Greater Intake of Plant-Based Foods Is Unrelated to the Risk of Endometriosis among Predominantly Omnivorous Women in the United States

Mitsunami M, Makiko Mitsunami, Soria-Contreras DC, Diana C. Soria‐Contreras, Diana C Soria-Contreras, Harris HR, Holly R. Harris, Stacey A. Missmer, Missmer SA, Jorge E. Chavarro, Chavarro JE
The Journal of nutrition · 2026 · vol. 156(9) , pp. 101737 · doi:10.1016/j.tjnut.2026.101737 · PMID:42471120 · W7169713724
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In a 30-year study of over 82,000 predominantly omnivorous women, plant-based diet indices were not associated with the risk of laparoscopically-confirmed endometriosis.

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Abstract

BACKGROUND: Longitudinal studies suggest that diets encouraging a higher intake of fruits and vegetables and a lower intake of red meat are associated with a lower risk of laparoscopically confirmed endometriosis. However, no studies have examined whether plant-focused dietary patterns are associated with endometriosis risk. OBJECTIVES: This study aimed to investigate the association between 3 plant-based diet indices and the risk of laparoscopically confirmed endometriosis in a predominantly omnivorous population. METHODS: We followed 82,084 premenopausal women participating in the Nurses' Health Study II for 30 y. Diet was assessed using a validated food frequency questionnaire every 4 y. We calculated an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI); higher scores indicated greater intake of plant foods and lower intake of animal foods. Laparoscopically confirmed endometriosis was ascertained from 1993. We used Cox proportional hazards models with age in months to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During 1,038,888 person-years of follow-up, 3829 cases of laparoscopically confirmed endometriosis were reported. We observed no association between PDIs and endometriosis risk. The HRs of each plant-based diet index with multivariable-adjusted models comparing participants in the highest quintile of adherence to those in the lowest quintile were 1.01 (95% CI: 0.91, 1.13) for PDI, 1.07 (95% CI: 0.96, 1.20) for hPDI, and 1.05 (95% CI: 0.94, 1.16) for uPDI. Estimates were consistent regardless of infertility status. CONCLUSIONS: This study suggests that variation in the proportion of plant to animal foods, as captured by plant-based diet indices within predominantly omnivorous populations, is unrelated to the risk of laparoscopically confirmed endometriosis.

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MeSH descriptors

Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian Diet, Vegetarian

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