Maximizing post-menopausal health: Opportunities for nutrition intervention
by Celeste C. Tanchoco
Butuan City (17 May) -- Among older persons, there are a number of nutrition-related health problems that are particularly pertinent to women, namely, osteoporosis, cardiovascular diseases, cancer and weight problems. Most of these problems are largely due to a reduced secretion of estrogen which occurs at menopause.
Health issues for women after menopause: Osteoporosis. Osteoporosis is characterized by a low bone mass and increased fragility of bones, making them more susceptible to fracture. Bone loss occurs with aging, but it occurs earlier in women than in men. Accelerated bone loss occurs at menopause as a result of low estrogen levels.
Nutritional Factors Affecting Bone Strength. One of the most significant nutritional factors affecting bone strength is calcium status. The rate of bone loss can be reduced in post-menopausal women by ensuring an optimal calcium intake throughout the life stages.
Other key nutrients essential for bone health include vitamin D, vitamin C, phosphorus, magnesium and zinc. Vitamins C and D facilitate the absorption and utilization of calcium.
Studies revealed that the ability of the skin to synthesize vitamin D when exposed to sunlight dramatically decreases with age. Furthermore, elderly women who are homebound may have less opportunity for exposure to sunlight.
As components of bone, phosphorus and magnesium stabilize bone structure and improve bone strength. A varied diet usually meets the recommended intakes of these minerals.
Many elderly persons are reported to have marginal zinc stores. This can be a result of decreased meat intakes, medical conditions that impair zinc status, or the use of drugs that either reduce zinc absorption or increase zinc excretion.
Supplements to improve zinc status should, however, be used with caution because excessive zinc intake can cause gastrointestinal irritation, copper deficiency, anemia, hypercholesterolemia and impaired immune functions.
Weight-bearing exercise has a significant effect on bone strength, but sufficient calcium must be consumed to optimize the benefits of exercise on bone.
Cancer. Breast cancer is the most common and risk increases with early menarche and late menopause. In the Philippines, breast cancer is the leading type of cancer among Filipino women according to the Department of Health's (DOH) latest data. It has been reported that postmenopausal women aged 55 years and over have a 66% incidence of breast cancer mortality.
There is evidence that diet may play a role in some types of cancer, in particular, the high-fat intake and breast cancer. The role of other dietary factors is unclear. What is known though is that obesity increases risk of post-menopausal breast cancer, and for obese women, weight loss can reduce cancer risk.
The increased consumption of fruits and vegetables is also thought to be protective against breast cancer.
Cardiovascular Disease. Modifiable coronary heart disease (CHD) Risk Factors in Women - Modifiable CHD risk factors are important target for intervention in post-menopausal women. Modifiable risk factors include smoking, hypertension, obesity, physical inactivity and diabetes.
Although each factor may affect CHD risk independently, controlling non-lipid risk factors like weight, blood pressure, and lifestyle factors can also control hyperlipidemia.
Reducing obesity and increasing physical activity can control hypertension and diabetes in addition to improving lipid profile. Smoking cessation not only removes the strongest independent modifiable risk factor for CHD but also affects lipid profile favorably.
Hyperlipidemia Management in Women. For primary prevention, the initial or routine screening should include assessment of total cholesterol and high density lipoprotein (HDL) levels to determine the client's lipid risk status.
A routine visit should also include assessment of the client's dietary habits and other risk factors for CHD, such as family history, smoking, hypertension, diabetes, obesity, and physical inactivity.
For patients who have desirable total cholesterol levels at less than 200 milligrams per deciliter (?200 mg/dL) and HDL levels that do not signal increased risk at equal to or more than 35 milligrams per deciliter (?35 mg/dL), no additional testing is needed and follow-up cholesterol screening can be deferred for up to five years.
Nevertheless, clients who have desirable total cholesterol and HDL levels and are not overweight should be advised about diet and physical activity. In addition, all patients should be encouraged to be physically active.
The current recommendation is to accumulate at least 30 minutes of moderate-intensity physical activity on most or preferably all days of the week.
Even when cholesterol levels are desirable, women who have modifiable CHD risk factors, such as smoking, obesity, and hypertension, should be counseled on risk reduction. Those who have diabetes should be referred to specialty care for lipid management.
Appropriate management for patients with undesirable total cholesterol or HDL levels depends on a combination of their levels and CHD risks. Determining a patient's risk level on this basis is termed risk stratification.
Overweight and Obesity. Menopause is often believed to cause weight gain, although there is little sound evidence to describe it as a particular risk period. Menopause is, however, associated with a change in the distribution of fat, with more fat deposited around the abdominal area. Excess abdominal weight is associated with an increased risk of CHD.
Obese women should be strongly encouraged to lose weight. A 10 kilogram (kg) weight loss can lead to a fall in systolic blood pressure of 10 millimeter mercury (mmHg) and a fall in diastolic blood pressure of 20 mmHg. It can also reduce total cholesterol levels by 10%, and reduce obesity-related cancer deaths by 40%.
Excess weight also puts additional strain to already fragile bones of some menopausal women. With so much weight to carry, obese women may have difficulty moving around, making them more prone to accidents.
Long-term weight loss and weight-maintenance strategies need to be implemented with dietary management, behavior modification and an increase in physical activity.
A healthy diet for post-menopausal women. The combination of dietary changes, increased physical activity and weight loss work together to promote overall health and well-being of post-menopausal women and reduce their risks of osteoporosis, cancer, cardiovascular disease and weight problems.
The general characteristics of a healthy diet for menopausal women are the same as those for all adults.
Specific instruction may be given for the following:
1. Calorie intake: An appropriate energy intake for an individual is the amount of calories that will achieve or maintain a desirable body weight. Particularly for an overweight or obese woman, it is desirable to assess current calorie intake and recommend a reduction in calorie intake accordingly.
2. Fat intake: The recommended fat intake for Filipinos is 20-30% of calorie intake. This conforms to the recommendation of the National Cholesterol Education Program (NCEP).
3. Calcium intake: An adequate calcium intake is not only protective against osteoporosis, but also promotes cardiovascular health.
For bone health in older individuals, an adequate calcium intake throughout the lifestages is important, and calcium supplementation at menopause has little effect on bone mineral density.
Thus, the US Food and Nutrition Board (1998) recommends the same calcium intake of 1000 milligrams per day (mg/d) for all adults, including post-menopausal women. The recommendation for Filipinos has been increased from 500 mg/d to 800 mg/day.
Excellent sources of calcium are milk and calcium-fortified juices. Good sources include seafoods and green leafy vegetables.
4. Fruits and vegetables: The NCEP panel pointed to epidemiologic evidence that a diet emphasizing fruits, vegetables, grains and fish affords protection against CHD. Not only do these foods tend to be low in fat, cholesterol, and calories, they also supply substances, such as antioxidants, fiber and carotenoids which are protective against CHD, cancer, and other degenerative diseases.
For more information on food and nutrition, contact: Dr. Mario V. Capanzana, FNRI Director, Food and Nutrition Research Institute, Department of Science and Technology, General Santos Avenue, Bicutan, Taguig City; Telephone/Fax Nos.: 837-2934, 837-3164; e-mail: firstname.lastname@example.org or at email@example.com; FNRI-DOST website: http://www.fnri.dost.gov.ph. (Dr.P.H., Scientist III & Chief Science Research Specialist, FNRI-DOST S& T Media Service) [top]