EMAS position statement: Diet and health in midlife and beyond

Factors Associated with the Development of High Nutrition Risk: Data from the Canadian Longitudinal Study on Aging

This study aimed to determine which social network, demographic, and health-indicator variables were able to predict the development of high nutrition risk in Canadian adults at midlife and beyond, using data from the Canadian Longitudinal Study on Aging. Multivariable binomial logistic regression was used to examine the predictors of the development of high nutrition risk at follow-up, 3 years after baseline. At baseline, 35.0 per cent of participants were at high nutrition risk and 42.2 per cent were at high risk at follow-up. Lower levels of social support, lower social participation, depression, and poor self-rated healthy aging were associated with the development of high nutrition risk at follow-up. Individuals showing these factors should be screened proactively for nutrition risk.

Body composition analysis: A snapshot across the perimenopause

During the perimenopause, estrogen concentrations gradually decrease, and this is associated with changes to women's energy expenditure and intake. These changes result in weight gain and altered body fat distribution, with increased abdominal fat deposition and cardiometabolic risk via insulin resistance. Body composition analysis is a useful clinical tool in outpatient settings, as it is simple, not expensive and provides information on body mass index, skeletal mass, fat mass, fat percentage and basal metabolic rate. This review discusses body composition analysis as part of a health assessment for healthy women during the perimenopause and investigates the associations between body composition and cardiometabolic profile.

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging

OBJECTIVE

There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk.

DESIGN

A retrospective cross-sectional study.

SETTING

Data from the Canadian Longitudinal Study on Aging (CLSA).

PARTICIPANTS

17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA.

RESULTS

CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk.

CONCLUSIONS

Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.

Social Network Factors Affect Nutrition Risk in Middle-Aged and Older Adults: Results from the Canadian Longitudinal Study on Aging

OBJECTIVES

To determine which social network, demographic, and health-indicator variables are associated with SCREEN-8 (nutrition risk) scores at two time points, three years apart, using data from the Canadian Longitudinal Study on Aging.

DESIGN

A retrospective cross-sectional study.

SETTING AND PARTICIPANTS

17051 Canadians aged 45 years and older with data from baseline and first follow-up of the Canadian Longitudinal Study on Aging.

MEASUREMENTS

Nutrition risk was measured using SCREEN-8. Social network factors included social network size, frequency of contact with social network members, social participation, social support, self-rated social standing, and household income. Demographic variables included age, sex assigned at birth, marital status, educational attainment, and living situation (alone or with others). Health-indicator variables included depression, disability, and self-rated general health, mental health, healthy aging, and oral health. Multivariable linear regression was used to analyze the relationship between the social network, demographic, and health-indicator variables and SCREEN-8 scores at two time points, three years apart.

RESULTS

Among the social network variables, individuals with higher social participation, self-rated social standing, and social support had higher SCREEN-8 scores at baseline and follow-up. Among the demographic variables, individuals who were single or widowed, compared to married or partnered, had lower SCREEN-8 scores at both time points. For the health-indicator variables, individuals who screened negative for depression, and those with higher self-rated general health, healthy aging, and oral health had higher SCREEN-8 scores at both time points. At baseline, as age increased, SCREEN-8 scores also increased.

CONCLUSION

Individuals with low social participation, low social standing, and low social support may be at increased nutrition risk and should be proactively screened by healthcare professionals. Interventions and community programs designed to increase levels of social participation and foster social support may help to reduce the prevalence of nutrition risk.

Menopause: a cardiometabolic transition

Menopause is often a turning point for women's health worldwide. Increasing knowledge from experimental data and clinical studies indicates that cardiometabolic changes can manifest at the menopausal transition, superimposing the effect of ageing onto the risk of cardiovascular disease. The menopausal transition is associated with an increase in fat mass (predominantly in the truncal region), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Exposure to endogenous oestrogen during the reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. In particular, women with vasomotor symptoms during menopause seem to have an unfavourable cardiometabolic profile. Early management of the traditional risk factors of cardiovascular disease (ie, hypertension, obesity, diabetes, dyslipidaemia, and smoking) is essential; however, it is important to recognise in the reproductive history the female-specific conditions (ie, gestational hypertension or diabetes, premature ovarian insufficiency, some gynaecological diseases such as functional hypothalamic amenorrhoea, and probably others) that could enhance the risk of cardiovascular disease during and after the menopausal transition. In this Review, the first of a Series of two papers, we provide an overview of the literature for understanding cardiometabolic changes and the management of women at midlife (40-65 years) who are at higher risk, focusing on the identification of factors that can predict the occurrence of cardiovascular disease. We also summarise evidence about preventive non-hormonal strategies in the context of cardiometabolic health.

Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

BACKGROUND AND AIMS

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women.

METHODS

The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach.

RESULTS

-The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight.

CONCLUSION

These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.

Executive summary of evidence and consensus-based clinical practice guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.

Dietary intake and menopausal symptoms in postmenopausal women: a systematic review

Despite literature pointing to a relation between dietary intake and menopausal symptoms, most studies have evaluated either only supplements or only specific nutrients or foods. Therefore, this study aimed to provide a systematic review of the literature regarding the association between dietary intake and menopausal symptoms in postmenopausal women. A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase to identify studies published between 2009 and 2019. We identified 3828 studies; after screening, 73 studies were reviewed and 19 of these investigated nutrient and food intake and eating patterns associated with the intensity of menopausal symptoms. Studies evaluating diet quality or dietary patterns showed an association between lower intensity of psychological symptoms, sleep disorders, and vasomotor, urogenital, and somatic symptoms and higher consumption of vegetables, whole grains, and unprocessed foods. Also, the intensity of these symptoms is associated with high-processed foods, saturated fats, and sugars. Regarding nutrient and/or specific food, the studies indicated an association between caffeine intake and type of fat intake and the intensity of menopausal symptoms. Dietary intake was found to be associated with the severity of menopausal symptoms; however, evidence for the association between dietary intake and menopausal symptoms is inconsistent and inconclusive, and is provided by a small number of studies.

Menopause and diabetes: EMAS clinical guide

INTRODUCTION

Whether menopause increases the risk of type 2 diabetes mellitus (T2DM) independently of ageing has been a matter of debate. Controversy also exists about the benefits and risks of menopausal hormone therapy (MHT) in women with T2DM.

AIMS

To summarise the evidence on 1) the effect of menopause on metabolic parameters and the risk of T2DM, 2) the effect of T2DM on age at menopause, 3) the effect of MHT on the risk of T2DM, and 4) the management of postmenopausal women with T2DM.

MATERIALS AND METHODS

Literature review and consensus of experts' opinions.

RESULTS AND CONCLUSION

Metabolic changes during the menopausal transition include an increase in and the central redistribution of adipose tissue, as well as a decrease in energy expenditure. In addition, there is impairment of insulin secretion and insulin sensitivity and an increase in the risk of T2DM. MHT has a favourable effect on glucose metabolism, both in women with and in women without T2DM, while it may delay the onset of T2DM. MHT in women with T2DM should be administered according to their risk of cardiovascular disease (CVD). In women with T2DM and low CVD risk, oral oestrogens may be preferred, while transdermal 17β-oestradiol is preferred for women with T2DM and coexistent CVD risk factors, such as obesity. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as progesterone, dydrogesterone or transdermal norethisterone. Postmenopausal women with T2DM should be managed primarily with lifestyle intervention, including diet and exercise. Most of them will eventually require pharmacological therapy. The selection of antidiabetic medications should be based on the patient's specific characteristics and comorbidities, as well on the metabolic, cardiovascular and bone effects of the medications.

Physical Activity, Lifestyle Factors and Oxidative Stress in Middle Age Healthy Subjects

Oxidative stress (OS) has been recognized to play a primary role in many acute and chronic diseases. Environmental and lifestyle factors, such as physical activity and dietary intake are involved in the oxidative balance, but their specific influence remains unclear. In order to contribute to a greater characterization of the oxidative status in relation to exercise training and to environmental and lifestyle factors, different biomarkers—pro-oxidant capacity (d-ROMs), anti-oxidant capacity (BAP), radical scavenging activity (DPPH) and DNA damage (8-OHdGuo)—were measured in biological samples of a group of healthy middle aged subjects. The evaluation of the investigated biomarkers highlighted a significant effect of exercise training on OS, measured as d-ROMs and 8OhdGuo, in subjects playing regular physical activity. An association of the OS status measured by DPPH and 8-OhdGuo with the condition of living in urban high traffic areas was also found. Otherwise dietary habits did not reveal any significant effect on OS levels by the investigated biomarkers. As a whole the results obtained in this investigation suggested that a correct lifestyle, with regular physical activity practice, contributes to control the OS status in middle age subjects.

