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must be given (eg, two of seven, not 29%); percent may also be
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after a
whole percent number (Correct: 72%, Incorrect: 72.0%).
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1,000 kcal). Chemical formulas should be written out, unless
they are used
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provide
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in the text (note that if an abbreviation has been spelled out in
the
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or more
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javascript:void(0);
!
!
IUGR%or%intrauterine%
growth%retardation%is%
designated%when%the%birth%
weight%is%>%two%standard%
deviations%below%median%
weight%for%gestational%age%
(5).%
!
IUGR!is!associated!with:!
• Neonatal!death!
• Poor!cognitive!development!
• Neurological!impairment!in!
adulthood!
• Learning!disabilities!
• Childhood!psychiatric!disorder!
• Hypertension!
• Cardiovascular!disease!
• Pulmonary!disease!
• Renal!disease!(2,6)!
!
1.!AbuHSaad!K,!Fraser!D.!Maternal!nutrition!and!birth!outcom
es.!
Epidemiologic+reviews.!2010;32(1):5–25.!!
!
2.!AbuHSaad!K,!Shahar!DR,!Fraser!D,!Vardi!H,!Friger!M,!Bol
otin!A,!
Freedman!LS.!Adequacy!of!usual!dietary!intake!and!nutritional
!
status!among!pregnant!women!in!the!context!of!nutrition!
transition:!the!DEPOSIT!Study.!The+British+journal+of+nutriti
on.!
2012:1–10.!!
!
3.!Bhasin!KKS,!Nas!AV,!Martin!LJ,!Davis!RC,!Devaskar!SU.!
Maternal!
LowHProtein!Diet!or!Hypercholesterolemia!Reduces!Circulatin
g!
Essential!Amino!Acids!and!Leads!to!Intrauterine!Growth!
Restriction.!2009;58(March):559–566.!
!
4.!Brown!J.!Nutrition+Through+the+Life+Cycle.!4th!ed.!Belmo
nt,!CA:!
Wadsworth;!2011:!224.!
!
5.!Gropper!SS,!Smith!JL,!Groff!JL.!Advanced+Nutrition+and+
Human+
Metabolism.!5th!ed.!Belmont,!CA:!Wadsworth;!2009:!189.!
!
5.!Imdad!A,!Bhutta!Z!a.!Effect!of!balanced!protein!energy!
supplementation!during!pregnancy!on!birth!outcomes.!BMC+pu
blic+
health.!2011;11!Suppl!3(Suppl!3):S17.!!
!
6.!Muthayya!S,!Kurpad!a!V,!Duggan!CP,!Bosch!RJ,!Dwarkanat
h!P,!
Mhaskar!a,!Mhaskar!R,!Thomas!a,!Vaz!M,!Bhat!S,!Fawzi!WW.
!Low!
maternal!vitamin!B12!status!is!associated!with!intrauterine!gro
wth!
retardation!in!urban!South!Indians.!European+journal+of+clini
cal+
nutrition.!2006;60(6):791–801.!!
!
7.!Stephens!BE,!Walden!RV,!Gargus!R!a,!Tucker!R,!McKinley
!L,!
Mance!M,!Nye!J,!Vohr!BR.!FirstHweek!protein!and!energy!int
akes!
are!associated!with!18Hmonth!developmental!outcomes!in!
extremely!low!birth!weight!infants.!Pediatrics.!2009;123(5):13
37–43.!!
!
School!of!Nutrition!and!Health!Promotion!!
Phoenix,!Arizona!85004!
[email protected]!
Farryl%Bertmann,%MA,%MS%
References!
IUGR!
Protein!and!
IUGR!
Consuming!adequate!protein!
during!pregnancy!can!protect!
against!intrauterine!growth!
retardation!
!
!
!
!It!has!been!found!that!in!nutritional!interventions!
conducted!in!developing!countries,!the!most!promising!
interventions!in!preventing!adverse!pregnancy!
outcomes!is!protein!supplementation!(3,5).!!In!a!review!
of!literature,!there!is!a!significant!reduction!of!
intrauterine!growth!retardation!(restriction)!(IUGR)!and!
small!for!gestational!age!(SGA)!with!a!pooled!relative!
risk!(RR)!of!0.69!when!protein!was!supplemented!(5).!
These!interventions!have!a!more!pronounced!impact!of!
malnourished!mothers!(5).!The!IUGR!designation!is!used!
for!both!the!pathological!inhibition!of!fetal!growth!and!
lack!of!full!fetal!growth!attainment!(3,5).!!IUGR!however!
does!not!have!an!agreed!upon!definition;!definitions!
include!birth!weight!less!than!2!standard!deviations!
below!the!median!weight!for!gestational!age,!3
rd
!or!5
th
!
percentile!weight!for!age,!and!a!birth!weight!of!less!than!
the!10
th
!percentile!(5).!The!majority!of!low!birth!weight!
