Healthy mother healthy infant
Download
1 / 66

- PowerPoint PPT Presentation


  • 414 Views
  • Updated On :

Healthy Mother, Healthy Infant:. Achieving Optimal Pregnancy Outcomes Through Nutritional Intervention . Presentation Background. Information on nutrition for women is abundant

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - Pat_Xavi


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Healthy mother healthy infant l.jpg

Healthy Mother, Healthy Infant:

Achieving Optimal Pregnancy Outcomes Through Nutritional Intervention


Presentation background l.jpg
Presentation Background

  • Information on nutrition for women is abundant

  • But gaps persist between recommended daily amounts of nutrients and actual consumption—whether or not a woman is pregnant

  • Challenging situation for health care professionals (HCPs)

  • Recommended Dietary Allowances established by Food and Nutrition Board of the Institute of Medicine offer opportunity for consensus on nutrition counseling

  • Much broader education is still needed


Presentation background3 l.jpg
Presentation Background

  • Contemporary OB/GYN convened panel of clinicians, with support from Xanodyne Pharmaceuticals, Inc.

    • The Council for Nutrition During Pregnancy

    • Members have special interest and expertise in nutrition during pregnancy

  • Discussed challenges in the field of prenatal nutrition

    • Need for standardized definitions and terminology

    • Value of professionally endorsed intake guidelines

    • Overall importance of nutrition for women

    • Specific role of folic acid, iron, omega-3 fatty acids

      • Optimal maternal/fetal health and pregnancy outcomes

  • Presentation is based on the panel discussion


The council for nutrition during pregnancy l.jpg

Mary Ann Barnes, MD

Assistant Director

Family Medicine Residency Program

St. Elizabeth Medical Center

Covington, Kentucky

Robert DiSilvestro, PhD

Professor of Human Nutrition

The Ohio State University College

of Education and Human Ecology

Columbus, Ohio

Osman M. Galal, MD, PhD

Professor, Community Health Sciences

University of California, Los Angeles

School of Public health

Secretary General

International Union of Nutritional Sciences

Los Angeles, California

Andrea S. Lukes, MD, MHSc

President and CEO

Carolina Women’s Research and

Wellness Center

Albermarle, North Carolina

Consulting Assistant Professor

Duke University Medical Center

Durham, North Carolina

Karen M. McGirr, RN, MSN, CNM

Coordinator

Fetal Care Center of Cincinnati

Cincinnati, Ohio

Beth Reardon, MS, RD, LDN

Director of Integrative Nutrition

Carolina Women’s Research

and Wellness Center

Albermarle, North Carolina

The Council for Nutrition During Pregnancy


Nutritional adequacy during pregnancy four important reasons for this review l.jpg
Nutritional Adequacy During Pregnancy:Four Important Reasons for This Review

  • It is essential for HCPs and patients to understand the significance of nutritional adequacy throughout a woman’s life, and especially during pregnancy.

  • HCPs must take responsibility for raising patient and partner awareness of the particular importance of folic acid, iron, and omega-3 fatty acids to maternal and fetal health and optimal outcomes of pregnancy.

HCP= health care professional


Nutritional adequacy during pregnancy four important reasons for this review6 l.jpg
Nutritional Adequacy During Pregnancy:Four Important Reasons for This Review

  • It is important that HCPs recognize the applied—not just theoretical—value of the Recommended Dietary Allowances and other professional recommendations so that we can plan and monitor an appropriate nutritional program for an expectant mother.

  • HCPs must fully recognize and be able to educate patients about the risks posed by nutrient deficiency to the fetus during gestation, especially with respect to cognitive development and the potential for chronic disease later in life.

HCP= health care professional



Definitions of terms to be used l.jpg
Definitions of Terms to Be Used

  • Absorption: The uptake of substances into or across tissues, eg skin, intestine, renal tubules1

  • Adequate intake (AI): The recommended average daily intake based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate; used when an RDA cannot be determined2

  • Dietary reference intakes (DRIs): A set of reference values that serve as standards for nutrient intakes for healthy persons in the United States and Canada, used for planning and assessing nutrient intake3

  • Elemental iron: The amount of iron in a supplement that is available for absorption4

1. Dorland’s Medical Dictionary. www.merksource.com/pp/us/cns/cns_hl_dorlands.2. IOM. www.iom.edu/CMS/3788/4574/45105.aspx.3. IOM. www.iom.edu/CMS/3788/4574.aspx.4. NIH. http://dietary-supplements.info.nih.gov/factsheets/iron.asp.


Definitions cont d l.jpg
Definitions (cont’d)

  • Essential nutrient: “…any substance normally consumed as a constituent of food which is needed for growth and development and the maintenance of healthy life and which cannot be synthesized in adequate amounts by the body”1

  • Fortification: “…The addition of one or more essential nutrients to a food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups.”1

  • Iron deficiency anemia: Condition in which hemoglobin is <11 g/dL2

  • Macronutrients: Proteins, fats, carbohydrates, and water3

  • Micronutrients: Vitamins and minerals4

  • Nutraceutical: A food or food component that may provide medicinal or health benefits, including disease prevention and treatment5

1. FAO/WHO Food Standards Programme. Codex Alimentarius. www.codexalimentarius. net/web/index_en.jsp. 2. CDC. MMWR. 1998;47(RR-3):1-363. Dorland’s Medical Dictionary. www.merksource.com/pp/us/cns/cns_hl_dorlands.4. Bartley KA. Am J Clin Nutr. 2005;81(suppl):1188S-1193S. 5. ANA. www.ana-jana.org/nut_info_details.cfm?NutInfoID=4.


Definitions cont d10 l.jpg
Definitions (cont’d)

  • Nutrition: Ingestion, assimilation, and utilization of nutrients, food, and food components**

  • Prenatal vitamin: A combination product used to supplement the diet and avoid nutritional deficiencies prior to, during, and after pregnancy**

  • Recommended Dietary Allowances (RDAs): The average daily intake of a nutrient determined to be sufficient to meet the needs of 98% of the healthy members of a specific age and gender group in the United States1

  • Supplementation: Nutrients added to the usual diet**

  • Tolerable upper intake level (UL): The maximum amount of a nutrient likely to pose no risk of adverse health effects to almost all individuals in the general population1

**Definition agreed upon for purpose of panel discussion.1. IOM. www.iom.edu/CMS.3788/4574/45105.aspx.


The impact of nutrition throughout a woman s life l.jpg

The Impact of Nutrition Throughout a Woman’s Life


Importance of adequate nutrition l.jpg
Importance of Adequate Nutrition

  • Optimizes completion of adolescent growth

  • Establishes nutrient reserves before pregnancy

  • Protects maternal/fetal health during pregnancy

  • Maintains adequate nutritional status after menopause

  • Combats chronic and/or life-threatening disease

Adapted with permission from The American Journal of Clinical Nutrition.

Bartley KA et al. Am J Clin Nutr. 2005;81(suppl):1188S-1193S.


Impact of nutrition on morbidity and mortality in women l.jpg

Impact of Nutrition on Morbidity and Mortality in Women


Major causes of death in women l.jpg
Major Causes of Death in Women

  • Cardiovascular disease1

    • Leading cause of death among women in the United States

    • Responsible for 39% of deaths in American women

    • Fatality rates within one year of a heart attack average 38% in women (versus 24% in men)

    • 2003: 484,000 women died of heart disease, compared with 268,000 deaths from all forms of cancer combined

  • Diabetes2

    • Strikes about 10 million women; one-third are unaware of it

    • Women with diabetes are at greater risk for heart attack, and at a younger age, than women without diabetes

    • The dangers of diabetes extend to the fetus

    • Complications increase potential for miscarriage and birth defects

  • Cancer3

    • Remains a leading cause of death in women

    • 2005: Took 275,000 lives

1. AHA. www.americanheart.org/presenter.jhtml?identifier=107.

2. ADA. www.diabetes.org/type-1-diabetes/women-diabetes.jsp.3. ACS. www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf.


Professional organizations recommend nutritional intervention to fight disease l.jpg
Professional Organizations Recommend Nutritional Intervention to Fight Disease

  • American Heart Association (AHA)1

    • Eat foods rich in omega-3 fatty acids

  • American Diabetes Association (ADA)2

    • Maintain normal body mass index

  • American Cancer Society (ACS)3

    • Eat whole versus refined grains, 5 or more servings of fruits and vegetables daily, and limited amounts of processed and red meats

1. AHA. www.americanheart.org/presenter.jhtml?identifier=107.

2. ADA. www.diabetes.org/type-1-diabetes/women-diabetes.jsp.

3. ACS. www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pdf.


Pregnancy related morbidity and mortality in the united states l.jpg

Pregnancy-Related Morbidity and Mortality in the United States


Infant morbidity and mortality in the united states l.jpg
Infant Morbidity and Mortalityin the United States

  • Even though deaths have declined, United States has the 27th poorest infant mortality rate among industrialized nations1

    • 1970: 20 deaths/1000 live births

    • 2000: 6.9 deaths/1000 live births

  • Birth defects affect 120,000 babies/year2

    • Responsible for 22% of deaths

    • Neural tube defects (NTDs) affect 1300 babies/year;primary cause of spina bifida and related disorders

  • Preterm birth: About 12% of infants2

1. USD HHS. www.hhs.gov/news/press/2002pres/infant.html.

2. MOD. www.marchofdimes.com/prihec/4439-1206.asp.


Mortality during pregnancy l.jpg
Mortality During Pregnancy

  • Mortality ratios increased from 7.2 to 12.9 (per 100,000 births) between 1987 and 19971,2

  • Black women were affected most2

  • Hemorrhage, embolism, and preeclampsia caused most deaths1

1. Berg C et al. Obstet Gynecol. 1996;88:161-167.2. Berg C et al. Obstet Gynecol. 2003;101:289-296.


Maternal morbidity l.jpg
Maternal Morbidity

  • Maternal health issues increase risk and contribute to poor outcome1

    • Adverse pregnancy outcomes threaten maternal/infant survival

  • Maternal diet affects fetal stress tolerance1

  • Poor nutritional status, infection, and personal stress limit the mother’s ability to support fetal development1

  • Iron deficiency anemia (IDA) is common and contributes to poor maternal/fetal outcomes2

1. Jackson AA et al. J Nutr. 2003;133:1589S-1591S.

2. CDC. MMWR. 1998;47(RR-3):1-36.


Healthy pregnancy healthy outcomes the role of nutrition l.jpg

Healthy Pregnancy, Healthy Outcomes:The Role of Nutrition


Nutritional issues during pregnancy l.jpg
Nutritional Issues During Pregnancy

  • How much should a pregnant woman eat?

  • How much weight gain is healthy? How much is too much?

  • Which vitamins are necessary?

  • Is diet enough, or does a pregnant woman need more nutrients than are available through her daily food choices?

  • Which nutrients are most important during pregnancy? At what point? Why?


Importance of micronutrient balance during pregnancy l.jpg
Importance of Micronutrient Balance During Pregnancy

  • Examples of important micronutrients during pregnancy: vitamin A, vitamin D, folic acid, iron, calcium, zinc

  • Deficiency can be especially dangerous to mother and fetus

    • Impaired maternal/fetal immunity,1 vision disturbance,1 osteoporosis,2,3 hypertension2,3

    • Stillbirth, birth defects, decreased cognitive development1

  • Bartley KA et al. Am J Clin Nutr. 2005;81:1188S-1198S.

  • Holick MF. South Med J. 2005;98:1024-1027.

  • Lips P. Prog Biophys Mol Biol. 2006;92:4-8.


Importance of macronutrient balance during pregnancy l.jpg
Importance of Macronutrient Balance During Pregnancy

  • Fats, protein, carbohydrates, water

  • Adequate intake essential to healthy pregnancy

  • Excessive intake may cause maternal obesity and associated morbidity

    • Hypertension, gestational diabetes

  • Maternal obesity also linked to birth defects1

    • NTDs, congenital heart disease, intestinal malformations

NTDs=neural tube defects

Bartley KA et al. Am J Clin Nutr. 2005;81:1188S-1198S.


