Lipedema prevalence and risk factors in Brazil

Amato, Alexandre Campos Moraes; Amato, Fernando Campos Moraes; Amato, Juliana Lelis Spirandeli; Benitti, Daniel Augusto

doi:10.1590/1677-5449.202101981

person Alexandre Campos Moraes Amato

schoolAmato, Instituto de Medicina Avançada, São Paulo, SP, Brasil.

0000-0003-4008-4029

person Fernando Campos Moraes Amato

schoolAmato, Instituto de Medicina Avançada, São Paulo, SP, Brasil.

0000-0001-7068-0820

person Juliana Lelis Spirandeli Amato

schoolAmato, Instituto de Medicina Avançada, São Paulo, SP, Brasil.

0000-0001-5744-476X

person Daniel Augusto Benitti

schoolValens Medical Center, Campinas, SP, Brasil.

0000-0002-3295-1236

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Alexandre Campos Moraes Amato Av. Brasil, 2283 - Jardim América CEP 01431-001 - São Paulo (SP), Brasil Tel.: +55 (11) 99981-2588 E-mail:
dr.alexandre@amato.com.br

Author information ACMA - PhD in Ciências, Universidade de São Paulo (USP); Full member, Sociedade Brasileira de Angiologia e Cirurgia Vascular; Board certified in Cirurgia Vascular e Endovascular, Sociedade Brasileira de Angiologia e Cirurgia Vascular; Board certified in Eco-Doppler Vascular, Colégio Brasileiro de Radiologia. FCMA - MSc in Ciências, Universidade Federal de São Paulo (UNIFESP); Plastic surgeon. JLSA - Gynecologist and obstetrician, Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). DAB - Vascular surgeon; Chief, Departamento de Cirurgia Vascular e Endovascular, Valens Medical Center.

Author contributions Conception and design: ACMA, DAB Analysis and interpretation: ACMA, DAB Data collection: ACMA, DAB, FCMA, JLSA Writing the article: ACMA, DAB Critical revision of the article: ACMA, DAB, FCMA, JLSA Final approval of the article*: ACMA, DAB, FCMA, JLSA Statistical analysis: ACMA Overall responsibility: ACMA *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

Cutoff point	Probability of diagnosis of lipedema	95% confidence interval	Sensitivity	Specificity	Prevalence in the study population
5	21.9%	12.7-35.2%	1	0.593	51.0% (129)
6	28.7%	18.4-41.8%	0.94	0.644	42.3% (107)
7	36.6%	25.5-49.4%	0.9	0.695	37.2% (94)
8	45.3%	33.6-57.6%	0.88	0.729	30.4% (77)
9	54.3%	42.0-66.1%	0.78	0.780	24.9% (63)
10	63.0%	50.1-74.3%	0.66	0.831	19.4% (49)
11	71.0%	57.5-81.5%	0.58	0.831	15.0% (38)
12	77.8%	64.2-87.3%	0.46	0.880	12.3% (31)
13	83.4%	70.1-91.5%	0.38	0.949	7.9% (20)
14	87.8%	75.2-94.5%	0.26	0.966	4.7% (12)
15	91.2%	79.6-96.5%	0.18	0.966	4.7% (12)
16	93.7%	83.3-97.8%	0.06	0.983	3.2% (8)
17	95.5%	86.4-98.6%	0.04	1.000	2.4% (6)

	Value	Lower limit	Upper limit
Sensitivity	0.460	0.318	0.607
Specificity	0.881	0.771	0.951
Positive predictive value	0.767	0.598	0.856
Negative predictive value	0.658	0.513	0.834
Positive likelihood ratio	3.877	1.818	8.270
Negative likelihood ratio	0.613	0.467	0.805

Patient characteristics	Study population	2021 census projection
Volunteers	253	212,854,215
Educational level²¹
Secondary education, incomplete	2.4% (6)	6.7%
Secondary education, complete	29.2% (74)	25.1%
Primary education	4.0% (10)	8.0%
Technical college	7.5% (19)	-
Higher education, incomplete	11.5% (29)	4.8%
Higher education, complete	28.5% (72)	14.7%
Post-graduation	16.6% (42)	-

