Nutrition Lifecycle (10/12)

• because nutrition can affect her ability to actually become pregnant, she should:
• 1. achieve/maintain a healthy body weight
• 2. follow an adequate/balanced diet
• 3. be physically active
• 4. receive regular medical care
• 5. manage chronic conditions
• 6. avoid harmful influences

• 1. achieve/maintain a healthy body weight: a higher BMI is correlated w/ low sperm count
• 2. have adequate zinc, which plays a role in testosterone production & DNA (sperm) replication
• 3. have enough antioxidants to keep sperm healthy (contain lots of PUFAs which can spoil easily but is prevented by antioxidants)
• 4. minimize alcohol intake: lots of alcohol can lower sperm count

• its birthweight
• women should NOT diet during pregnancy: may deprive fetus of critical nutrients
• women must gain some but not too much weight during pregnancy; women who don't gain enough weight OR who gain too much put the baby at risk for health complications

• Underweight Moms have an increased risk of preterm births & infant death
• Overweight Moms have an increased risk of complications DURING birth & health complications for infant after birth

• during the 2nd & 3rd trimester
• brain development occurs in the last (3rd) trimester

• 10-14 lbs
• a small amount of weight gain was recommended because it was noted that large weight increases were associated with preeclampsia
• *this weight was actually coming from EDEMA
• after 1970 the recommendation was increased to 20-25 lbs

• they based weight gain on a womans weight (BMI) prior to pregnancy
• those who weigh more should gain less
• those who weigh less should gain more
• the recommendation was DEVELOPED b/c of concern about low birth weight (LBW) infants
• it aimed to PREVENT premature births & small for gestational age (SGA) infants

to include a new category addressing pre-pregnancy obesity

• Underweight Women (<18.5) → gain 28-40 lbs
• Normal weight Women (18.5-24.9) → 25-35 lbs
• Overweight Women (25-29.9) → 15-25 lbs
• Obese Women (>30) → 11-20 lbs
• only ~1/3 of women stay within these ranges; vast majority gain more weight
• 

• it SLOWS DOWN, which is why weight gain isn't recommended until the 2nd & 3rd trimesters
• 
• all women except obese ones should gain ~4.4 pounds during the 1st trimester
• WEEKLY weight gain changes in the 2nd & 3rd trimester: .5-1 lbs depending on BMI

• 1. fetus: 25-27% (only 1/4 of the weight gain goes to baby)
• 2. fat stores: 25-27%
• 3. extra fluid: 13%
• 4. uterus & breast growth: 11%
• 5. expanded blood volume: 10%
• 6. amniotic fluid: 6%
• 7. placenta: 5%

• times of intense development & rapid cell division in the fetus
• if cell division & development is compromised, it may be impossible for the baby to develop the structures & functions at all
• oran & tissue development (esp during the 1st trimester) are the most vulnerable to adverse influences such as deficiencies, toxicities, or teratogens during critical periods

• or developmental plasticity: persisting changes in the body structure & function can be caused by environmental stimuli (especially NUTRITION)
• genes can express different ranges of physiological or morphological states in response to environmental conditions during fetal development
• explains how the groundwork for chronic diseases can originate if the fetus is exposed to adverse influences during critical periods of fetal development
• such changes can potentially influence successive generations

• a famine in the German-occupied western part of the Netherlands during the winter of 1944-1945
• a German blockade cut off food & fuel shipments to punish the Dutch for not aiding Nazi war efforts

• birth weights were normal (DIDN'T decrease)
• offspring had elevated rates of obesity, altered lipid profiles, & cardiovascular disease
• females born to mothers during this time who went on to give birth had babies with LOW birth weights

• babies had low birth weights & continued to be small people throughout their lives
• had lower rates of obesity as adults
• females born to mothers during this time who went on to give birth had babies with NORMAL birth weights
• *don't see the same tie to chronic disease as observed with early exposure to starvation

• during LACTATION & PREGNANCY needs tend to be higher than any other time in ADULT life
• order: lactation > pregnancy > infancy
• BMR increases during the 2nd & 3rd trimester after slowing down in the 1st
• food intake should increase by ~15-20% during pregnancy

