Females face gender specifi c nutritional challenges that may affect
their health and wellbeing, and these must be discovered and
adequately dealt with.
-The changes in the anatomy and physiology of females caused by
sex hormones throughout their lifetime offer nutritional challenges
that may require special care.
-Physical demands on females concerning reproductive function
and child-bearing affect nutrition, appetite, and weight regulation.
These may have both acute and long-term effects on their health.
-Cultural and social factors stressing gender-specifi c roles, body
shape, and weight in females increases their risk of eating disorders,
and the chance that they will seek unhealthy methods to lose weight.
- Neural and hormonal regulation of appetite varies between males
and females and even among females at different stages in life,
which makes it diffi cult for them to manage their appetite and
Body dissatisfaction and its’ impact on Nutrition:
Girls and women of all ages struggle with body dissatisfaction.This
may lead them to seek unhealthy ways to change their bodies. As
women age, the self-reported “importance” of their body shape
and size declines. Body image can be impacted by body changes
during adolescence, and early adulthood, in addition to monthly
body changes associated with menstruation, the enormous body
changes that occur with pregnancy and delivery, as well as changes
in body composition and fat deposition due to midlife hormonal
changes. Counseling for these issues may improve nutritional,
mental and physical health.
Weight management problems:
Obesity and eating disorders are more common in females than
males. The factors responsible for this are not clear. Multiple
appetite regulating hormones are currently being investigated for
their roles in the energy imbalances seen in females. Appetite
regulation in females is complicated by their gender-specifi c roles
as family meal preparers, menstrual cycle fl uctuations, major
changes in sex hormone levels at the onset and the end of the
reproductive years, and body changes associated with pregnancy
and lactation. For example, drinking carbohydrate beverages has
been associated with reduced premenstrual symptoms; this effect
is linked to carbohydrate craving and is attributed to the promotion
of tryptophan and the serotonin system.
Individualized nutrition management programs are more successful
than a one-size-fi ts-all approach. Calorie restriction may lead to
eating disorders; therefore, any diet should be done under supervision,
also to ensure adequate carbohydrate and protein intake. Perhaps
a size acceptance approach that encourages attention to internal
eating cues may be more effective than dieting.
Nutritional challenges related to reproduction:
Menses, pregnancy, delivery, lactation, and menopause may all
affect, and be affected by nutrition.
Very high or low body mass index (BMI >35 or BMI<20, respectively)
is associated with diffi culties in conceiving, complications during
pregnancy, labor and delivery, and increased risk to the baby. Any
disordered eating present must be addressed before weight gain or
loss is encouraged. History of dieting is associated with increased
weight gain during pregnancy except in underweight women.
Use of hormonal contraceptives increases osteoporosis risk in
naturally menstruating women, but may reduce amenorrheaassociated
osteoporosis in anorexia nervosa or in the female
athlete triad. Also, during pregnancy, calcium will be supplied
to the fetus at the expense of the mother. Thus, adequate calcium
is recommended for all women, especially adolescents and young
women because this is when peak bone mass is being developed.
Because of the common preoccupation of girls and women with
weight, they may purposefully consume less calcium- rich foods,
for instance, they may replace milk with diet drinks. Three servings
of low-fat dairy products to provide both calcium and vitamin D
are recommended. If a vegetarian lifestyle or lactose intolerance
exists, other calcium-fortifi ed beverages or foods, such as orange juice, or a calcium and vitamin D supplement maybe useful.
Women are at risk of anemia due to iron loss(15–20 mg) during
menstruation, especially heavy or frequent menses with reduced
dietary iron intake, and athletic-induced hemolysis and anemia.
Heme iron has better bioavailability than non-heme iron. Non-heme
iron absorption can be enhanced by the presence of protein and
vitamin C. Iron supplementation is recommended in all women
of childbearing age.
Adequate periconceptional and pregnancy intake of folate decreases
the risk of neural tube defects and may reduce other complications
of pregnancy, including preeclampsia and miscarriage. Repeated
miscarriages and infertility have been linked to insuffi cient amounts
of vitamin B12 and folate. Unlike iron, folic acid in supplement
form has a higher bioavailability (85%) than in food (50%).
Calcium supplementation (1,000–1,300 mg/day) may alleviate
some premenstrual symptoms, including irritability and cramping.
Vitamin B6 in doses up to 100 mg/day may help reduce premenstrual
symptoms and depression. However, the effi cacy of using nutrition
to improve premenstrual symptoms still needs further study.
Menopause and the use of Nutritional supplements:
The peri- and postmenopausal period is nutritionally very challenging
for women. The use of hormone replacement therapy (HRT) to
alleviate symptoms of menopause has declined sharply after it has
been shown to pose an increased risk-to-benefi t ratio. This led many
women to turn to nutritional supplements and, complementary
and alternative medicine (CAM) for relief of their symptoms.
