Fourth and finally, there was a general lack of focus on the relevant delivery platforms for nutrition interventions. Many studies were not explicit about how and where interventions were delivered, and we had to cross-reference multiple sources to identify the delivery platform for many interventions. Delivery platforms are important and relevant information in terms of replicability, but also for identifying who is effectively reached and missed. Information about delivery platforms is also instrumental in understanding gaps in implementation. A greater emphasis on delivery platforms could enhance the reach of nutrition interventions and could also strengthen the capacity to mobilize resources more effectively. For instance, organizing and grouping interventions by delivery platform (e.g., antenatal care, community centers, schools, clinics) or by the relevant stakeholders required for delivery (e.g., ministries, health care providers, teachers, administrators, transporters, etc.) could have the potential to more efficiently deliver nutrition interventions.
Improvements in maternal health, in addition to professional assistance at delivery, will require routine antenatal care, basic emergency obstetric care, including the availability of antibiotics, oxytocics, anticonvulsants, the ability to manually remove a retained placenta, perform instrumented deliveries, and postpartum care. Research has shown the most effective programmes are those focussing on patient and community education, prenatal care, emergency obstetrics (including access to cesarean sections) and transportation. As with women's health in general, solutions to maternal health require a broad view encompassing many of the other MDG goals, such as poverty and status, and given that most deaths occur in the immediate intrapartum period, it has been recommended that intrapartum care (delivery) be a core strategy. New guidelines on antenatal care were issued by WHO in November 2016.
All of the identified studies focused on LNSs for pregnant and lactating women through antenatal care–based and –affiliated delivery platforms (97–101). These studies relied on antenatal care to recruit mothers but delivered the intervention through home visits. There was no evidence evaluating use of LNSs for women who were not pregnant or lactating. The majority of studies evaluating LNS interventions involved children with severe or moderate acute malnutrition. Although LNS supplementation could be an intervention to provide essential nutrients to women and girls, it is expensive. Filling energy gaps using local foods or other commodities can often be done at a lower cost (97). LNS supplementation should be limited to contexts in which cheaper, more sustainable solutions are not available.
What you eat and drink is influenced by where you live, the types of foods available in your community and in your budget, your culture and background, and your personal preferences. Often, healthy eating is affected by things that are not directly under your control, like how close the grocery store is to your house or job. Focusing on the choices you can control will help you make small changes in your daily life to eat healthier.
In our review, we found that fortification interventions that provided fortified foods reached women of all life stages through home visits, community distribution centers, local markets, and retail stores. Delivery of fortified foods in school-based programs, at work, and in maternal–child health centers were also used to target school-age children, women of reproductive age, and pregnant and lactating women that were engaged with those facilities (37, 72–74, 84). There was mixed evidence that consumption of fortified foods reached all socioeconomic groups. Some studies showed differences in consumption between nonpoor and extremely poor, and between urban and rural stakeholders (33, 64, 85). Women who have restricted access to markets, depend largely on locally grown foods, are in areas with underdeveloped distribution channels, or have limited purchasing power, might have limited access to fortified foods (64). Additional research is needed to address implementation gaps and to determine the best platforms for reaching high-risk populations.
Fats contain both saturated and unsaturated (monounsaturated and polyunsaturated) fatty acids. Saturated fat raises blood cholesterol more than unsaturated fat, which may even help lower harmful cholesterol. Reducing saturated fat (most comes from meat, dairy and bakery products) to less than seven percent of total daily calories may help you reduce your cholesterol level. Whenever possible, replace saturated fat with monounsaturated and polyunsaturated fats.
Educational interventions most often targeted school-age children and adolescent girls, and there were few examples of programs targeting women of reproductive age (174). The majority of education interventions were delivered in formal school-based settings (174). However, this is a “selective” delivery platform given that not all adolescents attend schools (193). School fees and distance to school are major barriers to school enrollment (174, 194). Educational interventions need to be sensitive to the reasons why girls are not in school, e.g., work, and to the hours and locations that might make education interventions more accessible (193). Nonformal education, alternative education, mobile schools, and literacy programs can target women and girls not in school, although these approaches were less common and not as well evaluated (174). Interventions that target girls who are no longer in school provide valuable examples about how such interventions could be delivered to hard-to-reach groups (182).
Low-fat diets also can help you lose weight.16 But the amount of weight lost is usually small. You can lose weight and lower your risk for heart disease and stroke if you follow an overall healthy pattern of eating that includes more fruits, vegetables, whole grains and beans that are high in fiber, nuts, low-fat dairy and fish, in addition to staying away from trans fat and saturated fat.
Consider including peppermint in your pre-workout snack or drink. In a small study published in the Journal of the International Society of Sports Nutrition, men drank 2 cups water with 0.05 milliliters (basically, a drop) peppermint oil mixed in and then ran on a treadmill to test their stamina and power. The mint appeared to help relax muscles, boost oxygen to muscles and the brain, and elevate pain threshold, leading to improved overall performance.
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).
If you do decide to diet, you still need to maintain good nutrition. You want to cut back on calories, not nutrients. And while you want to reduce fat, don't eliminate it entirely. Some studies suggest that older women who maintain a higher body-fat percentage are less likely to suffer from osteoporosis and other conditions associated with menopause. Fat cells also retain estrogen, which helps maintain the calcium in your bones. Younger women should be careful, too: a low body fat percentage can lead to infertility; below 17 percent may lead to missed periods, also known as amenorrhea.
Systematically report and evaluate women's nutrition outcomes in research and program evaluation documents in low- and middle-income countries, including outcomes for adolescents, older women, and mothers (as opposed to reporting on women's nutrition as child nutrition outcomes alone). When possible, report and evaluate differences by setting (e.g., rural compared with urban) and socioeconomic status.
Home visits ↓ anemia, ↑ Hgb, ↑ food consumption, ↑ weight gain (underweight adolescents), NC mortality, ↓ fatigue ↓ anemia, ↑ serum folate, ↑ serum B-12, NC mortality, NC depression ↓ anemia, ↑ MN status (Hgb, ferritin, folate, B-12, zinc, riboflavin), ↑/NC serum retinol, ↓/NC night blindness, ↑ weight gain, NC maternal mortality, NC depression
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance. In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (e.g. midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits. A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.