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Intake of dietary fat and fat subtypes and risk of premenstrual syndrome in the Nurses’ Health Study II

  • Serena C. Houghton (a1), JoAnn E. Manson (a2) (a3) (a4), Brian W. Whitcomb (a1), Susan E. Hankinson (a1) (a2), Lisa M. Troy (a5), Carol Bigelow (a1) and Elizabeth R. Bertone-Johnson (a1)...


Approximately 8–20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses’ Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2–4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; P trend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; P trend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.

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Corresponding author

* Corresponding author: S. C. Houghton, fax +1 413 545 1645, email


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1. Rapkin, AJ & Winer, SA (2009) Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Rev Pharmacoecon Outcomes Res 9, 157170.
2. O’Brien, S, Rapkin, A, Dennerstein, L, et al. (2011) Diagnosis and management of premenstrual disorders. BMJ 342, d2994.
3. Johnson, SR (1987) The epidemiology and social impact of premenstrual symptoms. Clin Obstet Gynecol 30, 367376.
4. Halbreich, U, Borenstein, J, Pearlstein, T, et al. (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 28, Suppl. 3, 123.
5. Chocano-Bedoya, PO & Bertone-Johnson, ER (2013) Premenstrual syndrome. In Women Health, 2nd ed. pp. 179191 [MB Goldman, R Troisi and KM Rexrode, editors]. Amsterdam: Elsevier/Academic Press.
6. Bertone-Johnson, ER, Whitcomb, BW, Rich-Edwards, JW, et al. (2015) Premenstrual syndrome and subsequent risk of hypertension in a prospective study. Am J Epidemiol 182, 10001009.
7. The American College of Obstetricians and Gynecologists (2011) Frequently asked questions FAQ057 gynecologic problems, premenstrual syndrome. (accessed April 2017).
8. Houghton, S & Bertone-Johnson, ER (2015) Macronutrients and premenstrual syndrome. In Advances in Medicine and Biology, vol. 87, pp. 137156 [LV Berhardt, editor]. Hauppauge, NY: NOVA Science Publishers, Inc.
9. Nagata, C, Hirokawa, K, Shimizu, N, et al. (2004) Soy, fat and other dietary factors in relation to premenstrual symptoms in Japanese women. BJOG 111, 594599.
10. Gold, EB, Bair, Y, Block, G, et al. (2007) Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women’s Health Across the Nation (SWAN). J. Womens Health (Larchmt) 16, 641656.
11. Sohrabi, N, Kashanian, M, Ghafoori, SS, et al. (2013) Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: ‘a pilot trial’. Complement Ther Med 21, 141146.
12. Sampalis, F, Bunea, R, Pelland, MF, et al. (2003) Evaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrhea. Altern Med Rev J Clin Ther 8, 171179.
13. Rocha Filho, EA, Lima, JC, Pinho Neto, JS, et al. (2011) Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reprod Health 8, 2.
14. Watanabe, S, Sakurada, M, Tsuji, H, et al. (2005) Efficacy of γ-linolenic acid for treatment of premenstrual syndrome, as assessed by a prospective daily rating system. J Oleo Sci 54, 217224.
15. Budeiri, D, Li Wan, Po A & Dornan, JC (1996) Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 17, 6068.
16. Aeberli, I, Molinari, L, Spinas, G, et al. (2006) Dietary intakes of fat and antioxidant vitamins are predictors of subclinical inflammation in overweight Swiss children. Am J Clin Nutr 84, 748755.
17. Santos, S, Oliveira, A & Lopes, C (2013) Systematic review of saturated fatty acids on inflammation and circulating levels of adipokines. Nutr Res 33, 687695.
18. Turunen, AW, Jula, A, Suominen, AL, et al. (2013) Fish consumption, omega-3 fatty acids, and environmental contaminants in relation to low-grade inflammation and early atherosclerosis. Environ Res 120, 4354.
