuroendocrine upstream regulation of the human reproductive system. In this review, we summarize the current knowledge on the physiological roles of kisspeptin in human reproduction, as well as its involvement in complex biological functions such as metabolism, inflammation and pain sensitivity. Importantly, these functions are known to be dysregulated in both PCOS and endometriosis. Within the evolving scientific field of "kisspeptinology", we critically discuss the clinical relevance of these discoveries and their potential translational applications in endometriosis and PCOS. By exploring the possibilities of manipulating this complex signaling system, we aim to pave the way for novel targeted therapies in these reproductive diseases.
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Affiliation(s)
- Noemi Salmeri
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti 6, 20122, Milan, Italy.
| | - Paolo Cavoretto
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Roberto Marci
- Gynecology & Obstetrics, University of Ferrara, 44121, Ferrara, Italy
| | - Massimo Candiani
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
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Is There a Correlation between the Second-to-Four Digit Ratio (2D:4D) and Endometriosis? Results of a Case-Control Study. J Clin Med 2023; 12:jcm12052040. [PMID: 36902827 PMCID: PMC10004093 DOI: 10.3390/jcm12052040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/05/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The second-to-four digit ratio (2D:4D) has been proposed as a marker of prenatal hormonal exposure. It is suggested that prenatal exposure to androgens results in a shorter 2D:4D ratio, whereas a prenatal oestrogenic environment results in a longer one. In addition, previous research has shown an association between exposure to endocrine-disrupting chemicals and 2D:4D in animals and humans. On the endometriosis side, hypothetically, a longer 2D:4D ratio, reflecting a lower androgenic intrauterine milieu, could represent an indicator of the presence of the disease. In this light, we have designed a case-control study to compare 2D:4D measurements between women with and without endometriosis. Exclusion criteria included the presence of PCOS and previous trauma on the hand that could impact the measurement of the digit ratio. The 2D:4D ratio of the right hand was measured using a digital calliper. A total of 424 participants (endometriosis n = 212; controls n = 212) were recruited. The group of cases included 114 women with endometriomas and 98 patients with deep infiltrating endometriosis. The 2D:4D ratio was significantly higher in women with endometriosis compared to controls (p = 0.002). There is an association between a higher 2D:4D ratio and the presence of endometriosis. Our results support the hypothesis claiming potential influences of intrauterine hormonal and endocrine disruptors exposure on the onset of the disease.
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Rossi HR, Uimari O, Terho A, Pesonen P, Koivurova S, Piltonen T. Increased overall morbidity in women with endometriosis: a population-based follow-up study until age 50. Fertil Steril 2023; 119:89-98. [PMID: 36496274 DOI: 10.1016/j.fertnstert.2022.09.361] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether there is an association between endometriosis and nongynecological diseases in the general female population by age 50? DESIGN A prospective cohort study. SETTING Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years. PATIENT(S) Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis. MAIN OUTCOME MEASURE(S) International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities were assessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed. RESULT(S) Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis (adjusted odds ratio [aOR] 2.32; 95% CI, 1.07-5.02). In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56; 95% CI, 2.73-4.64), especially abdominal and pelvic pain (aOR 4.33; 95% CI, 3.13-4.76) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts. CONCLUSION(S) Women with endometriosis have a high risk for several chronic diseases compared with women without endometriosis, underlying the need for awareness and targeted resources for these women in the health care system. Moreover, endometriosis should be considered in the presence of nonspecific symptoms and abdominal pain, as they may conceal the disease and cause considerable delay in diagnosis and treatment.
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Affiliation(s)
- Henna-Riikka Rossi
- Department of Obstetrics and Gynecology, Oulu University Hospital, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland
| | - Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University Hospital, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland
| | - Anna Terho
- Department of Obstetrics and Gynecology, Oulu University Hospital, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynecology, Oulu University Hospital, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Finland; Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, University of Oulu, Oulu, Finland.
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Schliep KC, Farland LV, Pollack AZ, Buck Louis G, Stanford JB, Allen-Brady K, Varner MW, Kah K, Peterson CM. Endometriosis diagnosis, staging and typology and adverse pregnancy outcome history. Paediatr Perinat Epidemiol 2022; 36:771-781. [PMID: 35570746 PMCID: PMC9588543 DOI: 10.1111/ppe.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity. OBJECTIVES We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women. METHODS Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors. RESULTS Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes. CONCLUSIONS While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.
