Obstetrics and Gynecology Center, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
Hum Reprod. 2010 May;25(5):1325-34. doi: 10.1093/humrep/deq039. Epub 2010 Feb 19.
An inverse association between adult body mass index (BMI) and risk of endometriosis has frequently been reported. However, the association between body size during childhood and early adulthood and endometriosis is not as well documented.
Using data collected from the Nurses' Health Study II, a prospective cohort study of premenopausal US nurses, that began in 1989, we have attempted to clarify this relationship. Data are updated every 2 years with follow-up for these analyses through 2001. In 1989 women recalled their body size at ages 5, 10 and 20 years using a validated 9-level figure drawing.
During 831 910 person-years of follow-up, 1817 cases of self-reported laparoscopically-confirmed endometriosis were observed among women with no past infertility. After adjusting for age, birthweight, age at menarche, parity, oral contraceptive use and adult BMI, we observed a significant reduction in the incidence of endometriosis with increasing body size for all time periods. The relative risks (RRs) comparing the smallest and largest figure sizes to the middle category during childhood (ages 5-10) were 1.18 (95% confidence interval 1.02-1.36) and 0.82 (0.66-1.02), P-trend = 0.0002. At age 20, the RRs for the same comparisons were 1.32 (1.06-1.65) and 0.87 (0.74-1.03), P-trend = 0.04. Additional adjustment by menstrual cycle length and regularity yielded similar associations. The associations were stronger among nulliparous women than among parous women, although not all differences were statistically significant.
In this large cohort of premenopausal women, there was evidence of a persistent inverse association between childhood and early adulthood body size and incidence of laparoscopically confirmed endometriosis, independent of adult BMI and menstrual cycle characteristics.
成人的体重指数（BMI）与子宫内膜异位症的风险呈负相关，这一现象已被广泛报道。然而，儿童期和成年早期的体型与子宫内膜异位症之间的关联尚未得到充分证实。
本研究利用前瞻性队列研究护士健康研究 II 的数据进行分析。该研究始于 1989 年，对象为美国的绝经前护士。我们试图阐明这种关系。从 1989 年开始，每两年对数据进行更新，这些分析的随访时间截至 2001 年。在研究开始时，女性通过验证过的 9 级图像描绘来回忆她们在 5 岁、10 岁和 20 岁时的体型。
在 831910 人年的随访期间，在没有既往不孕史的女性中，观察到 1817 例经腹腔镜证实的子宫内膜异位症病例。在校正年龄、出生体重、初潮年龄、产次、口服避孕药使用和成人 BMI 后，我们观察到所有时间段的子宫内膜异位症发病率随着体型的增加而显著降低。与中间体型相比，儿童期（5-10 岁）体型最小和最大的相对风险（RR）分别为 1.18（95%置信区间 1.02-1.36）和 0.82（0.66-1.02），P 趋势=0.0002。在 20 岁时，相同比较的 RR 分别为 1.32（1.06-1.65）和 0.87（0.74-1.03），P 趋势=0.04。通过月经周期长度和规律性的额外调整得出了类似的关联。在未生育的女性中，这种关联比已生育的女性更强，尽管并非所有差异均具有统计学意义。
在这项针对绝经前女性的大型队列研究中，有证据表明，儿童期和成年早期的体型与腹腔镜确诊的子宫内膜异位症的发病率之间存在持续的负相关，这种关联独立于成人 BMI 和月经周期特征。