19. Rangel-Huerta, OD, Aguilera, CM, Mesa, MD, et al. (2012) Omega-3 long-chain polyunsaturated fatty acids supplementation on inflammatory biomakers: a systematic review of randomised clinical trials. Br J Nutr 107, Suppl. 2, S159S170.
20. Calder, PC (2006) Polyunsaturated fatty acids and inflammation. Prostaglandins Leukot Essent Fatty Acids 75, 197202.
21. Bertone-Johnson, ER, Ronnenberg, AG, Houghton, SC, et al. (2014) Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women. Hum Reprod 29, 19871994.
22. Gold, EB, Wells, C & Rasor, MO (2016) The association of inflammation with premenstrual symptoms. J Womens Health (Larchmt) 25, 865874.
23. Puder, JJ, Blum, CA, Mueller, B, et al. (2006) Menstrual cycle symptoms are associated with changes in low-grade inflammation. Eur J Clin Invest 36, 5864.
24. Azizieh, FY, Alyahya, KO & Dingle, K (2017) Association of self-reported symptoms with serum levels of vitamin D and multivariate cytokine profile in healthy women. J Inflamm Res 10, 1928.
25. Tsuji, M, Tamai, Y, Wada, K, et al. (2012) Associations of intakes of fat, dietary fiber, soy isoflavones, and alcohol with levels of sex hormones and prolactin in premenopausal Japanese women. Cancer Causes Control 23, 683689.
26. Bäckström, T, Andreen, L, Birzniece, V, et al. (2003) The role of hormones and hormonal treatments in premenstrual syndrome. CNS Drugs 17, 325342.
27. Bertone-Johnson, ER, Hankinson, SE, Bendich, A, et al. (2005) Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med 165, 12461252.
28. Bertone-Johnson, ER, Hankinson, SE, Johnson, SR, et al. (2007) A simple method of assessing premenstrual syndrome in large prospective studies. J Reprod Med 52, 779786.
29. Mortola, JF, Girton, L, Beck, L, et al. (1990) Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences. Obstet Gynecol 76, 302307.
30. Willett, WC (2013) Nutritional Epidemiology, 3rd ed. Oxford; New York: Oxford University Press.
31. Harvard, TH. Chan School of Public Health Nutrition Department Food Composition Table. (accessed April 2017).
32. London, SJ, Sacks, FM, Caesar, J, et al. (1991) Fatty acid composition of subcutaneous adipose tissue and diet in postmenopausal US women. Am J Clin Nutr 54, 340345.
33. Willett, W, Stampfer, M, Chu, NF, et al. (2001) Assessment of questionnaire validity for measuring total fat intake using plasma lipid levels as criteria. Am J Epidemiol 154, 11071112.
34. Sun, Q, Ma, J, Campos, H, et al. (2007) Comparison between plasma and erythrocyte fatty acid content as biomarkers of fatty acid intake in US women. Am J Clin Nutr 86, 7481.
35. Bertone-Johnson, ER, Whitcomb, BW, Missmer, SA, et al. (2014) Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: a longitudinal study. J Womens Health (Larchmt) 23, 729739.
36. U.S. Department of Health and Human Services & U.S. Department of Agriculture (2015) 2015–2020 Dietary Guidelines for Americans. (accessed April 2017).
37. Kris-Etherton, PM & Mustad, VA (1994) Chocolate feeding studies: a novel approach for evaluating the plasma lipid effects of stearic acid. Am J Clin Nutr 60, 1029S1036S.
38. Kelly, FD, Sinclair, AJ, Mann, NJ, et al. (2001) A stearic acid-rich diet improves thrombogenic and atherogenic risk factor profiles in healthy males. Eur J Clin Nutr 55, 8896.
39. Evans, LM, Cowey, SL, Siegal, GP, et al. (2009) Stearate preferentially induces apoptosis in human breast cancer cells. Nutr Cancer 61, 746753.
40. Ding, EL, Hutfless, SM, Ding, X, et al. (2006) Chocolate and prevention of cardiovascular disease: a systematic review. Nutr Metab (Lond) 3, 2.
41. Rossignol, AM & Bonnlander, H (1991) Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med 36, 131136.
42. Missmer, SA, Chavarro, JE, Malspeis, S, et al. (2010) A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod 25, 15281535.
43. Oh, K, Hu, FB, Manson, JE, et al. (2005) Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses’ health study. Am J Epidemiol 161, 672679.



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