Article 4 of 5:
Is there a link between
diet and endometriosis?
Is there a link between diet and endometriosis?
BY M. ALEXANDER OTTO
Increasingly, women with endometriosis are turning to diet to help control their symptoms, and researchers are beginning to ask if diet could be part of a prevention strategy.
At the 13th World Congress on Endometriosis held in Vancouver, investigators presented findings from a 20-year observational study of 81,378 premenopausal women in the Nurses’ Health Study II that sheds light on the relationship between endometriosis and diet.
Although a healthy diet was associated with a decreased risk of laparoscopically-confirmed endometriosis, it’s unclear if the link was true cause-and-effect, or simply an artifact of study design.
Still, it’s the largest study to date assessing dietary patterns and endometriosis, said investigator Holly Harris, ScD, an epidemiologist at the Fred Hutchinson Cancer Research Center, Seattle.
Perspectives on Endometriosis Management
The women in the study completed health and lifestyle surveys every 2 years, and food frequency questionnaires every 4 years from 1991 to 2011. The researchers assigned them to diet categories based on what they reported eating. A total of 3,720 women were surgically diagnosed with endometriosis during the study period.
After adjusting for age, body mass index, alcohol consumption, menstrual cycle length, oral contraceptive use, and other potential confounders, the investigators found that women who scored well on the 2010 alternative Healthy Eating Index – a measure of adherence to federal dietary guidelines – had a lower risk than did others of surgically-confirmed endometriosis (hazard ratio, 0.88, 95% confidence interval, 0.79-0.98, P = .03).
Women who fit into the Western diet pattern – high in red meat and processed foods – had an increased risk (HR, 1.21, 95% CI, 1.06-1.39, P = .02). Other eating patterns, including the Dietary Approaches to Stop Hypertension (DASH) diet, were not associated with endometriosis either way.
The findings held only for women who did not report fertility problems on their surveys and likely had laparoscopy because of pelvic pain. The findings did not hold for women who reported fertility problems and probably had endometriosis discovered incidentally when undergoing procedures to enhance fertility, Dr. Harris said.
“It could be that a healthy diet just decreases the chances of being diagnosed because women have fewer pain symptoms,” she said, making them less likely to undergo laparoscopy. “GI symptoms could play into this.”
A healthier diet might also be a marker of a healthier lifestyle, she said.
It was impossible to address all the possibilities in an observational study, but Dr. Harris said she’s confident enough in the findings to conduct a dietary trial to see what happens when women are randomized to eat their usual diet or a healthy one.
Meanwhile, there are no drawbacks to eating according to the alternative Healthy Eating Index, with plenty of fruits, vegetables, whole grains, and healthy fats, and little or no red meat, sugary beverages, and trans fats, among other things. The diet has proved to reduce cardiovascular disease, diabetes, and other problems.
If it turns out that healthy eating does help prevent endometriosis, it could be because of its anti-inflammatory effects, Dr. Harris said.
The work was funded by the National Cancer Institute, and Dr. Harris reported having no relevant financial disclosures.
Alex Otto is a writer for Ob.Gyn. News.