Why midlife nutrition is different
From the late thirties and into midlife, a cluster of hormonal, metabolic, and physiological changes begin to shift how your body manages energy, fat storage, muscle maintenance, sleep, and stress. These changes do not happen all at once and they do not affect everyone equally. But they do happen, and they require a different nutritional response.
The midlife years represent a critical window for preventing chronic disease and optimising long-term health. The behaviours established during this period shape outcomes for the decades ahead.
Research published in Women's Midlife Health (Harlow & Derby[10]) identifies midlife as a vulnerable period during which conditions including bone loss, adverse lipid changes, insulin resistance, metabolic syndrome, and sleep disturbance often begin or accelerate. The WHO[11]'s World Report on Ageing and Health frames this as a matter of functional capacity: the goal is not simply to avoid disease but to maintain the ability to do what matters.
The physiological changes in midlife are not the same for men and women, but both sexes experience hormonal decline that reshapes metabolism. Understanding what is happening in your body is the starting point for making nutritional changes that actually work.
Hormonal decline
Oestrogen, progesterone, and testosterone all decline through midlife in both sexes. Each hormone influences metabolism, body composition, sleep, mood, and appetite in ways that compound over time.
Metabolic slowdown
Energy needs often decrease in midlife due to changes in muscle mass, activity patterns, and hormonal influences on body composition [7]. Energy needs shift even without changes to activity level.
Sleep disruption
Disrupted sleep directly affects the hormones that regulate appetite. Leptin (satiety) decreases and ghrelin (hunger) increases with sleep curtailment [8], making dietary behaviour harder to maintain.
Stress load
Chronic stress is associated with abdominal adiposity and disrupted blood sugar regulation through several hormonal pathways, including but not limited to cortisol. Research supports an association between HPA axis dysregulation and visceral fat accumulation, though the mechanisms are multifactorial.[1] Most people in midlife are carrying significant cumulative stress load.
Hormones, body composition, and fat distribution
One of the most consistent complaints in midlife is body composition change that feels disconnected from eating or exercise habits. This is not imagined. Hormonal changes directly affect where fat is stored, how muscle is maintained, and how the body responds to food.
For women
- Declining oestrogen shifts fat storage from the hips and thighs toward the abdomen
- Subcutaneous abdominal fat increasingly takes on the metabolic characteristics of visceral fat [12]
- Visceral fat is metabolically active and linked to higher cardiovascular and insulin resistance risk [13]
- Arterial stiffness accelerates significantly within one year of the final menstrual period [14]
- Perimenopause can begin up to 10 years before the final menstrual period; the range across the population is broad, typically spanning ages 40 to 51[2]
For men
- Testosterone declines gradually from the mid-thirties, accelerating after 50
- Lower testosterone is associated with increased fat mass, decreased lean muscle, and reduced insulin sensitivity
- Growth hormone decline reduces lipolysis, the body's ability to break down stored fat
- Visceral fat accumulation increases with age in men and is associated with the same metabolic risks as in women
Why waist circumference matters more than weight
Research by Ross et al. (2020) published in a major international consensus statement advocates for waist circumference to be treated as a clinical vital sign, independent of BMI. Visceral fat (the fat stored around internal organs) carries greater metabolic risk than subcutaneous fat regardless of total body weight. A person with a healthy BMI but elevated waist circumference still carries elevated cardiovascular and metabolic risk. Reducing waist circumference through nutrition and movement is one of the highest-value midlife health targets.
General reference ranges: For women, a waist circumference above 80cm is associated with elevated risk; above 88cm indicates high risk. For men, above 94cm is elevated risk; above 102cm is high risk. These are population reference points, not clinical thresholds. Discuss your individual context with your GP.
The nutrition foundations that matter most in midlife
Midlife nutrition does not require an extreme approach. It requires a recalibration of fundamentals getting the right things right, consistently, in a way that is sustainable across years rather than weeks.
The PREDICT I study (Berry et al.[16]), which examined metabolic responses to food in over 1,000 people, found significant individual variation in how the body responds to the same foods. This finding supports the case for a personalised, rather than prescriptive, approach to nutrition. The foundations below apply broadly. How you apply them depends on your life stage, health history, and current physiology.
