Week 15

Chapter 16: Nutritional Aspects of Pregnancy & Breastfeeding

In A Nutshell:

	Adequate nutrition is vital during pregnancy to ensure the well-being of both the infant and mother. Poor maternal nutrition and use of some medications, especially during the first trimester, can cause birth defects. Growth retardation and altered development can also occur if these insults happen later in pregnancy.
	Infants born preterm (before 37 weeks gestation) usually have more medical problems at and following birth than infants born after 37 weeks.
	A woman typically needs an additional 300 kcals per day during the second and third trimesters of pregnancy to meet her energy needs. A better measure of meeting energy needs is adequate weight gain. This should occur slowly, reaching a total of 25-35 lbs in a woman of healthy weight.
	Protein, vitamin, and mineral needs increase during pregnancy. Extra servings from the milk, yogurt, and cheese group and the meat, poultry, fish, dry beans, eggs, and nuts group of the Food Guide Pyramid are recommended. Supplements of folate and iron may be needed. Folate nutriture especially should be adequate at the time of conception. Any supplement use needs to be guided by a physician, as an excess intake of vitamin A and other nutrients during pregnancy can have harmful effects on the infant.
	The factors that contribute to poor pregnancy outcome include inadequate health care in general and prenatal care in particular, teenage pregnancy, closely spaced births, smoking, alcohol consumption, illegal drug use, insufficient CHO intake (less than 100 grams/day), obesity, heavy caffeine use, and various infections such as Listeria and AIDS.
	Pregnancy-induced hypertension, gestational diabetes, heartburn, constipation, nausea, vomiting, edema, and anemia are all possible discomforts and complications of pregnancy. Nutrition therapy can help minimize some of these problems.
	Almost all women are able to nurse their infants. The nutrient composition of human milk is very different from that of unaltered cow's milk and is much more desirable. Colostrum, the first fluid produced by the human breast, is very rich in immune factors. Mature milk is rich in the protein lactalbumin and in lactose.
	For the infant, the advantages of breastfeeding over formula feeding are numerous, including fewer intestinal, respiratory, and ear infections and fewer allergies and food intolerances. Moreover, breastfeeding is also less expensive and possibly more convenient for the mother than formula feeding. However, an infant can be adequately nourished with formula if the mother chooses not to breastfeed. Breastfeeding is not desirable if the mother has certain diseases or must take medications potentially harmful to the infant. Likewise, breastfeeding is not advised for infants with certain medical conditions, including some preterm infants.

Pregnancy begins with the fertilization of an egg by a sperm, producing a zygote. About two weeks after fertilization, the embryonic period of development begins. The embryo grows and the cells differentiate and move to form the organs and structures of a human body. At nine weeks, the fetal period of development begins. The fetus grows and the organs formed during the embryonic period mature. The fetal period continues until birth, which occurs after about 40 weeks of gestation. Because the embryo and fetus are developing and growing rapidly, they are susceptible to damage from poor nutrition and physical, chemical, or other environmental teratogens.

During pregnancy, maternal physiology changes to support the pregnancy and prepare for lactation. The amniotic sac and the placenta develop; maternal blood volume increases; the uterus and supporting muscles expand; body fat is deposited; the heart, lungs, and kidneys work harder; the breasts enlarge; and total body weight increases.

Recommended weight gain during pregnancy is 25 to 35 pounds for normal-weight women. All pregnant women, whether normal-weight, underweight, or overweight, should gain weight at a similar rate during pregnancy. If too little weight is gained, the infant may be small at birth and at increased risk for illness and death. Too much weight gain can place both mother and baby at risk, but weight loss should never be attempted during pregnancy.

During healthy pregnancies, a carefully planned program of moderate-intensity exercise can be beneficial and safe.

The changes in maternal physiology and the growth and development of the fetus sometimes cause unwanted side effects. Digestive system discomforts that are common in pregnancy include morning sickness, heartburn, constipation, and hemorrhoids. Changes in glucose utilization can cause gestational diabetes. An elevation in blood pressure, called pregnancy-induced hypertension, can cause edema, weight gain, and proteinuria (preeclampsia), and in severe cases can be life-threatening (eclampsia).

Factors that can increase the risks of pregnancy include the nutritional status of the mother; preexisting maternal health conditions; a maternal age that is under 20 or over 35 years; a short interval between pregnancies; a history of poor reproductive outcomes; poverty; and behaviors such as smoking, alcohol use, and illicit drug use.