Women's experience and attitudes towards menopause and health: descriptive research

Introduction: The physiological changes in hormonal levels occurring during perimenopause and postmenopause may affect the health of women. The purpose of the research was to explore the views and attitudes of women of this stage towards menopause, health, healthy lifestyle and some aspects of information regarding menopause. Methods: The study was based on a quantitative and qualitative approach. A semi-structured questionnaire (Cronbach α = 0.813) was used as a research instrument. The open question was interpreted by a qualitative method. A random systematic sample consisted of one hundred female patients, aged 45 to 60 years, attending a private healthcare institution. The survey was conducted in October 2014. The data collected were processed with the software Microsoft Excel and SPSS version 20.0. Results: The self-reported health status of the respondents was good (57.3 %) or very good (22.3 %). The most commonly cited symptoms included hot flushes and night sweats (x̅ = 2.73), sleep problems (x̅ = 2.8), and mental and physical exhaustion (x̅ = 2.70). Information from nurses was never sought by 57.6 % and occasionally by 9.8 % of the respondents, although the interviewees expressed the need for more comprehensive information on the subject. The identified subcategories include a positive attitude and self-confidence, support of the environment, consumer health information and healthy lifestyle. Discussion and conclusion: The research participants have a positive attitude to health, they are aware that there is much they can do to maintain and improve their health. As they also expressed the need to be better informed, the scope of nurses' work in referential out-patient clinics may be extended to menopausal counselling. However, more research on this topic needs to be undertaken.

A model of care for healthy menopause and ageing: EMAS position statement

Worldwide, the number of menopausal women is increasing. They present with complex medical issues that lie beyond the traditional scope of gynaecologists and general practitioners (GPs). The European Menopause and Andropause Society (EMAS) therefore provides a holistic model of care for healthy menopause (HM). The HM healthcare model's core consists of a lead clinician, specialist nurse(s) and the woman herself, supported by an interdisciplinary network of medical experts and providers of alternative/complementary medicine. As HM specialist teams are scarce in Europe, they are also responsible for structuring and optimizing processes in primary care (general gynaecologists and GPs) and secondary care (HM specialists). Activities for accreditation of the subspecialty Women's Health are encouraged.

Maintaining postreproductive health: A care pathway from the European Menopause and Andropause Society (EMAS)

This position statement from the European Menopause and Andropause Society (EMAS) provides a care pathway for the maintenance of women's health during and after the menopause. It is designed for use by all those involved in women's health. It covers assessment, screening for diseases in later life, treatment and follow-up. Strategies need to be optimised to maintain postreproductive health, in part because of increased longevity. They encompass optimising diet and lifestyle, menopausal hormone therapy and non-estrogen-based treatment options for climacteric symptoms and skeletal conservation, personalised to individual needs.

The cardiovascular safety aspects of calcium supplementations: where does the truth lie? A personal perspective

Clinical guidelines may change with time, as more information from topline studies emerges. Calcium plus vitamin D supplementation became routine decades ago, especially in the older population, based on the assumption that it may promote bone health and prevent fractures, and perhaps induce additional favorable health outcomes. During the past years, an ongoing debate defies this paradigm, mainly because of a potential cardiovascular risk on the one hand, and uncertainty in regard to the extent of the beneficial bone effects on the other hand. The following article summarizes the main recent developments, trying to put some order into the controversial information and opinions which have been published in the medical literature. We conclude that the best current evidence supports a primary strategy of obtaining recommended intakes of calcium and vitamin D from dietary sources. But, since most western diets are inadequate in that regard, and since there is no clear evidence of harm from modest supplementation (up to 1000 mg of elemental calcium and 400 IU of vitamin D3), supplementation is appropriate when dietary intake is inadequate.

Nutritional contributions to dementia prevention: main issues on antioxidant micronutrients

There is an impressing body of evidence supporting the beneficial role of balanced nutrition in lowering the risk of dementia and its commonest form, Alzheimer's disease. Nevertheless, and despite worldwide dementia epidemic, there is much unfounded skepticism and lack of information among physicians. As a result, the diagnosis of cognitive impairment occurs still far too late, at best symptomatic drugs keep being prescribed and patients and caregivers are left with little concrete support in the hands of the natural history of the disease. This review summarizes knowledge about the impact of nutrition as part of a healthy lifestyle and of micronutrients in particular on delaying and avoiding dementia onset.

Fruit and vegetable intake and related nutrients are associated with oxidative stress markers in middle-aged men

OBJECTIVE

The aim of this cross-sectional study was to assess the potential relationships between fruit and vegetable (FV) intake and oxidative stress markers in middle-aged men, with an emphasis on vitamin C, fiber, and magnesium content.

METHODS

The study was conducted with 296 healthy men, age 50.5 ± 5.0 y, and body mass index (BMI) of 25.8 ± 3.5 kg/m(2). Dietary intake, anthropometry, blood pressure, lifestyle features, and blood and urine biochemical data were assessed with validated procedures. The oxidative stress markers selected were plasma oxidized low-density lipoprotein (ox-LDL), urinary 8-iso-prostaglandin F2 α (8-iso-PGF2 α) and 8-hydroxy-2'-deoxyguanosine (8-OHdG).

RESULTS

The men included in the highest tertile of FV intake (≥341.1 g/d) displayed lower concentrations of ox-LDL, 8-iso-PGF2 α and 8-OHdG (P for trend < 0.05), regardless of confounding factors. Concentrations of ox-LDL were negatively associated with fiber from the FV intake (P for trend < 0.05) regardless of confounding factors. ox-LDL and 8-OHdG concentrations tended to be lower in the higher tertile of magnesium (P for trend = 0.06) and vitamin C from FV intake (P for trend = 0.05), respectively. Additionally, concentrations of 8-iso-PGF2 α were lower in men in the highest tertile of fiber (≥6.5 g/d; P for trend = 0.034), vitamin C (≥98.0 mg/d; P for trend = 0.007), and magnesium (≥48.9 mg/d; P for trend = 0.018) from the FV-group intake.

CONCLUSIONS

Greater FV intake was independently associated with reduced ox-LDL, 8-OHdG, and 8-iso-PGF2 α in middle-aged men. Fiber, vitamin C, and magnesium from FV seem to contribute to this beneficial relationship.

2013 Up-date of the consensus statement of the Spanish Menopause Society on postmenopausal osteoporosis

Postmenopausal osteoporosis is a major female health problem that increases morbidity, mortality and healthcare system costs. Considering that gynecologists are the primary health practitioners involved in the treatment of women with osteoporosis in our country, a panel of experts from the Spanish Menopause Society met to establish a set of criteria and procedures for the diagnosis and treatment of this disease based on the best available evidence and according to the model proposed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to elaborate clinical practice guidelines and to classify the quality of the evidence and the strength of the recommendations. These recommendations should be a reference to gynecologist and other health professionals involved in the treatment of postmenopausal women.

The metabolic syndrome and its components in postmenopausal women

BACKGROUND

Prevalence of the metabolic syndrome (METS) increases significantly after the menopause.

OBJECTIVE

To assess the prevalence of the METS and its components in postmenopausal women. Factors relating to each of the composing items of the METS were also analyzed.

METHODS

Natural postmenopausal women (40-65 years) were invited to participate in this cross-sectional study in order to assess the presence of the METS using modified Adult Treatment Panel III (ATP-III) criteria. Participants were also requested to fill out a general socio-demographic questionnaire.

RESULTS

A total of 204 women were surveyed with a median age of 56 years. A 52.9% presented the METS according to modified ATP-III criteria, with 37.3% presenting hyperglycemia, 51.5% hypertension, 58.3% abdominal obesity, 45.6% high triglyceride levels and 56.4% low HDL-C levels. Women with the METS presented a higher rate of dyslipidemia (high triglyceride and low HDL-C levels), hyperglycemia, hypertension and abdominal obesity than those without the syndrome. Those with abdominal obesity and hyperglycemia significantly displayed higher rates of low HDL-C levels (bivariate analysis). Multiple linear regression analysis found a positive correlation between glucose and triglyceride levels. Systolic blood pressure significantly and positively correlated to age and abdominal circumference. Abdominal circumference displayed an inverse correlation with educational level.

CONCLUSION

Prevalence of the METS in this postmenopausal female sample was high and associated to metabolic and lipid derangements. As abdominal obesity was significantly associated to lower education, there is an urgent need of implementing educational programs directed to high-risk populations in order to increase awareness of the problem.