Precision Nutrition for Management of Cardiovascular Disease Risk during Menopause

Abstract

Background: Women can spend up to 40% of their lives in the postmenopausal state. As women begin to transition into menopause, known as perimenopause, changes in hormonal concentrations and body composition dramatically increase overall cardiometabolic risk. Dietary patterns and interventions can be utilized to prevent and treat cardiovascular disease (CVD) and some dietary patterns over others may be more beneficial due to their specific effects on the health aspects of menopause. In this narrative review, we summarize key cardiovascular alterations that occur during the menopause transition and explore current dietary recommendations to address CVD risk as well as explore the new frontier of precision nutrition and the implications for nutrition prescription during menopause.

Summary: Popular dietary interventions for CVD such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet (MED) have limited data in women following menopause. However, both diets improve CVD risk biomarkers of total cholesterol and low-density lipoprotein cholesterol as well as lower oxidative stress and inflammation and improve endothelial function. As the menopause transition increases the risk for developing metabolic syndrome, insulin insensitivity, and dyslipidemia, the DASH diet and MED may be impactful dietary strategies for mediating CVD risk in menopausal women. However, these are "one-size-fits-all" approaches that neglect individual characteristics such as genetic predisposition and environmental factors. Precision nutrition considers individual factors for nutrition prescription, spanning from evaluating food intake preferences and behaviors to deep phenotyping. Data from a large-scale investigation of the menopause transition suggests nutritional strategies that address postprandial glycemic responses, and the gut microbiome may attenuate some of the unfavorable effects of menopause on CVD risk factors.

Key messages: Considering menopause, women are a clinical population that would greatly benefit from precision nutrition. Future research should explore the use of machine learning and artificial intelligence in a precision nutrition framework to modify the DASH diet and MED to address adverse effects that occur during the menopause transition are vital for supporting women's health as they age.

Keywords: Diabetes; Dietary Approaches to Stop Hypertension; Mediterranean diet; Perimenopause; Postmenopause.

Fig. 1.

Health risks experienced during the menopause transition can be mitigated by nutritional strategies that target CVD risk factors, bone health and preserving optimal body composition.

Figure 2.

Adherence to specific dietary patterns such as Mediterranean, low-sodium, low-fat, low-carbohydrate, and energy restriction has been shown to improve CVD risk factors in menopausal women. Research needs to examine the impact of such dietary patterns on improving other CVD risk factors including weight, body composition, and vascular dysfunction in menopausal women and the associated factors (i.e., genetics, menopausal status) impacting variability in outcomes to prescribe diets at the individual level for this population. Precision nutrition should include three levels: stratification nutrition (i.e. social determinants, menopause symptoms), individual nutrition (i.e. CVD risk factors), and genotype-directed nutrition based on rare genetic variants having high penetrance and impact on individuals’ response to particular foods [44].

Figure 3.

Distribution of a) sugar intake, b) sleep quality, and c) postprandial glucose peak_0–2h variability between age-matched premenopausal (PRE; n=86) and postmenopausal (POST; n=64) females. The grey line indicates group median. *, Indicates significant difference between groups. Figure modified from [43].