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Does  HYPERLINK  "http://www.tandfonline.com/doi/abs/10.1080/16546628.2017.1341809" Food Consumption and Nutrient Intake  Affect Endometriosis Risk? 
Samaneh Youseflu, M.Sc.1, Shahideh Jahanian Sadatmahalleh, Ph.D.1*, Azadeh Mottaghi, Ph.D.2,  Anoshirvan Kazemnejad, Ph.D.3.
Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
*Corresponding Author:
Shahideh Jahanian Sadatmahalleh, Department of Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Ale-Ahmad Highway, Tehran, Iran.
Email: shahideh.jahanian@modares.ac.ir
Tel/Fax: (+98) 2182884826
Abstract:
Background: Endometriosis, defined as the attendance of endometrial-like lesions in extra uterine locations, causes pain, infertility and reduced quality of life. 
Objective: The aim of this study is to evaluate the relationship of food consumption and nutrient intake with endometriosis risk. 
Methods: A case-control study was conducted on 78 women with a laparoscopically confirmed diagnosis of endometriosis and on 78 healthy women (as the control group). Dietary data were collected using a validated 147-item semi-quantitative FFQ with a standard serving size. Logistic regression model was used to determine the association of macronutrients and energy intake with the risk of endometriosis.
Result: In the women with higher protein intake (Fourth Quartile OR:0.36), total fat (Third Quartile OR:0.39), eicosapentaenoic acid (OR:0.0001), docosahexaenoic acid (OR:0.03), monounsaturated fatty acid (Third Quartile OR:0.31) and oleic acid (Second Quartile OR:0.39 and Third Quartile OR:0.28), the risk of endometriosis was less common. High consumption of vegetables (Fourth Quartile OR:0.38), fruits (Fourth Quartile, OR:0.29), potatoes (Third Quartile OR:0.33 and Fourth Quartile OR:0.40), legumes (Third Quartile OR:0.23 and Fourth Quartile OR:0.31), red meat (Fourth Quartile OR:0.36), total dairy food ( Fourth Quartile OR:0.32) and liquid oil (Third Quartile OR:0.42) was associated with a lower risk of endometriosis. But a significant increase in the risk of endometriosis was found for the consumption of fried potatoes (Third Quartile OR: 4.13).
Conclusion: Diet has a major impact on the level of hormones, as well as the immune and inflammatory markers, so it plays an important role in the control and prevention of endometriosis.
Key word: endometriosis, Food Consumption, nutrient intake, Case-Control Study
Introduction:
Endometriosis is defined as the attendance of endometrial glands and stroma in extrauterine locations, it causes pain, infertility and reduced quality of life. Certain diagnosis of endometriosis is performed by using the laparoscopic surgery  ADDIN EN.CITE  ADDIN EN.CITE.DATA (1). The accurate prevalence of endometriosis is secret because there is not a noninvasive tool for diagnosing this disease. Endometriosis affects approximately 2.5-3.3% of reproductive age women  ADDIN EN.CITE <EndNote><Cite><Author>Houston</Author><Year>1987</Year><RecNum>15</RecNum><DisplayText>(2)</DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="pdr0x2ttetw9znexdt1ppv5i295ve9rrrres" timestamp="1524126141">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Houston, D. E.</author><author>Noller, K. L.</author><author>Melton, L. J., 3rd</author><author>Selwyn, B. J.</author><author>Hardy, R. J.</author></authors></contributors><titles><title>Incidence of pelvic endometriosis in Rochester, Minnesota, 1970-1979</title><secondary-title>Am J Epidemiol</secondary-title><alt-title>American journal of epidemiology</alt-title></titles><periodical><full-title>Am J Epidemiol</full-title><abbr-1>American journal of epidemiology</abbr-1></periodical><alt-periodical><full-title>Am J Epidemiol</full-title><abbr-1>American journal of epidemiology</abbr-1></alt-periodical><pages>959-69</pages><volume>125</volume><number>6</number><edition>1987/06/01</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Endometriosis/*epidemiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Medical Records</keyword><keyword>Middle Aged</keyword><keyword>Minnesota</keyword><keyword>Pelvic Neoplasms/*epidemiology</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>1987</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0002-9262 (Print)&#xD;0002-9262</isbn><accession-num>3578254</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(2). while in women with pelvic pain and/or infertility, its prevalence ranges from 30 to 50%  ADDIN EN.CITE <EndNote><Cite><Author>Bulletti</Author><Year>2010</Year><RecNum>5</RecNum><DisplayText>(3)</DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513496604">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bulletti, Carlo</author><author>Coccia, Maria Elisabetta</author><author>Battistoni, Silvia</author><author>Borini, Andrea</author></authors></contributors><titles><title>Endometriosis and infertility</title><secondary-title>Journal of assisted reproduction and genetics</secondary-title></titles><periodical><full-title>Journal of assisted reproduction and genetics</full-title></periodical><pages>441-447</pages><volume>27</volume><number>8</number><dates><year>2010</year></dates><isbn>1058-0468</isbn><urls></urls></record></Cite></EndNote>(3). A common theory for the explanation of endometriosis is as follows: �the reflux of endometrial tissue flows through the fallopian tubes into the peritoneal cavity�  ADDIN EN.CITE <EndNote><Cite><Author>Abomaray</Author><Year>2017</Year><RecNum>3</RecNum><DisplayText>(4)</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513445131">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abomaray, Fawaz</author><author>Gidl�f, Sebastian</author><author>G�therstr�m, Cecilia</author></authors></contributors><titles><title>Mesenchymal Stromal Cells Are More Immunosuppressive In Vitro If They Are Derived from Endometriotic Lesions than from Eutopic Endometrium</title><secondary-title>Stem Cells International</secondary-title></titles><periodical><full-title>Stem Cells International</full-title></periodical><volume>2017</volume><dates><year>2017</year></dates><isbn>1687-966X</isbn><urls></urls></record></Cite></EndNote>(4). The etiology of endometriosis is complex and multifaceted that involves hormonal, genetic and immunologic mechanisms, contraction of the smooth muscle and inflammatory factors, as well as anatomic and environmental agents such as diet and exercise  ADDIN EN.CITE <EndNote><Cite><Author>Sourial</Author><Year>2014</Year><RecNum>4</RecNum><DisplayText>(5)</DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513495856">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sourial, Samer</author><author>Tempest, Nicola</author><author>Hapangama, Dharani K</author></authors></contributors><titles><title>Theories on the pathogenesis of endometriosis</title><secondary-title>International journal of reproductive medicine</secondary-title></titles><periodical><full-title>International journal of reproductive medicine</full-title></periodical><volume>2014</volume><dates><year>2014</year></dates><isbn>2356-7104</isbn><urls></urls></record></Cite></EndNote>(5). Agents that impress the volume of retrograde menstruation or affect a woman�s aptitude for implantation of the endometriotic lesion are of etiological fondness. Scientific research has proposed that estrogen without progesterone may enhance the endometriosis risk  ADDIN EN.CITE <EndNote><Cite><Author>Vercellini</Author><Year>2016</Year><RecNum>7</RecNum><DisplayText>(6)</DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513498111">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vercellini, Paolo</author><author>Buggio, Laura</author><author>Berlanda, Nicola</author><author>Barbara, Giussy</author><author>Somigliana, Edgardo</author><author>Bosari, Silvano</author></authors></contributors><titles><title>Estrogen-progestins and progestins for the management of endometriosis</title><secondary-title>Fertility and sterility</secondary-title></titles><periodical><full-title>Fertility and sterility</full-title></periodical><pages>1552-1571. e2</pages><volume>106</volume><number>7</number><dates><year>2016</year></dates><isbn>0015-0282</isbn><urls></urls></record></Cite></EndNote>(6). 
