1. Women’s Health Provided Courtesy of Nutrition411.com Review Date 7/14 G-1121 Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC Updated by Nutrition411.com staff

2. Objectives Discuss leading causes of death Learn how to prevent or manage leading health conditions

3. What Do You Think Are the Leading Causes of Death for American Women?

4. Leading Cause of Death: 2010 Source: Leading causes of death in females United States, 2010. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/women/lcod/2010/index.htm. Updated October 2013. Accessed July 10, 2014. http://www.cdc.gov/women/lcod/2010/index.htm All Females, All Ages 1. Heart disease23.5% 2. Cancer22.1% 3. Stroke6.2% 4. Chronic lower respiratory diseases 5.9% 5. Alzheimer's disease4.7% 6. Unintentional injuries3.6% 7. Diabetes2.7% 8. Influenza and pneumonia2.1% 9. Kidney disease2.1% 10. Septicemia1.5%

5. Facts Heart disease kills six times as many women as breast cancer Source: Women and heart disease facts. Women’s Heart Foundation website. http://www.womensheart.org/content/heartdisease/heart_disease_facts.asp. Accessed July 10, 2014. http://www.womensheart.org/content/heartdisease/heart_disease_facts.asp

6. Can Anyone Tell Me the Difference Between a Heart Attack and a Stroke?

7. Stroke vs Heart Attack Stroke—blocked blood flow to the brain Heart attack—blocked blood flow to the heart Risk factors are the same for both

8. What Causes Heart Disease/Stroke? Arteries—blood vessels that carry blood away from the heart to the rest of the body Normal Artery

9. Plaque Starts to Build Up Tear in Artery Wall

10. Plaque Can Grow and Harden and Obstruct the Artery Atherosclerosis

11. Ischemic Stroke

12. Heart Attack

13. What Increases Risk? You Cannot HelpYou Can Help Age −Men <45 years −Women postmenopausal Sex Race Family History Smoking Alcohol Poor diet Overweight/obesity Diabetes Physical inactivity High LDL cholesterol Low HDL cholesterol High blood pressure HDL=high-density lipoprotein, LDL=low-density lipoprotein Source: Coronary artery disease—coronary heart disease. American Heart Association ® website. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart- Disease_UCM_436416_Article.jsp. Accessed July 10, 2014.— http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart- Disease_UCM_436416_Article.jsp

14. To Help Prevent Heart Disease Know your numbers: −Cholesterol (LDL=lousy, HDL=healthy) −Triglycerides −Blood pressure −Blood glucose Maintain a healthy weight Stay physically active Manage stress Do not smoke Do not drink alcohol excessively Eat heart healthy

15. Three Most Common Cancers in Women Breast cancer: −First among women of all races and Hispanic origin populations Lung cancer: −Second among white, black, American Indian/Alaska Native, and Hispanic women −Third among Asian/Pacific Islander women Colorectal cancer: −Second among Asian-Pacific Islander women −Third among white, black, American Indian/Alaska Native, and Hispanic women Source: Cancer among women. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/dcpc/data/women.htm. Updated October 24, 2013. Accessed July 10, 2014. http://www.cdc.gov/cancer/dcpc/data/women.htm

16. Leading Causes of Cancer Deaths in Women Lung cancer: −First among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women −Second among Hispanic women Breast cancer: −First among Hispanic women −Second among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women Colorectal cancer: −Third among women of all races and Hispanic origin populations Source: Cancer among women. Centers for Disease Control and Prevention website. http://www.cdc.gov/cancer/dcpc/data/women.htm. Updated October 24, 2013. Accessed July 10, 2014. http://www.cdc.gov/cancer/dcpc/data/women.htm

17. Cancer Prevention Avoid smoking and second-hand smoke Eat a healthy diet Keep active Stay safe in the sun Get recommended screening tests for your age and gender Source: Stay healthy. American Cancer Society website http://www.cancer.org/healthy/index. Accessed July 10, 2014.http://www.cancer.org/healthy/index

18. Other Common Health Concerns for Women Osteoporosis Depression Iron deficiency Menopause/weight management

19. How Many Women Get Osteoporosis in Their Lifetime?

20. Osteoporosis Affects 200 million women worldwide Worldwide, one out of every three women 50 years of age and older will have an osteoporosis-related fracture in their lifetime Affects women more than men Source: Facts and statistics. International Osteoporosis Foundation website. http://www.iofbonehealth.org/facts- statistics. Accessed July 10, 2014.http://www.iofbonehealth.org/facts- statistics

