Abstract
Objectives
To provide health care professionals in Canada with the basic knowledge and tools
to provide nutrition guidance to women through their lifecycle.
Outcomes
Optimal nutrition through the female lifecycle was evaluated, with specific focus
on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The
guideline begins with an overview of guidance for all women, followed by chapters
that examine the evidence and provide recommendations for the promotion of healthy
nutrition and body weight at each life stage. Nutrients of special concern and other
considerations unique to each life stage are discussed in each chapter.
Evidence
Published literature, governmental and health agency reports, clinical practice guidelines,
grey literature, and textbook sources were used in supporting the recommendations
made in this document.
Values
The quality of evidence was rated using the criteria described in the report of the
Canadian Task Force on Preventive Health Care.
Chapter 2: General Female Nutrition
Summary Statements
- 1.A balanced and varied diet higher in vegetables, fruit, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (for non-pregnant and non-lactating women); lower in red and processed meats; and low in sugar-sweetened beverages and refined grains reduces the risk of chronic diseases including type 2 diabetes, cardiovascular disease, and cancer. (II-2)
- 2.Women’s health, including their nutritional status, can be adversely affected by psycho-social, economic, or geographic circumstances which comprise their “food environment.” Barriers to healthy eating may include individual factors (e.g., physical ability, income), social factors (e.g., family situation, social support), community factors (e.g., proximity to grocery stores), and relevant policies (e.g., eligibility for social support programs). Women at high risk for poor nutritional status may benefit from additional dietary counselling or targeted interventions. (III)
- 3.A carefully planned vegetarian diet is healthy throughout the lifecycle; careful attention to protein is required. Other nutrients of concern for strict vegetarians (e.g., vegans) include zinc, iron, vitamin B12, and omega-3 fatty acids. (II-2)
Recommendations
- 1.Emphasize the importance of sound nutrition throughout the female lifecycle, with an overall focus on women’s intake of nutritious foods in appropriate amounts for maintaining a healthy weight. (I-A)
- 2.Discussions of dietary intake with women should identify practical, easy to understand, easy to implement, and sustainable dietary practices. (III-B)
- 3.Stress the importance of maintaining a healthy body weight throughout the lifecycle. Body mass index (weight in kg/height in metres2) and waist circumference (cm) provide a general idea of health risk and should be measured as a routine part of physical assessments. (II-2A) This recommendation does not apply to adolescents and women with eating disorders or women who are pregnant.
- 4.Support women in understanding specific nutrients of concern across the female lifecycle, which include calcium, iron, folate, vitamin B12, and vitamin D. Ensure that women are aware of foods rich in these nutrients, and encourage their regular consumption in appropriate amounts. (III-A)
- 5.Women who are at high risk for iron deficiency (e.g., low or no meat intake; low socioeconomic status; immigrants from developing countries; First Nations, Inuit, and Métis women; significant blood loss due to menstruation, child birth) should be screened by measuring hemoglobin and serum ferritin. If iron deficiency is identified, oral elemental iron therapy should be initiated and continued for at least 6 months; higher doses are required for women with severe anemia. Iron should be taken with a source of vitamin C. (III-A) Patients with an underlying condition that causes iron deficiency or who do not respond to treatment should be referred for further investigation and management.
- 6.Routine testing of healthy women without symptoms or risk factors for vitamin B12 deficiency is not recommended. Consider supplementary vitamin B12 for women with risk factors for deficiency (e.g., vegetarian/vegan diet, over age 50, gastric disorders such as atrophic gastritis or gastric bypass, small bowel disease, and regular use of metformin, chronic H2-blockers, or proton pump inhibitors). (III-A)
- 7.Women who are not able to consume the recommended dietary allowance of calcium in their diet may benefit from a calcium supplement. (II-2A) When counselling a woman in the selection of a calcium supplement, ensure that the supplement provides an adequate dose of “elemental calcium” and that the woman understands she needs to look specifically for this on the label. It is best to take multiple small doses of calcium as absorption is inversely related to intake; no more than 500 to 600 mg of elemental calcium at any one time. (II-2A) Caution should be used to avoid exceeding the upper limit for calcium from diet and supplements combined (2500 mg for adult women).
- 8.Recommend a vitamin D supplement to all Canadian women who consume insufficient dietary vitamin D (I-A), particularly those with decreased cutaneous synthesis due to being homebound, having darker skin pigmentation, or who cover their skin.
