title: Overall Adiposity, Adipose Tissue Distribution, and Endometriosis: A Systematic Review.
abstract: BACKGROUND
  Endometriosis has been associated with a lean body habitus. However, we do not understand whether endometriosis is also associated with other characteristics of adiposity, including adipose tissue distribution and amount of visceral adipose tissue (VAT; adipose tissue lining inner organs). Having these understandings may provide insights on how endometriosis develops-some of the physiological actions of adipose tissue differ depending on tissue amount and location and are related to proposed mechanisms of endometriosis development.
  
  
  OBJECTIVE
  The aim of this study was to review the literature regarding overall adiposity, adipose tissue distribution and/or VAT, and endometriosis.
  
  
  METHODS
  We reviewed and synthesized studies indexed in PubMed and/or Web of Science. We included studies that had one or more measures of overall adiposity, adipose tissue distribution, and/or VAT and women with and without endometriosis for comparison. We summarized the findings and commented on the methods used and potential sources of bias.
  
  
  RESULTS
  Of 366 identified publications, 19 (5.2%) were eligible. Two additional publications were identified from reference lists. Current research included measures of overall adiposity (e.g., body figure drawings) or adipose tissue distribution (e.g., waist-to-hip ratio), but not VAT. The weight of evidence indicated that endometriosis was associated with low overall adiposity and with a preponderance of adipose tissue distributed below the waist (peripheral).
  
  
  CONCLUSIONS
  Endometriosis may be associated with being lean or having peripherally distributed adipose tissue. Well-designed studies with various sampling frameworks and precise measures of adiposity and endometriosis are needed to confirm associations between adiposity measures and endometriosis and delineate potential etiological mechanisms underlying endometriosis.
authors.affiliation: Uba Backonja, PhD, RN, is National Library of Medicine Biomedical Informatics Postdoctoral Fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle. Germaine M. Buck Louis, PhD, MS, is Director and Senior Investigator, Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland. Diane R. Lauver, PhD, RN, FAAN, is Professor, School of Nursing, University of Wisconsin-Madison.
authors.forename: Uba
authors.initials: U
authors.lastname: Backonja
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
authors.forename: Diane R
authors.initials: DR
authors.lastname: Lauver
mesh_terms: D050154:Adiposity; D004715:Endometriosis / Q000209:etiology*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat