2

Soodeh Razeghi Jahromi

Assistant Prof. of Nutrition

Nutrition & Menopause

3

IntroductionWeight

managementGlycemic

control

Preserving

muscle mass

Bone

healthNutritional

insufficiencyNutrition and

Timing

of Menopause

Sleep

4Introductionmenopause

women live on average one-third of their life after menopause

A systematic review of 9 surveys concluded that 50.5% of women reported using integrative medicine therapies specifically for menopausal symptoms, though 55% did not disclose use to their health care professional

Weight

O'Connor, Journal of Obstetrics and Gynaecology Canada38.6 (2016): 508-554.

-High waist/hip ratio: High risk of Dm, hypertension, CAD, premature death-Older adults who gain >5% of their BMI: Poorer upper & lower body function, Negative impact on ADLs & IADLs, Increase in pain- Dm: 2.9 fold higher in obese-OA: 45% of 85+, increased to 60% in overweight

-15 kg over IBW is healthier than IBWprotective from mortality-Goal of BMI: 25-30-decease the risk of pressure ulcer-May protective against dementia in women

Simplified formula for calculating energy requirement

BEE= X kcal*Kg body weight

X=

adult Male BEE= Wt in Kg* 24Female BEE=Wt in Kg* 24*0.95

Healthy elderly 19.4

Sick elderly 20.4-30

BMI<21 32-38

6

• Adjusting BEE for thermogenic effect of food, Stress and physical activity level

8

Purcell, Katrina, et al. The Lancet Diabetes & Endocrinology 2.12 (2014): 954-962.Proietto, Joseph. Australian family physician 46.6 (2017): 368

Management of obesitythe best method for postmenopausal women is to lose weight is to do so rapidly and with the help of mild ketosis

VLCDModified Atkins diet

For some people who cannot tolerate VLEDs because of their taste or texture, or because they may develop symptoms such as diarrhea, balanced reduced energy diet

Not less than 1200 kcal/dmodest calorie restriction reduced by about 600 kcal, along with adequate protein intake (0.8 to 1.2 g/kg divided over 3 meals)

Available very low calorie diet product

10

O'Connor, Deborah L., et al. Journal of Obstetrics and Gynaecology Canada38.6 (2016): 508-554.

Insulin resistance increases with age

Glycemic control

Van Ommen, Ben, et al. Frontiers in endocrinology 8 (2018): 381.

12Preserving muscle mass

Tang, M , et al. The American journal of clinical nutrition, 99,4 (2014). 891-898.Rafii, Mahroukh, et al. The Journal of nutrition 145,1 (2015): 18-24.Beasley JM, et al. J Am Geriatr Soc. 2013; 61:1863–1871

• 1-1.2 g protein/kg/d according to amino acid oxidation technique

• A 6-year longitudinal observational study on 134,961(50-79y): higher protein intake was associated with better physical function and with slower rates of functional decline in postmenopausal women

• regular, weight-bearing exercise

13

Why do older adults require more protein than younger individuals?

• inadequate intake of dietary protein• loss of appetite

• gastrointestinal issues

• reduced energy need

• changes in food preference

• a reduction in the utilization of available protein• anabolic resistance

• insulin resistance

• higher splanchnic extraction

• higher basal requirement• acute and chronic diseases

• Inflammatory disease

both the total daily protein and the patterns of intake are important to maximally stimulate MPS and maintain muscle mass in older adults.

Bollwein J, et al. Nutr J 2013; 12:109

15HMB

HMB (beta-hydroxy-beta-methylbutyrate),a metabolite of leucine, has shown promise as an effective nutrition supplement for treatment of people with age-related sarcopenialean body mass, strength, and functionality were improved by HMB. HMB is believed to work by slowing protein breakdown and by increasing protein synthesis.

Baier S et al. JPEN J Parenter Enteral Nutr. Jan-Feb 2009;33(1):71-82.Vukovich MD, et al. J Nutr. Jul 2001;131(7):2049-2052.

