Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.
Fiber is an important part of an overall healthy eating plan. Good sources of fiber include fortified cereal, many whole-grain breads, beans, fruits (especially berries), dark green leafy vegetables, all types of squash, and nuts. Look on the Nutrition Facts label for fiber content in processed foods like cereals and breads. Use the search tool on this USDA page to find the amount of fiber in whole foods like fruits and vegetables.
A BMI of 25 to 29.9 is considered overweight and one 30 or above is considered obese. For an idea of what this means, a 5-foot 5-inch woman who weighs 150 pounds is overweight with a BMI of 25. At 180 pounds, she would be considered obese, with a BMI of 30. Keep in mind that the tables aren't always accurate, especially if you have a high muscle mass; are pregnant, nursing, frail or elderly; or if you are a teenager (i.e., still growing).
Salt, caffeine and alcohol intake may interfere with the balance of calcium in the body by affecting the absorption of calcium and increasing the amount lost in the urine. Moderate alcohol intake (one to two standard drinks per day) and moderate tea, coffee and caffeine-containing drinks (no more than six cups per day) are recommended. Avoid adding salt at the table and in cooking
However, many fortification programs in low- and middle-income countries are regional or voluntary and, thus, might have a limited nutritional impact at the national level (76). Although many efficacy trials show benefits of fortification interventions, scaling up fortification is limited by inadequate coverage and resources (13, 77, 78). Evidence for impact is also affected by suboptimal programming, low-bioavailability fortificants (e.g., reduced iron powder), poor consumption rates, weak enforcement mechanisms, and inadequate monitoring (76, 79, 80). More research is needed to evaluate the long-term impact of fortification and biofortification programs (75). In addition, there is also growing concern about fortifying and promoting food vehicles that have adverse health consequences when consumed in excess, such as salt and sugar, given the rising prevalence of overweight, obesity, and noncommunicable disease (81–83).
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The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.
In low- and middle-income countries, health care services often respond to acute health needs and many focus on maternal–child health (105, 106, 110, 112). The use of preventative care is limited, and there are concerns about the capacity of health systems to address noncommunicable diseases, such as diabetes, in low- and middle-income settings (108, 112). This has implications for the reach of integrated health care interventions across the life course. Maternal and reproductive health care is often sought by women when they are pregnant and in the early years of their children's lives (3, 113). Even so, many women visit health facilities late in their pregnancy or not at all (114–116). For adolescents and adult women, care is often not sought until they are sick (3, 117, 118). This is problematic for older women, in particular, as screening and treatment for age-related health issues, such as diabetes, cancer, and hypertension, require access to preventative health care services (3).
Vickers, M. R; MacLennan, A. H; Lawton, B.; Ford, D.; Martin, J.; Meredith, S. K; DeStavola, B. L; Rose, S.; Dowell, A.; Wilkes, H. C; Darbyshire, J. H; Meade, T. W (4 August 2007). "Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women". BMJ. 335 (7613): 239. doi:10.1136/bmj.39266.425069.AD. PMC 1939792. PMID 17626056.
A number of implementation challenges exist for micronutrient supplementation. Access to care is often associated with socioeconomic status and may influence women's access to and use of supplementation programs. For instance, in one study, the highest wealth quintile of pregnant women had the highest use of iron and folic acid supplementation during antenatal care (33). However, even for women who have access to micronutrient supplements, the coverage and quality of micronutrient supplementation programs were limited (39). Incorrect doses, inadequate supplies, and incomplete adherence were major limitations (33), and poorly performing programs had limited impact on nutrition outcomes (59). Integration of supplementation programs with behavior change interventions improved knowledge, adherence, and coverage of supplementation interventions (32, 33, 60). The use of local micronutrient-rich foods can also help overcome limitations associated with supplement provision. In Nepal, improvements in the dark adaptation of night-blind pregnant women did not differ significantly between food and synthetic sources of vitamin A (61). When available, consumption of micronutrient-rich foods can be as effective as micronutrient supplements.