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Affiliation(s)
- Karen C. Schliep
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Anna Z. Pollack
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Germaine Buck Louis
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristina Allen-Brady
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael W. Varner
- Department of Obstetrics and Gynecology University of Utah Health, Salt Lake City, Utah, USA
| | - Kebba Kah
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - C. Matthew Peterson
- Department of Obstetrics and Gynecology University of Utah Health, Salt Lake City, Utah, USA
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Appleyard CB, Cruz ML, Velazquez-Cruz J, Rivera-Mendez RM, Jimenez-Garcia JG, Rivera LA, Mendez-Casillas MDM, Flores I, Al-Nakkash L, Chompre G. Voluntary Wheel Running Reduces Vesicle Development in an Endometriosis Animal Model Through Modulation of Immune Parameters. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 3. [PMID: 36284640 PMCID: PMC9580825 DOI: 10.3389/frph.2021.826541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Endometriosis is a chronic gynecological disorder characterized by the growth of endometrial glands and stroma outside the endometrial cavity producing inflammation and pain. Previously we demonstrated that modulation of the hypothalamic pituitary adrenal (HPA) axis exacerbates the development and severity of this condition. A physically active lifestyle has been shown to confer health benefits in many chronic conditions by potentially acting as a stress buffer, thus we hypothesized that voluntary physical exercise can “realign/reset” the HPA axis resulting in reduced endometriosis symptoms in an animal model. Methods Endometriosis was induced in female Sprague Dawley rats by implanting uterine tissue next to the intestinal mesentery on day 0. Sham controls received sutures only. One group of endometriosis animals had access to a running wheel for 2 weeks prior to endometriosis induction until time of sacrifice at day 60. Sham and endometriosis controls received no exercise. All animals were examined for developed vesicles which were collected and measured. Uterine tissue was analyzed for cellular infiltration. Brain, liver, spleen, adrenal glands, leg muscles, and fat were collected, along with peritoneal fluid and blood. Results Endometriosis animals developed vesicles in 86.96% of the implants with significantly increased mesenteric fat compared to sham (p < 0.05). Exposure to exercise significantly decreased the size (p < 0.01) and number (p < 0.05) of vesicles that developed, as well as the mesenteric fat (p < 0.01). Exercised animals had higher levels of lactoferrin in peritoneal fluid, and decreased serum fractalkine and leptin. Exercise significantly increased estrogen alpha receptor expression levels (p < 0.01), while significantly decreasing estrogen receptor beta expression (p < 0.01) and macrophage infiltration (p < 0.05) in vesicles compared to non- exercised animals. Conclusions Our results suggest that voluntary physical activity might protect against endometriosis and alleviate the associated inflammation via immune modulation of the HPA axis. This offers the potential for further exploration of exercise as a complementary therapy in endometriosis patients.
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Affiliation(s)
- Caroline B. Appleyard
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
- *Correspondence: Caroline B. Appleyard
| | - Myrella L. Cruz
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | | | - Raquel M. Rivera-Mendez
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Juan G. Jimenez-Garcia
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Luis A. Rivera
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | | | - Idhaliz Flores
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
| | - Layla Al-Nakkash
- Department of Physiology, Midwestern University, Glendale, AZ, United States
| | - Gladys Chompre
- Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University-Medical School, Ponce, Puerto Rico
- Biology Department, Pontifical Catholic University of Puerto Rico, Ponce, Puerto Rico
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Park S, Chung C. Differences in metabolic syndrome indicators by body mass index of women with endometriosis. Nurs Open 2021; 8:3306-3314. [PMID: 34469076 PMCID: PMC8510718 DOI: 10.1002/nop2.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/04/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
Aim The study aimed to identify the relationships between metabolic syndrome indicators and BMI in women with endometriosis. Design A retrospective observational study design was utilized to analyse secondary data from a longitudinal dataset. Methods A total of 281,810 women diagnosed with endometriosis and aged 15 through 49 were drawn from the National Health Insurance Service‐National Health Screening Cohort data of the Republic of Korea from the year 2009 to 2016. Body mass index (BMI) and five indicators of metabolic syndrome were extracted. Descriptive statistics, Cochran–Mantel–Haenszel test, chi‐square test and Cochran‐Armitage test were used. Results Yearly changes in abnormal waist circumference, elevated fasting blood sugar and abnormally low levels of high‐density lipoprotein cholesterol were statistically significant. The risk groups of these indicators all showed statistically significant differences according to BMI. The proportions of women with abnormal findings for all indicators significantly increased as BMI increased.
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Affiliation(s)
- SoMi Park
- Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - ChaeWeon Chung
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Dinsdale NL, Crespi BJ. Endometriosis and polycystic ovary syndrome are diametric disorders. Evol Appl 2021; 14:1693-1715. [PMID: 34295358 PMCID: PMC8288001 DOI: 10.1111/eva.13244] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
Evolutionary and comparative approaches can yield novel insights into human adaptation and disease. Endometriosis and polycystic ovary syndrome (PCOS) each affect up to 10% of women and significantly reduce the health, fertility, and quality of life of those affected. PCOS and endometriosis have yet to be considered as related to one another, although both conditions involve alterations to prenatal testosterone levels and atypical functioning of the hypothalamic-pituitary-gonadal (HPG) axis. Here, we propose and evaluate the novel hypothesis that endometriosis and PCOS represent extreme and diametric (opposite) outcomes of variation in HPG axis development and activity, with endometriosis mediated in notable part by low prenatal and postnatal testosterone, while PCOS is mediated by high prenatal testosterone. This diametric disorder hypothesis predicts that, for characteristics shaped by the HPG axis, including hormonal profiles, reproductive physiology, life-history traits, and body morphology, women with PCOS and women with endometriosis will manifest opposite phenotypes. To evaluate these predictions, we review and synthesize existing evidence from developmental biology, endocrinology, physiology, life history, and epidemiology. The hypothesis of diametric phenotypes between endometriosis and PCOS is strongly supported across these diverse fields of research. Furthermore, the contrasts between endometriosis and PCOS in humans parallel differences among nonhuman animals in effects of low versus high prenatal testosterone on female reproductive traits. These findings suggest that PCOS and endometriosis represent maladaptive extremes of both female life-history variation and expression of sexually dimorphic female reproductive traits. The diametric disorder hypothesis for endometriosis and PCOS provides novel, unifying, proximate, and evolutionary explanations for endometriosis risk, synthesizes diverse lines of research concerning the two most common female reproductive disorders, and generates future avenues of research for improving the quality of life and health of women.
