Association between obesity and bacterial vaginosis as assessed by Nugent score

Abstract

BACKGROUND: Bacterial vaginosis is 1 of the most common vaginal conditions in the United States. Recent studies have suggested that obese women have an abnormal microbiota reminiscent of bacterial vaginosis; however, few studies have investigated the prevalence of bacterial vaginosis in overweight and obese populations. Moreover, despite the increased prevalence of obesity and bacterial vaginosis in black women, it is not known whether racial disparities exist in the relationship between obesity and bacterial vaginosis. OBJECTIVE: The objective of this study was to examine the relationship between body mass index and bacterial vaginosis as determined by Nugent score and to determine the influence of race in this context. STUDY DESIGN: We performed a cross-sectional study using patient data and vaginal smears from 5918 participants of the Contraceptive CHOICE Project. Gram-stained vaginal smears were scored with the Nugent method and categorized as bacterial vaginosisenegative (Nugent score, 0e3), bacterial vaginosiseintermediate (Nugent score, 4e6), or bacterial vaginosisepositive (Nugent score, 7e10). Body mass index was determined with Centers for Disease Control and Prevention guidelines, and obese individuals were categorized as class I, II, or III obese based on National Institutes of Health and World Health Organization body mass index parameters. Linear regression was used to model mean differences in Nugent scores; Poisson regression with robust error variance was used to model prevalence of bacterial vaginosis. RESULTS: In our cohort, 50.7% of participants were black; 41.5% were white, and 5.1% were of Hispanic ethnicity; the average age of 25.3 years old. Overall, 28.1% of participants were bacterial vaginosisepositive. Bacterial vaginosis was prevalent in 21.3% of lean, 30.4% of overweight, and 34.5% of obese women (P<.001). The distribution of bacterial vaginosiseintermediate individuals was similar across all body mass index categories. Compared with the scores of lean women, Nugent scores were highest among overweight and obese class I women (adjusted mean difference: overweight women, 0.33 [95% confidence interval, 0.14e0.51] and obese women, 0.51 [95% confidence interval, 0.29e0.72]). Consistent with this, overweight and obese women had a higher frequency of bacterial vaginosis compared with lean women, even after adjustment for variables that included race. Among white women, the prevalence of bacterial vaginosis was higher for overweight and class I and class II/III obese white women compared with lean white women, which is a phenomenon not observed among black women and suggests an effect modification. CONCLUSION: Overweight and obese women have higher Nugent scores and a greater occurrence of bacterial vaginosis compared with lean women. Black women have a greater prevalence of bacterial vaginosis independent of their body mass index compared with white women.

Effects of Synbiotic Supplement on Human Gut Microbiota, Body Composition and Weight Loss in Obesity

“…In addition to this observation, further modulation of the gut microbiota was observed, for example, Prevotella and Gardnerella genera were significantly decreased after the synbiotic intervention (see Figure 2). Previous studies have reported that these genera are associated with chronic inflammatory conditions and positively correlated with obesity [40][41][42]. Therefore, the reduction in these genera could help to modulate the balance to improve metabolism within the host.…”

Daily Vaginal Microbiota Fluctuations Associated with Natural Hormonal Cycle, Contraceptives, Diet, and Exercise

“…These results reveal the possibility that long-term diet and energy metabolism influence the vaginal microbiome. In support, studies reveal that obesity and diets with high fat, high glycemic load/energy density, and low vitamins A, C, and E and ␤-carotene are associated with increased risk of bacterial vaginosis (63)(64)(65)(66). One proposed explanation for why humans are the only mammals with Lactobacillus dominance is that the high starch content of human diets leads to high levels of glycogen in the vaginal tract, creating a suitable environment for Lactobacillus (67).…”

Structure and regulation of the cervicovaginal microbiome in a cohort of Afro-Caribbean women

“…Therefore, any factors (such as age, obesity/ body mass index (BMI) and ethnicity) that influence oestrogen levels should not have any significant impact on the OAS. Hence, as predicted, in contrast to white women no correlations have been demonstrated to date between oestrogen levels, body mass index (BMI) and the cervicovaginal microbiome in black women [86,87] even though they possess higher levels of oestrogen compared to Caucasians [88]. Refer to supplementary Figure S1 for additional analyses.…”