Nutritional status is important before, during, and after pregnancy. Poor nutrition before pregnancy can decrease fertility or lead to a poor pregnancy outcome. During pregnancy the requirements for energy, protein, water, vitamins, and minerals increase. The B vitamins are needed to support increased energy and protein metabolism; calcium, vitamin D, and Vitamin C are needed for bone and connective tissue growth; protein, folate, vitamin B-12, and zinc are needed for cell replication; and iron is needed for red blood cell synthesis.

During lactation, the need for energy, protein, fluid, and many vitamins and minerals is even greater than during pregnancy.

Newborns grow more rapidly and require more energy and protein per kilogram of body weight than at any other time in life. Fat and fluid needs are also proportionately higher than in adults. A diet that is adequate in energy, protein, and fat may not necessarily meet the needs for iron, fluoride, and vitamins D and K.

Breast milk is the ideal food for new babies. It is designed specifically for the human newborn, is always available, requires no special equipment, mixing, or sterilization, and provides immune protection. When breast-feeding is not chosen, there are many infant formulas on the market that are patterned after human milk and provide adequate nutrition to the baby.

Infant formulas are the best option when the mother is ill or is taking prescription or illicit drugs, or when the infant has special nutritional needs. The major disadvantages of bottle-feeding are the potential for bacterial contamination, overfeeding, and errors in mixing formula.

Study Guide
1. What is a favorable pregnancy outcome?

2. What are the risks associated with being born at a low birth weight?

3. What are the phases of prenatal growth and development?

4. What are the critical periods?

5. What is the role of the placenta?

6. What effect can eating too few calories during pregnancy have on offspring?

7. What nutrients are needed to build cells during fetal growth? What effect will consuming insufficient amount of these nutrients during pregnancy have on offspring?

8. Why is it important to ensure an adequate folate intake before pregnancy?

9. How do iron deficiency anemia and physiological anemia differ?

10. How might practicing pica during pregnancy affect the pregnancy outcome?

11. How many servings from each food group should pregnant women consume in the
      last 2 trimesters?

12. Nutrient supplements during pregnancy are recommended for which groups of
      women?

13. What types of physical activities should pregnant women avoid?

14. How does maternal pre-pregnancy weight and weight gain during pregnancy affect
      pregnancy outcome?

15. What are the maternal weight gain recommendations for underweight,
      normal-weight, and overweight women?

16. What are the symptoms of pregnancy-induced hypertension?

17. Why is it important to keep blood glucose levels under control during pregnancy?

18. What precautions should pregnant women take to avoid foods that might contain
      environmental contaminants or foodborne disease pathogens?

19. What effects can lifestyle choices related to alcohol, drugs, herbal and botanical
     products, and smoking have on pregnancy outcome?

20. What is the role of prolactin?

21. How is oxytocin involved in the let-down reflex?

22. How does colostrum differ from mature milk?

23. What effect does maternal nutritional status have on the quality and quantity
      of the breast milk she produces?

24. What are the calorie intake recommendations for lactating women?

25. What steps can lactating women take to ensure they consume an adequate
      amount of nutients?

26. What is the basic food plan suitable for breastfeeding wormen?

27. How does maternal pre-pregnancy weight and age affect breastfeeding success?

28. What diseases are incompatible with breastfeeding?

29. What steps can pregnant and lactating women take to overcome common
      socio-cultural factors that affect breastfeeding success?

30. What effects can lifestyle choices related to alcohol, drugs, herbal and
      botanical products, and smoking have on breastfed infants?

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Chapter 17- Nutrition During The Growing Years

In A Nutshell:

