Abstract
To the Editor,
The Women’s Health journal recently published an article in volume 20, 2024 by Al Sabbah et al. “Prevalence of premenstrual syndrome and its associations with dietary and other lifestyle factors among university female students in Dubai: A cross-sectional study.” 1
We have read the article with great interest. These findings underscore the association of dietary habits and psychosocial status with the prevalence of premenstrual syndrome. We gathered valuable information and congratulated the authors for this. However, there are some issues, which need clarification.
First, we noted a lack of precise explanation regarding sample size calculation. The sample size was calculated using a 95% confidence interval, 80% power of the study, and 5% error. However, it has been proposed that cross-sectional studies or cross-sectional surveys are done to estimate a population parameter in a community or find the average value of some quantitative variable in a population. 2 So the sample size should have been precisely mentioned using the formula n = Zα2 P(1 − P)/d2 where n stands for the number of participants, Zα is the level of significance set as 1.96 for 95% confidence interval, P stands for proportion, and d is an error set as 5%. 2
The authors claimed that many questions regarding the association between premenstrual syndrome and lifestyle factors are still not answered, excluding diet and smoking. 1 The authors have studied various factors including smoking; however, exposure to passive smoking has been one of the factors influencing premenstrual syndrome which was not undertaken in the present study. 3 Also, authors have not undertaken the level of education and the type of course the participants were enrolled in. There is evidence from previous work that most of the (89.1%) postgraduate students had premenstrual syndrome. 4
Also, the authors should have undertaken other dietary factors already studied in UAE such as dietary behaviors during/before premenstrual syndrome; and consumption of green tea and other herbal teas they have shown trends in previous studies. 5 The study reported that most participants (88.9%) had experienced dietary changes during pre-menstruation, with consumption of traditional eastern sweets, cakes, and chocolates. 5
Also, the participants were taken from one country so, identified risk factors may be unique to that single place, that is, Dubai. Already there exists a study from Sharjah, UAE. 5 The authors should have considered the factors studied in Sharjah, UAE for comparison of geographical and cultural differences. This methodological choice may weaken the generalizability of the study findings.
Finally, the author did not undertake the normality test under consideration. For meaningful conclusions, the assumption of normality should be followed regardless of the sample size. Selecting the incorrect representative data might give erroneous interpretation.
The study provides valuable information but the above-mentioned points need to be considered for clinical interpretation.
