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Alcohol intake affects the female body differently than it affects the male body. This is caused by females' lower levels of dehydrogenase enzymes, the enzyme that breaks down alcohol, coupled with the higher fat/water ratio of the female body. Both these factors cause alcohol levels to rise more quickly after ingestion in women than in men. This makes females more vulnerable to alcohol's harmful effects, and consequently women tend to develop alcohol-related diseases earlier in life than do men. As women age and go through menopause, they experience changes in body composition and life changes like retirement or loss of a loved one. The disparity between men's and women's rates of alcohol consumption decreases, especially in last 2 decades. Stress and depression related to menopause may trigger the onset of alcohol abuse or worsen established alcohol misuse. Alcohol abuse decreases quality of life and any potential positive effects of moderate alcohol intake are minuscule in comparison to the adverse effects caused by alcohol abuse. Further, due to social stigmas, women tend to have more difficulty gaining access to treatment and recovering from alcohol dependence than do men. Current research on interventions and treatments that aim to reduce alcohol use disorder (AUD) or to prevent its occurrence in middle-aged and elderly women is limited. We provide an overview of drinking patterns, and of the prevalence, risk factors, health impacts and treatment challenges of AUD for women as they progress through middle and older age.

New emerging evidence suggests that the role of epigenetic alterations in diabetes is a crucial intersection between genetic predisposition and environmental factors. Two of the most studied epigenetic marks, DNA methylation and histone modifications, were investigated in relation to type 2 diabetes and glycemic traits, including glucose, insulin, and insulin resistance. However, no consistent associations between epigenetic marks and diabetes have been found. The majority of studies have reported differential DNA methylation of candidate genes in relation to diabetes and glycemic indices, but no overlap has been found between the differentially methylated CpGs sites in epigenome-wide association studies. Although there have been some promising results in the field of diabetes and epigenetics, challenges related to study design, harmonized methodology of assessment, tissue heterogeneity, and others remain. Diabetes epigenetics may hold the future potential of generating new information that can be used to predict high-risk patients and disease prevention.

The risk of cardiometabolic disease such as type II diabetes and cardiovascular disease (CVD) increases with age. Both of these diseases are important determinants of overall health and longevity. Although environmental and genetic studies have improved our understanding of the etiology and pathophysiologic mechanisms associated with diabetes and CVD, the etiology for the majority of these traits remains poorly understood. Alterations in the epigenetic mechanisms, including DNA methylation and histone modification, have been recently implicated in the onset and progression of cardiometabolic outcomes and may account for the missing heritability determinants of these diseases. Despite a growing body of literature addressing the role of the environment in gene expression affecting cardiometabolic risk, little is known about the epigenetic pathways involved in the pathophysiology of diabetes and CVD. In this chapter we describe the current knowledge about epigenetic control mechanisms in the development of cardiometabolic diseases.

Multiple health issues affect women throughout the life course differently from men, or do not affect men at all. Although attention to women's health is important in all stages in life, health among middle-aged and elderly women has not received sufficient attention by scientists and policy-makers. Related to the menopausal transition and the experiences accumulated until that age, many diseases occur or further develop in middle-aged and elderly women. To improve women's quality of life and guarantee a long-lasting and active role for middle-aged and elderly women in society, prevention of chronic diseases and disability is a key aspect. In this manuscript we give an overview of the major health issues for pen- and post-menopausal women, we summarize risk factors and interventions to improve menopausal health. Based on the available scientific literature and the global burden of disease endeavor, we have selected and herein describe the following top 11 key health issues, selected in terms of burden exerted in women's mortality, morbidity, disability and quality of life: cardiovascular disease, musculoskeletal disorders, cancer, cognitive decline and dementia, chronic obstructive pulmonary disease, diabetes mellitus, metabolic syndrome, depression, vasomotor symptoms, sleep disturbances and migraine. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Background Results from observational and genetic epidemiological studies suggest that lower serum homocysteine levels are associated with lower incidence of cardiovascular disease (CVD). Numerous randomized controlled trials have investigated the efficacy of lowering homocysteine with folic acid supplementation for CVD risk, but conflicting results have been reported. Methods and Results Three bibliographic databases (Medline, Embase, and the Cochrane Database of Systematic Reviews) were searched from database inception until December 1, 2015. Of the 1933 references reviewed for eligibility, 30 randomized controlled trials involving 82 334 participants were included in the final analysis. The pooled relative risks of folic acid supplementation compared with controls were 0.90 (95% CI 0.84–0.96; P =0.002) for stroke, 1.04 (95% CI 0.99–1.09; P =0.16) for coronary heart disease, and 0.96 (95% CI 0.92–0.99; P =0.02) for overall CVD. The intervention effects for both stroke and combined CVD were more pronounced among participants with lower plasma folate levels at baseline (both P P =0.006 for interaction) or in trials with larger reduction in homocysteine levels ( P =0.009 for interaction). Conclusions Our meta‐analysis indicated a 10% lower risk of stroke and a 4% lower risk of overall CVD with folic acid supplementation. A greater benefit for CVD was observed among participants with lower plasma folate levels and without preexisting CVD and in studies with larger decreases in homocysteine levels. Folic acid supplementation had no significant effect on risk of coronary heart disease.

$\textbf{Importance}$ Between 40% and 50% of women in Western countries use complementary therapies to manage menopausal symptoms. $\textbf{Objective}$ To determine the association of plant-based therapies with menopausal symptoms, including hot flashes, night sweats, and vaginal dryness. $\textbf{Data Sources}$ The electronic databases Ovid MEDLINE, EMBASE, and Cochrane Central were systematically searched to identify eligible studies published before March 27, 2016. Reference lists of the included studies were searched for further identification of relevant studies. $\textbf{Study Selection}$ Randomized clinical trials that assessed plant-based therapies and the presence of hot flashes, night sweats, and vaginal dryness. $\textbf{Data Extraction}$ Data were extracted by 2 independent reviewers using a predesigned data collection form. $\textbf{Main Outcomes and Measures}$ Hot flashes, night sweats, and vaginal dryness. $\textbf{Results}$ In total, 62 studies were identified, including 6653 individual women. Use of phytoestrogens was associated with a decrease in the number of daily hot flashes (pooled mean difference of changes, −1.31 [95% CI, −2.02 to −0.61]) and vaginal dryness score (pooled mean difference of changes, −0.31 [95% CI, −0.52 to −0.10]) between the treatment groups but not in the number of night sweats (pooled mean difference of changes, −2.14 [95% CI, −5.57 to 1.29]). Individual phytoestrogen interventions such as dietary and supplemental soy isoflavones were associated with improvement in daily hot flashes (pooled mean difference of changes, −0.79 [−1.35 to −0.23]) and vaginal dryness score (pooled mean difference of changes, −0.26 [−0.48 to −0.04]). Several herbal remedies, but not Chinese medicinal herbs, were associated with an overall decrease in the frequency of vasomotor symptoms. There was substantial heterogeneity in quality across the available studies, and 46 (74%) of the included randomized clinical trials demonstrated a high risk of bias within 3 or more areas of study quality. $\textbf{Conclusions and Relevance}$ This meta-analysis of clinical trials suggests that composite and specific phytoestrogen supplementations were associated with modest reductions in the frequency of hot flashes and vaginal dryness but no significant reduction in night sweats. However, because of general suboptimal quality and the heterogeneous nature of the current evidence, further rigorous studies are needed to determine the association of plant-based and natural therapies with menopausal health.