	Growth is very rapid during infancy; birth weight doubles in 4-6 months, and length increases by 50% in the first year. An adequate diet, especially in terms of energy, as well as the nutrients protein and zinc, is essential to support normal growth. Under-nutrition can cause irreversible changes in growth and development. Growth in infants and children can be assessed by measuring body weight, height (or length), and head circumference over time. Growth charts have recently been revised to include a more valid measurement for determining children's growth, body mass index (BMI).
	Nutrient needs in the first 6 months can be met by human milk or iron-fortified infant formula. Supplementary vitamin D and iron may be needed in the first 6 months for breastfed infants, and many infants may need supplemental fluoride after 6 months of age.
	Infant formulas generally contain lactose or sucrose, heat-treated proteins from cow's milk, and vegetable oil. These formulas may or may not be fortified with iron. Sanitation is very important when preparing and storing formula.
	Most infants don't need solid foods before about 4-6 months of age. Solid food should not be added to an infant's diet until the nutrients are needed, the GI tract can digest complex foods, the infant has the physical ability to control tongue thrusting, and the risk of developing food allergies has decreased.
	The first solid foods given should be iron-fortified infant cereals or ground meats. Other single foods can be added gradually, at the rate of about one each week. Some foods to avoid giving infants in the first year include honey, cow's milk (especially fat-reduced varieties), very salty or sweet foods, and foods that may cause choking.
	Introducing iron-containing solid food at the appropriate time and not offering cow's milk until 1 year of age can generally prevent iron deficiency anemia in late infancy.
	A slower growth rate in preschool years underlies the importance of children's eating nutrient-dense foods and reducing their food serving sizes. Choosing iron-rich foods, such as lean red meats, is important at this age. Portion sizes, at meals of 1 Tablespoon of each food for each year of life is a good rule of thumb for vegetables, fruits, and meats.
	Preschoolers should be given some leeway in determining serving size and should be encouraged to try new foods. Highly restrictive diets designed to reduce the risk of cardiovascular disease or hypertension are not recommended for preschoolers or older children, unless prescribed by a physician.
	Obese children and adolescents are more likely to become obese adults and, so incur greater health risks. Parents can provide healthful food choices, and children should control portion sizes. When controlled early through diet and exercise interventions, a problem of obesity may correct itself as the child continues to grow in height.
	During the adolescent growth spurt, both boys and girls have increased needs for iron and calcium. Inadequate calcium intake by teenage girls is a major concern because it can set the stage for the development of osteoporosis later in life. Teenagers generally should moderate their intake of high-fat foods, especially snacks and quick-service foods, which they often consume in abundance- and perform regular physical activity.

Good nutrition in childhood sets the stage for nutrition and health in the adult years.
The diet must meet the needs for growth and development as well as reduce the risk of
chronic disease later in life.

Growth that follows standard patterns indicates adequate nutrition. Too little weight gain can signal malnutrition or other health problems. Too much weight gain can lead to obesity. Overweight and obesity among children are important health concerns. Obese children are likely to become obese adults and children who are overweight are more likely to have elevated blood pressure, blood glucose, and blood cholesterol.

Introducing solid foods between four and six months of age adds iron and other nutrients to the diet and aids in muscle development. Children like to have control over what they eat. In order to meet nutrient needs and develop nutritious habits, a variety of healthy foods should be offered at meals and snacks throughout the day.

Energy and protein needs per kilogram of body weight decrease as children grow, but total needs increase because of the increase in total body weight and activity level. Beginning at two years of age, fat intake should be decreased gradually to 30% or less of energy. Dietary carbohydrates should come primarily from whole grains, vegetables, fruits, and milk.

Low dietary intakes of vitamin A, vitamin C, calcium, iron, and zinc put some American children at risk of deficiencies.

During adolescence, accelerated growth and sexual maturation have an impact on nutrient requirements. Body composition and the nutritional requirements of boys and girls diverge. Males gain more lean body tissue, while females have a greater increase in body fat.

During the adolescent growth spurt, total energy and protein requirements are higher than at any other time of life. Young men require more protein and energy than young women.

In adolescence, vitamin and mineral requirements increase to meet the needs of rapid growth. The minerals calcium, iron, and zinc are likely to be low in the adolescent diet. Iron deficiency anemia is common, especially in girls as they begin losing iron through menstruation.

Dental caries is the most common nutritional disease in the United States.

Food allergies are caused by the absorption of allergens, most of which are proteins. Food allergies involve the immune system and are more common in infancy when the gastrointestinal tract is not fully mature and is therefore more likely to absorb whole proteins. An elimination diet and a food challenge can identify specific foods that cause allergies. Unlike food allergies, food intolerances do not involve the immune system. Newly introduced foods should be appropriate to the child's stage of development and offered one at a time to monitor for food allergies.

Lead is absorbed more efficiently in small children, so toxicity is of particular concern. Once inside the body, it interferes with nervous system function. Children who consume vegetarian diets are at risk for low intakes of iron, zinc, calcium, vitamin D, and vitamin B-12. Meals away from home at school or at fast food restaurants are common and impact overall nutrient intake. The School Breakfast and Lunch Programs can improve the nutritional intake of students who participate.

