2025
Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Healt.
Vol 9 No 2
p-ISSN: 2580-0590/ e-ISSN: 2621-380X
PREVENTIVE HEALTH INSIGHTS: THE CORRELATION OF JUNK FOOD
INTAKE AND SLEEP QUALITY WITH DYSMENORRHEA
Lilik Sofiatus Solikhah*1.
Raehani2.
Ni Ketut Kariani3
1,2,3
Nutrition Study Program.
Faculty of Health.
Widya Nusantara University.
Indonesia Author corresponding: sofi@uwn.
ABSTRACT
Background: Dysmenorrhea is a prevalent gynecological problem among adolescent girls, often influenced by modifiable lifestyle factors such as diet, sleep quality, and nutritional status.
This study aimed to examine the association of junk food consumption, sleep quality, and nutritional status with dysmenorrhea among female students.
Methods: A cross-sectional study was conducted among 169 female students at SMKN 1 Palu.
Indonesia.
Data were collected using validated questionnaires: Food Frequency Questionnaire (FFQ) for junk food intake.
Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and BMI-for-age for nutritional status.
Dysmenorrhea severity was assessed using the Numeric Rating Scale (NRS).
Data were analyzed using Chi-square and Spearman tests.
Results: The findings revealed that poor sleep quality was significantly associated with dysmenorrhea .
= 0.
, while junk food consumption .
= 0.
and nutritional status .
= 0.
showed no significant Conclusion: Sleep quality emerged as a modifiable determinant of dysmenorrhea, suggesting that improving sleep hygiene may help alleviate menstrual pain among adolescents.
Integrated health promotion strategies that combine sleep education and balanced nutrition are recommended for adolescent reproductive health programs.
Keywords: Dysmenorrhea.
Junk Food.
Sleep Quality.
Nutritional Status.
Adolescent Health
INTRODUCTION
DysmenorrheaAipainful menstrual contractions and associated biochemical mediatorsAiis among the most common gynecological complaints in adolescent girls worldwide and constitutes a major cause of functional impairment during the reproductive years 1Ae3.
Global prevalence estimates vary widely by study design and population, with systematic reviews and large cross-sectional surveys reporting ranges from roughly 16% to over 90%, and school-based estimates commonly exceeding 50% among adolescents 2Ae4.
A substantial subset of affected adolescents report severe pain:
population syntheses and community studies indicate that approximately 10Ae 15% of young women experience dysmenorrhea severe enough to limit daily activities or require absenteeism from school or work, thereby producing measurable educational and economic consequences 2,3,5.
Beyond episodic pain, dysmenorrhea has recurrent associations with diminished health-related quality of life and elevated psychological distressAi relationships that compound individual morbidity and generate a broader societal burden through increased healthcare use and losses in productivity 2,5,6.
The high burden of dysmenorrhea is evident in Indonesia and across Southeast Asia, where school- and community-based estimates above 50% in adolescent samples, with several local studies Preventive Health Insights: The Correlation of Junk Food Intake and Sleep Quality with Dysmenorrhea Lilik Sofiatus Solikhah.
Raehani.
Ni Ketut Kariani reporting prevalences near or above the 60% mark .
or example.
East Java and 7Ae9 Indonesian Comparable regional evidence from neighboring countries confirms the magnitude of the problem: crosectional studies in Jordan and in Palestinian adolescent populations report accompanied by substantive interference with schooling and daily activities, indicating a consistent regional pattern of reproductive health need 10,11.
Indonesian studies further highlight gaps in health literacy and a tendency toward selfmanagement of menstrual pain, which together contribute to underutilization of formal health services and lost opportunities for school-based prevention and early intervention 4,12.
Etiologic models of primary dysmenorrhea emphasize prostaglandinmediated uterine hypercontractility.
Still, modifiable lifestyle and nutritional determinants are increasingly recognized as contributors to symptom occurrence and severity in adolescents, with dietary quality .
otably frequent AujunkAy food consumptio.
