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maternal nutrition 1.pdf
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  2. 2. Importance of preconceptional nutrition • Optimal preconceptional nutrition lowers risk of birth defects. • The embryo is particularly vulnerable during the first few weeks when organs are formed. N.M.W
  3. 3. Importance of preconceptional nutrition • Required levels of Vitamins and amino acids are needed for DNA synthesis, especially folate, vitamin B12 and B6, are needed. • Excess retinol intake, on the other hand, increases the risk for heart and other organ defects. N.M.W
  4. 4. Nutrition before conception Some deficiency related problems develop very early in pregnancy: • Adequate folate (400 μg daily) before conception can reduce the risks • Neural tube defects: N.M.W
  5. 5. Nutrition before conception A healthy diet before conception includes • Avoiding teratogens: substances that cause birth defects • Avoiding alcohol and illegal drugs • Avoiding other possible hazards: Smoking, caffeine N.M.W
  6. 6. Nutrition before conception A healthy diet and appropriate levels of physical activity before conception: • Promotes optimal body weight • Reduces the risk of developing nutrition- related disorders during pregnancy, such as gestational diabetes N.M.W
  7. 7. Nutrition Before Conception A man’s nutrition before conception • Adequate nutrition keeps the immune system strong and promotes fertility (Sperm number and motility (ability to move) • Fertility can be reduced by alcohol consumption, certain prescription, and illegal drugs. N.M.W
  8. 8. Nutrition during pregnancy A full term pregnancy lasts 38 – 42 weeks: • 1st trimester: conception to 13th week • 2nd trimester: 14th to 27th week • 3rd trimester: 28th to 40th week Embryonic stage: ~ day 15 to the 8th week • After the 3rd month, the developing baby is called a fetus. N.M.W
  9. 9. Nutrition during Pregnancy 1st trimester • Zygote (fertilized egg) gets implanted in the wall of the uterus • Development of organs, limb buds, facial features, placenta begins (adequate nutrients required) • Embryos are extremely vulnerable to teratogens during this time N.M.W
  10. 10. Critical Period of Development During the first trimester, malnutrition in the mother can cause irreversible damage to the developing embryo. • Heart damage • Neural tube defects • Incomplete development of limbs, eyes, and ears N.M.W
  11. 11. Nutrition During Pregnancy 2nd trimester • Continued development of organ systems • Growth from ~ 3 inches to over a foot long by the end of the 2nd trimester N.M.W
  12. 12. Nutrition During Pregnancy 3rd trimester • Time of intense growth and maturation • Fetus gains ¾ of it’s weight in this time • Brain growth is also extensive • Lungs become fully mature • A balanced, adequate diet for the mother continues to be critical N.M.W
  13. 13. Nutrient source for fetus • Nutrients are provided by chorionic fluid first, later via placenta. • During the first weeks the embryo gets all nutrients from fluids secreted by the chorion into the chorionic sac which envelops the embryo. N.M.W
  14. 14. Nutrient source for fetus • Glucose, amino acids, vitamins and other essential compounds are absorbed by the embryo’s yolk sac, by both passive and active transport mechanisms • Towards the end of the first trimester the placenta takes over the maternal-fetal exchange of nutrients, fluids and gases. N.M.W
  15. 15. Meeting fetal nutrient needs • Maternal diet and nutrient stores together provide for fetal needs. • Pregnancy increases the requirement for nearly all nutrients; folate and iron needs increase dramatically. N.M.W
  16. 16. Meeting fetal nutrient needs • Maternal stores (especially iron and B12) are important to cover some of the additional nutrient needs of pregnancy. • Lack of sufficient energy, protein and micronutrients can interfere with fetal brain and other organ development. N.M.W
