Central obesity—measured as waist-to-hip ratio—is an independent risk factor for disease. Women with a waist circumference greater than 35 inches are at higher risk of diabetes, dyslipidemia, hypertension, and cardiovascular disease (37). Metabolic syndrome is a complication of obesity that, while somewhat variably defined, includes a clustering of atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose, and abdominal obesity and confers an increased risk for cardiovascular disease and diabetes (38). One-third to one-half of premenopausal women with polycystic ovarian syndrome (PCOS) meet the criteria for metabolic syndrome (39).
Figure 8.1 MyPlate Icon. This is a new communications initiative based on 2010 Dietary Guidelines for Americans, replacing the Food Pyramid. It is designed to remind Americans to eat healthfully, and illustrates the five food groups using a familiar the familiar mealtime visual of a place setting. (From the United States Department of Agriculture, http://www.
ChoseMyPlate.gov)
Key nutritional recommendations were issued by the Dietary Guidelines Advisory Committee to the U.S. Department of Agriculture (40). These recommendations are included in the MyPlate 2010 Guidelines, which has an emphasis on fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products (Fig. 8.1) (41). The guidelines include recommendations to balance food and physical activity and stay within daily calorie requirements.
Fiber content of the diet is being studied for its potential role in the prevention of several disorders, particularly colon cancer. It is recommended that the average diet for women contain 25 g of fiber per day (40). Whole-grain foods, and vegetables, citrus fruits, and some legumes, are high in fiber and are emphasized in the guidelines for healthy foods.
Adequate calcium intake is important in the prevention of osteoporosis. A postmenopausal woman should ingest 1,500 mg per day. Adolescents require 1,300 mg per day. Because it may be difficult to ingest an adequate amount of calcium daily in an average diet, supplements may be required.
The U.S. Public Health Service has recommended that women of reproductive age who are capable of becoming pregnant take supplemental folic acid (0.4 mg daily) to help prevent neural tube defects in their infants. Surveys indicate that in 2007, 40% of women of childbearing age consumed a supplement, a percentage that is only half of the Healthy people 2010 objective of 80% (42). Women who are contemplating pregnancy should be counseled about the risk of fetal neural tube defects and the role of folic acid supplementation prior to conception in their prevention (43).
Alcohol Alcoholic beverages should be limited to one drink per day for women (40). A simple device called the T-ACE questionnaire (Tolerance; been Annoyed by criticism of drinking; felt need to Cut down; need for Eye-opener) can be used to elicit information about alcohol use and identify problem drinkers (44). Women should be questioned in a nonjudgmental fashion about their alcohol use and directed to counseling services as required.