National Nutrition Week: Uncover the hidden power of nutrition on women's health — An expert guide

Nutrition is one of the most important, yet most overlooked, aspects of women's health. According to a report by UNICEF, 30 per cent of women aged 15-49 years are living with the effects of anaemia globally while 10 per cent of women aged 20-49 years suffer from being underweight. On the other hand, overweight is affecting more than 35 per cent of women aged 20-49 years, of which 13 per cent are living with obesity, a severe form of overweight. All these conditions, though affected by several factors, can significantly be managed with the right nutrition.

National Nutrition Week is marked from 1st to 7th September in order to bring the spotlight on the role of diet and nutrition in ensuring overall well-being. One must note that nutrition is a cornerstone of health for everyone. However, the nutritional needs of women differ and evolve with different stages of life from adolescence to menopause and beyond.

We speak to Dr. Alka Walavalkar, clinical nutritionist, integrative health and medicine specialist and diabetes educator, Rajeshwari V Shetty, HOD (Nutrition & Dietetics), SL Raheja Hospital, Mahim - A Fortis Associate, and Mansi Padechia, a Mumbai-based dietician and founder of Go Beyond Diet, who highlight the nutritional requirements of women at different ages and share tips for a healthy diet.

What role does nutrition play in women's health at different ages?
Walavalkar: As women age, their nutritional needs evolve, reflecting changes in their bodies and lifestyles.
• Adolescence: During adolescence, girls undergo significant physical, emotional, and cognitive development. This period of rapid growth demands increased calories, protein, and vital nutrients such as calcium, iron, and vitamins. Calcium is essential for developing strong bones and teeth, which helps prevent osteoporosis later in life. Iron is particularly important due to the onset of menstruation, which increases the risk of iron deficiency anaemia. A diet rich in lean protein, leafy greens, and fortified cereals can help meet these increased nutritional needs.

• Reproductive age: For women of childbearing age, nutrition plays a crucial role in menstrual health, fertility, and pregnancy. Nutrients like folate, iron, calcium, and omega-3 fatty acids are essential. Folate is vital for preventing neural tube defects in developing fetuses, making it a critical nutrient for women before and during pregnancy. Iron helps prevent anaemia, a common issue during pregnancy due to increased blood volume and the needs of the growing fetus. Omega-3 fatty acids support brain development and reduce inflammation.

• Menopause: Menopause brings about significant hormonal changes that can impact a woman's health, including a decrease in bone density and an increased risk of osteoporosis and heart disease. To counter these effects, a diet rich in calcium and vitamin D is essential for maintaining bone health. Additionally, heart-healthy fats along with a high intake of fruits and vegetables, can help manage cholesterol levels and support cardiovascular health.

• Older age: In the post-menopausal years, the risk of osteoporosis and cardiovascular diseases remains a concern. Nutrition should continue to focus on adequate calcium and vitamin D intake to maintain bone health. Moreover, consuming a diet rich in fiber, antioxidants, and lean proteins can help manage weight, reduce the risk of chronic diseases, and maintain overall vitality. Staying hydrated and ensuring sufficient intake of vitamin B12, which is often poorly absorbed in older adults, is also important for cognitive health and energy levels.

Shetty: Nutrition plays a very important role in women's health at different stages of life like puberty, child bearing age, pregnancy and post-delivery. Even after the ages of 30 and 50, nutrition is important. Also, if an expectant mother is not adequately nourished, her child will be malnourished. In India, malnutrition is quite common. A malnourished child is more prone to infections as their immunity levels are low and their growth might be stunted. Both adolescent girls, expectant mothers and women suffer from iron-deficiency anaemia or pernicious anaemia if their diet is lacking in nutrients.

Padechia: Nutrition plays a vital role in women's health across different ages, influencing reproductive health, energy levels, and chronic disease risk. Key considerations include:
• Adolescence: Iron, calcium, and vitamin D for growth and development
• Childbearing years: Folic acid, iron, and calcium for pregnancy and lactation
• Menopause: Calcium, vitamin D, and omega-3 fatty acids for bone health and heart healthy

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How do nutrition requirements of women differ from those of men?
Walavalkar: There are several factors.
• Caloric needs: Generally, females have lower caloric needs than males due to lower muscle mass. However, individual needs vary based on activity levels, age, and overall health.
• Iron needs: Women of reproductive age require more iron than men due to blood loss during menstruation. This need decreases after menopause.
• Calcium needs: Women, especially post-menopausal, need more calcium to prevent osteoporosis. Estrogen, which helps protect bones, decreases significantly during menopause, increasing the need for calcium and vitamin D.
• Folate needs: Women of child-bearing age need more folate compared to men to prevent neural tube defects during pregnancy.

