{"paper_id":"35bb56c0-3d4e-4dfc-8334-661c2a2df866","body_text":"Abstract\nBackground\nPrevious studies have suggested the close link between endometriosis and body size index. However, there are inconsistent associations between central, general, and visceral adiposity index and endometriosis. This study aimed to evaluate and compare trend of general, central, and visceral adiposity indices in women with and without endometriosis using longitudinal population-based data.\nMethods\nWe analyzed data from 3159 premenopausal women aged 20–45 years with defined status of endometriosis who participated in the TLGS from phases 3 to 7. The interval between phases was 3 years. Adiposity indices including general (body mass index), abdominal (waist circumference, waist-to-hip ratio, waist-to-height ratio) and visceral (lipid accumulation product, a body shape index, body roundness index, and visceral adiposity index) were evaluated. Generalized Estimating Equations were used to examine longitudinal trends and associations of endometriosis status with adiposity indices, adjusting for age, parity, smoking, education, and physical activity.\nResults\nAmong the participants, 421 women (13.3%) had diagnosed endometriosis. All adiposity indices showed significant increasing trends over time in both groups. Endometriosis status was not significantly associated with general or central adiposity indices. However, among visceral adiposity measures, the visceral adiposity index was consistently higher in women with endometriosis (adjusted difference: 0.56; 95% CI: 0.10–1.03; p = 0.016), indicating greater visceral fat accumulation.\nConclusions\nThis study is the first to use longitudinal population-based data to simultaneously evaluate general, central, and visceral adiposity indices in women with endometriosis. Findings indicate that visceral adiposity, rather than general or central obesity, may represent a metabolically relevant phenotype.\nSimilar content being viewed by others\nReferences\nGiudice LC, Kao LC (2004) Endometr lancet 364:1789–1799. https://doi.org/10.1016/S0140-6736(04)17403-5\nParasar P, Ozcan P, Terry KL (2017) Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 6:34–41. https://doi.org/10.1007/s13669-017-0187-1\nZhang Y, Ma NY (2021) Environmental risk factors for endometriosis: an umbrella review of a meta-analysis of 354 observational studies with over 5 million populations. Front Med 8:680833. https://doi.org/10.3389/fmed.2021.680833\nOttolina J, Schimberni M, Makieva S, Bartiromo L, Fazia T, Bernardinelli L, Vigano P, Candiani M, Gentilini D (2020) Early-life factors, in-utero exposures and endometriosis risk: a meta-analysis. Reprod biomed online 41:279–289. https://doi.org/10.1016/j.rbmo.2020.04.005\nNnoaham KE, Webster P, Kumbang J, Kennedy SH, Zondervan KT (2012) Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies. Fertil steril 98:702–712. https://doi.org/10.1016/j.fertnstert.2012.05.035\nTreloar SA, O’Connor T, O’Connor D, Martin VM NG (1999) Genetic influences on endometriosis in an Australian twin sample. Fertil steril 71:701–710. https://doi.org/10.1016/s0015-0282(98)00540-8\nKershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2548–2556. https://doi.org/10.1210/jc.2004-0395\nKuryłowicz A (2023) Estrogens in adipose tissue physiology and obesity-related dysfunction. Biomedicines 11:690. https://doi.org/10.3390/biomedicines11030690\nGrant RW, Dixit VD (2015) Adipose tissue as an immunological organ. Obes 23:512–518. https://doi.org/10.1002/oby.21003\nWang Q, Li H, Huan Y, Zhou T, Zhang J, Fang R, Sun Y, Xu AL W (2025) Adipose tissue: an inflammatory organ that can not be ignored in periodontal disease related to obesity. Front Immunol 16:1698207. https://doi.org/10.3389/fimmu.2025.1698207\nPatel BG, Lenk EE, Lebovic DI, Shu Y, Yu J, Taylor RN (2018) Pathogenesis of endometriosis: Interaction between Endocrine and inflammatory pathways. Best Pract Res Clin Obstet Gynaecol 50:50–60. https://doi.org/10.1016/j.bpobgyn.2018.01.006\nAhn SH, Monsanto SP, Miller C, Singh SS, Thomas R, Tayade C (2015) Pathophysiology and immune dysfunction in endometriosis. Biomed Res Int. 2015: 795976. https://doi.org/10.1155/2015/795976\nHong J, Yi KW (2022) What is the link between endometriosis and adiposity? OGS 65:227–233. https://doi.org/10.5468/ogs.21343\nYong L, Weiyuan Z (2017) Association between body mass index and endometriosis risk: a meta-analysis. Oncotarget 8:46928. https://doi.org/10.18632/oncotarget.14916\nAzizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, Mehrabi Y, Zahedi-Asl S, Tehran Lipid and Glucose Study Group azizi@ endocrine (2009). ac. ir. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials. 10: 5. https://doi.org/10.1186/1745-6215-10-5\nBe A (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S504. https://doi.org/10.1097/00005768-200009001-00009\nKriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, Bennett PH, Kuller LH (1990) Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 13:401–411. https://doi.org/10.2337/diacare.13.4.401\nAzizi F, Khalili D, Aghajani H, Esteghamati A, Hosseinpanah F, Delavari A, Larijani B, Kelishadi R, Hadaegh F (2010) Appropriate waist circumference cut-off points among Iranian adults: the first report of the Iranian National Committee of Obesity. Arch Iran med 13:243\nZafari N, Lotfaliany M, Mansournia MA, Khalili D, Azizi F, Hadaegh F (2018) Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes: results of a cohort study. BMC Public Health 18:691. https://doi.org/10.1186/s12889-018-5611-6\nKahn HS (2005) The lipid accumulation product performs better than the body mass index for recognizing cardiovascular risk: a population-based comparison. BMC Cardiovasc Disord 5:26. https://doi.org/10.1186/1471-2261-5-26\nBehboudi-Gandevani S, Tehrani FR, Cheraghi L, Azizi F (2016) Could a body shape index and waist to height ratio predict insulin resistance and metabolic syndrome in polycystic ovary syndrome? Eur J Obstet Gynecol Reprod Biol 205:110–114. https://doi.org/10.1016/j.ejogrb.2016.08.011\nValdez R (1991) A simple model-based index of abdominal adiposity. J Clin Epidemiol 44:955–956. https://doi.org/10.1016/0895-4356(91)90059-i\nThomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson CM, Ravussin E, Heymsfield SB (2013) Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obes 21:2264–2271. https://doi.org/10.1002/oby.20408\nAranaz P, Navarro-Herrera D, Zabala M, Miguéliz I, Romo-Hualde A, López-Yoldi M (2013) American Diabetes Association 2010. Diagnosis and classification of diabetes mellitus. Diabetes Care 33:S62–69. https://doi.org/10.2337/dc13-S067\nBehboudi-Gandevani S, Tehrani FR, Cheraghi L, Noroozzadeh M, Farahmand M, Azizi F (2017) Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002–2011. SRH 12:116–122. https://doi.org/10.1016/j.srhc.2017.04.003\nTehrani FR, Behboudi-Gandevani S, Dovom MR, Farahmand M, Minooee S, Noroozzadeh M, Amiri M, Nazarpour S, Azizi F (2018) Reproductive assessment: findings from 20 years of the Tehran lipid and glucose study. IJEM 16:e84786. https://doi.org/10.5812/ijem.84786\nShafrir AL, Wise LA, Palmer JR, Shuaib ZO, Katuska LM, Vinayak P, Kvaskoff M, Terry KL, Missmer SA (2021) Validity of self-reported endometriosis: a comparison across four cohorts. Hum Reprod 36:1268–1278. https://doi.org/10.1093/humrep/deab012\nPantelis A, Machairiotis N, Lapatsanis DP (2021) The formidable yet unresolved interplay between endometriosis and obesity. Sci World J. 2021: 6653677. https://doi.org/10.1155/2021/6653677\nRahman MS, Park Y, Hosseinirad H, Shin JH, Jeong JW (2025) The interplay between endometriosis and obesity. https://doi.org/10.1016/j.tem.2025.03.011. TEM\nTang B, Zhao Y, Lin M, Gao L, Chen Y, Chen GQ, Chen S Q (2020) Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China? BMJ open 10:e037095. https://doi.org/10.1136/bmjopen-2020-037095\nPiriyev E, Mennicken C, Schiermeier S, Römer T (2025) Does BMI Have an Impact on Endometriosis Symptoms and Endometriosis Types According to the# ENZIAN Classification? J Clin Med 14:4040. https://doi.org/10.3390/jcm14124040\nBell JA, Carslake D, O’Keeffe LM, Frysz M, Howe LD, Hamer M, Wade KH, Timpson NJ, Davey Smith G (2018) Associations of body mass and fat indexes with cardiometabolic traits. J Am Coll Cardiol 72:3142–3154. https://doi.org/10.1016/j.jacc.2018.09.066\nShah DK, Correia KF, Vitonis AF, Missmer SA (2013) Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum Reprod 28:1783–1792. https://doi.org/10.1093/humrep/det120\nRossi HR, Nedelec R, Jarvelin MR, Sebert S, Uimari O, Piltonen TT (2021) Body size during adulthood, but not in childhood, associates with endometriosis, specifically in the peritoneal subtype—population-based life‐course data from birth to late fertile age. AOGS 100:1248–1257. https://doi.org/10.1111/aogs.14090\nShuster A, Patlas M, Pinthus JH, Mourtzakis M (2012) The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. BJR 85:1–10. https://doi.org/10.1259/bjr/38447238\nZhang J, Zhang Q, Chu T, Chen X, Zhou H, Xu D, Dong C, Wu Y (2025) Association between visceral adiposity index and endometriosis: a population-based study. Front nutr 12:1602288. https://doi.org/10.3389/fnut.2025.1602288eCollection 2025\nAmato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A, AlkaMeSy Study Group (2010) Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 33:920–922. https://doi.org/10.2337/dc09-1825\nZhang M, Xu T, Tong D, Li S, Yu X, Liu B, Jiang L, Liu K (2023) Research advances in