SUMMARY

Menopause is when the menstruation cycle stops. Nutrients are required to relieve symptoms and also to prevent certain conditions women can develop.

INTRODUCTION

The World Health Organisation (WHO, 2018) describes nutrition as the intake of food, considered in relation to the body’s dietary needs. There are six main components of nutrition; protein, fats vitamins, water, minerals and carbohydrates. Eating these nutrition’s in a balanced diet are all which are necessary for growth and development of bodies cells and tissues, aids in the prevention of chronic disease for example; Type Two Diabetes, caused by an excess of carbohydrate simple sugars sucrose, High Blood Pressure, caused by eating an excess of the mineral sodium i.e. salt, the consumption of processed foods that contain high amount of saturated fat which leads to Coronary Heart Disease. (WHO, 2018)

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The food pyramid is an effortless way to identify if a person is consuming the correct amount of nutrients, in December 2016, The Safe Food Authority of Ireland updated the existing food pyramid by introducing a new shelf which has been split from the lower shelves indicating that these foods should not be eaten every day as they are high in saturated fat, sugar. The location of the cereals and fruit and vegetable shelves have been swapped around by placing fruit and vegetables on the bottom, increased the serving to 5-7 servings a day, and placing the cereal shelf up one with the reduction of serving sizes reduced. (Safe Food Authority of Ireland, 2016) This new food pyramid aids in the healthy living of the Irish population of 4.7 million people. The 2016 Census indicates that the Ireland population is composed of 880, 208 children aged 0-12 years, 371, 588 teenagers aged 13-18 year, 368,368 adults aged 19-65 years and 637,567 adults aged 65+ years with 2,407,437 women. (Census, 2016)

On average there are 318,783 women aged 65+ who have been through menopause.

Menopause is sometimes known as the ‘change of life’ and is marked by the ending of menstruation (when a woman’s periods stop) (HSE 2018). All these women may have experienced a combination of hot flushes, night sweats, mood changes, and sleep disturbance which indicates the start of the menopause process. As every experience of menopause is different for each woman it is called ‘perimenopausal transition period’ The female hormone, Ostergoen’s function is to regulate a woman’s periods. Once these levels fall, menopause has begun. (Cleveland Clinic, 2018)

The objectives of this case study as follows;

To identify the nutritional requirements for a postmenopausal woman

To describe the developments/ physiological milestones (growth/ development/maintenance) of the woman at this particulate life stage

Analyse if postmenopausal women are achieving the recommended nutrient intakes.

To plan a one-day menu for a postmenopausal woman ensuring that the menu is balanced and that the woman would achieve all her nutrient requirements

Margaret is sixty-two years old woman, she has a relatively healthy BMI (Body Mass Index) of 32.0kg/m and is postmenopausal.

NUTRITIONAL REQUIREMENTS

In 2017, there are an estimated 962 million people aged 60 or over in the world, comprising 13 per cent of the global population (United Nations, 2018). With the high increase in elderly people this leads to a higher demand for medical care as these people will require to seek help. There may be health issues in the elderly, some which can be caused by nutrition imbalance and also the ageing process can cause health concerns also. Some of these concerns can be that elderly maybe be unable to provide for themselves. In March 2018 the weekly full state pension was €243.30 which may not be enough for some if they are paying for car fuel, electricity, heating, food etc. With the state pension comprising of a low sum, their expenses weight out their needs. The purchasing of cheap food is evident, which leads to nutrition imbalance. A study was conducted by Safe Food Ireland from 2006 to 2014. In their findings that the cost of living in Ireland for elderly has increased by 8.4% and that on average 20% of their money goes to food. (Safe Food Ireland, 2016) It is unclear to know if Margaret has a job or is receiving the state pension if she was, one-fifth of her state pension would be going to foods to aid her body during her post-menopausal stage. Also, we know that Margaret has a relatively healthy BMI which would aid us to determine that she would buy foods that nourish her body and that 20% of her money would be going to food. As she is post-menopausal she would buy foods that benefit her stage in life.

