Nutrition problems in adulthood Dr Rania Abd El
Nutrition problems in adulthood Dr Rania Abd El Hamid Hussein MBBSch Master’s degree in Internal Medicine Doctor in Nutrition and Public Health Assistant Professor of Nutrition Faculty of Applied Medical Sciences KAU Dr rania Hussein
Menopause Dr rania Hussein
What is Menopause? • Menopause is a normal event that signals the end of a woman’s reproductive years. • It is the point when menstruation stops permanently. • Menopause is considered complete when a woman has not menstruated for at least 1 year. Dr rania Hussein
• The onset of natural menopause occurs between the ages of 40 and 58, with an average of 47. 5 years, according to the North American Menopause Society (NAMS). • Surgical menopause occurs if both ovaries are removed for medical reasons. Dr rania Hussein
What Happens at Menopause? �� The ovaries stop producing female hormones—estrogen and progesterone �� The ovaries no longer release eggs �� Pregnancy does not occur �� Periods become irregular and then stop Dr rania Hussein
Advantages of menopause �� No risk of unwanted pregnancy �� Resolution of many gynecologic problems Menorrhagia / dysmenorrhea Uterine fibroids Endometriosis Dr rania Hussein
Menopause Symptoms 1 • First symptoms are menstrual irregularities: – Menstrual cycles shorten or lengthen 2 • Hot flushes : – sudden sensation of warmth, skin of face and chest will become flushed – then patient will experience a chill – this is the result of lower estrogen levels – more bothersome at night Dr rania Hussein
3. Other symptoms of menopause • vaginal dryness • mood swings • sleep disturbances • loss of breast fullness • fat on abdomen • thinning of hair Dr rania Hussein
4. Loss of Bone/Osteoporosis �� Bone in the spine and hip is most estrogen sensitive; loss is greatest early in menopause with 50% loss in 20 yr �� Women at greatest risk for fractures are those having the smallest bones before menopause. Dr rania Hussein
Normal bone loss Dr rania Hussein
5 • Cardiovascular Lipid changes –↓ HDLC, ↑LDLC →↑ risk of heart attack and stroke in women after menopause Dr rania Hussein
What Can I Do to Improve My Health After Menopause? Dr rania Hussein
Nutritional changes for menopause can help in two ways: 1) Decreasing symptoms associated with menopause 2) Preventing diseases associated with menopause. Dr rania Hussein
Special recommendations for Nutritional Changes During Menopause 1. Avoiding hot sauces, hot drinks, spicy foods, smoking, alcohol, caffeine containing beverages, as they may aggravate hot flashes. 2. Avoiding or reducing caffeine intake may also reduce stress and sleep problems. Dr rania Hussein
3. Including Phytoestrogens: Found in soy, flaxseed, ½ cup soybeans ½ cup soy milk 2 tbsp ground flax seed. . Dr rania Hussein
4. Diet: Maintaining a ↑ fiber, ↓ fat, ↓ animal protein diet, including at least 9 - 10 servings of vegetables and fruits, avoiding sugar and limiting sweeteners. 5. Eating Organic: → Fewer hormone-disrupting pesticides Dr rania Hussein
Who should not use phytoestrogens for Menopause? 1) Higher amounts of plant estrogens in the body may increase the risk of estrogensensitive cancers. 2) Abnormal bleeding after menopause was found to be related to a high intake of soy products. 3) Those with allergy to flaxseed. Dr rania Hussein
Finally Menopause symptoms are unique. What works for one woman may not work for another, and what works for a woman now may not work as well a year from now. Dr rania Hussein
Osteoporosis Dr rania Hussein
Low serum Ca Parathyroid gland Calcium released in blood PTH Calcitriol dr Dr. Rania rania Hussein Calcidiol
Typical comments from people with osteoporosis “I’ve lost six inches in height and none of my clothes fit me anymore. Plus, it’s hard to get clothes that look nice when my back is so hunched over. ” Dr rania Hussein
Problem 1. ↑ calcium intakes during menopause do not completely offset this bone loss 2. Hormone replacement therapy (HRT) → many potential health risks associated. Dr rania Hussein
Bones are living organs • Calcium is deposited and withdrawn from bones daily. • Bones build up to age 25. • We need to build up a healthy bone account while young and continue to make deposits with age. Dr rania Hussein
• After mid-30’s, we begin to slowly lose bone mass. Dr rania Hussein
• Osteoporosis is more likely to develop if optimal bone mass was NOT reached during the bone-building years. Dr rania Hussein
Osteoporosis risk factors that can NOT be changed 1. Gender: Men are less affected than women , due to: • Their higher peak bone mass at skeletal maturity • Their slower rate of bone loss • The shorter male life expectancy 2. Age: Bones become thinner and weaker with age. dr Rania Hussein Dr rania Hussein