Psychosocial changes occurring during the adolescent years make physical appearance of great concern. Obesity can be psychologically and socially devastating. Eating disorders are more common in adolescence than at any other time. Adolescent athletes can be influenced by nutrition misinformation, and they may try dangerous practices such abusing anabolic steroids to increase muscle mass or following fad diets and using fluid restriction to lose weight.

Inactivity is an important factor contributing to the increased incidence of overweight among children and teens. It is recommended that children engage in some type of physical activity for at least an hour and up to several hours per day. TV introduces children to foods they might otherwise not be exposed to, promotes snacking, and reduces physical activity.

A pregnant teenager must meet nutrient needs for her own growth and development as well as for her pregnancy.

Alcohol has short-term effects on the central nervous system, including the impairment of reasoning, judgment, and coordination, and eventually the loss of consciousness. Chronic alcohol use damages the liver and can cause malnutrition by decreasing nutrient intake and absorption and interfering with nutrient utilization.

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Study Guide

1. Approximately how much would you expect a baby born weighing 8 pounds
     to weigh at their first birthday?

2. At which stage of the growing years (infancy, childhood, adolescence)
     is growth the fastest?

3. How does body composition differ between males and females at the beginning
    and end of adolescence?

4. How does a mature digestive system help support growth?

5. What factors affect the percentile growth curve a child follows?

6. Why are growth charts used to track growth over time?

7. what factors contribute to failure to thrive?

8. When is it no longer possible to grow taller?

9. Why do adolescent males need more of many nutrients than females?

10. Why are the calorie and protein needs of infants, per pound of body weight,
      higher than adults?

11. What are the recommended fat intake levels for infants and young children?

12. Why is the need for water of critical importance during infancy?

13. Why are children 1-2 years old vulnerable to iron deficiency anemia?

14. Why do calcium needs rise sharply during adolescence?

15. What vitamin and mineral supplements are recommended for infants, children,
      and teens?

16. Why is human milk better suited to infants than cow or goat milk?

17. How do foremilk and hind milk differ?

18. What are 5 benefits of breastfeeding?

19. How might an infant signal they have had enough to eat?

20. How can a breastfeeding mother judge whether her infant is receiving
      enough nourishment?

21. Why physical ability signs indicate babies are developmentally ready for solid foods?

22. Why do babies need solid foods at around 6 months of age?

23. How can you determine whether a particular food has caused a sensitivity
      or an allergy in an infant?

24. Why should juice be served in a cup?

25. When are appetite fluctuations during childhood considered a problem?

26. Why is bribing a child to eat a food not recommended?

27. What are some steps caregivers can take to help children accept new foods?

28. What is the best way to handle children who go on food jags or refuse to eat?

29. What advice would you give to help parents calm a colicky infant?

30. How does sleeping with a bottle contribute to early dental caries and ear infections?

31. Why is a weight-loss diet usually not necessary for children?

32. What risks do overweight children face?

33. What family characteristics indicate a child should be screened for elevated
      cholesterol?

Chapter 18 - Nutrition During The Adult Years

In A Nutshell:

	Compression of morbidity means delaying symptoms of and disabilities from chronic disease for as many years of life as possible. Good nutritional habits play a role in this process.
	Although a maximum life span hasn't changed, life expectancy has increased dramatically over the past century. For many societies, this means that an increasing proportion of the population is over 65 years of age. As health-care costs rise, the goal of delaying disease becomes even more important for all of us.
	Aging begins before birth. Cell aging probably results from automatic cellular changes and environmental influences, such as DNA damage. Add to this list damage caused by electron-seeking free radical compounds, high blood glucose, hormonal changes, and alterations in the immune system as possible causes.
	Nutritional problems of older adults are related to the presence of chronic diseases and to the normal decreases in organ function that occur with time. These include loss of teeth, lessened sensitivity to taste and smell, changes in gastrointestinal tract function, and deterioration in cardiovascular and bone health. Although disease affects nutritional state, the reverse is also true. Under- nutrition adversely affects immune function, allowing for infection.
	Alzheimer's disease is a progressive and irreversible brain disorder. Its causes are only beginning to be understood. It differs from other types of senile dementia in that the brain tissue accumulates abnormal protein plaques and tangled nerves (observable by autopsy). Nutritional health for people in advanced stages of disease is often complicated by special feeding problems.
	Scientists are only now beginning extensive study of specific nutrient needs for older people. Diet plans should be based on a nutrient-dense approach and individualized for existing health problems, decreased physical abilities, presence of drug-nutrient interactions, possible depression, and economic constrains. Specific nutrients, such as protein, vitamin D, vitamin E, vitamin B-6, folate, vitamin B-12, zinc, and calcium, along with dietary fiber, often deserve special attention in diet planning. Careful supplementation can help meet needs, especially for adults 70 years of age and older.
	Health care workers and family members should use available options for the procurement of food for the elderly, especially for those who are nutritionally compromised. Most communities have congregate or home-delivered meal systems, food stamps, and other provisions for those who qualify.

