Original Article

Comparison of carbohydrate quality index amongst nurses with and without premenstrual syndrome: a case-control study


Background and Objectives: Due to lack of adequate evidence on the association between intake of carbohydrate and risk of premenstrual syndrome, we aimed to address this issue by analyzing the carbohydrate quality index amongst nurses with and without premenstrual syndrome as a stress intensive career group.
Methods: We examined 151 nurses with and 156 nurses without premenstrual syndrome in current study (totally: 307). Data were collected through interviews using socio-demographic questionnaire, Pre-menstrual Symptom Scale, Food Frequency Questionnaire and International Physical Activity Questionnaire. The carbohydrate quality index was calculated by sum of scores including solid carbohydrate/total carbohydrate, total dietary fiber, GI, and whole grains/total grains. We were utilized Independent sample t-test, Chi-square, One-way analysis of variance, analysis of Covariance and Logistic regression tests to analyze the data.
Results: After adjusting for covariates, participants in the highest quartile of carbohydrate quality index had lower odds ratio of premenstrual syndrome (odds ratio: 0.97, confidence interval: 0.50-1.86) compared with the lowest quartile. However, this difference was not significant (P-trend=1.0). In addition, no relationship was found between premenstrual syndrome and carbohydrate quality index subscales including glycemic index, solid carbohydrate/total carbohydrate, total dietary fiber, and whole grains/total grains.
Conclusions: There is no relationship between different dietary carbohydrate indices and premenstrual syndrome, although further studies are needed to fully determine the possible associations.