Benefits of nutritional intervention l.jpg

Benefits of Nutritional Intervention



Establishing nutritional adequacy during pregnancy l.jpg

Establishing Nutritional Adequacy During Pregnancy Nutritional Adequacy

Organizations and Recommendations


The role of organizations in promoting prenatal nutrition l.jpg
The Role of Organizations in Nutritional AdequacyPromoting Prenatal Nutrition

  • American College of Obstetricians and Gynecologists (ACOG): Issues basic nutritional advice for pregnant women1

  • Institute of Medicine (IOM): Originated RDAs;2 established guidelines to support a favorable outcome of pregnancy3

  • World Health Organization (WHO): The United Nations’ specialized agency; formulates health policy, conducts global health surveillance4

1. ACOG. www.acog.org/publications/patient_education/bp001.cfm.

2. IOM. www.iom.edu/CMS/3788/42135/44011/44197.aspx.

3. IOM. www. nap.edu/openbook/0309041384/html/R1.html

4. WHO. www.euro.who.int/document/373182.pdf.


General nutritional recommendations during pregnancy acog l.jpg
General Nutritional Recommendations During Pregnancy: ACOG Nutritional Adequacy

  • Pregnancy particularly increases nutrient requirements for folic acid and iron

  • If diet is insufficient, provide vitamin/mineral supplementation to raise intake to RDAs for pregnant women

ACOG. www.acog.org/publications/patient_education/bp001.


General nutritional recommendations during pregnancy iom l.jpg
General Nutritional Recommendations During Pregnancy: IOM Nutritional Adequacy

  • Established the RDAs1

    • Most authoritative source of information on adequate nutrient levels for healthy populations

  • Established tolerable ULs1

  • Encourages appropriate weight gain and nutritional intake during pregnancy2

1. IOM. www.iom.edu/CMS/3788/42135/44011/44197.aspx.

2. IOM. www.nap.edu/openbook/0309041384/html/R1.html.

IOM=Institute of Medicine

ULs=upper intake levels


Establishment of rdas l.jpg

Designed to meet the nutritional needs of 98% of the healthy population

Specific for age, gender,pregnancy status

Establishment of RDAs

IOM. www.iom.edu/CMS/3788/42135/44011/44197.aspx.

NRC, CDA. Recommended Daily Allowances. 10th ed. 1989.


General nutritional recommendations during pregnancy who l.jpg
General Nutritional Recommendations During Pregnancy: WHO population

  • A balanced diet draws from 5 distinct food groups

  • Discourages excessive weight gain

    • “Eating for 2” does NOT mean doubling intake

  • Folic acid is essential before conception and during early pregnancy

  • Insufficient iron intake can lead to anemia

  • Women should consult a physician before/when taking any supplements

WHO=World Health Organization

WHO. www.euro.who.int/document/e73182.pdf.


Prenatal powerhouses l.jpg

Prenatal Powerhouses population

Folic Acid, Iron, Omega-3 Fatty Acids


Pregnancy and the powerhouse nutrients l.jpg
Pregnancy and the Powerhouse Nutrients population

  • Folic acid supplementation reduces the incidence of NTDs by 36%

    (0.4 mg/d) and 82% (4 mg/d)1

  • Folic acid and iron deficiency are risk factors for preterm birth, anemia, and infant mortality2,3

    • Folic acid and iron supplementation are the most widely used nutritional interventions during pregnancy4

  • Omega-3 fatty acid supplementation ensures appropriate fetal and neonatal development

    • Brain growth and central nervous systems (CNS) maturation5

NTDs=neural tube defects

1. ACOG. Practice Bulletin No. 44, July 2003.

2. MOD. www.marchofdimes.com/professionals/14332_1151.asp.

3. Bartley KA et al. Am J Clin Nutr. 2005;81(suppl):1188S-1193S.

4. Jackson AA et al. J Nutr. 2003;133(suppl 2):1589S-1591S.

5. Hornstra G. Am J Clin Nutr. 2000;7(suppl):1262S-1269S.


Folate folic acid l.jpg

Folate/Folic Acid population


Folic acid and ntds l.jpg
Folic Acid and NTDs population

  • About 1 out of every 1000 US babies are born with an NTD1

  • Consuming supplemental folic acid reduces the incidence of NTDs

    • 0.4 mg/d could reduce NTDs by as much as 70%2

    • 5 mg/d, taken through the first trimester, could prevent

      85% of NTDs3

  • Folic acid works to prevent NTDs only if taken before conception and during early pregnancy2

