Association of Central and General Obesity Measures With Pelvic Organ Prolapse

OBJECTIVE: To examine the association between the combination of central and general obesity measures and the risk of pelvic organ prolapse (POP). METHODS: Waist/height ratio and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) for 251,143 participants (aged 39–71 years) without pre-existing POP from the UK Biobank were collected at enrollment between 2006 and 2010. Participants were followed through December 19, 2022. Incident POP was identified using International Classification of Diseases, Tenth Revision codes and operating procedure codes in the medical records. Cox proportional hazards model was used to estimate the association between obesity measures and incident POP. Population-attributable fractions were calculated to indicate the proportion of cases that were attributable to obesity measures. RESULTS: During a median follow-up of 13.8 years, 9,781 POP cases were recorded. Central obesity (waist/height ratio 0.5 or greater) was associated with a 48% increased risk of POP regardless of BMI (hazard ratio [HR] 1.48; 95% CI, 1.41–1.56). Approximately 21.7% (95% CI, 19.1–24.4%) of all POP cases were attributable to central obesity. In addition, overweight without central obesity (BMI 25–29.9 and waist/height ratio less than 0.5) was associated with a 23% higher risk of POP (HR 1.23; 95% CI, 1.14–1.34), and this accounted for 2.0% (95% CI, 1.1–2.9%) of all POP cases. The magnitude of increased POP risk associated with central obesity varied by age (younger than 60 years vs 60 years or older: 57% vs 39%) and by history of hysterectomy (no vs yes: 54% vs 27%). CONCLUSION: Central obesity and overweight without central obesity are risk factors for POP.