Meal structure
When and how you eat matters as much as what you eat in midlife
Diet quality
Whole food load, variety, and minimising ultra-processed food
Protein adequacy
Meeting life-stage appropriate protein needs to protect muscle
Fibre and plants
Gut diversity, hormonal clearance, and micronutrient density
Meal structure and timing
Irregular eating patterns in midlife are associated with greater blood sugar variability, poor sleep, and dysregulated appetite hormones. While intermittent fasting has gained popularity, there is insufficient evidence to recommend it as a universal approach in midlife, particularly for those already experiencing disrupted sleep, elevated stress, or peri-menopausal hormonal fluctuation. Aggressive fasting can elevate cortisol, which in this context is counterproductive.
What the evidence does support is eating in a consistent pattern, not skipping meals under high stress load, and front-loading energy intake earlier in the day where possible. For most people in midlife, three structured meals with optional protein-forward snacks is a well-supported framework.
Practical meal structure principles
- Many people with poor sleep, high stress, or appetite regulation challenges benefit from a protein-rich breakfast within a couple of hours of waking; this is not a universal requirement and individual response varies
- Do not skip breakfast when carrying high stress load or poor sleep
- Include protein at every meal this is the single most important structural change for midlife
- Avoid eating within 2 to 3 hours of bed where possible to support sleep quality and blood sugar stability overnight
- Aim for consistency across the week rather than a perfect weekday and chaotic weekend
Diet quality and whole food load
There is no single dietary pattern with exclusive evidence in midlife. Mediterranean, DASH, and whole food plant-based approaches all have strong supporting research. What they share is a high whole food load, diverse plant intake, adequate protein, and a low proportion of ultra-processed food.
Ultra-processed foods are those that have been significantly altered from their original form and typically contain additives, emulsifiers, and refined ingredients. A high ultra-processed food intake is independently associated with increased inflammatory markers, disrupted appetite signalling, and poorer metabolic outcomes all of particular concern in midlife when baseline inflammation is already rising.
Aim for a high whole food load
- At least 80 percent of your food intake from whole or minimally processed sources
- A wide variety of vegetables across colours and types diversity matters for gut health
- Legumes, whole grains, nuts, and seeds as regular features rather than occasional additions
- Oily fish two to three times per week for omega-3 fatty acids and cardiovascular support
- Limit alcohol it disrupts sleep architecture, elevates cortisol, and is independently associated with increased visceral fat in midlife
Protein the most underestimated midlife nutrient
Muscle loss in midlife (sarcopenia) is one of the most significant and underappreciated drivers of long-term functional decline, metabolic slowing, and loss of physical capacity. Protein is the primary nutritional lever for protecting against it.
Buckinx and Aubertin-Leheudre[17] identify sarcopenia as common among postmenopausal women due to declining oestrogen, and document its consequences: functional impairment, increased risk of falls and fractures, and reduced quality of life. The same hormonal and physiological mechanisms apply to men experiencing androgen decline. Peeters et al.[18] identified a disability threshold in physical functioning that is reached on average at age 79 but with a wide range depending on baseline activity level and physical function maintained through midlife.
Protein requirements increase in midlife, not decrease. The body becomes less efficient at using dietary protein to build and maintain muscle, a process called anabolic resistance. More is needed to achieve the same response.
How much protein do you need?
| Population | General guidance | Notes |
|---|---|---|
| Midlife adults, moderate activity | 1.0 to 1.2g per kg body weight per day minimum | The Australian RDI of 0.8g/kg (which applies to adults under 70) is considered a minimum floor for general health, not an optimal target for midlife adults with body composition or functional goals[6] |
| Midlife adults where higher intake may be beneficial | 1.2 to 1.6g per kg body weight per day | Often beneficial for those working on body composition, muscle maintenance, or metabolic health. Discuss with a qualified health professional. |
| Athletes or individuals in a significant caloric deficit | Up to 1.6 to 2.0g per kg | Higher intakes may be appropriate under professional supervision. Not a general population recommendation. |
These targets reflect current international research consensus for active midlife and older adults (including ESPEN guidelines and the PROT-AGE study group[6]) and exceed the general population Australian RDI, which was established for sedentary adults. Individual protein needs vary based on health status, kidney function, and activity level. Discuss personalised targets with your GP, a registered dietitian, or a qualified nutritionist if you have any existing health conditions.
