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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Elizabeth. R. Bertone-Johnson

Second Advisor

Brian W. Whitcomb

Third Advisor

Carol Bigelow

Fourth Advisor

Lisa M. Troy

Subject Categories

Epidemiology | Nutrition | Nutritional Epidemiology | Public Health | Women's Health


Premenstrual syndrome (PMS) affects 8-20% of reproductive-aged women, impacting work, family, and social interactions. Limitations in available PMS treatments, including side effects and limited medication efficacy, indicate the need for improved prevention. Modifiable risk factors for prevention of PMS include dietary factors. Several micronutrients have been identified as risk factors, but there has been little evaluation of macronutrients. Thus, the research aim was to examine prospectively whether macronutrient consumption was associated with PMS development among a subset of women enrolled in the Nurses’ Health Study II cohort. Chapter 1 evaluates the association of fat intake and PMS risk. Among 3,638 women, total fat intake was not associated with PMS risk, but stearic acid was associated with a 25% decrease risk of PMS. As this was the first study to observe this association, the finding needs to be replicated. Chapter 2 assesses intake of carbohydrates and PMS risk. Overall, carbohydrate intake was not associated with PMS risk but maltose was associated with a 45% increased risk of PMS. Again, this is the first study to find this and replication is needed. Chapter 3 evaluates intake of protein and PMS risk. Protein intake was not associated with PMS risk. Additionally, substitution of macronutrients for each other did not suggest that any macronutrient was importantly associated with PMS risk. In conclusion, macronutrient intake was not associated with risk of developing PMS after controlling for micronutrient intake and other potential confounders. Micronutrients may play a more important role in PMS development than macronutrient intake.