Mary A Andrews1, Karen C Schliep2, Jean Wactawski-Wende3, Joseph B Stanford4, Shvetha M Zarek5, Rose G Radin2, Lindsey A Sjaarda2, Neil J Perkins2, Robyn A Kalwerisky2, Ahmad O Hammoud6, Sunni L Mumford7. 1. Department of Preventive Medicine and Biometrics and Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. 2. Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 7B05, MSC 7510, Rockville, MD 20852, USA. 3. Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY 14214, USA. 4. Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA. 5. Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 7B05, MSC 7510, Rockville, MD 20852, USA Program in Reproductive and Adult Endocrinology, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development,10 CENTER DR Room 1-3140, MSC 1109, Bethesda MD 20892, USA. 6. Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 N Medical Drive, Salt Lake City, UT 84132, USA IVF Michigan Fertility Center, Bloomfield Hills, 37000 Woodward Ave. Suite 350, Bloomfield Hills, MI 48304, USA. 7. Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 7B05, MSC 7510, Rockville, MD 20852, USA mumfords@mail.nih.gov.
Abstract
STUDY QUESTION: Are prospectively assessed dietary factors, including overall diet quality, macronutrients and micronutrients, associated with luteal phase deficiency (LPD) in healthy reproductive aged women with regular menstrual cycles? SUMMARY ANSWER: Mediterranean Diet Score (MDS), fiber and isoflavone intake were positively associated with LPD while selenium was negatively associated with LPD after adjusting for age, percentage body fat and total energy intake. WHAT IS KNOWN ALREADY: LPD may increase the risk of infertility and early miscarriage. Prior research has shown positive associations between LPD and low energy availability, either through high dietary restraint alone or in conjunction with high energy expenditure via exercise, but few studies with adequate sample sizes have been conducted investigating dietary factors and LPD among healthy, eumenorrheic women. STUDY DESIGN, SIZE, DURATION: The BioCycle Study (2005-2007) prospectively enrolled 259 women from Western New York state, USA, and followed them for one (n = 9) or two (n = 250) menstrual cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women aged 18-44 years, with self-reported BMI between 18 and 35 kg/m(2) and cycle lengths between 21 and 35 days, were included in the study. Participants completed baseline questionnaires, four 24-h dietary recalls per cycle and daily diaries capturing vigorous exercise, perceived stress and sleep; they also provided up to eight fasting serum samples during clinic visits timed to specific phases of the menstrual cycle using a fertility monitor. Cycles were included for this analysis if the peak serum luteal progesterone was >1 ng/ml and a urine or serum LH surge was detected. Associations between prospectively assessed diet quality, macronutrients and micronutrients and LPD (defined as luteal duration <10 days) were evaluated using generalized linear models adjusting for age, percentage body fat and total energy intake. MAIN RESULTS AND THE ROLE OF CHANCE: LPD occurred in 41 (8.9%) of the 463 cycles from 246 women in the final analysis. After adjusting for age, percentage body fat and total energy intake, LPD was positively associated with MDS, adjusted odds ratio (aOR): 1.70 (95% confidence interval [CI]: 1.17, 2.48), P = 0.01. In separate macro- and micronutrient adjusted models, increased fiber and isoflavone intake showed modest positive associations with LPD: fiber (per g), aOR: 1.10 (95% CI: 0.99, 1.23), P = 0.07; and isoflavones (per 10 mg), aOR: 1.38 (95% CI: 0.99, 1.92), P = 0.06. In contrast, selenium (per 10 mcg) was inversely associated with LPD, aOR: 0.80 (95% CI: 0.65, 0.97), P = 0.03. Additional adjustments for relevant lifestyle factors including vigorous exercise, perceived stress and sleep did not appreciably alter estimates. LIMITATIONS, REASONS FOR CAUTION: The number of LPD cycles was limited, and thus these findings are exploratory. We relied on participant self-report of their medical history to apply exclusion criteria; it is possible that we admitted to the study women with a gynecologic or medical disease who were unaware of their diagnosis. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that diet quality may be associated with LPD among healthy eumenorrheic women. As LPD may contribute to infertility and early miscarriage, further research is warranted to elucidate how dietary factors, such as MDS, may influence LPD. The inverse association we found with selenium is supported by previous research and deserves further investigation to determine whether this finding has pathophysiologic and therapeutic implications. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. No competing interests declared. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
