Managing Menopause - Nutritional Supplements

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Nutritional Supplements

Dietary recommendations

Bread For women aged 40 and over dietary recommendations include general food guidelines, such as The Australian guide to healthy eating¹, and specific nutrient recommendations, as outlined in the Recommended dietary intakes for use in Australia.² Recent advances in nutritional science and research have prompted review of recommended dietary intakes (RDIs), and this may result in future recommendations for novel food components such as phytoestrogens and antioxidants.³

Currently, RDIs for adult women are divided into two age groups

19-54 years and
over 54 years.

RDIs for women over 54 years more closely reflect the needs of women aged 40 and over, particularly menopausal women.

Suggested food servings to achieve a healthy diet for women*

Food	Serves per day†	Sample serving size	Further suggestions
Breads, cereal, rice, pasta, noodles	4-9	2 slices bread, 1 bread roll, 1 cup rice	Try rye breads, fruit breads, multigrain breads, pasta, noodles. Encourage wholegrain choices
Vegetables	5-7	1/2 cup cooked vegetables, 1 cup salad vegetables, 1 small potato	Include a wide variety of colourful vegetables
Fruit	2-3	1 medium piece of fruit, 2 smaller pieces of fruit, 1 cup diced or canned fruit
Milk, yoghurt, cheese	3-4	1 cup milk, 200g yoghurt, 1 cup soy milk (calcium fortified) Choose low fat varieties.	Include some fermented products
Meat, fish, eggs, nuts, legumes	1-1.5	65-100g lean meat, or 80-120g cooked fish (1 small fillet), or 1/2 cup dried beans or lentils, 1/3 cup peanuts or almonds, 1/4 cup seeds (eg, sesame seeds)	Include fish 1-2 serves per week (1 medium fillet), includes tinned fish, sardines, tuna
Extra foods‡	0-2.5	Plain biscuits, cake, alcohol, chocolate, crisps, pastries, oils and fats	Additional foods can be included if energy requirements are high. Obtain oils through foods such as olives, raw nuts, seeds, grains and legumes, olive and canola oils and seed oils. Watch for fat content of processed foods

*Adapted from The Australian guide to healthy eating.¹

†The wide variation in serves is because of individual variation in activity.

‡In addition to the 1-2 serves of extra foods, the guide also recommends modest consumption of margarine on foods like bread and toast and modest amounts of margarine or oil in food preparation.

Zinc and Calcium

The National Nutrition Survey (NNS)⁴ showed that mean intakes of zinc and calcium in women aged 45-64 years were below RDIs. Their mean fibre intake of 21g per day was also below the suggested daily intake (30g). Lower intakes of calcium, zinc and fibre in these women correlate with a low intake of breakfast cereals, milk, yoghurt, cheese, fruit, vegetables, fish and seafood, which are good sources of these nutrients.⁵

Mean intake of breakfast cereals was 12.2g per day, much less than a standard serve of 30-45g. Mean daily intakes of fruit of 1.1 serves and vegetables of 3.4 serves were below recommended intakes of two serves of fruit and five of vegetables daily.6 Mean intakes of calcium-rich foods such as milk, yoghurt and cheese were all less than a standard serve per day, which might explain why this group's calcium intake fell short of the RDI, achieved by eating a minimum of 3-4 serves of dairy foods daily. Intake of fish was low (only 12g per day⁶) compared with the National Heart Foundation's recommendation of at least two fish meals per week (standard serve of 80-120g).⁷

Dietary factors and breast cancer risk have been extensively researched.⁸ Women with greater dietary intakes of vitamins A, C and E, and fibre, have a reduced risk of breast cancer.^9,10 Large intakes of the antioxidant vitamins A, C and E, taken as supplements, do not appear to protect against breast cancer in women whose dietary requirements of these vitamins are met. Further, vitamin A supplements have been associated with a reduction in breast cancer risk among women who have very low vitamin A intake from food, but not for women with an adequate dietary intake.¹¹ Dietary fibre interferes with the enterohepatic circulation of oestrogen metabolites in bile, so that reabsorption and hence recycling of endogenous oestrogen is reduced.¹² However, the inverse relationship between vegetable intake and breast cancer risk is not explained by any single dietary factor. The multiple nutrients in vegetables may have a synergistic effect on breast cancer risk, or other, unidentified components may influence risk.¹³

Alcohol consumption is associated with a linear increase in breast cancer incidence, and it has been proposed that a reduction in alcohol consumption by women who consume alcohol regularly may reduce breast cancer risk.¹³

Given the high prevalence in Australia of overweight and obesity in women aged 40 and over, and the lower than recommended intake of some important foods and nutrients, women in this age group should be encouraged to follow The Australian guide to healthy eating. Specifically, more emphasis needs to be placed on a diet low in saturated fat, with more breads, cereals, fruits and vegetables, and more calcium-rich foods, as well as maintaining a healthy body weight by balancing food intake and regular physical activity.

Summary

Many Australian women over 40 years consume insufficient zinc, calcium and fibre. Greater consumption of foods rich in vitamins A, C and E and fibre is associated with a lower risk of breast cancer. Concentrated supplements of A, C and E have no effect on breast cancer risk when dietary intake is adequate, but vitamin A supplementation in women whose dietary intake of vitamin A is inadequate appears to reduce the risk of breast cancer. Alcohol consumption by women has been associated with a linear increase in breast cancer risk.

References

1. Smith A, Kellett E, Schmerlab Y. The Australian guide to healthy eating. Background information for nutrition educators. Adelaide: Children's Health Development Foundation, 1998.

2. National Health and Medical Research Council. Recommended dietary intakes for use in Australia. Canberra: AGPS, 1991.

3. Recommended dietary intakes - is it time for a change? Canberra: Commonwealth Department of Health and Family Services. 1998.

4. Australian Bureau of Statistics. National nutrition survey: nutrient intakes and physical measurements, Australia, 1995. Canberra: AGPS, 1998.

5. Australian Bureau of Statistics. National nutrition survey: foods eaten, Australia, 1995. Canberra: AGPS, 1998.

6. Cashel K, Jefferson S. The core food groups. Canberra: National Health and Medical Research Council, 1992.

7. National Heart Foundation of Australia. A review of the relationship between dietary fat and cardiovascular disease. Aust J Nutr Diet 1999; 56 Suppl: 4.

8. Adlercreutz H, Hamalainen E, Gorbach S, et al. Diet and plasma androgens in postmenopausal vegetarian and omnivorous women and postmenopausal women with breast cancer. Am J Nutr 1989; 49: 433-442.

9. Freudenheim JL, et al. Premenopausal breast cancer risk and intake of vegetables, fruits, and related nutrients. J Natl Cancer Inst 1996; 88: 340-348.

10. Yuan JM, Wang QS, Ross RK, et al. Diet and breast cancer in Shanghai and Tianjin, China. Br J Cancer 1995; 71: 1353-1388.

11. Hunter DJ, Manson JE, Colditz GA, et al. A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med 1993; 329: 234-240.

12. Adlercreutz H, Martin F. Biliary exaction and intestinal metabolism of progesterones and oestrogens in man. J Steroid Biochem 1980; 13: 231-244.

13. Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA 1998; 279: 535-540.