endometriosis-related signaling pathways: a review. Biomed Pharmacother 164:114909. https://doi.org/10.1016/j.biopha.2023.114909\nWang Z, Zhan C, Liao L, Luo Y, Lin S, Yan S (2024) Bidirectional causality between the levels of blood lipids and endometriosis: a two-sample mendelian randomization study. BMC Womens Health 24:387. https://doi.org/10.1186/s12905-024-03213-w\nKrasnyi AM, Sadekova AA, Smolnova TY, Chursin VV, Buralkina NA, Chuprynin VD, Yarotskaya E, Pavlovich SV, Sukhikh GT (2022) The levels of ghrelin, glucagon, visfatin and glp-1 are decreased in the peritoneal fluid of women with endometriosis along with the increased expression of the CD10 protease by the macrophages. Int J Mol Sci 23:10361. https://doi.org/10.3390/ijms231810361\nAmato MC, Giordano C (2014) Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol 201:730827. https://doi.org/10.1155/2014/730827\nPeng D, Zhong W, Wang Y, Fu Y, Shang W (2024) The relationship between blood lipids and endometriosis: a cross-sectional study from NHANES (1999–2006) and a bidirectional Mendelian randomization study. J Psychosom Obstet Gynaecol 45:2441196. https://doi.org/10.1080/0167482X.2024.2441196\nBurton NW, Brown W, Dobson A (2010) Accuracy of body mass index estimated from self-reported height and weight in mid‐aged Australian women. ANZJPH 34:620–623. https://doi.org/10.1111/j.1753-6405.2010.00618.x\nZondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Vigano P (2018) Endometriosis. Nature reviews. Dis Primers 4:9. https://doi.org/10.1111/j.1753-6405.2010.00618.x\nRowlands IJ, Abbott JA, Montgomery GW, Hockey R, Rogers P, Mishra GD (2021) Prevalence and incidence of endometriosis in Australian women: a data linkage cohort study. BJOG 128:657–665. https://doi.org/10.1111/1471-0528.16447\nLake JK, Power C, Cole TJ (1997) Women’s reproductive health: the role of body mass index in early and adult life. IJO 21:432–438. https://doi.org/10.1038/sj.ijo.0800424\nHamdy O, Porramatikul S, Al-Ozairi E (2006) Metabolic obesity: the paradox between visceral and subcutaneous fat. Curr Diabetes Rev 2:367–373. https://doi.org/10.1016/j.arcmed.2024.103064\nGalvez-Sánchez CM, Camacho-Ruiz JA, Contreras-Merino AM, Limiñana-Gras RM (2026) Women with Endometriosis: A Narrative Review of Adiposity and Metabolic Function from a Biopsychosocial and Intersectional Perspective. Women 6:12. https://doi.org/10.3390/women6010012\nAbobeleira JP, Neto AC, Mauersberger J, Salazar M, Botelho M, Fernandes AS, Martinho M, Serrão MP, Rodrigues AR, Almeida H, Gouveia AM (2024) Evidence of browning and inflammation features in visceral adipose tissue of women with endometriosis. Arch Med Res 55:103064. https://doi.org/10.1016/j.arcmed.2024.103064\nFunding\nThis study funded by the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Grant number: 43016364).\nAuthor information\nAuthors and Affiliations\nContributions\nM.F.A. contributed substantially to the conception and design, interpretation of data, drafted the article and revised and approved the final version to be published. M.S.G.N. contributed substantially to interpretation of data, drafted the article and revised and approved the final version to be published. M.M. contributed substantially to analysis data, drafted the article, and revised and approved the final version to be published. P.P. contributed substantially to the draft of the article and revised and approved the final version to be published. F.A. contributed substantially to conception and design, revised and approved the final version to be published. F.R.T contributed substantially to conception and design, interpretation of data, drafting the article, and revising and approving the final version to be published.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare that there are no conflicts of interest.\nEthical approval\nThe ethics review board of the Research Institute for Endocrine Sciences approved the study proposal (approval number: IR.SBMU.ENDOCRINE.REC.1404.058).\nConsent to participate\nWritten informed consent was signed by all participants after a full explanation of the purpose of the study to them. Written consent was obtained from their parents if they were under 18 years old.\nConsent for publication\nAll authors approved the final version of the article for publication.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nFarhadi-Azar, M., Saei Ghare Naz, M., Mousavi, M. et al. Longitudinal trends in general, central, and visceral adiposity indices among women with endometriosis: a population-based study. J Endocrinol Invest (2026). https://doi.org/10.1007/s40618-026-02993-2\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s40618-026-02993-2","source_license":"public-domain-us","license_restricted":false}