Position of the American Dietetic Association and Dietitians of Canada: Nutrition and Women’s Health

Benefits and Barriers to Healthful Eating

A lack of cooking skills and reduced food preparation knowledge are significant barriers to the production of home cooked meals in the United States. The benefits and barriers to healthful eating in relationship to decreased food preparation ability are summarized in this review. In particular, home food preparation barriers, the consequences that result from eating out frequently, and the benefits of home-produced meals are presented. Strategies for preparing meals at home and specific recommendations for health care professionals are presented in this article.

Disparities exist between National food group recommendations and the dietary intakes of women

BACKGROUND

Preconception and pregnancy dietary intakes can influence the health of future generations. In this study we compared the food intakes of reproductive-aged women by pregnancy status, to current Australian recommendations.

METHODS

Data are from the Australian Longitudinal Study on Women's Health, younger cohort aged 25-30 years in 2003, with self-reported status as pregnant (n = 606), trying to conceive (n = 454), given birth in the last 12 months (n = 829) or other (n = 5597). Diet was assessed using a validated 74-item food frequency questionnaire. Food group servings and nutrient intakes were compared to the Australian Guide to Healthy Eating (AGHE) and Australian Nutrient Reference Values (NRVs).

RESULTS

No women met all AGHE food group recommendations. Highest adherence rates [mean (95% CI) servings/day] were for meat [85%, 1.9(1.8-1.9)], fruit [44%, 2.1(2.1-2.2)] and dairy [35%, 1.8(1.8-1.9)], with < 14% meeting remaining recommendations. Women who achieved NRVs (folate, iron, calcium, zinc, fibre) for pregnancy, breastfeeding and adult life stages were 1.5%, 3.3% and 13.7%, respectively. Compared to AGHE, women consumed more servings of fruit (4.9 vs 4.0;P = 0.034) and dairy (3.4 vs 2.0;P = 0.006) to achieve pregnancy NRVs; more dairy (2.9 vs 2.0;P = 0.001), less fruit (3.9 vs 5.0;P < .001) and vegetables (3.4 vs 7.0;P < .001) to achieve breastfeeding NRVs; more fruit (3.6 vs 3.0;P < .001), dairy (2.5 vs 2.0;P < .001), meat (1.8 vs 1.5;P = 0.015), less vegetables (3.6 vs 5.0;P < .001) to achieve adult NRVs.

CONCLUSIONS

The AGHE does not align with contemporary diets of Australian women or enable them to meet all NRVs. Current tools to guide food consumption by women during pregnancy require revision.

Comparison of a dietary intervention promoting high intakes of fruits and vegetables with a low-fat approach: long-term effects on dietary intakes, eating behaviours and body weight in postmenopausal women

The aim of the present study was to compare the long-term effects of two dietary approaches on changes in dietary intakes, eating behaviours and body weight: (1) approach using restrictive messages to limit high-fat foods (low-fat intake; LOFAT); (2) approach emphasising non-restrictive messages directed towards the inclusion of fruits and vegetables (high intake of fruits and vegetables; HIFV). A total of sixty-eight overweight or obese postmenopausal women were randomly assigned to one of the two dietary approaches. The 6-month dietary intervention included three group sessions and ten individual sessions with a dietitian. Dietary intakes, eating behaviours and anthropometrics were measured at baseline, at the end of the dietary intervention (T = 6) and 6 months and 12 months after the end of the intervention (T = 12 and T = 18). In the LOFAT group, energy and fat intakes were lower at T = 6 when compared with baseline and remained lower at T = 12 and T = 18. In the HIFV group, fruit and vegetable intakes increased significantly at T = 6 but were no longer significantly different from baseline at T = 12 and T = 18. Dietary restraint increased at T = 6 and remained higher than baseline at T = 18 in the LOFAT group while no significant change was observed in the HIFV group. At T = 6, body weight was significantly lower than baseline in both groups (LOFAT: - 3.7 (SD 2.8) kg; HIFV: - 1.8 (SD 3.0) kg) and no significant difference in body-weight change from baseline was found between groups at T = 18. We concluded that weight loss was similar at 1-year follow-up in both dietary approaches. Despite relatively good improvements in the short term, the adherence to a 6-month dietary intervention promoting high intakes of fruits and vegetables was difficult to maintain.

Weight history of overweight pregnant women

PURPOSE

Pre-conception weight gain and postpartum weight retention may contribute to women's increased risk of developing overweight/obesity; however, weight history data that would permit an examination of this hypothesis have been lacking. Our objective was to describe the weight history of pregnant overweight women and their families.

METHODS

Between 16 and 20 weeks of gestation, 107 overweight pregnant women (21 Aboriginal, including 20 First Nations and one Métis, and 86 non-Aboriginal) completed a weight history questionnaire.

