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Association between obesity and the risk of uterine fibroids: a systematic review and meta-analysis
  1. Hao Qin1,2,
  2. Zhijuan Lin3,
  3. Elizabeth Vásquez4,
  4. Xiao Luan2,
  5. Feifei Guo2,
  6. Luo Xu2
  1. 1 School of Public Health, Weifang Medical University, Weifang, China
  2. 2 School of Basic Medicine, Qingdao University, Qingdao, China
  3. 3 Key Lab for Immunology in Universities of Shandong Province, School of Basic Medicine, Weifang Medical University, Weifang, China
  4. 4 School of Public Health, University at Albany, State University of New York, New York, USA
  1. Correspondence to Zhijuan Lin, School of Basic Medicine, Weifang Medical University, 7166 Baotongxi Street, Weifang 261053, China; eva1949{at} and Luo Xu, School of Basic Medicine, Qingdao University, 308 Ningxia Road, Qingdao, Shandong 266071, China; xu.luo{at}


Background Uterine fibroids (UFs) are the most common form of sex steroid hormone-dependent benign tumours that grow in the walls of the uterus. Several observational studies have examined the association between obesity and the risk of UFs, but findings are inconsistent. The objective of this systematic review and meta-analysis is to further examine the association of obesity with the risk/prevalence of UFs.

Methods A literature search was performed in three databases (PubMed, EMBASE and Web of Science) from 1 January 1992 to 30 May 2020. We used random-effect models to calculate the pooled ORs with corresponding 95% CIs. Additionally, we performed a dose–response meta-analysis to analyse the effect of body mass index (BMI), weight change since age 18, waist-to-hip ratio and waist circumference on the risk/prevalence of UFs.

Results A total of 22 articles, covering 24 studies including 325 899 participants and 19 593 cases, were selected based on our inclusion criteria. We found a positive association between obesity and the risk/prevalence of UFs (OR, 1.19; 95% CI, 1.09 to 1.29). Among participants with the highest BMI, the pooled OR was 1.19 (1.09 to 1.31) when compared to participants with normal BMI. For weight change since age 18, the pooled OR (95% CI) of UFs was 1.26 (1.12 to 1.42) among the highest change group when compared with no change. Additionally, our meta-analysis indicated the relationship of BMI with risk of UFs to be an inverse J-shaped pattern.

Conclusions The results of this meta-analysis suggest that obesity may increase the risk/prevalence of UFs, and the association is non-linear.

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  • Contributors HQ and LX conceived and designed the study. HQ, ZL and LX extracted data. HQ, FG and XL performed the data analyses. HQ, ZL and EV wrote the paper, and LX edited the manuscript. All authors reviewed the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (No.32000495, No.81470815, No.81270460 and No.81500414), the Project of Shandong Province Higher Educational Science and Technology Program (No. J18KA290) and Project Funding approved by the National Medical Degree Postgraduate Education Steering Committee (C-YX20190201-09).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.