  17. 17. Meeting fetal nutrient needs • Regardless of pre-pregnancy weight, all pregnant women need to gain some weight during pregnancy. The average recommended weight gain is between 11- 16 kg. N.M.W
  18. 18. Nutrition During Pregnancy • Weight gain during pregnancy: • Pattern of weight gain is important: –1st trimester: 1.5 to3 kg. –2nd-3rd trimesters: average 0.5kg. per week –Typically 11-16kg. • Too much weight gain is also risky • Women should not diet during pregnancy: this may deprive the fetus of critical nutrients N.M.W
  19. 19. Macronutrients Energy • 2nd and 3rd trimesters: additional 350-450 kcal/day • Nutrient-dense foods to obtain sufficient nutrients • Safe and physician-approved program of regular moderate physical activity Proteins and Carbohydrates • 1.1 gm/kg body wt/day of protein • 175 grams/day minimum of carbohydrates N.M.W
  20. 20. Macronutrients Fat • The percentage of calories obtained from fat should not change during pregnancy. • Limit saturated fat, avoid trans fats • Fat is required by the newborn for temperature regulation and as an energy source • Omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) is critical for embryo’s neurologic and eye development N.M.W
  21. 21. Micronutrients The micronutrients that are most critical during pregnancy include • Folate • Vitamin B12 • Vitamin A • Vitamin C • Vitamin D Assignment: Check out for functions of each during pregnancy. • Calcium • Zinc • Iron • Sodium • Iodine N.M.W
  22. 22. Neural Tube Defect N.M.W
  23. 23. Nutrition-Related Concerns Nutrition-related problems during pregnancy can include: • Morning sickness • Cravings, pica and food aversions • Heartburn • Constipation and hemorrhoids • Gestational diabetes • High blood pressure – causing nutrient discharge thru urine N.M.W
  24. 24. Fluids Intake During Pregnancy The need for fluids increases to 3 liters per day for: • Increase in the mother’s blood volume • Regulating body temperature • Production of amniotic fluid to protect and cushion the fetus • Combat fluid retention and constipation • Prevent urinary tract infections N.M.W
  25. 25. Nutrition during Breast feeding Lactation: production of breast milk Prolactin: hormone responsible for the synthesis of milk • Produced toward the end of pregnancy • Suppressed by estrogen and progesterone until childbirth Colostrum: first milk produced; rich in proteins, antibodies, vitamins, minerals N.M.W
  26. 26. Breastfeeding • Milk production requires 700 – 800 kcal/day • Lactating women should consume an extra 330- 400 kcal/day above their own needs • Allow for gradually weight loss (0.5–2 kg/mo) N.M.W
  27. 27. Breastfeeding • Increased need for protein, certain vitamins and minerals (folate, iron, calcium), fluid • Multivitamin: not substitute for proper nutrition • BENEFITS OF BREAST FEEDING • OBSTACLES TO BREAST FEEDING N.M.W
  28. 28. Nutrition during Infancy Optimal nutrition is critical in the first year: • The baby’s organs are developing • The nervous system continues to develop • Babies typically grow 10 inches in length and triple their weight in the 1st year N.M.W
  29. 29. Infants Nutrition • The most appropriate food for an infant is human milk. • Infants require 93-120 Kcal/kg/day, the highest requirements of the lifecycle, and must nurse several times a day to meet these needs. • They require 86-103 ml/kg/day of fluid; N.M.W
  30. 30. Infants: Appropriate infant food • At birth, low secretion of digestive enzymes makes digesting solids foods or cow’s milk difficult. • Low renal capacity means high protein intake can cause renal overload and induce osmotic diuresis and water loss. N.M.W
  31. 31. Infants: Appropriate infant food • After 4-6 months an infant’s kidneys will mature enough to handle the high solute loads caused by solid foods. N.M.W
  32. 32. Infant Nutrition • Infants double their birth weight by 4-6 months of age and triple it by I year • The length increase by 50% in the 1st year and double by 4 years • Stomach capacity increases from 10-20ml at birth to 200ml by I year enabling infants to consume more food. N.M.W