NTDs=neural tube defects

1. CDC. www.cdc.gov/ncbddd/bd/mp.htm.

2. MOD. www.marchofdimes/professionals/14332_1151.asp.

3. Wald NJ. N Engl J Med. 2004;350:101-103.


Folic acid risk benefit ratio of achieving nutritional adequacy l.jpg
Folic Acid: Risk/Benefit Ratio of Achieving Nutritional Adequacy

NTDs=neural tube defects

  • MOD. www.marchofdimes.comprofessionals/14332_1151.asp.

  • Brouwer IA et al. Nutrition ResRev. 2001;14:267-293.


Folate folic acid estimated intakes l.jpg

Folate/Folic Acid: AdequacyEstimated Intakes


Folate folic acid estimated intakes38 l.jpg

Adapted with permission from AdequacyThe American Journal of Clinical Nutrition.

Graphs present data obtained from the third National Health and Nutrition Examination Survey (NHANES; 1988-1994) in men (squares) and women (circles) aged 19-30 years. Each graph represents the distribution of estimated folate intakes relative to the Institute of Medicine's estimated average requirement (EAR; an intake below which, on a population basis, inadequate intake may be a concern). The top graph (unmodified data) represents natural folate intakes (in micrograms) prior to government mandated fortification of foods with synthetic folic acid (ie, during NHANES III). The bottom graph (modified data) represents NHANES III data modified to account for synthetic folic acid fortification of foods and dietary supplements, as well as for the reported increase in bioavailability of synthetic folic acid relative to natural folate. Briefly, NHANES III food data was updated to account for synthetic folic acid fortification and synthetic folic acid intakes were multiplied by 1.7 (the bioavailability correction factor) then added to natural folate intakes to calculate estimated dietary folate equivalents (represented above in micrograms). According to these data, 67%-95% of the population met or surpassed the new estimated average folate intake requirement; however, 68%-87% of women of childbearing age had intakes below the recommended intake of 400 µg/d.

Folate/Folic Acid: Estimated Intakes

• Some subgroups get >0.4 mg/d folate

  • 68%-87% of women of childbearing age have synthetic folic acid intakes below the recommended level of 0.4 mg/d

Lewis C et al. Am J Clin Nutr. 1999;70:198-207.


Folate folic acid diet is not enough l.jpg
Folate/ AdequacyFolic Acid: Diet Is Not Enough

  • 50% of folate from food is not absorbed1

  • Bioavailability is greater for synthetic folic acid than for naturally occurring folate2

  • Flour must be fortified with at least 0.14 mg folic acid per 100 g of cereal grain3

  • Diet alone is often insufficient to meet folate demands of pregnancy and nursing4

  • Folate levels in young women have dropped5

  • Brouwer IA et al. Nutrition ResRev. 2001;14:267-293.

  • Lewis C et al. Am J Clin Nutr. 1999;70:198-207.

  • WaldNJ. N Engl J Med. 2004;350:101-103.

  • Sherwood KL et al. J Nutr. 2006;136:2820-2826.

  • CDC. MMWR. 2007;55:1377-1380.


Folate folic acid recommended intakes l.jpg

Folate/ AdequacyFolic Acid: Recommended Intakes


Intake guidelines for folate folic acid l.jpg
Intake Guidelines for AdequacyFolate/Folic Acid

1. Wald NJ. N Engl J Med. 2004;350:101-103.

2. ACOG. www.acog.org/publications/patient_education/bp001.cfm.

3. ACOG. ACOG Practice Bulletin No. 44, July 2003.

4. NRC, CDA. Recommended Dietary Allowances. 10th ed. 1989.

5. USFDA. www.fda.gov/fdac/features/796_fol.html.

6. WHO. www.euro.who.int/Document/e73182.pdf.

IOM=Institute of Medicine

NTDs=neural tube defects

WHO=World Health Organization


Acog recommendation for folate supplements in pregnancy l.jpg
ACOG Recommendation for AdequacyFolate Supplements in Pregnancy

  • 0.4 mg/d should reduce the risk of NTDs by 36%

  • 4 mg/d should reduce the risk of NTDs by 82%

NTDs=neural tube defects

  • ACOG. Practice Bulletin No. 44, July 2003.


