Introduction• The importance of nutrition throughout thelife cycle cannot be refuted• However, the significance of nutritionduring specific times of growth,development, and aging is becomingincreasingly appreciated• Proper nutrition during pregnancy isessential for good health of baby
Healthy Mothers for Healthy andSmart Babies!• Studies have shown that women with poornutritional status had adverse pregnancyoutcome1• Nutritional intake is extremely important duringall phases of life and pregnancy is no exception.In fact, a diet rich in the right nutrients, vitaminsand minerals before and during pregnancy willhelp lady and her baby be as healthy as possible• So it is very essential to take nutritionalsubstance for healthy & smart babies1 Food, Nutrition & Diet 2000 edition
Nutritional deficiencies inPregnancy• There are several factors which lead tonutritional deficiencies during pregnancy– Infection– Pre-existing anemia– Poverty– Low pre-pregnancy body weight
Infection• Infection plays big role in causing depletion innutrition• As in India the incidence of infectious diseasesis very high it is one of the prime cause of lack ofnutrition1• Infection lessens the immune power of humanbeing which leads to less assimilation ofnutrients from food• So there is need of external nutritional supportother than food1 W.H.O.
Pre-existing anemia• Anemia is defined as reduction in circulatinghemoglobin (Hb) mass below critical level• WHO has accepted 11 gm% as the normal Hblevel in pregnancy• Nutritional anemia is one of Indias major publichealth problems. The prevalence of anemiaranges from 33% to 89% among pregnantwomen1• So there is need of external nutritional supportother than food1 Food Nutr Bull. 2006 Dec;27(4):311-5.Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India.Toteja GS, Singh P, Dhillon BS, Saxena BN etal
Poverty• The Planning Commission has estimatedthat 27.5% of the population was livingbelow the poverty line in 2004–20051• Poverty causes less intake of nutrient foodwhich itself leads loss of health• As for healthy babies healthy mothers areneeded poverty is one of the cause forpoor nutritional status of ladies1Poverty estimates for 2004-05, Planning commission, Government of India, March 2007. Accessed: August 25, 2007
Low pre-pregnancy body weight• To gain something you have to losesomething• To gain slim & trim body physique ladiesare losing their health• It leads to poor nutritious health ofmothers• So the nutritional supplement is neededfor healthy mothers
Maternal nutrition before andduring pregnancy• Emerging evidence now suggests that useof micronutrient- containing prenatalvitamins before and during pregnancy isassociated with reductions in the risk ofcongenital defects, preterm delivery, lowinfant birth weight, and pre-eclampsia11 Maternal nutrition before and during pregnancy.Scholl TO.Nestle Nutr Workshop Ser Pediatr Program. 2008; 61:79-89.
Nutritional requirements duringpregnancy• Folic Acid: This vitamin is needed beforepregnancy as well as during pregnancy. Folicacid helps to reduce the baby’s risk for neuraltube defects that affect the brain and spinal cord.Neural tube defects likely occur in the first monthof pregnancy, making it important to get theproper amount of folic acid before pregnancy.• Folic acid also plays a role in DNA synthesis andcell formation.• Folic acid has become recognized as animportant nutrient during pregnancy11 J Obstet Gynaecol. 2008 Jan;28(1):3-13 Folic acid in pregnancy and fetal outcomes.Goh YI, Koren G.
Vitamin B(12)• A diet low in vitamin B(12) is associated with anincreased risk of a child with a CHD1• Iron, folate and B(12) status should bemonitored during pregnancy/lactation indeveloping countries, where nutritionaldeprivation is more prevalent 2• Infant health may also be at risk through acompromised endowment of thesemicronutrients at birth21 Dietary intake of B-vitamins in mothers born a child with a congenitalheart defect. Verkleij-Hagoort AC, etalEur J Nutr. 2006 Dec;45(8):478-86. Epub 2006 Nov 21.2 Iron status, serum folate and B (12) values in pregnancy andpostpartum: report from a study in Jordan.Ann Saudi Med. 2000 Sep-Nov;20(5-6):371-6.