A survey conducted by Healthy Ireland in 2016 found that 29% of people aged 55-64, consume five or more fruit and vegetables a day and 83% of people surveyed ate breakfast every day. Nutrition is necessary for all stage of development. A diet rich in calcium, vitamin d and omega three fatty acids is extremely important in women postmenopausal, like Margaret. Calcium and vitamin d aids in the stretching of bones and omega three fatty acids in aiding heart thus preventing the building of cholesterol. It would be presumed that Margaret would fall in with the 29% and 83% of the population that ate five or more fruit and vegetables and also breakfast every day. In these meals, she would eat foods that are high in calcium, vitamin d and omega three fatty acids. Postmenopausal women, like Margaret, are shown to be more at risk of osteoporosis which is a condition of the bones thinning and becoming porous and also cardiovascular diseases like stroke and heart attack. 78% of people aged 55-64 have good health and 64% do a minimum of exercise a week (Healthy Ireland survey, 2016) which is in line with National Guidelines on Physical Activity in Ireland. We are aware that Margaret has a relatively healthy BMI, which we can consider that she would do the National Guidelines on Physical Activity which is thirty minutes a day for five days a week (Lordan-Dunphy et al., 2014). There is a vast variety of healthy eating guidelines all which stem from the same original source which is the Food Pyramid.

It is also for women post-menopausal like Margaret to include foods in her diet to aid her development from the menopausal process. Rita Patnaik in the Nutrition Foundation of India Bulletin 2003 describes some of the nutrition requirements essential for women during menopause. For instance, Margaret would need to watch her fat intake as the estrogen hormone which used to protect her against heart disease is now low meaning that she is at a higher risk of developing heart disease. The mineral Magnesium aids the relieve of hot flushes, irritability, hyperactivity, insomnia and anxiety symptoms that Margaret may get. Sources of Magnesium can be found in green leafy vegetables, whole grains like oats, nuts and almonds. Phytoestrogens are naturally found in plants and they have the same effect of estrogen in the body. They also relieve menopause symptoms. Phytoestrogen-rich foods i.e. soya bean, apples, barley, cabbage, carrot, cherries, green beans, peas, potatoes, rice, wheat, can also aid the vaginal tissue. Additionally, alcohol, caffeine and red meat should be reduced as magnesium and calcium can excretion which can cause osteoporosis (Patnaik, 2003) According to the Journal of nutrition and Food sciences Osteoporosis is a major public health issue with 50% of postmenopausal women experiencing an osteoporosis fracture in her lifetime.  (Richarson et al., 2017)  The RDA for calcium is 1200 mg and the RDA of vitamin D is 800-1000IU however only 16% of women are getting their daily dose of calcium. (Keaskin, 2013) If Margaret does not get enough vitamin D or calcium in her diet, her bones can become thinner and she is more at risk to osteoporosis.

Margaret is my selected case study group, it was found from the NANS survey 2011 found that the population aged, 18-64 years ate 66% cheese, 42% yoghurt two foods that are very high in vitamin D and calcium, 42% of the population ate green vegetables which are high in magnesium, vitamin d and calcium and 47% of the population ate fish and fish products which are high in omega three fatty acids. The average daily intake of fish in consumers was approximately 50g. 263g of Dairy products was consumed by 18-64-year-olds, which is also very high in vitamin d and calcium. However, 78% of women had an intake of less than 5g of vitamin D which leads to the consumption that Margaret is not achieving the recommended nutrient intakes. Although it is seen that Margaret has is over the BMI average for her age group which is 29.7kg/m2. This could lead to obesity in the long term (Irish Universities Nutrition Alliance, 2011).