Dose response relationship between folic acid and reduced incidence of ntds l.jpg
Dose-Response Relationship Between AdequacyFolic Acid and Reduced Incidence of NTDs

52%

Data from 13 published studies that assessed the effect of folic acid supplementation on serum folate concentration and from the results of a large cohort study that assessed the risk of neural tube defects according to serum folate concentrations were assembled into a two-stage dose-response model by Wald et al. By specifying the relationship between dietary folic acid and plasma folate concentrations, and the relationship between plasma folate concentrations and the risk of neural tube defects, the model predicts the effects of a given amount of supplemental folic acid intake and the associated risk reduction for neural tube defects. The model predicts that (1) increases in folic acid intake reduce the risk nural tube defects and (2) that background plasma folate concentrations influence the effect of folic acid supplementation (higher background levels reflect lower reductions in risk). The data presented above represent background serum folate concentrations of 5 ng/mL.

Wald NJ et al. Lancet. 2001;358:2069-2073. Wald NJ. N Engl J Med. 2004;350:101-103.

NTDs=neural tube defects


Slide44 l.jpg

Iron Adequacy


Importance of iron in pregnancy l.jpg
Importance of Iron in Pregnancy Adequacy

  • Iron intake during pregnancy is essential

    • Supports full-term pregnancy, normal birth weight1-3

    • Protects against IDA (Hb <11 g/dL), leading to poor maternal health, developmental delays, behavioral deficits2,3

    • 11% of nonpregnant woman aged 16-49 years are iron deficient4

    • 3%-5% also had IDA4

IDA=iron deficiency anemia

  • Bartley KA, et al. Am J Clin Nutr. 2005;81:1188-1198.

  • Jackson AA et al. J Nutr. 2003;133(suppl 2):1589S-1591S.

  • CDC. MMWR. 1998;47(RR-3):1-36.

  • Berg CJ et al. Obstet Gynecol. 2003;101:289-296.


Slide46 l.jpg
IDA Adequacy

  • IDA is a common complication of pregnancy

  • Severe IDA may be associated with1:

    • Premature delivery

    • Low birth weight

  • Factors unique to pregnancy that contribute to IDA include2:

    • Intrauterine growth retardation

    • Increased blood volume

    • Fetal demands

    • Blood loss during delivery

IDA=iron deficiency anemia

1. CDC. MMWR. 1998;47(RR-3):1-36.2. NIHODS. http://ods.od.nih.gov/factsheets/iron/asp.


Iron demand during pregnancy l.jpg
Iron Demand During Pregnancy Adequacy

  • Normal iron requirement for adult women is 18 mg/d

  • Requirement escalates to 27 mg/d during pregnancy

    • Gestational increase in blood volume

    • Fetal demands

    • Blood loss during delivery

  • Demand may not be met

    • Average US diet supplies only 15 mg/d of iron; the body’s iron stores are insufficient

NIHODS. http://ods.od.nih.gov/factsheets/iron/asp.


Recommended intake levels of iron during pregnancy l.jpg
Recommended Intake Levels of AdequacyIron During Pregnancy

Recommended Iron Intake (mg/d)

30

IOM=Institute of Medicine

CDC=Centers for Disease Control and Prevention

UL=tolerable upper intake level

1. NRC, CDA. Recommended Daily Allowances. 10th ed. 1989.

2. AAP/ACOG. Guidelines for Perinatal Care. 5th ed. 2002.

3. CDC. MMWR. 1998;47(RR-3):1-36.


Iron risk benefit ratio of achieving nutritional adequacy l.jpg
Iron: Risk/Benefit Ratio of AdequacyAchieving Nutritional Adequacy

