A Prospective Study of Diet and Fibroids in Black Women

描述（由申请人提供）：子宫平滑肌瘤（UL），或肌瘤，是育龄妇女妇科疾病的主要来源，在美国每年花费21亿美元的医疗费用。黑人女性被诊断为UL的可能性是白人女性的2-3倍，并且在临床表现时疾病更为严重。雌激素和黄体酮参与了UL的发育和生长。使用来自黑人妇女健康研究（BWHS）的数据，一项对59,000名非裔美国妇女的全国性前瞻性随访研究，我们建议前瞻性评估饮食风险因素（如纤维和脂肪摄入），这些因素可能导致黑人妇女临床相关UL的高发病率。我们将把重点放在可能对性激素合成、代谢或生物利用度有影响的饮食因素上。我们将调查这些饮食因素对经超声或手术证实的自报UL发生率的影响。自1995年BWHS成立以来，每两年对妇女进行一次问卷调查。参与者分别于1995年和2001年完成了食物频率调查问卷。BWHS中的验证研究表明，自我报告的UL具有很高的准确性（bbb96 %），并且食物频率数据与饮食回忆和日记具有令人满意的相关性。在1997-2007年的随访中，超过6000例经超声或手术确诊的肌瘤病例将被报道。大量的事件病例将提供高统计能力，并允许进行信息丰富的亚组分析，例如，在35岁以下的女性（N= 2400例）和非肥胖女性（N= 3800例）中，应尽量减少错误分类。黑人妇女UL的高发病率是一个重要的公共卫生问题。假设会增加风险的饮食模式（例如，高脂肪和低纤维摄入）在黑人女性中比白人女性更普遍。因此，拟议的研究将允许评估可能导致黑人妇女UL发病率过高的可变风险因素。此外，这项研究可以以较低的成本进行，因为BWHS数据的收集得到了其他赠款的支持。这项拟议的研究由一位在研究UL风险因素方面具有丰富经验的新研究者领导，将是迄今为止最大的饮食和UL研究，第一个前瞻性研究，也是第一个针对黑人女性的研究。

DESCRIPTION (provided by applicant): Uterine leiomyomata (UL), or fibroids, are a major source of gynecologic morbidity among reproductive-aged women and account for 2.1 billion dollars in health care costs each year in the United States. Black women are 2-3 times more likely than white women to be diagnosed with UL and have more severe disease at the time of clinical presentation. Estrogen and progesterone have been implicated in the development and growth of UL. Using data from the Black Women's Health Study (BWHS), a nationwide prospective follow-up study of 59,000 African-American women, we propose to prospectively assess dietary risk factors (e.g., fiber and fat intake) that might contribute to the high incidence of clinically relevant UL in black women. We will focus on dietary factors that plausibly have an effect on sex hormone synthesis, metabolism, or bioavailability. We will investigate the influence of these dietary factors on the incidence of self-reported UL confirmed by ultrasound or surgery. Since the inception of the BWHS in 1995, women have been followed biennially by questionnaire. Food frequency questionnaires were completed by participants in 1995 and 2001. Validation studies in the BWHS have demonstrated high accuracy of self-reported UL (>96%) and satisfactory correlation of the food frequency data with dietary recalls and diaries. During follow-up from 1997-2007, over 6,000 incident cases of fibroids confirmed by ultrasound or surgery will have been reported. The large number of incident cases will provide high statistical power and allow for informative subgroup analyses, e.g. among women under age 35 (N=2,400 cases) and non-obese women (N=3,800) among whom misclassification should be minimized. The high incidence of UL in black women is a problem of public health importance. Dietary patterns hypothesized to increase risk (e.g., high fat and low fiber intake) are more prevalent in black women than white women. Thus, the proposed study will permit evaluation of modifiable risk factors that may contribute to the excess UL incidence among black women. Moreover, the study can be carried out at low cost because BWHS data collection is supported by other grants. The proposed study, led by a new investigator with extensive experience in studying risk factors for UL, would be the largest by far of diet and UL, the first prospective study, and the first study in black women. Project Narrative: Uterine leiomyomata (UL), or fibroids, are a major source of gynecologic morbidity among black women and account for 2.1 billion dollars in health care costs each year in the United States. Using data from the Black Women's Health Study (BWHS), a large prospective follow-up study of African-American women, we propose to study dietary risk factors that might contribute to the high incidence of clinically relevant UL in black women. Dietary patterns hypothesized to increase risk (e.g., high fat and low fiber intake) are more prevalent in black women than white women. Thus, the proposed study will permit the evaluation of risk factors for clinically relevant UL that may contribute to the excess incidence among black women.