STUDY QUESTION: Are prospectively assessed dietary factors, including overall diet quality, macronutrients and micronutrients, associated with luteal phase deficiency (LPD) in healthy reproductive aged women with regular menstrual cycles? SUMMARY ANSWER: Mediterranean Diet Score (MDS), fiber and isoflavone intake were positively associated with LPD while selenium was negatively associated with LPD after adjusting for age, percentage body fat and total energy intake. WHAT IS KNOWN ALREADY: LPD may increase the risk of infertility and early miscarriage. Prior research has shown positive associations between LPD and low energy availability, either through high dietary restraint alone or in conjunction with high energy expenditure via exercise, but few studies with adequate sample sizes have been conducted investigating dietary factors and LPD among healthy, eumenorrheic women. STUDY DESIGN, SIZE, DURATION: The BioCycle Study (2005-2007) prospectively enrolled 259 women from Western New York state, USA, and followed them for one (n = 9) or two (n = 250) menstrual cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS:Women aged 18-44 years, with self-reported BMI between 18 and 35 kg/m(2) and cycle lengths between 21 and 35 days, were included in the study. Participants completed baseline questionnaires, four 24-h dietary recalls per cycle and daily diaries capturing vigorous exercise, perceived stress and sleep; they also provided up to eight fasting serum samples during clinic visits timed to specific phases of the menstrual cycle using a fertility monitor. Cycles were included for this analysis if the peak serum luteal progesterone was >1 ng/ml and a urine or serum LH surge was detected. Associations between prospectively assessed diet quality, macronutrients and micronutrients and LPD (defined as luteal duration <10 days) were evaluated using generalized linear models adjusting for age, percentage body fat and total energy intake. MAIN RESULTS AND THE ROLE OF CHANCE: LPD occurred in 41 (8.9%) of the 463 cycles from 246 women in the final analysis. After adjusting for age, percentage body fat and total energy intake, LPD was positively associated with MDS, adjusted odds ratio (aOR): 1.70 (95% confidence interval [CI]: 1.17, 2.48), P = 0.01. In separate macro- and micronutrient adjusted models, increased fiber and isoflavone intake showed modest positive associations with LPD: fiber (per g), aOR: 1.10 (95% CI: 0.99, 1.23), P = 0.07; and isoflavones (per 10 mg), aOR: 1.38 (95% CI: 0.99, 1.92), P = 0.06. In contrast, selenium (per 10 mcg) was inversely associated with LPD, aOR: 0.80 (95% CI: 0.65, 0.97), P = 0.03. Additional adjustments for relevant lifestyle factors including vigorous exercise, perceived stress and sleep did not appreciably alter estimates. LIMITATIONS, REASONS FOR CAUTION: The number of LPD cycles was limited, and thus these findings are exploratory. We relied on participant self-report of their medical history to apply exclusion criteria; it is possible that we admitted to the study women with a gynecologic or medical disease who were unaware of their diagnosis. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that diet quality may be associated with LPD among healthy eumenorrheic women. As LPD may contribute to infertility and early miscarriage, further research is warranted to elucidate how dietary factors, such as MDS, may influence LPD. The inverse association we found with selenium is supported by previous research and deserves further investigation to determine whether this finding has pathophysiologic and therapeutic implications. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. No competing interests declared. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Authors: N I Williams; D L Helmreich; D B Parfitt; A Caston-Balderrama; J L Cameron Journal: J Clin Endocrinol Metab Date: 2001-11 Impact factor: 5.958
Authors: Nancy I Williams; Heather J Leidy; Brenna R Hill; Jay L Lieberman; Richard S Legro; Mary Jane De Souza Journal: Am J Physiol Endocrinol Metab Date: 2014-10-28 Impact factor: 4.310
Authors: Amy F Subar; Victor Kipnis; Richard P Troiano; Douglas Midthune; Dale A Schoeller; Sheila Bingham; Carolyn O Sharbaugh; Jillian Trabulsi; Shirley Runswick; Rachel Ballard-Barbash; Joel Sunshine; Arthur Schatzkin Journal: Am J Epidemiol Date: 2003-07-01 Impact factor: 4.897
Authors: Rebecca S Usadi; Jeremy M Groll; Bruce A Lessey; Ruth A Lininger; Richard J Zaino; Marc A Fritz; Steven L Young Journal: J Clin Endocrinol Metab Date: 2008-07-22 Impact factor: 5.958
Authors: Joanne F Dorgan; Sally A Hunsberger; Robert P McMahon; Peter O Kwiterovich; Ronald M Lauer; Linda Van Horn; Norman L Lasser; Victor J Stevens; Lisa A Friedman; Jack A Yanovski; Susan F Greenhut; Donald Walt Chandler; Frank A Franklin; Bruce A Barton; Dennis W Buckman; Linda G Snetselaar; Blossom H Patterson; Arthur Schatzkin; Philip R Taylor Journal: J Natl Cancer Inst Date: 2003-01-15 Impact factor: 13.506
Authors: Amelia K Wesselink; Elizabeth E Hatch; Ellen M Mikkelsen; Ellen Trolle; Sydney K Willis; Susan E McCann; Liisa Valsta; Annamari Lundqvist; Katherine L Tucker; Kenneth J Rothman; Lauren A Wise Journal: J Nutr Date: 2020-05-01 Impact factor: 4.798