Shetty: Women need less calories than men, as the latter have more muscle mass. Iron, folic acid, vitamin B12, zinc, selenium, omega-3 fatty acids, vitamin B6, antioxidants like vitamin C and vitamin E, magnesium and water help when women are ovulating. Women also need calcium and vitamin D3 for good bone health. Men require other nutrients like magnesium and vitamin B5.

Padechia: Due to natural biological differences, women generally have less muscle mass than men, resulting in lower daily calorie needs. On average, women require 1,600-2,200 calories, while men need 2,000-3,200 calories per day. This means women typically need fewer macronutrients, but can prioritise them based on individual goals and lifestyles.
Certain vitamins and minerals have different requirements for women and men. For example:
• Calcium: Women need more calcium after menopause (1,000 mg/day) to maintain strong bones, compared to men (800 mg/day).
• Iron: Women lose iron during menstruation and need 18 mg/day before menopause, while men need 8 mg/day.
• Folic acid: Women of child-bearing age need 400 mcg/day to prevent neural tube defects in babies.

Some food sources for these essential nutrients are:
• Calcium: dairy, nuts, seeds, salmon, beans, and lentils
• Iron: meat, seafood, green leafy veggies, and iron-fortified foods
• Folic acid: spinach, black-eyed beans, and fortified cereals

Are there any specific health issues that you have observed in women in India? What role does nutrition play in alleviating the same?
Walavalkar: India faces a unique set of health challenges, particularly among women. Several common issues include anaemia, vitamin D deficiency, osteoporosis, obesity, and metabolic syndrome. Nutrition plays a vital role in addressing these issues:
• Anaemia: A significant health problem in India, anaemia affects a large number of women due to inadequate intake of iron and other essential nutrients. Incorporating iron-rich foods with vitamin C-rich foods to enhance absorption, can help combat anaemia.

• Vitamin D deficiency: Limited sun exposure and low dietary intake contribute to widespread vitamin D deficiency among Indian women. Encouraging outdoor physical activities for natural sunlight exposure and incorporating vitamin D-rich foods can improve vitamin D status.

• Osteoporosis: This condition is prevalent among post-menopausal women due to low calcium and vitamin D intake. Increasing the consumption of dairy products, green leafy vegetables, nuts, and fortified foods, along with supplements, if necessary, is crucial for bone health.

• Obesity and Metabolic Syndrome: Lifestyle changes and urbanisation have led to an increase in obesity and related metabolic disorders (diabetes, PCOS/PCOD, NAFLD, etc.) among women in India. A balanced diet along with regular physical activity, can help manage weight and prevent metabolic syndrome.

Shetty: Women in India generally suffer from ailments like anaemia, low vitamin D3 levels, osteoporosis, obesity, PCOD and diabetes. A balanced diet with the right amount of nutrients will help to get rid of these health problems. For anaemia, depending on the type, iron-rich or vitamin B12 and vitamin C-rich food can help. For those with diabetes, wholegrains in right proportion, fiber-rich diet with adequate protein and low fat is very essential.

Padechia: Specific health issues that are prevalent among women in India include:
• Anaemia: Iron deficiency is common due to inadequate dietary intake especially in rural area, menstruation, and pregnancy.
• Osteoporosis: Inadequate calcium and vitamin D intake, combined with a sedentary lifestyle, increases the risk of osteoporosis.
• Polycystic Ovary Syndrome (PCOS): It is a hormonal disorder affecting reproductive health, often linked to insulin resistance and dietary factors common among girls from age of 12 to 35.
• Gestational Diabetes: This is a growing concern due to dietary habits, obesity, and lack of physical activity and pregnancy treatment.
• Malnutrition: Inadequate nutrition, particularly among rural and disadvantaged women, leads to health issues like stunting, wasting, and micronutrient deficiencies.

Nutrition for specific conditions among women

Some health conditions are especially prevalent among women, and nutrition plays an important role in managing the effects of these health issues. Nutritionists share common challenges and tips for some of these.

PCOS/PCOD (Polycystic Ovarian Syndrome / Polycystic Ovarian Disorder)
PCOS is the most common endocrine disorder among women globally. According to a 2020 study by Statista, 16.5 per cent women in India in the age group of 19-29 suffer from PCOS.

"PCOS is characterised by hormonal imbalances, irregular menstrual cycles, insulin resistance and weight gain. It is a common endocrine disorder affecting many women of reproductive age," informs Dr. Walavalkar.