Some dietary components could modulate endogenous hormone metabolism as well as demonstrate or imitate estrogen; for example, consumption of fat, phytoestrogen, coffee, fiber and alcohol has been related with endogenous estrogen levels. Fatty acids of diet can modify inflammatory markers  ADDIN EN.CITE <EndNote><Cite><Author>Minihane</Author><Year>2015</Year><RecNum>8</RecNum><DisplayText>(7)</DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513498905">8</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Minihane, Anne M</author><author>Vinoy, Sophie</author><author>Russell, Wendy R</author><author>Baka, Athanasia</author><author>Roche, Helen M</author><author>Tuohy, Kieran M</author><author>Teeling, Jessica L</author><author>Blaak, Ellen E</author><author>Fenech, Michael</author><author>Vauzour, David</author></authors></contributors><titles><title>Low-grade inflammation, diet composition and health: current research evidence and its translation</title><secondary-title>British Journal of Nutrition</secondary-title></titles><periodical><full-title>British Journal of Nutrition</full-title></periodical><pages>999-1012</pages><volume>114</volume><number>7</number><dates><year>2015</year></dates><isbn>0007-1145</isbn><urls></urls></record></Cite></EndNote>(7). Dairy foods contain estrogen, progesterone, anti-tumorigenic and anti-inflammatory ingredients, calcium, vitamin D, butyric acid and polyunsaturated fatty acids (PUFAs)  ADDIN EN.CITE <EndNote><Cite><Author>Feeney</Author><Year>2017</Year><RecNum>10</RecNum><DisplayText>(8)</DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513499789">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Feeney, EL</author><author>O&apos;sullivan, A</author><author>Nugent, AP</author><author>McNulty, B</author><author>Walton, Janette</author><author>Flynn, Albert</author><author>Gibney, ER</author></authors></contributors><titles><title>Patterns of dairy food intake, body composition and markers of metabolic health in Ireland: results from the National Adult Nutrition Survey</title><secondary-title>Nutrition &amp; diabetes</secondary-title></titles><periodical><full-title>Nutrition &amp; diabetes</full-title></periodical><pages>e243</pages><volume>7</volume><number>2</number><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>(8). Consumption of fruits and vegetables, rich in different antioxidants, phytochemicals and anti-carcinogenic substances can modify the function of the immune system and ruin the free radicals  ADDIN EN.CITE <EndNote><Cite><Author>Duthie</Author><Year>2017</Year><RecNum>9</RecNum><DisplayText>(9)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1513499357">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Duthie, Susan J</author><author>Duthie, Garry G</author><author>Russell, Wendy R</author><author>Kyle, Janet AM</author><author>Macdiarmid, Jennie I</author><author>Rungapamestry, Vanessa</author><author>Stephen, Sylvia</author><author>Megias-Baeza, Cristina</author><author>Kaniewska, Joanna J</author><author>Shaw, Lindsey</author></authors></contributors><titles><title>Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change: a randomised trial</title><secondary-title>European journal of nutrition</secondary-title></titles><periodical><full-title>European journal of nutrition</full-title></periodical><pages>1-18</pages><dates><year>2017</year></dates><isbn>1436-6207</isbn><urls></urls></record></Cite></EndNote>(9). The objective of the present study was to compare the dietary intake of fruits and vegetables, cereals, meats, oils, dairy products and other macronutrients in women with and without pelvic endometriosis.
Materials and Methods:
This case-control study was conducted between May 2016 and February 2017 on endometriosis women in Infertility Clinic of Arash Hospital in Tehran, Iran. The total number of infertile women who underwent diagnostic laparoscopy during the period of the study was allocated. Those women who had abnormalities other than endometriosis at laparoscopy were excluded from the study. The total of 156 women were included in the study. They were divided according to the laparoscopy findings into two groups: a case group (N=78), consisting of women with pelvic endometriosis, and a control group (N=78) including women with a normal pelvis. Women in the two groups were comparable in demographic and personal characteristics.
Inclusion criteria included age between 15-45 years, absence of the history of chronic diseases, Iranian race, no pervious pregnancy, not using medication affecting the adsorption of food, appetite and basal metabolism of the body, no smoking and lack of mental retardation.
In the beginning, a socio-demographic questionnaire including questions about socio-economic status was completed. This study was approved by the Ethics Committee of Tarbiat Modares University of Medical Sciences (IRB#528239). All women participated voluntarily and provided a signed informed consent. Marital status, age, smoking, education, habitat, physical activity, ethnicity, anthropometric measures, obstetrics and gynecology characteristics and medical histories was completed by women. Then the dietary information was completed by the researcher.
Assessment of diet
In the face-to-face interviews by trained staff, common dietary intake in the one beforehand year was assessed by validated 147-item semi-quantitative FFQ  ADDIN EN.CITE <EndNote><Cite><Author>Mirmiran</Author><Year>2010</Year><RecNum>37</RecNum><DisplayText>(10)</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537619">37</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mirmiran, Parvin</author><author>Esfahani, Firoozeh Hosseini</author><author>Mehrabi, Yadollah</author><author>Hedayati, Mahdi</author><author>Azizi, Fereidoon</author></authors></contributors><titles><title>Reliability and relative validity of an FFQ for nutrients in the Tehran Lipid and Glucose Study</title><secondary-title>Public health nutrition</secondary-title></titles><periodical><full-title>Public health nutrition</full-title></periodical><pages>654-662</pages><volume>13</volume><number>5</number><dates><year>2010</year></dates><isbn>1475-2727</isbn><urls></urls></record></Cite></EndNote>(10). This questionnaire includes a number of dietary items from Iranian usual foods with standard serving measures. The Persian version of FFQ has previously been evaluated for both reliability and validity  ADDIN EN.CITE <EndNote><Cite><Author>Mirmiran</Author><Year>2010</Year><RecNum>37</RecNum><DisplayText>(10)</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537619">37</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mirmiran, Parvin</author><author>Esfahani, Firoozeh Hosseini</author><author>Mehrabi, Yadollah</author><author>Hedayati, Mahdi</author><author>Azizi, Fereidoon</author></authors></contributors><titles><title>Reliability and relative validity of an FFQ for nutrients in the Tehran Lipid and Glucose Study</title><secondary-title>Public health nutrition</secondary-title></titles><periodical><full-title>Public health nutrition</full-title></periodical><pages>654-662</pages><volume>13</volume><number>5</number><dates><year>2010</year></dates><isbn>1475-2727</isbn><urls></urls></record></Cite></EndNote>(10). 
The participants were asked to report their usual food intake during the previous year on a daily, weekly, monthly and yearly basis; all these were converted to daily intakes. By using domestic measurement, portion sizes of the consumed food were transformed to grams  ADDIN EN.CITE <EndNote><Cite><Author>Ghaffarpour</Author><Year>1999</Year><RecNum>21</RecNum><DisplayText>(11)</DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="r550wva5fv0ez1e2et45d20taere0f5v5drp">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ghaffarpour, M.</author><author>Houshiar-Rad, A.</author><author>Kianfar, H.</author></authors></contributors><titles><title>The manual for household measures, cooking yields factors and edible portion of foods</title><secondary-title>Tehran: Nashre Olume Keshavarzy</secondary-title></titles><periodical><full-title>Tehran: Nashre Olume Keshavarzy</full-title></periodical><pages>1-40</pages><dates><year>1999</year></dates><urls></urls></record></Cite></EndNote>(11). All consumed dietary items were analyzed for their energy and nutrient components using a nutrient database (Nutritionist H, Mosby Nutritract software, and ver.7.0, N-Squared computing, Salem, OR, USA), which was modified according to the Iranian Food Composition Table (FCT)  ADDIN EN.CITE <EndNote><Cite><Author>Azar</Author><Year>1980</Year><RecNum>22</RecNum><DisplayText>(12)</DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="r550wva5fv0ez1e2et45d20taere0f5v5drp">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Azar, M.</author><author>Sarkisian, E.</author></authors></contributors><titles><title>Food composition table of Iran</title><secondary-title>Tehran: National Nutrition and Food Research Institute, Shaheed Beheshti University</secondary-title></titles><periodical><full-title>Tehran: National Nutrition and Food Research Institute, Shaheed Beheshti University</full-title></periodical><volume>65</volume><dates><year>1980</year></dates><urls></urls></record></Cite></EndNote>(12) because the Iranian FCT is incomplete. 
We excluded individuals who reported unusual total energy intake levels (more than 4300 kcal or less than 670 kcal).
Statistical analysis
Statistical analysis of the obtained data was performed by using the, SPSS Software (ver.21). The K�S test was selected to check the variables� normality. Comparisons between the two groups were done using T, Mann-Whitney and Chi-square tests, and P-values under 0.05 were considered statistically significant. For the different variables, odds ratio and 95% confidence intervals (CIs) were calculated using logistic regression models to assess the strength of the associations between the intake of food groups or nutrients and the risk of endometriosis. Each dietary variable was divided into four groups using quartile of intake based on the distribution of control subjects. To calculate the linear trend in the odds of dietary variable quartile, median factor score of each quartile was entered into the logistic regression analysis. 