Distributing protein across the day
Research consistently shows that spreading protein intake across meals is more effective for muscle protein synthesis than concentrating it in one meal. Aim for 25 to 40g of protein per meal across three meals, rather than a small breakfast, small lunch, and large protein load at dinner. This means breakfast in particular needs attention most Australians are under-eating protein at the first meal of the day.
Practical protein sources
Animal sources
Chicken, turkey, lean red meat, eggs, dairy (Greek yoghurt, cottage cheese, milk), fish and seafood. These are complete proteins containing all essential amino acids.
Plant sources
Legumes (lentils, chickpeas, black beans), tofu, tempeh, edamame, quinoa, hemp seeds, and pea protein. Combining plant sources across the day ensures a complete amino acid profile.
Protein at breakfast
Eggs, Greek yoghurt, smoked salmon, cottage cheese, protein-enriched oats, or a legume-based breakfast bowl. Target 25 to 35g at the first meal of the day.
Important note on kidney health
If you have a history of kidney disease or reduced kidney function, higher protein intakes require medical supervision. Please discuss protein targets with your GP before making significant changes. This guide is not appropriate as a standalone resource for anyone with diagnosed kidney conditions.
Blood sugar regulation in midlife
Insulin sensitivity declines with age and is further compromised by the hormonal changes of midlife, increased visceral fat, disrupted sleep, and elevated cortisol. Supporting blood sugar stability is one of the most impactful nutritional priorities in this life stage.
The PREDICT I study (Berry et al.[16]) demonstrated significant individual variation in blood sugar responses to the same foods, supporting the case for personalised approaches. However, certain patterns are broadly protective across most people in midlife.
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Prioritise fibre at every meal
Dietary fibre slows glucose absorption and reduces postprandial (after-meal) blood sugar spikes. Aim for vegetables, legumes, or whole grains at every meal. The fibre from these sources also feeds beneficial gut bacteria, which play a role in metabolic health. Some research suggests the gut microbiome may influence oestrogen metabolism; this area is still evolving and should not be interpreted as established clinical guidance.[3]
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Pair carbohydrates with protein, fat, or fibre
Eating carbohydrate-rich foods alongside protein, healthy fat, or fibre significantly moderates the blood sugar response. The mechanism differs slightly depending on what you pair them with: protein slows gastric emptying and blunts the insulin response; dietary fat slows glucose absorption into the bloodstream; and fibre creates a physical barrier that reduces the rate at which glucose enters circulation. A piece of fruit on its own produces a different blood sugar response than the same fruit eaten alongside Greek yoghurt (protein), a handful of nuts (fat), or as part of a meal with vegetables (fibre). All three pairings are effective and using more than one at the same time provides additional benefit.
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Choose lower glycaemic index carbohydrates
Not all carbohydrates are equal in their blood sugar impact. Whole grains, legumes, sweet potato, and most fruits produce a more gradual glucose response than refined bread, white rice, or processed snacks. Refined carbohydrates are foods that have been processed to remove fibre, bran, and most nutrients, leaving primarily starch and sugar. Common examples include white bread, white rice, most commercial breakfast cereals, crackers, pastry, and many packaged snack foods. They are not inherently harmful in small amounts, but they digest quickly, produce a rapid blood sugar rise, and offer minimal nutritional return compared to their whole food equivalents. This does not mean eliminating them; it means they are not the foundation of the diet.
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Move after meals where possible
Even a 10-minute walk after eating meaningfully reduces postprandial blood glucose. This is one of the simplest and most evidence-supported interventions for blood sugar management in midlife and does not require a gym or dedicated exercise session.
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Limit added sugar and refined carbohydrates
This is not about restriction for its own sake. In midlife, with reduced insulin sensitivity and an already elevated metabolic risk profile, a high sugar intake provides significant glycaemic load with minimal nutritional return. Read labels: many apparently healthy foods contain significant added sugar.
