By Caroline Hill
Gender-related inequalities in health and access to health care are evident globally, with wide recognition of the need for a more targeted approach to women’s health. In 2022 the first Women’s Health Strategy for England was launched. It is a 10-year strategy that sets out a range of commitments to improve the health of women everywhere, including a plan to transform women's health content on the NHS website, a definition of trauma-informed practice for the health sector, alongside plans to increase female participation in vital research.1 For women’s health, there are important physiologic, neurologic, and hormonal distinctions throughout the lifecycle that impact nutritional needs.2
Studies suggest that few women achieve recommended nutrient intakes across the lifespan. A study by Wakeman et al (2020)3 which critically evaluated the current dietary and nutrient intakes at women’s different life stages, found that across all age groups and at different stages of a woman’s life, there is some degree of nutrient shortfall. These nutritional shortfalls are of concern and have the potential to impact on long-term health if not addressed.
A large study of over 200,000 men and women from the UK Biobank showed that there are some notable sex differences in macronutrient intakes and adherence to dietary recommendations.4 They found that women were more likely to have intakes that exceeded recommendations for total fat, saturated fat and total sugar.
Another study of women’s dietary intake, the UK Women’s Cohort Study (UKWCS) aimed to explore relationships between diet (including foods, nutrients, dietary supplements, dietary patterns and diet costs) and chronic disease (including cancer, cardiovascular disease, obesity and other health outcomes).5 This study found that a third of women studied were not meeting the recommended intakes for fruit and vegetables and 80% had a low level of physical activity. These are all risk factors for cancer prevention.
During adolescence, numerous biological and psychosocial changes prompt the transition from childhood to adult life. It is a period of hormonal changes; the production of adrenal androgens increases, and the growth hormone and thyroid axes mature.6
In this period, 50% of the adult body weight and 15–25% of final height are gained.6 In sum, adolescence is a period of rapid growth, and consequently, the energy and nutrient requirements increase.
In addition, in this life stage, dietary patterns, physical activity, and eating behaviours are heavily influenced by internal factors (such as attitudes, beliefs, perceived barriers, food preferences, self-efficacy, and biological changes), external factors (family, friends, access to fast food outlets, and social and cultural norms), and macro-systems (such as food availability, food production, distribution systems, mass media, and advertising). Thus, adolescents are nutritionally vulnerable because of the increased nutritional demands alongside the social adaptation to adulthood.6
Diet and nutrition before pregnancy may modify maternal and perinatal outcomes via effects on BMI or other nutritional factors, including micronutrient deficiencies.7 Seventy-seven percent of women aged 18-25 years had dietary intakes below RNI daily recommendations for iodine and 96% of women of reproductive age had intakes below iron and folate recommendations for pregnancy. Adequate folate levels in pregnancy (red blood cell folate concentration above 906 nmol/L) are essential for prevention of foetal neural tube defects. During pregnancy, there is a drastic physiologic increase in the need for uptake of iron compared to the non-pregnant period to prevent anaemia.8 Iodine deficiency is associated with reduced fertility.9
Menopause is another female life stage with health and nutritional consequences. During menopause transition, diet and nutrition can be used to manage symptoms. Phytoestrogens or plant oestrogens have been shown to be effective in reducing the frequency of hot flushes and night sweats.10 Phytoestrogens are available as 2 different types: isoflavones and lignans. Food sources include soy, legumes, lentils, chickpeas and flaxseeds. During the menopause transition the decline in oestrogen levels, can lead to weight gain, particularly around the abdomen. It can be difficult to lose weight during this period, however making dietary changes to prevent further weight gain and ensure a nutritionally balanced diet can minimise the impact of these bodily changes. Additional lifestyle measures such as increasing exercise can help with weight changes. Clients are encouraged to use other measurements to track changes such as hip and waist circumference measures, sleep patterns, stress levels and mood. These additional measures can all support a woman during this changing period of her life.
Declining oestrogen levels as a result of menopause increase the risk of conditions such as osteoporosis and heart disease in women.11
Nutritional changes that occur post-menopause include increased calcium requirements and increased protein needs. Due to the associated risk of osteoporosis following menopause, guidelines recommend women consume 1000-1200mg calcium per day.12,13
As we age, lean muscle mass loss occurs. This can result in sarcopenia which is defined as the age-related loss of muscle mass and function.14 The latest research suggests that the older adult (>65 years) has protein requirements of 1.2g/kg body weight/day.15 It has also been shown that older adults need to consume 25-30 grams of protein at each of their three daily meals to stimulate muscle protein synthesis.16
Heart disease risk is also elevated in post-menopausal women due to loss of the protective effect of oestrogen. The Framingham study reported a 2.6-fold higher incidence of cardiovascular events in age-matched post-menopausal women when compared with pre-menopausal women.17 Managing the risk of heart disease with diet is focused on managing cholesterol levels, reducing blood pressure, addressing raised BMI and diabetes risk. The Mediterranean diet has been shown to be an effective dietary pattern that can reduce weight and cardiovascular risk factor levels.18
During the time of a woman’s life, there are several events that can change nutritional needs and require dietary changes to prevent adverse events or reduce the effect of changes such as menopause symptoms. Understanding these different life stages and the physical changes that occur can help in supporting women with their diet and nutrition.
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