Results: 
Table 1 describes the characteristics of women in the case and control groups. There was no statistically significant difference in the women�s age, BMI, parity, educational, marital status, occupation, income, and age at menarche between the two groups.
Table 2 summarizes the ORs for endometriosis by daily nutrient intake such as energy, type of protein, carbohydrate and selected fatty acids according to quartile of intake. 
There was no significant difference between the two groups for received energy from protein, carbohydrate and fat. Also consumption of total protein showed not significant relationship between the two groups (Fourth Quartile OR: 0.36; %95CI: 0.14-0.91; P-trend=0.06), but in the women with higher protein intake, especially animal protein (Fourth Quartile OR: 0.36; %95CI: 0.14-0.91; P-trend=0.02), endometriosis is less common. Intake of total fat was significant only for the third quartile (Third Quartile OR: 0.39; %95CI: 0.16-0.97; P-trend=0.60). Consumption of eicosapentaenoic acid (EPA) (OR: 0.0001, %95CI: 00.0-0.62, P-trend=0.049) and docosahexaenoic acid (DHA) (OR: 0.03; %95CI: 0.00-0.95; P-trend=0.04) was statistically significant between the two groups. We observed inverse associations between the consumption of monounsaturated fatty acids (MUFAs) and endometriosis risk in the third quartile (OR: 0.31; %95CI: 0.12-0.79; P-trend=0.60). Oleic acid intake in women with endometriosis was less than in the control group (Second Quartile OR: 0.39; %95CI: 0.15-0.96 and third quartile OR: 0.28; %95CI: 0.11-0.71; P-trend=0.64). In the women with endometriosis, consumption of soluble and insoluble fiber was significantly less than in the control group (P=0.04) but this relationship was not seen in total fiber consumption.
Table 3 demonstrates the Odds Ratios (OR) of endometriosis and the corresponding 95% confidence intervals (CI) according to the quartiles of daily intake of food. 
High consumption of vegetables was associated with a lower risk of endometriosis (Fourth Quartile OR: 0.38; %95CI: 0.15-0.96; P-trend: 0.25), but this difference was more related to the consumption of yellow vegetables (OR: 0.98; %95CI: 0.96-0.99; P-trend= 0.03). Increased consumption of potatoes as one of the starchy vegetables was associated with a reduced risk of endometriosis (Third Quartile OR: 0.33; %95CI: 0.13-0.85, Fourth Quartile OR: 0.40; %95CI: 0.16-0.99; P-trend=0.11), but a significant increase in the risk of endometriosis was found for fried potatoes (Third Quartile OR: 4.13; %95CI: 1.6-10.66; P-trend= 0.19). Consumption of fruit in the upper quartile was associated with a significantly decreased endometriosis risk (Fourth Quartile, OR: 0.29; %95CI: 0.11-0.74; P-trend= 0.10). A higher consumption of legumes was inversely associated with endometriosis risk (Third Quartile OR: 0.23; %95CI: 0.09-0.60, Fourth Quartile OR: 0.31; %95CI: 0.12-0.83, P-trend= 0.02). Consumption of red meat in the fourth quartile was associated with a lower risk for endometriosis (Fourth Quartile OR: 0.36; %95CI: 0.14-0.91; P-trend=0.09). The individuals in the highest quartile of total dairy products, consumption had a significantly lower risk of endometriosis than those in the lowest quartile (OR: 0.32; %95CI: 0.13-0.82; P-trend=0.01). However, this relationship was not seen in the type of dairy products (low-fat or high-fat). Cconsumption of liquid oil in the third quartile was associated with reduced risk of endometriosis (Third Quartile OR: 0.42; %95CI: 0.19-0.90; P-trend=0.21). 
Discussion:
Our findings suggest that higher consumption of vegetables, especially yellow vegetables, dairy products, fruits, legumes, red meat, potato and liquid oil was associated with reduced endometriosis risk in women, whereas positive associations were found for the consumption of fried potatoes and endometriosis risk. Regarding nutrient intake, protein, especially animal protein, total fat, EPA, MUFA and oleic acid, as well as soluble and insoluble fiber were related to a decreased risk of endometriosis.
Only in the upper quartiles, protein intake was associated with a reduced risk of endometriosis. By dividing the proteins into two groups of animal and plant origin, this association was seen only in the consumption of animal-based proteins. Eggs, dairy products, fish, and meat are the main sources of meat-based proteins. Dietary sources of vegetable protein include cereals, legumes and nuts. The body requires the protein for production of hormones, enzymes, antibodies and hemoglobin. Net protein synthesis is more with a high animal-protein diet than with a high vegetable-protein diet. Plant-based proteins are deficient in most of amino acids, including lysine, methionine, cysteine, tryptophan, threonine, and glycine  ADDIN EN.CITE <EndNote><Cite><Author>Hoffman</Author><Year>2004</Year><RecNum>1</RecNum><DisplayText>(13)</DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="w59wt2t2g0fwe8e9d9rpfdfp9rs09txswp5t" timestamp="1512972786">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoffman, Jay R.</author><author>Falvo, Michael J.</author></authors></contributors><titles><title>Protein � Which is Best?</title><secondary-title>Journal of Sports Science &amp; Medicine</secondary-title></titles><periodical><full-title>Journal of Sports Science &amp; Medicine</full-title></periodical><pages>118-130</pages><volume>3</volume><number>3</number><dates><year>2004</year><pub-dates><date>09/01&#xD;05/26/received&#xD;06/28/accepted</date></pub-dates></dates><publisher>Asist Group</publisher><isbn>1303-2968</isbn><accession-num>PMC3905294</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905294/</url></related-urls></urls><remote-database-name>PMC</remote-database-name></record></Cite></EndNote>(13). Eggs are rich sources of bioactive proteins that are effective in the down regulation of cytokine-induced inflammatory proteins and reduction of oxidative stress  ADDIN EN.CITE <EndNote><Cite><Author>Majumder</Author><Year>2013</Year><RecNum>16</RecNum><DisplayText>(14)</DisplayText><record><rec-number>16</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">16</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Majumder, Kaustav</author><author>Chakrabarti, Subhadeep</author><author>Davidge, Sandra T</author><author>Wu, Jianping</author></authors></contributors><titles><title>Structure and activity study of egg protein ovotransferrin derived peptides (IRW and IQW) on endothelial inflammatory response and oxidative stress</title><secondary-title>Journal of agricultural and food chemistry</secondary-title></titles><periodical><full-title>Journal of agricultural and food chemistry</full-title></periodical><pages>2120-2129</pages><volume>61</volume><number>9</number><dates><year>2013</year></dates><isbn>0021-8561</isbn><urls></urls></record></Cite></EndNote>(14). Casein and whey protein in milk products have anti-inflammatory properties as well as immunomodulation and anti-carcinogenic activity  ADDIN EN.CITE <EndNote><Cite><Author>Davoodi</Author><Year>2016</Year><RecNum>13</RecNum><DisplayText>(15)</DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Davoodi, Seyed Hossein</author><author>Shahbazi, Roghiyeh</author><author>Esmaeili, Saeideh</author><author>Sohrabvandi, Sara</author><author>Mortazavian, AmirMohamamd</author><author>Jazayeri, Sahar</author><author>Taslimi, Aghdas</author></authors></contributors><titles><title>Health-Related Aspects of Milk Proteins</title><secondary-title>Iranian journal of pharmaceutical research: IJPR</secondary-title></titles><periodical><full-title>Iranian journal of pharmaceutical research: IJPR</full-title></periodical><pages>573</pages><volume>15</volume><number>3</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>(15). High-protein diet helps improve lipid profile and weight loss  ADDIN EN.CITE <EndNote><Cite><Author>Layman</Author><Year>2003</Year><RecNum>15</RecNum><DisplayText>(16)</DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Layman, Donald K</author><author>Boileau, Richard A</author><author>Erickson, Donna J</author><author>Painter, James E</author><author>Shiue, Harn</author><author>Sather, Carl</author><author>Christou, Demtra D</author></authors></contributors><titles><title>A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women</title><secondary-title>The Journal of nutrition</secondary-title></titles><periodical><full-title>The Journal of nutrition</full-title></periodical><pages>411-417</pages><volume>133</volume><number>2</number><dates><year>2003</year></dates><isbn>0022-3166</isbn><urls></urls></record></Cite></EndNote>(16). Therefore, high protein diet is effective on the immune and hormonal systems. Inflammatory response and weight loss can be related to endometriosis risk.
