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News on Vitamins1. Obesity is associated with Vit D deficiency. Vit D is stored in

fat cells and can be unavailable. ↓ BMI = ↑ bioavailability2. Dark pigmentation ↓ Vit D absorption via skin. Pigmentation

acts as UV protection.3. Daily doses of moderate/excess Vit A can weaken bones.4. LDL and polyunsaturated lipids in cell membranes have ↑

chance of free radical damage. Vit E suppresses free radicals. ↑ PUFA=↑ Vit E

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Nutrition During Pregnancy and LactationCH 10

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Energy Needs Increase1. Increased fuel demand2. Spare protein for added tissue building

↑ 340kcal/day during 2nd trimester↑ 450kcal/day during 3rd trimester Increase of 15-20% over the energy needs of a

nonpregnant women Sufficient wt gain is vital

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Protein Needs IncreaseBuilding blocks for growth of body tissue - ↑ 25g/day

◦ Development of the placenta◦ Growth of fetus◦ Growth of maternal tissues

Increased maternal blood volume◦ Plasma volume increases by 40-50%◦ ↑ hemoglobin – supply oxygen to growing cells◦ ↑ albumin – regulate blood volume

Amniotic fluidStorage reserves for labor

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Complete and Incomplete Protein Sources Complete- ↑ biological value 1. Egg

2. Milk

3. Cheese

4. Soy

5. Meat

Incomplete1. Beans

2. Legumes

3. Grains

Protein rich foods also contribute other nutrients such as: iron, B-vitamins, and Calcium

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Vit and Minerals Increase Minerals

◦ Calcium◦ Iron, DRI 27mg (non pregnant 18mg)

Vitamins◦ A◦ C◦ B-complex◦ D (preeclampsia, GDM) *Meet the requirements with 3 cups fortified milk daily ◦ Folate, DRI 600mcg/d (non pregnant 400mcg)

◦ Neural Tube defects – most common: spine ebifida

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Question of the DayWhat are good sources of Iron?

Heme Iron:Best absorbed

Derived from hemoglobin found in animal foods: Beef or chicken LIVER

(3.5mg/serving) Clams, mussels, oysters

(3.5mg) Cooked beef, sardines,

turkey (3.1mg) Chicken, halibut, salmon,

veal, tuna, ham (0.7 mg)

Non Heme IronLess efficiently absorbedFound in plants and fortified

foods: Breakfast cereals, cooked

beans, tofu, 1oz pumpkin/sesame seeds (3.5mg)

Lima, kidney, split, chickpeas, dried apricots, backed potato, broccoli (2.1mg)

Peanuts, almonds, walnuts, spinach, green pepper, rice, bread, pasta (0.7mg)

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Daily Food Intake General Guidelines

◦ Regular meals – don’t skip◦ Eat enough food◦ Eat fruits and vegetables◦ Protein sources◦ Cultural aspects of eating

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Rate of Weigh Gain ~2-4# in 1st trimester ~ 1#/wk for the remainder of the pregnancy Sharp wt ↑ may be water retention Low maternal wt gain ↑ risk of intrauterine growth restriction

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Common ProblemsN/V (nausea and vomitting) Hyperemesis Gravidarum [n/v <1st tri] (persisting past 1st trimester)ConstipationHemorrhoidsHeartburn

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High Risk• Identify as soon as possible•Based on clinical evidence of inadequate nutrition•Patterns that do not support optimal maternal and fetal health

1. Insufficient food intake2. Poor food selection 3. Poor distribution throughout the day

•Teenage pregnancy• Special care must be given• DRI recommendation for ˂18 yo

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Special NeedsAge (when having kids as teenagers or < 35yr olds)

High Parity Rate

Alcohol (spectrum of disorders caused by intaking alcohol) [leading cause of preventable disorders – fetal alcohol syndrome]

Smoking [connected to fetal abnormalities]

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Special Needs (con’t)Drug Abuse [goes through the placenta]

Caffeine [goes through the placenta as well]

Pica [cravings for non-food products]

