Relationships Between the Dietary Inflammatory Index, Food Cravings, and Mood States in Women with Premenstrual Syndrome

Öz

Objective: This study aimed to evaluate the inflammatory potential of diet using the Dietary Inflammatory Index (DII) and to examine the effects of diet-induced inflammation on food craving and mood status (depression, anxiety, and stress) in individuals with premenstrual syndrome (PMS). Material and Methods: This cross-sectional study included 432 women aged between 18 and 55 years. The Premenstrual Syndrome Scale was administered to all participants, and on the basis of this evaluation, the data of 214 women diagnosed with PMS were included in the study. Data were collected face-to-face via a questionnaire consisting of a sociodemographic form, the Food Craving Questionnaire-Trait Reduced, the Depression Anxiety Stress Scale-21 and a 3-day dietary intake record. The DII was calculated from the data obtained from the 3-day food records. Results: The prevalence of PMS was 49.5%. Increased food craving was positively associated with increased body weight, body mass index and increased intake of energy, fat, carbohydrates, and saturated fat (p<0.05). Menstruation-related weight gain, edema, and appetite changes were also significantly associated with increased food craving (p<0.05). Low intake of fiber, vitamin A, vitamin C, and vitamin D was associated with increased levels of anxiety and stress (p<0.05). No statistically significant relationships were found between the DII and food craving or mood status (p>0.05). Conclusion: The complex relationship between dietary components and food craving/mood status in individuals with PMS suggests that nutrition-focused interventions may play an important role in symptom management. However, further research is needed to clarify the effects of dietary inflammatory potential on food craving and mood.

Anahtar Kelimeler

• Dietary inflammatory index
• food craving
• mood status
• premenstrual syndrome

Etik Beyan

This study was conducted with the approval of the Üsküdar University Non-Interventional Research Ethics Committee (Decision No: 61351342/June 2024-73), dated 24.06.2024. Verbal informed consent was obtained from all participants after providing information about the purpose of the research. All procedures of the study were carried out in accordance with the principles of the Declaration of Helsinki.

Premenstrüel Sendromlu Bireylerde Diyet İnflamatuar İndeksi, Yeme Arzusu ve Duygu Durumu Arasındaki İlişki

Öz

Amaç: Bu çalışma, Diyet İnflamatuar İndeksi kullanılarak premenstrüel sendromlu (PMS) bireylerde diyetin inflamatuar potansiyelini değerlendirmeyi ve diyet kaynaklı inflamasyonun yeme arzusu ile duygu durumu (depresyon, anksiyete ve stres) üzerindeki etkilerini incelemeyi amaçlamaktadır. Gereç ve Yöntem: Bu kesitsel çalışmaya 18–55 yaş aralığında 432 kadın birey katılmıştır. Çalışmaya katılmayı kabul eden kadınların tümüne Premenstrüel Sendrom Ölçeği uygulanmış ve değerlendirme sonucunda PMS’li 214 bireyin verileri çalışmaya dahil edilmiştir. Çalışmada veriler; sosyo-demografik form, Yeme Arzusu ölçeği-kısa formu, Depresyon-Anksiyete-Stres ölçeği ve 3 günlük besin tüketim kaydı’ndan oluşan anket formu ile yüz yüze toplanmıştır. Diyet İnflamatuar İndeksi ise 3 günlük besin tüketim kayıtları kullanılarak hesaplanmıştır. Bulgular: Çalışmada PMS prevalansı %49,5 olarak saptanmıştır. Yeme arzusunda artış; vücut ağırlığı, beden kütle indeksi ile enerji, yağ, karbonhidrat ve doymuş yağ alımlarındaki artış ile pozitif yönde ilişkili bulunmuştur (p<0,05). Menstruasyona bağlı kilo artışı, ödem ve iştah değişiklikleri de yeme arzusu artışı ile anlamlı ilişkili olduğu belirlenmiştir (p<0,05). Posa, A vitamini, C vitamini ve D vitamininin düşük düzeyde alınması, daha yüksek anksiyete ve stres düzeyleri ile ilişkili bulunmuştur (p<0,05). Diyetin inflamatuar indeksi ile yeme arzusu ve duygu durumu arasında istatistiksel olarak anlamlı bir ilişki belirlenmemiştir (p>0,05). Sonuç: Premenstrüel sendromlu bireylerde diyet bileşenleri ile yeme arzusu ve duygu durumu arasındaki kompleks ilişki, beslenme odaklı müdahalelerin semptom yönetiminde önemli bir rol oynayabileceğini düşündürmektedir. Ancak diyetin inflamatuar potansiyelinin yeme arzusu ve duygu durumuna etkisinin netleştirilmesi için daha fazla araştırmaya ihtiyaç vardır.