Gut health, the microbiome, and midlife metabolism
The gut microbiome (the diverse community of bacteria, fungi, and other microorganisms in the digestive tract) plays a role in metabolism, immune function, inflammation, and in women, oestrogen clearance. Midlife changes to the gut microbiome are now an active area of research with direct implications for body composition and metabolic health.
Research by Becker and Manson[19] demonstrates that menopause alters gut microbiome composition, with rodent studies showing associated increases in adiposity, decreased metabolic rate, and insulin resistance. Vieira et al.[20] identified that oestrogen deficiency during menopause alters both oral and gut microbiota, contributing to inflammatory conditions including periodontitis. The hepatobiliary-gut axis (the relationship between the liver, gallbladder, bile acids, and gut bacteria) is positively influenced by regular physical activity [21].
What supports gut diversity
- Varying your plant food intake across vegetables, fruits, legumes, whole grains, nuts, seeds, and herbs supports microbial diversity. A practical target of 30 different plant foods per week is associated with greater microbial diversity in observational studies,[4] but this is based on observational data and is best understood as a useful heuristic rather than a proven clinical threshold
- Fermented foods: natural yoghurt, kefir, sauerkraut, kimchi, miso, tempeh
- Prebiotic foods: onions, garlic, leeks, asparagus, bananas, oats, flaxseeds
- Adequate dietary fibre both soluble and insoluble
- Regular physical activity, particularly aerobic exercise
What disrupts the gut microbiome
- A diet high in ultra-processed food and low in fibre
- Chronic stress: via the gut-brain axis, prolonged cortisol elevation directly affects gut bacteria composition
- Disrupted sleep (the gut microbiome follows a circadian rhythm, so irregular sleep patterns directly affect microbial composition)
- Excess alcohol intake
- Unnecessary or prolonged antibiotic use (when clinically avoidable)
- Low dietary variety eating the same foods repeatedly limits microbial diversity
Bone health and calcium in midlife
Bone density declines in midlife in both men and women, accelerating in women in the perimenopausal and early postmenopausal period. Adequate calcium intake supports bone mineral density alongside vitamin D and resistance training. Calcium-rich sources include dairy products, fortified plant-based milks, tinned fish with bones, tofu (where set with calcium sulphate), almonds, and tahini. Vitamin D is essential for calcium absorption. Inadequacy is common in Australia, particularly in southern states during winter, and supplementation may be warranted. Discuss your vitamin D status with your GP, who can test your serum levels.
Stress, sleep, and their nutritional consequences
Stress and sleep are not separate from nutrition. They are physiologically integrated with it. For many people in midlife, sleep quality and stress load are the primary drivers of the nutritional problems they are trying to solve through diet alone.
How chronic stress affects nutrition
Dallman et al.[22] documented a direct neurobiological link between chronic HPA axis activation (the chronic stress response) and preference for energy-dense, high-fat, high-sugar foods. This is not a failure of willpower. It is a hormonal and neurological response. Cortisol promotes visceral fat storage and drives the body toward energy conservation in the presence of chronic perceived threat [1].
McEwen (1998) introduced the concept of allostatic load: the cumulative physiological cost of chronic stress across systems. A high allostatic load is associated with cardiovascular disease, metabolic dysfunction, immune impairment, and cognitive decline. The dietary implications are significant: people under chronic stress commonly have suboptimal intake or status of key micronutrients including magnesium, B vitamins, and vitamin C; disrupts gut microbiome composition; and makes sustained behaviour change physiologically harder.
Magnesium
People experiencing chronic stress often have suboptimal magnesium intake or status. Magnesium supports sleep quality, muscle function, blood sugar regulation, and nervous system function. Found in dark leafy greens, legumes, seeds, nuts, and dark chocolate.[5]
B vitamins
Suboptimal B vitamin status is commonly observed in people under chronic stress, with high alcohol intake, or with diets high in refined carbohydrates. Critical for energy metabolism and nervous system health. Found in wholegrains, legumes, eggs, meat, leafy greens, and nutritional yeast.
Vitamin C
People under chronic stress may have suboptimal vitamin C status. Supports adrenal function, immune health, and collagen synthesis. Found in citrus fruits, capsicum, broccoli, kiwifruit, and strawberries.
