MIDTERM

WEEK DATE LECTURE LABORATORY

7 SYNCHRONOUS Nutrition in Human Development: MEAL PLANNING

SEPT.19 – 23 PREGNANCY (Recommended dietary allowance)
LACTATING
8 ASYNCHRONOUS (QUIPPER) INFANCY/PRE & SCHOOL AGE MIDTERM LAB#1
SEPT 26 – SEPT 30 PREGNANT WITH GDM/PIH (ALL
GROUPS)
9 SYNCHRONOUS ADOLESCENT VIDEO PRESENTATION OF MIDTERM
OCT.3 – OCT. 7 LAB#1 (GROUPS 1-3)

10 ASYNCHRONOUS (QUIPPER) Nutrition for special groups: MIDTERM LAB #2

OCT.10 – OCT. 14 -Nicotine and alcohol abuse SCHOOL AGE WITH PKU/CD
-Vegetarian diets ELDERLY WITH OA
-Feeding athletes (ALL GROUPS)

11 SYNCHRONOUS VIDEO PRESENTATION OF MIDTERM

OCT.17 – OCT. 21 ELDERLY LAB # 2 (GROUPS 4-5)
12 TENTATIVE MIDTERM EXAM
OCT 24- OCT 28
 At the end of 2 hours of Lecture in NCM 205
Nutrition &
Diet Therapy the BSN 2 Students will be
able to:

A. Describe physical changes and nutritional health concerns during

pregnancy

B. Enumerate the benefits of breastfeeding to the mother and baby.

C. Formulate health teachings to achieve required nutritional level and to

address physical or health concerns during pregnancy/lactation.

D. Apply the 4 aspects of meal planning and MyPlate in modifying a meal.

PREGNANCY AND LACTATION
 Gestation - is the period from conception to birth
- that is 38 to 42 weeks or 9 months pregnancy
- divided into 3 trimesters
- has 3 events or periods
1. Implantation period
- fertilized ovum implants itself in the uterus
and begins to develop
- occurs during the 1st 2 weeks of conception
Source of nourishment : - uterine substances (UTMP)
- glands in the endometrium ( the lining of the uterus) will
secrete UTMP ( Uterine Milk Protein )
- progesterone will stimulate the glands to secrete UTMP
- estrogen causes endometrium to thicken to produce UTMP
 Adverse Influences are :
- smoking, drug abuse and malnutrition
- these will result to failure to implant
- Neural Tube Defect (NTD )

2. Organogenesis
- period of organ formation
- occurs from 2 to 8 weeks after conception or next 6 weeks
- critical period when organs are formed and most vulnerable
to adverse influences
3. Rapid Fetal Growth
- the last 7 months
- characterized primarily by growth in the number of cells and
size of the organs until it can support extra uterine environment.

Source of nourishment : Placenta

Simple diffusion – passive process in w/c nutrients move from high
concentration in the maternal blood to lower concentration in
the fetal capillaries until equilibrium is reached.
- O2 ,CO2 , FA, Steroids , Nucleotides ,electrolytes
and Fat soluble vitamins
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

1. Achieve and maintain a healthy body weight.

2. Choose an adequate and balance diet.
3. Be physically active.
4. Avoid harmful influences.
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

1. Achieve and maintain a healthy body weight.

Underweight Pregnant
- if the pregnant mother is underweight she is a high
risk of giving birth to a low birth weight (LBW) infant.

LBW – infants have impaired growth and development

- prone to infection and disease
- will have lower adult IQ
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
1. Achieve and maintain a healthy body weight.
Overweight or Obese Pregnant
Birth defects— heart defects and neural tube defects (NTDs)
Problems with diagnostic tests— too much body fat leads to
inaccurate ultrasound results.
Macrosomia—In this condition, the fetus is larger than normal.
Baby have a greater chance of being obese later in life.
Preterm birth— obese pregnant may developed preeclampsia,
may lead to a medically indicated preterm birth.
Stillbirth—The higher the woman’s BMI, the greater the risk of stillbirth.
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
Recommended Weight Gains Based on Pregnancy Weight

Pre-pregnancy Weight Recommended Weight Gain

Underweight (BMI <18.5) 28 to 40 lb (12.5 to 18.0 kg)

Healthy weight (BMI 18.5 to 24.9) 25 to 35 lb (11.5 to 16.0 kg)

Overweight (BMI 25.0 to 29.9) 15 to 25 lb (7.0 to 11.5 kg)

Obese (BMI ≥30) 15 lb minimum (6.8 kg minimum)

FACTORS THAT CONTRIBUTE TO THE WEIGHT GAIN
IN PREGNANCY
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
2.Choose an adequate and balance diet
- malnutrition reduces fertility and impairs the
early development of an infant.
- placental development, implantation, and early critical periods
of embryonic and fetal development depend on maternal
nutrition before and during pregnancy.

