Association Between Breakfast to Dysmenorrhea Degree on Students

SMAN 2 in Banda Aceh, Indonesia

Husnah1
1.
Department of Nutrition Faculty of Medicine, Syiah Kuala University

Abstract

Introduction: Dysmenorrhea is a common problem in women and can affect the quality of life of
personal health and decreased status of quality of life. The risk of dysmenorrhea is age, age of menarche,
nutritional status, marital status, family history, physical activity and food intake. Breakfast is an energy
supplier that is needed in the first hour of activities. The purpose of this study was to know the
relationship of breakfast with the degree of dysmenorrhea in high school students of SMAN 2 Banda
Aceh, Indonesia. The SMAN 2 school is located in the coastal area where most of the students come from
families with the job of fishermen and traders. People in that area often do the activity early with the habit
of having breakfast after completing their activities. Students from SMAN 2 generally have breakfast
during rest time after studying, this habit can cause problems such as dizziness, weakness, nausea,
bloating, decreased concentration which will affect the health of the students.

Methods: The design of the study was analytic observational with cross sectional approach. Sampling
from 6th to 13th of January 2018 taken by nonprobability sampling with stratified random sampling
method, obtained sample of 132 students. Inclusion criteria are all students of SMAN 2 Class X, XI, XII,
have a history of dysmenorrhea since menarche, not suffering from chronic disease (DM, Hypertension,
Hyperthyroidism, Ovarian Cyst, myoma) secondary dysmenorrhea, not taking NSAID medicines,
unmarried, and not routine doing physical activity. Measurement of dysmenorrhea with Visual Analog
scale (VAS) and breakfast using Frequency Food Questionnaire (FFQ) with interview technique.

Results: The student with age of menarche most at the age of 10 year that is 43 student (32,6%), normal
nutrition status 71 student (53,8%). Student who always eat breakfast is 24 students (18,2%), Student who
eat breakfast sometimes is 36 students (27,2%) and student who rarely eat breakfast is 41 students
(31,1%). The degree of dysmenorrhea is more on mild pain, 60 students (45,5%) unbearable pain 5
students (3,8%) and moderate pain 35 students (26,5%). Statistical analysis with spearman correlation
rank with 95% confidence interval (CI) (α < 0.05) obtained p value = 0.022, it means there is a
relationship between breakfast with degrees of dysmenorrhea with correlation coefficient r = 0.2 with the
strength of a strong relationship.

Conclusion: We concluded that regular breakfast habits can reduce the degree of dysmenorrhea.

Keyword: Breakfast, Dysmenorrhea Degrees, Visual Analog Scale

Introduction

Every individual needs health including a woman that desperately need of optimal health where
optimal health quality can be achieved with Life style or healthy lifestyle. Good lifestyle includes
breakfast patterns and physical activity.1 The intake of foods we consume will affect the body's
metabolism and provide energy for the body.2

Many teenagers who are on a diet to maintain physical appearance to keep their weight
proportional. One of the diets that teens or students do is regular breakfast, an irregular breakfast does not
even eat breakfast at all.3 Dysmenorrhea can lead to a decrease in the productivity of life as well as a
major cause of decreased the Quality of Life (QoL) status.3,4

Prevalence of dysmenorrhea in the world is 28% to 71.7%.2,7 In the United States reported in
women suffering from dysmenorrhea almost 90% and heavy menstrual pain of about 10-15%, and women
lose 1.7 million workdays every month due to menstrual pain.3 The prevalence of menstrual pain in
Indonesia is 54.89% and 14% of adolescents and students are absent from school due to menstrual pain.3
Primary dysmenorrhea often occurs at the age of 17-22 years whereas secondary dysmenorrhea is at age
above 23 years and due to pathology of pelvic organs, women that less than 25 years of age have twice
the risk of developing dysmenorrhea with the severity of moderate to severe pain, compared with women
aged 25 to 35 years. Primary dysmenorrhea is often experienced by adolescents who are in the process of
growth and development so that it can affect the psychic.4

