Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.
The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.
Getting enough water also is important. Many experts recommend at least eight 8-ounce glasses of water daily—more if you exercise frequently or are exposed to extremes of heat and cold. The 2010 Dietary Guidelines for Americans emphasize drinking more water and other calorie-free beverages, along with fat-free or low-fat milk and 100 percent fruit juices, instead of calorie-packed regular sodas.