Advertisement

A prospective cohort study of meat and fish consumption and endometriosis risk

  • Author Footnotes
    1 These authors contributed equally to this article.
    Ayae Yamamoto
    Footnotes
    1 These authors contributed equally to this article.
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

    Department of Health Policy and Management, University of California-Los Angeles Field School of Public Health, Los Angeles, CA
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this article.
    Holly R. Harris
    Correspondence
    Corresponding author: Holly R. Harris, ScD.
    Footnotes
    1 These authors contributed equally to this article.
    Affiliations
    Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
    Search for articles by this author
  • Allison F. Vitonis
    Affiliations
    Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA
    Search for articles by this author
  • Jorge E. Chavarro
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
    Search for articles by this author
  • Stacey A. Missmer
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

    Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA

    Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this article.

      Background

      Only 2 case-control studies have examined the associations between consumption of meat products and endometriosis risk with inconsistent results. Consumption of animal products has the potential to influence endometriosis risk through effects on steroid hormones levels.

      Objective

      We sought to determine whether higher intake of red meat, poultry, fish, and seafood are associated with risk of laparoscopically confirmed endometriosis.

      Study Design

      A total of 81,908 participants of the prospective Nurses’ Health Study II were followed up from 1991 through 2013. Diet was assessed via food frequency questionnaire every 4 years. Cox proportional hazards models were used to calculate rate ratios and 95% confidence intervals.

      Results

      During 1,019,294 person-years of follow-up, 3800 cases of incident laparoscopically confirmed endometriosis were reported. Women consuming >2 servings/d of red meat had a 56% higher risk of endometriosis (95% confidence interval, 1.22–1.99; Ptrend < .0001) compared to those consuming ≤1 serving/wk. This association was strongest for nonprocessed red meats (rate ratio, 1.57; 95% confidence interval, 1.35–1.83 for ≥2 servings/d vs ≤1 servings/wk; Ptrend < .0001), particularly among women who had not reported infertility (Pinteraction = .0004). Women in the highest category of processed red meat intake also had a higher risk of endometriosis (rate ratio, 1.20; 95% confidence interval, 1.06–1.37 for ≥5 servings/wk vs <1 serving/mo; Ptrend = .02). Intakes of poultry, fish, shellfish, and eggs were unrelated to endometriosis risk.