• 1st: NO extra calories (or a few)
• 2nd: 340 more kcals/day
• 3rd: 450 kcals/day

an additional 25 g/day

• fluid needs RISE to 3 Liters/day to help increase maternal blood volume, regulate body temperature, produce amniotic fluid to protect the fetus, combat constipation, & reduce risk of UTIs
• + dehydration is a large cause of premature labor

• embryo's precursor to the CNS (brain & spinal cord)
• it closes by 18-26 days after conception
• defects (NTD) such as anencephaly or spinal bifida are caused by failure of the tube to close or failure for it to close completely

• supplementation of 400-600 micrograms/day & intake of 200-300 micrograms/day during the PERICONCEPTUAL period reduces risk of NTD
• there is an increased need in pregnancy due to erythropoiesis (process by which RBCs are made)
• was added to cereal grains in 1998 & reduced NTD by 28% in the US & 46% in Canada

• failure of spinal chord to close
• is characterized at birth by an opening in upper part of the spinal chord

absence or failure to develop a brain

• 1. Calcium
• 2. Vitamin D

• the RDA of Ca²⁺ does NOT increase b/c maternal absorption of Ca²⁺ increases during pregnancy (more doesn't need to be consumed)
• if required Ca²⁺ intake is not met, the fetus gets it at the expense of the mother's bones; the mother suffers bone loss
• RDA: 1000-1300 mg/day

• the RDA of vitamin D does NOT increase
• RDA: 600 IU/day
• a deficiency interferes w/ calcium metabolism

• 1. Iron
• 2. Zinc

• the RDA of iron DOES go up to increase blood volume, fetal needs, & compensate for blood loss during delivery
• even though maternal & baby absorption of iron also increases during pregnancy
• RDA: 18-27 mg/day

• 6 months
• after 6 months an iron source needs to be given to the baby because breast milk is low is iron
• AAP recommends supplementing iron at 4 months for breastfed infants
• a mother's iron stores are transferred to the fetus during the 3rd trimester

• the RDA of zinc DOES increase to facilitate DNA, RNA, & protein synthesis and "cell development"
• low levels increase absorption & excess can be toxic to the fetus
• RDA: 8-11 mg/day

• 1. preeclampsia - pregnancy induced hypertension
• 2. decreased cell mediated immunity (T cell immune responses)

• the RDA of iodine increases - can be obtained from iodized salt
• mental retardation due to cretinism is entirely preventable using iodine supplementation during pregnancy
• mental retardation due to cretinism = single largest cause of mental retardation

a condition of severely stunted physical & mental growth due to untreated congenital deficiency of thyroid hormones (hypothyroidism) usually due to maternal hypothyroidism

• IRON, Zinc, & Iodine
• calcium, vitamin C, & vitamin D levels remain unchanged

• megadoses/excess vitamin A leads to fetal malformation, especially in the central nervous system
• prior to 7 WEEKS such excess (eg. acutane) would be most damaging

• intake during pregnancy increases the rate of miscarriage, fetal death, or limited fetal growth
• should limit intake to one coffee or 2 sodas a day; no more than 200mg should be consumed

• Vitamin A
• Alcohol
• Caffeine
• Sugar Substitutes, especially saccharine (exception of diabetics)

• a teratogen that crosses the placenta associated w/ various birth defects, delivery complications, sudden infant death syndrome, & increased risk of miscarriage
• FAS (fetal alcohol syndrome): characteristics associated w/ prenatal exposure to high quantities of alcohol [developmental/learning disabilities + facial, limb, & heart malformations]

• vegetarians: should take Iron supplement
• vegans: vitamin B12, Iron, Ca²⁺, vitamin D
• are able to meet most nutrient needs through diet only

• a vitamin B12 deficiency during pregnancy can result in fetal spinal cord damage & psychomotor retardation
• if deficiency is recognized providing vitamin B12 after birth can correct the damage, however preventing the deficiency is preferred