Supplement type

Gain-up (20% whey, 80% carbohydrate) 1 scope (30 g)+120 ml water=150

Whey-Alb, super whey (44% protein, 56%

carbohydrate)Supper whey contains glutamin

1 scope (30 g)+120 ml water=150

Nutriplex (55% protein, 45% carbohydrate) 1 scope (34 g)+ 100 ml= 130 ml

Pure protein (each 26 gr contain 25 gr protein) 1 sachet (26 g)+ 100 ml water=120 ml

Iso-wehy (each 24 gr contains 22 gr protein)

V.M.Protein (each 15 gr contains 10.5 g protein) 1 sachet+ 100 ml water= 120 ml

17Bone health

Uptodate and IOM suggest 1200 mg of calcium (total of diet and supplement- at least half from diet) and 800 IU of vitamin D daily for most postmenopausal women with osteoporosisUptodate recommends not administering yearly high-dose (eg, 500,000 units) vitamin D.The American Geriatrics Society and the National Osteoporosis Foundation recommend a slightly higher dose of vitamin D supplementation (at least 1000 IU/d, for postmenopausal womenregular moderate- to vigorous-intensity physical activity of at least 2.5 hours per week which includes weight-bearing activity

18Bone health

Uptodate suggests that as much as possible (at least half) of the calcium come from dietary sources. Calcium appears to be as well absorbed from supplements as from milksupplements may have more adverse effects, particularly kidney stonesA rough method of estimating dietary calcium intake is to multiply the number of dairy servings consumed per day by 300 mgIn 2010, the Institute of Medicine defined the Safe Upper Limit for vitamin D as 4000 international units per day

FOOD SOURCES OF BIOAVAILABLE CALCIUM

• Calcium supplementation in excess of 500 mg/day should be given in divided doses.

• Higher individual doses are associated with a plateau in calcium absorption that may prevent the attainment of positive calcium balance

• The total intake of calcium (diet plus supplements) should not routinely exceed 2000 mg/day because of the possibility of adverse effects

• In general, concern that high dietary calcium increases the risk of nephrolithiasis in otherwise healthy patients is unfounded

Antiaging (3 softgel)

amount RDA

Vitamin D 100 IU 25 %

Vitamin K 100 mcg 13 %

Calcium 1000 mg 100 %

Magnesium 400 mg 100 %

Boron 1 mg *

Equisetum Arvense Extract

25 mg *

Schiff Nutrition (softgel) amount

Calories 25

Total Fat 2.5 g

Vitamin D 800 IU

Calcium 1.2 g

Magnesium 400 mg

Boron 3 mg

Liquid calciumSoftgel

amount

Calcium 1200 mg

Vitamin D3 400 IU

یم پالساستئو کلتکس لیکوئید کلس

Softgel amount

Calcium 900 mg

Magnesium 450 mg

Vitamin D 600 IU

21century -Tab مقدار نیاز روزانه

Calcium 500 mg 50 %

Vitamin D3 200 IU 50 %

Calcium fort amount

Calcium Lactate Gluconate

2940 mg

Calcium Carbonate 300 mg

Beta-Carotene 1% 35 mg

Calcicare, syrup

میلي لیتري5هر دو پیمانه amount RDA

Calcium 500 mg 50 %

Magnesium 150 mg 38 %

Zinc 4 mg 27 %

Vitamin D 400 IU 100 %

Calcicare (2 Tab) amount RDA

Calcium 800 mg 80 %

Magnesium 200 mg 50 %

(زینک)روی 8 mg 53 %

Vitamin D3 400 IU 100 %

Sup

plem

ent

Yong people

• 10-15minutes of sun exposure at least two times per week to the face, arms, hands allows adequate time for Vitamin D synthesis

• AND should be followed by application of a sunscreen with an SPF of at least 15 to protect the skin

Elderly

• Elderly individuals should expose themselves regularly to sunlight , esp. during summer & around noon

• Exposure of suboptimal duration seems to be safe regarding the development of skin cancer

• Following the exposure to UV, serum response of elderly was ¼ young adult• Elderly should either stay longer in the sun light (which bear the risk of

erythema

• OR expose larger skin surface to the sun (which allow a shorter sun

exposure with no cutaneous risk

• protein intake was related to greater BMD. Dietary protein explained 1–8% of BMD for lumbar spine, hip, and radius (clinically relevant sites).• Dietary protein has been shown to increase intestinal calcium

absorption

• Decrease bone resorption at the cellular level

• increase levels of IGF-1

• improve lean muscle mass and strength

Mangano, et al. Current opinion in clinical nutrition and metabolic care 17.1 (2014): 69Darling, Andrea L., et al. The American journal of clinical nutrition (2009): ajcn-27799.

Other nutrients

• Other essential nutrients: Magnesium, Vitamin K, Vitamin A (retinol), Boron, copper, fluoride, iron, Isoflavones

• To be considered:

• Limit Na intake to less than 2400 mg/d• Limit Caffeine and carbonated beverages to less than 2 cup/d

• Alcohol

• Three or more drinks per day is associated with increased risk of falling and may pose other threats to bone health.