	Volunteers with diagnostic criterion for lipedema	Volunteers without diagnostic criterion for lipedema	All volunteers	Correlation with lipedema diagnosis
Age	38.419 years (± 11.05)	38.072 years (± 12.6)	38.115 years (± 12.4)	Kolmorov-Smirnov
				distribution equivalent, p = 0.696
				OR 0.951, SE 0.005
BMI	27.000 kg/cm² (31)	26.920 kg/cm² (222)	26.937 kg/cm² (253)	Kolmorov-Smirnov
				distribution equivalent, p = 0.193
				OR 0.93, SE 0.007
Underweight	-	1.3% (3)	1.2% (3)	Independent (z score, p = 0.515)
Underweight	-	1.3% (3)	1.2% (3)	OR 1, SE 0
Normal weight	32.3% (10)	43.2% (96)	41.9% (106)	Independent (z score, p = 0.246)
Normal weight	32.3% (10)	43.2% (96)	41.9% (106)	OR 0.104, SE 0.035
Overweight	41.9% (13)	32.4% (72)	33.6% (85)	Independent (z score, p = 0.294)
Overweight	41.9% (13)	32.4% (72)	33.6% (85)	0.181, SE 0.054
Obesity I	22.6% (7)	13.5% (30)	14.6% (37)	Independent (z score, p = 0.181)
Obesity I	22.6% (7)	13.5% (30)	14.6% (37)	OR 0.233, SE 0.098
Obesity II	3.2% (1)	5.4% (12)	5.1% (13)	Independent (z score, p = 0.607)
Obesity II	3.2% (1)	5.4% (12)	5.1% (13)	OR 0.083, SE 0.087
Obesity III	-	4.1% (9)	3.6% (9)	Independent (z score, p = 0.2540
Obesity III	-	4.1% (9)	3.6% (9)	OR 0, SE 1,525E-9

	Volunteers with diagnostic criterion for lipedema	Volunteers without diagnostic criterion for lipedema	All volunteers	Correlation with lipedema diagnosis
Arterial hypertension	41.90% (13)	21.60% (48)	24.10% (61)	Not independent (z score, p = 0.013), positive correlation (Spearman)
Arterial hypertension	41.90% (13)	21.60% (48)	24.10% (61)	OR 0.271, SE 0.085
Hypothyroidism	19.40% (6)	10.36% (23)	11.50% (29)	Independent (z score, p = 0.141)
Hypothyroidism	19.40% (6)	10.36% (23)	11.50% (29)	OR 0.126, SE 0.027
Varicose veins and venous insufficiency	35.50% (11)	20.27% (45)	22.10% (56)	Independent (z score, p = 0.056)
Varicose veins and venous insufficiency	35.50% (11)	20.27% (45)	22.10% (56)	OR 0.244, SE 0.082
Depression	38.70% (12)	20.70% (46)	22.90% (58)	Not independent (z score, p = 0.026), positive correlation (Spearman)
Depression	38.70% (12)	20.70% (46)	22.90% (58)	OR 0.108, SE 0.026
Anxiety	61.30% (19)	41.80% (93)	44.30% (112)	Not independent (z score, p = 0.042), positive correlation (Spearman)
Anxiety	61.30% (19)	41.80% (93)	44.30% (112)	OR 0.093, SE 0.028
Changed bowel movements	29.00% (9)	15.70% (35)	17.40% (44)	Independent (z score, p = 0.068)
Changed bowel movements	29.00% (9)	15.70% (35)	17.40% (44)	OR 0.118, SE 0.027
Knee problems/knee disease	22.60% (7)	13.50% (30)	14.60% (37)	Independent (z score, p = 0.181)
Knee problems/knee disease	22.60% (7)	13.50% (30)	14.60% (37)	OR 0.233, SE 0.098
Hypercholesterolemia	19.40% (6)	19.80% (44)	19.80% (50)	Independent (z score, p = 0.951)
Hypercholesterolemia	19.40% (6)	19.80% (44)	19.80% (50)	OR 0.14, SE 0.03
Lymphedema	3.20% (1)	0.45% (1)	0.80% (2)	Independent (z score, p = 0.102)
Lymphedema	3.20% (1)	0.45% (1)	0.80% (2)	OR 0.136, SE 0.026
Anemia	41.90% (13)	17.50% (39)	20.60% (52)	Not independent (z score, p = 0.002), positive correlation (Spearman)
Anemia	41.90% (13)	17.50% (39)	20.60% (52)	OR 0.098, SE 0.0240
Leg pain	90.30% (28)	42.70% (95)	48.60% (123)	Not independent (z score, p < 0.001), positive correlation (Spearman)
				OR 0.295, SE 0.063