• 1. Nausea: caused by hormone changes oftentimes more during 1st trimester
• 2. Constipation & Hemorrhoids: related to slowing of digestion in GI tract (can treat w/ fluid and fiber)
• 3. Heartburn: caused by fetus' physical presence pushing on internal organs
• 4. Food Cravings/Aversions: caused by hormone changes
• 5. Pica: nonfood cravings, often a side-effect of dietary anemia

• *pregnant women are essentially immunosuppressed so are at higher risk for getting food-born illnesses (eg. Listeria)
• hot dogs or deli meat (unless STEAMING)
• smoked seafood (unless FULLY COOKED)
• meat spreads/pâté
• unpasteurized milk & cheese (brie, feta, blue, mexican cheeses)
• more common to tell pregnant woman what NOT to eat than what to eat (b/c of time)

• Swordfish, Shark, King mackerel, White Canned Tuna, Tilefish (golden snapper or bass)
• these fish are high mercury b/c they're large fish that consume OTHER fish, compounding their mercury content
• it's okay to eat ~12 oz. a week of shrimp, salmon, pollock, catfish or ~6 oz. of LIGHT canned tuna (smaller fish)

• production of breast milk suppressed by estrogen/progesterone until childbirth
• oxytocin: responsible for milk "let-down"
• prolactin: responsible for milk synthesis
• colostrum: 1st milk produced right after birth [yellowish, thick, clear] high in PROTEIN, antibodies, vitamins, & minerals

• energy & protein needs are higher than in pregnancy for mother
• iron & folate needs are lower during lactation than in pregnancy; other vitamin & mineral requirements stay ~same
• lots of water intake is required
• alcohol, drugs, smoking, excess caffeine should all be avoided while breastfeeding

• normal → pregnancy → lactation
• 11mg 18-27 mg 8mg
• iron needs decrease during lactation because woman isn't menstruating

breast milk production takes 700-800 kcals/day but women are only recommended to consume an extra 300-400 kcals/day (depending on how long after they've given birth) to help facilitate weight loss after pregnancy

• it's nutritionally superior to formula
• is always sterile & fresh
• contains immunoglobins
• is more digestible
• reduces the risk of respiratory, GI, & ear infections
• reduces the likelihood of overfeeding (infant controlled process)
• promotes mouth/jaw development
• provides omega-3 FAs
• reduces the risk of SIDS, diabetes mellitus (DM), food allergies, & asthma

• enhances recovery of uterus size
• decreases post partum bleeding (conserving iron stores)
• it's more convenient/economical (free!)
• triggers hormones that help return internal organs to original state
• decreases the risk of breast + ovarian cancer
• delays ovulation (natural BC)
• increases E expenditure facilitating weight loss

specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the patient

• HIV (in the US but not 3rd world countries w/ poor water supply; it can be passed through breast milk)
• Metabolism Issues/Allergies in Child (eg. galactosemia is a component in breast milk; if child can't metabolize or is allergic a special formula needs to be given)
• Lifestyle Practices (alcohol, drugs, smoking, environmental contaminants, caffeine)

• infants should exclusively breastfeed for 6 months
• infants should be breastfed for at least 12 months

• the QUANTITY of breast milk is reduced, NEVER the quality of the milk (her body just won't produce enough)
• the body will never make poor quality breast milk

• has 20 cal/oz.
• contains more whey than casein (70:30) b/c whey is more easily digested
• composition of milk changes DURING a feeding
• 1st = foremilk: sweeter, higher in lactose
• 2nd = hindmilk: designed to satiate the infant, hold them over until next feeding
• the milk is not a good source of iron but contains a small amount, the absorption of which is facilitated by lactose & vitamin C

sore nipples, letdown failure, overactive letdown, engorgement, plugged duct, mastitis

• infants are MORE LIKELY to be overfed w/ formula
• need to make sure it's safely prepared
• it's easier to tell how much the infant is getting
• the father (pshh) can be more involved
• may require fewer feedings (takes longer to digest)
• can iNTERFERE with breastfeeding (nipple confusion)

• after birth: birth WEIGHT
• during infancy: growth (& development) - way to measure if a child is well-nourished & healthy

