The authors’ contributions were as follows—ELF and CD: were involved in the acquisition of the data; ELF, CD, SMD, and JF: were responsible for the interpretation of the data; ELF: wrote the paper and had primary responsibility for the content; CD, SMD, WS, and JF: were involved in providing detailed comments and revising the manuscript for important intellectual content; and all authors: were involved in the conception of this review and read and approved the final manuscript.
Calcium: Although some bone loss is inevitable with age, women can slow the process by getting enough calcium and vitamin D. Women between the ages of 50 and 70 need 1200 mg of calcium and 600 IU of Vitamin D a day. Women older than 70 require 1200 mg of calcium and 800 IU of Vitamin D a day. Because the skin becomes less efficient at converting sunlight to vitamin D as we age, older women may need more vitamin D in the form of supplements. Talk to your doctor.
Social protection interventions are intended to support vulnerable households by providing them with in-kind (e.g., food) or cash transfers. The impact of social protection on women's nutrition was nuanced, as such interventions were associated with protecting against adverse nutrition outcomes, but were also associated with excess weight gain in some settings. In-kind transfers, including food baskets, fortified foods, and school lunches, improved women's and adolescent girls’ energy and micronutrient intakes, as described in the preceding sections. Both CCTs and unconditional cash transfers were common around the world and were associated with improvements in health care utilization and increased food expenditures (5, 14, 195, 196). CCTs were dependent on “conditions” such as school attendance and health care utilization. For children in Burkina Faso, CCTs were associated with greater numbers of preventative health visits compared with unconditional cash transfers (197), and this could be relevant to adult women's health care utilization as well. Unconditional cash transfers, such as old-age pensions, were also common, including in low- and middle-income countries (5, 198). Older women who received pensions had fewer missed meals (199), although evidence was mixed (200). In South Africa, granddaughters who cohabitated with women who received pensions had improved anthropometric measures and fewer missed meals, indicating spillover effects of pension transfers (199, 201).
Our review highlighted how a focus on delivery platforms could indicate who is missed by different nutrition interventions, by evaluating where there is overlap or divergence in where interventions are delivered (as represented in the Venn diagram in Figure 1). Our findings showed that a large proportion of nutrition-specific interventions were delivered at clinic-based settings or community-based health posts. Health centers are important delivery platforms, particularly for pregnant and lactating women (113, 210). However, only half of women worldwide even attend the appropriate number of antenatal care visits (with nearly 86% of women attending 1 visit) and only 59% receive appropriate postnatal care (211). Other delivery platforms, such as schools and universities, were more effective at reaching some adolescents and women of reproductive age. However, interventions delivered at “facilities” (schools, health clinics, health posts) require participation with those facilities, and participation is often limited because of time, costs, distance, and other responsibilities, including work and childcare (116). Facilities-based care is also more likely to miss certain groups, including older women.
Calcium is extremely important after menopause when your osteoporosis risk increases. But it’s actually vital to women’s health at every age, particularly while the body is still making bone. For optimal bone health, you need three daily servings of dairy products (for example, eight ounces of milk or yogurt, or one and a half ounces of cheese per serving), which also provide other nutrients, like protein, potassium, magnesium, and zinc. “If you can tolerate dairy, low-fat sources are extremely important,” says Hincman. Besides low-fat or skim milk, try calcium-rich Greek-style yogurt, which supplies twice the protein with less or none of the sugar of traditional yogurt varieties, she says.
Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.
It sounds counterintuitive, but fatty fish are actually good for you because they deliver omega-3 polyunsaturated fatty acids (PUFAs), fats with cardiovascular and anti-inflammatory benefits. While fish oil capsules will help you meet your PUFA needs, studies have found that fish itself offers even more nutritional benefits, including vitamin D, selenium, and antioxidants. Among the best choices are salmon, albacore tuna, herring, and trout. Recommendations are for 1 gram of PUFAs daily for people with coronary heart disease and at least 250 to 500 mg daily for those who want to prevent it.
