Introduction
The menopause is the challenging period of time for a woman’s life marking the end of reproductive age and is an ongoing part of aging.1, 2, 3, 4, 5 According to WHO “menopause is a stage when the menstrual cycle ceases for over 12 months and there is fall down in the levels of the two responsible hormones in women’s body namely estrogen and progesterone.6 Drop in level of estrogen and progesterone produce two types of effects, one is of short-term effect of the symptoms and another is Long term effects.7 The short-term symptoms effect includes, hot flushes, irritability, depressions and mood swings, and Long-term effect includes Alzheimer’s disease, lower back ache, cardiovascular problems, joint pain, and brittle bone. Menopause normally occurs in mid forty between the age-group of 45-55 years.8 India is a country of large population, with 43 million of postmenopausal women and it is forecasted further to be 103 million by 2026.9 Sometimes before the age of 40 years, menopause occurs as a result of surgical removal irradiation or abnormalities of ovaries, or some more peri menopausal effects.10 The phases of menopause are recognized as chronologically decreasing of hormonal production associated with post-menopausal syndrome that reduce the quality of life of many women.11 Menopausal symptoms usually begin for 2 to 8 years prior to menopause, include mental abnormality, mood swings, anxiety, depressed feeling, irritability, lowered judgment, lowered psychomotor coordination, loss of memories, insomnia, loss of attention, tiredness, loneliness.12 Menopausal women have many of behavioral changes including, avoid social interaction, lowered work efficiency, staying alone.13 Balance diet and appropriate nutrient intake plays a vital role in maintaining health in menopausal women as well as all age-group while unhealthy diet and nutrient deficiencies may lead to obesity and various disorders.14
In Indian rural women suffer from poverty of economic and information insufficiency while India’s national economy has a vital and productive working share provided by the rural women.15
Best of our knowledge and searching’s available literature hardly any article focused nutritional status of rural postmenopausal women. Ultimate aim of this interventional Study is to assess the appropriate nutrient intake and dietary approaches among menopausal women in rural regions of north India.
Materials and Methods
A total sample of 100 postmenopausal women from Barhalganj town area, Gorakhpur (UP), India was selected using purposive random sampling technique. Experiment was conducted in three phases. In I phase of experiment, the information on socio-economic background, menopausal problems, exercise pattern, knowledge regarding importance of functional foods and their sources, food consumption pattern and the intake of different foods and nutrient per day were assessed.
Table 1
Shows about the distribution according to the demographic profile of the respondents.
Table 2
Shows the distribution of the respondents according to their food habits, physical activity.
Table 3
Shows the distribution of the respondents according to their physical activity
Table 4
Shows the distribution of the complications during menopause.
Table 5
Distribute the respondents according to their food consumption pattern, mean intake of different food groups, mean intake calories from different nutrients after imparting education.
In the II phase of experiment, the nutrition education material like booklet, Diet-charts were developed. The knowledge regarding menopause, health problems during menopause, foods important to reduce menopausal problems and their sources, importance of exercise and meditation etc. were imparted through lectures using booklet as education materials. Beside these personal and group discussions were also conducted.
In phase III The pre and post exposure data of menopausal women were collected as intervention on 10 random samples to know the impact of nutrition education.
Sampling techniques
The study was conducted within 100 menopausal women from 40-60 years of ages. Randomly selected from Barahalganj region of Gorakhpur district attar Pradesh India. Collected Information regarding dietary habit, from different colonies of Barhalganj town-area.
General and socio economic profile.
Menopausal status.
Anthropometry data included- [BMI= weight(kg)/height(m2)] as a tool for assessing nutritional status. Digital scale was used to take weight measurement, with the accuracy of 0.1 kg and wearing lightweight clothing and without shoes.16 BMI was calculated and analyzed by World Health Organization (2012) recommendations.17
Dietary pattern.
Food consumption habits and nutrient intake assessment.
Widely used food preferences.
Nutrient intake, to collect information of food consumption, nutrients intake, 24 hours recall method for three consecutive days were used and calculated mean values of the data were used for further comparative analysis with RDA.18
Physical activity- to categorize data for the physical activity pattern among sedentary, moderate or heavy working subjects.19
Ten (10) most affected respondents from the symptomatic disease respondents were included in the intervention of the study. Clinical and nutritional status of menopausal women was assessed and data was collected from the respondents in order to find out the root cause of nutritional deficiency symptoms in menopausal women. This part of the study includes post data collection after exposure of intervention programmed. After imparting education effectiveness of the diet chart was re-assessed after one month to check the improvements in the nutritional status of the menopausal women. The subjects were let aware about the various nutrients, importance of balanced diet as well as the essential dietary approached and requirement of basic lifestyle modifications for healthy and quality living. The interaction was mostly in Hindi language with local dialect. All selected subjects were counseled during the period of data collection. Collected data were presented with frequencies of categorical variables and to interpret data mean and the standard deviation was used.
