Dietary factors and risk of uterine fibroids

 描述(申请人提供)：子宫肌瘤(UL)是育龄妇女最常见的盆腔肿瘤。尽管这些平滑肌肿瘤是良性的，但UL是一个重大的公共卫生问题，每年有超过20万例子宫切除术，大约每4名女性中就有1人会出现UL并引起临床关注。尽管与UL相关的发病率和医疗费用很高，但其病因尚不清楚，几乎没有可改变的、保护性的危险因素被确定。饮食因素可能在UL的病因中发挥作用，因为它们可能改变内源性激素以及它们的炎症效应。假设/特定目的：我们的总体假设是，影响内源性激素和炎症反应的饮食成分的摄入量和血浆生物标记物水平与UL风险相关。很少有研究研究饮食因素与UL之间的联系。据我们所知，只有一个前瞻性队列研究了乳制品和膳食脂肪摄入量与UL之间的关联，观察到随着乳制品消费量的增加和某些脂肪酸的关联，UL的风险降低。此外，还没有前瞻性研究研究维生素D水平与这种关系的关系。使用前瞻性数据，我们将评估以下目标：目的1.使用完成饮食评估的NHSII队列中97,807名女性的数据，评估饮食脂肪与子宫肌瘤发病风险之间的关系。在这些女性中，我们将研究循环脂肪酸水平与子宫肌瘤之间的关系。目的2.乳制品摄入量与子宫肌瘤的发病风险相关。目的3.维生素D水平与子宫肌瘤的风险相关。研究设计：这项拟议的研究包括护士健康研究II参与者，他们在1991年完成了关于他们日常饮食的食物频率问卷(FFQ)。后续的FFQ分别于1995年、1999年、2003年和2007年完成。将生成饮食摄入量的五分位数或类别，并将使用Cox比例风险模型来估计与每个饮食因素相关的UL发病率的风险比率。在一组具有诊断前生物标志物的女性中，血浆维生素D和循环脂肪酸与UL风险之间的关联将通过Logistic回归模型进行评估。预期收集的UL、饮食和协变量数据以及储存的血液样本的存在，允许经济高效和有效地考虑疾病诊断的暂时性-支持潜在的可改变的风险因素的识别。

 DESCRIPTION (provided by applicant): Uterine leiomyoma (UL) are the most common pelvic tumor in women of reproductive age. Despite the fact that these smooth muscle tumors are benign, UL are a significant public health problem, accounting for over 200,000 hysterectomies annually, and approximately 1 in 4 women will have a UL that comes to clinical attention. Despite the high morbidity and health care costs associated with UL, the etiology is not understood, and few modifiable, protective risk factors have been identified. Dietary factors may play a role in UL etiology due to their potential to modify endogenous hormones as well as their inflammatory effects. Hypothesis/Specific Aims: Our overall hypothesis is that intake and plasma biomarker levels of dietary components that influence endogenous hormonal and inflammatory response are associated with UL risk. Few studies have examined the association between dietary factors and UL. To our knowledge, only one prospective cohort has examined the association between dairy and dietary fat intake and UL observing a reduced risk of UL with increasing dairy consumption and associations with some fatty acids. In addition, no prospective studies have examined the association with vitamin D levels. Using prospective data we will evaluate the following aims: Aim 1. Evaluate the association between dietary fat and risk of incident uterine leiomyoma using data among 97,807 women in the NHSII cohort who completed a dietary assessment. In a subset of these women we will examine the association between circulating fatty acid levels and uterine leiomyoma. Aim 2. Dairy food intake is associated with risk of uterine leiomyoma. Aim 3. Vitamin D levels are associated with risk of uterine leiomyoma. Study Design: The proposed study consists of Nurses' Health Study II participants who completed a food frequency questionnaire (FFQ) about their usual diet in 1991. Follow-up FFQs were completed in 1995, 1999, 2003, and 2007. Quintiles or categories of dietary intake will be generated and Cox proportional hazards models will be used to estimate hazard ratios of UL incidence associated with each of the dietary factors. Among a subset of women with pre-diagnostic biomarkers, the association between plasma vitamin D and circulating fatty acids with UL risk will be assessed with logistic regression models. The presence of prospectively collected UL, dietary, and covariate data and stored blood samples, allows cost-efficient and valid consideration of the temporality of disease diagnosis - supporting the potential identification of modifiable risk factors.