- 9.Screening for vitamin D deficiency by measuring serum 25(OH)D is not necessary for the general population but should be carried out in high risk women such as those with a history of fractures, malabsorption, renal disease, or using medications that impact vitamin D or bone metabolism (e.g., chronic steroid use, anticonvulsant therapy). (III-A)
- 10.During routine visits, advise all women of reproductive age about the benefits of adequate intake of folate from foods (e.g., dark green, leafy vegetables and legumes) and folic acid in a multivitamin supplement. (I-A)
Chapter 3: Adolescence Nutrition
Summary Statements
- 1.Adolescence is a key time to continue or initiate obesity prevention. (III)
- 2.The highest prevalence of eating disorders occurs among female adolescents. (II-2)
Recommendations
- 1.Discuss good nutrition and explore and address potential body image concerns with all adolescent female patients. Teach adolescents and their parents about the benefits of a varied diet higher in vegetables, fruit, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; lower in red or processed meat; and low in sugar-sweetened beverages and refined grains. (III-A)
- 2.Since it is known to produce widespread positive outcomes, encourage adolescents and their families to eat meals together. (I-A)
- 3.The weight and height of all adolescents should be measured and their body mass index calculated using the World Health Organization Growth Charts which are for children and youth up to 19 years. (III-A)
- 4.To ensure optimal bone development, adolescent females should be counselled to consume their RDAs for calcium (1300 mg/day) and vitamin D (600 IU/day), ideally through food or, if necessary, through supplementation. (I-A)
- 5.Be alert to eating patterns and body image of all preteen and adolescent females. (III-A)
Chapter 4: Pre-conceptual Nutrition
Summary Statement
- 1.It is estimated that approximately one half of pregnancies in Canada are unplanned and thus it is important that all women of reproductive age maintain good nutrition. (III)
Recommendations
- 1.Follow the 2015 Society of Obstetricians and Gynaecologists of Canada guideline for the supplementary use of folic acid by women of reproductive age. Women of childbearing age should consume 0.4 mg folic acid in a daily multivitamin for at least 2 to 3 months prior to pregnancy. Women of childbearing age at moderate or high risk for bearing an offspring with a neural tube defect should consume a 1 and 4.0 mg folic acid supplement, respectively, at least 3 months prior to conceiving and until 12 weeks gestational age. Thereafter, daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid throughout pregnancy and postpartum as long as breastfeeding continues.(III-A)
- 2.Promote increased dietary intake for women who are ovulating abnormally due to underweight by encouraging increased meal frequency and size, and avoidance of fasting, meal-skipping, and excessive exercise. (II-3A)
- 3.Provide a weight-management strategy for women who are ovulating abnormally due to overweight by recommending strategies such as appropriate dietary adjustments, increased physical activity, and reduced sedentary behaviour. (II-2A)
- 4.Recommend a low glycemic index diet to overweight women with polycystic ovary syndrome to improve insulin sensitivity and fertility. (I-A)
Chapter 5: Nutrition in Pregnancy
Summary Statements
- 1.High-quality dietary intake and appropriate food selections are important for all pregnant women, and can be achieved by following Canada’s Food Guide as applied to pregnancy. Food selections should emphasize choosing a variety of nutrient-dense foods from all 4 food groups, as opposed to energy-dense, nutrient-poor foods. A nutrient-rich, energy-appropriate diet will help to ensure a woman’s own nutritional requirements are met and facilitate healthy development of her fetus throughout the pregnancy. (III)
- 2.The amount of energy required to support pregnancy (for women with a pre-pregnancy body mass index of 18.5 to 25) is modest, with no recommended increase in calorie intake during the first trimester and an increase of only 340 and 450 kcal/day in the second and third trimesters, respectively. This generally equates to only 2 to 3 additional Canada’s Food Guide servings per day from any of the 4 food groups in the second and third trimesters. (III) Energy requirements for women with a pre-pregnancy body mass index above 25 kg/m are not well established.
Recommendations
- 1.Measure and discuss weight gain for pregnancy with all women as early in pregnancy and as regularly as is feasible. Recommendations for the range of pregnancy-related weight gain should be based on the woman’s pre-pregnancy body mass index (Table 6). Gaining weight within recommended ranges will help to optimize maternal, infant, and child health outcomes. (III-A)
- 2.Women who have not met the minimum or have exceeded the maximum amount of weight gain recommended for a specific gestational age require additional follow-up and assessment. They should be encouraged to increase or slow their rate of weight gain to fall within the recommended ranges of weekly rate of gain until delivery. (III-A)
- 3.Support women in understanding how to meet recommendations for specific nutrients of concern during pregnancy, which include folate, iron, choline, omega-3 fatty acids, and iodine. (III-A)
- 4.Follow the 2015 Society of Obstetricians and Gynaecologists of Canada guideline for the supplementary use of folic acid by pregnant women. Pregnant women at low or moderate risk for bearing an offspring with a neural tube defect should consume 0.4 and 1 mg folic acid, respectively, in a daily multivitamin or if they are at high risk for bearing offspring with neural tube defects, a 4.0 mg folic acid supplement 12 weeks prior to and after conception followed by 0.4 to 1 mg until weaning. (II-2A) Caution women not to take more than 1 daily dose of their multivitamin. (III-B)
- 5.Recommend a supplement containing 16 to 20 mg of elemental iron to pregnant women who are in good health. Therapeutic doses of iron may be required for women demonstrating biochemical evidence of iron deficiency. (e.g., a low hemoglobin and a serum ferritin <30 ug/L at any point during pregnancy). (I-A)
- 6.Emerging evidence suggests that choline (II-2B), omega-3 fatty acids (I-A), and iodine (I-B) are important nutrients that may be limited in the diets that pregnant women consume. Discuss foods rich in these nutrients (e.g., eggs for choline; fatty fish and nuts/seeds for omega-3 fatty acids; saltwater fish low in methylmercury; and iodized salt) with women as the pregnancy progresses.