Results Discussion
Demographic profile like age, educational status, working pattern, type of family shown in (Table 1). Out of the total menopausal subjects, maximum number i.e 49 ±16.32 of the respondents were of 46-50 years of age-group which almost similar to the mean age-group of menopause for Indian women 20, 21.Majority of respondents i.e. 42±14.21 were graduate while 7±13.95 were illiterate. Out of total subjects 74±30.33 respondents were house-wives, 54±5.32 were from joint family.
It was found that most of the selected menopausal women 59±3.45 were vegetarian and 43±12.42 were following 3 meal patterns in a day. It was noticed that only 18±17.21 of menopausal women had the habit of consuming milk daily and majority 51±12.16 of them were found to be consuming milk once a week. Intake of fruits, green leafy vegetables, were significantly low i.e., only 22±14.07 of women had intake it daily in their diet. physical behavior 53±15.21of respondents were held between (18-25) range of BMI. Exercise pattern revealed that 63±18.38 of respondents were found in physical activity and rest of them did not do exercise. Moreover, yoga, walking and exercise activities were reported as 18±14.73, 37±13.12 and 8±15.1 respectively. (Table 2)
In a Comparative Study of rural and urban women it is mentioned that joint and muscular symptoms was the most common problem with 62±20.16 followed by hot flushes and night sweats with 37±9.1322. While a study of coastal areas of Karnataka, India showed that physical and psychosocial symptoms were reported more than vasomotor and sexual symptoms in which 56.92% of the menopausal women felt firmly that they were affected by menopause in negative aspects23, 24. The vasomotor symptoms was occur on an average among them 60% reporting hot flushes and 47% sweating. 25 Most prevalent (94%) reported psychosocial symptoms were feeling of anxiety and nervousness and (88%) feeling depressed. While results of present study shows that mood swing 53±18.19, stress 52±9.81 irritability 32±19.05 were highly prevalent psychological symptoms among menopausal women. but in present study 62±20.16 percent of women had aching joint and muscle pain as a physiological symptom and collagen changes like vaginal dryness, skin wrinkling and skin itching breast tenderness were perceived in respondents. (Table 4) as compared to a study of Puducherry, the problem of low back ache (79%) and muscle-joint pain (77.2%).26, 27
On the basis of data analysis of 24 hours recall method, the mean intake of food groups in a day, cereal, pulses, Sugar and jiggery, Fats and oil intake were decreased from 327.91± 3.98 to 298.2 ± 4.32, 55.42±13.24 to 72.42±14.34, 25.42±17.12 to 17.28±14.23, and 29.42±17.13 to 16.26±13.18 respectively while GLV (green leafy vegetables) , Roots & tuber , Fruits, Milk & its product, intake were increased from 55.42 ±13.24 to 72.42 ±14.34 , 102.6±9.67 to 120.67±12.32 , 173.02 ± 14.13 to 326.42±13.43 ,and 229.1± 15.32 to 520.34±15.12. respectively.
The comparative analysis of pre and post intervention data analysis of nutrients intake there was decreased in energy, and fat nutrients from 2304.2± 29.56 to 1985.3± 18.34 and respectively, while increments in protein calcium and iron intake from 45.59±17.23 to 56.39±13.32, 432.23±6.14 to729.2 ±4.47 and 23.56±12.14 to 29.22±11.21 respectively.
Conclusion
It can be concluded that the prevalence of physiological symptoms like insomnia, bladder problem, physical and mental exhaustion and psychological symptoms like anxiety and irritability were reported by more per cent of premenopausal women. Results indicated that before imparting nutrition education less per cent of menopausal women were having the knowledge about psychological symptoms, collagen changes and physiological symptoms which occurs during menopause. But after imparting nutrition education using developed nutrition education material like booklet, diet-charts, a significant improvement in awareness regarding various aspects of menopause was noticed among menopausal women.
Recommendations for Improving the Nutritional Status of Menopausal Women
In present study, improvement was observed in nutritional status of menopausal women after one month of intervention, therefore there are following long term recommendations that may help to tackle with symptoms of menopause.
Hence, there is need to impart nutrition education to the adult women about menopausal symptoms, food and nutrient intake, importance of consumption of functional foods, benefit of exercise, food supplementation and importance of recreational activities.
As it is a well-known fact that a balanced diet is necessary for a wellbeing healthy life and had an ameliorative effect for the complications of menopause at a certain extent. Menopausal women should include phytoestrogen rich foods as soyabean, flax seed etc., in which isoflavones of such food substitute estrogen hormone action in the body.
Attention needs to be given towards calcium rich foods intake (milk, ragi, nuts and oilseeds, fresh seasonal fruits, citrus fruits and green leafy vegetables, lettuce and fresh salads). Intake of fried foods and snacks rich in oil must be reduced.
Every woman should aware that menopause is an inevitable phase and therefore has to be conscious about diet, exercise and good for self-help under this stage with positive attitude towards life, sharing views with friends, spouse and relatives.
Beside these, modifications in lifestyle are necessary. Walking is most convenient exercise for maintaining muscular and skeleton health and the problem of weight gaining. It is necessary to visit a gynecologist for routine health checkups which may help to optimize complications early.
On the whole, efforts are necessary for creating nutritional and health awareness among menopausal women about how to combat and tackle this important phase in their life to ensure a better quality of life.
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