Reviewer's report
Title:Anti-stress effects of short-term fasting in menstrual phases in young
women
Version:3Date:11 March 2015
Reviewer: Audra Gollenberg
Reviewer's report:
Major compulsory revisions (some are minor embedded):
ABSTRACT:
1. Minor- include age in the parentheses for mean age.
2. Conclusion – include a statement on implications of research findings.
BACKGROUND:
3. Pg. 5, lines 6-8. Suggest providing some quantitative estimates on prevalence
of women experiencing moderate to severe menstrual symptoms.
4. Pg. 5. Suggest expanding the section and providing more discussion on the
physiological involvement of the nervous system in contributing to menstrual
symptoms. This will provide more clarity to the readers and provide a justification
for the anti-stress measurements used in this study.
5. Pg. 6. Suggest providing more justification for the plausibility of dietary
restriction as a feasible and safe means of stress reduction, as compared to the
multitude of other means of stress reduction, including the plausibility that
short-term anti-stress measures will translate into reduced menstrual symptoms.
In the paper’s current version, only a limited explanation of the suitability of this
method exists, and one example is in men, which may not be a useful population
of comparison.
6. Pg. 6, line 10-13. Authors suggest that the possibility exists that “short-term
fasting reduces stress and leads to the alleviation of menstrual-cycle symptoms.”
This is a fairly strong statement, yet it is followed by a statement that “there is
little evidence of ant-stress effects of short-term fasting on menstrual cycles.”
Given that little evidence exists on this research question, I suggest that authors
revise their language to reflect the level of uncertainty on whether short-term
fasting will actually reduce menstrual cycle symptoms. Further, the authors did
not measure a change in menstrual symptoms in this intervention, so this point
should be made with softer language.
7. Pg. 6. Provide a clear hypothesis for this study.
METHODS
8. Give dates of study implementation.
9. Explain how the dietary composition was chosen for this study. Is there
particular dietary recommendation that served as the basis for the study meals?
How did the dietary composition differ from the study participants’ normal diet
and could this have had any role in the stress effects? (For Discussion)
10. How were study participants recruited and did they have any indication of
high stress at the time of enrollment (e.g. near exam periods)? Were they given
any incentives?
11. Pg. 8. Clarify the total fasting time for each fasting phase.
DISCUSSION
12. Pg. 13, lines 19-24. Clarify – “conditions of subjects” could have contributed
to inconsistency in results. Explain in more detail what is meant by this.
13. More discussion is needed on interpretation of the effect size of the HR, HF
power, and salivary cortisol. While statistical significance is one measure, it is
important to relate the effect size to clinical significance and/or a meaningful
anti-stress effect.
14. The comparison of results in women with anorexia and bulimia needs more
clarification, as the study participants in the present study were normal/healthy,
per the author’s description. These disorders with respect to dietary intake and
stress levels may limit comparison of results to this study population.
15. Further, the comments with respect to obesity and sympathetic activity seem
tangential and not relevant. Perhaps further clarification could explain its
relevance.
16. More discussion and interpretation is needed for the results that were not
statistically significant, whereas the results that achieved statistical significance
were highlighted more often in the Discussion. The measurements that did not
differ between treatment groups may add to the interpretation for the underlying
mechanisms for the potential anti-stress effects observed.
17. For the Limitations section, the Authors should acknowledge further study
limitations of the small and controlled experimental conditions and the potential
for anti-stress effects persisting in a non-controlled setting? Perhaps the
expected differences are minimal but it should be addressed. Further, it is
unclear how a short-term fasting intervention will translate into longer-term stress
reduction and if so, what are the implications of fasting in policy/treatment
conditions for menstrual symptoms? How will stress levels change once eating is
resumed? There are still a number of unknowns that should be acknowledged by
the authors. How was the fasting tolerated by the study subjects?
18. Conclusion –I suggest the authors add some statements that speak broadly
to clinical and/or women’s health policy implications of this research, with study
limitations in mind. Readers of this journal will be interested in this link.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.