- 7.Emphasize the importance of limiting or avoiding certain foods during pregnancy (e.g., avoid foods potentially contaminated with bacteria and fish with high levels of methylmercury). Many herbs should be limited or avoided during pregnancy (Appendix B). (III-A)
- 8.Follow the 2010 Society of Obstetricians and Gynaecologists of Canada guideline for alcohol use during pregnancy. There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2A) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III-C)
Chapter 6: Postpartum Nutrition and Lactation
Summary Statements
- 1.Optimal postpartum nutrition can be achieved by consuming a high-quality and varied diet following Canada’s Food Guide. The elevated nutritional requirements of breastfeeding women can be met by consuming 2 to 3 extra servings each day from any of the 4 groups from Canada’s Food Guide and a multivitamin supplement, as during pregnancy. These extra servings will supply the modest increase in energy requirements to support lactation (∼ 350 to 400 kcal over pre-pregnancy requirements). (III)
- 2.Gradual weight loss postpartum to achieve pre-pregnancy weight and a healthy body weight is encouraged. There is little evidence that either breastmilk volume or nutrient content is adversely affected by gradual postpartum weight loss and exercise. (I)
- 3.Breastfeeding is the normal and unequalled method of feeding infants. Exclusive breastfeeding should be encouraged for the first 6 months, and sustained for up to 2 years or longer, with appropriate complementary feeding of infants. (I)
Recommendations
- 1.Emphasize the need for appropriate nutrition to achieve a healthy body weight postpartum (I-A) and promote lactation. (II-2B)
- 2.Discuss the benefits of exclusive breastfeeding for improving short- and long-term health outcomes for the mother and infant. (II-2A)
- 3.A reduction in caloric intake of 500 kcal/day and participation in moderate aerobic exercise (walking, jogging, dancing; 65% to 80% maximum heart rate) 4 days per week should promote a gradual measured weight loss of 0.5 kg/week postpartum. (I-A)
- 4.Advise lactating mothers to provide their infants with 400 IU of vitamin D per day. (I-A)
- 5.Women should consume at least 150 g of fish each week, as fatty fish are an important source of docosahexaenoic acid. However, lactating women need to limit consumption of tuna, shark, swordfish, marlin, orange roughy, and escolar to < 150 g per month. Lactating women should avoid canned albacore (white) tuna, but may consume up to 300 g/week of light canned tuna. (III-A)
- 6.Maternal intake of allergy and infant colic-associated foods (dairy, eggs, peanuts, tree nuts, wheat, soy, and fish) and cruciferous vegetables, cow’s milk, onion, and chocolate have been associated with colic symptoms in exclusively breastfed young infants, but not allergy formation in the child. Eliminate foods one at a time to determine association with infant symptoms. (I-B)
- 7.Bulk-forming laxatives (psyllium or methylcellulose) are not absorbed by the gut and should not have negative consequences for the breastfed infant. Stimulant laxatives should be avoided. (III-A)
- 8.Women with hemorrhoids or perineal injury are advised to eat a high-fibre diet along with adequate water intake (Table 7). (I-A)
Chapter 7: Nutrition During Menopause and Beyond
Summary Statement
- 1.Changes in women’s health, social, or family circumstances at the time of menopause may adversely impact nutrition (e.g., changes in meal habits, distracted eating, ill health, mood, family stresses). (III)
Recommendations
- 1.Women are often concerned with perimenopausal weight gain; advise that weight gain can be reduced by modest calorie restriction, along with adequate protein intake (0.8 to 1.2 g/kg divided over 3 meals). (III-B)
- 2.Insulin resistance increases with age; recommend that menopausal women consume complex carbohydrates with a low glycemic index. (II-2B)
- 3.Recommend regular, weight-bearing exercise to preserve skeletal muscle mass. (I-A)
- 4.To preserve bone health, advise a daily intake of 1200 mg calcium and 800 IU vitamin D to menopausal women, along with regular moderate- to vigorous-intensity physical activity of at least 2.5 hours per week which includes weight-bearing activity (see Chapter 2 for more detail on calcium supplementation). (I-A)
- 5.Menopausal women are less likely to absorb naturally occurring vitamin B12 (II-2A) and should aim to consume 2.4 μg/day through fortified foods (e.g., non-dairy milks, meat substitutes) or supplements, and may benefit from having their B12 status assessed. (I-A)
Key Words
Abbreviations:
AI (adequate intake), ALA (alpha-linolenic acid), BMI (body mass index), CFG (Canada’s Food Guide), CPNP (Canada Prenatal Nutrition Program), CVD (cardiovascular disease), DASH (Dietary Approaches to Stop Hypertension), DHA (docosahexaenoic acid), DRI (Dietary Reference Intakes), EAR (estimated average requirement), GDM (gestational diabetes mellitus), GWG (gestational weight gain), LGA (large for gestational age), NTD (neural tube defect), PCOS (polycystic ovary syndrome), PHAC (Public Health Agency of Canada), RDA (recommended dietary allowance), SGA (small for gestational age), SOGC (Society of Obstetricians and Gynaecologists of Canda), UL (tolerable upper intake level), WHI (Women’s Health Initiative)To read this article in full you will need to make a payment
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- Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic acid fortification.Pediatrics. 2009; 123: 917-923
- Vitamin B12, folic acid, and the nervous system.Lancet Neurol. 2006; 5: 949-960
- Update on vitamin B12 deficiency.Am Fam Physician. 2011; 83: 1425-1430
- Dietary Reference Intakes for calcium and vitamin D.The National Academies Press, Washington, DC2011
International Osteoporosis Foundation. Calcium Calculator. 2015. Available at: http://www.iofbonehealth.org/calcium-calculator. Accessed on November 17, 2015.
Dietitians of Canada. EaTracker. 2015. Available at: https://www.eatracker.ca/. Accessed on August 14, 2015.
- A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada.J Nutr. 2012; 142: 534-540
- Bone health after menopause.Curr Opin Endocrinol Diabetes Obes. 2015; 22: 490-494
- The vitamin status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use.Am J Clin Nutr. 2011; 94: 128-135
- Vitamin D levels and relative insufficiency in Saskatchewan.Clin Biochem. 2013; 46: 1489-1492
- Standardizing 25-hydroxyvitamin D values from the Canadian Health Measures Survey.Am J Clin Nutr. 2015; 102: 1044-1050
- Vitamin D supplementation: recommendations for Canadian mothers and infants. Position Statement of the Canadian Paediatric Society.Paediatr Child Health. 2007; 12: 583-589
- Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada.Can Med Assoc J. 2010; 182: E610-E618
- Obesity and vitamin D deficiency: a systematic review and meta-analysis.Obes Rev. 2015; 16: 341-349
- Vitamin D and calcium: updated Dietary Reference Intakes. Health Canada, Ottawa2012
Canada Gazette Part II. Food and drug regulations - amendment SOR/96-527, 130:3318–3320, 1996.
