Nutritional Health in Premenopausal Women: A Cross‑Sectional Study from Turkey

Selin Akturk Esen, İrfan Esen, Yusuf Açikgöz

Abstract


Background: The aim of this study was to evaluate the nutritional habits of premenopausal women using the Food Consumption Frequency Questionnaire (FCFQ) and to evaluate the relationship between anthropometric measurements, lipid parameters, and the presence of anemia with the findings obtained. Methods: This study was carried out in the internal medicine outpatient clinics of the Health Sciences University Bursa Yüksek İhtisas Training Research Hospital (located in Yıldırım districts) and Gürsu State Hospital (located in Gürsu districts) of Bursa province between 1 June–31 August 2019. We used clustered sampling in patient selection. One hundred seventy‑one premenopausal participants aged between 18 and 55 who were known to be healthy and who came for routine control to the internal medicine outpatient clinics were included in the study. The FCFQ was used to determine how often the participants consumed different food groups in the last 1 month. Results: Overweight participants were 29.20% and 17% were obese. 43.90% of the women had anemia and 65.50% of the women had iron deficiency. The milk‑dairy products nutrition score of the group with triglycerides (TG) <150 mg/dL was higher than the group with TG ≥150 mg/dL (P = 0.029). The meat‑egg‑legumes nutrition score (2.11 ± 0.57) of the group with high density lipoprotein (HDL) ≥50 mg/dL was higher than the group with HDL <50 mg/dL (1.91 ± 0.58) (P = 0.04). Conclusions: Anemia and obesity are high in premenopausal women. Community‑based screening programs are needed to evaluate premenopausal women for anemia and obesity. Scales to assess the nutritional habits of the population are also needed in screening programs.

Keywords


Anemia; eating habits; lipid profile; obesity; premenopausal women

Full Text:

PDF

References


Gunes FE, Imeryuz N, Akalin A, Bekiroglu N, Alphan E,

Oguz A, et al. Development and validation of a semi‑quantitative

food frequency questionnaire to assess dietary intake in Turkish

adults. J Pak Med Assoc 2015;65:756‑63.

Ünüvar NMS, Yardim N. Turkey Burden of Disease Study.

RSHMB School of Public Health Directorate; 2006. p. 1-56.

Chen Y, Copeland WK, Vedanthan R, Grant E, Lee JE, Gu D,

et al. Association between body mass index and cardiovascular

disease mortality in east Asians and south Asians: Pooled

analysis of prospective data from the Asia Cohort Consortium.

BMJ 2013;347:f5446.

Dehghan M, del Cerro S, Zhang X, Cuneo JM, Linetzky B,

Diaz R, et al. Validation of a semi‑quantitative Food

Frequency Questionnaire for Argentinean adults. PLoS One

;7:e37958.

Johnson F, Cooke L, Croker H, Wardle J. Changing perceptions

of weight in Great Britain: Comparison of two population

surveys. BMJ 2008;337:a494.

WHO. Diet, nutrition and the prevention of chronic diseases.

Geneva; 2003.

Drewnowski A, Specter SE. Poverty and obesity: The role of

energy density and energy costs. Am J Clin Nutr 2004;79:6‑16.

University/WHO UUN. Iron Deficiency Anaemia Assessment,

Prevention and Control. A Guide for Programme Managers.

Geneva: World Health Organization; 2001.

Karakus VGA, Ersil SD, Bozkurt S, Kurtoglu E. Evaluation of

anemia in terms of etiology, risk factors, and relapse in adult

patients. Mugla Med J 2016;3:1‑6.

WHO. Worldwide prevalence of anaemia 1993‑2005: WHO

global database on anaemia. Geneva, Switzerland; 2008.

Consultation WHOE. Appropriate body‑mass index for Asian

populations and its implications for policy and intervention

strategies. Lancet 2004;363:157‑63.

Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG,

Donato KA, et al. 2013 AHA/ACC/TOS guideline for the

management of overweight and obesity in adults: A report of the

American College of Cardiology/American Heart Association

Task Force on Practice Guidelines and The Obesity Society.

J Am Coll Cardiol 2014;63:2985‑3023.

Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR,

Sakamoto Y. Healthy percentage body fat ranges: An approach

for developing guidelines based on body mass index. Am J Clin

Nutr 2000;72:694‑701.

Okosun IS, Cooper RS, Rotimi CN, Osotimehin B, Forrester T.