How poor sleep affects nutrition
Spiegel et al. (2004) demonstrated that even short-term sleep curtailment in healthy adults significantly decreases leptin (the hormone that signals satiety) and increases ghrelin (the hormone that drives hunger). The practical consequence is that poor sleep makes it physiologically harder to eat appropriate amounts, independent of what you consciously decide to do.
D'Antono and Bouchard[23] documented that poor sleep quality is associated with elevated inflammatory markers including CRP, IL-6, and TNF-α all of which are also elevated by the physiological changes of midlife. This compounding effect makes sleep one of the highest-leverage interventions available, with direct downstream benefit to nutritional outcomes.
Nutritional strategies to support sleep quality
- Adequate magnesium intake through diet consider a practitioner-recommended supplement if dietary intake is consistently low
- Limit alcohol, which disrupts sleep architecture even when it assists falling asleep
- Avoid caffeine after 1pm. Caffeine has an average half-life of 5 to 7 hours in most adults, though individual variation is significant (ranging from 3 to 12 hours depending on genetics and liver enzyme activity), and it directly disrupts deep sleep stages
- A protein-containing evening meal supports overnight blood sugar stability and reduces overnight cortisol spikes
- Do not go to bed significantly hungry a small protein-forward snack is preferable to disrupted overnight sleep from hypoglycaemia
- Tryptophan-containing foods (turkey, eggs, dairy, seeds, bananas) support melatonin production
Key micronutrients in midlife
While total dietary quality matters more than any individual nutrient, several micronutrients warrant particular attention in midlife due to increased need, common insufficiency, or direct relevance to the physiological changes of this life stage.
| Nutrient | Why it matters in midlife | Food sources | Note |
|---|---|---|---|
| Vitamin D | Al Mheid et al.[24] found lower vitamin D associated with increased arterial stiffness and vascular dysfunction. Also critical for calcium absorption and immune function. | Sunlight (primary), oily fish, eggs, fortified foods | Insufficiency is common; blood test recommended via GP |
| Calcium | Bone density declines in midlife in both sexes. Adequate calcium is a foundational bone health strategy. | Dairy, fortified plant milks, tinned fish with bones, tofu, almonds, tahini | Requires vitamin D for absorption |
| Magnesium | Supports sleep quality, blood sugar regulation, muscle function, and stress response. Suboptimal magnesium status is commonly observed in people experiencing chronic stress. | Dark leafy greens, legumes, pumpkin seeds, almonds, dark chocolate | Commonly under-consumed; consider dietary audit first |
| Omega-3 fatty acids | Anti-inflammatory; supports cardiovascular, brain, and joint health. El Hadi et al.[26] identified omega-3 as supporting thermogenic fat activity. | Oily fish (salmon, sardines, mackerel), walnuts, flaxseeds, chia seeds | EPA and DHA from fish are more bioavailable than plant-based ALA |
| Iron | Particularly relevant for pre-menopausal women and those eating plant-based diets. Fatigue, reduced cognitive function, and impaired immune response with deficiency. | Red meat, chicken, fish, lentils, tofu, spinach, pumpkin seeds | Plant-based iron is better absorbed alongside vitamin C |
| B vitamins (B6, B12, folate) | Feraj[25] identified B6 and D as associated with depression symptoms and inflammation in women. B12 absorption declines with age. | Wholegrains, eggs, meat, dairy, leafy greens, legumes, nutritional yeast | B12 supplementation may be warranted for plant-based eaters and those over 60 |
Supplements and scope of practice
Supplementation decisions should be based on assessed need, not prevention. Before adding any supplement, discuss with your GP and consider blood testing to identify actual deficiencies. High-dose supplementation of fat-soluble vitamins (A, D, E, K) carries risk when taken without clinical guidance. A food-first approach is recommended as the starting point, with supplementation used to address confirmed gaps.
Where to start a practical action plan
Behaviour change research consistently shows that trying to change everything at once produces worse outcomes than choosing one high-leverage change and embedding it before adding the next. Lally et al.[27] found that real-world habit formation takes an average of 66 days not the popular 21-day figure, and progress is rarely linear. Start with the change most likely to have the greatest downstream effect for your specific situation.