Nutritional requirements duringpregnancyIron: There is a high iron demand duringpregnancy, as extra iron is needed to make redblood cells that carry oxygen through body andto baby. If lady do not have enough iron in herdiet, her body will draw on its own iron stores tosupply it to baby. The result is feelings oftiredness and low iron stores called irondeficiency anemia.• According to the DRIs1pregnant women shouldhave at least 27mg of iron daily1 Dietary Reference Intakes
Iron• Iron deficiency is the most common causeof nutritional anemia. During pregnancythere is a high risk of developing it, due tothe increase of iron requirements for fetaland maternal tissues growth11 Iron stores status at early pregnancyInvest Clin. 2005 Jun;46(2):121-30.Barón MA, Solano L, Peña E, Del Real S.
Carbonyl IronCarbonyl iron exhibits 2-5 times higher bioavailability thanother elemental iron formsCarbonyl iron is as well absorbed as ferrous sulfate and ferrousfumarate without the attendant risk of iron toxicityThe natural, self-regulated delayed release of carbonyl ironmakes it significantly safer than other ferrous iron salts used inordinary prenatal vitamins.Carbonyl iron leads to an enhanced increase in meanhaemoglobin levels, reticulocyte counts, haematocrit and meancorpuscular volume with MR carbonyl iron as compared toferrous fumarateGastric tolerability and patient compliance are superior tofumarate.Sacks and Houchin, Am. J. Clin. Nutr. 31:566-571, 1978J Indian Med Assoc. 2005 Jun;103(6):338-42
The key lines• Protein is essential for life• Protein is the main building component ofthe body• Protein forms the basic structure of eachcell in the body
Protein consists of amino acids• Can be compared with a chain of beads- - - - - - - -| | | | | | | |- etcpoly-peptide = protein• Building unit-|- = amino acid• A few amino acids linked together- -| |- -| | |- - - di-, tri-, or oligo-peptides
A m i n o a c id s f o ld e d in a3 - d im e n s io n a l s t r u c t u r eP r o t e in c o n t a in s• C = c a r b o n• H = h y d r o g e n• O = o x y g e n• N = n it r o g e nN = k e y e le m e n t f o r b u ild in g t is s u e s
Amino acids: 2 groups• Essential amino acids— Must be supplied with food— Cannot be synthesised (made) by our body• Non essential amino acids— Can be synthesised by our body
Function of protein (1)• Major functional & structural componentof all cells in body Î required for growth,maintenance, renewal (repair) of all bodycells• Functions as enzyme, transport carrier,hormone— All enzymes, many hormones, bloodtransport molecules, hair, fingernails, etc.are proteins
Function of protein (2)• Amino acids play a role as precursors(forerunner) for e.g. many enzymes,hormones, vitamins• Constituent of antibodies which protectagainst infection & disease• Supplies energy in particularcircumstances (e.g. in malnourishment),— When fat & carbohydrate intake isinadequate
Sources & quality• Protein in food: different quantity & quality• Nutritional value of protein: determined byamino acid composition— Biological value (BV)High biological valueProtein that contains all essential amino acidsin sufficient proportionsLow biological valueProtein which is deficient (poor) in 1/moreessential amino acids
Animal & vegetable proteinAnimal protein• Sources: e.g. meat, poultry, fish, eggs, milk,dairy products• Almost same proportion of each essential aminoacid as human protein— Complete protein: high BVVegetable protein• Sources: e.g. vegetables, legumes, plants,grains, nuts, seeds• Deficient in 1/more essential amino acids— Incomplete protein: low BV• Deficient (poor) amino acid = limiting amino acid
Digestion• Protein is hydrolysed (digested / cleaved)by particular protein-cleaving enzymes• Place of action: stomach & small intestine• Enzymes cleave protein in small units:— amino acids & short chain peptides
Absorption• Small units: absorbed by small finger-likeprojections (villi), lining the intestinal wall• Small peptides Î free amino acids• Free amino acids Î blood Î liver
Synthesis• Amino acids Î new (cell specific) protein =synthesis = continuing process• Body protein is continuously broken down(into amino acids) and re-synthesised (aminoacids are re-built to protein)
Milk = high quality protein• Cow’s milk (and dairy products) =excellent source of high quality protein— All essential amino acids in proportionsneeded by the bodycows milk 80/20caseinwheyprotein
