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Micronutrient Intake and Premenstrual Syndrome

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Micronutrient Intake and Premenstrual Syndrome University of Massachusetts Amherst ScholarWorks@UMass Amherst Open Access Dissertations 9-2011 Micronutrient Intake and Premenstrual Syndrome Patricia O. Chocano-Bedoya University of Massachusetts Amherst, [email protected] Follow this and additional works at: https://scholarworks.umass.edu/open_access_dissertations Part of the Epidemiology Commons Recommended Citation Chocano-Bedoya, Patricia O., "Micronutrient Intake and Premenstrual Syndrome" (2011). Open Access Dissertations. 433. https://scholarworks.umass.edu/open_access_dissertations/433 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Open Access Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. MICRONUTRIENT INTAKE AND PREMENSTRUAL SYNDROME A Dissertation Presented by PATRICIA O. CHOCANO-BEDOYA Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY September 2011 Department of Public Health Biostatistics and Epidemiology © Copyright by Patricia O. Chocano-Bedoya 2011 All Rights Reserved MICRONUTRIENT INTAKE AND PREMENSTRUAL SYNDROME A Dissertation Presented by PATRICIA O. CHOCANO-BEDOYA Approved as to style and content by: ________________________________ Elizabeth Bertone-Johnson, Chair ________________________________ Lisa Chasan-Taber, Member _______________________________ Carol Bigelow, Member ________________________________ Alayne Ronnenberg, Member _______________________________ Paula Stamps, Graduate Program Director Department of Public Health DEDICATION To my husband, my parents, and my sister, for they have inspired me to work hard to reach my goals and to never give up on my dreams. ACKNOWLEDGMENTS I would like to thank my advisor and chair of my dissertation committee, Elizabeth Bertone-Johnson, for her support since I started my doctoral studies, her encouragement and guidance, her constructive criticism and for her dedicated time. She is a great mentor and role model. Every single thing she taught me, from basic epidemiology to advanced data analysis, has been useful and completely necessary for completing this work and I will be forever indebted to her. I would also like to thank Dr. Alayne Ronnenberg for her guidance as I completed my minor in Nutrition, and for her encouragement and advice as I completed this project. Also, I am grateful to Dr. Lisa Chasan-Taber and Dr. Carol Bigelow for their time invested in this project and their useful advice. An extended thank you to the professors at the University of Massachusetts Amherst who have contributed to my development as an Epidemiologist, particularly Dr. Phillip Nasca, as well as to my mentors abroad, Dr. Stephan Weiland in Germany and Dr. Himmler Montes in Peru. Finally, I would like to thank my husband for all the days we have worked together in our dissertations side by side, his support and his willingness to come to the United States to get our PhDs, and to my parents and sister, who I have missed deeply throughout these years and who have always been supportive and great role models. v ABSTRACT MICRONUTRIENT INTAKE AND PREMENSTRUAL SYNDROME SEPTEMBER 2011 PATRICIA O. CHOCANO-BEDOYA, M.D., UNIVERSITY OF SAINT AGUSTIN, AREQUIPA, PERU PH.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Elizabeth Bertone-Johnson Premenstrual syndrome (PMS) is characterized by the presence of physical and psychological symptoms restricted to the late luteal phase of the menstrual cycle and associated with substantial impairment in life activities. In the U.S. about 8 to 15% of women of reproductive age suffer from PMS. Many micronutrients are potentially involved in the development of this disorder due to their role in the synthesis of neurotransmitters and hormones or in their regulation, but few previous studies have evaluated the effects of micronutrients on PMS. The first study examined the association between B vitamin intakes, and PMS development among women participating in the Nurses' Health Study 2 (NHS2). We found that high thiamin and high riboflavin intake from food sources were associated with lower risk of PMS. There were not significant associations between niacin, vitamin B6, folate, and vitamin B12 dietary intake and incident PMS. Intakes of B vitamins from supplements were not associated with lower risk of PMS. vi The second study evaluated the association between selected mineral intakes and PMS development in the NHS2. In this study, high iron intakes were associated with lower risk of PMS. Although there was no association between zinc and PMS risk, high intake of zinc relative to copper was associated with lower risk of PMS. There were no associations between of magnesium, copper, and manganese intakes and PMS. We observed a significantly higher risk of PMS in women with high intakes of potassium from food sources. The third study focused on the association between dietary intakes of B vitamins, zinc, magnesium, iron, potassium, and sodium and some biomarkers and PMS prevalence among younger women. In this study, we found an association between zinc intake and lower prevalence of PMS. Each 1 mg/d increase in vitamin B6 from foods was associated with a lower PMS symptom score. Blood magnesium levels were higher in women with PMS compared to women without PMS. We observed that intakes of some micronutrients were associated with lower risk of PMS, but further studies should be conducted. This dissertation contributes to the research on modifiable risk factors for PMS. vii TABLE OF CONTENTS Page ACKNOWLEDGMENTS .............................................................................................v ABSTRACT ................................................................................................................ vi LIST OF TABLES ...................................................................................................... xi LIST OF FIGURES ................................................................................................. xviii CHAPTER 1. PREMENSTRUAL SYNDROME REVIEW ...........................................................1 1.1 Definition and Diagnosis ...................................................................................1 1.2 Incidence, Prevalence and Burden of PMS .......................................................7 1.3 Pathophysiology ..............................................................................................11 1.4 Treatment .........................................................................................................22 1.5 Conclusion .......................................................................................................36 References ..............................................................................................................37 2. DIETARY B VITAMIN INTAKE AND PREMENSTRUAL SYNDROME ........48 2.1 Background ....................................................................................................48 2.1.1 Introduction ..........................................................................................48 2.1.2 Physiologic Mechanisms .....................................................................49 2.1.3 Epidemiologic Evidence ......................................................................59 2.1.4 Summary ..............................................................................................70 2.1.5 Specific Aims and Hypotheses ............................................................72 2.2 Methods.........................................................................................................73 2.2.1 Study design and Population ................................................................73 2.2.2 Exposure Assessment ...........................................................................74 2.2.3 Outcome Assessment ...........................................................................76 2.2.4 Covariate Assessment ..........................................................................79 viii 2.2.5 Data Analysis .......................................................................................81 2.3 Results .........................................................................................................85 2.4 Discussion ...................................................................................................91 2.5 Significance .................................................................................................97 2.6 Human Subject Protection ...........................................................................98 2.7 Permission to access data ............................................................................99 References .......................................................................................................122 3. DIETARY INTAKE OF SELECTED MINERALS AND PREMENSTRUAL SYNDROME .............................................................................................................130 3.1 Background ..................................................................................................130 3.1.1 Introduction ........................................................................................130 3.1.2 Physiologic Mechanisms ...................................................................131 3.1.3 Epidemiologic Evidence ....................................................................143
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