(LBW)!infants!in!the!developing!world!are!a!result!of!
IUGR!(1,6).!!Complications!such!as!IUGR!and!LBW!
account!for!40%H80%!of!neonatal!death!(2).!In!addition!
to!protein!deficiency,!factors!such!as!low!socioHeconomic!
status!(SES)!and!maternal!illiteracy!are!associated!with!
IUGR!(6).!In!the!developing!world,!many!expecting!
mothers!have!a!diet!based!primarily!on!cereal.!Cereal!is!
an!incomplete!source!of!protein!and!is!limited!in!the!
essential!amino!acid!lysine!(2).!!Lysine!plays!a!key!role!in!
protein!synthesis!making!it!a!critical!amino!acid!during!
gestation!(1,2).!!In!animal!studies,!lysine!restricted!diets!
have!been!directly!associated!with!LBW!(2).!In!lysineH
deficient!human!populations!there!has!been!an!increase!
in!infant!birth!weight!in!mothers!who!either!receive!
protein!supplements!or!have!consistent!access!to!dairy!
during!pregnancy!(2).!!These!improvements!have!been!
found!to!positively!affect!the!child’s!growth!and!mental!
capacities!in!follow!up!studies!at!age!3!(2,7).!It!is!critical!
that!the!expecting!mother!consumes!adequate!animal!
and!soyHbased!protein!during!gestation!or!incorporates!a!
wide!variety!of!plantHbased!protein!to!meet!adequate!
percentages!and!quantities!of!all!the!essential!amino!
acids.!
1.1+gram+/+kg+body+weight+is+the+recommended+protein+
intake+for+expecting+mothers+(4)+
Inexpensive!
Sources!of!Protein!
Protein!is!an!important!component!
of!a!healthy,!wellHbalanced!diet.!!
Protein!can!be!found!in!animal!and!
plantHbased!sources,!but!fruits!and!
oils!contain!little!to!no!protein!(5).!!
Animal!sources!of!protein!such!as!
chicken,!fish,!pork!and!beef!as!well!
as!soybean!products!such!as!tofu!
contain!the!same!essential!amino!
acid!percentages!that!are!needed!
by!the!human!body.!PlantHbased!
protein!is!limited!in!one!or!more!
essential!amino!acids.!By!eating!a!
variety!of!plantHbased!protein!
sources;!expecting!mothers!can!
overcome!limited!essential!amino!
acids!associated!with!plantHbased!
proteins.!For!example,!an!
inexpensive!source!of!protein,!
which!contains!all!of!the!essential!
amino!acids,!is!a!meal!of!rice!and!
beans.!!
The Good and the Bad News:
Colorectal Cancer (CRC) is the third most
commonly diagnosed cancer and the third
leading cause of cancer death in both men and
women in the United States (1). The good news
is that a diet high in fiber has been shown to
reduce the risk of colon cancer (1)! Studies
have consistently found a protective effect of
fiber, especially fruit and vegetable fiber, against
colon cancer (2).
______________________________________
What exactly is Colorectal Cancer (3)?
It is a type of cancer that develops in the colon
(the first and longest part of the large intestine)
and the rectum (where waste from digestion
ends up). Generally, this type of cancer arises
slowly over a period of 10-15 years and starts
with the development of polyps (growth of
tissue on the lining of the colon or rectum),
which can become cancerous overtime.
Possible Signs and Symptoms to look for (3):
Often there are no early symptoms; therefore,
regular screenings from your doctor is
important. If you detect signs or symptoms of
bleeding from the rectum, bloody or black
stools, severe cramping, constant constipation or
diarrhea, and unintentional weight loss, then you
should consult a doctor for further screening.
______________________________________
Dietary Recommendations for the Prevention
of Colon Cancer (3):
• The American Cancer Society
recommends consuming a healthy diet
with an emphasis on plant and fiber
sources.
• Select foods and beverages in moderate
quantities that aid in reaching and
maintaining a healthy weight.
• Consume 5 or more servings of a range
of fruits and vegetables each day.
• Make the majority of your grains 100%
whole grains and limit consumption of
processed (refined) grains.
• Limit consumption of processed and red
meats.
