He Qingwen, Feng Yangkun, Zhang Yun, Lin Mengyuan
Department of Public Health, Affiliated Women's Hospital of Jiangnan University, Wuxi, Jiangsu 214002, China.
Center of Reproductive Medicine, Affiliated Women's Hospital of Jiangnan University, Wuxi, Jiangsu 214002, China.
J Reprod Immunol. 2025 Jun;169:104528. doi: 10.1016/j.jri.2025.104528. Epub 2025 Apr 5.
Previous studies have revealed a the relationship between changes in the gut microbiota composition and female infertility. While the association between the dietary index for gut microbiota (DI-GM) and female infertility remains unstudied. The correlation was investigated with NHANES data from 2013 to 2018, with dietary recall data being used to calculate the DI-GM. Mediation analysis was performed to explore the role of lymphocyte count (LC) and red blood cell (RBC) folate in the DI-GM-induced risk of female infertility risk. Among the 1555 individuals included in our study, 311 were diagnosed with female infertility. According to the weighted binary logistic regression analyses, when all the covariates were adjusted, a negative association was observed between the DI-GM score and the risk of female infertility (OR: 0.80, 95 %CI: 0.74-0.88). After grouping participants by DI-GM score, compared with scores in the lowest quartile (Q1), the scores in Q3 and Q4 of DI-GM score were negatively associated with female infertility in crude and adjusted models, with ORs (95 %CI; P for trend) of 0.44 (0.27-0.70; <0.001); 0.43 (0.28-0.64; <0.001) and 0.43(0.26-0.71; <0.001); 0.41(0.27-0.60; <0.001). Additionally, restricted cubic splines logistic analysis uncovered a nonlinear association between the DI-GM score and the prevalence of female infertility. Mediation analysis indicated that LC and RBC folate mediated 4.64 % and 7.08 %, respectively of the association of the DI-GM scores with risk of female infertility. The nomogram exhibited good performance in this study (AUC 0.70, 95 % CI = 0.67-0.73). Our research revealed that the DI-GM score was negatively related to risk of female infertility. Mediation analyses demonstrated that LC and RBC folate levels significantly mediate the association between the DI-GM and the prevalence of female infertility.
以往的研究揭示了肠道微生物群组成变化与女性不孕症之间的关系。而肠道微生物群饮食指数（DI-GM）与女性不孕症之间的关联尚未得到研究。利用2013年至2018年的美国国家健康与营养检查调查（NHANES）数据进行了相关性调查，使用饮食回忆数据来计算DI-GM。进行中介分析以探讨淋巴细胞计数（LC）和红细胞（RBC）叶酸在DI-GM诱发的女性不孕症风险中的作用。在我们纳入研究的1555名个体中，有311人被诊断为女性不孕症。根据加权二元逻辑回归分析，当对所有协变量进行调整后，观察到DI-GM评分与女性不孕症风险之间存在负相关（比值比：0.80，95%置信区间：0.74-0.88）。按DI-GM评分对参与者进行分组后，与最低四分位数（Q1）的评分相比，DI-GM评分的Q3和Q4在粗模型和调整模型中与女性不孕症均呈负相关，比值比（95%置信区间；趋势P值）分别为0.44（0.27-0.70；<0.001）；0.43（0.28-0.64；<0.001）和0.43（0.26-0.71；<0.001）；0.41（0.27-0.60；<0.001）。此外，受限立方样条逻辑分析发现DI-GM评分与女性不孕症患病率之间存在非线性关联。中介分析表明，LC和RBC叶酸分别介导了DI-GM评分与女性不孕症风险关联的4.64%和7.08%。列线图在本研究中表现良好（曲线下面积0.70，95%置信区间=0.67-0.73）。我们的研究表明，DI-GM评分与女性不孕症风险呈负相关。中介分析表明，LC和RBC叶酸水平显著介导了DI-GM与女性不孕症患病率之间的关联。
