Mediterranean diet quality is inversely associated with premenstrual symptom severity in young adult women

Abstract Premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, are common cyclic conditions influenced by neuroendocrine, inflammatory, and metabolic mechanisms. Emerging evidence suggests that diet quality may be associated with premenstrual symptom severity; however, the association between Mediterranean diet adherence and PMDs, particularly the extent to which this association may be confounded by body mass index (BMI), remains insufficiently characterized. This cross-sectional study included 849 young adult women. Data were collected using a structured questionnaire assessing dietary habits, sociodemographic characteristics, menstrual history, physical activity, sleep duration, and anthropometric measurements. Mediterranean diet adherence was evaluated using the “Mediterranean Diet Quality Index (KIDMED)”, and premenstrual symptoms were assessed using the “Premenstrual Symptoms Diagnostic Scale (PSDS)”. Multivariable linear regression analyses were performed to examine associations between KIDMED scores and PSDS outcomes. BMI was added to the fully adjusted model to evaluate its potential confounding influence on these associations. The mean age of participants was 19.62 ± 2.02 years, and the mean BMI was 21.55 ± 3.16 kg/m 2 . Higher KIDMED scores were significantly associated with lower PSDS total scores. Specifically, each one-unit increase in KIDMED score was significantly associated with a 0.795-point reduction in PSDS total score (95%CI: -1.255; -0.335; Model 1; R 2 = 0.013, p < 0.001). After adjustment for demographic and lifestyle covariates, higher KIDMED scores remained associated with lower total PSDS scores (Model 2: B = − 0.723, p = 0.003). Further adjustment for BMI modestly attenuated this association (Model 3: B = − 0.636, p = 0.007), corresponding to an approximately 12% reduction in the magnitude of the KIDMED coefficient, while the association remained statistically significant. Greater adherence to the Mediterranean diet was independently associated with lower premenstrual symptom severity. Adjustment for BMI modestly attenuated, but did not eliminate, this association, suggesting that BMI may account for part of the observed relationship between Mediterranean diet quality and premenstrual symptoms.