title: Excessive adiposity, metabolic health, and risks for genital human papillomavirus infection in adult women: a population-based cross-sectional study.
abstract: BACKGROUND
  The role of excessive adiposity or its metabolic consequences in persistent HPV infection among general adult women remains unknown.
  
  
  METHODS
  Using data from the National Health and Nutrition Examination Survey (NHANES) in 2003-2010, we compared adult women's likelihood for any- or high-risk (HR) type HPV infection by degrees of excessive adiposity and metabolic health status.
  
  
  RESULTS
  Any-type (41.1 % vs. 44.9 %, P = 0.045) or HR-type HPV prevalence (21.9 % vs. 25.4 %, P = 0.055) was comparable in women aged 20-59 years with or without central obesity. After adjusting for age, socioeconomic indicators, and lifetime sexual risks, centrally-obese women barely showed a different likelihood for any-type (aPR [adjusted prevalence ratio] = 0.91, P = 0.03) or HR-HPV infection (aPR = 0.92, P = 0.279). However, obesity (aPR = 0.76, P = 0.017) or centrally-obesity (aPR = 0.72, P = 0.003) was negatively correlated with HR-HPV infection in women reporting an early sex debut (<16 years; P for interaction <0.05). In the fasting subpopulation, obesity (aPR = 0.77, P = 0.016) or metabolically unhealthy obesity (aPR = 0.69, P = 0.018) was significantly correlated with a 23 % or 31 % reduced prevalence of HR-HPV infection.
  
  
  CONCLUSIONS
  In contrary to findings for the general population, HR-HPV prevalence was decreased in a subgroup of women with obesity or central obesity. Possible explanations for such heterogeneity included less risky sexual behaviors, an altered immune milieu that promoted viral clearance, and increased access to healthcare resources due to other obesity-related co-morbidities in this subpopulation.
  
  
  CONCLUSIONS
  Obesity or central obesity was not significantly associated with prevalent any-type or HR-type HPV infection among adult women in general. However, in certain subpopulations, excessive adiposity or its relevant metabolic dysfunction was negatively associated with HR-HPV infection.
authors.affiliation: College of Medicine, Chang Gung University, Wen Hwa 1st Rd., Gueishan District, Taoyuan City, 333 Taiwan ; Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, 5 Fuhsin Street, Gueishan District, Taoyuan City, 333 Taiwan.
authors.forename: Su-Hsun
authors.initials: SH
authors.lastname: Liu
authors.affiliation: Department of Public Health, School of Medicine, National Yang Ming University, No.155, Sec.2, Li Nong Street, Taipei, 112 Taiwan.
authors.forename: Hsin-Jen
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, 5 Fuhsin Street, Gueishan District, Taoyuan City, 333 Taiwan.
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Hsieh
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, 5 Fuhsin Street, Gueishan District, Taoyuan City, 333 Taiwan.
authors.forename: Jih-Chang
authors.initials: JC
authors.lastname: Chen
authors.affiliation: College of Medicine, Chang Gung University, Wen Hwa 1st Rd., Gueishan District, Taoyuan City, 333 Taiwan ; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, 5 Fuhsin Street, Gueishan District, Taoyuan City, 333 Taiwan.
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
keywords: Cervical cancer; Human papillomavirus infection; Metabolic health; Obesity