Social economic problems

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Complications of PregnancyAnemia [more prevalent in poor women] Women need more iron or anemia will occurIUGR (inter uterine growth restriction) – leads to more chronic disease. Just read the damn bookPIH (pregnancy induced hypertension) – spilling out proteins in urine? Gestational Diabetes – diabetes during pregnancy

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Pre-Existing ConditionsDM – diabetes mellitus PKU – unable to absorb phenyl alanine urea Food AllergiesCeliac (disease) – limits the food you can eat Lactose Intolerance – most high Ca foods come from dairy

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Breast FeedingBest nutrition for baby for 1st 6 months

Milk productionProlactin – stimulates milk productionOxytocin – release of milk

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Breast Milk CompositionColostrum – 1st milk – yellow

Mature milk – occurs in a couple of days (protein is higher in the 1st couple of days then decreases)

Hind milk – has essential fatty acids

Cows milk is not appropriate for infants under one year of age(Too harsh for the baby in the early years)

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Nutrition Needs for LactationPrenatal Supplements should continueEnergy needed for process and product

330 kcal/day in first 6 months400 kcal/day last 6 months↑ 25g protein/day

Fluid intake ~3/L day

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Question of the Day Prenatal MVI’s for non – pregnant women

It’s OK if you need the nutrients Look at overall diet then make a decision

Fat Souble vitamins are stored in tissue, not needed everyday

Absorption is best with food If its for hair and nails decide if this is what you want

long term Costly

Weigh out benefits/long term effects unknown/continual usage/cost

*Excessive Vitamin A over time make weaken bones *Vitamin E supplementation may slightly ↑ mortality

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Benefits of BreastfeedingInfant:

• Decrease in severity or incidence of infectious dx• Increase cognitive performance• Decrease rate of SID syndrome, DM 1 and 2, lymphoma, leukemia,

obesity, hypercholesterolemia, asthma

Mother:• Earlier return to pre pregnancy weight• Decreased risk of breast cancer, ovarian cancer, osteoporosis

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Nutrition During Infancy Childhood and Adolescence

Ch 11

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Measuring Growth Infancy

◦ WHO growth chart (birth to 24 months)◦ Head circumference

Childhood/Adolescence◦ CDC growth chart (2-18)◦ BMI

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Energy and Nutrient NeedsPremature: 110-130kcal/kg 1-3 yo: 80-120kcal/kg

• Adult 30-40kcal/kg bodyweight

Macronutrients• Carbohydrates are main energy source and spare protein• Protein for the 6 months of life: 1.5g/kg• Adults: 0.8g/kg

• Fat is necessary for growth• Back up source of energy

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Nutrient Needs Water

• Infant consumes 10-15% body weight in fluid• Adult 2-4%

Vitamins• Needed in supplement form: Vitamin D (400 iu) and vitamin K

Minerals• Ca – bone development• Fe – hemoglobin synthesis (cognitive and behavioral performance)

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Age Group NeedsPremature: ˂2500g• TPN ˃ Enteral ˃ Trophic feeds ˃ Oral feeds• Breast milk with fortification is optimal• Premature BM is higher in nutrients• Donor milk

Term Infants • Iron fortified foods added ~6 months of age (early introduction of meat)• Bottle feeding• AA based formulas/Fat malabsorption

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Age Group Needs (con’t) Childhood (1-3)

◦ Energy needs are still high◦ Food preferences◦ 19g fiber/day to prevent constipation

Preschool- Aged (3-5)◦ Patterns and food jags (food jags are very particular food)◦ Food variety, appropriate portion, role model◦ Growth is in spurts

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Age Group Needs (con’t) School Aged (5-12)

◦ Growth is irregular◦ Reserves occur 1-2 years before adolescence◦ Girls growth bypasses boys◦ Food preferences and new stimuli◦ Food choices at school

Nutritional Problems• FTT• Anemia (milk anemia) – no iron in milk • Obesity• Lead poisoning

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Age Group Needs (con’t) Adolescence (12-18)

◦ Final growth spurt◦ Timing of sexual maturation◦ Eating habits◦ Eating Disorders – more commonly found in girls