Casein• In milk: salt of calcium• Fraction that forms curds• Not coagulated by heat— Precipitated (separated) by acids (action of acidin e.g. stomach) or by enzyme obtained fromstomach of calves (production of cheese)• Does not denature easily: proteins denaturewhen they lose their 3-dimensional structure
W h e y - p r o t e i n• O c c u r s in w h e y f r a c t io n : w a t e r y p a r t o f m ilk• W h e y = liq u id r e m a in in g a f t e r m ilk h a s b e e nc u r d le d a n d s t r a in e d• B y - p r o d u c t o f c h e e s e p r o d u c t io n : u s e d f o rn u t r it io n a l ( a n d c o m m e r c ia l) u s e s
Protein requirements• Requirement depends on age, gender (andsituation)• Infants, children, pregnant & lactating needadditional protein (essential amino acids)— Synthesis of new body tissues Î healthy growth& development• Healthy adults require continuous supply ofprotein Î tissue maintenance & repair• Every country: own, local nutrientrecommendations— Internationally: US/Canadian Dietary ReferenceIntakes (DRIs)
H i g h q u a lit y p r o t e i n• C o w ’s m ilk ( a n d d a ir y p r o d u c t s ) = e x c e lle n t s o u r c e o fh ig h q u a lit y p r o t e in— A ll e s s e n t ia l a m in o a c id s in p r o p o r t io n s n e e d e d b yt h e b o d y f o r g o o d g r o w t h & d e v e lo p m e n t— B V = c o m p le t e p r o t e in— C a s e in / w h e y p r o t e in = 8 0 / 2 0
3.4 g protein/100 ml:500 ml/day = 17 g of protein = RDA30% (men) and 37% (women)020406080100Protein RDA500 ml cows milk versus RDAaverage men 19-50 years020406080100Protein RDA500 ml cows milk versus RDAaverage women 19-50 years
Whey protein• It is the name for a collection of globularproteins that can be isolated from whey, aby-product of cheese manufactured fromcows milk.• It is typically a mixture of beta-lactoglobulin (~65%), alpha-lactalbumin(~25%), and serum albumin (~8%), whichare soluble in their native forms,independent of pH.
Whey Protein Nutritional valuesEssentialAmino AcidProtein-SourceWheat Rice Soya Egg Casein WheyProteinsIso-leucine 14 15 21 28 46 55Leucine 27 32 31 34 91 111Lysine 11 15 26 29 77 88Methionine 6 10 5 14 29 25Phenylanine 18 18 19 23 51 34Threonine 12 15 16 21 43 72Tryptophan 5 5 5 5 12 30Valine 18 25 24 29 57 52Histidine 21 21 24 21 30 22mg/gram of protein Source: Nutritive values of Indian food by G.Gopalan & Others, Published by National Institute ofNutrition, Hyderabad
Protein Efficiency RatioProtein Source PER valueWheat 1Rice 1.25Soya 2.12Casein 2.5Lactabumin 2.86Whey proteins 3The Protein Efficiency Ratio ( PER) is used as measure of growth expressedIn terms of weight gain of an adult by consuming 1 gm of food proteinSource : Newzealand Dairy Board
Biological value (BV)• It is a measure of the proportion ofabsorbed protein from a food whichbecomes incorporated into the proteins ofthe organisms body• It summarizes how readily the brokendown protein can be used in proteinsynthesis in the cells of the organism• Whey has the highest Biological Value(BV) of any known protein
Comparison for BV for differentsources of proteinWhey Protein 104Whole Egg 100Egg White (Albumin) 88Casein 77Rice 74Soya 59Wheat 54Source: European Dairy Association
Whey Protein• Protein requirements are increased duringpregnancy due to cell growth, bloodproduction and maternal storage reservesfor labor, delivery and lactation• Whey is a dietary supplement used forbabies and malnourished people to helpthem gain weight1• Whey protein enhances the hemoglobinlevels in blood21. Kennedy RS, Konok GP, Bounous G et al:The use of a whey protein concentrate in the treatment of patients with metastatic carcinoma:A phase I/II clinical study. Anticancer Res 1995; 15:2643-2650.2. Report from the Dept. of Nutrition, College ofHome Science U.A.S., Dharwad (2000-2001)
Vitamin C• Vitamin C or L-ascorbate is an essentialnutrient• In humans, vitamin C is a highly effectiveantioxidant, acting to lessen oxidativestress• Vitamin C is categorized as Pregnancycategory ‘A’• It aid in the body’s ability to absorb ironThe pregnancy category of a pharmaceutical agent is anassessment of the risk of fetal injury due to the pharmaceutical, if itis used as directed by the mother during pregnancyPregnancy Category A Adequate and well-controlled studies havefailed to demonstrate a risk to the fetus in the first trimester ofpregnancy (and there is no evidence of risk in later trimesters).
