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explore their relationship with the menstrual cycle and to determine the ... Results: In both age groups, women with menstrual cycle disorders were more likely to ...
DOI: 10.1111/1747-0080.12394

DA A

Dietitians Association of Australia

Nutrition & Dietetics 2017

ORIGINAL RESEARCH

Comparison of anthropometrical parameters and dietary habits of young women with and without menstrual disorders Karolina ŁAGOWSKA

, Daria KAZMIERCZAK and Katarzyna SZYMCZAK

 Poland Department of Human Nutrition and Hygiene, Poznan University of Life Sciences, Poznan,

Abstract Aim: The aim of this study was to assess the nutritional status and dietary habits of young women, in order to explore their relationship with the menstrual cycle and to determine the proportion of women with menstrual cycle irregularities. Methods: A total of 348 young women aged 15–25 years (19.7  3.7 years) participated in the study and were assigned to a younger group (15–18 years; YG) or an older group (19–25 years; OG). Two subgroups were also distinguished: women with menstrual disorders (MD) and women with regular cycles (RC). Body mass, waist circumference, fat mass (FM), energy and nutrient intakes, and eating behaviour of the subjects were evaluated. Results: In both age groups, women with menstrual cycle disorders were more likely to have higher body weight, higher body mass index, larger waist circumference and higher body FM. The daily diets of these women contained larger quantities of animal protein and fat, including saturated fat (in OG), but were poorer in vitamins B1 and B6 (in YG) and in iron. Disinhibition was significantly more common in the MD group. Conclusions: The results of this study suggest that nutritional habits and status can interfere with the course of the menstrual cycle in young women.

Key words: menstrual disorders, nutritional habits, nutritional status.

Introduction Both body mass index (BMI) and the mass of fatty tissue in the body are positively correlated with the risk of developing lipid disorders, cardiovascular diseases, hypertension and other disorders.1 With the general increase in overweight and obesity, the incidence of disturbances in glucose metabolism has also risen. It may be that poor nutrition resulting in changes in nutritional status is also a significant factor interfering with the course of the menstrual cycle in women.2 It should be stressed here that teenage girls with excess body weight begin puberty earlier and are much more at risk of menstrual cycle disturbances than girls of normal weight. Less frequent menstruation and anovulatory cycles are more common among women with overweight and obesity.1 Features of hyperandrogenism are also often seen which, if left untreated, can result in the development of K. Łagowska, PhD, Lecturer D. Kazmierczak, MSc student K. Szymczak, MSc student Correspondence: K. Łagowska, Poznan University of Life Sciences, Department of Human Nutrition and Hygiene, Dietetic Division, Wojska Polskiego 28, 60-637 Pozna n, Poland. Email: karolina@up. poznan.pl Accepted September 2017

© 2017 Dietitians Association of Australia

polycystic ovary syndrome. Disorders of the menstrual cycle can also be seen in women with insufficient body mass and insufficient amounts of adipose tissue.2 Insufficient energy intake can trigger mechanisms that reduce the energy expenditure associated with the resting metabolic rate, thermoregulation and the regular occurrence of menstrual bleeding, thus protecting the woman from the increased energy expenditure associated with maintaining a regular cycle, as well as from pregnancy.1,3 Recommendations for reducing the incidence of menstrual cycle disturbances indicate that the most important factor is the intake of an adequate amount of energy and nutrients to maintain the proper body weight and physical activity at a sufficient level—that is, at least 30 minutes of activity 3–4 times a week. Given the above, this study evaluated the nutritional status and nutrition habits of teenage girls and young women, with the aim of exploring their relationship with the course of the menstrual cycle, as well as to estimate the prevalence of these dysfunctions.

Methods A total of 348 young women were recruited from Wielkopolska High School and Pozna n University. The inclusion criteria were: no serious medical conditions, no use of hormonal contraception or other medications that might interfere with the activity of the 1