Osteoporosis risk factors that can NOT be changed 3. �� Body size: Small, thin-boned women are at greater risk. 4. �� Early menopause before age 45: Estrogen receptors were identified on the osteoblasts’ surface Estrogen blocks production of PTH-stimulated cytokines→ osteoclasts are not stimulated →↓ bone resorption 5. �� History of a broken bone after age 50 6. �� Positive family history of osteoporosis Dr rania Hussein
Osteoporosis risk factors that can be changed 1. Poor calcium or vitamin D intake 2. Physical inactivity: muscle contraction and maintaining the body in an upright position against gravity → osteoblast stimulation 3. Smoking, or Alcohol intake Dr rania Hussein
Other risk factors for osteoporosis �� Certain medical conditions that may alter hormone levels: Hyperthyroidism, Cushing's disease Cancer Inflammatory bowel disease Chronic liver or kidney disease Dr rania Hussein
Other risk factors for osteoporosis. cont The following medications �� Oral glucocorticoids (steroids) �� Thyroid hormone �� Cancer treatment �� Gonadal hormone suppression Dr rania Hussein
Osteoporosis; The “silent disease” – First sign may be a fracture after even a sudden strain due to weakened bones Dr rania Hussein
The most common breaks in weak bones are in the wrist, spine and hip. Dr rania Hussein
We are never too young or old to improve bone health Dr rania Hussein
Both men and women can benefit from dietary changes Calcium: The demand for calcium is greater during • Childhood • Adolescence • Pregnancy • Breastfeeding Dr rania Hussein
Good sources of Ca in food: Dairy sources: milk, yogurt, and cheese are rich sources Nondairy sources : • Fish with edible bones • Dried fruits • Legumes , soy milk • Foods fortified with calcium : fruit juices and drinks, tofu, and cereals. dr Rania Hussein Dr rania Hussein
An easy way to meet calcium needs is consuming 3 cups (8 oz. ) each day of fat-free or low-fat* milk or equivalent milk products in combination with a healthy diet. Children ages 2– 8 years need 2 cups. My Pyramid equivalents: • 8 oz. milk • 1 cup yogurt • 2 oz. cheese Dr rania Hussein
For lactose intolerance • Start with small portions of foods such as milk and gradually increase serving size. • Eat dairy foods in combination with solid foods. • Try dairy foods other than milk: - Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milk - Yogurt made with live, active bacteria Dr rania Hussein
Soymilk • Not all soymilk is calcium-fortified or contains vitamin D • 4 (8 -oz. ) glasses of soy milk may equal 3 (8 -oz. ) glasses of cow’s milk in availability of calcium. Dr rania Hussein
Vitamin D Direct exposure to sunlight Dietary: fortified milk (2 cups/d), egg yolks, saltwater fish, and liver. Dr rania Hussein
+ Consider vitamin D and calcium supplementation to: 1. young women before the menopause → beneficial, 2. postmenopausal women → marked beneficial effect 3. Those with a strong positive family history of osteoporosis 4. Those with a history of previous fractures 5. Persons following a vegan diet, and those not exposed to the sun may need supplements. Dr rania Hussein
Food and supplement labels Dr rania Hussein
Nutrition labels & calcium • FDA uses “Percent Daily Value” (% DV) to describe amount of calcium needed by general U. S. population daily • 100% DV for calcium = 1, 000 mg • Look for this label: – “Nutrition Facts” on foods – “Supplement Facts” on vitamin/mineral supplements Dr rania Hussein
Engage in regular weight-bearing Exercise: walking, running, and activities where one's feet leave and hit the ground work against gravity, - resistance exercises as those involving weights Dr rania Hussein
Exercise Strengthening of muscles ↓ Falls Bone mass ↓ Fractures ↑ Quality of life Dr rania Hussein
A Word of Caution About Exercise • It is important to avoid exercises that can injure already weakened bones. • In patients over 40 and those with heart disease, obesity, diabetes mellitus, and high blood pressure, exercise should be prescribed and monitored by their doctors. • extreme levels of exercise (such as marathon running) → weight loss and loss of menstrual periods →↑ osteoporosis. Dr rania Hussein
Live well, live strong, live long Dr rania Hussein
References • Brown JE, Isaacs J, Wooldridge N, Krinke B, Murtaugh M. Nutrition through the lifecycle, 2007. 3 rd ed. Wadsworth publishing. • Mahan LK, Escott- Stamp S. krause’s food, and nutrition therapy 2008. 12 th ed. Saunders Elsevier. Canada. dr Rania Hussein
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