In the current study, total fat intake in the third quartile was associated with reduced risk of endometriosis. Following the classification of fats, this relationship was found only in the consumption of MUFAs (in the third quartile), especially oleic acid for the second and third quartiles and EPA. Consumption of MUFAs, oleic acid, and EPA was associated with decreased CRP levels and suppression of immune cell functions  ADDIN EN.CITE <EndNote><Cite><Author>Niknam</Author><Year>2014</Year><RecNum>18</RecNum><DisplayText>(17, 18)</DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Niknam, Mahdieh</author><author>Paknahad, Zamzam</author><author>Maracy, Mohammad Reza</author><author>Hashemi, Mohammad</author></authors></contributors><titles><title>Dietary fatty acids and inflammatory markers in patients with coronary artery disease</title><secondary-title>Advanced biomedical research</secondary-title></titles><periodical><full-title>Advanced biomedical research</full-title></periodical><pages>148-148</pages><volume>3</volume><dates><year>2014</year></dates><urls></urls></record></Cite><Cite><Author>Yaqoob</Author><Year>2016</Year><RecNum>20</RecNum><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Yaqoob, Parveen</author><author>Childs, Caroline</author></authors></contributors><titles><title>Fatty Acids and the Immune System</title><secondary-title>Encyclopedia of Immunotoxicology</secondary-title></titles><periodical><full-title>Encyclopedia of Immunotoxicology</full-title></periodical><pages>315-318</pages><dates><year>2016</year></dates><isbn>3642545955</isbn><urls></urls></record></Cite></EndNote>(17, 18). In this regard, the results of Trabert et al.�s study  ADDIN EN.CITE <EndNote><Cite><Author>Trabert</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText>(19)</DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trabert, Britton</author><author>Peters, Ulrike</author><author>De Roos, Anneclaire J</author><author>Scholes, Delia</author><author>Holt, Victoria L</author></authors></contributors><titles><title>Diet and risk of endometriosis in a population-based case�control study</title><secondary-title>British Journal of Nutrition</secondary-title></titles><periodical><full-title>British Journal of Nutrition</full-title></periodical><pages>459-467</pages><volume>105</volume><number>3</number><dates><year>2011</year></dates><isbn>1475-2662</isbn><urls></urls></record></Cite></EndNote>(19) showed that more consumption of total fats, MUFAs and dairy products was associated with a decrease in the risk of endometriosis. On the contrary, in the study by Britton et al.  ADDIN EN.CITE <EndNote><Cite><Author>Britton</Author><Year>2000</Year><RecNum>11</RecNum><DisplayText>(20)</DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Britton, Julie A</author><author>Westhoff, Carolyn</author><author>Howe, Geoffrey</author><author>Gammon, Marilie D</author></authors></contributors><titles><title>Diet and benign ovarian tumors (United States)</title><secondary-title>Cancer Causes and Control</secondary-title></titles><periodical><full-title>Cancer Causes and Control</full-title></periodical><pages>389-401</pages><volume>11</volume><number>5</number><dates><year>2000</year></dates><isbn>0957-5243</isbn><urls></urls></record></Cite></EndNote>(20), high intake of vegetable fat and MUFAs was associated with an increased risk of endometriosis. While Missmer et al. ADDIN EN.CITE <EndNote><Cite><Author>Missmer</Author><Year>2010</Year><RecNum>17</RecNum><DisplayText>(21)</DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Missmer, Stacey A</author><author>Chavarro, Jorge E</author><author>Malspeis, Susan</author><author>Bertone-Johnson, Elizabeth R</author><author>Hornstein, Mark D</author><author>Spiegelman, Donna</author><author>Barbieri, Robert L</author><author>Willett, Walter C</author><author>Hankinson, Susan E</author></authors></contributors><titles><title>A prospective study of dietary fat consumption and endometriosis risk</title><secondary-title>Human Reproduction</secondary-title></titles><periodical><full-title>Human Reproduction</full-title></periodical><pages>1528-1535</pages><volume>25</volume><number>6</number><dates><year>2010</year></dates><isbn>1460-2350</isbn><urls></urls></record></Cite></EndNote>(21), did not observe a significant association between total fat consumption and endometriosis risk, but high intake of Omega-3 was linked to a reduced risk of endometriosis, and high intake of trans-unsaturated fat was associated with an increased risk of endometriosis.
In this study, total fiber intake was not significantly different between the two groups, but both soluble and insoluble fibers� intake in the case group was less than in the control group.
Experimental studies have shown that a high-fiber diet has a down-regulation role on inflammation and reduces CRP level  ADDIN EN.CITE <EndNote><Cite><Author>Khayyatzadeh</Author><Year>2017</Year><RecNum>14</RecNum><DisplayText>(22)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Khayyatzadeh, Sayyed Saeid</author><author>Kazemi-Bajestani, Seyyed Mohammad Reza</author><author>Bagherniya, Mohammad</author><author>Mehramiz, Mehraneh</author><author>Tayefi, Maryam</author><author>Ebrahimi, Mahmoud</author><author>Ferns, Gordon A</author><author>Safarian, Mohammad</author><author>Ghayour-Mobarhan, Majid</author></authors></contributors><titles><title>Serum high C reactive protein concentrations are related to the intake of dietary macronutrients and fiber: Findings from a large representative Persian population sample</title><secondary-title>Clinical Biochemistry</secondary-title></titles><periodical><full-title>Clinical Biochemistry</full-title></periodical><dates><year>2017</year></dates><isbn>0009-9120</isbn><urls></urls></record></Cite></EndNote>(22). A diet rich in fiber could elevate SHBG levels  ADDIN EN.CITE <EndNote><Cite><Author>Huang</Author><Year>2017</Year><RecNum>25</RecNum><DisplayText>(23)</DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Huang, Mengna</author><author>Liu, Jinjie</author><author>Lin, Xiaochen</author><author>Goto, Atsushi</author><author>Song, Yiqing</author><author>Tinker, Lesley F</author><author>Chan, Kei hang Katie</author><author>Liu, Simin</author></authors></contributors><titles><title>Relationship between dietary carbohydrates intake and circulating sex hormone binding globulin levels in postmenopausal women</title><secondary-title>Journal of Diabetes</secondary-title></titles><periodical><full-title>Journal of Diabetes</full-title></periodical><dates><year>2017</year></dates><isbn>1753-0407</isbn><urls></urls></record></Cite></EndNote>(23) and thus decrease the level of bioavailable estrogens. On the contrary, in the study of Savaris, high dietary fiber intake was associated with an increased risk of endometriosis  ADDIN EN.CITE <EndNote><Cite><Author>Savaris</Author><Year>2011</Year><RecNum>29</RecNum><DisplayText>(24)</DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Savaris, Ana Luiza</author><author>do Amaral, Vivian F</author></authors></contributors><titles><title>Nutrient intake, anthropometric data and correlations with the systemic antioxidant capacity of women with pelvic endometriosis</title><secondary-title>European Journal of Obstetrics &amp; Gynecology and Reproductive Biology</secondary-title></titles><periodical><full-title>European Journal of Obstetrics &amp; Gynecology and Reproductive Biology</full-title></periodical><pages>314-318</pages><volume>158</volume><number>2</number><dates><year>2011</year></dates><isbn>0301-2115</isbn><urls></urls></record></Cite></EndNote>(24). In other studies, there was no significant relationship between dietary fiber intake and risk of endometriosis.