DEVELOPMENTS/ PHYSIOLOGICAL MILESTONES

As we age we go through many milestones in our life and there are different milestones for each age group. For women of Margaret’s age, she would have gone through puberty which developed her breast, widening of her hips and she got menstruation which she got every twenty-eight days every month until she was in her fifties. In her fifties she went goes through menopause. Based on an article by Rita Patnaik in the Nutrition Foundation of India Bulletin she describes that the menopause process, it is broken down into three stages Pre, Peri & Postmenopause. (Pre-menopause is when female’s ovaries are disrupted and the menstruation cycle remains regular for the time being and some symptoms may begin to occur. Perimenopause is when the menstruation cycle starts to be irregular and the symptoms become painful. Post-menopause is when there has been no menstruation cycle for 12 months, in which this is the stage Margaret is in. The hormone, estrogen’s function is to maintain the endometrium, bones, ligaments, body temperature and our mood, During menopause, estrogen drops to 40% in the female body. This causes hormonal imbalance and also women can be prone to heart disease, osteoporosis (bone loss), memory problems and breast cancer. (Patnaik, 2003)

There is to new research done for women that are going through menopause who now can have  Hormone Replacement Therapy (HRT) which aids menopausal women to have their estrogen levels back to the normal pre-menopausal range. (Patnaik, 2003)

CONCLUSION

Menopause is a natural process that all women go through. We found that women of menopausal and also post-menopausal age develop an array of symptoms all which can be relieved by nutrients found in foods and that they can develop certain conditions if they do not receive these nutrients. All of which the information was found by researching published reports and journals from Ireland and the United Kingdom. 

One Day Menu Plan

Breakfast

Low fat Greek yogurt  (125g) topped with blueberries, (10 each) and a handful of natural granola with 200ml glass of natural squeezed orange Juice 

Mid-Morning

1 small banana banana 

500ml of water

Lunch

Ham, cheese,  chicken breast, Romaine lettuce and tomato sandwich on whole meal commercial bread with one packet of low fat butter

Two crackers with avocado and tomato   

1 litre of Water

Mid Afternoon

A Pear and a handful size of mixed nuts

Dinner

Spaghetti Bolognese (mushroom, white onion, carrot peas)  on wholemeal pasta

3 squares of dark chocolate

1 litre of Water

Before bed

200ml glass of milk

One Day Menu Plan Description

Breakfast

Low fat Greek yogurt (Calcium, HBV Protein, vitamin D) (125g) topped with blueberries, raspberries (F+V, vitamin C, antioxidants, Iron, Fibre ) (10 each) and a handful of natural granola (fibre) with 200ml glass of natural squeezed orange Juice  (F+V, vitamin C, antioxidants, Iron, Fibre)

Mid-Morning

1 small banana banana  (F+V, potassium, magnesium and phosphorus, vitamin C)

500ml of water

Lunch

Ham, cheese  (Calcium, HBV Protein, vitamin D), chicken breast , Romaine lettuce (vitamin A and  potassium) and tomato sandwich on whole meal commercial bread (magnesium, potassium, phosphorous, fibre) with one packet of low fat butter

Two crackers (fibre) with avocado (monounsaturated fat, potassium, magnesium, Beta Carotene) and tomato  (potassium, Beta Carotene)

1 litre of Water

Mid Afternoon

A Pear (fibre, calcium and potassium) and a handful size of mixed nuts

Dinner

Spaghetti Bolognese (mushroom (magnesium, potassium), white onion (potassium), carrot (calcium, potassium vitamin A), peas (magnesium, vitamin B) on wholemeal pasta (magnesium, potassium, phosphorous, fibre)

3 squares of dark chocolate

1 litre of Water

Before bed

200ml glass of milk (Calcium, HBV Protein, vitamin D)

Information of nutrients from Nutrient Value of Some Common Foods, 2008

Food Pyramid

Recommended servings

Our menu plan provides

Do we meet the recommendations?

Fruit & Vegetables

5-7 servings

8

Yes

Wholemeal cereals

4-5 servings

4

Yes

Meat, Fish & Poultry

2 servings

2

Yes

Milk, Cheese & Yogurt

3 servings

3

Yes

Fats spreads oils

Small amounts

1

Yes

HFSS

1 per week

1

Yes

Calcium

750-100mg

Yes

Vitamin D

5ug

Yes

Fibre

25g

Yes

Folic acid

400ug

Yes

References

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