The extent to which interventions target women more generally, as opposed to just mothers, is not well documented. It requires reflecting on “Who is the woman in women's nutrition?” to identify which women are actually targeted in nutrition interventions, which are not, how they are reached, and gaps in policies and interventions to reach women who are missed. To address this, in this comprehensive narrative review, we 1) summarize existing knowledge about interventions targeting women's health and nutrition in low- and middle-income countries, 2) identify gaps in current delivery platforms that are intended to reach women and address their health and nutrition, and 3) determine strategies to reshape policies and programs to reach all women, at all stages of their lives, with a particular focus on women in low- and middle-income countries.
Third, of the interventions that were evaluated, many interventions targeted women who were pregnant, lactating, or with young children <5 y of age. We do not refute the important focus on mothers and their children as a group deserving of special attention, given women's increased nutrient needs during pregnancy and lactation and the intergenerational consequences during this period. However, even the interventions that focused on maternal nutrition often only reported on birth and nutrition outcomes of the child, and not those of the mother. In addition, although there were interventions that targeted adolescent girls and women of reproductive age, they were fewer and less well evaluated than interventions that targeted women as mothers. This aligns with findings from other research which illustrated a higher proportion of programs targeting pregnant and lactating women and women with young children (209). We also found major gaps in the targeting of interventions for older women. With growing rates of overweight, obesity, and noncommunicable diseases, in addition to undernutrition and micronutrient deficiencies, it is essential to think outside of the maternal-focused paradigm to reach women at all life stages.
For girls and adult women, educational interventions are considered a powerful means of improving their health and nutritional status throughout their lives. Education level is often associated with maternal caregiving practices and the nutritional outcomes of their children (174, 175). Few studies, however, evaluated the impact of education as an intervention on women's nutrition outcomes. Instead, many studies used survey data and reported on associations between education and nutrition. For instance, in low- and middle-income countries, higher levels of education were associated with lower prevalence of underweight and higher prevalence of overweight among women (176, 177). However, this depended on the type of employment in which women participated (178, 179). In addition, in many high-income settings, the converse was true (177). Level of literacy was also associated with improved anthropometric measures. In southern Ethiopia, literate mothers were 25% less likely to be undernourished than were illiterate women (180). One econometric analysis suggested that doubling primary school attendance in settings with low school attendance was associated with a 20–25% decrease in food insecurity (181). Overall, though, these associations were limited in their ability to draw conclusions about causality and the effect of education interventions on nutrition outcomes.
Markets and retail ↓/NC anemia, ↑ MN status (Hgb, Fe stores, ferritin, folate, iodine), ↓/NC goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe) ↓/NC anemia, ↑ Hgb, ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, ↑ urinary iodine, ↓ goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe) ↓/NC anemia, ↑ serum folate, ↓ folate deficiency, ↑ urinary iodine concentration, ↓ goiter prevalence, ↑ mean adequacy ratio of diet, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe) ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, NC B-12 deficiency, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)
Animal products, such as meat, fish and poultry are good and important sources of iron. Iron from plant sources are found in peas and beans, spinach and other green leafy vegetables, potatoes, and whole-grain and iron-fortified cereal products. The addition of even relatively small amounts of meat or foods containing vitamin C substantially increases the total amount of iron absorbed from the entire meal.
Eat healthy fats. According to the American Heart Association, women should get at least five to 10 percent of total daily calories from omega-6 fatty acids (equal to 12 to 20 grams), and between 0.5 and 3 grams of omega-3 fatty acids, depending on individual risk for heart disease. Good sources of omega-6 fatty acids include sunflower, safflower, corn, cottonseed and soybean oils. And good sources of omega-3 fatty acids include fatty fish, tofu and other forms of soybeans, canola, walnuts, flaxseed, and their oils. Talk with your health care professional about how much of these beneficial oils you should be getting, how you can best incorporate them into your diet and whether or not you should be taking them in supplement form.
