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Lambrinoudaki I.,National and Kapodistrian University of Athens | Ceasu I.,Carol Davila University of Medicine and Pharmacy | Depypere H.,Ghent University | Erel T.,Istanbul University | And 6 more authors.
Maturitas | Year: 2013

Introduction: There is increasing evidence that life-style factors, such as nutrition, physical activity, smoking and alcohol consumption have a profound modifying effect on the epidemiology of most major chronic conditions affecting midlife health. Aims: To provide guidance concerning the effect of diet on morbidity and mortality of the most frequent diseases prevalent in midlife and beyond. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: A healthy diet is essential for the prevention of all major chronic non-communicable diseases in midlife and beyond, both directly, through the effect of individual macro- and micronutrients and indirectly, through the control of body weight. Type 2 diabetes mellitus is best prevented or managed by restricting the total amount of carbohydrate in the diet and by deriving carbohydrate energy from whole-grain cereals, fruits and vegetables. The substitution of saturated and trans-fatty acids by mono-unsaturated and omega-3 fatty acids is the most important dietary intervention for the prevention of cardiovascular disease. Obesity is also a risk factor for a variety of cancers. Obese elderly persons should be encouraged to lose weight. Diet plans can follow the current recommendations for weight management but intake of protein should be increased to conserve muscle mass. The consumption of red or processed meat is associated with an increase of colorectal cancer. Adequate protein, calcium and vitamin D intake should be ensured for the prevention of osteoporotic fractures. Surveillance is needed for possible vitamin D deficiency in high risk populations. A diet rich in vitamin E, folate, B12 and omega-3 fatty acids may be protective against cognitive decline. With increasing longevity ensuring a healthy diet is a growing public health issue. © 2012 Elsevier Ireland Ltd. All rights reserved. Source


Perez-Lopez F.R.,University of Zaragoza | Ceausu I.,Carol Davila University of Medicine and Pharmacy | Depypere H.,Ghent University | Tamer Erel C.,Istanbul University | And 6 more authors.
Maturitas | Year: 2013

Introduction: Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms. Aims: The purpose of this clinical guide is to provide advice on early recognition and treatment. Material and methods: Literature review and consensus of expert opinion. Results and conclusions: The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management. © 2012 Elsevier Ireland Ltd. Source


Dreisler E.,Copenhagen University | Poulsen L.G.,Copenhagen University | Antonsen S.L.,Copenhagen University | Ceausu I.,Carol Davila University of Medicine and Pharmacy | And 8 more authors.
Maturitas | Year: 2013

Introduction Invasive as well as non-invasive methods are available for assessment of the endometrium. Aims The purpose of this clinical guide is to provide evidence-based advice on endometrial assessment in peri and postmenopausal women. Material and methods Literature review and consensus of expert opinion. Results and conclusions Presuming speculum examination and cervical cytology are assessed, transvaginal ultrasound should be undertaken initially as it is non-invasive and will not only measure endometrial thickness, but will also detect other pelvic pathology such as leiomyomas and ovarian tumours. The main indication for invasive methods is to obtain endometrial tissue to diagnose or exclude the presence of endometrial cancer or pre-malignancies. Biopsy is mainly undertaken as an outpatient procedure, but sampling is 'blind'. Hysteroscopy is used when focal lesions affecting the uterine cavity are suspected such as endometrial polyps or sub-mucous fibroids. None of the available methods are perfect. Ultrasound evaluation is dependent on the experience of the examiner, the equipment and the quality of visualization. Hysteroscopy too is dependent on the examiner and fibroids may obstruct visualization. Blind endometrial biopsy procedures often miss focal lesions. Thus re-examination is necessary when symptoms persist and no explanation for these has been identified. This clinical guide will evaluate the different methods of endometrial assessment, their indications and limitations. Guidance is also given about dealing with inconclusive investigations and persistent symptoms. © 2013 Elsevier Ireland Ltd. Source


Perez-Lopez F.R.,University of Zaragoza | Brincat M.,Materials Dei Hospital | Erel C.T.,Istanbul University | Tremollieres F.,Menopause and Metabolic Bone Disease Unit | And 7 more authors.
Maturitas | Year: 2012

Introduction: There is emerging evidence on the widespread tissue effects of vitamin D. Aims: To formulate a position statement on the role of vitamin D in postmenopausal women. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: Epidemiological and prospective studies have related vitamin D deficiency with not only osteoporosis but also cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. However the evidence is robust for skeletal but not nonskeletal outcomes where data from large prospective studies are lacking. The major natural source of vitamin D is cutaneous synthesis through exposure to sunlight with a small amount from the diet in animal-based foods such as fatty fish, eggs and milk. Vitamin D status is determined by measuring serum 25-hydroxyvitamin D [25(OH)D] levels. Optimal serum 25(OH)D levels are in the region of 30-90 ng/mL (75-225 nmol/L) though there is no international consensus. Levels vary according to time of the year (lower in the winter), latitude, altitude, air pollution, skin pigmentation, use of sunscreens and clothing coverage. Risk factors for low serum 25(OH)D levels include: obesity, malabsorption syndromes, medication use (e.g. anticonvulsants, antiretrovirals), skin aging, low sun exposure and those in residential care. Fortified foods do not necessarily provide sufficient amounts of vitamin D. Regular sunlight exposure (without sunscreens) for 15 min, 3-4 times a week, in the middle of the day in summer generate healthy levels. The recommended daily allowance is 600 IU/day increasing to 800 IU/day in those aged 71 years and older. Supplementation can be undertaken with either vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) with monitoring depending on the dose used and the presence of concomitant medical conditions such as renal disease. © 2011 Elsevier Ireland Ltd. All rights reserved. Source


Palacios S.,Palacios Institute of Womans Health | Brincat M.,Materials Dei Hospital | Erel C.T.,Istanbul University | Gambacciani M.,University of Pisa | And 7 more authors.
Maturitas | Year: 2012

Osteoporosis and the resulting fractures are major public health issues as the world population is ageing. Various therapies such as bisphosphonates, strontium ranelate and more recently denosumab are available. This clinical guide provides the evidence for the clinical use of selective estrogen modulators (SERMs) in the management of osteoporosis in postmenopausal women. © 2011 Elsevier Ireland Ltd. Source

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