      Conclusion

      Our prospective analysis among premenopausal US nurses suggests that red meat consumption may be an important modifiable risk factor for endometriosis, particularly among women with endometriosis who had not reported infertility and thus were more likely to present with pain symptoms. Well-designed dietary intervention studies among women with endometriosis could help confirm this observation.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wheeler J.M.
        Epidemiology of endometriosis-associated infertility.
        J Reprod Med. 1989; 34: 41-46
        • Eskenazi B.
        • Warner M.L.
        Epidemiology of endometriosis.
        Obstet Gynecol Clin North Am. 1997; 24: 235-258
        • Brinkman M.T.
        • Baglietto L.
        • Krishnan K.
        • et al.
        Consumption of animal products, their nutrient components and postmenopausal circulating steroid hormone concentrations.
        Eur J Clin Nutr. 2010; 64: 176-183
        • Bartram H.P.
        • Gostner A.
        • Scheppach W.
        • et al.
        Effects of fish oil on rectal cell proliferation, mucosal fatty acids, and prostaglandin E2 release in healthy subjects.
        Gastroenterology. 1993; 105: 1317-1322
        • Harel Z.
        • Biro F.M.
        • Kottenhahn R.K.
        • Rosenthal S.L.
        Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents.
        Am J Obstet Gynecol. 1996; 174: 1335-1338
        • Seli E.
        • Berkkanoglu M.
        • Arici A.
        Pathogenesis of endometriosis.
        Obstet Gynecol Clin North Am. 2003; 30: 41-61
        • Parazzini F.
        • Chiaffarino F.
        • Surace M.
        • et al.
        Selected food intake and risk of endometriosis.
        Hum Reprod. 2004; 19: 1755-1759
        • Trabert B.
        • Peters U.
        • De Roos A.J.
        • Scholes D.
        • Holt V.L.
        Diet and risk of endometriosis in a population-based case-control study.
        Br J Nutr. 2011; 105: 459-467
        • Missmer S.A.
        • Hankinson S.E.
        • Spiegelman D.
        • Barbieri R.L.
        • Marshall L.M.
        • Hunter D.J.
        Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors.
        Am J Epidemiol. 2004; 160: 784-796
        • Yuan C.
        • Spiegelman D.
        • Rimm E.B.
        • et al.
        Relative validity of nutrient intakes assessed by questionnaire, 24-hour recalls, and diet records compared with urinary recovery and plasma concentration biomarkers: findings for women.
        Am J Epidemiol. 2018; 187: 1051-1063
        • Yuan C.
        • Spiegelman D.
        • Rimm E.B.
        • et al.
        Validity of a dietary questionnaire assessed by comparison with multiple weighed dietary records or 24-hour recalls.
        Am J Epidemiol. 2017; 185: 570-584
        • Salvini S.
        • Hunter D.J.
        • Sampson L.
        • et al.
        Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption.
        Int J Epidemiol. 1989; 18: 858-867
        • Hu F.B.
        • Stampfer M.J.
        • Rimm E.
        • et al.
        Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements.
        Am J Epidemiol. 1999; 149: 531-540
        • Halton T.L.
        • Willett W.C.
        • Liu S.
        • Manson J.E.
        • Stampfer M.J.
        • Hu F.B.
        Potato and French fry consumption and risk of type 2 diabetes in women.
        Am J Clin Nutr. 2006; 83: 284-290
        • Pan A.
        • Sun Q.
        • Bernstein A.M.
        • et al.
        Red meat consumption and mortality: results from 2 prospective cohort studies.
        Arch Int Med. 2012; 172: 555-563
        • Missmer S.A.
        • Cramer D.W.
        The epidemiology of endometriosis.
        Obstet Gynecol Clin North Am. 2003; 30 (vii): 1-19
        • Missmer S.A.
        • Chavarro J.E.
        • Malspeis S.
        • et al.
        A prospective study of dietary fat consumption and endometriosis risk.
        Hum Reprod. 2010; 25: 1528-1535
        • Prentice R.
        • Thompson D.
        • Clifford C.
        • Gorbach S.
        • Goldin B.
        • Byar D.
        Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. The Women’s Health Trial Study Group.
        J Natl Cancer Inst. 1990; 82: 129-134
        • Wu A.H.
        • Pike M.C.
        • Stram D.O.
        Meta-analysis: dietary fat intake, serum estrogen levels, and the risk of breast cancer.
        J Natl Cancer Inst. 1999; 91: 529-534
        • Andersson A.M.
        • Skakkebaek N.E.
        Exposure to exogenous estrogens in food: possible impact on human development and health.
        Eur J Endocrinol. 1999; 140: 477-485
        • Carpenter C.E.
        • Mahoney A.W.
        Contributions of heme and nonheme iron to human nutrition.
        Crit Rev Food Sci Nutr. 1992; 31: 333-367
        • Hunt J.R.
        Moving toward a plant-based diet: are iron and zinc at risk?.
        Nutr Rev. 2002; 60: 127-134
        • Hurrell R.
        • Egli I.
        Iron bioavailability and dietary reference values.
        Am J Clin Nutr. 2010; 91: 1461-1467s
        • Donnez J.
        • Binda M.M.
        • Donnez O.
        • Dolmans M.M.
        Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis.
        Fertil Steril. 2016; 106: 1011-1017
        • Lousse J.C.
        • Van Langendonckt A.
        • Defrere S.
        • Ramos R.G.
        • Colette S.
        • Donnez J.
        Peritoneal endometriosis is an inflammatory disease.
        Front Biosci (Elite Ed). 2012; 4: 23-40
        • Van Langendonckt A.
        • Casanas-Roux F.
        • Donnez J.
        Oxidative stress and peritoneal endometriosis.
        Fertil Steril. 2002; 77: 861-870
        • Wolfler M.M.
        • Meinhold-Heerlein I.M.
        • Henkel C.
        • et al.
        Reduced hemopexin levels in peritoneal fluid of patients with endometriosis.
        Fertil Steril. 2013; 100: 777-781
        • Barnard N.D.
        • Scialli A.R.
        • Hurlock D.
        • Bertron P.
        Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms.
        Obstet Gynecol. 2000; 95: 245-250
        • Missmer S.A.
        • Hankinson S.E.
        • Spiegelman D.
        • Barbieri R.L.
        • Michels K.B.
        • Hunter D.J.
        In utero exposures and the incidence of endometriosis.
        Fertil Steril. 2004; 82: 1501-1508
        • Zondervan K.T.
        • Cardon L.R.
        • Kennedy S.H.
        What makes a good case-control study? Design issues for complex traits such as endometriosis.
        Hum Reprod. 2002; 17: 1415-1423
        • Willett W.
        Nutritional epidemiology.
        2nd ed. Oxford University Inc, New York (NY)1998
        • Ferrero S.
        • Anserini P.
        • Remorgida V.
        • Ragni N.
        Body mass index in endometriosis.
        Eur J Obstet Gynecol Reprod Biol. 2005; 121: 94-98
        • Matalliotakis I.M.
        • Cakmak H.
        • Fragouli Y.G.
        • Goumenou A.G.
        • Mahutte N.G.
        • Arici A.
        Epidemiological characteristics in women with and without endometriosis in the Yale series.
        Arch Gynecol Obstet. 2008; 277: 389-393
        • Vitonis A.F.
        • Baer H.J.
        • Hankinson S.E.
        • Laufer M.R.
        • Missmer S.A.
        A prospective study of body size during childhood and early adulthood and the incidence of endometriosis.
        Hum Reprod. 2010; 25: 1325-1334