By Carol A. Kemper, MD, FACP
Lin HY, Fu Q, Tseng TS, et al. Impact of dietary quality on genital oncogenic human papillomavirus infection in women. J Infect Dis 2023;228:1385-1393.
Data from a large-scale national health and nutrition survey from 2003-2016 were used to examine the risk of genital human papillomavirus (HPV) infection in 10,543 women ages 18-59 years. Nearly two-thirds were non-Hispanic white; nearly two-thirds were married or living with a partner; and 13% reported two or more partners within the previous year. HPV deoxyribonucleic acid (DNA) was collected from self-collected vaginal swabs, and a molecular linear array was used to detect 37 HPV genotypes. In addition, information on demographic factors, sexual behavior, and dietary quality were collected.
Dietary quality was measured based on a 2015 Health Eating Index (HEI) that sums 13 different dietary components (including total fruits, including juice, whole fruits, total vegetables, green vegetables, beans, whole grains, dairy, total protein foods, seafood, and plant proteins). A higher score indicates higher quality.
High-risk HPV genotypes, low-risk HPV genotypes, and no HPV were found in 19.2%, 21.5%, and 59.3% of the group, respectively. Higher rates of high-risk HPV genotypes were observed, with decreasing frequency, in those with two or more partners in the previous year (40%), younger age (18-26 years) (31%), never married (30%), low income (28%), current smokers (27%), non-Hispanic Black (27%), and high school education (23%).
In addition, there was a strong association between dietary quality and the risk of high-risk HPV. The mean HEI score was 50.8 for those with high-risk HPV, 51.6 for those with low-risk genotypes, and 54.6 for no HPV (P ≤ 0.001). The frequency of high-risk HPV was only 10.2% for those with a high-quality diet (HEI > 80) vs. 25.2% for those with a poor-quality diet (HEI < 40). After adjusting for several factors, several dietary components stood out in the analysis as significantly associated with lower rates of high-risk HPV: greens and beans, total fruits, and whole fruits. There also was some benefit of whole grains and dairy on the prevalence of low-risk HPV but not high-risk HPV.
The authors theorized that the increase in vitamin C and other immunological benefits of a regular diet including dark green vegetables and beans and fruits may reduce inflammation and enhance the immune system response, facilitating clearance of genital HPV. One wonders if other behaviors associated with ingestion of a regular quality diet also contribute to this improved health outcome. Of course, not only is healthy eating a behavior, it also is increasingly a bigger budget item in households.
Carol A. Kemper, MD, FIDSA, is Medical Director, Infection Prevention, El Camino Hospital, Palo Alto Medical Foundation.
