title: Association of endometriosis with body size and figure.
abstract: OBJECTIVE
  To determine whether body size and perceived figure, both current and historical, are associated with a diagnosis of endometriosis on laparoscopy.
  
  
  METHODS
  Cohort study of consecutively identified patients undergoing laparoscopy for tubal sterilization or as a diagnostic procedure.
  
  
  METHODS
  Two university-affiliated hospitals.
  
  
  METHODS
  A cohort of 84 women aged 18-40 years. Endometriosis was visualized in 32 cases; 52 women (controls) had no visualized endometriosis, including 22 undergoing tubal sterilization and 30 with other gynecologic pathology.
  
  
  METHODS
  None.
  
  
  METHODS
  Body mass index (BMI, kg/m2) from self-report and perception of body figure were compared for their ability to predict case status (diagnosed endometriosis), using logistic regression models. Longitudinal trends in BMI based on perceived figure at 5-year intervals from age 15 years were compared using mixed linear models.
  
  
  RESULTS
  Based on self-report, women diagnosed with endometriosis were taller, thinner, and had a significantly lower BMI. In this series, cases were more likely to be late maturers (menarche at > or = 14 y) and late to initiate sexual activity (> or = 21 y), and they were less likely to be gravid, parous, and a current smoker. Adjusting for age (in years), being tall (height > or = 68 in), and parity (yes vs. no), a higher current BMI was statistically protective for a diagnosis of endometriosis, regardless of whether BMI was determined by self-report (adjusted odds ratio [AOR] = 0.88, 95% confidence interval [CI] 0.79-0.99) or from perceived figure (AOR = 0.86, 95% CI 0.75-0.99). For every unit increase in BMI (kg/m2), there was an approximate 12%-14% decrease in the likelihood of being diagnosed with endometriosis. In an adjusted repeated measures model, BMI was 21.3 +/- 0.6 kg/m2 (estimate +/- SE) for women with endometriosis, compared with 23.2 +/- 0.4 kg/m2 for the controls, a difference over all ages of -1.9 +/- 0.8 kg/m2. This is a consistent difference of about 10 lb at every age, assuming an average height of about 64.5 in.
  
  
  CONCLUSIONS
  In a laparoscopy cohort, women diagnosed with endometriosis were found to have a lower BMI (leaner body habitus), both at the time of diagnosis and historically. That women diagnosed with endometriosis may have a consistently lean physique during adolescence and young adulthood lends support to the suggestion of there being an in utero or early childhood origin for endometriosis.
authors.affiliation: Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-7510, USA. hedigerm@exchange.nih.gov
authors.forename: Mary L
authors.initials: ML
authors.lastname: Hediger
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hartnett
authors.forename: Germaine M Buck
authors.initials: GM
authors.lastname: Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D049628:Body Size; D015331:Cohort Studies; D016001:Confidence Intervals; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D012189:Retrospective Studies