Serum Lipids, Insulin-Like Growth Factor Binding Protein-3 and Treatment Outcomes in Women with and without Cervical Lesions in South Western Uganda: A Cohort Study

Figures & data

Table 1 Socio-Demographic Characteristics of Study Participants at Mbarara Regional Referral Hospital

Variable		Controls	Cases	Test	p-Value
		N=94	N=94
		Frequency (%)†	Frequency (%)†
Age (years)		38.67±8.23	34.53±7.79	Ind. t-test	<0.001**
Age group (years)	19–29	16 (17%)	24 (26%)	Fisher’s exact	0.03**
	30–39	33 (35%)	42 (45%)
	40–49	38 (40%)	27 (29%)
	50–59	7 (7%)	1 (1%)
Region of residence	Central	1 (1%)	2 (2%)	Fisher’s exact	0.74
	Rest of South West Uganda	46 (49%)	49 (52%)
	Mbarara city	47 (50%)	43 (46%)
History of high BP	No	70 (74%)	74 (79%)	Chi-square	0.49
	Yes	24 (26%)	20 (21%)
History of diabetes	No	79 (84%)	82 (87%)	Chi-square	0.53
	Yes	15 (16%)	12 (13%)
Marital status	Single	14 (15%)	21 (22%)	Chi-square	0.43
	Married	60 (65%)	54 (57%)
	Divorced	19 (20%)	19 (20%)
Highest level of education	Never studied	13 (14%)	4 (4%)	Chi-square	0.013**
	Pre-primary	5 (5%)	3 (3%)
	Primary	35 (38%)	45 (48%)
	Secondary	34 (37%)	25 (27%)
	Tertiary	5 (5%)	9 (10%)
	University	1 (1%)	8 (9%)
HIV status	Negative	52 (55%)	50 (53%)	Chi-square	0.56
	Positive	41 (44%)	44 (47%)
	Unknown	1 (1%)	0 (0%)
Smoking	No	93 (99%)	86 (92%)	Fisher’s exact	0.035**
	Yes	1 (1%)	7 (8%)
Contraceptive use	No	54 (59%)	37 (41%)	Chi-square	0.015**
	Yes	38 (41%)	54 (59%)
Type of contraceptive	IUD	3 (8%)	8 (14.8%)	Chi-square	0.62
	Hormonal	33 (87%)	44 (81.5%)
	Condom	2 (5%)	2 (3.7%)
Baseline IGFBP-3 (µg/mL)		3.29±1.01	3.4±7.93	Ind. t-test	0.21
Baseline total cholesterol (mg/dL)		151.01±43.12	145.32±35.86	Ind. t-test	0.33
Baseline triglycerides (mg/dL)		121.39±59.59	94.96±50.68	Ind. t-test	0.001**
Baseline HDL (mg/dL)		45.29±8.25	44.20±8.04	Ind. t-test	0.36
Baseline LDL (mg/dL)		159.08±694.38	79.56±28.79	Ind. t-test	0.27

Notes: †Continuous variables (age, baseline IGFBP-3, baseline total cholesterol, baseline triglycerides, baseline HDL and baseline LDL) are presented as mean±SD. **Statistically significant (p≤0.05).

Abbreviations: BP, blood pressure; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; IGFBP-3, insulin-like growth factor binding protein-3; IUD, intrauterine device; LDL, low-density lipoprotein.

Table 2 Distribution of Baseline Serum IGFBP-3 and Lipid Concentrations Across Grades of Cervical Lesions of Study Participants at Mbarara Regional Referral Hospital

Variable		ASCUS	HSIL	LSIL	NILM	Test	p-Value
		N=1	N=12	N=81	N=94
		Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
IGFBP-3 (µg/mL)	Low	0 (0%)	6 (50%)	29 (36%)	42 (45%)	Fisher’s exact	0.47
	Raised	1 (100%)	6 (50%)	52 (64%)	52 (55%)
Total cholesterol (mg/dL)	<200	1 (100%)	12 (100%)	74 (91%)	83 (88%)	Fisher’s exact	0.62
	≥200	0 (0%)	0 (0%)	7 (9%)	11 (12%)
Triglycerides (mg/dL)	35–135	1 (100%)	8 (67%)	67 (83%)	58 (62%)	Fisher’s exact	0.009**
	0–34/≥136	0 (0%)	4 (33%)	14 (17%)	36 (38%)
HDL (mg/dL)	35–55	1 (100%)	11 (92%)	76 (94%)	90 (96%)	Fisher’s exact	0.59
	0–34/≥56	0 (0%)	1 (8%)	5 (6%)	4 (4%)
LDL (mg/dL)	<100	1 (100%)	12 (100%)	62 (77%)	70 (74%)	Fisher’s exact	0.2
	≥100	0 (0%)	0 (0%)	19 (23%)	24 (26%)

Notes: All data are categorical, and are presented as frequency (proportion). **Statistically significant (p≤0.05).

Abbreviations: ASCUS, atypical squamous cells of undetermined significance; HDL, high-density lipoprotein; HSIL, high-grade squamous intraepithelial lesion; IGFBP-3, insulin-like growth factor binding protein; LDL, low-density lipoprotein; LSIL, low-grade squamous intraepithelial lesion; NILM, negative for intraepithelial lesions or malignancy.

