10/6/2017 Disclosures • I have no disclosures Nutrition & Menopause Making changes when you can’t eat like a 25 year old, and get away with it.. What changes? Mindless Eating • Social situation • The “empty ‐ nester” can lead to changes in meal preparation and eating routines. • Family and family meals • Less regular meal habits, • Activity levels • Eating while watching television or otherwise • Hormonal influences distracted • Stress • Prepared meals, • Metabolism • Meals eaten out, • Concurrent illnesses or limitations • Comfort eating 1
10/6/2017 Eating “errors” Physical Activity • Mistaking fatigue or thirst for hunger • Women are less active than men • Eating quickly • Become less active with time • Eating foods that do not produce satiety • More likely to have sedentary occupations – Fats and protein do • Experience barriers to physical activity – Carbs don’t – Safety and security • Kitchen clean up – Financial – Body image • Alcohol – Time Weight gain • Weight control consistently emerges as a major concern among women in/at menopause We under ‐ estimate what we eat, and • Weight gain is typical at this time. • In SWAN, an observational study of healthy overestimate our activity level women throughout the menopausal transition, women gained on average 4.5 pounds J Clin Endocrinol Metab. 2007 March ; 92(3): 895–901. Am J Epidemiol. 2004 Nov 1;160(9):912 ‐ 22. 2
10/6/2017 Does MHT Cause weight gain? Body Fat Goes Up Several large trials and longitudinal studies on three continents and Cochrane meta ‐ analysis: • No increase or reduced gain in women on HT compared to controls • Denmark, SOFT : The reduction in weight was almost entirely accounted for by decreased fat accumulation. • 5 year prospective Australian study showed weight gain in all groups except those on hormone therapy • WHI found that women randomized to E+P had less fat gain and maintained or gained lean body mass . Endocrinol Metabol Syndrome S1:009. doi:10.4172/2161 ‐ 1017.S1 ‐ J Bone Miner Res. 2003 Feb;18(2):333 ‐ 42.; Cochrane Database Syst Rev 2000 ; (2) : CD001018.; 009 Climacteric. 2012 Oct;15(5):419 ‐ 29. ; J Bone Miner Res. 2003 Feb;18(2):333 ‐ 42.; Climacteric. 1999 Sep;2(3):205 ‐ 11; Am J Clin Nutr. 2005 Sep;82(3):651 ‐ 6 . What is the role of hormones? Cortisol and Fitness • Abdominal fat deposition increased by chronic • Estrogens influence adipose tissue lipoprotein stress, through the action of cortisol, lipase activity and increase lipolysis • Basal and 24 hour cortisol and ACTH levels rise • In the absence of estrogen, increased central with age. fat deposition • Modified by fitness. • The ACTH and cortisol levels of un ‐ fit (younger) women are greater than fit older women, • ACTH and cortisol responses of physically fit older women to a stress test are more like those of younger women Maturitas. 2010 Mar;65(3):219 ‐ 24; Maturitas.2009.12.003. Maturitas. 2010 Mar;65(3):219 ‐ 24; Maturitas.2009.12.003. 3
10/6/2017 It is a situation, not a sentence Increased Risk for Overweight women • SWAN: Forty ‐ three percent of women who SWAN followed a cohort of obese women over were obese when they entered menopause, seven years progressed from benign obesity to an at ‐ risk • impaired glucose tolerance was most phenotype over seven years of observation. predictive of the progression to high risk • The increase of visceral adipose tissue begins metabolic state, in the peri ‐ menopause phase, 3–4 years prior • physical fitness was the only lifestyle factor to menopause that was protective from progressing to higher – correlated with a decrease in estrogen (estradiol) and increase in Follicular Stimulating Hormone. risk state. J Clin Endocrinol Metab. 2014 Jul;99(7):2516 ‐ 25. J Clin Endocrinol Metab. 2014 doi: 10.1210/jc.2013 ‐ 3259. Jul;99(7):2516 ‐ 25. Muscle mass Goes Down Muscle Mass Goes Down • Regular exercise may not arrest loss of muscle mass, • Loss of 0.6 % ‐ 1% muscle mass/ year post ‐ but does improve muscle function menopause • Quantified with standardized measures of strength, • Decline in muscle strength of 1.5%/ year ‐ and with decreased performance on tests of overall – a loss of 21% between the ages of 25 and 55. strength, such as the “timed up and go”. – Both measures are directly related to risk of disability and • Aggravated by inactivity and low protein intake, death • Vitamin D, sex hormones, growth hormone, – Studies conflicting as to role of estrogen or estrogen plus progesterone dehydroepiandrosterone, , insulin ‐ like growth factor 1and insulin are associated with better maintenance of muscle mass and strength Calcif Tissue Int. 2008 Aug;83(2):93 ‐ 100. BMJ. 2010 Sep 9;341:c4467. J Musculoskelet Neuronal Interact. J Musculoskelet Neuronal Interact 2009; 9(4):186 ‐ 2009 Oct ‐ Dec;9(4):186 ‐ 97. 197 4