In this study, increased consumption of vegetables and fruits in the fourth quartile was related to a reduced risk of endometriosis, but the difference was related to the consumption of yellow vegetables. High consumption of vegetables and fruits was associated with improved serum antioxidant status and lower concentrations of CRP  ADDIN EN.CITE <EndNote><Cite><Author>Almeida-de-Souza</Author><Year>2017</Year><RecNum>21</RecNum><DisplayText>(25)</DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Almeida-de-Souza, Juliana</author><author>Santos, Rute</author><author>Lopes, Luis</author><author>Abreu, Sandra</author><author>Moreira, Carla</author><author>Padr�o, Patr�cia</author><author>Mota, Jorge</author><author>Moreira, Pedro</author></authors></contributors><titles><title>Associations between fruit and vegetable variety and low-grade inflammation in Portuguese adolescents from LabMed Physical Activity Study</title><secondary-title>European Journal of Nutrition</secondary-title></titles><periodical><full-title>European journal of nutrition</full-title></periodical><pages>1-14</pages><dates><year>2017</year></dates><isbn>1436-6207</isbn><urls></urls></record></Cite></EndNote>(25). Similarly, in Parazzini�s study, increased intake of vegetables was associated with a reduction in the risk of endometriosis  ADDIN EN.CITE <EndNote><Cite><Author>Parazzini</Author><Year>2004</Year><RecNum>28</RecNum><DisplayText>(26)</DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parazzini, F</author><author>Chiaffarino, F</author><author>Surace, M</author><author>Chatenoud, L</author><author>Cipriani, S</author><author>Chiantera, V</author><author>Benzi, G</author><author>Fedele, L</author></authors></contributors><titles><title>Selected food intake and risk of endometriosis</title><secondary-title>Human Reproduction</secondary-title></titles><periodical><full-title>Human Reproduction</full-title></periodical><pages>1755-1759</pages><volume>19</volume><number>8</number><dates><year>2004</year></dates><isbn>1460-2350</isbn><urls></urls></record></Cite></EndNote>(26). On the contrary, in the study of Trabert, high consumption of fruits was significantly associated with increased risk for endometriosis  ADDIN EN.CITE <EndNote><Cite><Author>Trabert</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText>(19)</DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trabert, Britton</author><author>Peters, Ulrike</author><author>De Roos, Anneclaire J</author><author>Scholes, Delia</author><author>Holt, Victoria L</author></authors></contributors><titles><title>Diet and risk of endometriosis in a population-based case�control study</title><secondary-title>British Journal of Nutrition</secondary-title></titles><periodical><full-title>British Journal of Nutrition</full-title></periodical><pages>459-467</pages><volume>105</volume><number>3</number><dates><year>2011</year></dates><isbn>1475-2662</isbn><urls></urls></record></Cite></EndNote>(19).
The data showed that the consumption of potato was associated with the reduced risk of endometriosis; however, eating fried potatoes increased the risk of endometriosis. Potatoes contain plant phenols and antioxidant compounds, which improve the level of lipids and lipoproteins in the blood; thus they have anti-inflammatory properties and reduce the concentration of CRP and IL6  ADDIN EN.CITE <EndNote><Cite><Author>McGill</Author><Year>2013</Year><RecNum>26</RecNum><DisplayText>(27)</DisplayText><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McGill, Carla R</author><author>Kurilich, Anne C</author><author>Davignon, Jean</author></authors></contributors><titles><title>The role of potatoes and potato components in cardiometabolic health: a review</title><secondary-title>Annals of medicine</secondary-title></titles><periodical><full-title>Annals of medicine</full-title></periodical><pages>467-473</pages><volume>45</volume><number>7</number><dates><year>2013</year></dates><isbn>0785-3890</isbn><urls></urls></record></Cite></EndNote>(27). High carbohydrate foods fried at high temperatures lead to the release of carcinogens like acrylamide. Dietary acrylamide in fried potatoes causes decreased serum level of total high-density lipoprotein and total testosterone and increases the production of reactive oxygen species, CRP, interleukin-6 and �-glutamyl transferase  ADDIN EN.CITE <EndNote><Cite><Author>Naruszewicz</Author><Year>2009</Year><RecNum>7</RecNum><DisplayText>(28)</DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="atwp9frd4v0rriesewvv25eqtvp52r9fa5tf" timestamp="1513517454">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naruszewicz, Marek</author><author>Zapolska-Downar, Danuta</author><author>Ko[mider, Anita</author><author>Nowicka, Gra|yna</author><author>KozBowska-Wojciechowska, MaBgorzata</author><author>Vikstr�m, Anna S</author><author>T�rnqvist, Margareta</author></authors></contributors><titles><title>Chronic intake of potato chips in humans increases the production of reactive oxygen radicals by leukocytes and increases plasma C-reactive protein: a pilot study</title><secondary-title>The American journal of clinical nutrition</secondary-title></titles><periodical><full-title>The American journal of clinical nutrition</full-title></periodical><pages>773-777</pages><volume>89</volume><number>3</number><dates><year>2009</year></dates><isbn>0002-9165</isbn><urls></urls></record></Cite></EndNote>(28). 
In our study, increased consumption of red meat in the fourth quartile was associated with a reduced risk of endometriosis. Red meat is a rich source of high biological components such as protein, iron, vitamin B12, folic acid, zinc, selenium, and phosphorus. Taurine and PUFAs in animal meats have antioxidant and anti-inflammatory effects  ADDIN EN.CITE <EndNote><Cite><Author>Baltic</Author><Year>2015</Year><RecNum>22</RecNum><DisplayText>(29)</DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baltic, Milan Z</author><author>Boskovic, Marija</author></authors></contributors><titles><title>When man met meat: meat in human nutrition from ancient times till today</title><secondary-title>Procedia Food Science</secondary-title></titles><periodical><full-title>Procedia Food Science</full-title></periodical><pages>6-9</pages><volume>5</volume><dates><year>2015</year></dates><isbn>2211-601X</isbn><urls></urls></record></Cite></EndNote>(29). In Trabert et al.�s study, there was no significant relationship between the consumption of red meat and endometriosis risk. However, the meat intake was slightly higher in the control group  ADDIN EN.CITE <EndNote><Cite><Author>Trabert</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText>(19)</DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trabert, Britton</author><author>Peters, Ulrike</author><author>De Roos, Anneclaire J</author><author>Scholes, Delia</author><author>Holt, Victoria L</author></authors></contributors><titles><title>Diet and risk of endometriosis in a population-based case�control study</title><secondary-title>British Journal of Nutrition</secondary-title></titles><periodical><full-title>British Journal of Nutrition</full-title></periodical><pages>459-467</pages><volume>105</volume><number>3</number><dates><year>2011</year></dates><isbn>1475-2662</isbn><urls></urls></record></Cite></EndNote>(19). Only in the study of Parazzini, increased consumption of red meat was significantly associated with an increased risk of endometriosis  ADDIN EN.CITE <EndNote><Cite><Author>Parazzini</Author><Year>2004</Year><RecNum>28</RecNum><DisplayText>(26)</DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parazzini, F</author><author>Chiaffarino, F</author><author>Surace, M</author><author>Chatenoud, L</author><author>Cipriani, S</author><author>Chiantera, V</author><author>Benzi, G</author><author>Fedele, L</author></authors></contributors><titles><title>Selected food intake and risk of endometriosis</title><secondary-title>Human Reproduction</secondary-title></titles><periodical><full-title>Human Reproduction</full-title></periodical><pages>1755-1759</pages><volume>19</volume><number>8</number><dates><year>2004</year></dates><isbn>1460-2350</isbn><urls></urls></record></Cite></EndNote>(26). Average meat consumption in Iranian population is much lower than in the Italian population. Another difference is that there has been a dioxin contamination in foodstuff and animal food in Italy during the above study period, which could be effective on the study results  ADDIN EN.CITE <EndNote><Cite><Author>Feil</Author><Year>1998</Year><RecNum>36</RecNum><DisplayText>(30)</DisplayText><record><rec-number>36</rec-number><foreign-keys><key app="EN" db-id="xpeas5frtewtx4efwerp2pvtt0zpfrzsf2rd">36</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Feil, V. J.</author><author>Ellis, R. L.</author></authors></contributors><auth-address>Biosciences Research Laboratory, ARS, USDA, Fargo, ND 58105, USA.</auth-address><titles><title>The USDA perspective on dioxin concentrations in dairy and beef</title><secondary-title>J Anim Sci</secondary-title><alt-title>Journal of animal science</alt-title></titles><pages>152-9</pages><volume>76</volume><number>1</number><edition>1998/02/17</edition><keywords><keyword>Animals</keyword><keyword>Carbon Radioisotopes</keyword><keyword>Cattle</keyword><keyword>Dairy Products/*analysis</keyword><keyword>Dioxins/*analysis/metabolism</keyword><keyword>Female</keyword><keyword>Furans/analysis/metabolism</keyword><keyword>Male</keyword><keyword>Meat/*analysis</keyword><keyword>Medicago sativa/chemistry</keyword><keyword>Polychlorinated Biphenyls/analysis/metabolism</keyword><keyword>Rats</keyword><keyword>Tissue Distribution</keyword><keyword>Triticum/chemistry</keyword><keyword>United States</keyword><keyword>*United States Department of Agriculture</keyword><keyword>Zea mays/chemistry</keyword></keywords><dates><year>1998</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0021-8812 (Print)&#xD;0021-8812 (Linking)</isbn><accession-num>9464896</accession-num><work-type>Review</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/9464896</url></related-urls></urls><language>eng</language></record></Cite></EndNote>(30). In addition, the way of cooking meat can be highly effective in its components  ADDIN EN.CITE <EndNote><Cite><Author>Di Maso</Author><Year>2013</Year><RecNum>32</RecNum><DisplayText>(31)</DisplayText><record><rec-number>32</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537619">32</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Di Maso, M</author><author>Talamini, R</author><author>Bosetti, C</author><author>Montella, M</author><author>Zucchetto, A</author><author>Libra, M</author><author>Negri, E</author><author>Levi, F</author><author>La Vecchia, C</author><author>Franceschi, S</author></authors></contributors><titles><title>Red meat and cancer risk in a network of case�control studies focusing on cooking practices</title><secondary-title>Annals of oncology</secondary-title></titles><periodical><full-title>Annals of oncology</full-title></periodical><pages>3107-3112</pages><volume>24</volume><number>12</number><dates><year>2013</year></dates><isbn>1569-8041</isbn><urls></urls></record></Cite></EndNote>(31), and we know that different nations and cultures have different cooking habits/styles.
