NUTRITION NEWS Symposium on Nutrition, Women, A symposium on Nutrition, Women and Their Health was held in Washington, DC, on December 11, 1991, at the National Academy of Sciences. Sponsored by the Food and Nutrition Board, the Institute of Medicine, and the National Academy of Sciences, the symposium focused on critical issues relative to women’s health and well-being. Specific examples of the paradox as well as the parallel of health care issues observed in developed versus developing countries drew attention to the socioeconomic, educational, and cultural differences that exist. Socioeconomic and demographic trends affecting women’s health in developing countries was discussed by Dr. Susan C. M. Scrimshaw. This spirited, challenging, and well-documented presentation was drawn largely from broad personal experience of travel to and study in numerous underdeveloped countries. Overwhelming objective evidence supports the inequalities of the cultural values, power, and influence of women compared with men in many developing countries. Women are often at increased risk for morbidity and mortality. This relates to the fact that women work longer and harder, get less food, and are less &dquo;valued&dquo; than men. The cultural, economic, and social factors are complex, and frequently have a negative effect on the health status of women. In contrast, the socioeconomic and demographic trends affecting women’s health in the United States indicate that about two thirds of women have excellent health and one third have poor health. Dr. Jacqueline D. Forrest pointed out that with increasing age, women experience fair to poor health, limitation ofphysical activity, and increased mortality-associated diseases, especially cardiovascular disease and cancer (breast, lung). An increase in sexual activity early in life, multiple sex partners, and failure to protect against pregnancy increase the risks for unintended pregnancies. About two thirds of US women are not married, are heads of households, and may have children. Compared with men, more women have a limited income, greater poverty, and no health care insurance. Major health problems of US women are:

and Their Health obesity, hypertension, and hypercholesterolemia. While smoking and alcohol consumption have decreased, these practices are still common among American women. Dr. Bernadine Healy, recently appointed Director of the National Institutes of Health (NIH), was unable to attend the symposium; therefore, Dr. Vivian Penz, NIH, provided detailed information regarding the recently established Office of Research on Women’s Health at the National Institutes of Health. The NIH Task Force on Opportunities for Research on Women’s Health has been assessing current status of research needs. A major initiative is a 10-year study, the Women’s Health Initiative, that will examine the major causes of death, disability, and frailty in women. This will comprise a large prospective surveillance study, a nationally based community intervention and prevention study, and randomized clinical trials. Nutrition during pregnancy and lactation was discussed by Dr. Janet King, who presented data regarding recommended weight gain during pregnancy. According to Dr. King, the range of weight gain is broad, ranging from 0 to 51 lb, and clearly indicates that one recommendation for all women is not reasonable. Nevertheless, suitable weight gain based on maternal body mass index is important, influences fetal growth, and is modified by maternal factors. Breastfeedingwas recommended and strongly supported. The percentage of protein, lipid, and carbohydrate in breast milk remains relatively constant regardless of maternal intake. The quality of lipids in breast milk reflects the maternal body lipid composition. The vitamin and mineral composition of breast milk is sensitive to fluctuation in maternal intake. Dr. Kathleen M. Rasmussen discussed the effects of pregnancy and lactation on women’s status and health. She cited specific changes in adiposity that occur during pregnancy. With reproduction cycles of reported pregnancies, there is an increase in overall adiposity that is clearly recognized by many women. The age-related gain has been estimated at approximately 250 to 300 g per year for

repeated pregnancies. Suggestions 90

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weight gain include: 1) limit weight gain during pregancy to the amount recommended; and 2) active breastfeeding. The overall concept ofbalancing energy in versus energy out is needed here. The epidemiology of nutrition and chronic diseases in women was addressed by Dr. Elizabeth Barrett-Connor. The relationship of specific dietary patterns associated with cardiovascular dis-

hypertension, diabetes, osteoarthritis, osteoporosis, and cancer (lung, breast) in women

ease,

discussed. Examples included: 1) increased esophageal cancer with alcohol intake and smoking ; 2) increased colorectal cancer with increased alcohol intake; 3) breast cancer with increasing fat intake; 4) osteoporosis with poor calcium intake; and 5) cardiovascular disease with high saturated were

fat intake. Dr. Judith Stern reviewed dietingbehaviors and weight maintenance strategies among women. A major health problem in women is obesity. Many women are excessively obese and yet may eat fewer calories, and have significantly reduced energy expenditure. The well-known concept of energy in versus energy out balance was strongly urged. Obesity is much more prevalent in women compared with men. More women than men &dquo;go on weight reduction diets,&dquo; but Yo-Yo, dieting-relapsing cycles are common. Strategies of self-control, self-confronting, self-coping, and problem-solving are needed, as this type of weight-cycling is associated with increased morbidity and mortality. A key is increased energy output via regular exercise. Nutrition for older women was reviewed by Dr. Irwin Rosenberg. Population characteristics of elderly women in the US and the emphasis needed on nutrition are high priorities in terms of research as well as education. Most recent studies, HANES

and BOSTON studies, have documented that the elderly are at risk for meeting less than two thirds of the RDA for the following nutrients: thiamin, riboflavin, niacin, ascorbic acid, folic acid, B12, pyridoxine, vitamin D, zinc, calcium, and iron. The elderly have a decrease in lean body mass with age, as well as a decrease in energy needs and basal metabolic rate. Significant reduction in bone mineral density is greater and more acute in women than in men. Regular walking may be protective and lessen loss of bone density. A decreased intake of vitamin D, required for the absorption of dietary calcium, occurs in the elderly, and less of this vitamin may be absorbed via the gut or skin. Nutrition issues unique to women in the military were presented by Major Nancy King and Colonel Karen Fridlund. While the women in the US armed services may usually have excellent access to adequate nutrition, their unique lifestyle may impose situations of increased nutritional risk. The recent tours of duty during Desert Storm are an

example of exceptional nutritional concerns

that may be encountered. The responsibility of military dietetic personnel (mostly women) to provide adequate nutrition for large groups of armed service personnel, particularly for those seriously wounded,*makes a major contribution in support of national defense. This symposium sparked spirited discussions following each presentation, and stimulated challenging questions about specific diseases either more prevalent or more serious in women, or unique to women. This will increase interest in research to improve the nutritional status and health of women in the US. Eleanor A. Young, PhD, RD /LD Professor, Department of Medicine The University of Texas

Health Science Center

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San Antonio