10/6/2017 Weight Loss Lose Fat not Muscle • To maintain their weight, and avoid weight • Weight loss at midlife requires careful gain: attention to nutritional intake; – Restrict caloric intake – It is important for women to maintain lean body mass. – Increase physical activity. – Unless adequate protein is maintained, weight – Awareness and portion control loss in older adults can be associated with further – Diet diaries or use of mobile apps loss of muscle mass. Health Care Women Int. 2012 ; 33(12): 1086–1095 Fight Bone Loss Heart health and diet • Bone mineral density declines with age, with • The healthiest adults consume a diet rapid losses associated with menopause. – rich in fruits and vegetables, plant and seafood • In a study of healthy post ‐ menopausal women, protein, healthy fats and low fat dairy, multiple nutrients were associated with increased – moderate alcohol intake, bone density, notably protein and calcium, as well – relatively low in refined grains, sugars and salt. as magnesium, zinc and vitamin C (ref). • A diet rich in these nutrients should be accompanied by weight bearing exercises, core strength and resistance training, all of which are helpful in reducing falls and fractures 5
10/6/2017 Diet and the Brain Protein • Diets that are rich in fish and • Adequate protein intake is important for vegetable fats, non ‐ starchy maintenance of muscle mass and strength, as vegetables, low ‐ glycemic index well as for maintenance of healthy bone mass. fruits, low refined carbohydrates, • 1 g protein/ kg body weight, with 25 ‐ 35 gm of and moderate wine intake. high quality of protein at each meal. • “Anti ‐ inflammatory “ diets and the – There are ongoing discussions as to whether this brain and gut Microbiome diets are should be increased. areas of ongoing interest and research Appl Physiol Nutr Metab. 2015 Aug;40(8):755 ‐ 61 Carbohydrates Dietary Fat: the about face? • Glucose resistance increases with age • Canada Food Guide (CFG) advises a small amount of fats, 30 to 45 mL of unsaturated fat – individual modifying factors, notably genetic predisposition, stress and physical activity. each day including oil used for cooking. The CFG recommends limiting butter, hard • Low glycemic index foods preferred margarine, lard and shortening. • Appropriate contribution of carbohydrates • The 2015 Dietary Guidelines for Americans to diet varies with age and between does not specify an upper limit on dietary fat. individuals . 6
10/6/2017 Fat??? Calcium • Reducing dietary cholesterol has not been found to • Recommendations for Calcium vary between reduce serum cholesterol countries, • Women’s Health Initiative did not find that a low fat dietary intervention impacted CVD risk • Osteoporosis Canada recommends 1200 mgm • Low fat diets may result in decreased healthy fats, for post ‐ menopausal women – such as fish, vegetables and nut ‐ derived oils. Low fat foods are often modified by the addition of • • Found in a variety of foods highly refined sugars or corn syrup; • Fats contribute to satiety, an important regulator of consumption. • Moderation, and attention to adequate consumption of healthy fats is prudent advice. Calcium Vitamin D • Health Canada recommends that all adults • Calcium cannot be absorbed in large over the age of 50 should take a daily vitamin quantities, D supplement of 10 micrograms (400 IU) – can cause hypercalemia and hypercalcuria • Osteoporosis Canada also recommends • Best absorbed over three meals routine vitamin D supplementation for post ‐ • Supplements should be divided doses, or in menopausal women, the recommendations is slow release formulation 800 to 1000 IU daily – to minimize the risk of hpercalcuuria, • Vitamin D measurement is not recommended hypercalcemia in the low risk population 7
10/6/2017 Iron Resources • Menstrual iron losses stop with menopause, but • Eatrightontario women who have had menorrhagia may have • Daily diaries persistent iron deficiencies, particularly if they have a diet, which is low in meat. • Food trackers • Iron is important for neuro ‐ cognitive function, so • Fitness trackers deficiencies should be corrected. • Hemochromatosis, a common inherited disorder, • SOGC Nutrition Guideline typically manifests in women in their sixties, and • Motivational interview techniques can have severe consequences if unrecognized. • Post ‐ menopausal women should not receive routine iron supplementation. Web resource • http://www.hernutrition.ca/ 8
Recommend
More recommend