"A low-glycemic index diet that stabilises blood sugar levels can help manage PCOS symptoms. Foods such as whole grains, fruits, vegetables, lean proteins, and healthy fats are recommended. Omega-3 fatty acids and anti-oxidants can help reduce inflammation. Regular physical activity is also crucial for managing insulin
sensitivity and maintaining a healthy weight," she further suggests.

"PCOS leads to weight gain, hence it is important to cut down on processed foods, include more fiber in diet, cut down on fat, and exercise regularly," says Shetty.

Menopause
Menopause comes with its own set of challenges. "This too leads to weight gain, osteoporosis, hair loss and insomnia, thus, a low-calorie diet with adequate nutrients that is high in calcium and vitamin D3, along with consumption of biotin rich food for hair loss and other essential nutrients will go a long way. Beverages like chamomile tea can help with insomnia," states Shetty.

"Menopause is accompanied by hormonal changes that can lead to hot flashes, weight gain, bone density loss, and increased risk of cardiovascular disease," says Dr. Walavalkar.

She gives the following nutrition tips.
• To alleviate these symptoms, women should focus on calcium and vitamin D for bone health, found in dairy products and fortified foods.
• Phytoestrogens, found in soy products, may help reduce hot flashes.
• A heart-healthy diet rich in omega-3 fatty acids, fruits, vegetables, and whole grains can help manage cholesterol levels and reduce the risk of heart disease.

Obesity
A 2023 Lancet study found that 40 per cent women in India are abdominally obese, as compared to 12 per cent men. Obesity is more prevalent among older women. What can be done to combat this?

"Obesity increases the risk of various health issues, including cardiovascular disease, diabetes, and joint problems. A diet high in fiber, lean proteins, and healthy fats, while reducing refined carbohydrates and sugars, is essential for weight management. Incorporating a variety of fruits, vegetables, whole grains, and lean protein can provide necessary nutrients while managing calorie intake. Regular physical activity, such as walking, swimming, or cycling, is also important for weight management," says Dr. Walavalkar.

Diabetes
Diabetes is a common health issue among women in India. "Diabetes management involves controlling blood sugar levels to prevent complications such as cardiovascular disease, nerve damage, and kidney issues," informs Dr. Walavalkar.

Nutrition tips include:
• A balanced diet focusing on low-glycemic index foods, regular meals, and healthy fats can help manage blood sugar levels.
• Foods such as whole grains, legumes, vegetables, and lean proteins should be prioritised.
• Monitoring carbohydrate intake and distributing it evenly throughout the day can prevent blood sugar spikes.

Bone health after the age of 30
Women are more likely to get osteoporosis due to weak bone health and sharp decrease in estrogen during menopause.
"Bone health may deteriorate after 30s resulting in osteoporosis. It is important to keep a check on vitamin D3 levels, get adequate sun exposure, vitamin D and follow a calcium rich diet," informs Shetty.

General diet and lifestyle tips for women to lead a healthy life

Dr. Walavalkar shares the following tips:
• Balanced diet: Consuming a variety of foods from all food groups ensures a balanced intake of essential nutrients. This includes whole grains, lean proteins, fruits, vegetables, and healthy fats.
• Regular physical activity: Engaging in at least 30 minutes of moderate exercise most days of the week helps maintain a healthy weight, improves cardiovascular health, and boosts mood. Activities such as walking, swimming, yoga, or strength training are beneficial.
• Stay hydrated: Drinking plenty of water throughout the day supports hydration, helps maintain skin health, and aids in digestion.
• Adequate sleep: Aiming for 7-9 hours of sleep per night supports overall health, enhances cognitive function, and improves mood.
• Stress management: Practicing mindfulness, yoga, meditation, or other stress-reducing activities can help manage stress and improve mental health.
• Regular health check-ups: Keeping up with regular health screenings and check-ups can help detect potential health issues early and ensure timely intervention.

Shetty suggests the following:
• Taking care of your family doesn't mean you neglect yourself. Exercise regularly and follow a proper diet to keep yourself fit. This will also help you take care of your family in a much better way.
• Have your meals on time.
• Follow a balanced nutrient-rich diet. Check your vitamin D3 levels - if low, work to correct them.
• Keep yourself hydrated.
• Control your cravings through yoga and meditation.
• Once in a while, you can have junk food, but not always.
• Cut down on processed food and avoid ultra-processed food items.
• Keep yourself happy. Set aside time for yourself and do things which make you happy.