Relationship between Dysmenorrhea, Dietary Inflammatory Index, and C-reactive Protein Level

Main Article Content

Salime Mucuk
Müge Yılmaz
Aslı Onur


Dysmenorrhea, C-reactive protein, Diet inflammatory index, Healthy lifestyle behaviors


Objective: Primary dysmenorrhea is a common health problem that affects women's quality of life. This study aimed to determine the relationship between dysmenorrhea, dietary inflammatory index (DII), and C-reactive protein (CRP) serum levels.

Study Designs: This cross-sectional study was conducted between March and June 2019 with 106 university students, including 56 with primary dysmenorrhea and 50 without dysmenorrhea. The data were collected via a survey form including questions about the participants’ socio-demographic characteristics and obstetric/gynecological histories, the Healthy Lifestyle Behaviors Scale-II (HLBS-II), and the Visual Analog Scale (VAS). Anthropometric measurements of the participants were performed, their three-day food consumption record was received, their DII scores were calculated, and their CRP level was measured. The independent samples t-test and Mann-Whitney U test were used to compare the participants’ DII scores and CRP levels. A linear regression analysis was performed to determine the relationship between dysmenorrhea, DII, and CRP level. A p-value of less than 0.05 was considered statistically significant.

Results: The DII 3rd tertile mean score of the dysmenorrhea group (5.017 ± 1.231) was higher than that of the non-dysmenorrhea group (3.681 ± 1.309) (t=3.154, p=0.003). The median value of CRP was higher in the dysmenorrhea group [0.72 (0.37-1.65)] than in the non-dysmenorrhea group [(0.48 (0.23-1.21)] (z=2.117, p=0.034). According to the linear regression analysis, dysmenorrhea significantly increased the CRP value by 0.471 units compared to the non-dysmenorrhea group (β=0.471; p=0.038).

Conclusion: Participants with dysmenorrhea had higher serum CRP levels and DII scores.