, sleep quality, and nutritional status repeatedly identified in observational and mechanistic studies 13Ae Frequent consumption of energydense, nutrient-poor AujunkAy foods promotes adiposity, systemic low-grade inflammation, and oxidative stress while tending to provide inadequate intakes of antioxidants and minerals.
metabolic and micronutrient disturbances are biologically plausible drivers of increased prostaglandin synthesis, altered uterine contractility, and greater menstrual pain.
These factors have been associated with menstrual complaints in multiple empirical reports 12,16.
Sleep disturbance and poor sleep quality exert effects on central pain processingAi lowering pain thresholds, promoting central sensitization, and enhancing proinflammatory signalingAiand mediation studies, have linked poor sleep to greater dysmenorrhea severity and to psychological pathways that amplify symptom perception 2,6,9.
Nutritional status, most often proxied by Body Mass Index (BMI), may influence menstrual pain through adipose-derived estrogenic nevertheless, recent meta-analytic and primary studies show heterogeneous BMI dysmenorrhea, suggesting that gross anthropometry alone may not capture clinically relevant nutritional domains such as micronutrient sufficiency or fat distribution 14,17.
Despite rationale and a substantive empirical literature, findings remain heterogeneous across settings and methodologies: some primary studies report significant positive associations between unhealthy dietary BMI dysmenorrhea, whereas others report null or context-specific effects 14,15,18.
Indonesia, the evidence base contains many single-exposure studies and few measure dietary behavior .
ith specific attention to junk-food frequenc.
, validated sleep indices, and objectively classified nutritional status within one adolescent cohort, thereby limiting the mediating, or interactive effects that would inform pragmatic school-level Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Healt.
Vol 9 No 2 Tahun 2025 interventions 7,12.
Given the demonstrated impact of dysmenorrhea on school attendance, academic performance, and psychosocial well-being, clarifying which modifiable determinants are most strongly and independently associated with menstrual pain in Indonesian adolescents is a public health priority that can guide nutrition education, sleep hygiene promotion, and targeted reproductive health services in schools 2,5,19 To address these evidence gaps in a school-based Indonesian adolescent population and to provide data directly relevant to school health programming and clinical guidance, the present crosectional study examines the concurrent associations of dietary behavior .
unk food consumptio.
, sleep quality, and nutritional status (BMI categorie.
with dysmenorrhea in adolescent girls 12,13,20.
This study aims to analyze the association of junk food consumption, sleep quality, and nutritional status with dysmenorrhea among adolescent girls 13,21.
METHOD
This study employed a quantitative descriptive design with a correlational analytic approach using a cross-sectional method, in which all variables were measured at a single point in time.
The research was conducted at SMKN 1 Palu, located in Palu City.
Central Sulawesi.
Indonesia.
The study population consisted of all female students who met the inclusion criteria: .
actively enrolled in school, .
present at the study location during data collection, .
unmarried, and .
had experienced menstruation.
The sample size was determined using the Slovin formula, resulting in 169 respondents.
Sampling was carried out using stratified random sampling.
The research instruments included:
Dysmenorrhea, measured using the Numeric Rating Scale
(NRS),
categorized as no pain, mild pain, and moderate pain 22, .
Frequency of junk food consumption, assessed using a Food Frequency Questionnaire (FFQ), which had been content-validated through a preliminary study among adolescents in Palu City in consultation with nutrition experts, and categorized as infrequent (< media.
and frequent (Ou media.
Categorization based on the median was used to account for the non-normal distribution of the data and to facilitate interpretation within the cross-sectional study design.
Sleep quality, measured with the Pittsburgh Sleep Quality Index (PSQI), was categorized as good (O.
and poor (>.
Nutritional status was assessed based on body weight, height, and age using the Body Mass Index (BMI)-for-age undernourished (<Ae 2 SD), normal (Ae2 SD to 1 SD), and overweight (> 1 SD), following the classification modified from the Indonesian Ministry of Health 25.