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance. In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (e.g. midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits. A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.
Schools (and universities) ↓/NC anemia, ↓ Fe-deficiency anemia, ↑/NC MN status [Hgb (↑ if anemic), ferritin, zinc, retinol], ↑ MN status [folate, riboflavin, 25(OH)D, iodine], ↓ PTH, ↓ goiter prevalence, ↓ MN deficiency (vitamin A, B-12, C), ↑ bone mineral accretion, ↑/NC weight gain/BMI, ↑ MUAC, ↑ gut inflammation, ↓/NC respiratory symptoms and diarrheal morbidity, ↑ fitness (for Fe-deficient subjects), ↑/NC short-term cognitive function ↑ Hgb (↑ if anemic), ↑ serum ferritin, ↑ total body Fe, ↑ urinary iodine concentration, ↑ serum zinc, ↑ aerobic power, NC net energetic efficiency
The best training tool you're not using: a jump rope. “It may seem a little juvenile until you think of all the hot-bodied boxing pros who jump rope every single day,” says Landon LaRue, a CrossFit level-one trainer at Reebok CrossFit LAB in L.A. Not only is it inexpensive, portable, and easy to use almost anywhere, you’ll burn about 200 calories in 20 minutes and boost your cardiovascular health while toning, he adds.
Call it a vegetable or a fruit, the tomato is in a food class by itself. Interestingly, cooked tomato products, like tomato paste, puree, stewed tomatoes, and even ketchup, deliver more of its well-known antioxidant lycopene, a cancer fighter, and potassium than when eaten raw. Tomatoes also have vitamins A and C and phytochemicals that make it an nutrition essential for women’s health.
For once we're not talking about breakfast but rather the recovery meal after your workout. “So many women skip post-exercise nutrition because they don’t want to 'undo the calories they just burned,'” says Amanda Carlson-Phillips, vice president of nutrition and research for Athletes’ Performance and Core Performance. “But getting a combination of 10 to 15 grams of protein and 20 to 30 grams of carbohydrates within 30 minutes of your workout will help to refuel your body, promote muscle recovery, amp up your energy, and build a leaner physique.”
When trying to adopt new healthy habits, it's important to work around other long-standing practices that could sabotage your efforts if overlooked. For example, if you are a morning person, working out in the a.m. is likely best, but if you’re a night person, exercise after work, says Tara Stiles, owner of Strala Yoga in New York City. [Tweet at Tara!]“Don't try to become one or the other if it's not natural to you. You're more likely to stick to it if you like the time of day and the whole experience.”
The ability to determine if and when to become pregnant, is vital to a woman's autonomy and well being, and contraception can protect girls and young women from the risks of early pregnancy and older women from the increased risks of unintended pregnancy. Adequate access to contraception can limit multiple pregnancies, reduce the need for potentially unsafe abortion and reduce maternal and infant mortality and morbidity. Some barrier forms of contraception such as condoms, also reduce the risk of STIs and HIV infection. Access to contraception allows women to make informed choices about their reproductive and sexual health, increases empowerment, and enhances choices in education, careers and participation in public life. At the societal level, access to contraception is a key factor in controlling population growth, with resultant impact on the economy, the environment and regional development. Consequently, the United Nations considers access to contraception a human right that is central to gender equality and women's empowerment that saves lives and reduces poverty, and birth control has been considered amongst the 10 great public health achievements of the 20th century.
Important sexual health issues for women include Sexually transmitted infections (STIs) and female genital cutting (FGC). STIs are a global health priority because they have serious consequences for women and infants. Mother-to-child transmission of STIs can lead to stillbirths, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities. Syphilis in pregnancy results in over 300,000 fetal and neonatal deaths per year, and 215,000 infants with an increased risk of death from prematurity, low-birth-weight or congenital disease.
Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don't know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.