- Folate status of the population in the Canadian Health Measures Survey.Can Med Assoc J. 2011; 183: E100-E106
- Population red blood cell folate concentrations for prevention of neural tube defects: bayesian model.BMJ. 2014; 349: g4554
- Folate levels and neural tube defects. Implications for prevention.JAMA. 1995; 274: 1698-1702
- Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age.Appl Physiol Nutr Metab. 2012; 2-12: 284-292
- Prevalence and correlates of folic acid supplement use in Canada.Health Rep. 2012; 23: 39-44
- Socio-demographic and lifestyle factors associated with folate status among non-supplement-consuming Canadian women of childbearing age.Can J Public Health. 2014; 105: e166-e171
- Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.J Obstet Gynaeol Can. 2015; 37: 534-549
- Nutritional consequences of celiac disease and the gluten-free diet.Expert Rev Gastroenterol Hepatol. 2014; 8: 123-129
- Modeling demonstrates that folic acid fortification of whole-wheat flour could reduce the prevalence of folate inadequacy in Canadian whole-wheat consumers.J Nutr. 2015; 145: 2622-2629
- A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004.J Am Diet Assoc. 2011; 111: 819-827
- Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets.J Am Diet Assoc. 2009; 109: 1266-1282
- Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review.BJOG. 2015; 122: 623-633
- The skeletal muscle anabolic response to plant- versus animal-based protein consumption.J Nutr. 2015; 145: 1981-1991
- Plant proteins in relation to human protein and amino acid nutrition.Am J Clin Nutr. 1994; 59: 1203S-1212S
- Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.Circulation. 2002; 106: 2747-2757
- The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.J Perinat Med. 2008; 36: 5-14
- Feeding and eating disorders.(DSM-5)in: American Psychiatric Assocition Diagnostic and statistical manual of mental disorders. 5th edition. American Psychiatric Association, Arlington, VA2013
- Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders.J Am Diet Assoc. 2011; 111: 1236-1241
- Assessment measures for child and adolescent eating disorders: a review.Child Adolesc Mental Health. 2010; 16: 122-127
- Identification and management of eating disorders in children and adolescents.Pediatrics. 2010; 126: 1240-1253
- Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents.Am Fam Physician. 2001; 64: 445-450
- Eating disorders, fertility, and pregnancy: relationships and complications.J Perinat Neonatal Nurs. 2001; 15: 36-48
- The human microbiome: at the interface of health and disease.Nat Rev Genet. 2012; 13: 260-270
- Obesity alters gut microbial ecology.Proc Natl Acad Sci U S A. 2005; 102: 11070-11075
- The impact of the gut microbiota on human health: an integrative view.Cell. 2012; 148: 1258-1270
- Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa.Proc Natl Acad Sci U S A. 2010; 107: 14691-14696
- Review article: dietary fibre-microbiota interactions.Aliment Pharmacol Ther. 2015; 42: 158-179
- Dietary effects on human gut microbiome diversity.Br J Nutr. 2015; 113: S1-S5
Chapter 3: Adolescent Nutrition
- The protective role of family meals for youth obesity: 10-year longitudinal associations.J Pediatr. 2015; 166: 296-301
- Family meals and substance use: is there a long-term protective association?.J Adolesc Health. 2008; 43: 151-156
- Correlations between family meals and psychosocial well-being among adolescents.Arch Pediatr Adolesc Med. 2004; 158: 792-796
- Family dinner meal frequency and adolescent development: relationships with developmental assets and high-risk behaviors.J Adolesc Health. 2006; 39: 337-345
Dietitians of Canada. WHO Growth Charts. Available at: www.whogrowthcharts.ca Accessed on April 28, 2016.
Dietitians of Canada. BMI Calculator for Children and Teens. 2014. Available at: www.whogrowthcharts.ca Accessed on April 28, 2016.
- Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care.CMAJ. 2015; 187: 411-421
- Recommendations for the treatment of child and adolescent overweight and obesity.Pediatrics. 2007; 120: S254-S288
- Childhood obesity: Causes, consequences, and management.Pediatr Clin North Am. 2015; 62: 821-840
- Overweight and obesity in Canadian adolescents and their associations with dietary habits and physical activity patterns.J Adolesc Health. 2004; 35: 360-367
- Associations between the use of social networking sites and unhealthy eating behaviours and excess body weight in adolescents.Br J Nutr. 2015; 114: 1941-1947
- Dietary Reference Intakes for calcium and vitamin D.The National Academies Press, Washington, DC2011
- Optimizing bone health and calcium intakes of infants, children and adolescents.Pediatrics. 2006; 117: 578-585
- A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada.J Nutr. 2012; 142: 534-540
- Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D.Am J Clin Nutr. 2013; 97: 72-78
- The vitamin status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use.Am J Clin Nutr. 2011; 94: 128-135
- Identification and management of eating disorders in children and adolescents.Pediatrics. 2010; 126: 1240-1253
Canadian Paediatric Society. Dieting in Adolescence. 2014. Available at: http://www.cps.ca/documents/position/dieting-adolescence. Accessed on August 20, 2015.