21. Osteoporosis Progression Normal bone Osteopenia Osteoporosis Severe osteoporosis

22. Bone Health and Osteoporosis Normal bone Osteoporosis

23. What’s the Big Deal? No early warning signs (silent disease) Broken bones usually are the first sign of a problem For older adults, when a fracture occurs, it results in a downward health spiral Source: NIH Osteoporosis and Related Bone Diseases National Resource Center. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. http://www.niams.nih.gov/Health_Info/Bone/default.asp. Accessed July 11, 2014.http://www.niams.nih.gov/Health_Info/Bone/default.asp

24. How Can You Prevent Osteoporosis? If younger than 30 years of age, attain a higher peak bone mineral density If older than 30 years of age, maintain or improve bone mineral density through: −Exercise −Nutrition −Not smoking Source: NIH Osteoporosis and Related Bone Diseases National Resource Center. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. http://www.niams.nih.gov/Health_Info/Bone/default.asp. Accessed July 11, 2014.http://www.niams.nih.gov/Health_Info/Bone/default.asp

25. Exercise for Prevention 30 minutes of exercise (walking or jogging) most or all days of the week Incorporate weight-bearing exercise, such as: −Walking −Jogging Include weight lifting Source: Calcium and bone health. Centers for Disease Control and Prevention website. http://www.cdc.gov/nutrition/everyone/basics/vitamins/calcium.html. Updated April 6, 2011. Accessed July 11, 2014. http://www.cdc.gov/nutrition/everyone/basics/vitamins/calcium.html

26. Nutrition for Prevention Calcium Vitamin D Adequate vitamin D intake helps the body absorb calcium

27. Recommended Calcium Intake for Women AgesAmount (mg/day) Birth to 6 months210 mg 6 months to 1 year270 mg 1 to 3 years500 mg 4 to 8 years800 mg 9 to 18 years1300 mg 19 to 50 years1000 mg >51 years1200 mg mg=milligram Source: Calcium. National Institutes of Health, Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/list-all/Calcium/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/list-all/Calcium/

28. Calcium Sources Foods High in Calcium

29. What If You Do Not Drink Milk? You can get calcium from other foods, including: −Canned fish with edible bones (good choices include salmon, sardines, and mackerel) −Cheese −Cream soups −Custard −Ice cream −Milk used in cooking, such as in mashed potatoes −Pudding

30. What If You Do Not Drink Milk? (cont’d) Other options are fortified foods, such as: −Fortified breakfast cereals −Fortified orange juice −Fortified soy, rice, or almond milk −Fortified tofu −Calcium supplements

31. Tips for Increasing Calcium in the Diet Drink calcium-fortified orange juice Make oatmeal with milk, instead of water Put cheese on your sandwiches Put milk instead of half-and-half or powdered creamer in your coffee or tea Make your own pudding with milk, instead of buying convenient prepackaged pudding Add nonfat dry-milk powder to gravies, peanut butter, and other foods

32. Where to Look for Calcium Add a “0” to the % to find out how many milligrams of calcium in a food The Daily Value for calcium on food labels is 1000 mg

33. Calcium Absorption Less calcium is absorbed as you age Many factors may decrease the calcium you are able to absorb from the foods you eat or increase the amount of calcium that comes out of your bones and into your blood Poor calcium absorption can result in decreased bone density You can absorb only 400 to 500 mg in one sitting

34. Does Diet Affect Absorption? Sodium Protein Caffeine Alcohol Phosphorus Phytates and oxalates Source: Calcium. National Institutes of Health, Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

35. Vitamin D Requirements for Women Adequate IntakeFemale 0 to 12 months*400 IU (10 mcg) 1 to 13 years600 IU (15 mcg) 14 to 18 years600 IU (15 mcg) 19 to 50 years600 IU (15 mcg) 51 to 70 years600 IU (15 mcg) >70 years800 IU (20 mcg) IU=international unit, mcg=microgram Source: Vitamin D. National Institutes of Health Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ *Values are the same for pregnant and lactating women

36. Why Is Vitamin D Important? Vitamin D helps your body absorb calcium and deposit the calcium in your bones to help keep your bones strong The best food sources of vitamin D are fortified milk products and fatty ocean fish

37. Calcium Supplements Calcium citrate: −Best absorbed in an acidic environment −Best absorbed supplemental form of calcium −Does not require extra stomach acid for absorption, so you can take it anytime during the day, even on an empty stomach Calcium carbonate (Tums ® or Caltrate ® ): −Most calcium pills are in this form −Requires extra stomach acid for better absorption −Best taken after meals Source: Calcium. National Institutes of Health Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