Anahtar Kelimeler

• Diyet inflamatuar indeksi
• yeme arzusu
• duygu durumu
• premenstrüel sendrom

Kaynakça

1. Yin W, Zhang J, Guo Y, Wu Z, Diao C, Sun J. Melatonin for premenstrual syndrome: A potential remedy but not ready. Front Endocrinol. 2023;9:1084249. DOI: 10.3389/fendo.2022.1084249
2. Kessel B. Premenstrual syndrome: Advances in diagnosis and treatment. Obstet Gynecol Clin North Am. 2000;27(3):625-39. DOI: 10.1016/S0889-8545(05)70160-1
3. Sahu R, Barnwal SL, Vishvakarma SK. Prevalence and severity of premenstrual syndrome among young women in Chhattisgarh, India. Asia Pac J Health Sci. 2022;9(1):123. DOI: 10.21276/apjhs.2022.9.1.34
4. Moghadam AD, Kaikhavani S, Sayehmiri K. The worldwide prevalence of premenstrual syndrome: A systematic review and meta-analysis study. Iran J Obstet Gynecol Infertil. 2013;16:11-8. DOI: 10.7860/JCDR/2014/8024.4021
5. Farpour S, Soleimani D, Moradinazar M, Samadi M. The relationship of dietary inflammatory index and dietary patterns with premenstrual syndrome among women in Kermanshah: An analytical cross-sectional study. Food Sci Nutr. 2023;11(7):4146-54. DOI: 10.1002/fsn3.3404.
6. MoradiFili B, Ghiasvand R, Pourmasoumi M, Feizi A, Shahdadian F, Shahshahan Z. Dietary patterns are associated with premenstrual syndrome: Evidence from a case-control study. Public Health Nutr. 2020;23(5):833-42. DOI: 10.1017/S1368980019002951.
7. Farasati N, Siassi F, Koohdani F, Qorbani M, Abashzadeh K, Sotoudeh G. Western dietary pattern is related to premenstrual syndrome: A case-control study. Br J Nutr. 2015;114(12):2016-21. DOI: 10.1017/S0007114515003364.
8. Bannister E. There is increasing evidence to suggest that brain inflammation could play a key role in the aetiology of psychiatric illness. Could inflammation be a cause of the premenstrual syndromes PMS and PMDD? Post Reprod Health. 2019;25(3):157–61. DOI:10.1177/2053369119864446.

