The Relationship Between Prognostic Nutritional Index and Vasomotor Symptoms in Natural and Surgical Menopause
DOI:
https://doi.org/10.58600/eurjther2937Keywords:
inflammation, natural menopause, prognostic nutritional index, surgical menopause, vasomotor symptomsAbstract
Objective: This study investigated the association between the prognostic nutritional index (PNI) and vasomotor symptoms (VMS) in women with natural and surgical menopause, and evaluated whether PNI can independently predict moderate-to-severe VMS.
Methods: This cross-sectional study included 84 menopausal women (39 surgical, 45 natural). Demographic and clinical characteristics and VMS were recorded. PNI was calculated using serum albumin and lymphocyte counts. Participants were stratified by menopausal type and VMS severity. Multivariate logistic regression identified independent predictors of moderate/severe VMS, and receiver operating characteristic (ROC) analysis assessed the discriminative performance of PNI.
Results: PNI levels were significantly lower in women with surgical menopause compared to natural menopause (39.6 ± 14.6 vs 50.4 ± 16.8, p = 0.002). While the prevalence of moderate/severe VMS was similar between groups, symptom severity was higher in surgical menopause. Women with moderate/severe VMS had significantly lower PNI levels than those with mild symptoms (39.8 ± 14.9 vs 52.1 ± 15.4, p = 0.001). Lower PNI independently predicted moderate/severe VMS (OR = 0.93, 95% CI: 0.89–0.97, p = 0.001), with each unit increase associated with a 7% risk reduction. Surgical menopause was also independently associated with greater symptom severity (OR = 2.27, p = 0.035). ROC analysis showed moderate discrimination in the overall cohort (AUC = 0.74) and stronger performance in the surgical menopause subgroup (AUC = 0.86).
Conclusion: Lower PNI is independently associated with increased VMS severity. Its predictive value is stronger in surgical menopause, suggesting a more prominent role of immune-nutritional status under abrupt estrogen decline. PNI may serve as a practical biomarker for VMS risk stratification.
References
[1] Freeman E, Sherif K (2007) Prevalence of hot flushes and night sweats around the world: A systematic review. Climacteric. 10(3):197-214. https://doi.org/10.1080/13697130601181486
[2] Freedman R (2014) Menopausal hot flashes: Mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 142:115-120. https://doi.org/10.1016/j.jsbmb.2013.08.010
[3] Thurston RC, Chang Y, Mancuso P, Matthews KA (2013) Adipokines, adiposity, and vasomotor symptoms during the menopause transition: findings from the Study of Women’s Health Across the Nation. Fertil Steril. 100(3):793-800. https://doi.org/10.1016/j.fertnstert.2013.05.005
[4] Cendek BD, Bayraktar B, Sapmaz MA, Yıldırım AE, Ibanoglu MC, Engin Ustun Y (2024) The role of inflammatory and nutritional indices in postmenopausal osteoporosis: a retrospective study. J Clin Med. 13(24):7741. https://doi.org/10.3390/jcm13247741
[5] Yang M, Zhang Q, Ge Y, Tang M, Hu C, Wang Z, Zhang X, Song M, Ruan G, Zhang X, Liu T, Xie H, Zhang H, Zhang K, Li Q, Li X, Liu X, Lin S, Shi H (2022) Prognostic roles of inflammation- and nutrition-based indicators for female patients with cancer. J Inflamm Res. 15:3573-3586. https://doi.org/10.2147/JIR.S361300
[6] Korpe B, Kose C, Keskin HL (2024) Systemic inflammation and menopausal symptomatology: insights from postmenopausal women. Menopause. 31(11):973-978. https://doi.org/10.1097/GME.0000000000002433
[7] Techatraisak K. Jiwornlerk N (2019) Association between body mass index and moderate-to-severe vasomotor symptoms in Thai postmenopausal women. Siriraj Medical Journal. 71(5):370-376. https://doi.org/10.33192/SMJ.2019.56
[8] Thurston R (2024) Basics of vasomotor symptoms.Menopause. 31(12):1085-1086. https://doi.org/10.1097/GME.0000000000002479
[9] Jeong H, Park H (2022) Metabolic disorders in menopause. Metabolites. 12(10):954. https://doi.org/10.3390/metabo12100954