Data analysis was performed using univariate analysis to describe respondent characteristics and bivariate analysis to examine associations between variables, employing Chi-Square and Spearman Ethical approval was obtained from the Research Ethics Committee of the Faculty of Public Health.
Hasanuddin University, on May 28, 2025, with ethical Preventive Health Insights: The Correlation of Junk Food Intake and Sleep Quality with Dysmenorrhea Lilik Sofiatus Solikhah.
Raehani.
Ni Ketut Kariani 919/UN4.
1/TP.
0/2025.
RESULTS AND DISCUSSION
A total of 169 respondents participated in this study, all of whom were female students at SMKN 1 Palu.
Central Sulawesi.
The characteristic distribution of respondents is presented in Table 1.
Most participants were aged 16 years .
0%), followed by 17 years .
8%) and 15 years .
2%).
The grade level distribution was relatively balanced, consisting of 49.
7% in Grade X 3% in Grade XI.
Based on the field of study, the largest proportion of respondents came from the Beauty Department .
2%), followed by Culinary .
3%).
Fashion .
2%).
Hospitality .
2%).
Tourism and Service Business .
6%), and Computer Network & Telecommunication Technology .
2%).
Regarding lifestyle and health-related variables, most respondents were infrequent junk food consumers .
7%), while 34.
were frequent consumers.
The majority of respondents .
9%) had poor sleep quality, 1% had good sleep quality.
terms of nutritional status, most respondents were within the normal category .
8%),
followed by overweight .
5%) and .
7%).
Based dysmenorrhea assessment, 65.
1% of dysmenorrhea, and 15.
4% reported no Table 1.
Respondent Characteristics Characteristics Age
15 years 16 years 17 years Grade Level Grade X
Grade XI
Major
Beauty Culinary Fashion
Hospitality TSB
CNTT
Junk Food Consumption Frequency Rarely Frequently Sleep Quality Good Poor Nutritional Status Normal Overweight Underweight Dysmenorrhea Mild Moderate Source: Primary Data, 2025.
Note: TSB= Tourism & Service Business.
CNTT= Computer Network Telecommunication Technology Bivariate analysis was conducted to determine the relationship between junk food consumption frequency, sleep The results are presented in Table 2.
The analysis revealed that sleep quality was significantly associated with dysmenorrhea .
= 0.
, whereas junk food consumption .
= 0.
and nutritional status .
= 0.
showed no statistically significant relationships.
Respondents with poor sleep quality exhibited a higher proportion of .
compared to those with good sleep quality .
7%).
Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Healt.
Vol 9 No 2 p-ISSN: 2580-0590/ e-ISSN: 2621-380X Table 2.
Association between Junk Food Consumption.
Sleep Quality.
Nutritional Status, and Dysmenorrhea Variable Dysmenorrhea n (%) p-value Mild Moderate Total Junk Food Consumption Rarely 15 .
Frequently 11 .
Sleep Quality 038 a* Good 15 .
Poor 11 .
Nutritional Status Underweight 3 .
Normal 18 .
Overweight 5 .
Source: Primary Data, 2025.
AEChi-Square test.
ANSpearman test.
*Significant .
< 0.
This discussion elaborates on the findings regarding the association between junk food consumption, sleep quality, and nutritional status with dysmenorrhea among adolescent girls at SMKN 1 Palu.
In the present cross-sectional sample of 169 female students .
ge predominantly 16Ae17 year.
, moderate dysmenorrhea was the most commonly reported level of pain .
1%), whereas 19.
5% reported mild pain 4% reported no dysmenorrhea.
frequent junk food consumption was reported by 34.
3%, poor sleep quality by 9%, and nutritional status was largely normal .
8%).
On bivariate analysis, sleep quality was significantly associated with dysmenorrhea .
= 0.
while junk food consumption .
= 0.
and nutritional status .
= 0.
were not.