• 1. WHO growth standards: used to monitor growth for infants & children ages 0-2
• 2. CDC growth charts: used for children ages 2+
• *growth charts are the primary tool in detecting changes in growth & normal development
• 50th percentile is "normal"

• height for age
• weight for age
• weight for height
• head circumference for age

• height for age
• weight for age
• BMI for age (*different from straight BMI)

• information about a child's growth pattern
• gestational age, birth weight, parental stature, & nutritional status may influence growth patterns

• because it's normal to drop weight after birth
• it's usually associated with fluid shifts associated with the trauma of birth
• should be regained in ~the 2 weeks after birth

• 4-6 months of age
• triple their birth weight by 12 months
• QUADRUPLE birth weight by 2 years!
• weight is the 1st measure affected by inadequate nutrition
• a drop to a lower percentile in weight is usually an indication of some disruption in the child's expected growth

HEIGHT

• it should INCREASE by 50% percent
• weight is affected before height
• height will be maintained at the expense of weight
• if height is affected/drops (stunting) that is indicative of a more long-term ailment

• 1. brain circumference: will be maintained at all costs (LEAST sensitive)
• 2. height: will go after weight has been compromised
• 3. weight: the 1st characteristic affected by malnutrition (MOST sensitive)
• *once head circumference for age once impacted will lead to irreversible poor developmental outcome

• an abnormally low weight for age
• can be caused by a recent illness or trauma (eg. rhodavirus)
• once recovered can generally catch up
• can also be caused by genetic or ethnic differences

• an abnormally low weight for height
• a child has a certain height but a low weight FOR that height
• caused by acute, prolonged inadequate intake
• wasting is correlated with mortality
• 

• an abnormally low height for age
• but the weight for length value is normal
• caused by chronic inadequate intake or genetic/ethnic differences
• the child will be unable to reach a height they should have reached genetically

• 100 kcals/kg/day (compared to 25-35 kcals/kg/day for adults)
• energy needs are extremely high for infants
• protein: 2 kcals/kg/day (compared to .8 kcals/kg/day for adults)
• fat: 40% of calories should be from fat (making CNS)
• also have high fluid needs but that can come from breast milk/formula; exogenous water isn't required

• nope
• Vitamin K injection given at birth to prevent hemorrhage & establish gut flora
• Vitamin D supplementation should be given to breastfed infants (formula has it)
• 

• ~4-6 months old
• recommended 1st food = iron fortified rice, wheat, or barley
• at this age an infant has increased digestive enzymes, loss of extrusion reflex, & increased musculature to sit upright
• 

food allergies

• ONE food at a time so that their reaction can be tracked
• ~1 new food every 3 days
• NO milk during the 1st year of life → GI bleeding
• NO honey/corn syrup → increased botulism risk
• introducing challenging textures improved oral-motor skills

• when babies/toddlers are allowed to have a bottle in their mouth for extended period of time, their teeth are bathed in the carbohydrate-rich formula or breast milk, causing tooth decay
• sugar + oral bacteria → acid acid + teeth = decay
• to prevent the bottle should be removed when the baby is done feeding
• causes immature dentition, plaque filled mouth, low saliva, & contributes to childhood obesity

• Colic (crying often tied with poor eating)
• Iron deficiency anemia
• Gastroesophageal reflux
• Diarrhea (often due to juice, has a high osmotic load)
• Failure to thrive

• infants & children who lose weight or fail to gain weight in accordance with standardized growth charts
• inadequate physical growth
• inability to maintain expected growth over time
• often identified in the 1st 3 years of a child's life

refers to a child with an underlying medical condition that contributes to poor growth

refers to a child who is younger than 5 years of age and has no known medical condition that causes poor growth

• a marked DECREASE in appetite
• this is because their growth rate slows quite significantly
• caretakers determine WHAT & WHEN children eat, but children decide IF & HOW MUCH they eat

