Sex-Stratified Bidirectional Mendelian Randomization Analysis of Eating Habits and Female Pelvic Peritoneal Adhesions

Tiantian Dai, Dandan Chu, Meng Yu, Jianfei Zu, Yanshuang Jia, Yi Zhang Department of Obstetrics and Gynecology, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, People’s Republic of ChinaCorrespondence: Yi Zhang, Department of Obstetrics and Gynecology, Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, 200050, People’s Republic of China, Email [email protected]: Female pelvic peritoneal adhesions (FPPA) represent a significant global health burden. Dietary habits play a crucial role in health outcomes, yet their influence on FPPA remains unclear. This study aims to explore the bidirectional causal relationships between 72 eating habits and FPPA using sex-stratified Mendelian randomization (MR).Methods: We employed a bidirectional MR approach, utilizing single nucleotide polymorphisms (SNPs) significantly associated with 72 different eating habits as instrumental variables. The causal relationships were assessed using five MR methods, including inverse variance weighting (IVW). After Bonferroni correction, eating habits with a p-value < 0.05 were considered to have a significant causal relationship with FPPA. For those habits with significant associations, reverse MR was conducted to assess potential reverse causality. Sensitivity analyses, including IVW, MR-Egger, and leave-one-out tests, were performed to ensure the robustness of the results.Results: Before Bonferroni correction, five eating habits showed potential associations with FPPA, including non-oily fish intake (OR: 0.989, 95% CI: 0.982– 0.995, p=0.000521), side salad intake: OR 1.003 (95% CI: 1.001– 1.006), p=0.007779, poultry intake: OR 1.005 (95% CI: 1.001– 1.009), p=0.018016, spirits intake: OR 1.010 (95% CI: 1.001– 1.019), p=0.036152, hard cheese intake: OR 0.995 (95% CI: 0.991– 1.000), p=0.043784. After correction, only non-oily fish intake remained significantly associated with a lower risk of FPPA. No reverse causal relationship was observed between non-oily fish intake and FPPA, and sensitivity analyses revealed no abnormalities, further confirming the robustness of the findings.Discussion: Our study identifies non-oily fish intake as a protective dietary factor against FPPA, with no evidence of reverse causality. These findings highlight the importance of dietary interventions in managing FPPA risk and suggest potential avenues for future research and public health strategies.Keywords: female pelvic peritoneal adhesions, Mendelian randomization, eating habits, non-oily fish intake, causal relationship, sensitivity analysis