1. Bartley KA et al. Am J Clin Nutr. 2005;81(suppl):1188S-1193S.

2. NIH. www.dietary-supplements.info.nih.gov/factsheets/iron.asp.


Types and absorption of iron supplements l.jpg
Types and Absorption of Iron Supplements Adequacy

  • The form of iron affects absorption and tolerance

    • Heme iron can be absorbed at >30%1

    • Ferrous sulfate absorption averages 2.5% to 3%1

    • Chelated iron appears to be better absorbed/tolerated than ferrous sulfate2

  • RDA values established for iron account for variation in bioavailability

Percentage of Elemental Iron in Iron Supplements

1. NIHODS. www.info.nih.gov/factsheets/iron.asp.

2. Bovell-Benjamin AC et al. Am J Clin Nutr. 2000;71:1563-1569.


New forms of iron have advantages l.jpg
New Forms of Iron Have Advantages Adequacy

  • Tend to have higher bioavailability, better absorption, be more easily tolerated

    • Bovell-Benjamin showed absorption from chelated iron is 4 times higher than from ferrous sulfate1

1. Bovell-Benjamin AC et al. Am J Clin Nutr. 2000;71:1563-1569.


Omega 3 fatty acids l.jpg

Omega-3 Fatty Acids Adequacy

Alpha-linolenic acid (ALA) Docosahexaenoic acid (DHA)Eicosapentaenoic acid (EPA)


The role of omega 3 fatty acids l.jpg
The Role of Omega-3 Fatty Acids Adequacy

  • Vital to human development and health

    • Necessary components of cell membranes and tissues

    • Involved in human reproductive, brain, and visual function

  • Cannot be synthesized by the body

  • Maternal fatty acid levels tend to fall

    • Supplementation during pregnancy is important for maternal health, fetal development, and early childhood development

Hornstra G. Am J Clin Nutr. 2000;71(suppl):1262S-1269S.


Fatty acids a balancing act l.jpg

Conversion of ALA is minimal and variable Adequacy

Only 0.2%-15% of ALA is converted

to DHA

DHA is a major fat of CNS, important to brain, heart, eye health, but the body’s conversion is inefficient

ALA conversion to EPA is better, but still not sufficient to maintain adequate recommended levels

Fatty Acids: A Balancing Act

ALA

1.4 g/d

From dietary sources

EPA

0.2%-15%

DHA

ALA=alpha-linolenic acid; EPA=eicosapentaenoic acid; DHA=docosahexaenoic acid

Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.


Omega 3 fatty acids risk benefit ratio of achieving nutritional adequacy l.jpg
Omega-3 Fatty Acids: Risk/Benefit Ratio of AdequacyAchieving Nutritional Adequacy

1. Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.

2. Hornstra G. Am J Clin Nutr. 2000;71(suppl):1262S-1269S.

3. Smuts CM et al. Obstet Gynecol. 2003;101:469-479.


Omega 3 fatty acids intake recommendations during pregnancy l.jpg
Omega-3 Fatty Acids: Intake Recommendations During Pregnancy Adequacy

IOM=Institute of Medicine

WHO=World Health Organization

1. IOM. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. 2002.

2. Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.

3. ISSFAL. www.issfal.org.uk/welcome/default.asp.


Gap between recommended and actual intakes of omega 3 fatty acids l.jpg
Gap Between Recommended and Actual Intakes of Omega-3 Fatty Acids

  • Typical diet contains 100-200 mg/d DHA and EPA1-3

  • Recommended DHA intake during pregnancy is ≥300 mg/d2

  • Average intake of DHA among pregnant women in the US is 77 mg/d4

  • <2% of pregnant women consume enough omega-3 fatty acids4

1. Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.