• a comprehensive survey conducted over the phone assessing food & nutrient intakes of over 3,000 infants & toddlers (up to age 3) by asking for a 24 hour diet recall
• showed that fruit/vegetable intake was limited
• older infants didn't get adequate iron & zinc
• the UL for sodium was EXCEEDED
• 80% of preschoolers (2-3 y/o) consumed nutrient poor energy dense drinks (soda/juice), desserts, & snacks dAILY

• energy & protein needs DECREASE from those of infancy
• getting micronutrients from regular food now - variety is necessary

• obese children begin puberty earlier
• they tend to be shorter than their peers
• they have more bone & muscle mass
• it's important to check their lipid profile, for type 2 diabetes, & respiratory disease

• prevent it…
• want to reduce their weight gain as opposed to have them lose weight
• encourage physical activity (at least 1 hr. a day)
• have their parents set a GOOD example

• sugar sweetened beverage; soda, juice, any drink that has calories
• "the only drink with calories someone at risk for metabolic syndrome should be consuming is milk"

• girls: 10-11 years old - gain ~6 in. in height, 35 lbs. in weight
• boys: 12-13 years old - gain ~8 in. in height, 45 lbs. in weight
• increase in calorie/protein needs after childhood

in adolescence mainly due to hormonal changes as opposed to food intake, which it's often incorrectly linked to

• red flag: vegetarianism for early teen girls; a socially acceptable way to restrict food intake
• anorexia, bulimia (classic presentation is slightly overweight), binge eating (most common), & eating disorder NOS (not otherwise specified)
• disordered eating: eg. disliking food touching on plate

• disordered eating (usually via a restricted diet) & inadequate intake of energy can lead to amenorrhea
• loss of a period changes hormonal status
• poor intake & no period can cause osteoporosis
• end result: potential long-term poor bone status, short-term poor health status
• 

• weight & body composition (add fat, lost lean mass, sarcopenia)
• reduced muscle & skeletal strength
• *FEWER calories are needed*
• decline in immune defense mechanisms (can contribute to chronic inflammation)
• decline in taste, smell, vision, mobility, hearing
• loss of Ca²⁺ & decreased BONE density
• decreased vitamin D synthesis (& intake)
• reduced thirst response & dry mouth
• Xerostomia - lack of saliva
• Atrophic Gastritis
• Reduced GI motility

• age-related degenerative loss of skeletal muscle mass, quality, & strength
• mediated by pro-inflammatory cytokines, growth hormone secretion, & input from a CNS that has fewer motor neurons
• 

• maximally nutrient dense but moderate in calories
• percentages of CHO, fat, & protein stay the same but FIBER recommendations are lower b/c they're based on calorie needs (which are decreasing)

• Ca2+ increases: it's less well absorbed (atrophic gastritis)
• Vitamin D increases: needed for Ca2+ balance
• Iron needs decrease: no longer monthly female losses
• *Zinc should be adequate: maintain immune function & the senses
• Vitamin A should stay the same
• Vitamin B12 should be adequate

• in food B12 is protein bound - must be separated in order for absorption to occur; this is done via 2 mechanisms in the stomach
• 1. gastric acid
• 2. protease enzymes (eg. pepsin)
• *often older adults have less stomach acid, compromising B12 absorption

• 1. drug-drug & drug-nutrient interactions
• 2. depression
• 3. anorexia of aging
• 4. arthritis
• 5. bowel & bladder regulation
• 6. dental health
• 7. osteoporosis
• 8. Alzheimer's

• food is HARD to chew & swallow - soft foods are preferred leaving less variety available
• overall can lead to a decreased desire & ability to eat
• 

• Dentures
• can't track food because tongue can't feel palate
• false palate prevents sensing of food via tongue

• a hole in the central part of vision
• risk factors include age, smoking, & family history
• may be reduced by antioxidants or lutein & zeaxanthin (can also reduce risk of cataracts)
• if overweight lutein & zeaxanthin tend to deposit in body fat as opposed to macula where it can be protective

• 1. dietary lutein
• 2. diabetes
• 3. BMI
• 4. waist to hip ratio

• 1 in 6
• b/c of that there's a specific nutrition screening initiative called DETERMINE
•