1. Nourjah P. Premenstrual syndrome among teacher training university students in Iran. Anxiety. 2008:145:45.3.
2. Dimmock PW, Wyatt KM, Jones PW, O'Brien PS. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. The Lancet. 2000:356(9236):1131-6. doi: 10.1016/S0140-6736(00)02754-9.
3. Chocano-Bedoya PO, Manson JE, Hankinson SE, Willett WC, Johnson SR, Chasan-Taber L, et al. Dietary B vitamin intake and incident premenstrual syndrome. Am J Clin Nutr. 2011:93(5):1080-6. doi: 10.3945/ajcn.110.009530.
4. Taylor D. Perimenstrual symptoms and syndromes: Guidelines for symptom management and self-care. Advanced Studies in Medicine. 2005:5(5):228-41.
5. Kaleli S, Aydın Y, Erel CT, Çolgar U. Symptomatic treatment of premenstrual mastalgia in premenopausal women with lisuride maleate: a double-blind placebo-controlled randomized study. Fertil Steril. 2001:75(4):718-23. doi: 10.1016/S0015-0282(01)01668-5.
6. Wyatt KM, Dimmock PW, Jones PW, O'Brien PS. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. Bmj. 1999:318(7195):1375-81. doi: 10.1136/bmj.318.7195.1375.
7. Chuong CJ, Dawson EB. Zinc and copper levels in premenstrual syndrome. Fertil Steril. 1994:62(2):313-20. doi: 10.1016/S0015-0282(16)56884-8.
8. Bertone-Johnson E, Ronnenberg A, Houghton S, Nobles C, Zagarins S, Takashima-Uebelhoer B, et al. Association of inflammation markers with menstrual symptom severity and premenstrual syndrome in young women. Hum Reprod. 2014:29(9):1987-94. doi: 10.1093/humrep/deu170.
9. Martini MC, Lampe JW, Slavin JL, Kurzer MS. Effect of the menstrual cycle on energy and nutrient intake. Am J Clin Nutr. 1994:60(6):895-9. doi: 10.1093/ajcn/60.6.895.
10. Cross GB, Marley J, Miles H, Willson K. Changes in nutrient intake during the menstrual cycle of overweight women with premenstrual syndrome. Br J Nutr. 2001:85(4):475-82. doi: 10.1079/BJN2000283P.
11. Cohen IT, Sherwin BB, Fleming AS. Food cravings, mood, and the menstrual cycle. Horm Behav. 1987:21(4):457-70. doi: 10.1016/0018-506X(87)90004-3.
12. Bowen DJ, Grunberg NE. Variations in food preference and consumption across the menstrual cycle. Physiol Behav. 1990:47(2):287-91. doi: 10.1016/0031-9384(90)90144-S.
13. Buffenstein R, Poppitt SD, McDevitt RM, Prentice AM. Food intake and the menstrual cycle: a retrospective analysis, with implications for appetite research. Physiol Behav. 1995:58(6):1067-77. doi: 10.1016/0031-9384(95)02003-9.
14. Cross GB. Premenstrual syndrome: food preferences, increasing brain serotonin availability and mood in women; 2002.
15. Gil Á, de Victoria EM, Olza J. Indicators for the evaluation of diet quality. Nutr Hosp. 2015:31(3):128-44. doi: 10.3305/nh.2015.31.sup3.8761.
16. Nishida C, Nocito FM. FAO/WHO scientific update on carbohydrates in human nutrition: introduction. Eur J Clin Nutr. 2007:61(S1):S1. doi: 10.1038/sj.ejcn.1602935.
17. Nagata C, Hirokawa K, Shimizu N, Shimizu H. Soy, fat and other dietary factors in relation to premenstrual symptoms in Japanese women. Br J Obstet Gynaecol. 2004:111(6):594-9. doi: 10.1111/j.1471-0528.2004.00130.x.
18. Johnson WG, Carr-Nangle RE, Bergeron KC. Macronutrient intake, eating habits, and exercise as moderators of menstrual distress in healthy women. Psychosom Med. 1995:57(4):324-30.
19. Rasheed P, Al-Sowielem LS. Prevalence and predictors of premenstrual syndrome among college–aged women in Saudi Arabia. Ann Saudi Med. 2003.
20. Murakami K, Sasaki S, Takahashi Y, Uenishi K, Watanabe T, Kohri T, et al. Dietary glycemic index is associated with decreased premenstrual symptoms in young Japanese women. Nutrition. 2008:24(6):554-61. doi: 10.1016/j.nut.2008.02.003.
21. Houghton SC, Manson JE, Whitcomb BW, Hankinson SE, Troy LM, Bigelow C, et al. Carbohydrate and fiber intake and the risk of premenstrual syndrome. Eur J Clin Nutr. 2018:72(6):861. doi: 10.1038/s41430-017-0076-8.
22. Abedian Kasgari K, Shahhosseini Z, Danesh M. Assessment of starch dietary regimen regarding pre-menstrual syndrome among high school students in Sari during 2007. J Mazandaran Univ Med Sci. 2008:18(65):19-27.
23. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Arch Womens Ment Health. 2003:6(3):203-9. doi: 10.1007/s00737-003-0018-4.
24. Hariri FZ, Moghaddam-Banaem L, Bazi SS, Malehi AS, Montazeri A. The Iranian version of the Premenstrual Symptoms Screening Tool (PSST): a validation study. Arch Womens Ment Health. 2013:16(6):531-7. doi: 10.1007/s00737-013-0375-6.
25. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003:35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB.
26. Moghaddam MB, Aghdam FB, Jafarabadi MA, Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World Appl. Sci. J. 2012:18(8):1073-80. doi: 10.5829/idosi.wasj.2012.18.08.754.
27. Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol. 2010:20(2):150-8.
28. Zazpe I, Sánchez-Taínta A, Santiago S, de la Fuente-Arrillaga C, Bes-Rastrollo M, Martínez JA, et al. Association between dietary carbohydrate intake quality and micronutrient intake adequacy in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Br J Nutr. 2014:111(11):2000-9. doi: 10.1017/S0007114513004364.
29. Welch AA, Luben R, Khaw K, Bingham S. The CAFE computer program for nutritional analysis of the EPIC‐Norfolk food frequency questionnaire and identification of extreme nutrient values. J Hum Nutr Dietet. 2005:18(2):99-116. doi: 10.1111/j.1365-277X.2005.00593.x.
30. Sanchez-Villegas A, Zazpe I, Santiago S, Perez-Cornago A, Martinez-Gonzalez MA, Lahortiga-Ramos F. Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project. Br J Nutr. 2018:119(2):211-21. doi: 10.1017/S0007114517003361.
31. Kim DY, Kim S, Lim H. Association between dietary carbohydrate quality and the prevalence of obesity and hypertension. J Hum Nutr Dietet. 2018:31(5):587-96. doi: 10.1111/jhn.12559.
32. Hussein RA, Hafiz M, Bin-Afif S, Al-Omari E, Al-Helou M. Premenstrual syndrome prevalence, and correlation with carbohydrate intake in young women. HEALTHMED. 2012:6(3):774-80.
33. Freeman E, Stout A, Endicott J, Spiers P. Treatment of premenstrual syndrome with a carbohydrate‐rich beverage. Int J Gynaecol Obstet. 2002:77(3):253-4. doi: 10.1016/S0020-7292(02)00033-4.
34. Wurtman JJ, Brzezinski A, Wurtman RJ, Laferrere B. Effect of nutrient intake on premenstrual depression. Am J Obstet Gynecol. 1989:161(5):1228-34. doi: 10.1016/0002-9378(89)90671-6.
35. Meltzer H. Serotonergic dysfunction in depression. BJPsych. 1989:155(S8):25-31. doi: 10.1192/S0007125000291733.
36. Rapkin AJ. The role of serotonin in premenstrual syndrome. Clin Obstet Gynecol. 1992:35(3):629-36.
37. Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. J Psychiatry Neurosci. 2000:25(5):459.
38. Fernstrom JD, Wurtman RJ. Brain serotonin content: increase following ingestion of carbohydrate diet. Science. 1971:174(4013):1023-5. doi: 10.1126/science.174.4013.1023.
39. Berry E, Growdon J, Wurtman J, Caballero B, Wurtman R. A balanced carbohydrate: protein diet in the management of Parkinson's disease. Neurology. 1991:41(8):1295-. doi: 10.1212/WNL.41.8.1295.
40. Wurtman RJ, Wurtman JJ, Regan MM, McDermott JM, Tsay RH, Breu JJ. Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. Am J Clin Nutr. 2003:77(1):128-32. doi: 10.1093/ajcn/77.1.128.
41. Teff KL, Young SN, Marchand L, Botez MI. Acute effect of protein or carbohydrate breakfasts on human cerebrospinal fluid monoamine precursor and metabolite levels. J Neurochem. 1989:52(1):235-41. doi: 10.1111/j.1471-4159.1989.tb10922.x.
42. Jahromi BN, Pakmehr S, Hagh-Shenas H. Work stress, premenstrual syndrome and dysphoric disorder: are there any associations? Iran Red Crescent Med J. 2011:13(3):199.
IssueVol 5, No 3/4 (Summer/Autumn 2019) QRcode
SectionOriginal Article(s)
Carbohydrate Quality Index Case Control Study Premenstrual Syndrome.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Khademian F, Koohdani F, Qorbani M, Siassi F, Farasati N, Abashzadeh K, Sotoudeh G. Comparison of carbohydrate quality index amongst nurses with and without premenstrual syndrome: a case-control study. J Nutr Sci & Diet. 2021;5(3-4).