These findings are considered against the contemporary literature on adolescent dysmenorrhea, diet and lifestyle correlates, and putative biological pathways.
Junk In this study, junk food consumption .
ategorized as frequent versus rar.
did not show a statistically significant association with the presence or level of dysmenorrhea .
= 0.
This non-significant bivariate result contrasts with several observational reports that have described positive associations between unhealthy dietary patterns .
ncluding frequent consumption of fast/junk food or high-sugar item.
and menstrual pain or greater dysmenorrhea severity 26Ae28.
At the same time, other studies have reported null or mixed adiposity/nutritional dysmenorrhea, indicating heterogeneity across contexts and methods 15,17.
Mechanistically, unhealthy diets high in saturated fat, refined carbohydrates, and food additives can promote systemic inflammation and adiposity, which may influence the synthesis or activity of prostaglandins and other mediators implicated in primary dysmenorrhea 13,29.
Nutrient deficits .
or example, lower intakes of antioxidants such as vitamin E, vitamin C, -carotene, and minerals such as zinc and calciu.
can impair redox balance and inflammatory regulation and have been linked to higher dysmenorrhea severity in observational analyses and to pain reduction in some supplementation trials 29,30 In addition, frequent consumption of energy-dense, nutrient-poor AujunkAy foods is consistently associated with increased overweight/obesity risk in adolescents 16,27.
Preventive Health Insights: The Correlation of Junk Food Intake and Sleep Quality with Dysmenorrhea Lilik Sofiatus Solikhah.
Raehani.
Ni Ketut Kariani and adiposity can itself modify sex steroid metabolism and low-grade inflammation, forming a plausible pathway to altered menstrual pain 31.
Several cross-sectional surveys in adolescent and young-adult populations have reported associations between fast/junk food intake and either higher prevalence or greater severity of dysmenorrhea 18,32.
, as well as highlighting poor dietary quality as an external influence on dysmenorrhea 33,34.
Conversely, other field studies have failed to find consistent relationships between indices of body composition or nutritional status and dysmenorrhea 17, emphasizing that the composition, and menstrual pain is complex and likely context-dependent.
The lack of a significant association in the present sample should be interpreted with caution.
First, statistical power may have been limited: only 34% of participants were classified as frequent junk-food consumers, and the absolute numbers of cases per exposure category may not have supported the detection of modest associations.
Second, exposure measurement was categorical and selfreported .
requency-base.
, which can attenuate doseAeresponse effects and is susceptible to misclassification and recall bias, a limitation commonly recognized in cross-sectional dietary studies 16,35.
Third, uncontrolled variables .
or example, family history of dysmenorrhea, detailed menstrual cycle characteristics, physical activity, analgesic use, caffeine intake, or psychosocial stres.
could mask true associationsAithese dysmenorrhea and adolescent eating behavior 18,26,32,35.
Fourth, the pathway from junk food to dysmenorrhea may be mediated .
ather than immediat.
: for example, junk food may have its strongest effect through promoting adiposity, which in turn may affect menstrual pain.
if the sample has a high proportion of adolescents with normal BMI .
s in the present stud.
, the mediating effect through obesity may be difficult to detect 16,27,31.
While our data do not show a direct cross-sectional frequency of junk-food consumption and dysmenorrhea, the broader literature supports continued public health efforts to reduce unhealthy food intake among adolescents given the established links between junk food, overweight/obesity, and other cardiometabolic risks 16,27,28, and because certain dietary patterns and micronutrient deficiencies have been associated with dysmenorrhea severity in other studies 13,29.
Intervention and education programs that aim to improve adolescent dietary choices .
or example, school-based nutrition education or behavior-change interventions grounded in the Theory of Planned Behavio.
are feasible and have demonstrated changes in consumption patterns.
such programs could be integrated into menstrual health promotion and evaluated for effects on dysmenorrhea as an outcome 19,36Ae38.
Sleep quality and dysmenorrhea The present analysis identified a statistically significant association between poor sleep quality and dysmenorrhea .