Vitamin C• Routine antioxidant supplementationduring pregnancy to reduce the risk of pre-eclampsia and other serious complicationsin pregnancy11 Antioxidants for preventing pre-eclampsia.Rumbold A, Duley L, Crowther CA, Haslam RR.Cochrane Database Syst Rev. 2008 Jan 23 ;( 1):CD004227
Docosahexaenoic Acid (DHA)• DHA is a type of fat that is mainly found in fattyfish. It seems to be important in the developmentof the brain and the retina• DHA plays a crucial role in the growth anddevelopment of the central nervous system aswell as visual functioning in infants1• Pregnant and lactating women should aim toachieve an average daily intake of at least 200mg DHA21 Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment at 21/2 years following fish oil supplementation in pregnancy: a randomizedcontrolled trial. Arch Dis Child Fetal Neonatal Ed . 2006 Dec 21.2 J Perinat Med. 2008; 36(1):5-14. Koletzko B, Lien E, Agostoni C, et.al,The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.
Docosahexaenoic Acid (DHA)• Docosahexaenoic acid (DHA) is essential for thegrowth and functional development of the brainin infants. DHA is also required for maintenanceof normal brain function in adults1• The inclusion of plentiful DHA in the dietimproves learning ability, whereas deficienciesof DHA are associated with deficits in learning1• The visual acuity of healthy, full-term, formula-fed infants is increased when their formulaincludes DHA11. Horrocks LA, Pharmacol Res 1999 Sep; 40(3):211-225
Docosahexaenoic Acid (DHA)• Poor maternal DHA status increases riskof inadequate DHA to support brain andretinal development, delaying or limitingneural and visual system development11 Early Hum Dev. 2007 Dec;83(12):761-6. Epub 2007 Oct 24Fatty acids and early human development.Innis SM.
Child Dev. 2004 Jul-Aug;75(4):1254-67. LinksMaternal DHA and the development of attention in infancy andtoddlerhood.– Colombo J, Kannass KN, Shaddy DJ, Kundurthi S, Maikranz JM,Anderson CJ, Blaga OM, Carlson SE.– Department of Psychology and The Schiefelbusch Institute for LifespanStudies, University of Kansas, Lawrence 66045, USA. email@example.com– Infants were followed longitudinally to document the relationshipbetween docosahexaenoic acid (DHA) levels and the development ofattention. Erythrocyte (red-blood cell; RBC) phospholipid DHA(percentage of total fatty acids) was measured from infants and mothersat delivery. Infants were assessed in infant-control habituation at 4, 6,and 8 months augmented with psychophysiological measures, and onfree-play attention and distractibility paradigms at 12 and 18 months.Infants whose mothers had high DHA at birth showed an accelerateddecline in looking over the 1st year and increases in examining duringsingle-object exploration and less distractibility in the 2nd year. Thesefindings are consistent with evidence suggesting a link between DHAand cognitive development in infancy. Copyright 2004 Society forResearch in Child
Calcium & Vitamin D• Calcium is required for normal growth anddevelopment as well as maintenance of theskeleton1• Vitamin D is also essential for intestinal calciumabsorption and plays a central role inmaintaining calcium homeostasis and skeletalintegrity2• Increasing maternal vitamin D intakes duringpregnancy may decrease the risk of wheezesymptoms in early childhood#1 Novartis Found Symp. 2007;282:123-38; discussion 138-42, 212-8.Calcium and vitamin D.Cashman KD2 Maternal vitamin D intake during pregnancy and early childhoodwheezing.Devereux G, etal Am J Clin Nutr. 2007 Mar; 85(3):853-9
Fats & Carbohydrates• Fats– Vitamins A, D, E, and K are fat-soluble,meaning they can only be digested, absorbed,and transported in conjunction with fats– Maintaining body temperature– Promoting healthy cell function– Serve as energy stores for the body• Carbohydrates– It is a source of fuel for the mother
CompositionMOMPLANSr No CompositionEach 30 gmMOMPLANcontains :1 Whey Protein 6 gm2 Carbohydrates 18gm3 Fat 0.3 gm4 Calcium Carbonate equivalent to elemental Calcium 500 mg5 Vitamin C 40 mg6 Carbonyl Iron equivalent to elemental iron 45 mg7 Folic Acid 400 mcg8 Vitamin B 12 1.5 mcg9 Vitamin D 200 i.u10 DHA 100 mg