DNT 200 NUTRITION FOR HEALTH SCIENCES

1. DNT 200NUTRITION FOR HEALTH SCIENCES NUTRITION THROUGH THE LIFE CYCLE PART 1

2. NUTRITION THROUGH THE LIFE CYCLE For all the advances in medicine, there is still no cure for the common birthday John Herschel Glenn, Jr.. (b. 1921) Senator, American astronaut, politician, oldest man to fly in space

3. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Pregnancy: the impact of nutrition on the future • Preparing for pregnancy • Nutrition before conception is important • In early weeks before pregnancy, significant developmental changes occur that depend on a woman’s nutrient intake and stores • Supplementation may be warranted if there are any deficiencies

4. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Preparing for pregnancy (con’t) • Appropriate weight for height benefits pregnancy outcome • 10% or more below or 20% or more above standard weight for height results in a greater risk for impaired pregnancy outcome • Women are advised to achieve a desirable body weight to maximize chances for a healthy baby and maintain their own good health

5. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Preparing for pregnancy (con’t) • A strong correlation exists between pre-pregnancy weight and infant birth weight -- infant birth weight is the most potent single indicator of the baby’s future health status • Low birth weight -- 5-1/2 pounds or less • Low birth weight babies are nearly 40 times as likely to die in first month of life as normal weight babies

6. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Preparing for pregnancy (con’t) • Importance of pre-pregnancy nutrition • Determines the growth of a healthy placenta in the first month of gestation • Only way nutrients can reach developing fetus is through the placenta • If mother’s stores are inadequate during placental development, now matter how well she eats later, fetus will not receive optimal nourishment

7. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy • Each organ of fetus needs nutrients most during its own intensive growth period • Deficiency during one stage of development may effect the heart, during another stage, the developing limbs

8. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION Critical Periods of Gestation

9. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION

10. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy (con’t) • Woman’s nutrient needs during pregnancy and lactation are greater than any other time in her adult life • Energy • Increases about 15% (300 kcalories per day) • Pregnant teenagers, underweight women, and physically active women need more -- 18 kcalories per pound

11. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy (con’t) • Protein • Recommend an additional 10 grams per day throughout pregnancy • Carbohydrate • Generous amount to spare protein • Vitamins • Folate -- DRI increases by half from 400 to 600 micrograms • Vitamin B-12 -- needs increase about 10%

12. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy (con’t) • Minerals • Calcium • Intestinal absorption of calcium doubles during pregnancy • Mother’s bone stores are drawn upon as fetal bones begin to calcify • Phosphorus • Needed for developing bones

13. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy (con’t) • Minerals • Magnesium • Needed for developing bones • Fluoride • Needed for mineralization of fetal teeth

14. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrient needs during pregnancy (con’t) • Minerals • Iron • Developing fetus draws on mother’s stores to create its own stores • Iron losses also occur with blood losses during birth • One of the most difficult needs to meet • Zinc • Required for DNA and RNA synthesis

15. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Weight gain and exercise • The pregnant woman must gain weight

16. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Weight gain and exercise (con’t) • Ideal pattern -- 2-4 pounds during the first three months and a pound per week thereafter • Weight gain reflected in • Infant’s weight • Placenta • Increase in mother’s blood volume to supply placenta • Increase in mother’s fluid volume

17. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Weight gain reflected in (con’t) • Increase in size of mother’s uterus and muscles to support it • Increase in size of mother’s breasts • Fluid to surround infant in amniotic sac • Mother’s fat stores

18. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Practices to avoid • Do not try to diet during pregnancy • Cigarette smoking • Restricts blood supply to growing fetus • Increases iron needs • Decreases availability of: • Vitamin B-12 • Vitamin C • Folate • Zinc

19. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Practices to avoid (con’t) • Caffeine • Crosses placenta • May retard fetal growth • Heavy consumption may increase risk of spontaneous abortion • Consumption should be minimal (one cup coffee or two 12 ounce colas per day

20. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Practices to avoid (con’t) • Drugs -- can cause serious birth defects • Alcohol consumption -- Can cause • Irreversible brain damage • Physical and mental retardation Pregnant woman should drink absolutely noalcohol

21. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy • Gestational Diabetes • Is the appearance of abnormal glucose tolerance during pregnancy with subsequent return to normal postpartum • Risk factors • Age 30 or older • Obesity • Complications in previous pregnancies • Family history of diabetes

22. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Gestational Diabetes • Without proper management, can lead to infant sickness and death • Medical nutrition therapy • Select foods rich in complex carbohydrates • Limit intakes of concentrated sweets • Provide for optimal protein intake • Three meals daily plus snacks • May be controlled by diet alone however insulin therapy can be required

23. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Transient Hypertension of Pregnancy • Is high blood pressure that develops in the second half of pregnancy • Most often is mild and does not affect pregnancy outcome • Along with preeclampsia and eclampsia was formerly known as pregnancy-induced hypertension and toxemia

24. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Pre-eclampsia -- a condition characterized by • High blood pressure • Generalized fluid retention • Protein in the urine • Pre-eclampsia may lead to eclampsia, a severe stage of eclampsia characterized by convulsions

25. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Pre-eclampsia can be fatal to the mother • Greater risk is for the baby • Only known cure is to give birth prematurely • Puts baby at risk for complications (respiratory distress, mental retardation)

26. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Nausea of morning sickness • Arises from normal hormonal changes taking place early in pregnancy • Helpful strategies • On waking, arise slowly • Eat dry toast or crackers • Eat small frequent meals • If some food odors are offensive, avoid those foods • When nauseated, drink no citrus juice, water, milk, coffee or tea

27. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Constipation • Results from • Hormones of pregnancy alter muscle tone • Thriving infant crowds intestinal organs • Painful hemorrhoids may develop • Treatment • Eat foods high in fiber (raw fruits and vegetables, whole-grain cereals) • Exercise daily • Drink plenty of liquids (at least 8 glasses a day), including fruit juices

28. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Medical complications and other problems of pregnancy (con’t) • Heartburn • Is a burning sensation in the lower esophagus, near the heart • Growing infant may put pressure on the woman’s stomach, causing acid to back up • Treatment • Eat small frequent meals • Drink liquids between meals • Avoid spicy or greasy foods • Sit up while eating • Wait an hour after eating before lying down • Wait two hours after eating before exercising

29. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION

30. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION Where do parents get their information? 1994 NS Infant Feeding Survey Results(NSDH, 1998) • 34% mothers find MDs most helpful source of info • 25% identified a female family member • Year One Food for Baby used by 46% of mothers • 90% who received it reported using it

31. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Breast feeding • The mother’s nutrient needs • Preparation • Eat high quality foods • Inadequate diet does not support the stamina, patience, and self confidence that a nursing infant demands • Don’t restrict weight unduly • Severe energy restriction will hinder milk restriction • Choosing nutrient-dense foods will result in gradual weight loss, even though energy intake may be greater than normal

32. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • The mother’s nutrient needs (con’t) • Enjoy ample foods and fluid at frequent intervals throughout lactation • Nursing mother produces an average of 25 ounces of milk per day (wide variations possible) • Breast milk contains 21 kcalories per ounce • An additional 525 kcalories per day are required to produce breast milk • Energy allowance during the first six months of lactation amounts to 640 kcalories above mother’s ordinary need

33. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • The mother’s nutrient needs (con’t) • Food choices for the mother -- should • Provide energy • Offer abundant nutrients, especially those needed to make milk • Calcium • Protein • Magnesium • Zinc • Fluid • Foods with strong or spicy flavors may alter the taste of breast milk -- may annoy some infants

34. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • The mother’s nutrient needs (con’t) • In general, nutritional deprivation of the mother will affect the quantity, not the quality of the mother’s milk • Vitamin supplements for undernourished mothers appears to raise the vitamin concentrations of their milk and appears beneficial

35. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Contraindications of breast feeding • Alcohol easily enters breast milk • Peaks within an hour after ingestion • Leads to decreased consumption by the infant • Excessive caffeine consumption may cause infant irritability and wakefulness • Smoking may reduce milk volume • Communicable diseases (tuberculosis, hepatitis) may require maternal-child separation

36. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Contraindications of breast feeding (con’t) • Medication may be secreted in breast milk • Oral contraceptives (containing estrogen) may reduce milk volume and the protein content of breast milk • Environmental contaminants may be present -- consult with physician or dietitian familiar with local condition

37. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Nutrient needs • Infant grows faster than ever during the first year • Birth weight doubles around four months and triples by one year • By the end of the first year, growth rate slows so that between the first and second birthdays, weight gain amounts to less than 10 pounds

38. Nutrition of the infant NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION

39. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Nutrient needs (con’t) • Energy nutrients and vitamins and minerals crucial to the growth process have special importance • Vitamin A • Vitamin D • Calcium • Iron • Need smaller amounts of nutrients than adults, but compared to weight, need over twice as much of most nutrients

40. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Nutrient needs (con’t) • Most important nutrient of all -- water • Normally breast milk provides enough water to replace losses in a healthy infant • Losses may result from • Vomiting • Diarrhea • Sweating • Urinary loss • Life threatening dehydration can result from losses without replacement • Infants may need supplemental water -- they cannot tell you why they’re crying

41. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Breast Milk • With possible exception of Vitamin D and fluoride, breast milk provides all the nutrients needed for the first six months • Advantages • Tailor-made to meet the nutrient needs of the human infant • Ample vitamins except Vitamin D • Minerals ideal for infants

42. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Breast Milk Advantages (con’t) • Immunological protection -- breast milk offers unsurpassed protection against infection • Colostrom • A milk-like secretion from the breast present during the first day or so after delivery • Contains antibodies and white cells from the mother’s cells • Helps protect the infant from infections from which the mother has developed an immunity

43. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Breast Milk Advantages (con’t) • Bifidus Factors • Factors in colostrum and breast milk that factor the growth, in the infant’s intestinal tract, of friendly bacteria so that less desirable inhabitants will not flourish • Lactoferrin • A protein in breast milk that binds iron and keeps it from supporting the growth of the infant’s intestinal bacteria • Helps absorb iron into the infant’s bloodstream • Works directly to kill some bacteria

44. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Infant formula • Breast feeding should be encouraged wherever possible • May be valid reasons for choosing formula • Does not differ significantly from breast milk in nutrient content • Concerns to be addressed • Formulas do not contain antibodies • Safety and sanitation

45. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Infant formula (con’t) • Bonding can still take place and include other members of the family • Many mothers choose to breast feed but wean children within one to six months -- must be weaned on to infant formula, not plain milk of any kind • American Academy of Pediatrics recommends iron fortified formula for all formula fed infants

46. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Infant formula (con’t) • Standard formulas may be inappropriate for some infants • Lactose intolerant • Milk hypersensitivity • Mother should be trained in formula preparation • Proper preparation techniques • Sanitation

47. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Introducing cow’s milk • Ordinary milk inappropriate during first four to six months -- inadequate in • Iron • Vitamin C • Many pediatricians recommend continued use of breast milk or infant formula during first year because of the iron it provides • Before six months of age, infant’s digestive tract may be sensitive to the protein content of cow’s milk and may bleed

48. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Introducing first foods • Changes in body organs during first year affect the baby’s readiness to accept solid foods • Ability to digest starch not present until infant is several months old • Foods may be started gradually beginning sometime between four and six months

49. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Introducing first foods (con’t) • Indications for readiness -- when infant • Has doubled birth weight • Can consume 8 oz of formula and is still hungry in less than 4 hours • Can sit up • Is consuming 32 oz formula per day and wants more • Is 6 months old

50. NUTRITION THROUGH THE LIFE CYCLENUTRITION DURING PREGNANCY AND LACTATION • Nutrition of the infant • Introducing first foods (con’t) • Schedule