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Affiliation(s)
| | - Bernard J. Crespi
- Department of Biological SciencesSimon Fraser UniversityBurnabyBCCanada
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Pantelis A, Machairiotis N, Lapatsanis DP. The Formidable yet Unresolved Interplay between Endometriosis and Obesity. ScientificWorldJournal 2021; 2021:6653677. [PMID: 33986637 PMCID: PMC8079185 DOI: 10.1155/2021/6653677] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
Obesity and endometriosis are two very common entities, yet there is uncertainty on their exact relationship. Observational studies have repeatedly shown an inverse correlation between endometriosis and a low body mass index (BMI). However, obesity does not protect against endometriosis and on the contrary an increased BMI may lead to more severe forms of the disease. Besides, BMI is not accurate in all cases of obesity. Consequently, other anthropometric and phenomic traits have been studied, including body adiposity content, as well as the effect of BMI early in life on the manifestation of endometriosis in adulthood. Some studies have shown that the phenotypic inverse correlation between the two entities has a genetic background; however, others have indicated that certain polymorphisms are linked with endometriosis in females with increased BMI. The advent of metabolic bariatric surgery and pertinent research have led to the emergence of biomolecules that may be pivotal in understanding the pathophysiological interaction of the two entities, especially in the context of angiogenesis and inflammation. Future research should focus on three objectives: detection and interpretation of obesity-related biomarkers in experimental models with endometriosis; integration of endometriosis-related queries into bariatric registries; and multidisciplinary approach and collaboration among specialists.
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Affiliation(s)
- Athanasios Pantelis
- Surgeon, 4th Department of Surgery, Evaggelismos General Hospital of Athens, Ipsilantou 45, Athens 106 76, Greece
| | - Nikolaos Machairiotis
- Fellow in Endometriosis and Minimal Access Surgery, Northwick Park, Central Middlesex and Ealing Hospitals, London North West University Heathcare, NHS Trust, London, UK
| | - Dimitris P. Lapatsanis
- Surgeon, 4th Department of Surgery, Evaggelismos General Hospital of Athens, Ipsilantou 45, Athens 106 76, Greece
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Pollack AZ, Krall JR, Kannan K, Buck Louis GM. Adipose to serum ratio and mixtures of persistent organic pollutants in relation to endometriosis: Findings from the ENDO Study. ENVIRONMENTAL RESEARCH 2021; 195:110732. [PMID: 33484721 PMCID: PMC8432300 DOI: 10.1016/j.envres.2021.110732] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Endometriosis is an estrogen-dependent disease. Endocrine disrupting chemicals (EDCs) and their mixtures may play an etiologic role. OBJECTIVES We evaluated an adipose-to-serum ratio (ASR) of lipophilic EDCs and their mixtures associated with incident endometriosis. METHODS We quantified 13 polychlorinated biphenyl (PCB) congeners, 6 polybrominated diphenyl ether (PBDE) congeners, and 11 organochlorine pesticides (OCPs) in serum and omental fat among women from the ENDO Study (2007-2009) aged 18-44 years diagnosed with (n=190) or without (n=283) surgically-visualized incident endometriosis. Odds ratios (OR) and 95% confidence intervals (CI) between ASR and endometriosis were estimated using logistic regression models adjusted for age (years), body mass index (kg/m2), serum cotinine (ng/ml), and breastfeeding conditional on parity. Bayesian hierarchical models (BHM) compared estimated associations for adipose and ASR to serum. Bayesian kernel machine regression (BKMR) estimated change in latent health and 95% posterior intervals (PI) between chemical mixtures and endometriosis. RESULTS Select ASR for estrogenic PCBs and OCPs were associated with an increased odds of an endometriosis diagnosis, but not for anti-estrogenic PCBs or PBDEs. Across all chemicals, BHMs generated ORs that were on average 14% (95% PI: 6%, 22%) higher for adipose and 20% (95% PI: 12%, 29%) higher for ASR in comparison to serum. ORs from BHMs were greater for estrogenic PCBs and OCPs, with no differences for PBDEs. BKMR models comparing the 75th to 25th percentile were moderately associated with endometriosis for estrogenic PCBs [adipose 0.27 (95% PI: 0.18, 0.72) and ASR 0.37 (95% PI: 0.06, 0.80)] and OCPs [adipose 0.17 (95% PI: 0.21, 0.56) and ASR 0.26 (95% PI: 0.05, 0.57)], but not for antiestrogenic PCBs and PBDEs. DISCUSSION ASR added little insight beyond adipose for lipophilic chemicals. BKMR results supported associations between ASR and adipose estrogenic PCB and OCP mixtures and incident endometriosis. These findings underscore the importance of choice of biospecimen and considering mixtures when assessing exposure-disease relationships.