Association of waist circumference with risk of hypertension and

type 2 diabetes in Nigerians, Jamaicans, and African‑Americans.

Diabetes Care 1998;21:1836‑42.

WHO. Waist Circumference and Waist‑Hip Ratio Report of a

WHO Expert Consultation. Geneva; 2008.

Ashwell MBL. The increasing importance of waist‑to height ratio

to assess cardiometabolic risk: A plea for consistent terminology.

Open Obes J 2011;3:70‑7.

Araştırması 2010 TBvS. Beslenme Durumu Ve Alışkanlıklarının

Değerlendirilmesi Sonuç Raporu. Hacettepe Üniversitesi Sağlık

Bilimleri Fakültesi Beslenme ve Diyetetik Bölümü. 2014.

Available from: https://hsgm.saglik.gov.tr/depo/birimler/sagliklibeslenme-hareketli-hayat-db/Yayinlar/kitaplar/diger-kitaplar/

TBSA-Beslenme-Yayini.pdf.

Pekcan G. Beslenme Durumunun Saptanması. Diyet El

KitabıAnkara: Hatiboğlu Yayınevi; 2011. p. 11-2.

Ermiş E, Doğan E, Erilli N, Satıcı A. Üniversite öğrencilerinin beslenme alışkanlıklarının incelenmesi. Fırat Sağlık Hizmetleri

Dergisi 2007;2:87‑104.

Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the

elderly: Current understanding and emerging concepts. Blood

Rev 2006;20:213‑26.

WHO. The Global Prevalence of Anaemia in 2011. Geneva,

Switzerland: World Health Organization; 2015.

Oberley MJ, Yang DT. Laboratory testing for cobalamin

deficiency in megaloblastic anemia. Am J Hematol

;88:522‑6.

Fairbanks VF. Laboratory testing for iron status. Hosp Pract (Off

Ed) 1991;26(Suppl 3):17‑24.

Zanella A, Gridelli L, Berzuini A, Colotti MT, Mozzi F, Milani S,

et al. Sensitivity and predictive value of serum ferritin and free

erythrocyte protoporphyrin for iron deficiency. J Lab Clin Med

;113:73‑8.

McMahon LF Jr, Ryan MJ, Larson D, Fisher RL. Occult

gastrointestinal blood loss in marathon runners. Ann Intern Med

;100:846‑7.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the

concentration of low‑density lipoprotein cholesterol in plasma,

without use of the preparative ultracentrifuge. Clin Chem

;18:499‑502.

Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S,

et al. BMI and all cause mortality: Systematic review and

non‑linear dose‑response meta‑analysis of 230 cohort studies

with 3.74 million deaths among 30.3 million participants. BMJ

;353:i2156.

Prospective Studies C, Whitlock G, Lewington S, Sherliker P,

Clarke R, Emberson J, et al. Body‑mass index and cause‑specific

mortality in 900 000 adults: Collaborative analyses of 57

prospective studies. Lancet 2009;373:1083‑96.

Guilbert JJ. The world health report 2002‑Reducing risks,

promoting healthy life. Educ Health (Abingdon) 2003;16:230.

Wiseman M. The second World Cancer Research Fund/American

Institute for Cancer Research expert report. Food, nutrition,

physical activity, and the prevention of cancer: A global

perspective. Proc Nutr Soc 2008;67:253‑6.

Rich‑Edwards JW, Manson JE, Hennekens CH, Buring JE. The

primary prevention of coronary heart disease in women. N Engl

J Med 1995;332:1758‑66.

Miller VT. Lipids, lipoproteins, women and cardiovascular

disease. Atherosclerosis 1994;108(Suppl):S73‑82.

Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non‑HDL

cholesterol, apolipoproteins A‑I and B100, standard lipid

measures, lipid ratios, and CRP as risk factors for cardiovascular

disease in women. JAMA 2005;294:326‑33.

Cui Y, Blumenthal RS, Flaws JA, Whiteman MK, Langenberg P,

Bachorik PS, et al. Non‑high‑density lipoprotein cholesterol

level as a predictor of cardiovascular disease mortality. Arch

Intern Med 2001;161:1413‑9.

Expert Panel on Detection Evaluation, and Treatment of High

Blood Cholesterol in Adults. Executive summary of the third

report of the national cholesterol education program (NCEP)

expert panel on detection, evaluation, and treatment of high

blood cholesterol in adults (Adult Treatment Panel III). JAMA

;285:2486‑97.