Research of Tomoro Fujiwara in Japan found that young women who does not have breakfast
have higher degrees of menstrual pain in comparison with women who do breakfast regularly (regular).4
Dysmenorrhea is a menstruation derived from the uterus that caused uterine muscle spasms. Nearly 50%
of women experience dysmenorrhea and 10% of women will suffer from severe menstrual pain for 1-3
days on each menstrual cycle. Young women with poor nutrition have an effect on growth and
reproductive function which has an impact on menstrual disorders. Balanced nutrition can reduce
dysmenorrhea because during menstruation especially the luteal phase there is an increase in nutritional
needs.5 Dysmenorrhea affects individual health, quality of life and economy in the family.2 Dysmenorrhea
is characterized by cramping pain begins before or immediately after menstruation and may last for 28
hours to 72 hours.6 Dysmenorrhea affects the quality of life in a personal and global economy because the
role of women in economic and community development is already very high.7 Premenstrual Syndrome
(PMS) is an abdominal symptoms (abdominal pain, bloating), headache, back pain and calf pain. Women
with symptoms of PMS had 56.1 times more likely to have dysmenorrhea compared to women without
symptoms of PMS.8 Women who experienced discomfort had a tendency of 1.75 times dysmenorrhea and
anxious women tended to be 2.17 times more likely to experience dysmenorrhea.1,9 Several studies in
Indonesia about the relationship of breakfast with achievement and concentration of students study, the
effect of breakfast, and the habit of breakfast. The relationship between breakfast and the degree of
dysmenorrhea in high school students does not exist particularly in Aceh. Dysmenorrhea is the reason
why students not attend school because the activity is disrupted and the body's immune system decreases
which affects student achievement. The people of Aceh are not used to eat breakfast at 7 or 8 o’clock in
the morning which the reason is it’s too fast for them but generally they eat breakfast at 10 o'clock at the
stand or cafeteria along with rest time after activities.
METHODS :

Subject and Study Design

This study used observational analytic design with cross sectional approach. The study was
conducted from 6th to 13th of January 2018 in high school students of SMAN 2 Banda Aceh class X, XI,
XII. In the sample obtained as many as 132 students who were taken by nonprobability sampling with
stratified random sampling method. Inclusion criteria are all students of SMAN 2 Class X, XI, XII, have a
history of dysmenorrhea since menarche, not suffering from chronic disease (DM, Hypertension,
Hyperthyroidism, Ovarian Cyst, myoma) secondary dysmenorrhea, not taking NSAID medicines,
unmarried, and not routine doing physical activity. Measurement of dysmenorrhea was done by visual
analogue questionnaire scale (VAS) with pain ruler 0-10 cm in interview for breakfast. Using Frequency
Food Questionnaire (FFQ) interview technique, data were analyzed un variate and bivariate with
spearman correlation test.
RESULTS

The results of research on students of SMAN 2 Banda Aceh from 6 to 13 January 2018 obtained
sample of 132 samples. Table 1 shows the characteristics sample based on age, age of menarche, marital
status, nutritional status, physical activity, smoking, medicine use.

Table 1. Characteristics of the subjects (n=132)

Frequency Percentage
Characteristics
(n) (%)
Age, y
16 10 7,6
17 92 69,7
18 27 20,4
19 3 2,3
Age of Menarche, y
8 1 0,8
9 17 12,9
10 43 32,6
11 35 26,5
12 25 18,9
13 9 6,8
14 2 1,6
Nutritional Status
Thin 28 21,2
Normal 71 53,8
Fat 22 16,7
Obesity I 10 7,6
Obesity II 1 0,8
Medicine Use
Yes 27 20,3
No 105 79,3
Marital Status
Single 132 100
Married - -
Smoking
No 132 100
Yes - -
Physical Activity
5x/Week - -
4x/Week 9 6,9
3x/Week 10 7,6
2x/Week 14 10,6
1x/Week 47 35,6
Never 52 39,4
The results showed that age above 17 years old are more dominant (69.7%), age of menarche at age 10
years (32.6%). The normal dominant nutritional status (53.8%) not use the medicine (79, 3%) not do
physical activity (39,4%).

The frequency distribution for breakfast students of SMAN 2 Banda Aceh can be seen in table 2 below :

Table 2. Distribution of the Breakfast (n=132)

Breakfast Frequency Percentage

(n) (%)
Never 3 3,2
Rarely 41 31,1
Sometimes 36 27,2
Often 28 21,2
Always 24 18,2

As shown in Table 2. Shows that more students who rarely do breakfast that is 41 female students
(31,1%), while that always do breakfast only 24 student (18,2%).

The frequency distribution degrees of dysmenorrhea of students SMAN 2 Banda Aceh can be seen in
table 3 below :

Table 3. Distribution of Dysmenorrhea Degrees (n=132)

Dysmenorrhea Degrees Frequency Percentage

(n) (%)
Unbearable Pain 5 3,8
Severe Pain 17 12,9
Moderate Pain 35 26,5
Mild Pain 60 45,5
No Pain 15 11,3

As shown in Table 3. Shows that the degree of dysmenorrhea more dominant in mild degree of pain that
is 60 students (45.5%) and unbearable pain as many as 5 students (3.8%).