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Affiliation(s)
- Anna Z Pollack
- Department of Global and Community Health, College of Health and Human Services George Mason University, Fairfax, VA, 22030, USA.
| | - Jenna R Krall
- Department of Global and Community Health, College of Health and Human Services George Mason University, Fairfax, VA, 22030, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, USA
| | - Germaine M Buck Louis
- College of Health and Human Services George Mason University, Fairfax, VA, 22030, USA
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Wang B. Diagnosis of Waist Muscle Injury after Exercise Based on High-Frequency Ultrasound Image. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5528309. [PMID: 33833856 PMCID: PMC8018867 DOI: 10.1155/2021/5528309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
The low back is the weight-bearing part of the human trunk and has a complex anatomy with a variety of lesions. The traditional diagnostic imaging methods include X-ray, CT, and magnetic resonance imaging (MRI). With the rapid development of ultrasound diagnostic instruments and diagnostic techniques, high-frequency ultrasonography plays a more important role in the diagnosis of musculoskeletal disorders by virtue of its advantages of being safe, noninvasive, inexpensive, repeatable in a short period of time, and real-time imaging, especially for the display of fine structures of soft tissues, which is superior to CT and MRI. In this paper, the puncture needle was punctured near the intervertebral foramen, anti-inflammatory analgesics were injected under ultrasound surveillance. The anti-inflammatory and analgesic drugs mainly consist of local anesthetics and glucocorticoids. Local anesthetics can immediately block the nociceptive transmission of the diseased nerve, improve muscle tension, and eliminate muscle spasm, and glucocorticoids can effectively eliminate edema and inflammation of the lumbar nerve root and its surrounding tissues. The results showed that high-frequency ultrasound, as a noninvasive imaging examination, can clearly display the structure and spatial hierarchy of the skin, superficial fascia, deep fascia, and muscles of the low back, can provide real-time dynamic bilateral contrast observation, which can be the preferred imaging examination method for soft tissue disorders of the low back, and can compensate with general X-ray, CT, and magnetic resonance imaging to provide richer clinical diagnosis and treatment. It can provide richer imaging information for clinical diagnosis and treatment.
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Affiliation(s)
- Bingke Wang
- Sports Institute, Pingdingshan University, Pingdingshan 467000, China
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Brassica Bioactives Could Ameliorate the Chronic Inflammatory Condition of Endometriosis. Int J Mol Sci 2020; 21:ijms21249397. [PMID: 33321760 PMCID: PMC7763502 DOI: 10.3390/ijms21249397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/26/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023] Open
Abstract
Endometriosis is a chronic, inflammatory, hormone-dependent disease characterized by histological lesions produced by the presence of endometrial tissue outside the uterine cavity. Despite the fact that an estimated 176 million women are affected worldwide by this gynecological disorder, risk factors that cause endometriosis have not been properly defined and current treatments are not efficient. Although the interaction between diet and human health has been the focus of many studies, little information about the correlation of foods and their bioactive derivates with endometriosis is available. In this framework, Brassica crops have emerged as potential candidates for ameliorating the chronic inflammatory condition of endometriosis, due to their abundant content of health-promoting compounds such as glucosinolates and their hydrolysis products, isothiocyanates. Several inflammation-related signaling pathways have been included among the known targets of isothiocyanates, but those involving aquaporin water channels have an important role in endometriosis. Therefore, the aim of this review is to highlight the promising effects of the phytochemicals present in Brassica spp. as major candidates for inclusion in a dietary approach aiming to improve the inflammatory condition of women affected with endometriosis. This review points out the potential roles of glucosinolates and isothiocyanates from Brassicas as anti-inflammatory compounds, which might contribute to a reduction in endometriosis symptoms. In view of these promising results, further investigation of the effect of glucosinolates on chronic inflammatory diseases, either as diet coadjuvants or as therapeutic molecules, should be performed. In addition, we highlight the involvement of aquaporins in the maintenance of immune homeostasis. In brief, glucosinolates and the modulation of cellular water by aquaporins could shed light on new approaches to improve the quality of life for women with endometriosis.
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García-Peñarrubia P, Ruiz-Alcaraz AJ, Martínez-Esparza M, Marín P, Machado-Linde F. Hypothetical roadmap towards endometriosis: prenatal endocrine-disrupting chemical pollutant exposure, anogenital distance, gut-genital microbiota and subclinical infections. Hum Reprod Update 2020; 26:214-246. [PMID: 32108227 DOI: 10.1093/humupd/dmz044] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endometriosis is a gynaecological hormone-dependent disorder that is defined by histological lesions generated by the growth of endometrial-like tissue out of the uterus cavity, most commonly engrafted within the peritoneal cavity, although these lesions can also be located in distant organs. Endometriosis affects ~10% of women of reproductive age, frequently producing severe and, sometimes, incapacitating symptoms, including chronic pelvic pain, dysmenorrhea and dyspareunia, among others. Furthermore, endometriosis causes infertility in ~30% of affected women. Despite intense research on the mechanisms involved in the initial development and later progression of endometriosis, many questions remain unanswered and its aetiology remains unknown. Recent studies have demonstrated the critical role played by the relationship between the microbiome and mucosal immunology in preventing sexually transmitted diseases (HIV), infertility and several gynaecologic diseases. OBJECTIVE AND RATIONALE In this review, we sought to respond to the main research question related to the aetiology of endometriosis. We provide a model pointing out several risk factors that could explain the development of endometriosis. The hypothesis arises from bringing together current findings from large distinct areas, linking high prenatal exposure to environmental endocrine-disrupting chemicals with a short anogenital distance, female genital tract contamination with the faecal microbiota and the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. SEARCH METHODS We performed a search of the scientific literature published until 2019 in the PubMed database. The search strategy included the following keywords in various combinations: endometriosis, anogenital distance, chemical pollutants, endocrine-disrupting chemicals, prenatal exposure to endocrine-disrupting chemicals, the microbiome of the female reproductive tract, microbiota and genital tract, bacterial vaginosis, endometritis, oestrogens and microbiota and microbiota-immune system interactions. OUTCOMES On searching the corresponding bibliography, we found frequent associations between environmental endocrine-disrupting chemicals and endometriosis risk. Likewise, recent evidence and hypotheses have suggested the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. Hence, we can envisage a direct relationship between higher prenatal exposure to oestrogens or estrogenic endocrine-disrupting compounds (phthalates, bisphenols, organochlorine pesticides and others) and a shorter anogenital distance, which could favour frequent postnatal episodes of faecal microbiota contamination of the vulva and vagina, producing cervicovaginal microbiota dysbiosis. This relationship would disrupt local antimicrobial defences, subverting the homeostasis state and inducing a subclinical inflammatory response that could evolve into a sustained immune dysregulation, closing the vicious cycle responsible for the development of endometriosis. WIDER IMPLICATIONS Determining the aetiology of endometriosis is a challenging issue. Posing a new hypothesis on this subject provides the initial tool necessary to design future experimental, clinical and epidemiological research that could allow for a better understanding of the origin of this disease. Furthermore, advances in the understanding of its aetiology would allow the identification of new therapeutics and preventive actions.