[10] Harborg S, Cronin-Fenton D, Jensen BR, Ahern TP, Ewertz M, Borgquist S (2023) Obesity and risk of recurrence in patients with breast cancer treated with aromatase inhibitors. JAMA Network Open. 6(10):e2337780. https://doi.org/10.1001/jamanetworkopen.2023.37780
[11] Zhu B, Liao Q, Tian H, Yu D, Xie T, Sun X, Zhou M, Han Y, Zhao J (2024) Estrogen: A forgotten player in metaflammation. Front Pharmacol. 15:1478819. https://doi.org/10.3389/fphar.2024.1478819
[12] Karvonen-Gutierrez C, Kim C (2016) Association of mid-life changes in body size, body composition and obesity status with the menopausal transition. Healthcare. 4(3):42. https://doi.org/10.3390/healthcare4030042
[13] Aslani Z, Abshirini M, Heidari-Beni M, Siassi F, Qorban M, Shivappa N, Hébert J , Soleymani M, Sotoudeh G (2020) Dietary inflammatory index and dietary energy density are associated with menopausal symptoms in postmenopausal women: A cross-sectional study. Menopause. 27(5):568-578. https://doi.org/10.1097/GME.0000000000001502
[14] Haghshenas N, Baharanchi F, Melekoğlu E, Sohouli H, Sidfar F (2023) Comparison of the predictive effects of dietary inflammatory index and empirically derived food-based dietary inflammatory index on menopause-specific quality of life and complications. BMC Womens Health. 23(1):349. https://doi.org/10.1186/s12905-023-02485-y
[15] Bayramı H, Gürbüz M (2025) Dietary Inflammatory Index: is it really associated with postmenopausal symptoms? Climacteric. 29(11):67-74. https://doi.org/10.1080/13697137.2025.2524174
[16] Kahleova H, Levin S, Barnard ND (2021) Plant-based diets for healthy aging. J Am Coll Nutr. 40(5):478-479. https://doi.org/10.1080/07315724.2020.1790442
[17] Gonçalves C, Moreira H, Santos R (2024) Systematic review of Mediterranean diet interventions in menopausal women. AIMS Public Health. 11(1):110-129. https://doi.org/10.3934/publichealth.2024005
[18] Tijerina A, Barrera Y, Solis-Pérez E, Salas R, Jasso L, López V, Ramírez E, Pastor R, Tur A, Bouzas C (2022) Nutritional risk factors associated with vasomotor symptoms in women aged 40–65 years. Nutrients. 14(13):2587. https://doi.org/10.3390/nu14132587
[19] Khan SJ, Kapoor E, Faubion SS, Kling JM (2023) Vasomotor symptoms during menopause: a practical guide on current treatments and future perspectives. Int J Womens Health. 15:273-287. https://doi.org/10.2147/IJWH.S365808
[20] K Kahleova H, Znayenko-Miller T, Uribarri J, Holubkov R, Barnard ND (2023) Dietary advanced glycation products and their associations with insulin sensitivity and body weight: a 16-week randomized clinical trial. Obes Sci Pract. 9(3):235-242. https://doi.org/10.1002/osp4.646
[21] Atalay BG, Özpak Ö, Yapıcı Y (2022) Adherence to a Mediterranean diet and cardio-metabolic risk in postmenopausal women by body composition. Asia Pac J Clin Nutr. 31(2):312-319. https://doi.org/10.6133/apjcn.202206_31(2).0017
[22] Yang Y, Yang Y, Yong Z, Yang L, Zhao Y, Yan M, Zheng R, Luo X (2025) Association between protein-rich foods, nutritional supplements, and age of natural menopause and its symptoms. Nutrients. 17(2):356. https://doi.org/10.3390/nu17020356
[23] Forma E, Urbańska K, Bryś M (2024) Menopause hot flashes and molecular mechanisms modulated by food-derived nutrients. Nutrients. 16(5):655. https://doi.org/10.3390/nu16050655
[24] Wang X, Yang D, Li J, Jin L, Xia S, Jin F (2025) Association between menopause-related symptoms and muscle mass index among perimenopausal and postmenopausal women and the mediating role of estrogen levels. Front Endocrinol. 16:1628612. https://doi.org/10.3389/fendo.2025.1628612
[25] Lowe EF, Stein M, Woolley T, Waycaster M, Scroggins B, Acuff R, Smith JT, Lefemine AA (1983) Prognostic nutritional index: Its usefulness as a predictor of clinical course. J Am Coll Nutr. 2(3):231-240. https://doi.org/10.1080/07315724.1983.10719927
Downloads
Published
How to Cite
License
Copyright (c) 2026 Zercan Kalı, Pınar Kırıcı , Fatma Tanılır Çağıran
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
