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. WeightPregnancy: 1-2 lb mo 1st trimester; 0.5-2 lb week in 2nd
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1. Nutrition Issues: Women's Life Stages Dr. Judith Wylie-Rosett jwrosett@aecom.yu.edu Learning Objectives Identify nutrition issues for a women:
During pregnancy focusing on high risk
In midlife to reduce chronic disease risk
In older age to address multiple medical and/or social problems
Assess Weight, Activity, Variety and Excess for each age cycle and determine when refer for medical nutrition therapy with Registered Dietitian (RD) is needed.
2. Weight
Pregnancy: 1-2 lb mo 1st trimester; 0.5-2 lb week in 2nd & 3rd Trimester
Midlife: Weight distribution & risks relate to metabolic syndrome.
Older Age: Unintentional weight loss > 10 lb at risk
Activity
Pregnancy: ? impact weight-baring activity > fetal distress.
Midlife: Weight-baring activity ? risk of osteoporosis.
Older Age:. Assess for unsteady gait.
Variety Pregnancy: Calcium iron, protein, fiber/water, and folate
Midlife: Metabolic syndrome, N-3 fatty acids; calcium intake, vegetables
Older age: Absorption/nutrient requirements; Calcium/Vit D, Vit B-12, and zinc supplements may be needed.
Excess
Pregnancy: Screen for cravings, EtOH intake,
Midlife: CHO & lipids, meat & calcium excretion
Older Age: Food/EtOH behaviors to cope with loneliness.
3. American Dietetic/Diabetes Association Exchange System Overview
4. Quick Carbohydrate Counting One Carbohydrate choice = 15 grams based on the ADA’s Exchange system
Exchange groups included are:
- Starch (1/2 cup, slice of bread)
- Fruit (1/2 cup)
- Milk (1 cup)
- Other Carbs (varies by concentration)
Glycemic Indexing Issues
5. Typical GDM Carbohydrate (~35-40% of Energy)
6. GDM Carbohydrate ~35-40% of EnergyMeat, Cheese, Vegetables- not measured
7. Weight Gain Recommendations for Pregnant Women(Overweight Cuts Weight Gain Rx in Half) Normal weight
3-5 pounds per month 1st trimester
1-2 pounds per week 2nd and 3rd trimesters
Overweight
11/2 - 21/2 pound per month 1st trimester
1/2 -1 pound per week in 2nd and 3rd trimesters
8. Dietary Approach to Stop Hypertension DASH Daily Recommendations 7-8 Serving - grains, emphasis on whole grains
4-5 Serving - vegetables
4-5 Servings - Fruits
2-3 Servings - low-fat dairy products
< 2 Servings - Meats
2-3 Servings Oils
* Eat 4-5 servings of nuts, seeds and dried bean per week
Limit intake of sweets to 5 per week
9. Nutrition-Related Pregnancy ProblemsRates in the United States Hypertension ~ 12-22%
Preeclampsia ~ 6-8%
Gestational Diabetes~ 2-14%
Anal fissures/external hemorrhoids disease occur ~ 35% of pregnancies.
Postpartum Iron Deficiency rates:
30% if < 130% of poverty level
7% if > 130% of poverty level
Neural tube Defects ~ 4000 annually
10. Recommended Weight Gain based on Prepregnancy BMI* BMI< 19.8 kg/m2 28-40 pounds
BMI 19.8-26 kg/m2 25-35 pounds
BMI > 26 kg/m2 15-25 pounds
*American Diabetes Association Guide to Medical Nutrition Therapy
11. Tight Glucose Control in GDMReduction in Adverse Outcome
12. Midlife CVD Risk for WomenMetabolic Syndrome Synonyms
Insulin resistance syndrome
(Metabolic) Syndrome X
Dysmetabolic syndrome
Multiple metabolic syndrome
13. Metabolic Syndrome Therapeutic Objectives
To reduce underlying causes
Overweight and obesity
Physical inactivity
To treat associated lipid and non-lipid risk factors
Hypertension
Prothrombotic state
Atherogenic dyslipidemia (lipid triad)
14. Specific Dyslipidemias: Possible Causes of Elevated Triglycerides
High carbohydrate diets (>60% of energy intake)
Several diseases (type 2 diabetes, chronic renal failure, nephrotic syndrome)
Certain drugs (corticosteroids, estrogens, retinoids, higher doses of beta-blockers)
Various genetic dyslipidemias
15. Lipoprotein pattern: atherogenic dyslipidemia (high TG, low HDL, small LDL particles)
Baseline triglycerides: ?200 mg/dL
Lifestyle option:
Weight loss
? EtoH and Carbohydrate
Supplement options:
Niacin
Omega-3 fatty acids
LDL-cholesterol goal: <100 mg/dL Diabetic Dyslipidemia
16. Older Age Assessment of Nutritional Risk Unintentional weight loss or BMI < 22 kg/m2
Serum Albumin < 3.5 mg/dL
Unintention reduction in cholesterol or < 150 mg/dL
Reduced calorie or protein intake
Difficult swallowing and/or gastric reflux
Decreased appetite or ability to eat/obtain food
Depression
Economic Issues
17. Treatment Options for Low Weight in Older Adults Liquid suppmements
Medications that stimulate appetite and weight gain
Vitamin/mineral supplementation
Referral to RD and social service
Use enteral nutrition before considering TPN
18. Congestive Heart FailureNutritional Evaluation Fluid retention (pedal edema or ascities)
All blood levels in relation to fluid retention
Serum electrolytes (high sodium and low potassium)
Hypotension
Protein (risk of cardiac cachexia)
19. Treatment of Congestive Heart Failure Reduce sodium to < 2400 mg; DASH diet
Check adequacy of protein and calorie intake
Check fluid status daily (sign of edema and daily weights)
Stablize before surgery and invasive medical procedures monitor afterwards
20. Nutrition Referral Issues Integrate nutrition into your overall workup by briefly assessing weight, activity, variety and excess.
Refer women to RD for in-depth Medical Nutrition Therapy consultation if:
1. You identify a nutrition-related problem
and
2. Patient is ready to address the problem.