K. Łagowska et al.

hypothalamic–pituitary–gonadal axis, no clinical diagnosis of eating disorders and non-smoking. Written informed consent was obtained from all participants, or from their parents when the subjects were younger than 18. The women were assigned to one of two age groups. The first contained respondents aged 15–18 (YG), while the second contained those aged 19–25 (OG). Each subject completed a medical questionnaire. The questions concerned menstruation—in particular, age at menarche, length of menstrual cycles and history of amenorrhoea. Primary amenorrhoea was taken to refer to the lack of onset of menses by 15 years, while secondary amenorrhoea meant there had been no menstruation for 6 months, or for more than three times the length of the previous cycle. Menstrual periods that occurred more than 35 days apart were described as oligomenorrhoea. Polymenorrhoea was taken to refer to the occurrence of a menstrual cycle shorter than 21 days.2 Based on this data, women from both age groups were assigned to one of two subgroups: those with a menstrual disorder (MD) and those with a regular cycle (RC). In order to evaluate nutritional status, height and weight were measured using an anthropometer coupled with a WPT 200 OC verified medical scale (Rad Wag). BMI (kg/m2) was calculated as body weight divided by body height squared. The participants were dressed in minimal clothing during the measurements, which were rounded to the nearest 0.5 kg and 0.5 cm. In the case of girls under the age of 18, the results for height and weight were referred to centile charts. Measurement of body fat mass (FM) and fat-free mass (FFM) was carried out using a Bodystat 1500 device, in the morning following an overnight fast, with the subjects lying in a supine position, as described by Heyward et al.4 The waist circumference was also measured at the narrowest point using a medical tape. Seven consecutive days of dietary records were obtained under the supervision of a dietitian. Subjects had regular contact with a registered dietitian who taught them how to record nutrition intake and monitored these records. All meals (including recipes and item masses), snacks, beverages and fluids were recorded in diary form, using a photographic album of dishes.5 The daily diets were analysed for their energy and nutrient levels, using the Dietitian computer software package (Warsaw, Poland), based on Polish food composition tables (Food and nutrition institute, Warsaw). The Three-Factor Eating Questionnaire (TFEQ) was used to assess dietary restrictions.6 This questionnaire contains

36 items in a true-or-false response format and 15 questions where it is necessary to select one of the following descriptors: never, seldom, often or always. All item responses were dichotomised and aggregated into three scales: a cognitive restraint scale of 21 items, a hunger scale of 14 items and a disinhibition scale of 16 items. The means and standard deviations of the quantitative variables were calculated. The distribution was checked for normality. Comparisons between data from different groups were carried out using the t-test for independent variables and the chi-square test. The statistical analysis was performed using Statistica 10.0 software (StatSoft, 2014). P-values of less than 0.05 were considered statistically significant. The study was approved by the Poznan Medical Ethics Committee (no. 334/09).

Results No statistically significant difference was seen between the menstrual cycles of the women in the two age groups. In both YG and OG, nearly one third of respondents indicated that they suffer from dysfunctions in the menstrual cycle, of which the most frequently reported complaint was oligomenorrhoea (YG: 86%, OG: 93.1%; Table 1). However, statistically significant differences were present in the results of the anthropometric parameter and body composition analysis. Women with regular menstruation were characterised by significantly lower body weight, lower BMI, smaller waist circumference and lower body fat (expressed both as percentage of body weight and in kilograms). Nearly 80% of the women with regular cycles had a normal body weight (as determined by BMI), 15% were underweight and only 7% were overweight. Among the women with menstrual cycle disorders, only one quarter of respondents were of normal weight, while 67% had excess body weight (35% overweight, 32% obese); 8% of these women were underweight. Similar findings were seen for both the younger and older age groups (Table 2). Analysis of the respondents’ diets demonstrates significant differences in macronutrient intake. Among both the younger and the older women, differences were visible in the daily protein intake. The women with menstrual cycle disorders consumed significantly more animal protein (YG: 62.4  15.4 g; OG: 59.4  15.4 g) and less protein of plant origin (YG: 22.8  5.9 g; OG: 19.8  5.9 g). Moreover, those members of OG with menstrual cycle disorders

Table 1 Menstrual cycle characteristics of study subjects (values  SDs) Parameters

All (n = 348)

YG (n = 174)

OG (n = 174)

P-value

Age (years) Age of menarche (years) Regular cycle (%) Menstrual disorders (%) Amenorrhoea (%) Oligomenorrhoea (%) Polymenorrhoea (%)

19.7  3.6 13.5  1.4 65.5 34.5 9.6 89.4 1.0

16.5  1.1 13.2  1.5 67.8 32.2 12.5 86 1.5

23.1  1.9 13.7  1.3 62.8 37.2 6.9 93.1 0

P < 0.001 NS NS NS NS NS NS

OG, older group; YG, younger group.

2

© 2017 Dietitians Association of Australia

23.3  1.8 58.1  7.5 25.2  5.6 15.0  5.0 74.8  5.6 43.2  4.6 65.0  4.7 21.2  2.8 16% 78% 6% 0

21.1 79.8 37.2 31.3 62.8 48.5 81.5 29.4

 3.7  18.4  7.8  12.4  8.9  7.7  13.7  6.2 5% 21% 37% 37%

NS < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 < 0.0001 NS