Our findings in this study showed decreased risk of endometriosis with increased intake of legumes. Legume consumption was inversely associated with the serum concentrations of CRP, TNF�, IL-6 and other adhesion molecules, as well as the level of adiponectin  ADDIN EN.CITE <EndNote><Cite><Author>Saraf-Bank</Author><Year>2015</Year><RecNum>40</RecNum><DisplayText>(32)</DisplayText><record><rec-number>40</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537619">40</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saraf-Bank, Sahar</author><author>Esmaillzadeh, Ahmad</author><author>Faghihimani, Elham</author><author>Azadbakht, Leila</author></authors></contributors><titles><title>Effect of non-soy legume consumption on inflammation and serum adiponectin levels among first-degree relatives of patients with diabetes: A randomized, crossover study</title><secondary-title>Nutrition</secondary-title></titles><periodical><full-title>Nutrition</full-title></periodical><pages>459-465</pages><volume>31</volume><number>3</number><dates><year>2015</year></dates><isbn>0899-9007</isbn><urls></urls></record></Cite></EndNote>(32). Regarding the inflammatory nature of endometriosis, legumes can play an important role in the prevention and control of this disease.
In this study, women with endometriosis compared with healthy women consumed less dairy products; however there was no significant difference between the two groups regarding the type of dairy products (low fat or high fat). High dairy consumption inhibits oxidative and inflammatory biomarkers  ADDIN EN.CITE <EndNote><Cite><Author>Bordoni</Author><Year>2017</Year><RecNum>9</RecNum><DisplayText>(33)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="atwp9frd4v0rriesewvv25eqtvp52r9fa5tf" timestamp="1513524209">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bordoni, Alessandra</author><author>Danesi, Francesca</author><author>Dardevet, Dominique</author><author>Dupont, Didier</author><author>Fernandez, Aida S</author><author>Gille, Doreen</author><author>Nunes dos Santos, Claudia</author><author>Pinto, Paula</author><author>Re, Roberta</author><author>R�mond, Didier</author></authors></contributors><titles><title>Dairy products and inflammation: a review of the clinical evidence</title><secondary-title>Critical reviews in food science and nutrition</secondary-title></titles><periodical><full-title>Critical reviews in food science and nutrition</full-title></periodical><pages>2497-2525</pages><volume>57</volume><number>12</number><dates><year>2017</year></dates><isbn>1040-8398</isbn><urls></urls></record></Cite></EndNote>(33), so it can reduce the risk of endometriosis. In a prospective cohort study by Harris et al.  ADDIN EN.CITE <EndNote><Cite><Author>Harris</Author><Year>2013</Year><RecNum>10</RecNum><DisplayText>(34)</DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="atwp9frd4v0rriesewvv25eqtvp52r9fa5tf" timestamp="1513524250">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Harris, Holly R</author><author>Chavarro, Jorge E</author><author>Malspeis, Susan</author><author>Willett, Walter C</author><author>Missmer, Stacey A</author></authors></contributors><titles><title>Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study</title><secondary-title>American journal of epidemiology</secondary-title></titles><periodical><full-title>American journal of epidemiology</full-title></periodical><pages>420-430</pages><volume>177</volume><number>5</number><dates><year>2013</year></dates><isbn>1476-6256</isbn><urls></urls></record></Cite></EndNote>(34), increased low-fat dairy consumption (more than three units) was associated with 18% reduction in the risk of endometriosis. Similarly, in  HYPERLINK  "#_ENREF_37" \o "Trabert, 2011 #15" Trabert et al.�s study  ADDIN EN.CITE <EndNote><Cite><Author>Trabert</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText>(19)</DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537579">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Trabert, Britton</author><author>Peters, Ulrike</author><author>De Roos, Anneclaire J</author><author>Scholes, Delia</author><author>Holt, Victoria L</author></authors></contributors><titles><title>Diet and risk of endometriosis in a population-based case�control study</title><secondary-title>British Journal of Nutrition</secondary-title></titles><periodical><full-title>British Journal of Nutrition</full-title></periodical><pages>459-467</pages><volume>105</volume><number>3</number><dates><year>2011</year></dates><isbn>1475-2662</isbn><urls></urls></record></Cite></EndNote>(19) increased consumption of dairy products was associated with decreased risk of endometriosis. In a case-control study by Parazzini et al.  ADDIN EN.CITE <EndNote><Cite><Author>Parazzini</Author><Year>2004</Year><RecNum>28</RecNum><DisplayText>(26)</DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="a2rp9pv5w255wkea9xrp2a0wew0ep5wrvxpx" timestamp="1520537595">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parazzini, F</author><author>Chiaffarino, F</author><author>Surace, M</author><author>Chatenoud, L</author><author>Cipriani, S</author><author>Chiantera, V</author><author>Benzi, G</author><author>Fedele, L</author></authors></contributors><titles><title>Selected food intake and risk of endometriosis</title><secondary-title>Human Reproduction</secondary-title></titles><periodical><full-title>Human Reproduction</full-title></periodical><pages>1755-1759</pages><volume>19</volume><number>8</number><dates><year>2004</year></dates><isbn>1460-2350</isbn><urls></urls></record></Cite></EndNote>(26), no association emerged between the risk of endometriosis and increasing servings of milk and cheese.
The main limitation of the present study was the problem of persuading the subjects to answer a lot of questions. Also because of the case-control study design, the possibility of selection bias and recall bias including under or over-reporting of the specific dietary item might have affected our results. 
Conclusion:
Diet has a major impact on the level of hormones and inflammatory markers, so it can play an important role in the control and prevention of many diseases. Due to the inflammatory nature of endometriosis and the effect of hormones on the progression or regression of the disease, the role of nutritional factors in the emergence and progression of the disease should be more determined.
Acknowledgements
    This study was carried out with the kind collaboration of the participants. We would also like to appreciate of the staff of Arash Hospital for their valuable contributions. This study was financed by Tarbiat Modares University, Tehran, Iran. There were no conflicts of interest.
Funding
None.
Author agreement
All authors have seen and approved the final version of the manuscript being submitted. All authors warrant that the article is the authors' original work, has not received prior publication, and is not under consideration for publication elsewhere. 
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Table 1: Demographic and anthropometric characteristics of women with and without endometriosis
P- valueControl groupCase groupCharacteristic0.1329.35�7.0031.01�6.56Age (years)*0.19
50(64.9)
23(29.9)
4(5.2)
50(64.1)
24(30.8)
4(5.1)BMI**
   <25
   25 29.9 (over weight)
   e"30 (obese) 0.58
38(49.4)
39(50.6)
42(53.8)
36(46.2)Education**
   Lower than university
   University0.7013.35�1.6413.49�2.38Age at menarche***0.90
21(27.3)
56(72.7)
22(28.2)
56(71.8)Marital status**
   Unmarried
   Married or cohabiting      0.06
42(54.6)
35(45.5)
32(41)
46(59)Parity**
   Parous   
   Nulliparous  0.09
68(88.3)
9(11.7)
61(78.2)
17(21.8)Occupation2
   Housewife
   Employed*Values are given as mean � SD using Student�s t test, **Values are given as number (%) using Chi-squared test, *** Values are given as mean � SD using Mann-Whitney�s test, 
BMI; Body mass index
Table 2: Odds ratios (OR) of endometriosis and corresponding 95% confidence intervals (CI) according to nutrient intake
Quartilep-trendTotal
OR (95% CI)4
OR (95% CI)3
OR (95% CI)2
OR (95% CI)1Nutrient item
0.30
1.00(0.99-1.00)