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Affiliation(s)
- Pilar García-Peñarrubia
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - Antonio J Ruiz-Alcaraz
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - María Martínez-Esparza
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología. Facultad de Medicina, IMIB and Regional Campus of International Excellence "Campus Mare Nostrum", Universidad de Murcia, 30100 Murcia, Spain
| | - Pilar Marín
- Servicio de Ginecología y Obstetricia, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Francisco Machado-Linde
- Servicio de Ginecología y Obstetricia, Hospital Clínico Universitario Reina Sofía, CARM, Murcia, Spain
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Cardoso JV, Machado DE, Silva MCD, Berardo PT, Ferrari R, Abrão MS, Perini JA. Epidemiological profile of women with endometriosis: a retrospective descriptive study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000400008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the epidemiological and clinical profile of women with endometriosis and to determine the association with the prognostic characteristics of the disease. Methods: retrospective descriptive study involving 237 women attended at two referral hospitals for endometriosis, between 2011 and 2017. Associations between groups were estimated using logistic regression models. Results: most women (65.4%) were of reproductive age (29-39 years), with a body mass index in the range of 18.5-24.9 kg/m2 and a high prevalence (23-81%) of symptoms of the disease, with 49.5% being infertile. The average time of diagnosis was 5 years. Ovarian endometrioma and/or deep infiltrative endometriosis (DIE) were the most frequent type of endometriosis (87%), and 59% of patients were in the III/IV stage of the disease. Approximately 87% of women with surgical diagnosis were aged over 30, married (70%) and had lower parity. Dyspareunia was negatively associated with superficial endometriosis. Infertility was positively associated with age (30-39 years) and DIE in the uterine tubes; dysmenorrhea with DIE in the uterosacral ligament; cyclic intestinal complaints with DIE in the rectosigmoid and intestine, and with DIE classification and III/IVstage. Conclusions: knowing the epidemiological and clinical profile of Brazilian women with endometriosis can help in diagnosis and treatment planning.
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Demézio da Silva CV, Felipe VL, Shivappa N, Hebert JR, Perini JA, de Brito PD, Cardoso JV, Ferrari R, de Almeida Filho GL. Dietary Inflammatory Index score and risk of developing endometriosis: A case–control study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520967599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The possible relationship between chronic inflammation from dietary exposure and endometriosis has not been investigated. Thus, the aim of this study was to investigate the association between the Dietary Inflammatory Index (DII®) and endometriosis. Women with endometriotic lesions were defined as cases ( n = 59), and controls ( n = 59) had no visible ectopic endometrium sites. Body mass index (BMI=weight(kg)/height(m)2) was calculated from measured height and weight and waist circumference was measured. A validated semi-quantitative food frequency questionnaire was used to calculate the DII score. Women with endometriosis were younger, thinner; and had a more pro-inflammatory diet and more pain (dysmenorrhea, chronic pelvic pain, deep dyspareunia), than controls. Women with higher DII scores (>0.86) were more likely to have endometriosis and to present with dyspareunia. Results obtained from modeling DII as a categorical variable in relation to risk of endometriosis showed a near tripling of risk (OR = 2.77; 95% CI = 1.13–6.77) for women with DII >0.86 versus those with DII ⩽ 0.86, after adjusting for age and BMI. After multivariable adjustment, women with DII > 0.86 were four times more likely to have endometriosis compared to women with DII ⩽ 0.86 (OR = 4.14; 95% CI= 1.50–11.4). In conclusion, a pro-inflammatory diet was significantly associated with endometriosis.
