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Recommendations Med J Aust 2000; 173 Suppl 6 November: S110-S111 The link between nutrition, physical activity, lifestyle factors and psychological well-being should be assimilated into any preventive or treatment regimen for women aged 40 and over. I. Focus on healthy eating Food variety has been shown to benefit health and is associated with longevity. Between 20 and 30 different foods can be consumed each day by selecting foods from each of the food groups, including a variety of grains, an assortment of fruits and vegetables, nuts and seeds. A guide to the number of servings of foods and a sample menu plan are provided in Box 3. Nutrient density: Emphasis should be placed on incorporating foods that provide the nutrients most likely to be deficient in the diet of women aged 40 and over, specifically calcium, zinc and dietary fibre. Lower intakes of these nutrients correlate with low intakes of foods which are good sources of these nutrients, namely fortified breakfast cereals; dairy products such as milk, yoghurt and cheese; fruits, vegetables, red meat, fish and seafood. Antioxidants and dietary fibre: Women with higher dietary intakes of vitamins A, C, E and fibre have a lower risk of breast cancer. When dietary requirements are met, large amounts of antioxidant vitamins A, C and E, taken as supplements, do not appear to protect against breast cancer. The multiple nutrients in foods such as vegetables may have a synergistic effect on breast cancer risk. Reduced alcohol consumption by women who consume excess alcohol on a regular basis may be a potential means of reducing breast cancer risk. Zinc intake should be increased through food sources such as oysters, lean red meat, fortified breakfast cereals and breads. Care must be taken when using zinc in a supplement form. II. Promotion of physical activity Regular physical activity combined with healthy eating is the key to weight management, bone and cardiovascular health and mental wellbeing. Moderate to vigorous physical activity for half an hour a day can reduce the risk of morbidity and mortality. To incorporate physical activity as a long term behavioural change, the type, duration, intensity and frequency of the activity needs to be realistic, achievable and pleasurable. III. Maintaining a healthy body weight Nutrition Emphasise consumption of minimally processed foods (eg, wholegrain breads and cereals, fruits and vegetables) low in saturated fats, and low fat, calcium-rich foods (refer to Box 3). Small amounts of fats can be included in the diet and should come from monounsaturated and polyunsaturated sources, such as olive and canola oils, fish, grains, nuts, seeds and legumes. Nutritious snacks are a means of topping up nutrient levels during the day The rate of weight loss needs to be gradual. Very low fat diets and quick weight-loss diets should be avoided as they can reduce lean body mass and promote weight regain. Physical activity Reduces total and central obesity, reducing the risk of type 2 diabetes, improves muscle insulin sensitivity and maintains lean muscle mass. See recommendations for healthy body weight. IV. Improving cardiovascular health Nutrition Diverse and balanced diets, rich in foods containing many nutrients, including antioxidants and phytoestrogens, can be safely recommended. Foods rich in antioxidants include fruits, vegetables, grains and garlic. Isolated supplements for prevention of cardiovascular disease are not recommended, as there are insufficient data to substantiate their efficacy. Women should be encouraged to increase their wholegrain intake, as eating at least one serving of wholegrain foods a day can substantially lower the risk of mortality from coronary heart disease. Women should avoid saturated fat and include more foods higher in monounsaturated and polyunsaturated fats (eg, fish, nuts, seeds, olive oil and canola oil). Physical activity See recommendations for healthy body weight. V. Improving bone health Nutrition Dairy foods provide the major, readily absorbed sources of calcium. Women aged 40 and over should consume 3-4 serves of low fat dairy food daily. Other, non-dairy sources of calcium include fortified breakfast cereals, canned fish with edible bones, some nuts, seeds and green vegetables. If calcium supplements are required, the best absorption rate is from a dose of 500-600mg of calcium once or twice daily. Avoid salty foods and adding salt to meals and during cooking. Vitamin D supplements may be necessary for elderly women with inadequate sun exposure. Physical activity Exercise that stresses the skeleton through the impact of weight-bearing exercise (eg, brisk walking, aerobics or tennis), or through muscle pull from resistance strength training, reduces the risk of osteoporosis by reducing bone loss. Exercise can reduce the risk of falls through improved muscle strength, balance and coordination. VI. Mental wellbeing Nutrition For overweight women weight loss can help improve mood (weight reduction should occur slowly). Omega 3 polyunsaturated fatty acids may play a role in mental wellbeing and other aspects of health, and foods rich in these fatty acids (eg, seafood, flax seed, canola oil, soybean oil, walnuts) should be consumed regularly. Regular meals and nutritious afternoon snacks may improve cognitive performance. Eating breakfast regularly improves mood and memory, and increases energy and promotes feelings of calmness. Physical activity Regular physical activity reduces depression and anxiety, improves mood and has been associated with increased ability to perform daily tasks.      to contributors... An initiative of The Jean Hailes Foundation Supported by Uncle Tobys Readers may print a single copy of these pages for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2000 Medical Journal of Australia. We appreciate your comments.