Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study

Pim Van Der Grinten,Iris Krabbenborg,Annemiek Nap,Nicole De Roos

doi:10.1016/j.rbmo.2021.07.011

Abstract

Research questionWhat is the current diet of women with endometriosis, in terms of adherence to dietary guidelines and use of diets, and what are the perceived effects of dietary modifications? DesignIn this online explorative observational study, the Dutch Healthy Diet 2015 index (DHD-15) and quality of life (QoL) with the Endometriosis Health Profile-30 questionnaire (EHP-30) were used to assess diet quality. ResultsThe questionnaires were completed by 157 participants. Many participants made one or more dietary adaptations for their endometriosis, in the form of a specific diet (46.5%), with the use of dietary supplements (56.1%), with other dietary adjustments (64.3%), or all. Endometriosis patients had a significantly lower DHD-15 score, indicating a lower diet quality than a healthy reference group (P = 0.004). In the endometriosis group, diet users had a significantly higher total DHD-15 score than non-diet users (P < 0.0001). Diet quality was not correlated with QoL (Pearson's r = –0.010, P = 0.904). Many specific dietary adjustments (71.3%), however, were reported to reduce endometriosis pain-related symptoms. The removal of gluten, dairy or soy, as well as the addition of vegetables, showed the greatest perceived reductions of symptoms in participants. ConclusionsAlthough no specific dietary adjustment was found to increase QoL, endometriosis patients do feel that dietary adjustments have a beneficial effect on their symptoms. Therefore, more research is needed to gain evidence about the specific effects of nutrients on endometriosis symptoms.

Highlights

Endometriosis is a debilitating disease, defined by the presence of functioning endometrium-like tissue outside the uterus
Costs are further incurred by the considerable diagnostic delay of endometriosis, which varies throughout studies, but can take up to 10 years from the onset of symptoms (Hadfield et al, 1996; Arruda et al, 2003; Ballard et al, 2006; Hudelist et al, 2012; Staal et al, 2016)
As a declaration conforming to the Medical Research Involving Human Subjects Act (WMO) was not necessary, a non WMO declaration (n-WMO) was received from the Medical Act Review Committee on 30 January 2020, indicating approval of the study

Summary

Introduction

Endometriosis is a debilitating disease, defined by the presence of functioning endometrium-like tissue outside the uterus. It is the most prevalent benign gynaecological disease worldwide, estimated to affect 10% of women in reproductive ages (Zondervan et al, 2020). Symptoms include chronic pelvic pain, fatigue, dysmenorrhoea, dysuria, dyspareunia, dyschezia and infertility (Dunselman et al, 2014; Lin et al, 2018). These can greatly affect the physical, mental, sexual and social wellbeing of patients (Zondervan et al, 2020) and cause high societal costs (Simoens et al, 2012). Hormonal, environmental (including organochlorine pesticides, which can be ingested through fish, fatty foods and dairy products) (Cooney et al, 2010; Upson et al, 2013) and immunological factors are thought to influence the development of this oestrogen-dependent inflammatory disease (Vercellini et al, 2014)

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