Copyright © 2017 by Elsevier Inc. All rights

reserved.24

Mahan, L. Kathleen, and Janice L. Raymond. Krause's food & the nutrition care process. Elsevier Health Sciences, 2016.

25

Mahan, L. Kathleen, and Janice L. Raymond. Krause's food & the nutrition care process. Elsevier Health Sciences, 2016..

Dietary fiber50 g of fiber a day are most likely to have a significant depression in intestinal calcium absorption, but this is often offset byadequate calcium intake.The inulin-type fructans are a group of fiber compounds found in wheat, onion, bananas, and garlic may enhance calcium and magnesium absorptionwhereas high-fiber foods that contain phytates or oxalates may lower calcium absorption. The calcium content of these foods, such as spinach or legumes, is also lower than in dairy foods

26Nutritional insufficiency

Menopausal women are less likely to absorb naturally occurring vitamin B12 and should aim to consume 2.4 μg/day through fortified foods (e.g., non-dairy milks, meat substitutes) or supplements, and may benefit from having their B12 status assessed

O'Connor, Deborah L., et al. Journal of Obstetrics and Gynaecology Canada38.6 (2016): 508-554.

Nutritional Factors AND Ovarian Reserve and Timing of Menopause

• Vitamin D:• in women aged <40 y, Daily supplementation of 1000 IU vitamin D3 prevented the

decline in serum AMH concentrations

• however, weekly supplementation of 50,000 IU vitamin D3 for 8 wk did not change AMH concentrations in women without PCOS

Moslehi, Nazanin, et al. Advances in nutrition 8.4 (2017): 597-612.

Nutritional Factors AND Ovarian Reserve and Timing of Menopause

• FSH concentrations were inversely correlated with the serum level of:

• zinc

• α-tocopherol

• ascorbic acid

• A higher intake of cholesterol was associated with later menopause in a cross-sectional study. A 26% lower risk of menopause was observed in study participants in the middle tertile for cholesterol intake relative to the first

• higher intakes of low-fat dairy and skimmed milk delayed menopause in women aged <51 y

29

Mahan, L. Kathleen, and Janice L. Raymond. Krause's food & the nutrition care process. Elsevier Health Sciences, 2016..

FiberFSH concentrations decreased by 0.034 nIU/mL per each 5-g increase in total fiber intake

Source of fibergreen and yellow vegetables intake was associated with later menopause Fruit intake was not associated with age at menopause in a prospective study

30

Mahan, L. Kathleen, and Janice L. Raymond. Krause's food & the nutrition care process. Elsevier Health Sciences, 2016..

Coffee and tea

In a cross-sectional study, which was the only study reporting coffee intake, the odds of menopause were 32% lower in women in the highest tertile of coffee intake compared with those in the lowest tertile

One study that examined tea intakes reported no significant associations

Phytoestrogens

• In 71 women with at least 5 hot flushes daily, a 280-mg thujone-free sage spissum extract, equivalent to 3.4-g tincture of fresh sage leaves, led to a significant decrease in the frequency of hot flashes

Sage

• composite and specific phytoestrogen supplementations are associated with modest reductions in the frequency of hot flashes and vaginal dryness but not night sweats

32

• circadian clocks affected by feeding/nutrients (macro and micronutrients & total calorie intake

• carbohydrate intake (>50% of energy intake) is inversely associated with DMS

• Sleeping >9h, and <5h per night results in consuming more energy from carbohydrate

• Duration of sleep affect metabolism (esp. Short sleep duration disrupt glucose tolerance & insulin sensitivity)

Sleep

33

Herbs and sleepCommiphora myrrha .Cucurbita pepo L ,(مور)Robinia ,(کدوحلوایی) hispida L. (اقاقیای سرخ), Nymphaea alba L. (نیلوفر آبی), Portulaca oleraceaL. (گل خشخاش), Hyoscyamus niger L. ,(مهرگیاه)Datura stramonium L (تاتوره), Viola odorata L. × Rosa ,(بومادران) damascenaSalix aegyptiaca ,(گل محمدی) L. (بیدمشک), Coriandrum sativum L. (والک)

34Suggestions

50-65% of total energy from

carbohydrate

16-19% of total energy

from protein

2-3 cup

180-240

gram

120-180

gram

4-5 cup of raw

3-4 medium

size

Thanks

Soodehrazeghi@gmail.comRazeghi@sina.tums.ac.ir

00989126229144