Reviewer ’s report  
 
Title:  Major Dietary Patterns in Relation to Menstrual Pain:A Nested Case Control Study  
 
Version: 1 Date: 29 Dec 2017 
 
Reviewer:  NEHAD  AYOUB  
 
Reviewer’s report:  
 
The study by Najafi et al. is presenting results of Nested Case Control (NCC) study assessing the 
potential associations between dietary patterns with dysmenorrhe a among a sample of University 
students.  
 
 
The followings are comments to authors:  
 
1. The authors indicated that a gynecologist performed physical examination and applied 
Ultrasound to identify genital disease for participants in the study. Please specify what you mean 
with genital disease. Would this imply the exclusion of cases with secondary dysmenorrhea?? 
Thus, the sample in this study is composed of subjects with primary dysmenorrhea? Please 
clarify.  
 
2. Among the factors analyzed for reproductive and m enstrual data, was there any information 
collected regarding menstrual cycle irregularities among study subjects. If yes, please consider in 
your analysis.  
 
3. The authors indicated that "being single" is a criteria for inclusion in the study. Results show 
that 90.8% of participants in the current study were single. Would you please explain the marital 
status for the remaining subjects (9.2%)?  
 
4. Authors indicated that participants who reported dysmenorrhea were included in the current 
study if they present with 2nd or 3rd grade dysmenorrhea. In addition, Methods part indicated 
that subjects who use oral contraceptives, herbal remedies, or dietary supplements were excluded 
from participation. In this regard, no statement indicated the status for other treatme nts to relieve 
menstrual pain as non -steroidal anti -inflammatory drugs (NSAIDs), acetaminophen, and/or 
antispasmodics. It is not unlikely, that with participants having moderate -to-severe dysmenorrhea 
to use the above mentioned treatments to relief pain. P lease indicate the pattern of use of these 
treatments in your analysis and compare the data between both groups. Also, you may need to 
adjust for treatment use, if any, for the calculations of odds ratio.  
 
5. Please indicate how menstrual pain was assessed in this study. If special pain scales or forms 
were used, please provide the name and reference.  
 
6. Were there data collected regarding serving size? Is it possible that not only the dietary 
pattern, but also, the serving number/size is affecting the prese ntation of menestral pain among 
the study groups? If any data is available, I would highly suggest including in your analysis.  
 
7. Some language and editorial comments are enclosed within the Word version of the 
manuscript using track changes options for co nsiderations by the authors.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in  your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requi re further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, eithe r now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree t o the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comme nts 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal