饮食干预能降低女性内异症疼痛，提高生活质量吗？

STUDY QUESTION

研究问题

What is the influence of dietary interventions, namely the low fermentable oligo-, di-, mono-saccharides, and polyols (Low FODMAP) diet and endometriosis diet, on endometriosis-related pain and quality of life (QoL) compared to a control group?

与常规饮食相比，饮食干预，特别是低可发酵寡糖、双糖、单糖和多元醇（低FODMAP）饮食和子宫内膜异位症饮食，对子宫内膜异位症相关疼痛和生活质量（QoL）有何影响？

SUMMARY ANSWER

结论

After adhering to a dietary intervention for 6 months, women with endometriosis reported less pain and an improved QoL compared to baseline whereas, compared to the control group, they reported less bloating and a better QoL in 3 of 11 domains.

坚持饮食干预6个月后，子宫内膜异位症患者与基线相比，疼痛有所减轻，生活质量改善，而与对照组相比，她们在11个领域中的3个领域报告称腹胀减轻，生活质量提高。

WHAT IS KNOWN ALREADY

已知情况

Standard endometriosis treatment can be insufficient or may be accompanied by unacceptable side effects. This has resulted in an increasing interest in self-management strategies, including the appliance of the Low FODMAP diet and the endometriosis diet (an experience-based avoidance diet, developed by women with endometriosis). The Low FODMAP diet has previously been found effective in reducing endometriosis-related pain symptoms, whereas only limited studies are available on the efficacy of the endometriosis diet. A survey study recently found the endometriosis diet effective in improving QoL but currently no guidelines on use of the diet exist.

标准的子宫内膜异位症治疗可能不足或伴有无法接受的副作用。这导致越来越多的人对自我管理策略产生了兴趣，包括采用低FODMAP饮食和子宫内膜异位症饮食（由患有子宫内膜异位症的女性开发的基于经验的限制饮食）。低FODMAP饮食在减轻子宫内膜异位症相关疼痛症状方面已被证明有效，而关于子宫内膜异位症饮食的疗效只有有限的研究可用。最近的一项调查研究发现子宫内膜异位症饮食在改善生活质量方面有效，但目前还没有关于使用该饮食的指南。

STUDY DESIGN, SIZE, DURATION

研究设计，规模，持续时间

A prospective one-center pilot study was performed between April 2021 and December 2022. Participants could choose between adherence to a diet—the Low FODMAP diet or endometriosis diet—or no diet (control group). Women adhering to a diet received extensive guidance from a dietician in training. The follow-up period was 6 months for all three groups. For all outcomes, women adhering to the diets were compared to their baseline situation and to the control group.

2021年4月至2022年12月进行了一项前瞻性单中心探索性研究。参与者可以选择遵循饮食——低FODMAP饮食或子宫内膜异位症饮食——或不遵循饮食（对照组）。遵循饮食的女性接受了一位正在接受培训的营养师的全面指导。所有三组的随访期为6个月。对于所有结果，将遵循饮食的女性与她们的基线情况和对照组进行比较。

PARTICIPANTS/MATERIALS, SETTING, METHODS

参与者/材料，设置，方法

We included women diagnosed with endometriosis (surgically and/or by radiologic imaging) who reported pain scores ≥3 cm on the visual analogue score (0–10 cm) for dysmenorrhea, deep dyspareunia, and/or chronic pelvic pain. The primary endpoint focused on pain reduction for all pain symptoms, including dysuria, bloating, and tiredness. Secondary endpoints, assessed via questionnaires, focused on QoL, gastro-intestinal health, and diet adherence.

我们纳入诊断为子宫内膜异位症的女性(经手术治疗和/或放射影像学)，报告痛经，深度性交痛和/或慢性盆腔疼痛视觉模拟评分(0-10cm)疼痛评分≥3cm骨盆疼痛。主要终点侧重于减轻所有疼痛症状，包括排尿困难，腹胀和疲劳。次要终点，通过问卷调查评估，侧重于生活质量，胃肠健康和饮食依从性。

MAIN RESULTS AND THE ROLE OF CHANCE

主要结果和机会的作用

A total of 62 participants were included in the low FODMAP diet (n = 22), endometriosis diet (n = 21), and control group (n = 19). Compared to their baseline pain scores, participants adhering to a diet reported less pain in four of six symptoms (range P < 0.001 to P = 0.012) and better scores in 6 of 11 QoL domains (range P < 0.001 to P = 0.023) after 6 months. Compared to the control group, analyzed longitudinally over the 6-month follow-up period, participants applying a diet reported significant less bloating (P = 0.049), and better scores in 3 of 11 QoL domains (range P = 0.002 to P = 0.035).

共有62名参与者被纳入低FODMAP饮食(n=22)，子宫内膜异位症饮食(n=21)和对照组(n=19)。与基线疼痛评分相比，坚持饮食的参与者报告6个月后6种症状中的4种(范围P<0.001至P=0.012)疼痛较少，11个生活质量领域中的6种(范围P<0.001至P=0.023)疼痛得分更高。与对照组相比，在6个月的随访期间进行纵向分析，应用饮食的参与者报告显著减少腹胀(P=0.049)，并且在11个生活质量领域中的3个得分更高(范围P=0.002至P=0.035)。

LIMITATIONS, REASONS FOR CAUTION

局限性分析

No sample size was calculated since efficacy data were lacking in the literature. In order to optimize dietary adherence, randomization was not applied, possibly resulting in selection bias.

由于文献中缺乏疗效数据，因此没有计算样本量。为了优化饮食依从性，没有采用随机分组，可能导致选择性偏差。

WIDER IMPLICATIONS OF THE FINDINGS

研究结果的更广泛意义

Our study suggests that women could benefit from adherence to a dietary intervention, since we found lower pain scores and better QoL after 6 months. However, caution is implied since this is a pilot study, no sample size was calculated, and data on long-term effects (>6 months) are lacking. The results of this pilot study underline the importance of further research and the drawing up of guidelines.

我们的研究表明，女性遵循饮食干预可能会受益，因为我们发现在6个月后疼痛评分降低，生活质量提高。然而，需要谨慎对待，因为这是一项试点研究，没有计算样本量，并且缺乏关于长期效果（超过6个月）的数据。这项试点研究的结果强调了进一步研究和制定指南的重要性。

参考文献：

A P van Haaps, J V Wijbers, A M F Schreurs, S Vlek, J Tuynman, B De Bie, A L de Vogel, M van Wely, V Mijatovic, The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group, Human Reproduction, Volume 38, Issue 12, December 2023, Pages 2433–2446, https://doi.org/10.1093/humrep/dead214