Oaks BM, Young RR, Adu-Afarwuah S, Ashorn U, Jackson KH, Lartey A, Maleta K, Okronipa H, Sadalaki J, Baldiviez LM et al. Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: results of two randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids 2017;117:28–35.
Women often received micronutrient supplements during antenatal and postnatal care (13, 35–42, 51, 60), and, as such, supplementation was often targeted to pregnant and lactating women. The delivery of micronutrient supplementation commonly occurred in health care settings for at-home consumption. Community-based antenatal care that involved home visits by community health workers was also a common delivery platform for supplementation delivery. There were some studies that reported micronutrient supplementation to adolescents, women of reproductive age, pregnant women, and women with young children outside of the antenatal care setting. These included primary health care clinics, home visits, community centers, pharmacies, and workplaces (32, 38–43, 45, 52, 53). Adolescent girls were also reached by community- and school-based programs (26, 41, 46). School-based programs were more efficacious in reducing rates of anemia among adolescent girls, compared with the community-based interventions (26, 46). However, many of the reported studies to date involved small samples of adolescents in controlled settings, and additional research is needed on the effectiveness of these programs (59, 62).
A year later, a second Harvard study added to the concern. The Physicians' Health Study of 20,885 men did not evaluate diet per se, but it did measure the blood levels of ALA in 120 men who developed prostate cancer and compared them with the levels in 120 men who remained free of the disease. Men with moderately high ALA blood levels were 3.4 times more likely to develop prostate cancer than men with the lowest levels; curiously, though, men with the very highest levels were only 2 times more likely to get the disease.
A person's caloric requirement depends on his body size and exercise level. Sedentary people of both genders will keep their weight stable by taking in about 13 calories per pound of body weight each day. Moderate physical activity boosts this requirement to 16 calories a pound, and vigorous exercise calls for about 18 calories a pound. On average, a moderately active 125-pound woman needs 2,000 calories a day; a 175-pound guy with a similar exercise pattern needs 2,800 calories. And like women, men will lose weight only if they burn more calories than they take in.
Not everyone who is underweight suffers from an eating disorder, but anorexia and bulimia are serious health problems in this country; an estimated 500,000 women suffer from anorexia, and 1 to 2 million women struggle with bulimia. Women with anorexia nervosa starve themselves and/or exercise excessively, losing anywhere from 15 percent to 60 percent of their normal body weight. Some die. Women with bulimia nervosa binge on large quantities of food—up to 20,000 calories at one time—and then try to get rid of the excess calories. Some purge by inducing vomiting, abusing laxatives and diuretics or by taking enemas. Others fast or exercise to extremes.
As women, many of us are prone to neglecting our own dietary needs. You may feel you’re too busy to eat right, used to putting the needs of your family first, or trying to adhere to an extreme diet that leaves you short on vital nutrients and feeling cranky, hungry, and low on energy. Women’s specific needs are often neglected by dietary research, too. Studies tend to rely on male subjects whose hormone levels are more stable and predictable, thus sometimes making the results irrelevant or even misleading to women’s needs. All this can add up to serious shortfalls in your daily nutrition.
Dietary fiber is found in plant foods like whole-grain breads and cereals, beans and peas, and other vegetables and fruits. At least one study suggests that women who eat high amounts of fiber (especially in cereal) may have a lower risk for heart disease. High-fiber intake is also associated with lower cholesterol, reduced cancer risk and improved bowel function. And one long-term study found that middle-aged women with a high dietary fiber intake gained less weight over time than women who ate more refined carbohydrates, like white bread and pasta.
If you do decide to diet, you still need to maintain good nutrition. You want to cut back on calories, not nutrients. And while you want to reduce fat, don't eliminate it entirely. Some studies suggest that older women who maintain a higher body-fat percentage are less likely to suffer from osteoporosis and other conditions associated with menopause. Fat cells also retain estrogen, which helps maintain the calcium in your bones. Younger women should be careful, too: a low body fat percentage can lead to infertility; below 17 percent may lead to missed periods, also known as amenorrhea.