A prospective study of diet and endometriosis

描述（由申请人提供）：子宫内膜异位症，在美国妇科住院的第三大原因，仍然是最神秘的妇科病理之一。通过子宫腔外子宫内膜组织的存在来定义，这些植入物对月经周期的激素提示做出反应，并像在子宫内一样“出血”。其后果是粘连、瘢痕形成和疼痛性炎症的发展。体征和症状包括痛经、性交困难、不孕、排尿困难和大便困难。这种疾病的影响可能会使身体和精神衰弱，经常误诊和治疗方案不佳。据估计，其在美国女性中的患病率约为10%。尽管与子宫内膜异位症相关的高发病率和医疗费用，病因尚未完全阐明，也没有确定可改变的保护性危险因素。饮食因素一直是越来越多的子宫内膜异位症患者发起的书籍和网站的焦点，子宫内膜异位症协会的新书中有一章专门介绍饮食选择和子宫内膜异位症的“预防”。不幸的是，迄今为止很少有研究直接评估饮食与子宫内膜异位症之间的关系。使用从1989年开始的护士健康研究II（一项正在进行的前瞻性队列研究）中收集的1,500例腹腔镜证实的子宫内膜异位症事件病例的数据，我们提出了一项研究来评估以下三个假设：a）摄入大量omega-6脂肪酸、饱和脂肪和反式脂肪的妇女患子宫内膜异位症的风险更大; B）摄入少量omega-3脂肪酸、单不饱和脂肪和纤维的妇女患子宫内膜异位症的风险更大; c）饮食中维生素B6和镁含量较低的妇女--通过食物或补充剂--患子宫内膜异位症的风险更大。所有分析将控制其他已知和建议的子宫内膜异位症风险因素，如体重指数，口服避孕药的使用和吸烟。我们将有相当大的权力来评估上述假设。这些分析将是第一次评估这些饮食因素和绝经前妇女发病率的重要和未充分研究的原因之间的关系。

DESCRIPTION (provided by applicant): Endometriosis, the third leading cause of gynecologic hospitalization in the United States, remains one of the most enigmatic gynecologic pathologies. Defined by the presence of endometrial tissue outside of the uterine cavity, these implants respond to the hormonal cues of the menstrual cycle and "bleed" as they would in the uterus. The consequence is the development of adhesions, scarring, and painful inflammation. Signs and symptoms include dysmenorrhea, dyspareunia, infertility, dysuria, and dyschezia. The effects of the disease can be physically and mentally debilitating with frequent misdiagnoses and poor treatment options. Its prevalence among U.S. women has been estimated to be approximately 10%. Despite the high morbidity and health care cost associated with endometriosis, the etiology has not been fully delineated, and no modifiable, protective risk factors have been identified. Dietary factors have been the focus of a growing number of endometriosis patient-initiated books and web sites, with a chapter in a new book from the Endometriosis Association dedicated to diet choices and "prevention" of endometriosis. Unfortunately, few studies to date have directly evaluated the relation between diet and endometriosis. Using data on 1,500 laparoscopically confirmed incident cases of endometriosis collected from the Nurses' Health Study II, an ongoing, prospective cohort study that began in 1989, we propose a study to assess the following three hypotheses: a) Women who consume greater amounts of omega-6 fatty acids, saturated fats, and trans fats are at greater risk of endometriosis; b) Women who consume smaller amounts of omega-3 fatty acids, monounsaturated fats, and fiber are at greater risk of endometriosis; and c) Women whose diets are lower in vitamins B6 and magnesium -- via foods or supplements -- are at greater risk of endometriosis. All analyses will control for other known and suggested risk factors for endometriosis such as body mass index, oral contraceptive use, and cigarette smoking. We will have substantial power to evaluate the above hypotheses. These analyses will be the first to evaluate the relation between these dietary factors and this important and understudied cause of morbidity among premenopausal women.