RESULTS

Average adult usual body weight (UBW) corresponded to a body mass index (BMI) of 29.2 +/- 5.5 kg/m2 (overweight). Average pre-pregnancy BMI (33.0 +/- 6.6 kg/m2) increased into the obesity category. Over two-thirds of subjects reported an unstable UBW. A large proportion of multiparous subjects had retained weight after pregnancy. The average weight retained was 12.7 +/- 9.4 kg, and it accounted for almost all of the weight change from UBW.

CONCLUSIONS

Weight history questionnaire results showed that pre-conception weight fluctuations and postpartum weight retention are significant problems for many overweight/obese women. Health care professionals can use this information for early prenatal through postpartum interventions designed to help overweight/obese women achieve an appropriate pregnancy weight and prevent sustained postpartum weight retention.

Pass the fruits and vegetables! A community-university-industry partnership promotes weight loss in African American women

This article describes a community-university-industry partnership to alleviate food insecurity while promoting weight loss. Twenty-one overweight African American women are randomly assigned to experimental or control groups. Each receives supermarket gift cards and brief health education monthly for 3 months. The experimental group buys fresh produce only, whereas the control group buys any groceries. Data on weight, body mass index (BMI), waist-hip circumferences, and dietary intake are collected at baseline and months 1 to 3. Nine (43%) have complete data. Quantitative data reveal that the experimental group have lost significantly more weight (-6, +4 lbs), significantly reduced BMI (-1, +0.7), and eat significantly more raw, fresh produce (1.29, 0.15 cups). A focus group held at month 4 is rich with the meanings of participating, eating "well," and forming new habits. A nutrient-dense diet that is calorically balanced is the hallmark of health and well-being and may be related to weight loss in new ways. However, this diet is not always affordable by those most in need of it. The unexpected outcome of a statistical relationship among consuming raw, freshly prepared produce, weight loss, and BMI reduction within 3 months is not altogether explainable. There are obvious benefits, however, to these outcomes that support the continuing study of the phenomenon.

Promoting Nutrition for Men's Health

Morbidity and mortality are significantly higher in men than in women and are particularly related to lifestyle-related chronic diseases. Men tend to consume fewer vegetables and fruits than women and fail to meet recommendations for intakes of fats, fibers, and sodium. Men in some population groups tend to consume diets with lower nutrient density than women. Barriers to healthy eating in men include lack of awareness and personal interest, perceptions that foods and diets are “women's business,” lack of social support, and cynicism regarding nutrition messages by health authorities. In addition, many men perceive health-promoting foods as expensive, bland, nonsatiating, and time-consuming to prepare. Research specifically focused on men's health and nutrition is critically needed. Topics to be addressed include biological, psychological, and social correlates of healthy eating in men and nutritional factors particular to chronic disease risk reduction in men. Social, cultural, religious, economic, educational, and other aspects should be taken into account.

Nutrition for Women in the Prevention and Treatment of Type 2 Diabetes and Cardiovascular Diseases

Awareness of women's risks for type 2 diabetes and cardiovascular diseases must be promoted by health care professionals. For overweight and obese women, weight reduction is critical for reducing risks; prevention of excess weight gain must be encouraged for women of healthy body weight. Vulnerable times for weight gain during a woman's life cycle include early adulthood, the childbearing years, and menopause. Thus, healthy diet and exercise behaviors must be particularly emphasized during these years. Polycystic ovary syndrome is also associated with obesity, insulin resistance, and cardiovascular disease risk, and weight loss can lower these risks. Foods comprising diets associated with reduced cardiovascular disease and type 2 diabetes risks tend to be unrefined plant foods (vegetables, legumes, fruits, whole grains, nuts, seeds), low-fat dairy products, fish rich in omega-3 fatty acids, and lean sources of protein. Artificial trans fatty acids should be avoided and saturated fats cholesterol, sodium, and added sugars minimized. A balance of micro-nutrients and fiber should be obtained from wholesome food sources rather than supplements. Dietary counseling for women should consider the context in which they live, cultural aspects, socioeconomic factors, menstrual cycle influences on food intake, and warning signs for eating disorders. Continued gender-specific research will be helpful in discerning the most effective lifestyle interventions for women.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

OBJECTIVES

The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.

SUBJECTS/SETTING

Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum.

DESIGN

At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized.

RESULTS

For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity.

CONCLUSIONS

Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.

Nutrition and Women’s Health: Position of the American Dietetic Association and Dietitians of Canada: Executive Summary (1)

It is the position of the American Dietetic Association (ADA) and Dietitians of Canada (DC) that women have specific nutritional needs and vulnerabilities and, as such, are at unique risk for various nutrition-related diseases and conditions that affect the duration and quality of their lives. Although women’s health-related issues are multifaceted, nutrition has been shown to influence significantly the risk of chronic disease and assist in maintaining optimal health status. Therefore, the ADA and DC encourage dietetics professionals to strongly support research, health promotion activities, health care services, and advocacy efforts that will enable women to adopt desirable nutrition practices for optimal health.