Orth‑Gomer K, Mittleman MA, Schenck‑Gustafsson K,

Wamala SP, Eriksson M, Belkic K, et al. Lipoprotein(a) as

a determinant of coronary heart disease in young women.

Circulation 1997;95:329‑34.

Grundy SM. Guidelines for cholesterol management:

Recommendations of the National Cholesterol Education

Program’s Adult Treatment Panel II. Heart Dis Stroke

;3:123‑7.

Criqui MH, Heiss G, Cohn R, Cowan LD, Suchindran CM,

Bangdiwala S, et al. Plasma triglyceride level and mortality from

coronary heart disease. N Engl J Med 1993;328:1220‑5.

Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A,

Petraglia F. Prevalence of heavy menstrual bleeding and

experiences of affected women in a European patient survey. Int

J Gynaecol Obstet 2015;128:196‑200.

Sekhar DL, Murray‑Kolb LE, Kunselman AR, Weisman CS,

Paul IM. Differences in risk factors for anemia between

adolescent and adult women. J Womens Health (Larchmt)

;25:505‑13.

Kilinc M, Yuregir GT, Ekerbicer H. Anaemia and iron‑deficiency

anaemia in south‑east Anatolia. Eur J Haematol 2002;69:280‑3.

Janssen CA, Scholten PC, Heintz AP. Reconsidering menorrhagia

in gynecological practice. Is a 30‑year‑old definition still valid?

Eur J Obstet Gynecol Reprod Biol 1998;78:69‑72.

Milman N, Clausen J, Byg KE. Iron status in 268 Danish women

aged 18‑30 years: Influence of menstruation, contraceptive

method, and iron supplementation. Ann Hematol 1998;77:13‑9.

Pala K, Dundar N. Prevalence & risk factors of anaemia among

women of reproductive age in Bursa, Turkey. Indian J Med Res

;128:282‑6.

O’Neil CE, Keast DR, Fulgoni VL, Nicklas TA. Food sources

of energy and nutrients among adults in the US: NHANES

‑2006. Nutrients 2012;4:2097‑120.

Papanikolaou Y, Fulgoni VL. Grains contribute shortfall nutrients

and nutrient density to older US adults: Data from the National

Health and Nutrition Examination Survey, 2011‑2014. Nutrients

;10:534.

Orshal JM, Khalil RA. Gender, sex hormones, and vascular tone.

Am J Physiol Regul Integr Comp Physiol 2004;286:R233‑49.

You SA, Wang Q. Ferritin in atherosclerosis. Clin Chim Acta

;357:1‑16.

Qayyum R, Schulman P. Iron and atherosclerosis. Clin Cardiol

;28:119‑22.

Minqin R, Rajendran R, Pan N, Tan BK, Ong WY, Watt F, et al.

The iron chelator desferrioxamine inhibits atherosclerotic lesion

development and decreases lesion iron concentrations in the

cholesterol‑fed rabbit. Free Radic Biol Med 2005;38:1206‑11.

Sengoelge G, Sunder‑Plassmann G, Horl WH. Potential risk for

infection and atherosclerosis due to iron therapy. J Ren Nutr

;15:105‑10.

Kruszewski M. The role of labile iron pool in cardiovascular

diseases. Acta Biochim Pol 2004;51:471‑80.

Yuan XM, Li W. The iron hypothesis of atherosclerosis and its

clinical impact. Ann Med 2003;35:578‑91.

Zheng H, Cable R, Spencer B, Votto N, Katz SD. Iron stores and

vascular function in voluntary blood donors. Arterioscler Thromb

Vasc Biol 2005;25:1577‑83.

Ozdemir A, Sevinc C, Selamet U, Türkmen F. The relationship

between iron deficiency anemia and lipid metabolism in

premenopausal women. Am J Med Sci 2007;334:331‑3.

Hristova K, Shiue I, Pella D, Singh RB, Chaves H, Basu TK,

et al. Prevention strategies for cardiovascular diseases and

diabetes mellitus in developing countries: World Conference of

Clinical Nutrition 2013. Nutrition 2014;30:1085‑9.

Wang Y, Crawford MA, Chen J, Ghebremeskel K, Campbell TC,

Fan W, et al. Fish consumption, blood docosahexaenoic acid and

chronic diseases in Chinese rural populations. Comp Biochem

Physiol A Mol Integr Physiol 2003;136:127‑40.

Chan DS, Lau R, Aune D, Vieira R, Greenwood DC, Kampman E, et al. Red and processed meat and colorectal

cancer incidence: Meta‑analysis of prospective studies. PLoS

One 2011;6:e20456.

Santarelli RL, Pierre F, Corpet DE. Processed meat and

colorectal cancer: A review of epidemiologic and experimental

evidence. Nutr Cancer 2008;60:131‑44.

Fagherazzi G, Vilier A, Saes Sartorelli D, Lajous M,

Balkau B, Clavel‑Chapelon F. Consumption of artificially and

sugar‑sweetened beverages and incident type 2 diabetes in the

Etude Epidemiologique aupres des femmes de la Mutuelle

Generale de l’Education Nationale‑European Prospective

Investigation into Cancer and Nutrition cohort. Am J Clin Nutr

;97:517‑23.

Mirmiran P, Noori N, Zavareh MB, Azizi F. Fruit and vegetable

consumption and risk factors for cardiovascular disease.

Metabolism 2009;58:460‑8.

Zhang X, Shu XO, Xiang YB, Yang G, Li H, Gao J, et al.

Cruciferous vegetable consumption is associated with a reduced

risk of total and cardiovascular disease mortality. Am J Clin Nutr

;94:240‑6.

La Vecchia C. Association between Mediterranean dietary

patterns and cancer risk. Nutr Rev 2009;67:126‑9.

Hadziabdić MO, Bozikov V, Pavić E, Romić Z. The antioxidative

protecting role of the Mediterranean diet. Coll Antropol

;36:1427‑34.

Farvid MS, Malekshah AF, Pourshams A, Poustchi H,

Sepanlou SG, Sharafkhah M, et al. Dairy food intake and

all‑cause, cardiovascular disease, and cancer mortality: The

Golestan Cohort Study. Am J Epidemiol 2017;185:697‑711.

O’Sullivan TA, Hafekost K, Mitrou F, Lawrence D. Food

sources of saturated fat and the association with mortality:

A meta‑analysis. Am J Public Health 2013;103:e31‑42.

Soedamah‑Muthu SS, Ding EL, Al‑Delaimy WK, Hu FB,

Engberink MF, Willett WC, et al. Milk and dairy consumption

and incidence of cardiovascular diseases and all‑cause mortality:

Dose‑response meta‑analysis of prospective cohort studies. Am J

Clin Nutr 2011;93:158‑71.

Michaelsson K, Wolk A, Langenskiold S, Basu S,

Warensjö Lemming E, Melhus H, et al. Milk intake and risk of

mortality and fractures in women and men: Cohort studies. BMJ

;349:g6015.

Soedamah‑Muthu SS, Masset G, Verberne L, Geleijnse JM,

Brunner EJ. Consumption of dairy products and associations

with incident diabetes, CHD and mortality in the Whitehall II

study. Br J Nutr 2013;109:718‑26.

Praagman J, Franco OH, Ikram MA, Soedamah‑Muthu SS,

Engberink MF, van Rooij FJ, et al. Dairy products and the risk

of stroke and coronary heart disease: The Rotterdam Study. Eur J

Nutr 2015;54:981‑90.

van Aerde MA, Soedamah‑Muthu SS, Geleijnse JM, Snijder MB,

Nijpels G, Stehouwer CD, et al. Dairy intake in relation to

cardiovascular disease mortality and all‑cause mortality: The

Hoorn Study. Eur J Nutr 2013;52:609‑16.

Praagman J, Dalmeijer GW, van der Schouw YT,

Soedamah‑Muthu SS, Monique Verschuren WM, Bas

Bueno‑de‑Mesquita H, et al. The relationship between fermented

food intake and mortality risk in the European Prospective

Investigation into Cancer and Nutrition‑Netherlands cohort. Br J

Nutr 2015;113:498‑506.

Wang H, Troy LM, Rogers GT, Fox CS, McKeown NM,

Meigs JB, et al. Longitudinal association between dairy

consumption and changes of body weight and waist

circumference: The Framingham Heart Study. Int J Obes (Lond)

;38:299‑305.

Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes

in diet and lifestyle and long‑term weight gain in women and

men. N Engl J Med 2011;364:2392‑404.