Aging is the accumulation of changes over time that result in an ever-increasing susceptibility to disease and death. A combination of genetic, environmental, and lifestyle factors determines how long we live and how long we remain healthy.

The elderly are the fastest-growing segment of the American population. As a population we are living longer but not necessarily healthier lives. Compression of morbidity-that is, increasing the number of healthy years-is an important public health goal.

Life span is a characteristic of a species. The average age to which people in a population live, or life expectancy, is a characteristic of a population. An individual's longevity is affected by genetic background, diet, and lifestyle.

As the body ages, reserve capacity decreases, causing organ function to decline. There are changes in vision and the sense of smell that affect the ability to eat as well as the appeal of food. Changes in digestion and absorption decrease the intake and absorption of nutrients, changes in metabolism affect nutrient utilization, changes in hormonal patterns affect body function, and changes in mobility and mental capacity limit the ability to acquire, prepare, and consume food.

The incidence of disease increases with advancing age. Both infectious and chronic diseases affect nutrient requirements and the ability to consume a nutritious diet. The medications used to treat disease also affect nutrition, especially when they are taken over long periods of time and when multiple medications are taken simultaneously.

Energy needs are reduced with age but the requirement for most nutrients remains the same. In addition, the absorption and metabolism of some nutrients change with age, making it more difficult to meet nutrient needs.

When planning diets for older adults, their medical, psychological, social, and economic circumstances must be considered. Meals should be economical, convenient to prepare and consume, and nutrient-dense. A modified Food Guide Pyramid is available to help plan diets for this age group.

The DETERMINE checklist helps identify older adults who are at risk of malnutrition. The federal Older Americans Act includes programs that provide older adults with low-cost or free meals in their homes or in a social setting. Although these programs are helpful, they do not ensure adequate nutrition for all elderly.

Study Guide

1. Why is an organ's reserve capacity important as one ages?

2. What factors contribute to successful aging?

3. What does compression of morbidity mean?

4. What effects can lifestyle have on heredity?

5. What are some examples of how a healthy diet can benefit adults?

6. Which nutrients tend to be too low in the diets of adults?

7. What are 3 signs that an older person's health needs extra attention?

8. How does body composition tend to change as people age?

9. What body systems are adversely affected by physical inactivity?

10. How might the nervous system changes caused by aging affect dietary intake?

11. What are the risks of eating alone?

12. Which agencies provide food and nutrition services for adults?

13. How do the Commodity food Program and Food Stamp Program differ?

14. What can and cannot be purchased with food stamps?

15. What types of services may be provided under the Older Americans Act?

16. Why might even small amounts of alcohol be problematic for older adults?

17. What are some steps an older adult can take to minimize the effects of
slowed restoration of homeostasis?

18. Which nutrients may provide protection against Alzheimer's disease?

19. How does maintaining a healthy weight help those with arthritis?

20. What are the 5 domains of CAM?

21. What are some tips you might give a person who is considering using
an alternative therapy?

22. What are some risks associated with herbal therapies?

23. How can the risks associated with using herbal therapies be minimized?

Becky Alejandre, Professor - Nutrition	Instructor's contact information Email: alejanb@arc.losrios.edu Phone: (916) 484-8145 FAX: (916) 484-8030	ARC Homepage	ARC Library
Office Location: Room #762 Health & Education Division (located between the tennis courts and the gym)		Office Hours: Mon. 8:00-10:00 a.m. Tues. 10:30-11:30 a.m. Wed. 10:30-11:30 a.m. (online) Thurs.10:30-11:30 a.m. Fri. 7:00-8:00 a.m. (online)

Becky Alejandre, Professor - Nutrition

Becky Alejandre,
Professor - Nutrition