Abstract
Introduction and hypothesis
Data regarding possible associations between metabolic syndrome (MS) and pelvic organ prolapse (POP) are scarce. The primary hypothesis was that the prevalence of MS and its components was higher in postmenopausal women with POP than in age-matched women without POP staged with the Pelvic Organ Prolapse Quantification system (POP-Q). The secondary aim of the study was to analyze the association between MS and its components with POP severity.
Methods
Presence of MS and its components [elevated triglycerides (TG), waist circumference, blood pressure, and fasting glucose (FG) and decreased high-density lipoprotein cholesterol (HDL-C)] were assessed in 122 women with POP (POP-Q stage I–IV) and 77 without (POP-Q 0). Fasting insulin resistance [homeostasis model assessment for fasting insulin resistance (HOMA-IR)] was also assessed.
Results
TG levels, FG, and HOMA index were significantly higher in POP-Q stage I–IV compared with POP-Q 0 (p = 0.04, p = 0.0005 and p = 0.04); HDL-C was significantly reduced in POP-Q stage I-IV compared with POP-Q 0 (p = 0.0003). TG levels (p = 0.0315) were significantly higher in POP-Q stage III and IV vs. POP-Q 0; FG and HOMA-IR (p = 0.0015 and p = 0.0204) were significantly higher in POP-Q stage IV vs. POP-Q 0; HDL-C (p = 0.0047) was significantly lower in all stages vs. POP-Q 0. The prevalence of MS was different between groups (p = 0.04) and higher in POP-Q IV. Elevated TG [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.5–9.3, p = 0.004] and reduced HDL-C (OR 2.0, 95% CI 1.1–3.7, p = 0.0241) significantly increased the risk of POP-Q stage ≥III.
Conclusions
MS and its components may be associated with POP. Elevated TG and reduced HDL-C are associated with POP severity.
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References
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.
Smith FJ, Holman CDJ, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.
Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277–85.
Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the women’s health initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.
Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305.
Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.
Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.
Delancey JOL, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610.e1–5.
Brown JS, Vittinghoff E, Lin F, Nyberg LM, Kusek JW, Kanaya AM. Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Diabetes Care. 2006;29(6):1307–12.
Danforth KN, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Type 2 diabetes mellitus and risk of stress, urge and mixed urinary incontinence. J Urol. 2009;181(1):193–7.
Ponholzer A, Temml C, Wehrberger C, Marszalek M, Madersbacher S. The association between vascular risk factors and lower urinary tract symptoms in both sexes. Eur Urol. 2006;50(3):581–6.
Kim YH, Kim JJ, Kim SM, Choi Y, Jeon MJ. Association between metabolic syndrome and pelvic floor dysfunction in middle-aged to older Korean women. Am J Obstet Gynecol. 2011;205(1):71.e1–8.
Rogowski A, Bienkowski P, Tarwacki D, Dziech E, Samochowiec J, Jerzak M, et al. Association between metabolic syndrome and pelvic organ prolapse severity. Int Urogynecol J. 2015;26(4):563–8.
Tocci G, Ferrucci A, Bruno G, Mannarino E, Nati G, Trimarco B, et al. Prevalence of metabolic syndrome in the clinical practice of general medicine in Italy. Cardiovasc Diagn Ther. 2015;5(4):271–9.
NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Bethesda (MD): National heart, lung, and blood Institute; 1998. Sep. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2003/. Accessed 6 Nov 2018.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953–2041.
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.
Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J. 2018;29(5):647–66.
Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.
Shalom DF, Lin SN, St Louis S, Winkler HA. Effect of age, body mass index, and parity on pelvic organ prolapse quantification system measurements in women with symptomatic pelvic organ prolapse. J Obstet Gynaecol Res. 2012;38(2):415–9.
Washington BB, Erekson EA, Kassis NC, Myers DL. The association between obesity and stage II or greater prolapse. Am J Obstet Gynecol. 2010;202(5):503.e1–4.
Young N, Atan IK, Rojas RG, Dietz HP. Obesity: how much does it matter for female pelvic organ prolapse? Int Urogynecol J. 2018;29(8):1129–34.
Cӑtoi AF, Pârvu AE, Andreicuț AD, Mironiuc A, Crӑciun A, Cӑtoi C, et al. Metabolically healthy versus unhealthy morbidly obese: chronic inflammation, nitro-oxidative stress, and insulin resistance. Nutrients. 2018;1:10(9).
Lucero D, López GI, Gorzalczany S, Duarte M, González Ballerga E, Sordá J, et al. Alterations in triglyceride rich lipoproteins are related to endothelial dysfunction in metabolic syndrome. Clin Biochem. 2016;49(12):932–5.
Tilley BJ, Cook JL, Docking SI, Gaida JE. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review. Br J Sports Med. 2015;49(23):1504–9.
Collins KH, Herzog W, MacDonald GZ, Reimer RA, Rios JL, Smith IC, et al. Obesity, metabolic syndrome, and musculoskeletal disease: common inflammatory pathways suggest a central role for loss of muscle integrity. Front Physiol [Internet]. 2018 Feb 23 [cited 2018 Jul 12];9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829464/.
Rosenson RS, Davidson MH, Hirsh BJ, Kathiresan S, Gaudet D. Genetics and causality of triglyceride-rich lipoproteins in atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2014;64(23):2525–40.
Grygiel-Górniak B, Ziółkowska-Suchanek I, Kaczmarek E, Mosor M, Nowak J, Puszczewicz M. PPARgamma-2 and ADRB3 polymorphisms in connective tissue diseases and lipid disorders. Clin Interv Aging. 2018;13:463–72.
Isık H, Aynıoglu O, Sahbaz A, Selimoglu R, Timur H, Harma M. Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? Eur J Obstet Gynecol Reprod Biol. 2016;197:59–62.
Baldassarre M, Alvisi S, Berra M, Martelli V, Farina A, Righi A, et al. Changes in vaginal physiology of menopausal women with type 2 diabetes. J Sex Med. 2015;12(6):1346–55.
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Summary
Metabolic syndrome and its components may be associated with pelvic organ prolapse and increasing pelvic organ prolapse severity.
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Gava, G., Alvisi, S., Mancini, I. et al. Prevalence of metabolic syndrome and its components in women with and without pelvic organ prolapse and its association with prolapse severity according to the Pelvic Organ Prolapse Quantification system. Int Urogynecol J 30, 1911–1917 (2019). https://doi.org/10.1007/s00192-018-3840-y
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DOI: https://doi.org/10.1007/s00192-018-3840-y