“Water retention” in legs	64.50% (20)	19.80% (44)	25.30% (64)	Not independent (z score, p < 0.001), positive correlation (Spearman)
“Water retention” in legs	64.50% (20)	19.80% (44)	25.30% (64)	OR 0.455, SE 0.123
Sensitivity to touch	35.50% (11)	5.90% (13)	9.50% (24)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Sensitivity to touch	35.50% (11)	5.90% (13)	9.50% (24)	OR 0.846, SE 0.347
Swollen legs	51.60% (16)	7.60% (17)	13.00% (33)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Swollen legs	51.60% (16)	7.60% (17)	13.00% (33)	OR 0.073, SE 0.0200
Frequent bruising of the legs	54.80% (17)	16.60% (37)	21.30% (54)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Frequent bruising of the legs	54.80% (17)	16.60% (37)	21.30% (54)	OR 0.459, SD 0.135
Joint hypermobility	9.70% (3)	0.45% (1)	1.60% (4)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Joint hypermobility	9.70% (3)	0.45% (1)	1.60% (4)	OR 0.127, SD 0.025
Knee pain	58.10% (18)	33.30% (74)	36.40% (92)	Not independent (z score, p = 0.007), positive correlation (Spearman)
Knee pain	58.10% (18)	33.30% (74)	36.40% (92)	OR 0.088, SD 0.025
Feelings of heaviness in the legs	51.60% (16)	22.90% (51)	26.50% (67)	Not independent (z score, p < 0.001, positive correlation (Spearman)
Feelings of heaviness in the legs	51.60% (16)	22.90% (51)	26.50% (67)	OR 0.314, SD 0.090
Burning sensations in the legs	48.40% (15)	9.90% (22)	14.60% (37)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Burning sensations in the legs	48.40% (15)	9.90% (22)	14.60% (37)	OR 0.682, SD 0.228
Leg cramps	35.50% (11)	25.60% (57)	26.90% (68)	Independent (z score, p = 0.249)
Leg cramps	35.50% (11)	25.60% (57)	26.90% (68)	OR 0.121, SD 0.029
Difficulty losing weight or volume from legs	51.60% (16)	17.60% (39)	21.70% (55)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Difficulty losing weight or volume from legs	51.60% (16)	17.60% (39)	21.70% (55)	OR 0.082, SD 0.022
Difficulty sleeping/poor sleep	29.00% (9)	36.90% (82)	36.00% (91)	Independent (z score, p = 0.390)
Difficulty sleeping/poor sleep	29.00% (9)	36.90% (82)	36.00% (91)	OR 0.120, SD 0.039
Prior varicose veins surgery	48.40% (15)	12.10% (27)	16.60% (42)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Prior varicose veins surgery	48.40% (15)	12.10% (27)	16.60% (42)	OR 0.556, SD 0.179
Bariatric surgery	3.20% (1)	3.10% (7)	3.20% (8)	Independent (z score, p = 0.983)
Bariatric surgery	3.20% (1)	3.10% (7)	3.20% (8)	OR 0.143, SD 0.153
Liposuction	16.10% (5)	4.50% (10)	5.90% (15)	Not independent (z score, p = 0.034), positive correlation (Spearman)
Liposuction	16.10% (5)	4.50% (10)	5.90% (15)	OR 0.123, SD 0.025

	Volunteers with diagnostic criterion for lipedema	Volunteers without diagnostic criterion for lipedema	All volunteers	Correlation with diagnosis of lipedema
Excellent	9.7% (3)	6.7% (15)	7.1% (18)	Independent (z score, p = 0.553)
Excellent	9.7% (3)	6.7% (15)	7.1% (18)	OR 0.200, SD 0.126
Very good	6.5% (2)	23.8% (53)	21.7% (55)	Not independent (z score, p = 0.028), negative correlation (Spearman)
Very good	6.5% (2)	23.8% (53)	21.7% (55)	OR 0.038, SD 0.027
Good	12.9% (4)	39.6% (88)	36.4% (92)	Not independent (z score, p = 0.004), negative correlation (Spearman)
Good	12.9% (4)	39.6% (88)	36.4% (92)	OR 1, SD 0
Regular	64.5% (20)	28.8% (63)	32.8% (83)	Not independent (z score, p < 0.001), positive correlation (Spearman)
Regular	64.5% (20)	28.8% (63)	32.8% (83)	OR 0.317, SD 0.081
Poor	6.5% (2)	1.4% (3)	2.0% (5)	Independent (z score, p = 0.056)
Poor	6.5% (2)	1.4% (3)	2.0% (5)	OR 0.667, SD 0.609

[1] BMI: body mass index; OR: odds ratios; SE: standard error.

Lipedema prevalence and risk factors in Brazil

Abstract