CHOICE Institute, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA.
Nestlé Research, Lausanne, Switzerland.
J Nutr. 2022 Sep 6;152(9):2088-2096. doi: 10.1093/jn/nxac107.
The etiology of endometriosis is not well understood. Limited evidence suggests that dietary factors influence risk, but prospective data related to carbohydrate, fiber, and gluten consumption are scarce. Despite this, recommendations concerning fiber, gluten intake, and endometriosis are pervasive in the lay literature.
We aimed to investigate the associations of carbohydrate quality [glycemic index (GI) and glycemic load (GL)], fiber intake (total, legume, vegetable, cruciferous vegetable, fruit, cereal), and gluten intake with incident laparoscopically confirmed endometriosis.
This was a prospective cohort study using data collected from 81,961 premenopausal women in the Nurses' Health Study II (mean age = 36 y in 1991). Diet was assessed with a validated FFQ every 4 y. Cox proportional hazards models were used to calculate rate ratios (RRs) and 95% CIs.
A total of 3810 incident cases of laparoscopically confirmed endometriosis were reported over 24 y of follow-up. Women in the highest quintile of GI had 12% (95% CI: 1.01, 1.23; Ptrend = 0.03) higher risk of endometriosis diagnosis than those in the lowest quintile. Total vegetable and cruciferous vegetable fiber intakes were also associated with higher risk (highest compared with lowest quintile RR: 1.13; 95% CI: 1.02, 1.24; Ptrend = 0.004 and RR: 1.17; 95% CI: 1.06, 1.29; Ptrend = 0.02, respectively). Higher intake of fruit fiber was associated with lower risk of endometriosis but the association was not significant after adjusting for the Alternative Healthy Eating Index. Gluten intake was also associated with lower risk (highest compared with lowest quintile RR: 0.91; 95% CI: 0.80, 1.02; Ptrend = 0.01), but these results were not consistent in direction nor statistical significance across sensitivity analyses. No association was observed for GL or total, legume, or cereal fiber intake.
Our findings suggest that carbohydrate quality and specific types of fiber-total vegetable and cruciferous vegetable fiber-are associated with endometriosis diagnosis in premenopausal women. These results also indicate it is unlikely that gluten intake is a strong factor in the etiology or symptomatology of endometriosis.
子宫内膜异位症的病因尚不清楚。有限的证据表明，饮食因素会影响发病风险，但有关碳水化合物、纤维和麸质摄入的前瞻性数据却很少。尽管如此，关于纤维、麸质摄入和子宫内膜异位症的建议在非专业文献中却比比皆是。
我们旨在研究碳水化合物质量[血糖指数（GI）和血糖负荷（GL）]、纤维摄入（总纤维、豆类、蔬菜、十字花科蔬菜、水果、谷物）和麸质摄入与经腹腔镜确诊的子宫内膜异位症发病风险之间的关联。
这是一项前瞻性队列研究，使用了护士健康研究 II 中 81961 名绝经前妇女的数据（1991 年时平均年龄为 36 岁）。每 4 年通过验证后的 FFQ 评估饮食情况。使用 Cox 比例风险模型计算风险比（RR）和 95%置信区间（CI）。
在 24 年的随访中，共报告了 3810 例经腹腔镜确诊的子宫内膜异位症病例。与 GI 最低五分位数组相比，处于 GI 最高五分位数组的女性发生子宫内膜异位症的风险高出 12%（95%CI：1.01，1.23；Ptrend=0.03）。总蔬菜和十字花科蔬菜纤维的摄入量也与更高的风险相关（与最低五分位数相比，最高五分位数 RR：1.13；95%CI：1.02，1.24；Ptrend=0.004 和 RR：1.17；95%CI：1.06，1.29；Ptrend=0.02）。水果纤维摄入量较高与子宫内膜异位症风险降低相关，但在调整替代健康饮食指数后，关联并不显著。较高的麸质摄入量也与较低的风险相关（与最低五分位数相比，最高五分位数 RR：0.91；95%CI：0.80，1.02；Ptrend=0.01），但这些结果在敏感性分析中方向和统计学意义并不一致。GL 或总纤维、豆类或谷物纤维的摄入量与子宫内膜异位症均无关联。
我们的研究结果表明，碳水化合物质量和特定类型的纤维——总蔬菜和十字花科蔬菜纤维——与绝经前女性的子宫内膜异位症诊断相关。这些结果还表明，麸质摄入不太可能是子宫内膜异位症病因或症状的一个重要因素。
