Journal of Food Nutrition and Health

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Short Communication - Journal of Food Nutrition and Health (2021) Volume 4, Issue 4

Association between Dietary Inflammatory Index, Endometriosis and Dyspareunia

Clarissa Viana Demézio da Silva*, Valéria Lauriana de Carvalho Barros Felipe, Nitin Shivappa, James R, Hebert, Jamila Alessandra Perini, Patricia Dias de Brito, Jéssica Vilarinho Cardoso, Renato Ferrari, Gutemberg Leão de Almeida Filho

Institute of Gynecology, Federal University of Rio de Janeiro, Brazil

Corresponding Author:
Clarissa Viana Demézio da Silva Institute of Gynecology, Federal University of Rio de Janeiro, Brazil, Tel: +55 21 98199-1869, E-mail: [email protected]

Accepted date: 26th July, 2021

Citation: Clarissa VD da Silva, Valéria L de CB, Nitin S, et al. Association between Dietary Inflammatory Index, Endometriosis and Dyspareunia. J Food Nutr Health 2021; 4(4).

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Endometriosis is a gynaecological disease characterized by the presence of endometrial tissue outside the uterus that may cause dysmenorrhea, pelvic pain, dyspareunia, urinary and intestinal disorders, and infertility. Recently, diet has been identified a potential modifiable risk factor for endometriosis. However, the possible relationship between chronic inflammation from dietary exposure, endometriosis and its main symptoms has not been investigated [1].


The objective of the study is to investigate the association between the dietary inflammatory index (DII), endometriosis and its main symptoms.

Materials and Methods

In this case control study subjects diagnosed with endometriotic lesions by surgery or magnetic resonance were defined as cases (n=59) [2]. Controls (n=59) had no visible ectopic endometrium sites during surgical, that was performed for the treatment of benign diseases, such as ovarian, myoma or other reasons. Women previously diagnosed with adenomyosis, pregnant or breastfeeding; on corticosteroids for autoimmune diseases and malignancies; and those diagnosed with other conditions that could interfere with anthropometric evaluation (anasarca, ascites, lower and upper limb edema, and limbamputation), were excluded from this study. The present study focused on main symptoms of endometriosis, such as dysmenorrhea, chronic pelvic pain, deep dyspareunia and infertility [3]. Measurement of body weight and height (for the calculate of the body mass index BMI), and waist circumference (WC) were performed. Data on dietary intake were collected using a validated semi-quantitative food frequency questionnaire, for the calculate of the DII. This study was approved by the Human Research Ethics Committees of the University Hospital where patients were selected. All participating provided written informed consent [4]. DII scores were analyzed both as a continuous variable and as a dichotomous variable, categorized based on the controls’ median value of the DII (0.86). Continuous variables were analyzed by Student's t-test and categorical variables were analyzed according to association by Pearson's or Fisher's chi-square test. Odds ratios and 95% confidence intervals were estimated using logistic regression models. A p value <0.05 (2 tailed) was considered statistically significant [5].


The cases were younger and had normal weight, whereas the controls were obese. A more pro-inflammatory diet was observed in the cases (DII controls=0.72 ± 1.0 vs. DII cases=1.13 ± 0.8, p=0,025). Compared to controls, cases had more symptoms of pain (dysmenorrhea, chronic pelvic pain, deep dyspareunia). There was no significant difference in infertility between the groups. Women with higher DII scores (>0.86) were more likely to have endometriosis and to present with dyspareunia. Results obtained from the logistic regression model with the DII as a categorical variable showed an almost three times greater chance of having the disease (odds ratio OR=2,77; 95% confidence interval CI=1,13-6,77) for women with DII>0.86 vs those with DII ≤ 0.86, after adjusting for age and BMI. After multivariable adjustment, women with DII>0.86 were four times more likely to have endometriosis compared to women with DII ≤ 0.86 (OR=4,14; 95% CI=1,50-11,4).


A proinflammatory diet, as reflected by higher DII scores, was significantly associated with endometriosis and dyspareunia in a case control study in Brazil. Thus, encourage the intake of more anti-inflammatory dietary factors, such as fruits and vegetables, olive oil, nuts, omega-3 fatty acids, vitamin D and phytochemicals, and reducing intake of pro-inflammatory factors such as saturated fat, ultraprocessed foods rich in trans fatty acid and sugar, may be a nutritional strategy to reduce the chance of developing endometriosis and dyspareunia.


This study would not have been possible without the generous contribution of all women who participated voluntarily.


This research received no external funding.

Ethical Approval

This study was approved in December 6th, 2017, by the Human Research Ethics Committees of the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro (HUCFF-UFRJ 80149617.4.0000.5257/2017).

Informed consent to participate

Written informed consent was obtained from all subjects before the study.

Informed consent to publish

Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.


Study design and conduct, CVDS, VC, and JVC; Data analysis, CVDS, VC and NS; Data interpretation, CVDS; Drafting manuscript, CVDS, VC, NS, JRH, JAP, PDB, JVC, RF, GLAF; Primary responsibility for final version, CVD.

Conflict of Interest

A Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smartphone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project. The authors have no other potential competing interest to disclosure.


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