9. Bertone-Johnson ER. Chronic inflammation and premenstrual syndrome: A missing link found? J Womens Health (Larchmt). 2016;25(9):857–858. DOI:10.1089/jwh.2016.6019.
10. Shin D, Lee K, Brann L, Shivappa N, Hébert JR. Dietary inflammatory index is positively associated with serum high-sensitivity C-reactive protein in a Korean adult population. Nutrition. 2019;63-4:155-161. DOI: 10.1016/j.nut.2018.11.016
11. Tolkien K, Bradburn S, Murgatroyd C. An anti-inflammatory diet as a potential intervention for depressive disorders: A systematic review and meta-analysis. Clin Nutr. 2019;38(5):2045-52. DOI: 10.1016/j.clnu.2018.11.007
12. Shivappa N, Hebert JR, Marcos A, Diaz LE, Gomez S, Nova E, et al. Association between dietary inflammatory index and inflammatory markers in the HELENA study. Mol Nutr Food Res. 2017;61(6):1700078. DOI:10.1002/mnfr.201700078.
13. Bertone-Johnson ER, Ronnenberg AG, Houghton SC, Nobles C, Zagarins SE, Takashima-Uebelhoer BB, et al. Association of inflammation markers with menstrual symptoms and premenstrual syndrome in young women. Hum Reprod. 2014;29(9):1987–94. DOI: 10.1093/humrep/deu174.
14. Brennan AM, Fargnoli JL, Williams CJ, Li T, Willett W, Kawachi I, et al. Phobic anxiety is associated with higher serum concentrations of adipokines and cytokines in women with diabetes. Diabetes Care. 2009;32(5):926–31. DOI:10.2337/dc08-1812.
15. Lippi G, Mattiuzzi C, Cervellin G. C-reactive protein and migraine. Clin Chem Lab Med. 2014;52(9):1265–72.DOI: 10.1515/cclm-2014-0144.
16. Yılmaz HÖ, Meriç ÇS. The association between adherence to the DASH diet and premenstrual syndrome. Gümüşhane Sağlık Bilimleri Dergisi. 2023;12(4):1605-14. DOI: 10.37989/gumussagbil.1271053
17. Hızlı H, Kıyak Ş, Ertosun AF, Eryılmaz İ, Gasanova P. Investigation of changes in nutritional status and anthropometric measurements depending on the menstrual cycle in women: A cross-sectional study. Online Turk J Health Sci. 2020;5(3):406–14.
18. Aydoğan A, Atasayan K. Premenstrual sendromun yönetiminde güncel yaklaşımlar. Bezmialem Sci. 2018;6(4):305–11. DOI:10.14235/bas.galenos.2018.2358
19. Doğan T, Tekin EG, Katrancıoğlu A. Feeding your feelings: A self-report measure of emotional eating. Procedia Soc Behav Sci. 2011;15:2074–7. DOI:10.1016/j.sbspro.2011.04.058
20. Zysberg L. Emotional intelligence, anxiety, and emotional eating: A deeper insight into a recently reported association? Eat Behav. 2018;29:128–31. DOI: 10.1016/j.eatbeh.2018.03.005
21. Gençdoğan B. Premenstrual sendrom için yeni bir ölçek. Türkiye’de Psikiyatri. 2006; 8(2): 82-7.
22. Yılda A, Ataman H, Dişsiz M, Sevimli S. Genç kadınlarda premenstrual sendrom, fiziksel aktivite ve yaşam kalitesi. J Acad Res Nurs. 2018;4(2):75–82. DOI:10.5222/jaren.2018.075
23. WHO: A Healthy Lifestyle – WHO Recommendations; 2024 [cited 2025 March 28]. Available from: https://www.who.int/europe/newsroom/fact-sheets/item/a-healthy-lifestyle---who-recommendations
24. Cepeda-Benito A, Gleaves DH, Williams TL, Erath SA. The development of the Food Craving Questionnaire-Trait. Appetite. 2000;34(1):107-31.
25. Meule A. The psychology of food craving. Curr Opin Behav Sci. 2020;34:160-5.
26. Traş Z, Gökçen G. Yeme Arzusu Ölçeği Kısa Formunun Türk kültürüne uyarlanması: Geçerlilik ve güvenirlik çalışması. Ahmet Keleşoğlu Eğitim Fakültesi Derg. 2021;3(2):200–15.
27. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation of Australia; c1995.42p.
28. Yılmaz Ö, Boz H. Arslan A. Depresyon Anksiyete Stres Ölçeğinin (DASS 21) Türkçe kısa formunun geçerlilik-güvenilirlik çalışması. Finans Ekonomi ve Sosyal Araştırmalar Dergisi. 2017;2(2):78-91.
29. Besin Bilgi Sistemi (BeBiS) (Sürüm 9) [veri tabanı]. 2020 [cited 2025 May 15]. Available from: https://bebis.com.tr/anasayfa.
30. Cavicchia PP, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. The Journal of Nutrition. 2009;139(12):2365–72. DOI:10.3945/jn.109.114025.
31. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutrition. 2014;17(8):1689–96. DOI:10.1017/S1368980013002115.
32. Ongan D, Songür Bozdağ AN, Kuleli M, Ünsal B, Yıldırım E. Premenstrual sendromu olan kadınlarda yeme bağımlılığı: bulmacanın yeni parçası. İKÇÜSBFD. 2021;6(2):39-46.
33. Erbil N, Yücesoy H. Premenstrual syndrome prevalence in Turkey: a systematic review and meta-analysis. Psychol Health Med. 2023;28(5):1347–57. DOI:10.1080/13548506.2022.2141132
34. Arslan M, Yılmaz HÖ, Sarıyer ET, Arslan N. Effect of dietary carbohydrate quality index on the severity of premenstrual symptoms. Health Care Women Int. 2024;17:1–15. DOI:10.1080/07399332.2024.2414939.
35. Andualem F, Melkam M, Takelle GM, Nakie G, Tinsae T, Fentahun S, et al. Prevalence of premenstrual syndrome and its associated factors in Africa: a systematic review and meta-analysis. Front Psychiatry. 2024 Jan 31;15:1338304. DOI: 10.3389/fpsyt.2024.1338304.
36. Kwon YJ, Sung DI, Lee JW. Association among premenstrual syndrome, dietary patterns, and adherence to Mediterranean Diet. Nutrients. 2022;14(12):2460. DOI:10.3390/nu14122460.
37. Hashim MS, Obaideen AA, Jahrami HA, Radwan H, Hamad HJ, Owais AA, et al. Premenstrual syndrome is associated with dietary and lifestyle behaviors among university students: A cross-sectional study from Sharjah, UAE. Nutrients. 2019;11(8):1939. DOI:10.3390/nu11081939.
38. Souza LB, Martins KA, Cordeiro MM, Rodrigues YS, Rafacho BPM, Bomfim RA. Do food intake and food cravings change during the menstrual cycle of young women? Rev Bras Ginecol Obstet. 2018;40(11):686–92. DOI:10.1055/s-0038-1675831.
39. Chao A, Grilo CM, White MA, Sinha R. Food cravings mediate the relationship between chronic stress and body mass index. J Health Psychol. 2015;20(6):721–29. DOI:10.1177/1359105315573448.
40. Bahadur C, Ergen D, Yildiz N, Dokumacioglu E. Premenstrual syndrome levels and eating attitudes among university students. Makara J Health Res. 2023;27(2):114-9.
41. Thakur H, Pareek P, Sayyad MG, Otiv S. Association of premenstrual syndrome with adiposity and nutrient intake among young Indian women. Int J Womens Health. 2022;14:665–75. DOI:10.2147/IJWH.S359458.
42. Mitsuhashi R, Sawai A, Kiyohara K, Shiraki H, Nakata Y. Factors associated with the prevalence and severity of menstrual-related symptoms: A systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(1):569. DOI:10.3390/ijerph20010569.
43. Abdullah NF, Hamirudin AH, Sidek S, Hassan NAA. Food craving and symptoms of premenstrual syndrome among university students. Malays J Med Health Sci. 2021;17(2):1-7.
44. Duvan CI, Cumaoglu A, Turhan NO, Karasu C, Kafali H. Oxidant/antioxidant status in premenstrual syndrome. Arch Gynecol Obstet. 2011;283(2):299-304. DOI: 10.1007/s00404-009-1347-y.
45. Smits RM, Mackenzie-Proctor R, Fleischer K, Showell MG. Antioxidants in fertility: impact on male and female reproductive outcomes. Fertil Steril. 2018;110(4):578-80.
46. Frankel RA, Michels KA, Kim K, Kuhr DL, Omosigho UR, Wactawski-Wende J, et al. Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective cohort study. BMC Womens Health. 2021;21(1):49. DOI:10.1186/s12905-021-01187-7.
47. Berridge MJ. Vitamin D and depression: cellular and regulatory mechanisms. Pharmacol Rev. 2017;69(1):80-92.
48. Saghafian F, Hajishafiee M, Rouhani P, Saneei P. Dietary fiber intake, depression, and anxiety: a systematic review and meta-analysis of epidemiologic studies. Nutr Neurosci. 2023;26(2):108-26.
49. Salari-Moghaddam A, Keshteli AH, Afshar H,Esmaillzadeh A, Adibi P. Association between dietary inflammatory index and psychological profile in adults. Clin Nutr. 2019;38(5):2360-68. DOI: 10.1016/j.clnu.2018.10.015.
50. Li R, Zhan W, Huang X, Liu Z, Lv S, Wang J, et al. Association of dietary inflammatory index (DII) and depressive disorders. J Inflamm Res. 2021;14:6959-73 DOI: 10.2147/JIR.S344002.