A prospective study of dietary patterns and the incidence of endometriosis diagnosis - 18/05/24

Doi : 10.1016/j.ajog.2024.04.030

Marcelle M. Dougan, ScD ^a, Sable Fest, BA ^b, Kara Cushing-Haugen, MS ^b, Leslie V. Farland, ScD ^c,^d, Jorge Chavarro, MD, ScD ^e,^f,^g, Holly R. Harris, ScD ^b,^h,^⁎ , Stacey A. Missmer, ScD ^g,^i,^j,^k
^a Department of Public Health and Recreation, San Jose State University, San Jose, CA
^b Program in Epidemiology, Fred Hutchinson Cancer Center, Seattle, WA
^c Department of Epidemiology and Biostatistics, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ
^d Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
^e Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona, Tucson, AZ
^f Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
^g Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
^h Department of Epidemiology, University of Washington, Seattle, WA
ⁱ Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
^j Boston Center for Endometriosis, Boston Children’s Hospital and Brigham and Women’s Hospital, Boston, MA
^k Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI

^∗Corresponding author: Holly R. Harris, ScD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 18 May 2024
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Although endometriosis is a common condition—affecting ∼10% of premenopausal individuals—its etiology is unknown. Diet receives a lot of attention from patients, but studies of the role of diet are limited. Examining dietary patterns is essential to provide new insight.

Objective

We sought to determine whether dietary patterns are associated with laparoscopically-confirmed endometriosis diagnosis.

Study Design

We conducted a prospective cohort study among 81,997 premenopausal participants of the Nurses’ Health Study II, who were followed from 1991–2015. Diet was assessed with validated food frequency questionnaires every 4 years. We examined 6 dietary patterns: Western, Prudent, Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an estrogen-associated pattern, and a proinflammatory pattern. Cox proportional hazard ratios and 95% confidence intervals were used to quantify the association between each of these patterns and laparoscopically-confirmed endometriosis diagnosis.

Results

Three thousand eight hundred ten incident cases of endometriosis were diagnosed during 24 years of follow-up. Adherence to the Alternative Healthy Eating Index, reflecting a healthier dietary pattern, was associated with a 13% lower risk of endometriosis diagnosis (fifth vs first quintile 95% confidence interval, 0.78–0.96; P_trend=.02). Participants in the highest quintile of the Western dietary pattern, characterized by high intake of red meat, processed meat, refined grains, and desserts, had a 27% higher risk of endometriosis diagnosis than those in the lowest quintile (95% confidence interval, 1.09–1.47; P_trend=.004). The Prudent, Dietary Approaches to Stop Hypertension, and estrogen-associated dietary patterns did not demonstrate clear associations with endometriosis risk, and there was the suggestion of a higher risk of endometriosis diagnosis among those with a higher proinflammatory diet score (hazard ratio for fifth vs first quintile, 1.10 [95% confidence interval, 0.99–1.23]; P_trend=.01).

Conclusion

Our results suggest that consuming a dietary pattern that adheres to the Alternative Healthy Eating Index-2010 recommendations lowers the risk of endometriosis diagnosis, potentially through a beneficial impact on pelvic pain. In addition, consuming a less healthy diet high in red/processed meats and refined grains may have a detrimental impact on endometriosis symptoms.

Le texte complet de cet article est disponible en PDF.

Key words : diet, dietary patterns, endometriosis, epidemiology, pelvic pain

Plan

Introduction

Materials and Methods

Study population

Endometriosis ascertainment

Results in the context of what is known

Clinical implications

Strengths and limitations

Research implications

Conclusions

	H.R.H. and S.A.M. contributed equally as senior authors.
	The authors report no conflicts of interest.
	This work was supported by research grants HD48544, HD52473, and HD57210 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and grant P30 DK046200 from the National Institute of Diabetes and Digestive and Kidney Diseases. The Nurses’ Health Study II is supported by U01 CA176726 and U01 HL145386. The funders of this study had no role in the study design or conduct, in the collection, analysis, and interpretation of the data, in the preparation of the manuscript, or in the decision to submit the report for publication.
	Cite this article as: Dougan MM, Fest S, Cushing-Haugen K, et al. A prospective study of dietary patterns and the incidence of endometriosis diagnosis. Am J Obstet Gynecol 2024;XX:x.ex–x.ex.