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Affiliation(s)
- Clarissa Viana Demézio da Silva
- Institute of Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Post Graduate Program in Surgical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valéria Lauriana Felipe
- Post Graduate Program in Surgical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Jamila Alessandra Perini
- Research Laboratory of Pharmaceutical Sciences, West Zone State University Center, Rio de Janeiro, Brazil
- Post Graduate Program in Public Health and Environment, National School of Public Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Patricia Dias de Brito
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Jéssica Vilarinho Cardoso
- Research Laboratory of Pharmaceutical Sciences, West Zone State University Center, Rio de Janeiro, Brazil
- Post Graduate Program in Public Health and Environment, National School of Public Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Renato Ferrari
- Institute of Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gutemberg Leão de Almeida Filho
- Institute of Gynecology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Post Graduate Program in Surgical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Byun J, Peterson CM, Backonja U, Taylor RN, Stanford JB, Allen-Brady KL, Smith KR, Louis GMB, Schliep KC. Adiposity and Endometriosis Severity and Typology. J Minim Invasive Gynecol 2020; 27:1516-1523. [PMID: 31927045 DOI: 10.1016/j.jmig.2020.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
STUDY 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.
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Affiliation(s)
- Jiyoung Byun
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep)
| | - C Matthew Peterson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility (Drs. Peterson and Taylor), University of Utah, Salt Lake City, Utah
| | - Uba Backonja
- Department of Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma (Dr. Backonja); Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle (Dr. Backonja), Washington
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility (Drs. Peterson and Taylor), University of Utah, Salt Lake City, Utah
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep)
| | - Kristina L Allen-Brady
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep); Department of Internal Medicine, Genetic Epidemiology (Dr. Allen-Brady)
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences/Huntsman Cancer Institute (Dr. Smith), University of Utah, Salt Lake City, Utah
| | - Germaine M Buck Louis
- Dean's Office, College of Health and Human Services, George Mason University, Fairfax, Virginia (Dr. Buck Louis)
| | - Karen C Schliep
- Department of Family and Preventive Medicine, Division of Public Health (Ms. Byun and Drs. Stanford, Allen-Brady, and Schliep).
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16
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The effect of endometriosis on the antimüllerian hormone level in the infertile population. J Assist Reprod Genet 2019; 36:1179-1184. [PMID: 31020439 DOI: 10.1007/s10815-019-01450-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To determine whether the presence of endometriosis in infertile women without prior ovarian surgery influences markers of ovarian reserve, AMH and FSH. METHODS A retrospective cohort study included three groups of women who presented for IVF treatment at our tertiary care center from 04/27/2015 to 05/31/2017: women with endometriosis and prior ovarian surgery (EnSx), women with endometriosis without prior ovarian surgery (En), and women with a primary diagnosis of male factor infertility (MF; reference group). RESULTS There were 671 patients that met inclusion criteria (78 EnSx, 60 En, and 533 MF). Compared to the MF group (3.6 ± 3.0), a lower mean AMH level (ng/mL) was observed in the EnSx group (2.5 ± 2.5; aβ - 1.21; 95% CI [- 1.79, -0.62]) and in the En group (2.5 ± 2.2; aβ - 1.11; 95% CI [- 1.68, - 0.54]). Both endometriosis groups had a statistically significantly higher proportion of patients with an AMH < 1 (EnSx, 24.4%; OR, 2.39 [95% CI, 1.31, 4.36]; En, 28.3%; OR, 2.67 [95% CI, 1.41, 5.08]) compared to the MF group (13.9%). The mean baseline FSH level (lU/L) was statistically significantly higher in both endometriosis groups (EnSx, 8.6 ± 4.3; β, 1.37 [95% CI, 0.39, 2.34]; En, 8.4 ± 3.7; β, 0.96 [95% CI, 0.04, 1.87]) compared to the MF group (7.3 ± 2.2). CONCLUSIONS Among infertility patients with endometriosis, with and without a history of ovarian surgery, ovarian reserve markers were worse (lower AMH and higher FSH) and a higher proportion had decreased ovarian reserve as measured by AMH compared to women with MF.
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Jenabi E, Khazaei S, Veisani Y. The association between body mass index and the risk of endometriosis: A meta-analysis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519832814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Many epidemiologic studies have been conducted to assess factors that were associated to endometriosis, but there is no consistency in results. Therefore, we conducted this meta-analysis to investigate the association between body mass index and the risk of endometriosis. Methods: In this meta-analysis, relevant studies that published in major international electronic bibliographic databases of PubMed, Scopus and Web of Science were systematically searched during November 2017. The Begg and Egger’s test was used to investigate publication bias in included studies. The Q-statistic and I2 tests were carried out for measuring heterogeneity. The random-effects model was conducted to obtain pooled odds ratio. Results: Our results showed a direct association between underweight and endometriosis in woman (odds ratio = 1.41, 95% confidence interval = 1.16–1.66), so underweight woman had 41% higher chance for endometriosis. However, we did not find linear association between overweight and endometriosis (odds ratio = 0.95; 95% confidence interval: 0.72–1.18) and obesity and endometriosis (odds ratio = 0.88; 95% confidence interval: 0.54–1.21), respectively. Conclusions: Our results suggested that underweight was a risk factor for the endometriosis, while overweight and obesity were not protective factors for endometriosis.