Table 4. Association between Breakfast to Degrees of Dysmenorrhea (n=132)

Dysmenorrhea Degrees (n,%)

P
Unbearable Severe Moderate r
Breakfast Mild Pain No Pain Value
Pain Pain Pain

Never - - - - 2 (66,7) - - 1 (33,7) 0,022 0,2

Rarely 1 (2,4) 7 (17,1) 13 (31,7) 17 (41,5) 3 (7,3)
Sometimes 1 (2,8) 7 (19,4) 12 (33,3) 12 (33,3) 4 (11,1)
Often 2 (7,1) 2 (7,1) 6 (21,4) 14 (50) 4 (14,3)
Always 1 (20) 1 (5.9) 2 (5,7) 17 (28,3) 3 (20)
The result of data analysis in Table 4. Showed that breakfast category is rare and sometimes with the
degree of dysmenorrhea mild pain (41.5%) and moderate pain (33.3%), but never breakfast tended to the
degree of dysmenorrhea in moderate pain (66.7%) and always breakfasted then the dominant
dysmenorrhea degree in mild pain (50%) and no pain (20%). There was a significant relationship between
breakfast with degree of dysmenorrhea (p = 0,022) and correlation coefficient (r = 0,2) which means that
the strength of the strongest.

DISCUSSION

The results of this study is more students with breakfast percentage at 41 students (31.1%) in
comparison with students who always breakfast only 24 female students (18.2%). This result is not in line
with the Fujiwara research in Japan as much as 65.8% schoolgirl is always breakfast.11 Adesola research
in Nigeria students that get breakfast is 73%.2 Eittah research in Egypt that 73% always breakfast every
day, sometimes (3-4 days) in 1 week 28% and often 21% never breakfast 2.5%. Eittah said there was a
decrease in the intensity of dysmenorrhea in medical students in Egypt who were accustomed to eat
breakfast. The majority of students who routinely have eat breakfast, the menstrual cycle becomes more
regular, normal nutritional status and general health conditions are better.12 Morning breakfast is
recommended always because it is ideal for better metabolism including overcoming dysmenorrhea. 12
Abbaspour's study in Iran reported that 3% of women experienced severe dysmenorrhea, 2% unbearable
pain, 44% moderate pain, 40% mild pain, and 10% did not experience dysmenorrhea. 1 The results of this
study there are 132 female students obtained mild degrees of dysmenorrhea is more dominant of 60
female students (45.5%).2,12 The results of this study are not in line with Caro's research in India that the
degree of severe dysmenorrhea is 68%.9 Rigon's study in Italy was 56% subjected to severe
dysmenorrhea.13 This difference may be due to differences in breakfast habits, physical activity,
nutritional status and other factors such as age, age of menarche , smoking, genetics that affect
dysmenorrhea so that there are different degrees of dysmenorrhea in each country. 13 Different degrees of
dysmenorrhea are present in each country.12 Socioeconomics is also the cause of the different coping of
menstrual pain felt by each individual.14 Dysmenorrhea is related with an increase of the prostaglandin
hormone in the uterus which causes stronger and more frequent contractions of the uterine muscles, which
causes the reduced blood flow, and the nerves are more sensitive to pain. Prostaglandins play a role in the
mechanism of dysmenorrhea by inducing uterine contractions that cause ischemia and cause pain. This
mechanism occurs because of the response to progesterone withdrawal by the interaction of the ovarian
hormone and the immune system.16

The result of this research is the relationship of breakfast with degree of dysmenorrhea p = 0,024
(p <0,05). This result is in line with Eittah's study that breakfast has an effect on increased menstrual pain,
premenstrual pain.12 Fujiwara's study in Japan that respondents who had breakfast had lower intubation of
menstrual pain in comparison with respondents who did not eat breakfast.4 Respondents who did not have
breakfast early 71% will have dysmenorrhea, because dysmenorrhea in adolescents can be affected by
nutritional intake which results in excess nutritional status or poor nutritional status, balanced nutritional
intake with normal nutritional status can reduce the risk of dysmenorrhea.11 Diet may help in reducing
dysmenorrhea or menstrual pain. Intake of nutrients such as soybean fiber, fruits and vegetables and
calcium can help reduce menstrual pain.2 Diet control are very effective in dealing with the symptoms of
dysmenorrhea, foods that contain salt can aggravate dysmenorrhea. Fruits, vegetables and seeds are useful
for optimizing the function of the uterine muscles for example magnesium, calcium, and potassium.
adolescents with dysmenorrhea must avoid foods containing arachidonic acid, because arachidonic acid
acts as a PGF2-alpha precursor and PGE2 for example red meat, egg yolks, and poultry.7,17 Physical
activity or exercise is helpful to reduce dysmenorrhea because with regular exercise can increase the
release of beta endorphin into the blood flow that serves to reduce menstrual pain. 2,7 Breakfast is a
powerful intake of nutrients early in the day to help meet daily nutritional needs. Young women often
skip two meals and prefer snacks that can interfere with appetite. Adolescence occurs very rapid growth
and increased activity so that nutritional needs increase, nutrient intake in young women requires a higher
source of iron due to menstruation every month. Teens are more interested in consuming snacks
compared to breakfast at home and a strict diet pattern to support the appearance with the perception that
thin is more attractive than fat.5,10 According to Eittah routine breakfast habits then the menstrual cycle
will be more regular, normal BMI, menstrual pain is reduced and the general condition of the body
becomes better.12 Excessive nutritional status and deficiency will affect dysmenorrhea, a balanced
nutritional intake according to the daily needs of a person can reduce the risk of dysmenorrhea.11
CONCLUSION