0.59(0.24-1.46)
17/21
0.62(0.25-1.53)
18/21
0.80(0.33-1.97)
21/19
1.00
22/16Energy (kcal)
    OR (95% CI)
    Case/control
0.06
0.99(0.97-1.00)

0.36(0.14-0.91)
14/24
0.66(0.27-1.62)
21/16
0.66(0.27-1.62)
20/19
1.00
24/15Protein
    OR (95% CI)
    Case/control
0.56
0.99(0.97-1.02)

1.17(0.48-2.86)
20/19
1.11(0.45-2.73)
19/19
1.23(0.50-2.99)
21/19
1.00
18/20Herbal protein
    OR (95% CI)
    Case/control
0.02
0.97(0.95-0.99)

0.36(0.14-0.91)
12/26
1.38(0.55-3.43)
25/14
0.73(0.3-1.79)
19/20
1.00
22/17Animal protein
    OR (95% CI)
    Case/control
0.35
0.98(0.95-1.02)

0.56(0.23-1.38)
15/23
0.73(0.3-1.79)
18/21
1.37(0.56-3.38)
24/15
1.00
21/18Saturated fatty acids (g)
    OR (95% CI)
    Case/control
0.64
0.99(0.96-1.02)

0.62(0.24-1.55)
21/17
0.28(0.11-0.71)
14/25
0.39(0.15-0.96)
17/22
1.00
26/13Oleic acid (g)
    OR (95% CI)
    Case/control
0.60
0.99(0.99-1.01)

0.86(0.35-2.12)
12/16
0.39(0.16-0.97)
25/14
0.73(0.30-1.79)
19/20
1.00
23/16Total fat (g)
    OR (95% CI)
    Case/control
0.60
0.92(0.96-1.02)

0.69(0.27-1.73)
21/17
0.31(0.12-0.79)
14/25
0.48(0.19-1.19)
18/21
1.00
25/14Mono unsaturated fatty acids(g)
     OR (95% CI)
     Case/control
0.50
1.00(0.96-1.04)

0.86(0.23-3.15)
12/7
0.36(0.13-1.01)
29/40
0.5(0.17-1.46)
23/23
1.00
14/7Linoleic acid (g)
    OR (95% CI)
    Case/control
0.62
0.89(0.55-1.42)

0.73(0.29-1.81)
18/19
0.67(0.28-1.61)
19/22
0.77(0.31-1.89)
19/19
1.00
22/17Linolenic acid (g)
    OR (95% CI)
    Case/control
0.46
0.99(0.96-1.03)

0.69(0.28-1.72)
20/18
0.54(0.22-1.32)
18/21
0.43(0.17-1.08)
16/23
1.00
25/14Polyunsaturated fatty acids (g)
    OR (95% CI)
    Case/control
0.72
1.00(0.99-1.00)