_______________________________________
Some good fiber sources include (4):
Whole-wheat flour, wheat bran, whole wheat
bread, brown rice, nuts, seeds, oats, peas, beans,
apples, citrus fruits, carrots, barley, high fiber
cereals, tomatoes, dried fruit, broccoli, spinach,
cauliflower, bell peppers, brussel sprouts,
cabbage, onions, garlic, and sweet potatoes.
Daily fiber recommendation (5):
-25g for women and 38g for men (ages 19-50)
-21g for women and 31g for men (Ages 51+)
Additional benefits of fiber (5):
-Weight management
-Regular bowel movements
-Reduce risk of colorectal cancer
-Reduced blood cholesterol and CHD risk
-Improved blood glucose control
_____________________________________
Tips for fitting in your recommended fiber
daily (6):
-choose high fiber cereals for breakfast (at least
5g per serving)
- look for 100% whole grain products
-when baking, substitute whole grain flour for
half of the white flour; also can add flax, bran,
and oats to baked goods
-incorporate chopped up vegetables in things
like sauces and soups to add more bulk
-try to eat a piece of fruit at every meal
-prepare snacks to carry with your throughout
the day: nuts, trail mix, whole wheat crackers,
dried fruit, cut up raw vegetables with hummus,
fruit and yogurt are some of the many options
Fiber and Colorectal Cancer
-Be sure to increase your fiber intake to the
recommended goal slowly overtime and to drink
plenty of water; otherwise gas, bloating, and
cramping may result from increasing
consumption too quickly
___________________________________
Recipe: Whole Wheat Pasta Salad with
Mixed Vegetables (6):
Ingredients:
-12 ounces whole-wheat rotini (spiral-shaped)
pasta
-1 tablespoon olive oil
-1/4 cup low-sodium chicken broth
-1 garlic clove, chopped
-2 medium onions, chopped
-1 can (28 ounces) unsalted diced tomatoes in
juice
-1 pound mushrooms, sliced
-1 red bell pepper, sliced
-1 green bell pepper, sliced
-2 medium zucchini, shredded
-1/2 teaspoon basil
-1/2 teaspoon oregano
-8 romaine lettuce leaves
Directions:
-Cook pasta according to the package directions.
Drain the pasta thoroughly. Place pasta in a large
serving bowl. Add the olive oil and toss. Set
aside.
-In a large skillet, heat the chicken broth over
medium heat. Add the garlic, onions and
tomatoes. Sauté until the onions are transparent,
about 5 minutes.
-Add the remaining vegetables and sauté until
tender-crisp, about 5 minutes. Stir in the basil
and oregano.
-Add the vegetable mixture to the pasta. Toss to
mix evenly. Cover and refrigerate until well
chilled, about 1 hour.
-About 8g of fiber per serving size =
approximately 2 cups
______________________________________
Fiber is Important (7)!
Studies have shown evidence that consuming
high amounts of saturated fat is a contributing
risk factor for colon cancer and that increasing
consumption of foods high in fiber (specifically
fruits and vegetables) is a defensive factor.
Additionally, total fiber intake is associated with
decreased reappearance of polyps, which are the
growths that usually lead to the development of
colon cancer.
_______________________________________
References:
1. Tantamango YM, Synnove KF, Beeson L,
Fraser G, Sabate J. Association Between Dietary
Fiber and Incident Cases of Colon Polyps: The
Adventist Health Study. Gastrointest Cancer
Res. 2011; 4(5-6): 161–167.
2. Irabor, DO. Colorectal carcinoma: why is
there a lower incidence in Nigerians when
compared to Caucasians? J Cancer Epidemiol.
2011;2011:675154.
3. American Cancer Society. Colorectal Cancer
Facts & Figures 2011-2013. Atlanta: American
Cancer Society; 2011.
4.Steinmetz KA, Potter JD. Vegetables, Fruit,
and Cancer Prevention: A Review. J Am Diet
Assoc. 1996; 96: 1027-1039.
5. Anderson JW, Baird P, Davis RH Jr, Ferreri
S, Knudtson M, Koraym A, Waters V, Williams
CL. Health benefits of dietary fiber. Nutrition
Reviews. 2009;67(4):188-205.
6. Mayo Foundation for Medical Education and
Research. Dietary Fiber: Essential for a Healthy
Diet. Available at
http://www.mayoclinic.com/health/fiber/NU000
33/NSECTIONGROUP=2. Accessed February
29, 2012.
7.Neugut AI, Garbowski GC, Won CL, Murray
T, Nieves JW, Forde KA, Fenoglio-Preiser C.
Dietary Risk Factors for the Incidence and
Recurrence of Colorectal Adenomatous Polyps.
Annals Of Internal Medicine. 1993;118(2):91-
95.

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