This study found relationship between breakfast with the degree of dysmenorrhea in high school
students of SMAN 2 Banda Aceh with a positive correlation where irregular breakfast habits will increase
the degree of dysmenorrhea. It is advisable to always have breakfast regularly so that the general
condition of the body to be better and can reduce the degree of dysmenorrhea in women. Education
needed for students to do regular physical activity and balanced nutrition intake because it can reduce
dysmenorrhea.

Thank you very much to the principals and teachers also the students in SMAN 2 Banda Aceh who have
participated during the research.

REFERENCE

1. Abbaspour Z, Rostami M, Najjar Sh. The Effect of Exercise on Primary

Dysmenorrhea. Journal Res Health Science. 2004; 4(2): 26-31

2. Adesola OA, Ayodeji RAM, Akorede QJ, Oluranti O. Breakfast Habit and Nutritional
Status of Undergraduates in Ekiti State, Nigeria. Science Journal of Public Health. 2014;
2(4): 252-256
3. Shrotriya Charu, Ray Amita, Ray Sujoy, George Aneesh Thomas. 'Menstrual
Characteristics' and 'Prevalence and Effect of Dysmenorrhea' on Quality of Life
ofMedical Students. International Journal of Collaborative Research on Internal
Medicine & Public Health. 2012; 4(4).
4. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol
Rev. 2014;36(7):104-13.

5. Canadian Consensus. Primary Dysmenorrhea Consensus Guideline. JOGC. December

2005; No.169: 1117-1130.
6. Nooh M Ahmed. Menstrual Disorder Among Zagazig University Students, Zagazig,
Egypt. Middle East Fertility Society Journal. 2014.
http://dx.doi.org/10.1016/j.mefs.2014.08.022.
7. Unsal Alaettin, Ayranci Unal, Tozun Mustafa, Arslan Gul, Calik Elif. Prevalence of
Dysmenorrhea and its Effect on Quality of Life Among a Group of Female University
Students. Upsala Journal of Medical Sciences. 2010; 115(1): 138-145.

8. Charu S, Amita R, Sujoy R, Thomas GA, Charu S, Amita R, et al. Menstrual

characteristics and prevalence and effect of dysmenorrhea on quality of life of medical
students. Int J Collab Res Intern Med Public. 2012;4(4):276-84.
9. Caro Luis, Perez Luis, Preciado Ventura. Analysis of Knowledge about Healthy
Breakfast and Its Relation to Life Style Habits and Academic Performance in
Compulsory Secondary Students. Elsevier. 2014; 61(5): 242-251
10. Larega T S P. Effect of Breakfast on the Level of Concentration in Adolescents. J
Majority. 2015; 4(2): 115-121

11. Fujiwara Tomoko. Skipping Breakfast is Associated with Constipation in Post

Adolescent Female College Student in Japan: Smith Catto Anthony, editor. Constipation-
Causes, Diagnosis and Treatment. Croatia: InTech. 2012; Ch 4
12. Hayam Fathy A Eittah. Effect of Breakfast Skipping on Young Females' Menstuation.
Health Science Journal. 2014; 8(14) (4)

13. Rigon F, De Sanctis V, Bernasconi S, Bianchin L, Bona G, et all. Menstrual Pattern

and Menstrual Disorders Among Adolescents: an Update of the Italian Data. Italian
Journal of Pediatrics. 2012; 38:38.
14. Gagua T, Tkeshelashvili B and Gagua D. Primary Dysmenorrhea: Prevalence in
Adolescent Population of Tbilisi, Georgia and Risk Factors. J Turkish German Gynecol
Assoc. 2012; 13:162-8.
15. Corder K, van Sluijs EM, Steele RM, Stephen AM, Dunn V, Bamber D, et all.
Breakfast Consumption and Physical Activity in British Adolescents. British Journal of
Nutrition. 2011 Jan; 105(2): 316-321. Doi: 10.1017/S0007114510003272. Date of
Access: 22 June 2015 3:20 AM. [Open Access]
www.ncbi.nlm.nih.gov/pubmed/20807464.

16. International Association for The Study of Pain. Primary dysmenorrhea: an urgent
mandate. Pain Clin Updat. 2013;21(3):1-8
17. Gavin N. Primary dysmenorrhea. Naturophatic treatment options. Toronto;2015