- Assessment measures for child and adolescent eating disorders: a review.Child Adolesc Mental Health. 2010; 16: 122-127
- Eating disorders in adolescents: position paper of the Society for Adolescent Medicine.J Adolesc Health. 2003; 33: 496-503
- Position of the American Dietetic Association: Nutrition intervention in the treatment of eating disorders.J Am Diet Assoc. 2011; 111: 1236-1241
- Feeding and eating disorders.(DSM-5)in: American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association, Arlington, VA2013
Canadian Pediatric Society. Condition-Specific Screening Tools and Rating Scales. 2014. Available at: http://www.cps.ca/en/tools-outils/condition-specific-screening-tools-and-rating-scales#eating-disorders. Accessed on August 20, 2015.
- Reliability testing of a children’s version of the Eating Attitude Test.J Am Acad Child Adolesc Psychiatry. 1988; 27: 541-543
- Update on the medical management of eating disorders in adolescents.J Adolesc Health. 2015; 56: 370-375
- Position paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults.J Adolesc Health. 2015; 56: 121-125
Chapter 4: Pre-conceptual Nutrition
- Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.Perspect Sex Reprod Health. 2006; 38: 90-96
- Weight gain during pregnancy: adherence to Health Canada’s Guidelines.Health Rep. 2010; 21: 31-36
- Maternal obesity and risk of caesarean delivery: A meta-analysis.Obes Rev. 2007; 8: 385-394
Health Canada. Prenatal Nutrition Guidelines for Health Professionals. Gestational Weight Gain. 2010. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-eng.php. Accessed April 16, 2016.
- Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes.Am J Obstet Gynecol. 2010; 202: 574-578
Tjepkema M. Measured obesity. Adult obesity in Canada: measured height and weight. 2005. Available at: http://aboutmen.ca/application/www.aboutmen.ca/asset/upload/tiny_mce/page/link/Adult-Obesity-in-Canada.pdf. Accessed on April 16, 2016.
- Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis.Obes Rev. 2009; 10: 194-203
- Outcomes of maternal weight gain [evidence report/technology assessment No, 168].Agency for Healthcare Research and Quality, Rockville, MD2008
- Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses.BMJ. 2010; 341: c3428
- Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum.Pediatrics. 2004; 113: e465-e471
- Systematic review of maternal obesity and breastfeeding intention, initiation and duration.BMC Pregnancy Childbirth. 2007; 4: 9
- Maternal underweight and the risk of spontaneous abortion.Acta Obstet Gynecol Scand. 2005; 84: 1197-1201
- International comparison of common risk factors of preterm birth between the U.S. and Canada, using PRAMS and MES (2005-2006).Matern Child Health J. 2015; 19: 811-818
- Impact of weight loss between pregnancies on recurrent preterm birth.Am J Obstet Gynecol. 2006; 195: 818-821
- Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.J Obstet Gynaecol Can. 2015; 37: 534-549
- Prepregnancy dietary patterns and risk of pregnancy loss.Am J Clin Nutr. 2014; 100: 1166-1172
- Population study of causes, treatment, and outcome of infertility.BMJ. 1985; 291: 1693-1697
- Body mass and probability of pregnancy during assisted reproduction treatment: retrospective study.BMJ. 2000; 321: 1320-1321
- Effects of physical exercise on the female reproductive system.Minerva Endocrinol. 2013; 38: 305-319
- Menstrual dysfunction in anorexia nervosa.J Pediatr Adolesc Gynecol. 2004; 17: 81-85
- Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction.Am J Physiol Endocrinol Metab. 2015; 308: E29-E39
- Obesity and reproduction: a committee opinion.Fertil Steril. 2015; 104: 1116-1126
- Pregnancy outcomes decline with increasing recipient body mass index: an analysis of 22,317 fresh donor/recipient cycles from the 2008-2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry.Fertil Steril. 2016; 105: 364-368
- Metabolic syndrome: polycystic ovary syndrome.FP Essent. 2015; 435: 30-42
- Obesity and the polycystic ovary syndrome.Int J Obes Relat Metab Disord. 2002; 26: 883-896
- Ovulation induction in polycystic ovary syndrome - clinical guideline.J Obstet Gynaecol Can. 2010; 32: 495-502
- Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome.Am J Clin Nutr. 2010; 92: 83-92
Canadian Diabetes Association. The Glycemic Index. 2015. Available at: http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/the-glycemic-index. Accessed on November 13, 2015.
- A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility.Eur J Clin Nutr. 2009; 63: 78-86
- Diet and lifestyle in the prevention of ovulatory disorder infertility.Obstet Gynecol. 2007; 110: 1050-1058
- A prospective cohort study of vitamins B, C, E, and multivitamin intake and endometriosis.J Endometr. 2013; 5: 17-26
- The use of mitochondrial nutrients to improve the outcome of infertility in older patients.Fertil Steril. 2010; 93: 272-275
- A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia.Fertil Steril. 2004; 81: 1578-1584
Chapter 5: Nutrition in Pregnancy
Health Canada. Canada’s Food Guide: Pregnancy and Breastfeeding. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php. Accessed on November 17, 2015.
Health Canada. Prenatal Nutrition. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php. Accessed on November 17, 2015.
