Abstract
ObjectivesBacterial vaginosis (BV), a clinical condition characterized by decreased vaginal Lactobacillus spp., is difficult to treat. We examined associations between micronutrient intake and a low-Lactobacillus vaginal microbiota as assessed by molecular methods (termed “molecular-BV”).MethodsThis cross-sectional analysis utilized data collected at the baseline visit of the Hormonal Contraception Longitudinal Study, a cohort of reproductive-aged women followed over 2 years while initiating or ceasing hormonal contraception (HC). The Block Brief 2000 Food Frequency Questionnaire was administered and micronutrient intakes were ranked. Vaginal microbiota composition was assessed using 16S rRNA gene amplicon sequencing and clustered into community state types (CSTs) based on the types and relative abundance of bacteria detected. Associations between the lowest estimated quartile intake of nutrients and having a low-Lactobacillus CST (molecular-BV) were evaluated by logistic regression. Separate models were built for each nutrient controlling for age, body mass index, behavioral factors, HC use and total energy intake. We also conducted a literature review of existing data on associations between micronutrient intakes and BV.ResultsSamples from 104 women were included in this analysis. Their mean age was 25.8 years (SD 4.3), 29.8% were African American, 48.1% were using HC, and 25% had molecular-BV. In adjusted multivariable analyses, the lowest quartile of betaine intake was associated with an increased odds of molecular-BV (aOR 9.2, p value < 0.01, [CI 2.4–35.0]).ConclusionsThis is the first study to assess the association between estimated micronutrient intake and molecular-BV. Lower energy-adjusted intake of betaine was associated with an increased risk of molecular-BV. Betaine might have direct effects on the vaginal microenvironment or may be mediated through the gut microbiota. Additional research is needed to determine reproducibility of this finding and whether improved intake of select micronutrients such as betaine decreases the risk of BV and its sequelae.
Highlights
The clinical condition of bacterial vaginosis (BV), is characterized by low levels of Lactobacillus spp. and higherTuddenham et al Reproductive Health (2019) 16:151 abundances of gram negative and anaerobic bacteria [1]
We utilized 16S rRNA gene amplicon sequencing to characterize the communities of bacteria living in the vagina and found an increased risk of a low-Lactobacillus vaginal microbiota among women with the lowest quartile of the micronutrient betaine
Patients with molecular-Bacterial vaginosis (BV) had a higher BMI (p < 0.01), were more likely to engage in vaginal douching (p < 0.01) and were less likely to be using hormonal contraception (HC) at study entry (p = 0.01) compared to those with Lactobacillus-dominated Community State Type (CST) (See Table 1)
Summary
The clinical condition of bacterial vaginosis (BV), is characterized by low levels of Lactobacillus spp. and higherTuddenham et al Reproductive Health (2019) 16:151 abundances of gram negative and anaerobic bacteria [1]. The clinical condition of bacterial vaginosis (BV), is characterized by low levels of Lactobacillus spp. and higher. 16S rRNA gene amplicon sequencing techniques have enabled a higher resolution understanding of the bacterial composition of communities that inhabit the vagina, and have enabled the identification of several clusters, termed “community state types”(CSTs), that differ based on the composition and relative abundance of bacterial taxa. The CSTs are dominated by different species of Lactobacillus, or are characterized by a paucity of Lactobacillus spp. The latter CSTs are comprised of a variety of anaerobes such as Gardnerella vaginalis and Sneathia spp., and are consistent with BV [5]. The low-Lactobacillus CSTs have been collectively termed “molecular-BV,” as they reflect similar low-Lactobacillus states that are captured by Nugent score and Amsel’s criteria [6]
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