The priority sequence for most people in midlife
If you are unsure where to start, this sequence reflects where the evidence points for the greatest compounding return. Address sleep and stress first without these, every other nutritional change becomes significantly harder to sustain.
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Address sleep quality
If you are sleeping fewer than 7 hours per night or waking regularly, this is the first priority. Poor sleep directly undermines appetite regulation, cortisol management, blood sugar stability, and the neurobiological capacity for behaviour change.
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Increase protein at each meal, starting with breakfast
This single change has the most evidence behind it for midlife body composition, appetite regulation, and muscle maintenance. Start by auditing your current breakfast protein for most people, this is where the gap is largest.
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Add a vegetable to two meals per day
Rather than overhauling your entire diet, focus on adding rather than restricting. Two servings of vegetables added to existing meals increases fibre, micronutrient density, and gut diversity without requiring a complete dietary restructure.
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Stabilise meal timing
Eating at consistent times each day supports circadian rhythm, cortisol patterns, blood sugar regulation, and sleep quality. This does not need to be rigid a two-hour window is sufficient.
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Audit alcohol and ultra-processed food intake honestly
These two factors are among the most commonly underestimated contributors to midlife weight gain, disrupted sleep, and elevated inflammation. Tracking for one week without judgement provides a useful baseline.
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Add resistance training
This is not directly a nutrition strategy, but it is nutritionally inseparable from the protein conversation. Without the mechanical stimulus of resistance training, dietary protein alone cannot maintain muscle mass. Two sessions per week is the minimum effective dose.
A note on individuality
Body composition changes in midlife are influenced by genetics, life stage, health history, stress load, sleep quality, gut microbiome composition, and years of dietary history. Two people following the same nutritional approach will not get the same results at the same rate. What this guide provides is the evidence-informed framework. Applying it to your specific physiology, history, and life circumstances is where personalised coaching adds the layer that self-directed change often misses.
References
- [1]Bjorntorp P. (2001). Do stress reactions cause abdominal obesity and comorbidities? Obesity Reviews, 2(2), 73–86.
- [2]McKinlay S.M. (1996). The normal menopause transition: an overview. Maturitas, 23(2), 137–145. Note: median perimenopause onset 47.5 years; population range typically 40–51. Data now 30 years old; used as indicative reference only.
- [3]The role of the gut microbiome in oestrogen metabolism is an active and evolving area of research. Current evidence is largely observational and mechanistic. It does not yet support firm clinical recommendations. See Baker J.M. et al. (2017). Estrogen-gut microbiome axis. Maturitas, 103, 45–53 for an overview of current evidence.
- [4]McDonald D. et al. (2018). American Gut: an open platform for citizen science microbiome research. Cell Host and Microbe, 23(4), 622–635. The 30 plant foods per week figure is observational and represents a practical heuristic, not a clinically validated threshold.
- [5]Pickering G. et al. (2020). Magnesium status and stress: the vicious circle concept revisited. Nutrients, 12(12), 3672. Evidence supports an association between stress and suboptimal magnesium status; direct causal depletion language is not fully supported.
- [6]Bauer J. et al. (2013). Evidence-based recommendations for optimal dietary protein intake in older people (PROT-AGE Study Group). JAMDA, 14(8), 542–559. Deutz N.E.P. et al. (2017). Protein intake and exercise for optimal muscle function with aging (ESPEN guidelines). Clinical Nutrition, 36(6), 1823–1831.
- [7]Shaw G.A. (2021). Mitochondria as the target for disease related hormonal dysregulation. Frontiers in Endocrinology.
- [8]Spiegel K. et al. (2004). Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine, 141(11), 845–850.
- [9]McEwen B.S. (1998). Stress, adaptation, and disease: allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44.
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- [23]D'Antono B. & Bouchard V. (2019). Impaired sleep quality is associated with concurrent elevations in inflammatory markers: are post-menopausal women at greater risk? Biology of Sex Differences.
- [24]Al Mheid I. et al. (2011). Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. Journal of the American College of Cardiology, 58(2), 186–192.
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