= .
: participants reporting poor sleep were more likely to report dysmenorrhea.
This finding aligns with evidence from adolescent samples that links sleep disturbance or inadequate sleep with Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Healt.
Vol 9 No 2 Tahun 2025 menstrual pain and other menstrual disturbances 9,39.
Sleep quality modulates nociception, inflammatory status, and central pain
processing: insufficient or disrupted sleep
increases central sensitization, lowers pain
thresholds, and can augment proinflammatory signaling that may interact
with uterine prostaglandin-mediated pain
9,13
Sleep disruption is also closely related to psychological stress and impaired coping, which in turn worsen pain perception and symptom reporting 32,33.
Moreover, behaviors that negatively affect sleep .
or example, late caffeine intake or irregular sleep schedule.
are common in adolescents and may amplify menstrual pain through compounding physiological and behavioral mechanisms 9,26.
Empirical studies and literature reviews have reported associations between sleep problems and dysmenorrhea or other menstrual complaints in adolescents and young women 9,33,39.
Larger observational surveys have identified sleep as an important modifiable correlate of menstrual The convergence of evidence from different settings supports the plausibility of a sleepAepain link in adolescent menstrual health.
The cross-sectional design of the present study cannot determine the direction of the observed association:
dysmenorrhea may disrupt sleep .
ain disturbing nocturnal res.
, poor sleep may worsen pain perception, or a bidirectional relationship may exist 9,33.
Measurement considerations are also pertinent: sleep quality in many adolescent studies is assessed by self-report questionnaires rather than objective measures .
, actigraphy or subjectivity and possible reporting bias 9,35.
Additional confoundersAiparticularly caffeine intake, psychological stress, and coexisting mental health conditionsAimay partly account for associations between poor sleep and menstrual pain.
caffeine and stimulant intake, for example, have been associated with both sleep disturbance and higher dysmenorrhea pain in student Despite these limitations, the consistency of associations across studies strengthens the inference that sleep is a relevant and modifiable factor in adolescent Clinicians and school assessment of sleep quality among adolescents presenting with dysmenorrhea and offer sleep hygiene counseling and behavioral interventions as part of a holistic 9,31 Nonpharmacological interventions that target stress reduction and somatic comfort .
or example, therapeutic massag.
have demonstrated benefit for dysmenorrhea in adolescent cohorts and could be integrated alongside sleep interventions in controlled Future research employing longitudinal designs and objective sleep measurement is warranted to disentangle causality and to test sleep-focused interventions for menstrual pain reduction 9,13,19 Nutritional status and dysmenorrhea Nutritional status as classified by BMI categories in the present sample .
8%, overweight 12.
7%) did not show a significant bivariate association with dysmenorrhea .
= 0.
This null finding is consistent with multiple studies that report no simple linear relationship between Preventive Health Insights: The Correlation of Junk Food Intake and Sleep Quality with Dysmenorrhea Lilik Sofiatus Solikhah.
Raehani.
Ni Ketut Kariani BMI and dysmenorrhea but contrasts with other reports that link extremes of weight or poor eating habits with menstrual problems 15,17,27 Body composition may influence menstrual pain via several biological pathways: adipose tissue is hormonally active and contributes to estrogenic milieu and to systemic inflammatory cytokine production, which could plausibly affect uterine contractility and prostaglandin activity relevant for dysmenorrhea 13,31.
Simultaneously, inadequacies .
or example, low vitamin E, vitamin C, or zin.
associated with poor susceptibility to menstrual pain through oxidative and inflammatory mechanisms 13,29 Thus.
BMI alone may not capture the dimensions that determine dysmenorrhea measures of body fat distribution, lean mass, or direct micronutrient status may be more informative.
Supporting literature.
Evidence on the nutritional indicators and dysmenorrhea is Some studies report associations between high BMI or poor food habits and menstrual problems 17,27, whereas others have not found a significant relationship between BMI .
r body-fat percentag.
and dysmenorrhea 15,40.