- Physiology of pregnancy and nutrient metabolism.Am J Clin Nutr. 2000; 71: 1218S-1225S
- Effect of in utero and early-life conditions on adult health and disease.N Engl J Med. 2008; 359: 61-73
- The nutritional basis of the fetal origins of adult disease.Int J Epidemiol. 2001; 30: 15-23
- Nutrition in early life and the programming of adult disease: a review.J Hum Nutr Diet. 2015; 28: 1-14
- Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.The National Academies Press, Washington, DC2005
- Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies.BMJ. 2015; 351: h3978
- Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations.J Nutr. 2015; 145: 73-78
Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining the Guidelines. 2009. Available at: http://www.nap.edu/catalog.php?record_id=12584. Accessed on November 17, 2015.
Health Canada. Prenatal Nutrition Guidelines for Health Professionals. Gestational Weight Gain. 2010. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-eng.php. Accessed on April 16, 2016.
- Weight loss instead of weight gain within the guidelines in obese women during pregnancy: a systematic review and meta-analyses of maternal and infant outcomes.PLoS One. 2015; 10: e0132650
- Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index.J Matern Fetal Neonatal Med. 2011; 25: 538-542
- Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy.Obesity. 2013; 21: 1046-1055
- Maternal obesity: pregnancy complications, gestational weight gain and nutrition.Obes Rev. 2008; 9: 140-150
- The association between pregnancy weight gain and birthweight: a within-family comparison.Lancet. 2010; 376: 984-990
- Weight gain during pregnancy: adherence to Health Canada’s Guidelines.Health Rep. 2010; 21: 31-36
- Maternal prepregnant body mass index and gestational weight gain are associated with initiation and duration of breastfeeding among Norwegian mothers.J Nutr. 2015; 145: 1263-1270
- The effect of gestational weight gain by body mass index on maternal and neonatal outcomes.J Obstet Gynaecol Can. 2009; 31: 28-35
- Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada.BMC Pregnancy Childbirth. 2015; 15: 21
- Obesity and early cessation of breastfeeding in Denmark.Eur J Public Health. 2013; 23: 316-322
- Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis.Obes Rev. 2013; 15: 338-347
- Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis.Pediatr Obes. 2013; 8: 218-224
- Gestational weight gain and child adiposity at age 3 years.Am J Obstet Gynecol. 2007; 196: 322-328
- Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood.Int J Obes. 2010; 34: 67-74
- Maternal outcomes in pregnancies complicated by obesity.Obstet Gynecol. 2005; 106: 1357-1364
- Trends in pre-pregnancy obesity in nine states, 1993-2003.Obesity (Silver Spring). 2007; 15: 986-993
- Preconception predictors of weight gain during pregnancy: prospective findings from the Central Pennsylvania Women’s Health Study.Womens Health Issues. 2010; 20: 126-132
- Determinants of healthy eating in Aboriginal peoples in Canada: the current state of knowledge and research gaps.Can J Public Health. 2005; 96: S32-S41
- Gestational weight gain in obese mothers and associations with fetal growth.Am J Clin Nutr. 2010; 92: 644-651
- Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes.Am J Obstet Gynecol. 2010; 202: 574-578
- Outcomes of maternal weight gain [evidence report/technology assessment No. 168].Agency for Healthcare Research and Quality, Rockville, MD2008
- Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study.BMJ. 2016; 352: i555
- Committee on Implementation of the Institute of Medicine Pregnancy Weight Gain Guidelines, Board on Children, Youth, and Families, Food and Nutrition Board, Institute of Medicine, National Research Council. Leveraging action to support dissemination of the pregnancy weight gain guidelines.(Workshop summary) The National Acadmies Press, Washington, DC2013
- Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial.Int J Obes. 2013; 37: 814-821
- Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial.Obesity. 2013; 21: 904-909
- Iron sufficiency of Canadians.Health Rep. 2012; 23: 3-10
- The iron status of Canadian adolescents and adults: current knowledge and practical implications.Can J Diet Pract Res. 2006; 67: 130-138
- Pregnant Canadian women achieve recommended intakes of one-carbon nutrients through prenatal supplementation but the supplement composition, including choline, requires reconsideration.J Nutr. 2015; 145: 1824-1834
- Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.The National Academies Press, Washington, DC1998
- Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.The National Academies Press, Washington, DC2001
- Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.J Obstet Gynaecol Can. 2015; 37: 534-549
- Folate, vitamin B12, and vitamin B6 status of a group of high socioeconomic status women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort.Appl Physiol Nutr Metab. 2014; 39: 1402-1408
- [6S]-5-Methyltetrahydrofolate is at least as effective as folic acid in preventing a decline in blood folate concentrations during lactation.Am J Clin Nutr. 2006; 83: 842-850
- High concentrations of folate and unmetabolized folic acid in a cohort of pregnant Canadian women and umbilical cord blood.Am J Clin Nutr. 2015; 102: 848-857
- Moderately high intake of folic acid has a negative impact on mouse embryonic development.Birth Defects Res A Clin Mol Teratol. 2013; 97: 47-52
- High intake of folic acid disrupts embryonic development in mice.Birth Defects Res A Clin Mol Teratol. 2011; 91: 8-19
- Excess perigestational folic acid exposure induces metabolic dysfunction in post-natal life.J Endocrinol. 2015; 224: 245-259
- Folic acid supplementation during pregnancy induces sex-specific changes in methylation and expression of placental 11beta-hydroxysteroid dehydrogenase 2 in rats.PLoS One. 2015; 10: e0121098
- Maternal nutritional status, C(1) metabolism and offspring DNA methylation: a review of current evidence in human subjects.Proc Nutr Soc. 2012; 71: 154-165
- Is folate status a risk factor for asthma or other allergic diseases?.Allergy Asthma Immunol Res. 2015; 7: 538-546
