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High-fat diet may increase risk of bacterial vaginosis

Obstetrics and gynaecology

Obstetrics and gynaecology

Bacterial vaginosis is characterised by a watery discharge without vaginitis. In addition to malodour, it is associated with adverse pregnancy outcomes and an increase in the risk of HIV and other genital tract infections. It is known to be more common in women who smoke, use the combined contraceptive pill and those who are stressed, although the relationship with this is unclear.

It may be that bacterial vaginosis affects immunity. A study from the US has now investigated the role nutrition may play and found that women with a high-fat diet are at increased risk.

The study recruited 1,521 women from Birmingham, Alabama. Participants completed a detailed food questionnaire and had vaginal microbiological samples collected every three months for up to fifteen months. Total energy intake as well as macro- and micronutrient intake was assessed. Around 86% of the women were African-American and 72% were unmarried. The mean age was 25 years and 45% were obese.

Bacterial vaginosis was identified in 42% of the women and was classed as severe in 15% of the study population. After adjustment, only a weak association with high energy intake was identified. However, an increased incidence of bacterial vaginosis was seen in women with a high fat intake compared with those with the lowest fat intake. This was most marked in women with severe bacterial vaginosis (OR 2.3, 95% CI 1.3-4.3 P=0.04).

An inverse relationship was also noted for protein intake and severe bacterial vaginosis (OR 0.5, 95% CI 0.3-0.9 P=0.03). A similar inverse relationship was noted for several micronutrients, including folic acid, vitamin E and calcium, and severe bacterial vaginosis. These variables were not noted to be linked to incident or persistent cases of bacterial vaginosis over the period of the trial.

Although the study population is different from that typically seen in UK general practice, the association between diet and bacterial vaginosis is intriguing. Bacterial vaginosis appears to be a disturbance in the host's resistance rather than an infection. In women with bacterial vaginosis, attention to diet may be an avenue worth exploring; patients should be encouraged to eat less fat and more fruit and vegetables.

Neggers Y, Nansel TR, Andrews WW et al. Dietary Intake of Selected Nutrients Affects Bacterial Vaginosis in Women. J Nutr 2007;137:2128-33

Reviewer

Dr Chris Barclay
GP, Sheffield

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