0.77(0.31-1.90)
20/18
0.60(0.24-1.46)
18/21
0.54(0.22-1.32)
17/22
1.00
23/16Cholesterol (mg)
    OR (95% CI)
    Case/control
0.049
0.0001(0.00-0.62)

0.4(0.16-1.04)
20/24
0.59(0.25-1.39)
20/24
1.04(0.42-2.56)
22/15
1.00
24/17EPA1
    OR (95% CI)
    Case/control
0.047
0.03(0.00-0.95)

0.61(0.25-1.49)
14/21
0.62(0.25-1.57)
13/19
1.6(0.68-3.75)
28/16
1.00
23/21DHA2
    OR (95% CI)
    Case/control
0.55
0.00(0.00-1.37)
0.89(0.39-2.01)
17/18
0.66(0.23-1.93)
7/10
1.13(0.49-2.16)
18/15
1.00
36/34Trans fat
    OR (95% CI)
    Case/control
0.35
1.00(0.99-1.00)

1.06(0.43-2.60)
21/17
0.48(0.19-1.19)
14/25
1.11(0.45-2.71)
22/17
1.00
21/18Carbohydrate (g)
    OR (95% CI)
    Case/control
0.07
0.98(0.97-1.00)

0.77(0.31-1.89)
21/17
0.48(0.19-1.19)
14/25
1.00(0.41-2.45)
22/17
1.00
22/17Total fiber
    OR (95% CI)
    Case/control
0.04
0.33(0.11-0.99)

0.44(0.18-1.12)
16/21
0.53(0.21-1.30)
19/21
0.53(0.21-1.30)
19/21
1.00
24/14s. fiber3
    OR
    Case/control
0.04
0.76(0.59-0.99)

0.44(0.17-1.08)
17/21
0.48(0.19-1.20)
18/20
0.42(0.17-1.03)
17/22
1.00
26/14i.fiber4
    OR (95% CI)
    Case/control
0.27

0.97(0.91-1.02)
16/22
0.51(0.20-1.25)
20/19
0.73(0.30-1.79)
20/19
0.66(0.27-1.62)
19/20
1.00
23/16c.fiber5
    OR
    Case/control
0.38
0.99(0.99-1.00)

0.86(0.35-2.11)
20/18
0.60(0.24-1.46)
17/22
0.89(0.39-2.01)
19/20
1.00
22/17Total sugar 
    OR
    Case/controlCI, confidence interval; OR, odds ratio.1- Eicosa pentaenoic acid, 2- Docosahexaenoic  Acid, 3- soluble fiber, 4- insoluble fiber, 5- crude fiber, and quartile 1 as reference catagories
Table 3: Odds ratios (OR) of endometriosis and corresponding 95% confidence intervals (CI) according to daily intake of food
Quartilep-trendTotal
OR (95% CI)4
OR (95% CI)3
OR (95% CI)2
OR (95% CI)1Food intake
0.25

1.00(0.99-1.00)

0.38(0.15-0.96)
15/23
0.75(0.3-1.88)
22/17
0.45(0.18-1.12)
17/22
1.00
24/14Vegetables
    OR (95% CI)
    Case/control
0.10
0.99(0.98-1.00)

0.5(0.2-1.26)
18/20
0.48(0.19-1.19)
18/21
0.43(0.74-1.07)
17/22
1.00
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    OR (95% CI)
    Case/control
0.03
0.98(0.96-0.99)

0.5(0.2-1.25)
16/22
0.56(0.23-1.39)
17/21
0.85(0.35-2.07)
22/18
1.00
23/16Yellow Vegetables
    OR (95% CI)
    Case/control
0.10
1.00(0.99-1.00)

0.29(0.11-0.74)
13/25
0.8(0.32-2.01)
23/16
0.45(0.18-1.13)
35/42
1.00
25/14Fruit
    OR (95% CI)
    Case/control
0.65
1.00(0.99-1.00)

1.37(0.56-3.4)
20/19
1.45(0.59-3.56)
20/19
1.78(0.72-4.39)
22/17
1.00
16/22Cereal
     OR (95% CI)
    Case/control
0.02
0.98(0.97-0.99)

0.31(0.12-0.83)
12/18
0.23(0.09-0.60)
12/24
0.53(0.22-1.26)
25/22
1.00
28/13Legumes
    OR (95% CI)
    Case/control
0.09
0.98(0.97-1.00)

0.36(0.14-0.91)
14/25
0.81(0.33-1.99)
20/16
0.81(0.33-1.99)
19/23
1.00
25/13Red meat
    OR (95% CI)
    Case/control
0.59
1.00(0.99-1.02)

1.83(0.8-4.66)
19/10
0.84(0.34-2.07)
14/16
0.69(0.31-1.56)
18/25
1.00
27/26Poultry
    OR (95% CI)
    Case/control
0.08
0.97(0.94-1.00)

0.46(0.17-1.2)
12/21
0.67(0.27-1.61)
20/24
1.17(0.46-2.97)
22/15
1.00
20/16Fish
    OR (95% CI)
    Case/control
0.49
1.00(0.98-1.02)

0.99(0.4-2.45)
18/19
1.23(0.5-2.99)
21/18
1.05(0.44-2.54)
20/20
1.00
19/20Egg
    OR (95% CI)
    Case/control
0.99
1.03(0.99-1.08)

0.86(0.35-2.11)
14/25
0.69(0.28-1.72)
20/16
0.64(0.26-1.53)
19/23
1.00
22/17Processed meat
    OR (95% CI)
    Case/control
0.01

0.99(0.96-0.99)

0.32(0.13-0.82)
12/26
0.96(0.38-2.37)
22/16
0.81(0.33-1.99)
21/18
1.00
23/16Total dairy product
    OR (95% CI)
    Case/control
0.42
0.99(0.99-1.00)

0.69(0.28-1.72)
20/18
0.48(0.19-1.19)
17/22
0.48(0.19-1.19)
17/22
1.00
24/15Low-fat dairy foods
    OR (95% CI)
    Case/control
0.11
0.99(0.99-1.00)

0.5(0.2-1.24)
14/24
0.73(0.3-1.79)
18/21
1.52(0.62-3.8)
25/14
1.00
21/18High-fat dairy foods
    OR (95% CI)
    Case/control
0.11
0.98(0.96-1.00)

0.40(0.16-0.99)
16/23
0.33(0.13-0.85)
12/21
0.77(0.32-1.56)
24/18
1.00
26/15Potato
    OR (95% CI)
    Case/control
0.19
1.04(0.98-1.10)

1.53(0.54-4.31)
11/11
4.13(1.6-10.66)
27/10
1.17(0.52-2.66)
23/30
1.00
17/26Fried potatoes
    OR (95% CI)
    Case/control
0.10
0.97(0.86-1.08)

0.95(0.43-2.07)
19/19
0.9(0.41-1.97)
18/19
0.95(0.13-7.09)
2/2
1.00
39/37Olive oil
    OR (95% CI)
    Case/control
0.52
1.01(0.99-1.02)

1.74(0.7-4.33)
16/10
1.18(0.57-2.42)
26/24
0.22(0.02-1.95)
1/5
1.00
35/38hydrogenated vegetable oil
    OR (95% CI)
    Case/control
0.21
0.97(0.93-1.02)

0.68(0.3-1.53)
16/17
0.42(0.19-0.90)
15/26
1.00
0/0
1.00
47/34Liquid oil
    OR (95% CI)
    Case/control
0.23
0.98(0.96-1.01)

0.62(0.25-1.53)
16/22
0.81(0.33-1.98)
19/20
1.06(0.43-2.59)
21/17
1.00
21/18Nuts
    OR (95% CI)
    Case/controlCI, confidence interval; OR, odds ratio. Quartile 1 as reference catagories










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