Puberty and menopause bring in immense changes in a woman’s life which includes both physical and psychological. Her body undergoes staggering hormonal changes which in turn affect her body weight and food intake patterns too. Every girl needs immense care and comfort during her puberty years and every woman needs support and understanding nearing menopause. Ageing can increase body weight despite the individual eating the same number of calories as before. When menopause affects woman alongside ageing it causes double trouble-there are more chances of weight gain around the abdomen especially which pave way for an increased risk of diseases and health problems. Menopause is an indication that the ovaries make very little estrogen and such reduced estrogen levels increase the risk problems such as heart disease, stroke, osteoporosis and urinary incontinence in the years following menopause. Stringent dietary modifications and regular physical activity is recommended to avoid unnecessary weight gain changes in the absence of which overweight/obesity might be a common occurrence.
Diets low in saturated fats and cholesterol are associated with lower CVD rates and studies show that a Mediterranean-type dietary pattern (low-fat dietary pattern) prevented the occurrence of cardiovascular events.
Women’s Health Initiative Dietary Modification Trial
The main aim of the Women’s Health Initiative (WHI) Dietary Modification Trial was to understand whether a dietary pattern low in total fat alongside increase in the intake of vegetables, fruits and grains would decrease the risk of breast and colorectal cancer in postmenopausal women. The secondary aim was to note any link between such dietary intake and reduced risk of CVD. A total of 48,835 women aged between 50 and 79 years were enrolled between 1993 and 1998 in 40 US clinical centres and assigned to either the intervention group (40%) consisting of 19541 participants or the usual-diet comparison group (29,294 participants). While inclusion criteria stated being postmenopausal and consuming fat intake of 32% of total calories exclusion for WHI included prior occurrence of breast or colorectal cancer, medical conditions with survival rate less than 3 years and habits such as alcoholism. People with type 1 diabetes and those eating meals frequently away from home were also included in the exclusion list.
All the participants were monitored for their total fat, vegetable, fruit and whole grain intake, they were supplemented with group activities and were also invited to participate in any one of the WHI controlled trials of hormone therapy (HT). Participation in a trial of calcium and vitamin D supplementation (CaD) was offered after one year. In total, 20,592 (42.2%) participated in the Dietary Modification Trial, 8050 (16.5%) in the Dietary Modification plus HT Trial, 25,210 (51.6%) in the Dietary Modification plus CaD Trial and 5017 (10.3%) in all 3 trials. All the participants were contacted bi-annually for changes in health outcomes while height, weight and BMI measurements were taken annually. Electrocardiograms (ECGs) were taken every 3 years, a medical update questionnaire was given every 6 months to fill and CHD, the outcome variable involved in the study was defined as acute myocardial infarction (MI) that required hospitalization. Adherence assumption included 13% lower consumption of fats in the intervention group compared to the control group one year from baseline decreasing further to 11% energy difference at 9 years.
The participants’ mean age was 62.3 years, 3.4% reported instances of CVD. In comparison to the participants in the control group those in the intervention group reported significant changes in dietary components paving way for 8.2% lower mean total fat intake and 2.9% lower saturated fat intake which includes decreased intake of trans, mono- and polyunsaturated fat and cholesterol intake with increased consumption of fruits, vegetables, fibre, whole grains and soy. At the end of trial, 2404 women (4.9%) died, 1553 (3.2%) stopped follow-up and 527 (1.1%) were lost to follow-up. 5% in the intervention group and 4% in the control group withdrew, were lost to follow-up or stopped providing answers for more than 18 months during the study period. At 3 years of follow-up, women in the intervention group showed significant decrease in body weight, waist circumference diastolic blood pressure and LDL-C level but showed no effect on triglycerides and HDL-C levels, ratio of total cholesterol to HDL-C, levels of non-HDL-C, lipoprotein, glucose or insulin or insulin resistance as reported by homeostasis. Carotenoid levels that denotes increased vegetable consumption was significantly higher.
After 8.1 years of follow-up, major CHD incidence levels were 30% lower in the intervention group compared to the control group. Dietary intervention did not bring in significant changes in major CHD or composite CHD rates. Neither total, fatal or nonfatal stroke were influenced by dietary intervention nor were composite measure of CVD. There seemed to be no influence on stroke levels even after 9 years of follow-up and only a nonsignificant trend towards decreased CHD rates in the intervention group in the later years. The WHI trial reduced fat intake by 8.2% at the end of 6 years while increasing vegetable and fruits servings by 1.1 and whole grain servings by 0.5. The trial decreased fat intake and increased produce intake modestly only and did not show any reduction in risk of CHD or stroke.
Diabetes & Heart Disease Risk in Postmenopausal Women
83% participants in the WHI trial agreed for non-intervention follow-up and 86% of participants consented to an open-end follow-up. Analyses over the intervention and cumulative follow-up period identified significant intervention benefits related to breast cancer, CHD and diabetes.
Cancer outcomes were coded the US National Cancer Institute’s SEER system throughout the intervention and postintervention phases. CHD was defined as nonfatal myocardial infarction plus CHD death. Total stroke was defined as ischemic plus haemorrhagic stroke. Total CVD was defined as CHD plus coronary artery bypass graft or percutaneous coronary intervention plus total stroke.
Results showed that fat intake was lower by 11% in the intervention group, carbs intake higher by 10% and protein intake by almost 1%. Vegetable and fruits intake were higher by 1.2 servings to 5.1/d and grains was higher by ∼0.7 servings to 5.4/d in the intervention group. There was a significant reduction in breast cancer risk by 30% followed by death due to any cause. There was also a significant reduction in estrogen receptor positive, progesterone receptor negative and breast cancer incidence over the long-term follow-up. There were 13,498 deaths that happened during this period. A significant reduction in CHD rates happened among baseline normotensive participants while there was no effect seen on hypertensive participants. Total fat reduction in the follow-up of postmenopausal women showed that reduction in total fat was accompanied by increased vegetables, fruits and grains with increases in fiber and total carotenoid intakes. There were small but significant changes observed in blood pressure, LDL cholesterol, insulin, glucose, HOMA-IR and metabolic syndrome score that could help with CHD and diabetes risk.
Replacing fats with carbs in a well-nourished population of postmenopausal women showed ∼24% of energy from fats compared with ∼35% in the comparison group, ∼58% of energy from carbohydrates compared with ∼48% in the comparison group and ∼18% compared with 17% of energy from proteins. While consumption of saturated and unsaturated fats decreased among participants the intervention group started eating more of fruits, vegetables, whole grains, micronutrients and fiber along with increase in sugars. Such dietary modifications proved beneficial for participants at a risk for CHD, diabetes and stroke. Hence, dietary changes decreased breast cancer risk by ∼35% during intervention and 15% over cumulative follow-up; reducing in CHD incidence by ∼30% during intervention and 15% over the cumulative follow-up among normotensive women and reduction in insulin-requiring diabetes by ∼25% during the intervention and 13% over cumulative follow-up.
Low-fat Dietary Pattern & Risk of Cardiovascular Disease: https://jamanetwork.com/journals/jama/fullarticle/202339
Low-fat Dietary Pattern Among Postmenopausal Women Influences Long-term Cancer, Cardiovascular Disease and Diabetes Outcomes: https://academic.oup.com/jn/article/149/9/1565/5512736
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