  33. 33. Infant Nutrition Nutrition-related concerns for infants include • Allergies • Colic • Failure to thrive • Anemia • Dehydration • Nursing bottle syndrome N.M.W
  34. 34. Important nutrients • Zinc • Vitamin A • Iron • Energy • Protein • Carbohydrates N.M.W
  35. 35. Childhood and Adolescence N.M.W
  36. 36. Toddlers Age 12 to 36 months • Rapid growth rate of infancy begins to slow • Gain 5.5 to 7.5 inches, average 9-11 pounds • Higher energy expended for increased activity levels N.M.W
  37. 37. Toddlers Macronutrients: • 30%-40% of total kcal from fat • 1.1 grams of protein per kg body weight • 130 grams carbohydrates per day • 14 grams fiber per 1,000 kcal/day N.M.W
  38. 38. Toddlers Micronutrients: • Ensure adequate intake of the micronutrients including: Vitamins A, C, E, calcium, iron, zinc, potassium • Until age 2 or beyond, drink whole milk for calcium • Iron deficient anemia is the most common nutrient deficiency in young children N.M.W
  39. 39. Toddlers Fluid needs: • 1.3 liters per day • Supplements: • Toddlers may need supplements, especially for fluoride • Supplement should not exceed 100% Daily Value for any nutrient per dose N.M.W
  40. 40. Toddlers Nutritious Food Choices: • Innate ability to match intake with needs • Nutritious variety encourages a healthy diet • Food should not be forced on a child • Frequent small meals for small stomach • Developmentally appropriate foods • Small portions, limited healthy alternatives • Role modeling is important N.M.W
  41. 41. Preschoolers Age 3 to 5 years • Growth rate continues to slow • Will gain 3–4 inches, 5–6 pounds per year • Reduced appetite • Chew most foods adequately • Use a cup, spoon, and fork with relative ease N.M.W
  42. 42. Preschoolers Macronutrients: • Total fat intake should gradually be to a level closer to adult fat intake • 25%-35% of total energy from fat • 0.95 grams protein per kg body weight • 130 grams carbohydrate per day • 14 grams fiber per 1,000 kcal N.M.W
  43. 43. Preschoolers Micronutrients: • Adequate fruits and vegetables in the diet continues to be a concern • Fiber and potassium: priority nutrients lacking in the diets of low-income preschoolers • Concerns: vitamins A, C, E, calcium, iron, zinc • AI of calcium increases for toddlers • RDAs for iron and zinc also increase N.M.W
  44. 44. Preschoolers Fluid: • 1.7 liters per day Supplements: • May be recommended when particular food groups are not eaten regularly • Supplements should be appropriate for the child’s age N.M.W
  45. 45. Preschoolers Nutritious Food Choices: • Parents can teach preschoolers about healthy food choices • Some foods will “give them energy” • Some foods “help us grow healthy and strong” • Some foods are used as occasional treats N.M.W
  46. 46. Preschoolers Nutrition-Related Concerns: • Iron deficiency anemia • Constipation • Dental caries • Childhood food insecurity N.M.W
  47. 47. School-Aged Children Age 6 to 13 years • Growth is slow and steady, 2-3 inches/year • Children begin to make their own food choices • Activity levels vary N.M.W
  48. 48. School-Aged Children Macronutrients: • 25%-35% of total energy from fat • 0.95 grams protein per kg body weight • 130 grams carbohydrates • 45%-60% of kcal from carbohydrates • 14 grams fiber per 1000 kcal per day N.M.W
  49. 49. School-Aged Children Micronutrients: • The need for most micronutrients increases slightly through age 8 • Micronutrient needs rise sharply as children approach puberty • Calcium and iron are still very important N.M.W
  50. 50. School-Aged Children Fluid: • Adequate Intake (AI) of fluids varies by age and gender, ranging from 1.7 liters to 2.4 liters per day • Water should be encouraged during physical activities to maintain hydration • Water remains the beverage of choice N.M.W
  51. 51. School-Aged Children Nutritious Food Choices: • Peer pressure can influence food choices • School lunches should be based on the RDA for this age group • A variety of foods N.M.W