Phytoestrogens, particularly soy isofl avone extracts, are taken
to relieve symptoms such as hot fl ashes, though they may not
be effective. They have been claimed to have cancer-preventing
properties, although recent studies have attributed this to their
consumption earlier in life. Isofl avones are not recommended in
women who lack childhood exposure to isofl avones due to their
inconsistent effects on the mammary gland and uterus, which may
increase the risk of developing malignancies. Women who are at
increased risk of cancer should never be given these supplements.
Black cohosh is another nutritional supplement that has been used
by some woman to reduce menopause-related hot fl ashes and
Other supplements commonly used include fl axseed, Ginkgo
biloba, and red clover.
St. Johns Wort is mildly effective for mood improvement.
Few high-quality studies have been completed on the safety and
effi cacy of these treatments. A major problem is that up to 70% of
women taking supplements may not report them to their doctor, and
may thus risk drug interactions or unrecognized adverse reactions.
5-Control of osteoporosis, and weight during menopause:
Eighty percent of those affected by osteoporosis are women.
During menopause, bone losses of 3–5% occur per year. Adequate
calcium and vitamin D intake during childhood and the early
reproductive years promotes bone build up that will extend the
time until postmenopausal signs of osteoporosis appear. Consuming
fortifi ed dairy products has been shown to have better effects on bone
metabolism and bone mineral density (BMD) in postmenopausal women than taking the same amount of calcium in supplement form.
Greater bioavailability of calcium from dairy products may be due
to the role of milk protein and magnesium in bone metabolism.
A healthy diet, weight-bearing exercise, avoiding smoking, and
limiting alcohol intake can further prevent bone loss.
Calcium supplements and low-fat dairy products have been associated
with reduced postmenopausal weight gain or increased weight
loss in overweight women.
The female athlete triad:
The female athlete triad (TRIAD) involves three interrelated
conditions: amenorrhea, disordered eating (usually restricted),
and osteoporosis. The prevalence of the TRIAD has been reported
in 12 to 27% of women, especially in female athletes, due to
activity-associated pain and stress fractures, but it also occurs in
sedentary girls and women.
Presence of any one of the TRIAD components with screening,
or a patient presenting with amenorrhea, stress fractures, or low
body weight indicates assessment of the other two components.
Following diagnosis, these cases need careful assessment of
nutritional intake, social history, and body image; administration
of a screening tool, such as EAT-26; measurement of bone mineral
density (BMD) and body composition; and laboratory assessments
to rule out other causes of amenorrhea. Restoration of normal
eating patterns, energy balance, menses, and BMD are the aim of
treatment. Adequate calcium and vitamin D consumption should
also be monitored. Severe cases may need medical treatment
with hormonal replacement therapy (usually oral contraceptives),
activity restrictions, and/or more intensive family or even inpatient
Polycystic ovarian syndrome:
Polycystic ovarian syndrome (PCOS) is associated with fi ve
clinical features: hyperandrogenism, small ovarian cysts, menstrual
dysfunction, android-pattern overweight or obesity, and insulin
resistance with the resulting glucose intolerance.
It affects 5–10% of women of reproductive age and there is often
a family history.
Signs of hyperandrogenism include hirsutism, acne, dysmenorrhea,
The presence of insulin resistance and hyperinsulinemia are
suggested by episodic hypoglycemia and related carbohydrate
craving, acanthosis nigricans (dark patches on the skin), and
unexplained weight gain.
There may also be signifi cant mood disorder, body image disturbance,
and disordered eating, secondary to attempts to lose weight.
Dietary management of PCOS focuses on the consumption of low
saturated fats and high fi ber, and low glycemic-index carbohydrate
sources spread throughout the day in 4–6 meals/snacks. Also,
omega 3 fats, cinnamon, and chromium rich foods or supplements
may improve metabolic status.
Orlistat or metformin help reduce testosterone, improve insulin
sensitivity,and aid weight loss and maintenance. Oral contraceptives
and androgen-reducing medications, such as spironolactone, may also be helpful to stabilize sex hormone levels and improve menses.
Regular strength and endurance exercise can be helpful for weight
loss, improvement of insulin sensitivity, and self-esteem. Counseling
may also be indicated.
Early detection of PCOS can improve outcomes and reduce the
risks of chronic diseases and infertility later in life.
Special care and attention must be provided to meet the unique
nutritional needs of girls and woman. Annual physical examinations
of females must routinely include anthropometrics, diet pattern
analyses, and questions about body image and satisfaction, especially
during puberty, pregnancy and postpartum and peri-menopausal
periods, so that appropriate nutritional, medical, and/or exercise
interventions may be undertaken.