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.
The tiny gender differences in minerals other than calcium and iron depend on body size. But while the dietary requirements for selenium fit this rule, men may benefit from supplements of about 200 micrograms a day, a level about four times above the RDA. That's because both a clinical trial and an observational study suggest that selenium may reduce the risk of prostate cancer. It's far from proven, but it's something for men to consider.
The effect of education programs on nutrition outcomes is difficult to assess because programs often have poor baseline data or nutrition outcomes are not evaluated (174, 182). Studies that used longitudinal analyses and “natural” experiments (e.g., before and after a national education policy) found that education was associated with reduced fertility (183, 184), and delayed early marriages and pregnancies (184–187). The impact was more significant for higher levels of education (185). However, 1 study in Malawi identified negative associations between education and timing of first birth, although these findings were largely not statistically significant (188). Secondary education for adolescents and women of reproductive age also showed no impact on women's empowerment (184), although it did show an impact on improved literacy and leadership (174). Educational interventions that provided conditional cash transfers (CCTs) and school feeding, as well as other forms of social protection to families of enrolled girls, were associated with greater school enrollment and attendance (189–191), improved test scores (189, 190), reduced gender gaps (192), and reduced hunger (190, 191).
Foods that contain natural folic acid include orange juice, green leafy vegetables, peas, peanuts and beans. (One cup of cooked kidney beans contains 230 mcg of folic acid.) Fortified foods, such as ready-to-eat breakfast cereals, also contain a synthetic form of folic acid, which is more easily absorbed by your body than the natural form. Folic acid is now added to all enriched grain products (thiamin, riboflavin, niacin, and iron have been added to enriched grains for many years).
To help you learn how to eat healthfully, start with the U.S. Department of Agriculture's (USDA) dietary guidelines system, which you can find at http://www.mypyramid.gov. The MyPyramid system, which looks somewhat like the familiar food pyramid of old, offers guidance based on individual needs and replaces "serving" recommendations with actual amounts of food. It also emphasizes the importance of balancing nutritious (and tasty!) food choices from all food groups every day with daily physical activity.
Abortion is the intentional termination of pregnancy, as compared to spontaneous termination (miscarriage). Abortion is closely allied to contraception in terms of women's control and regulation of their reproduction, and is often subject to similar cultural, religious, legislative and economic constraints. Where access to contraception is limited, women turn to abortion. Consequently, abortion rates may be used to estimate unmet needs for contraception. However the available procedures have carried great risk for women throughout most of history, and still do in the developing world, or where legal restrictions force women to seek clandestine facilities. Access to safe legal abortion places undue burdens on lower socioeconomic groups and in jurisdictions that create significant barriers. These issues have frequently been the subject of political and feminist campaigns where differing viewpoints pit health against moral values.
Female genital mutilation (also referred to as female genital cutting) is defined by the World Health Organization (WHO) as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons". It has sometimes been referred to as female circumcision, although this term is misleading because it implies it is analogous to the circumcision of the foreskin from the male penis. Consequently, the term mutilation was adopted to emphasise the gravity of the act and its place as a violation of human rights. Subsequently, the term cutting was advanced to avoid offending cultural sensibility that would interfere with dialogue for change. To recognise these points of view some agencies use the composite female genital mutilation/cutting (FMG/C).
Poor nutrition can manifest itself in many ways. The more obvious symptoms of a nutritional deficiency include dull, dry or shedding hair; red, dry, pale or dull eyes; spoon-shaped, brittle or ridged nails; bleeding gums; swollen, red, cracked lips; flaky skin that doesn't heal quickly; swelling in your legs and feet; wasted, weak muscles; memory loss; and fatigue.
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.
Popular belief says if you really want to make a big change, focus on one new healthy habit at a time. But Stanford University School of Medicine researchers say working on your diet and fitness simultaneously may put the odds of reaching both goals more in your favor. They followed four groups of people: The first zoned in on their diets before adding exercise months later, the second did the opposite, the third focused on both at once, and the last made no changes. Those who doubled up were most likely to work out 150 minutes a week and get up to nine servings of fruits and veggies daily while keeping their calories from saturated fat at 10 percent or less of their total intake.
A 55-year-old woman who gets less than 30 minutes of daily physical activity should eat five ounces of grains; two cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and beans; five teaspoons of oils, and no more than 130 calories of additional fat and sugar. If she got 30 to 60 minutes of daily exercise, she could increase her intake to six ounces of grains; two and a half cups of vegetables; and up to 265 additional calories of fat and sugar.
Although canola oil appears to be good for the cardiovascular system, two Harvard studies have raised concerns that ALA might be bad for the prostate. In 1993, the Health Professionals Follow-up Study of 47,781 men published a major evaluation of dietary fat and prostate cancer. It found that saturated fat from animal sources such as red meat and whole-fat dairy products was linked to a 2.6-fold increase in prostate cancer. But the study also provided some disquieting news about ALA: Men who consumed the most ALA were 3.4 times more likely to be diagnosed with prostate cancer than those who had the lowest dietary intake.
More power to these women, and sure, you could say that fashion and magazines are aspirational over reality-based. If you want reality, look in a mirror, but that’s just it: The super-cut flat abs of Maria Menounos are a far cry from most of us, and can even more damaging to young girls who would do better to avoid the unrealistic ideals that their mothers and older sisters had to grow up with.
Changes in the way research ethics was visualised in the wake of the Nuremberg Trials (1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in clinical trials. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from thalidomide and diethylstilbestrol (DES), the United States Food and Drug Administration (FDA) prohibited women of child-bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women. Women, at least those in the child-bearing years, were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual cycle. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of evidence-based medicine to women, and compromise to care offered to both women and men.
Educational interventions most often targeted school-age children and adolescent girls, and there were few examples of programs targeting women of reproductive age (174). The majority of education interventions were delivered in formal school-based settings (174). However, this is a “selective” delivery platform given that not all adolescents attend schools (193). School fees and distance to school are major barriers to school enrollment (174, 194). Educational interventions need to be sensitive to the reasons why girls are not in school, e.g., work, and to the hours and locations that might make education interventions more accessible (193). Nonformal education, alternative education, mobile schools, and literacy programs can target women and girls not in school, although these approaches were less common and not as well evaluated (174). Interventions that target girls who are no longer in school provide valuable examples about how such interventions could be delivered to hard-to-reach groups (182).
While women tend to need fewer calories than men, our requirements for certain vitamins and minerals are much higher. Hormonal changes associated with menstruation, child-bearing, and menopause mean that women have a higher risk of anemia, weakened bones, and osteoporosis, requiring a higher intake of nutrients such as iron, calcium, magnesium, vitamin D, and vitamin B9 (folate).
Both your nutritional needs (the food and water) and your metabolism (how fast your body converts food to energy) change at this age. Your metabolism gets slower. Women lose about half a pound of muscle per year starting around the age of 40. That makes losing weight even more difficult. Some of the changes women experience are due to decreased hormones, reduced activity level, and medical conditions.
“It was a privilege to have taken the course with you. Already, I have used the cueing methods on 2 clients. I have also taken the initiative to ask one of my post-natal client today about her birthing journey and she was so open and excited to share with me. It struck me that usually nobody asks them about it as more attention is focused on the baby.”
Even if you are the most independent exerciser around, give a group fitness class a shot at least once a week—you may find that you enjoy it more than sweating solo. “Happiness and health are shared through social connectedness and closeness,” says Greg Chertok, director of sport psychology at the Physical Medicine and Rehabilitation Center in New Jersey. “Geography and proximity are predictors of how contagious emotions can be, and this may translate into an athletic environment too.” Sign up for Bikram, CrossFit, spin, or Zumba, and you could find yourself—gasp!—smiling at the gym thanks to your classmates.
Studies link high sodium intake to higher blood pressure, and evidence suggests that many people at risk for high blood pressure can reduce their risk by consuming less salt or sodium, as well as following a healthy diet. Most Americans consume more sodium than they need. The recommended amount is less than 2,300 mg per day for children and adults to age 50. The limit drops to 1,500 mg per day for those 51 and older or those of any age who are African American or have hypertension, diabetes or chronic kidney disease. You get 2,300 mg in just one teaspoon of salt. One good way to reduce your sodium intake is to eat fewer prepared and packaged foods.
Pregnancy presents substantial health risks, even in developed countries, and despite advances in obstetrical science and practice. Maternal mortality remains a major problem in global health and is considered a sentinel event in judging the quality of health care systems. Adolescent pregnancy represents a particular problem, whether intended or unintended, and whether within marriage or a union or not. Pregnancy results in major changes in a girl's life, physically, emotionally, socially and economically and jeopardises her transition into adulthood. Adolescent pregnancy, more often than not, stems from a girl's lack of choices. or abuse. Child marriage (see below) is a major contributor worldwide, since 90% of births to girls aged 15–19 occur within marriage.
So we can applaud some of the efforts of Women’s Health. As editor Amy Keller Laird announced in that Jan/Feb issue, the magazine “will no longer be using fitness models in our monthly ‘15-Minute Workout.’ We’ll feature readers of various body types and sizes,” like the refreshingly normal-sized Morgan Gibson Kanner, hurling a weight plate around in stretchy workout clothes. As progressive as the layout is, Laird points out that “it’s logistically difficult to book nonmodels who have day jobs”; sounds like she should hook up with Willcox’s modeling service.