  52. 52. School-Aged Children Nutrition Related Concerns: • Body image and appearance become more important to children as puberty approaches • Inadequate calcium intake can result as children make their own choices and may avoid milk in favor of other beverages N.M.W
  53. 53. Adolescents Age 14 to 18 years • Emotions and behaviors often unpredictable • Puberty: secondary sexual characteristics develop, capacity for reproduction • Growth spurts begins at age 10-11 for girls, 12- 13 for boys • Expect an average 20-25% increase in height • Weight and body composition also change N.M.W
  54. 54. Adolescents Macronutrients: • Estimated energy requirements (EER) for adolescents is based on gender, age, activity level, height and weight • 25%-35% of total energy from fat • 45%-60% of kcal from carbohydrates • 0.85 gram protein / kg body weight • 26-38 grams of fiber per day N.M.W
  55. 55. Adolescents Micronutrients: • Calcium intakes must be sufficient for achieving peak bone density: 1300 mg/day • Iron needs are relatively high: 11 mg/day for boys, 15 mg/day for girls • Vitamin A is critical for supporting rapid growth and development N.M.W
  56. 56. Adolescents Fluid: • The need to maintain fluid intake is increased by higher activity levels • Boys: 3.3 liters/day • Girls: 2.3 liters/day N.M.W
  57. 57. Adolescents • Nutritious Food Choices: • Peer influences and fast-paced lifestyle can lead adolescents to choose fast foods • Parents can act as role models and make healthy food choices available • Encourage fruits, vegetables, milk N.M.W
  58. 58. Adolescents Nutrition Related Concerns: • Adequate dietary calcium to maximize bone calcium uptake and bone mineral density • Disordered eating and eating disorders can begin in these years (anorexia nervosa; bulimia etc. ) • Acne and diet • Cigarette smoking, alcohol, and illegal drugs can have an impact on nutrition N.M.W
  59. 59. Nutrition in adulthood Age 18 to 65 years • Early adult hood (18 to 30 yrs) • Middle adulthood (30 to 65yrs) • There’s less physical activity in adulthood and nutrition needs decrease to a maintenance level except for iron in women. • After 21, energy needed for metabolism slowly decreases with age • Iron requirement in women decrease after menopause N.M.W
  60. 60. Nutrition in adulthood Nutrition related health problems: • Obesity • Hypertension • Atherosclerosis • Family planning methods may increase nutrient needs in women (e.g. the IUD) may lead to blood loss – increased iron needs N.M.W
  61. 61. NUTRITION IN THE ELDERLY • Age 65 and above Nutritional well being is influenced by: • Person’s general health • Established food habits • Ability to obtain and prepare food • Financial situation • Level of physical activity • Emotional state • Mental health N.M.W
  62. 62. NUTRITION IN THE ELDERLY • Nutrition concerns • Constipation – decreased GI motility and physical activity • Iron deficiency anemia • Pernicious anemia • Dental problems • Other chronic diseases N.M.W
  63. 63. Requirements of the elderly: – ↑Vitamin D for bone strength – ↓ Energy (not active) – ↓ Iron (females) d/2 menopause. – ↑ Vitamin to prevent diseases. – ↑ Proteins for body tissue repair. • Reasons – ↓ lean body mass. – ↓ Metabolic rates – ↓ Physical activity – Age related bone degeneration. N.M.W
  64. 64. As people age there are Physiological; psychological and economic changes that affect nutrition: • Physiological changes: body functions slow with age & ability of the body to reduce worn out tissues is reduced. Dentition is common among other challenges, if nutrition has been chronic immune system is compromised. N.M.W
  65. 65. • Psychological changes: Loneliness ; feelings of unworthy, / loss of self-esteem, grief, physical disabilities that come in old age can destroy the social life can lead to depression, diminish ones appetite and ability to shop or cook. • Economic changes: Decreased income affects ones quality of life and adds worries in paying bills… one may select less than healthy diet on the basis of cost rather than nutrients N.M.W

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