38. Depression More women than men experience depression As a woman, several factors increase your risk of depression, including: −Your unique biology −Your life situation −Your culture Source: Women and depression: discovering hope. National Institute of Mental Health, National Institutes of Health website. http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/index.shtml. Accessed July 11, 2014.http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/index.shtml

39. Depression: What Can You Do? Engage in mild activity or exercise: −Go to a movie, ball game, or another event or activity that you enjoyed going to before your depression −Participate in religious, social, or other activities Set realistic goals for yourself Break large tasks into smaller ones: −Set some priorities −Do what you can, as you can

40. Depression: What Can You Do? (cont’d) Try to spend some time with others: −Confide in a trusted friend or relative −Try not to isolate yourself −Let others help you Expect your mood to improve gradually, not immediately: −Do not expect to suddenly “snap out of” your depression −Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts

41. Depression: What Can You Do? (cont’d) Postpone important decisions, such as getting married or divorced, or changing jobs: −Wait until you feel better to make important decisions −Discuss decisions with others who know you well and have a more objective view of your situation

42. Depression: What Can You Do? (cont’d) Keep confident and know that your positive thinking will replace negative thoughts as your depression responds to treatment Psychotherapy and medication: Talk to your doctor

43. Iron: Recommended Dietary Allowance mg=milligram, N/A=not applicable Source: Iron. National Institutes of Health, Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ Age Infants and ChildrenWomenPregnantBreastfeeding 7 to 12 months11 mgN/A 1 to 3 years7 mgN/A 4 to 8 years10 mgN/A 9 to 13 years8 mgN/A 14 to 18 yearsN/A15 mg27 mg10 mg 19 to 50 yearsN/A18 mg27 mg9 mg >51 yearsN/A8 mgN/A

44. Iron Source: Iron. National Institutes of Health, Office of Dietary Supplements website. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed July 11, 2014. http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ Too little iron in the diet can result in iron-deficiency anemia Other forms of iron deficiency do exist, such as anemia of chronic disease

45. Menopause and Weight Gain Hormones play a critical role in weight gain during and after menopause Estrogen is the female sex hormone stored in fat Estrogen appears to influence where fat is distributed in the body Source: Mayo Clinic staff. Belly fat in women: taking—and keeping—it off. Mayo Clinic website. http://www.mayoclinic.org/healthy-living/womens-health/in-depth/belly-fat/art-20045809. Accessed July 11, 2014. http://www.mayoclinic.org/healthy-living/womens-health/in-depth/belly-fat/art-20045809

46. Weight Management Meal plan: −Start your day with a good breakfast −Eat from all food groups −Include whole grains, low-fat dairy, vegetables, lean protein, fruits, and healthy fats in your diet −Choose healthy snacks −Read nutrition labels −Remember moderation Exercise: −Exercise a minimum of 30 minutes most days

47. Why Reduce Calories? Reduce your calories if you are overweight and want to lose weight Calories are the energy in food that contribute to weight loss and weight gain 1 pound of fat=3500 calories

48. Physical activity can lower your risk of: −Heart disease −Stroke −High blood pressure −Unhealthy cholesterol levels −Type 2 diabetes −Metabolic syndrome −Colon cancer −Breast cancer −Falls −Depression Other Benefits of Exercise Source: Office of Women’s Health, US Dept of Health and Human Services. Physical activity (exercise) fact sheet. Womenshealth.gov website. http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html. Updated June 7, 2013. Accessed July 11, 2014.http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html

49. Physical activity may also help: −Improve functional health for older adults −Reduce waistline size −Lower risk of hip fracture −Lower risk of lung cancer −Lower risk of endometrial cancer −Maintain weight after weight loss −Increase bone density −Improve sleep quality Other Benefits of Exercise (cont’d) Source: Office of Women’s Health, US Dept of Health and Human Services. Physical activity (exercise) fact sheet. Womenshealth.gov website. http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html. Updated June 7, 2013. Accessed July 11, 2014.http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html

50. Eating well and exercising can have many benefits for women, including: −Preventing chronic diseases such as heart disease, cancer, osteoporosis, and iron-deficiency anemia −Managing depression −Managing weight The Bottom Line Source: Office of Women’s Health, US Dept of Health and Human Services. Physical activity (exercise) fact sheet. Womenshealth.gov website. http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html. Updated June 7, 2013. Accessed July 11, 2014.http://www.womenshealth.gov/publications/our-publications/fact-sheet/physical- activity.html

51. Questions???