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Affiliation(s)
- Ensiyeh Jenabi
- Pediatric Developmental Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan university of Medical Sciences, Hamadan, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Pinheiro PA, Coqueiro RDS, Carneiro JAO, Correia TML, Pereira R, Fernandes MH. Anthropometric indicators as screening tools for sarcopenia in older adult women. ENFERMERIA CLINICA 2019; 30:269-274. [PMID: 30737176 DOI: 10.1016/j.enfcli.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/09/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the association between sarcopenia and different anthropometric indicators, and identify the best indicator to discriminate sarcopenia in community-dwelling older adult women. METHOD Data from 173 older adult women (≥60 years), living in Lafaiete Coutinho, a small-sized city in northeastern Brazil, were analyzed. Sarcopenia was defined based on the European consensus on definition and diagnosis using three components: muscle mass, muscle strength and performance. The association between sarcopenia and anthropometric indicators (body mass index, corrected arm muscle area and calf perimeter) was tested using the binary logistic regression technique. RESULTS The adjusted regression model indicated that all anthropometric indicators were inversely associated with sarcopenia, and an increase by one unit in body mass index, corrected arm muscle area or calf circumference decreased the probability of sarcopenia in older adult women by approximately 85%, 16% and 72%, respectively. CONCLUSION All the studied anthropometric indicators can be used as discriminators of sarcopenia in an older adult women population. To this end body mass index exhibited better sensitivity and calf circumference better specificity. The results of the study may improve nursing practice and that of other healthcare professionals, enabling sarcopenia screening in older adult women from simple and low-cost anthropometric indicators.
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Affiliation(s)
- Paloma Andrade Pinheiro
- Núcleo de Estudos em Epidemiologia do Envelhecimento (NEPE), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil.
| | - Raildo da Silva Coqueiro
- Núcleo de Estudos em Epidemiologia do Envelhecimento (NEPE), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - José Ailton Oliveira Carneiro
- Núcleo de Estudos em Epidemiologia do Envelhecimento (NEPE), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Thiago Macedo Lopes Correia
- Integrative Physiology Research Center (IPRC), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Rafael Pereira
- Integrative Physiology Research Center (IPRC), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Marcos Henrique Fernandes
- Núcleo de Estudos em Epidemiologia do Envelhecimento (NEPE), Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
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Cano-Sancho G, Ploteau S, Matta K, Adoamnei E, Louis GB, Mendiola J, Darai E, Squifflet J, Le Bizec B, Antignac JP. Human epidemiological evidence about the associations between exposure to organochlorine chemicals and endometriosis: Systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2019; 123:209-223. [PMID: 30530163 DOI: 10.1016/j.envint.2018.11.065] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND Endometriosis is a gynaecological disease characterized by the presence of ectopic endometrial tissue that affects women during their reproductive years, having a strong impact on their lives, fertility and healthcare costs. The aetiology remains largely unknown, but current evidence suggests that it is multi-causal and oestrogen-dependent. Many epidemiologic studies have explored associations between organochlorine chemicals (OCCs) and endometriosis, but the findings are inconsistent. OBJECTIVES A systematic review (SR) and meta-analysis were conducted to gather and synthesize all the available evidence from human epidemiological studies about the associations between OCCs and endometriosis. DATA SOURCES The searches were conducted in PubMed and Web of Science in June 2016 with a final follow-up in August 2018. STUDY ELIGIBILITY CRITERIA Only human epidemiological studies were considered, independent of participant age, body mass index or life-stage. Studies reporting individual measures of exposure to OCCs were included, considering but not limited to polychlorinated dibenzodioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), or organochlorine pesticides (OCPs). The primary health outcome was presence of endometriosis, including all sub-types. Eligibility criteria excluded articles not written in English, conference papers, reviews and studies with overlapping information. STUDY APPRAISAL AND SYNTHESIS METHODS A SR protocol pre-registered at PROSPERO was applied in duplicate to gather and extract all eligible original papers from PUBMED and Web of Science databases. Odds ratios were pooled using the inverse variance method for random effects meta-analysis for each group of OCCs. Risk of bias was assessed using the National Toxicology Program/Office of Health Assessment and Translation (NTP/OHAT) Risk of Bias Rating Tool for Human and Animal Studies adapted to the review question. The confidence in the body of evidence and related level of evidence was measured by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) based NTP/OHAT framework. The results were structured and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 51 studies retained for the full-text screening, 17 provided effect sizes and metrics sufficient for pooling estimates through meta-analysis. The overall odds ratios and 95% confidence intervals were 1.65 (1.14; 2.39) for dioxins (n = 10), 1.70 (1.20; 2.39) for PCBs (n = 9), and 1.23 (1.13; 1.36) for OCPs (n = 5). Despite being statistically significant, these estimates should be considered with caution given the notable heterogeneity and small estimated effect size. Misclassification of exposure, due to varying laboratory detection rate capabilities, and disease status, due to varying definitions of endometriosis, were identified as major sources of uncertainty. LIMITATIONS, CONCLUSIONS, AND IMPLICATIONS OF KEY FINDINGS The level of evidence was considered to be "moderate" with "serious" risk of bias according the NTP/OHAT criteria, supporting the need for further well-designed epidemiological research to fill lingering data gaps. Given the complexity of endometriosis and lack of known biomarkers suitable for population-based research, carefully designed observational studies play an important role in better understanding the aetiology of endometriosis, as will evolving mixture modeling approaches capable of handling various environmental chemical exposures. Attention to critical windows of exposure will shed further light on the possible developmental origin of endometriosis. Considering the high economic and societal cost associated with endometriosis, further research on this field is urged. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42018080956.