- Iron status during pregnancy: setting the stage for mother and infant.Am J Clin Nutr. 2005; 81: 1218S-1222S
- Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.BMJ. 2013; 346: f3443
- Daily oral iron supplementation during pregnancy.Cochrane Database Syst Rev. 2012; 12: CD004736
- Application of the Dietary Reference Intakes in developing a recommendation for pregnancy iron supplements in Canada.Am J Clin Nutr. 2009; 90: 1023-1028
- Effect of iron content on the tolerability of prenatal multivitamins in pregnancy.BMC Pregnancy Childbirth. 2008; 8: 17
World Health Organization. Daily iron and folic acid supplementation during pregnancy. Available from: http://www.who.int/elena/titles/guidance_summaries/daily_iron_pregnancy/en/. Accessed March 22nd 2016
- The effectiveness of discontinuing iron-containing prenatal multivitamins on reducing the severity of nausea and vomiting of pregnancy.J Obstet Gynaecol. 2009; 29: 13-16
- Intermittent oral iron supplementation during pregnancy.Cochrane Database Syst Rev. 2012; 7: CD009997
- Choline: critical role during fetal development and dietary requirements in adults.Annu Rev Nutr. 2006; 26: 229
- Periconceptional dietary intake of choline and betaine and neural tube defects in offspring.Am J Epidemiol. 2004; 160: 102-109
- A higher maternal choline intake among third-trimester pregnant women lowers placental and circulating concentrations of the antiangiogenic factor fms-like tyrosine kinase-1 (sFLT1).FASEB J. 2013; 27: 1245-1253
- Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans.FASEB J. 2012; 26: 3563-3574
- Estimation of choline intake from 24 h dietary intake recalls and contribution of egg and milk consumption to intake among pregnant and lactating women in Alberta.Br J Nutr. 2014; 112: 112-121
- Maternal choline status, but not fetal genotype, influences cord plasma choline metabolite concentrations.J Nutr. 2015; 145: 1491-1497
- Omega-3 fatty acids and pregnancy.Rev Obstet Gynecol. 2010; 3: 163-171
- The effect of maternal omega-3 (n-3) LCPUFA supplementation during pregnancy on early childhood cognitive and visual development: a systematic review and meta-analysis of randomized controlled trials.Am J Clin Nutr. 2013; 97: 531-544
Health Canada. Prenatal Nutrition Guidelines for Health Professionals: Fish and Omega-3 Fatty Acids. 2009. Available at: http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/pubs/omega3-eng.pdf. Accessed on November 17, 2015.
- Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review.Paediatr Perinat Epidemiol. 2012; 26: 91-107
- Omega-3 supplementation during pregnancy to prevent recurrent intrauterine growth restriction: systematic review and meta-analysis of randomized controlled trials.Ultrasound Obstet Gynecol. 2015; 46: 659-664
- Iodine insufficiency: a global health problem?.Adv Nutr. 2013; 4: 533-535
Canadian Food Inspection Agency. Labelling Requirements for Salt: Iodide Declaration. 2015. Available at: http://inspection.gc.ca/food/labelling/food-labelling-for-industry/salt/eng/1391790253201/1391795959629?chap=5#s6c5. Accessed on August 23, 2015.
Statistics Canada. Iodine Status of Canadians, 2009-2011. 2013. Available at: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11733-eng.htm. Accessed on August 23, 2015.
- Assessment of iodine nutrition in populations: past, present, and future.Nutr Rev. 2012; 70: 553-570
- Urinary iodine concentration: United States National Health and Nutrition Examination Survey 2001-2002.Thyroid. 2005; 15: 692-699
- Some subgroups of reproductive age women in the United States may be at risk for iodine deficiency.J Nutr. 2010; 140: 1489-1494
- Improvement in iodine status of pregnant Australian women 3 years after introduction of a mandatory iodine fortification programme.Prev Med. 2013; 57: 26-30
- Iodine status in Danish pregnant and breastfeeding women including studies of some challenges in urinary iodine status evaluation.J Trace Elem Med Biol. 2015; 31: 285-289
- Gestational changes in iodine status in a cohort study of pregnant women from the United Kingdom: season as an effect modifier.Am J Clin Nutr. 2015; 101: 1180-1187
- Iodine status in pregnancy: role of dietary habits and geographical origin.Clin Endocrinol (Oxf). 2009; 70: 776-780
Public Health Agency of Canada. Summative Evaluation of the Canada Prenatal Nutrition Program 2004-2009. 2010. Available at: http://www.phac-aspc.gc.ca/about_apropos/evaluation/reports-rapports/2009-2010/cpnp-pcnp/index-eng.php. Accessed on April 16, 2016.
- Nausea and vomiting of pregnancy.Gastroenterol Clin North Am. 2011; 40 (vii): 309-334
- A prospective study of nausea and vomiting during pregnancy.Br J Gen Pract. 1993; 43: 245-248
- The management of nausea and vomiting of pregnancy.J Obstet Gynaecol Can. 2002; 24 (quiz 32–3): 817-831
- Alcohol use and pregnancy consensus clinical guidelines.J Obstet Gynaecol Can. 2010; 32: S1-S31
Chapter 6: Postpartum Nutrition and Lactation
- Breastfeeding and maternal and infant health outcomes in developed countries [evidence report/technology assessment No. 153].Agency for Healthcare Research and Quality, Rockville, MD2007
- Obesity levels in a national cohort of women 9 months after delivery.Am J Obstet Gynecol. 2013; 209: 124.e1-124.e7
- Interpregnancy body mass index change and success of vaginal birth after cesarean.Am J Obstet Gynecol. 2014; 210: 330.e1-330.e7
- Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review.Matern Child Nutr. 2014; 10: 166-183
- Early-life determinants of overweight and obesity: a review of systematic reviews.Obes Rev. 2010; 11: 695-708
- Breastfeeding and maternal health outcomes: a systematic review and meta-analysis.Acta Paediatr. 2015; 104: 96-113
- Breastfeeding and maternal and infant health outcomes in developed countries.AAP Grand Rounds. 2007; 18: 15-16
- Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum.Pediatrics. 2004; 113: e465-e471
- Recombinant human prolactin for the treatment of lactation insufficiency.Clin Endocrinol (Oxf). 2010; 73: 645-653
- Effects of recombinant human prolactin on breast milk composition.Pediatrics. 2011; 127: e359-e366
Health Canada. Canada’s Food Guide: Pregnancy and Breastfeeding. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php. Accessed on November 17, 2015.
- Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.J Obstet Gynaecol Can. 2015; 37: 534-549
- Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.The National Academies Press, Washington, DC2005
- Postpartum weight retention risk factors and relationship to obesity at 1 year.Obstet Gynecol. 2015; 125: 144-152
- Weight gain during pregnancy: reexamining the guidelines.The National Academies Press, Washington, DC2009
- Gestational weight gain and early postpartum weight retention in a prospective cohort of Alberta women.J Obstet Gynaecol Can. 2012; 34: 637-647
- How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis.Am J Clin Nutr. 2014; 99: 312-319
National Institute for Clinical Health and Excellence. Weight Management Before, During and After Pregnancy. 2010. Available at: https://www.nice.org.uk/guidance/ph27. Accessed on November 17, 2015.
- Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care.Can Med Assoc J. 2015; 187: 184-195
- Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.Can Med Assoc J. 2007; 176 ([summary]): S1-S13
- Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care.CMAJ. 2015; 187: 411-421
- Recommendations for the treatment of child and adolescent overweight and obesity.Pediatrics. 2007; 120: S254-S288
- Nutrition issues during lactation.in: Lammi-Keefe C.J. Couch S.C. Elliot H. Handbook of nutrition and pregnancy. Humana Press, Totowa, NJ2008: 257-282
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- Society of Obstetricians and Gynaecologists of Canada, SOGC Clinical Practice Obstetrics Committee. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period.Can J Appl Physiol. 2003; 28: 330-341
- Diet or exercise, or both, for weight reduction in women after childbirth.Cochrane Database Syst Rev. 2007; 18: CD005627
- Balancing exercise and food intake with lactation to promote post-partum weight loss.Proc Nutr Soc. 2011; 70: 181-184
- The effect of weight loss in overweight, lactating women on the growth of their infants.N Engl J Med. 2000; 342: 449-453
- Breast-feeding and postpartum weight retention: a systematic review and meta-analysis.Public Health Nutr. 2015; 18: 3308-3316
- The relationship between breastfeeding and postpartum weight change—a systematic review and critical evaluation.Int J Obes (Lond). 2014; 38: 577-590
- Postpartum dietary changes in women with previous gestational diabetes mellitus.Can J Diabetes. 2007; 31: 54-61
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- B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function.Adv Nutr. 2012; 3: 362-369
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- Dietary Reference Intakes for vitamin C, vitamin E, selenium, and carotenoids.The National Academies Press, Washington, DC2000
- The CDC’s second national report on biochemical indicators of diet and nutrition in the U.S. population is a valuable tool for researchers and policy makers.J Nutr. 2013; 143: 938S-947S
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- Urinary iodine concentration: United States National Health And Nutrition Examination Survey 2001-2002.Thyroid. 2005; 15: 692-699
- Some subgroups of reproductive age women in the United States may be at risk for iodine deficiency.J Nutr. 2010; 140: 1489-1494
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- Dietary Reference Intakes for calcium and vitamin D.The National Academies Press, Washington, DC2011
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- Impact of maternal diet on human milk composition and neurological development of infants.Am J Clin Nutr. 2014; 99: 734S-741S
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- The controversial role of food allergy in infantile colic: evidence and clinical management.Nutrients. 2015; 7: 2015-2025
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- Infantile colic: is there a role for dietary interventions?.Paediatr Child Health. 2011; 16: 47-49
- Recognizing cow’s milk protein allergy in infants - evidence shows eliminating milk and soy can help.Today’s Dietitian. 2012; 14: 14
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- Alcohol and breastfeeding: dispelling the myths and promoting the evidence.Nurs Womens Health. 2010; 14: 454-461
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- Dietary changes during pregnancy and the postpartum period in Singaporean Chinese, Malay and Indian women: the GUSTO birth cohort study.Pub Health Nutr. 2014; 17: 1930-1938
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- The impact of becoming a mother on eating problems.Int J Eat Disord. 2008; 41: 215-223
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- Pregnancy and postpartum bowel changes: constipation and fecal incontinence.Am J Gastroenterol. 2015; 110 (quiz 30): 521-529
- Breastfeeding and over-the-counter medications.J Hum Lact. 2000; 16: 319-331
- Effect of prune supplementation on dietary fiber intake and constipation relief.Korean J Community Nutr. 2008; 13: 426-438
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- Interventions for treating postpartum constipation.Cochrane Database Syst Rev. 2014; 9: CD010273
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Chapter 7: Nutrition During Menopause and Beyond
- Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging.Menopause. 2012; 19: 387-395
- Television-viewing characteristics of adults: correlations to eating practices and overweight and health status.Prev Chronic Dis. 2006; 3: A38
- Optimism and diet quality in the Women’s Health Initiative.J Acad Nutr Diet. 2014; 114: 1036-1045