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1. Armour M, Smith CA, Steel KA, Macmillan F. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine 2019; 19:22-38.
2. Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K. Inflammatory markers in dysmenorrheal and therapeutic options. Int J Environ Res Public Health 2020; 17:1191-205.
3. Bavil DA, Dolatian M, Mahmoodi Z, Baghban AA. A comparison of physical activity and nutrition in young women with and without primary dysmenorrhea [version 1; referees: 2 approved, 1 approved with reservations]. F1000Research 2018; 7:59-71.
4. Güner Ö, Öztürk R, Kavlak O. Evidence-based practices management of primary dysmenorrhea: review. Turkiye Klinikleri J Gynecol Obst 2015; 25:195-204.
5. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014; 36:104-13.
6. Akiyama S, Tanaka E, Cristeau O, Onishi Y, Osuga Y. Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database. Clinicoecon Outcomes Res 2017; 9:295-306.
7. Habibi N, Huang MSL, Gan WY, Zulida R, Safavi SM. Prevalence of primary dysmenorrhea and factors associated with its intensity among undergraduate students: a cross-sectional study. Pain Manag Nurs 2015; 16:855-61.
8. Sadeghi N, Paknezhad F, Nooshabadi MR, Kavianpour M, Rad SJ, Haghighian HK. Vitamin E and fish oil, separately or in combination, on treatment of primary dysmenorrhea: a double-blind, randomized clinical trial. Gynecological Endocrinology 2018; 34:804-8.
9. Tomas-Rodríguez MI, Palazon-Bru A, Martínez-St John DRJ, Navarro-Cremades F, Toledo-Marhuenda JV, Gil-Guillen VF. Factors associated with increased pain in primary dysmenorrhea: analysis using a multivariate ordered logistic regression model. J Pediatr Adolesc Gynecol 2017; 30:199-202.
10. Bavil DA, Dolatian M, Mahmoodi Z, Baghban AA. Comparison of lifestyles of young women with and without primary dysmenorrhea. Electronic Physician 2016; 8:2107-14.
11. Pejcic A, Jankovic S. Risk factors for dysmenorrheal among young adult female university students. Ann Ist Super Sanita 2016; 52:98-103.
12. Jeon GE, Cha NH, Sok SR: Factors influencing the dysmenorrhea among Korean adolescents in middle school. J Phys Ther Sci 2014; 26:1337-43.
13. Ozerdogan N, Sayiner D, Ayranci U, Unsal A, Giray S. Prevalence and predictors of dysmenorrhea among students at a university in Turkey. Int J Gynecol Obstet 2009;107:39-43.
14. Shrotriya C, Ray A, Ray S, George AT. 'Menstrual characteristics' and 'prevalence and effect of dysmenorrhea' on quality of life of medical students. International Journal of Collaborative Research on Internal Medicine & Public Health 2012; 4:276-94.
15. Bahar Z. Beşer A. Gördes N. Ersin F. Kıssal A. Validity and reliability study of the healthy lifestyle behaviors scale II. C.Ü. Hemşirelik Yüksekokulu Dergisi 2008; 12:1-13.
16. Cavicchia PP, Steck SE, Hurley TG, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity c-reactive protein. Journal of Nutrition 2009; 139:2365-72.
17. Shivappa N, Bonaccio M, Hebert JR, et al. Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study. Nutrition 2018; 54:182-8.
18. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutrition 2014; 17:1689-96.
19. Garcia-Arellano A, Ramalla R, Ruiz-Canela M, et al. Dietary inflammatory index and incidence of cardiovascular disease in the PREDIMED study. Nutrients 2015; 7:4124-38.
20. Hodge AM, Bassett JK, Dugué PA, et al. Dietary inflammatory index or Mediterranean diet score as risk factors for total and cardiovascular mortality. Nutr Metab Cardiovasc Dis 2018;28:461-9.
21. Phillips CM, Chen LW, Heude B, et al. Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutrients 2019; 11:1873-905.
22. Gaskins AJ, Wilchesky M, Mumford SL, et al. Endogenous reproductive hormones and C-reactive protein across the menstrual cycle: The Bio Cycle Study. Am J Epidemiol 2012; 175:423-31.
23. Wander K, Brindle E, O’Connor KA. C-Reactive Protein Across the Menstrual Cycle.
American Journal of Physical Anthropology 2008; 136:138-46.
24. Madden AM, Smith S. Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables. J Hum Nutr Diet 2016; 29:7-25.
25. Puder JJ, Blum CA, Mueller B, De Geyter C, Dye L, Keller, U. Menstrual cycle symptoms are associated with changes in low-grade inflammation. Eur J Clin Investig 2006; 36:58-64.
26. Gold EB, Wells C, O’NeillRasor M. The association of inflammation with premenstrual symptoms. Journal of Women’s Health 2016; 25:865-74.
27. MacDonald CJ, Laouali N, Madika AL, Mancini FR, Boutron-Ruault MC. Dietary inflammatory index, risk of incident hypertension, and effect modification from BMI. Nutrition Journal 2020; 19:62-80.
28. Yang Y, Hozawa A, Kogure M, et al. Dietary Inflammatory Index Positively Associated with High-Sensitivity C - reactive protein Level in Japanese from NIPPON DATA2010. J Epidemiol 2020; 30:98-107.
29. Bajalan Z, Alimoradi Z, Moafi F. Nutrition as a potential factor of primary dysmenorrhea: a systematic review of observational studies. Gynecol Obstet Invest 2019; 84:209-24.
30. Nagata C, Hirokawa K, Shimizu N, Shimizu H. Associations of menstrual pain within takes of soy, fat and dietary fiber in Japanese women. European Journal of Clinical Nutrition 2005; 59:88-92.
31. Najafi N, Khalkhali H, Moghaddam TF, Zarrin R. Major dietary patterns in relation to menstrual pain: A nested case-control study. BMC Women’s Health 2018; 18:1-7.
32. Rahbar N, Asgharzadeh N, Ghorbani R. Effect of omega 3 fatty acids on intensity of primary dysmenorrhea. Int J Gynecol Obstet 2012;117:45-47.
33. Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecological Endocrinology 2018; 34:659-63.

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