Observational and interventional research on micronutrients, however, indicates that low antioxidant and mineral status may be associated with supplementation in selected trials can reduce pain intensity, underscoring the importance of nutritional composition beyond gross anthropometry 13,29.
Several methodological and samplerelated factors could account for the null result in the current study.
The low prevalence of underweight and overweight in this cohort reduces statistical power to detect associations with either extreme 16,27.
Use of BMI as a crude proxy for nutritional status does not distinguish central adiposity, body fat percentage, or micronutrient deficiencies that may be mechanistically important 15,16.
Pubertal stage, recent weight change, and energy balance behaviors .
or example, meal skippin.
can modify menstrual characteristics but were not incorporated into the bivariate models here Given that micronutrient deficits .
ather than BMI per s.
have been implicated in dysmenorrhea, the absence of biochemical assessments .
or example, serum zinc, vitamin E) limits mechanistic inference 13,29 The findings indicate that BMI classification alone may be insufficient to characterize menstrual pain risk in Future investigations should include direct measures of body composition and assays of relevant micronutrients, as well as detailed dietary intake data, to clarify which nutritional domainsAiif anyAiare causally related to 13,19,29 Meanwhile, nutritional counseling for adolescents should emphasize a balanced diet rich in antioxidants and minerals, which has both general health benefits and the potential to suggested by prior studies 13,19,29.
Limitations and strengths Limitations of the present work deserve explicit acknowledgment.
The cross-sectional design precludes causal inference and temporal ordering between sleep, diet, nutritional status, and dysmenorrhea 9,13,35.
Exposures and Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Healt.
Vol 9 No 2 Tahun 2025 outcomes were based on self-report questionnaires, which are vulnerable to recall bias and misclassification.
categories for junk food consumption and a single measure of sleep quality lack granularity and objective confirmation .
or example, dietary records, actigraph.
16,35.
The sample was drawn from a single vocational high school, and the distribution of BMI categories was skewed toward normal weight, which limits external generalizability and reduces power to detect associations for underweight/overweight 16,27 Finally, potential confounders and mediatorsAisuch as family history of dysmenorrhea, menstrual cycle characteristics .
, duration, flo.
, analgesic use, psychosocial stress, and physical activityAiwere not fully adjusted in the bivariate analyses presented here, leaving open the possibility of residual confounding 18,32.
Notwithstanding these limitations, the study has strengths.
It examines several exposures .
ietary behavior, sleep quality, and anthropometric nutritional statu.
in the same adolescent sample, permitting a comparative appraisal of their relative associations with dysmenorrhea in a school setting where interventions can be feasibly delivered 16,33.
The findings add locally relevant data from an Indonesian adolescent epidemiologic evidence, and underscoring the importance of sleep as a potential target for symptom mitigation.
quality was significantly associated with dysmenorrhea, whereas the frequency of junk food consumption and BMI-based nutritional status showed no significant These findings suggest that sleep is a modifiable determinant of menstrual pain in adolescents.
Therefore, routine screening and management of sleep quality should be incorporated into schoolbased and primary health programs focusing on adolescent reproductive health.
Although this study did not identify a direct association between junk food intake or BMI and dysmenorrhea, unhealthy dietary habits remain an important target for adolescent health promotion due to their potential contribution to hormonal imbalance, micronutrient deficiency, and Encouraging balanced nutrition and healthy eating behaviors can indirectly support menstrual health and overall well-being.
From a public health perspective, integrated health promotion strategies that nutritional guidance, and behavioral interventions Ai including reducing caffeine and processed snack consumption Ai should be developed and implemented to alleviate the burden of dysmenorrhea among adolescents.
For future research, longitudinal and experimental designs using objective measures of sleep, diet, and nutritional biomarkers are recommended to clarify causal pathways and evaluate the effectiveness of targeted preventive or therapeutic interventions.
CONCLUSION
REFERENCE