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Affiliation(s)
| | - Stéphane Ploteau
- Service de gynécologie-obstétrique, CIC FEA, Hôpital Mère Enfant, CHU Hôtel Dieu, Nantes, France
| | - Komodo Matta
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307 Nantes, France
| | - Evdochia Adoamnei
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo (Murcia) and CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Germaine Buck Louis
- College of Health and Human Services, George Mason University, Fairfax, United States
| | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, IMIB-Arrixaca, 30100 Espinardo (Murcia) and CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Emile Darai
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, Sorbonne Université, Paris, France; Inserm, UMR S 938, Faculté de médecine Pierre-et Marie-Curie, Sorbonne Université, Paris, France
| | - Jean Squifflet
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Bruno Le Bizec
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307 Nantes, France
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Yen CF, Kim MR, Lee CL. Epidemiologic Factors Associated with Endometriosis in East Asia. Gynecol Minim Invasive Ther 2019; 8:4-11. [PMID: 30783582 PMCID: PMC6367920 DOI: 10.4103/gmit.gmit_83_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023] Open
Abstract
Aim With a perplexing pathogenesis and an incidence rate of approximately 10% among women of reproductive age, endometriosis affects more women in Asia than in any other continent in the world. This paper reviews the available data on the epidemiology and risk factors associated with endometriosis in East Asia. Methods Included studies were published between January 2000 and December 2016. Articles were required to include East Asian patients with a diagnosis of endometriosis and to study epidemiology, such as the prevalence and/or incidence, associated with inherited, environmental, and/or lifestyle factors. A total of 65 candidate articles were retrieved and 22 were included in the final review. Results Only one study provided an estimate of prevalence (6.8%). Short menstrual cycle, family history of endometriosis, and some genetic polymorphisms are associated with the risk of developing endometriosis. Smoking, lower body mass index, and lower parity associated with increased risk of endometriosis were suggested as modifiable factors. Limitations of this study include the poor quality of data identified, and the language barriers behind the study retrieval. Conclusions Data on the epidemiology of endometriosis in the East Asian populations are limited. The available data that examine potential genetic factors do not unveil whether such factors directly contribute to the increased risk of endometriosis. Further extensive studies on endometriosis in Asian women are required to improve the management of this disease.
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Affiliation(s)
- Chih-Feng Yen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Holdsworth-Carson SJ, Rogers PAW. The complex relationship between body mass index and endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518810586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is an inverse relationship between endometriosis and a women’s body mass index. To date, the precise mechanisms and aetiological basis linking body mass index with endometriosis remain unknown. Although an increased incidence of endometriosis is observed in women with low body mass indices; endometriosis is associated with conditions common to obesity (hypercholesterolemia, hypertension and coronary heart disease). In the context of endometriosis, further research is necessary in women with surgically confirmed disease to improve clinical advice and patient outcomes.
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Affiliation(s)
- Sarah J Holdsworth-Carson
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - Peter AW Rogers
- Department of Obstetrics and Gynaecology, The University of Melbourne and Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, VIC, Australia
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Cano-Sancho G, Labrune L, Ploteau S, Marchand P, Le Bizec B, Antignac JP. The challenging use and interpretation of circulating biomarkers of exposure to persistent organic pollutants in environmental health: Comparison of lipid adjustment approaches in a case study related to endometriosis. CHEMOSPHERE 2018; 200:388-396. [PMID: 29499519 DOI: 10.1016/j.chemosphere.2018.02.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 05/09/2023]
Abstract
The gold-standard matrix for measuring the internal levels of persistent organic pollutants (POPs) is the adipose tissue, however in epidemiological studies the use of serum is preferred due to the low cost and higher accessibility. The interpretation of serum biomarkers is tightly related to the understanding of the underlying causal structure relating the POPs, serum lipids and the disease. Considering the extended benefits of using serum biomarkers we aimed to further examine if through statistical modelling we would be able to improve the use and interpretation of serum biomarkers in the study of endometriosis. Hence, we have conducted a systematic comparison of statistical approaches commonly used to lipid-adjust the circulating biomarkers of POPs based on existing methods, using data from a pilot case-control study focused on severe deep infiltrating endometriosis. The odds ratios (ORs) obtained from unconditional regression for those models with serum biomarkers were further compared to those obtained from adipose tissue. The results of this exploratory study did not support the use of blood biomarkers as proxy estimates of POPs in adipose tissue to implement in risk models for endometriosis with the available statistical approaches to correct for lipids. The current statistical approaches commonly used to lipid-adjust circulating POPs, do not fully represent the underlying biological complexity between POPs, lipids and disease (especially those directly or indirectly affecting or affected by lipid metabolism). Hence, further investigations are warranted to improve the use and interpretation of blood biomarkers under complex scenarios of lipid dynamics.
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Affiliation(s)
- German Cano-Sancho
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307, Nantes, France.
| | - Léa Labrune
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307, Nantes, France
| | - Stéphane Ploteau
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307, Nantes, France; Service de Gynécologie-Obstétrique, CIC FEA, Hôpital Mère Enfant, CHU Hôtel Dieu, Nantes, France
| | - Philippe Marchand
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307, Nantes, France
| | - Bruno Le Bizec
- LABERCA, Oniris, INRA, Université Bretagne-Loire, 44307, Nantes, France
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