Table 3 Treatment Outcomes for Cervical Lesions at 12 Months Post-Treatment of Study Participants at Mbarara Regional Referral Hospital

Variable		Cleared	Persisted	Test	p-Value
		N=44	N=6
		Frequency (%)	Frequency (%)
Age group (years)	19–29	12 (27%)	2 (33%)	Fisher’s exact	1
	30–39	18 (41%)	2 (33%)
	40–49	14 (32%)	2 (33%)
Region of residence	Central	19 (43%)	2 (33%)	Fisher’s exact	0.73
	Rest of South Western Uganda	24 (55%)	4 (67%)
	Mbarara city	1 (2%)	0 (0%)
History of high BP	No	34 (77%)	4 (67%)	Fisher’s exact	0.62
	Yes	10 (23%)	2 (33%)
History of diabetes	No	36 (82%)	5 (83%)	Fisher’s exact	1
	Yes	8 (18%)	1 (17%)
Marital status	Single	7 (16%)	3 (50%)	Fisher’s exact	0.17
	Married	28 (64%)	2 (33%)
	Divorced	9 (20%)	1 (17%)
Highest level of education	Never studied	3 (7%)	0 (0%)	Fisher’s exact	0.17
	Pre-primary	0 (0%)	1 (17%)
	Primary	21 (48%)	2 (33%)
	Secondary	10 (23%)	3 (50%)
	Tertiary	5 (11%)	0 (0%)
	University	5 (11%)	0 (0%)
HIV status	Negative	18 (41%)	3 (50%)	Fisher’s exact	0.69
	Positive	26 (59%)	3 (50%)
Smoking	No	42 (95%)	5 (83%)	Fisher’s exact	0.32
	Yes	2 (5%)	1 (17%)
Contraceptive use	No	15 (36%)	3 (50%)	Fisher’s exact	0.66
	Yes	27 (64%)	3 (50%)
Type of contraceptive	IUD	3 (11%)	0 (0%)	Fisher’s exact	1
	Hormonal	23 (85%)	3 (100%)
	Condom	1 (4%)	0 (0%)
Treatment modality	Cryotherapy	38 (90%)	3 (50%)	Fisher’s exact	0.03**
	Thermocoagulation	4 (10%)	3 (50%)

Notes: All data are categorical variables, and are presented as frequency (proportion). **Statistically significant (p≤0.05).

Abbreviations: BP, blood pressure; HIV, human immunodeficiency virus; IUD, intrauterine device.

Table 4 Distribution of Follow-Up Serum IGFBP-3 and Lipid Concentrations Across Treatment Outcomes of Cervical Lesions of Study Participants at Mbarara Regional Referral Hospital

Variable		Cleared	Persisted	Test	p-Value
		N=44	N=6
		Frequency (%)†	Frequency (%)†
Total cholesterol (mg/dL)		191.61±27.89	187.67±31.31	Ind. t-test	0.75
Triglycerides (mg/dL)		124.71±29.19	119.18±40.88	Ind. t-test	0.68
HDL (mg/dL)		46.19±9.78	42.93±4.13	Ind. t-test	0.43
LDL (mg/dL)		120.09±25.82	120.33±26.12	Ind. t-test	0.98
Total cholesterol categories (mg/dL)	<200	22 (50%)	3 (50%)	Fisher’s exact	1
	≥200	22 (50%)	3 (50%)
Triglyceride categories (mg/dL)	35–135	34 (77%)	4 (67%)	Fisher’s exact	0.62
	0–34/≥136	10 (23%)	2 (33%)
HDL categories (mg/dL)	35–55	37 (84%)	6 (100%)	Fisher’s exact	0.58
	0–34/≥56	7 (16%)	0 (0%)
LDL categories (mg/dL)	<100	13 (30%)	2 (33%)	Fisher’s exact	1
	≥100	31 (70%)	4 (67%)
IGFBP-3 (µg/mL)		3.77±1.09	3.51±0.98	Ind. t-test	0.58
IGFBP-3 categories (µg/mL)	Low	14 (32%)	2 (33%)	Fisher’s exact	1
	Raised	30 (68%)	4 (67%)

Note: †Continuous variables (total cholesterol, triglycerides, HDL, LDL and IGFBP-3) are presented as mean±SD.

Abbreviations: HDL, high-density lipoprotein; IGFBP-3, insulin-like growth factor binding protein-3; LDL, low-density lipoprotein.

Table 5 Bivariate and Multivariable Logistic Regression Analysis Showing Associations Between Reduced Follow-Up Serum IGFBP-3 and Lipid Concentrations and Clearance of Cervical Lesions of Study Participants at Mbarara Regional Referral Hospital

Variable	Bivariate			Multivariate
	COR	p-Value	95% CI	AOR	p-Value	95% CI
IGFBP-3 (µg/mL)	0.93	0.94	0.15–5.72	1.65	0.67	0.17–16.57
Total cholesterol (mg/dL)	1.00	0.74	0.98–1.04	0.82	0.84	0.11–5.93
Triglycerides (mg/dL)	1.70	0.57	0.27–10.68	2.41	0.47	0.23–25.69
HDL (mg/dL)	1			1
LDL (mg/dL)	0.84	0.84	0.14–5.16	0.82	0.85	0.10–6.71

Note: All data are presented after controlling for age, region of residence, family planning use and type, HIV status, highest level of education, marital status, history of blood pressure and history of diabetes.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; HDL, high-density lipoprotein; HIV, human immunodeficiency virus; IGFBP-3, insulin-like growth factor binding protein-3; LDL, low-density lipoprotein.