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Food Is Medicine and Menopause CVD Risk 

By Heather Davis, MS, RDN, LDN 

Understanding how to decrease risk for chronic diseases, such as CVD, associated with the menopausal transition and postmenopause is critical for supporting women’s health throughout the lifespan. CVD is a leading cause of death in women and research reveals that risk for this disease may increase significantly after menopause.1 The interplay between sex hormone changes, alterations in body composition, lipids, and other vascular health markers contributes to this concerning trend.1 How can nutrition help?

From the research on this topic, we know that general dietary patterns such as Mediterranean, low-sodium, low-fat, low-carbohydrate, and energy restriction have each been shown to improve CVD risk factors in menopausal women.2 For menopause, energy-restricted diets have improved CVD risk factors similar to the low-fat and low-carbohydrate diets but also reduced systolic blood pressure and improved the ratio of HDL to LDL, indicating energy-restrictive diets may provide similar, if not more, beneficial effects on CVD risk factors as low-fat and low-carbohydrate diets.2 However, there remains great variability in outcomes for women following these generalized dietary approaches and, ultimately, there’s no one-size-fits-all diet for reducing CVD risk in menopausal women. Precision nutrition is gaining experts’ interest as a way to further tailor dietary intervention at the individual level to maximize beneficial outcomes.2

Unique Nutrition Concerns in Menopause
Though some research suggests energy restriction can be beneficial for this population, recommending this as a primary intervention may not be adequate or appropriate as a nutrition intervention for every woman. For example, research done on dietary patterns in menopausal and postmenopausal women reveals a notable risk for sarcopenia, malnutrition, and protein insufficiency and deficiency.3 Furthermore, increased chronic disease risk, including CVD risk, in this population may be present in part due to increased oxidative and inflammatory stress associated with poor dietary quality, including poor nutrient density, and inadequate protein intake.3

Ensuring protein adequacy in menopause may be particularly important for attenuating CVD risk, among other chronic disease risk factors. The decline in estrogen with menopause is associated with a decrease in growth hormone, insulin-like growth factor, and dehydroepiandrosterone, a reduction in muscle protein synthesis, and an increase in catabolic factors, including the proinflammatory cytokines. The PROT-AGE expert group recommendations propose that healthy older adults consume no less than 1 to 1.2 g per kg per day to maintain muscle mass. The higher recommendations reflect the reduced ability of the skeletal muscle to respond to both amino acid and insulin levels, otherwise known as anabolic resistance, as well as the increased need for protein as estrogen decreases due to the associated chronic inflammation.3

Precision Nutrition in Menopause
Precision nutrition considers individual differences in genetics, metabolomics, socioeconomic demographics, and other environmental and lifestyle factors as part of what informs effective nutrition recommendations.2

The Personalized Responses to Dietary Composition Trial-1 (PREDICT-1) was the first in a series of large-scale, nutrition science studies designed to quantify and predict individual metabolic responses to different foods. When they compared cohort data collected from pre-, peri-, and postmenopausal women, postprandial glycemic responses and other metabolic health indicators (eg, abdominal or visceral fat) were worsened in the postmenopause group, not because of increasing age, per se, but due to altered hormonal status. As estrogen decreased, along with other hormonal changes, changes in glucose metabolism and the gut microbiome also occurred. This finding led researchers to conclude that nutritional strategies addressing both postprandial glycemic responses and the gut microbiome may blunt some of the negative effects of menopause on CVD risk factors.2,4

Isoflavone-rich soy foods may elevate levels of gut microbial derived estrogen like metabolites and, in turn, reduce markers of systemic inflammation. Other dietary approaches that can target improvements to postprandial glycemic responses include reducing added sugar, boosting intake of whole foods with relatively more intact food matrices, ensuring adequate fiber consumption, incorporating appropriate physical activity, and once again, ensuring protein adequacy.

Deeper genotyping studies exploring single nucleotide polymorphisms (SNPs) offer great promise in their eventual contribution to precision nutrition in practice, though are currently still in early stages of interpretation regarding their clinical relevance. Caution should still be exercised at this point when deriving dietary interventions from these test results, as it’s not yet fully understood how different SNPs interact, what phenotypic variation results, and to what degree nutrition interventions based on these results hold long-term clinical efficacy.2

Food Is Medicine and Precision Nutrition in Synergy
There’s no doubt that nutrition-focused interventions may support reduced CVD risk in many instances, including postmenopause. However, there’s an ongoing need for research examining the most optimal means of harnessing precision nutrition considerations when delivering Food Is Medicine (FIM) interventions in vulnerable populations.

Experts invested in building a closer working connection between FIM and precision nutrition note that identifying at-risk individuals, assessing biology and context, and identifying the type of food and intervention (medically tailored meals, medically tailored groceries, or other nutrition programs) will be crucial for integrating precision nutrition and FIM approaches. They argue that precision nutrition can thrive and coexist with population-level policies, including food safety and regulations, consumer education strategies, and other wellness programs. However, a policy shift from an overly generalized approach to addressing food and nutrition security through personalized dietary plans based on individual needs and responses is crucial. Advanced technological tools like machine learning show promise for scaling these complexities, led by interprofessional teams with dietitians’ expertise as a guiding force behind curriculum development and practical applications of interventions.6

— Heather Davis, MS, RDN, LDN, is editor of Today’s Dietitian.

References

1. El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;142(25):e506-e532.

2. Cabre HE, Woolf EK, Redman LM. Precision nutrition for management of cardiovascular disease risk during menopause. Lifestyle Genom. 2024;17(1):93-101.

3. Black KE, Matkin-Hussey P. The impact of protein in post-menopausal women on muscle mass and strength: a narrative review. Physiologia. 2024;4(3):266-285.

4. Genazzani AD, Petrillo T, Semprini E, et al. Metabolic syndrome, insulin resistance and menopause: the changes in body structure and the therapeutic approach. GREM. 2024;4(2):086-091.

5. O'Keefe JH, Gheewala NM, O'Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008;51(3):249-255.

6. Sinha S, Huey SL, Shukla AP, Kuriyan R, Finkelstein JL, Mehta S. Connecting precision nutrition with the Food is Medicine approach. Trends Endocrinol Metab. 2024;S1043-2760(24)00251-0.