2. ISSFAL. www.issfal.org.uk/adequate-intake.htm.

3. NRC, CDA. Recommended Dietary Allowances. 10th ed. 1989.

4. Benisek D et al. Wednesday Posters. 2000;95(4):77S-78S.


Omega 3 fatty acids58 l.jpg

Omega-3 Fatty Acids Acids

Impact on Mental Development in Childhood


Slide59 l.jpg
Maternal Supplementation: AcidsOmega-3 Fatty Acids During Pregnancy and Lactation Augment Children’s Mental Processing

  • Helland and colleagues examined how maternal intake of DHA and EPA affected mental development of offspring

  • A longitudinal, double-blinded comparator study of 341 mothers

  • Random supplementation began at the 18th gestational week with either:

    • Omega-3s—cod liver oil

      • 1183 mg/10 mL of DHA; 803 mg/10 mL of EPA, or

    • Omega-6s—corn oil

      • 4747 mg/10 mL of linoleic acid; 92 mg/10 mL of ALA

  • Mental acuity assessed in 84 offspring

  • Helland M et al. Pediatrics. 2003;111:e39-e44.


Maternal omega 3 supplementation augments children s mental processing l.jpg

K-ABC scores (mean [SD]) Acids

P=0.098

P=0.11

P=0.17

P=0.049

Maternal Omega-3 Supplementation Augments Children’s Mental Processing

Values for subsets on K-ABC for children whose mothers had taken omega-3s (DHA and EPA) (n=48) or omega-6s (n=36) during pregnancy and lactation

  • Mental processing composite scores were highest in the omega-3 group

  • Mental processing scores at 4 years linked with maternal intake of DHA and EPA

  • Maternal intake of DHA was the only statistically significant variable for the children’s mental processing score at 4 years

Adapted from Helland M et al. Pediatrics. 2003;111:e39-e44.


Considerations for omega 3 supplementation during pregnancy l.jpg
Considerations for Omega-3 Supplementation During Pregnancy Acids

  • Omega-3 fatty acids help form new tissues and cell membranes and are essential components of human brain, retina

  • Fish is an excellent source of omega-3s but some species are now contaminated with unsafe levels of neurotoxins

  • US Food and Drug Administration recommendations for fish consumption during pregnancy and lactation

    • Avoid eating fish high in mercury, such as white albacore tuna, tile fish, shark, king mackerel1

    • Limit consumption of other fish to 12 oz/wk (3-4 servings)2

1. ACOG. www.acog.org/publications/patient_education/bp001.cfm.

2. Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.


Omega 3 fatty acids62 l.jpg

Omega-3 Fatty Acids: Acids

Impact on Heart Disease


Aha scientific statement omega 3 fatty acids and cardiovascular disease cvd l.jpg
AHA Scientific Statement: Omega-3 Fatty AcidsAcids and Cardiovascular Disease (CVD)

  • Omega-3 fatty acids shown to reduce the incidence of CVD

  • EPA + DHA supplementation between 0.5-1.8 g/d reduces subsequent cardiac and all-cause mortality

  • Recommended intake of omega-3 fatty acids

    • 0.3-0.5 g/d of EPA + DHA

    • 0.8-1.1 g/d of ALA

Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.

AHA=American Heart Association


Aha summary of recommendations for omega 3 fatty acid intake l.jpg
AHA Summary of Recommendations Acidsfor Omega-3 Fatty Acid Intake

CVD=cardiovascular disease

AHA=American Heart Association

Kris-Etherton PM et al. Arterioscler Thromb Vasc Biol. 2003;23:1-11.


Summary optimal pregnancy outcomes through nutritional intervention l.jpg
Summary: Optimal Pregnancy Outcomes AcidsThrough Nutritional Intervention

  • Balanced nutrition is essential for women during all stages of life, even more so during pregnancy

  • Adequate intake of folic acid, iron, and omega-3 fatty acids is particularly important during pregnancy

    • Folic acid helps prevent devastating birth defects

    • Iron supports normal gestational length, fetal weight, and behavioral development

    • Omega-3 fatty acids are primary components of the cell membrane and are involved in neural development in the CNS, including brain function and vision; they also play a role in cardiovascular health

CNS=central nervous system


Summary optimal pregnancy outcomes through nutritional intervention66 l.jpg
Summary: Optimal Pregnancy Outcomes AcidsThrough Nutritional Intervention

  • RDAs comprise the foundation of a system to help determine the nutritional adequacy of a given population throughout the lifespan

    • Designed to meet the needs of 98% of the healthy population, revised regularly

    • The most comprehensive reference for human nutrition and the closest approximation we have to standardized nutritional guidelines


ad