Dietary Management:
- Pinggang pinoy
- the basic food groups
NUTRITIONAL
REQUIREMENT
ENERGY
- Normal TER + 340 kcal on the start of 2nd semester
- Normal TER + 450 KCAL on the 3rd trimester
- Choose nutrient – dense foods

RATIONALE
- To supply the increase fuel, demanded by
the enlarged metabolic workload.
CARBOHYDRATES
- 60 % of TER/ day

RATIONALE
1. Necessary to fuel the fetal brain.
2. Fiber in CHO rich foods such as WG,V, F
will help alleviate constipation.
3.To spare CHON for the added
tissue-building requirement.
PROTEINS
+ 25g to normal CHON requirement/day

RATIONALE
1. For baby’s rapid growth
2. For the development of the placenta
3. Due to the increase in maternal blood volume
4. Needed in the synthesis of Hgb and plasma CHON.
5. For the formation of amniotic fluid
6. For tissue storage reserve
VITAMINS SUPPLEMENTATION
1.Viatmin C
1. AI or RDA
< 18 - 80mg/day
19-50 - 85mg/day
2. Rationale
1. To prevent pre-eclampsia
2. THIAMIN
1. AI or RDA ( according to age )
< 18 - 1.4mg/day
19-50 - 1.4mg/day
2. Rationale
1. For loss of appetite.
2. For increase in metabolic work load.
3. Prevention of beri-beri.
4. To prevent leg cramps.
3. Richest food source
-Enriched or fortified whole grains and products.
3.PYRIDOXINE
1. AI or RDA -1.9 mg / day
2. Rationale
1. To prevent nausea and vomiting.
2. To prevent convulsion.

3. Richest food source

- meats , fish , poultry , liver
- potatoes , legumes , non-citrus fruits
soy products
4. FOLIC ACID
1. AI or RDA - 600 mcg / day
2. RATIONALE
1. For blood volume increase.
2. Development of new cells
3. To prevent Neural Tube Defect (NTD)
FACTORS AFFECTING NTD

1. Inadequate folate
2. NTD on previous pregnancy
3. GDM
4. Use of anti-seizure medications
5. Maternal obesity
6. Exposure to high temperature( fever , hot tub use )
7. Race/ Ethnicity – common among Hispanic people
8. Low economic socio status
 2 kinds of NTD
1. Anencephaly
– an uncommon and always fatal
type of NTD
– characterized by the absence of
a brain.

2. SPINA BIFIDA
– one of the most common types of
NTD , characterized by the incomplete
closure of the spinal cord and its
bony encasement.
3. Highest Food sources of folate
Natural Folate Sources
1. Liver (3 ounces ) = 221mcg
2. Asparagus (1/2 cup ) = 131mcg
3. Spinach ( 1 cup raw ) = 131mcg
4. Avocado (1/2 cup ) = 45mcg
5. Orange juice (1 cup ) = 74 mcg

Fortified Folate sources

1. Pasta cooked ( 1 cup ) 110mcg
2. Rice cooked ( 1 cup ) 134mcg
3. white bread ( 1 slice ) 28mcg
5. COBALAMIN
1. AI or RDA = 2.6 mcg/day

2. RATIONALE - for maturation of RBC

3. Richest Food Sources

- meat , fish , poultry , shellfish,
milk , cheese and eggs
6.VITAMIN A or RETINOL
1. AI or RDA
18 Y.O and below = 750 mcg / day
19 to 50 Y.O = 770 mcg / day
FUNCTIONS
1. Important for the placenta functions
2. For the integrity of the epithelial cells
3. Skeletal formation
4. Tooth formation and normal bone growth
Food sources
Vegetables per 100g
Fruits per 100g . Malungay = 7,945 mcg
1.Milon = 1285 mcg .saluyot = 7,320 mcg
2. Tesa = 1235 mcg .Upo = 6439 mcg
3. Mango ripe = 1165 mcg .tanglad = 4,205 mcg
. Ampalaya
LIVER per100mg = 5,525 mcg leaves = 4,105
. Kamote tops = 3,195 mcg
. Alugati = 2,735 mcg
. Lettuce = 2,350 mcg
. Onion leaves = 2,065 mcg
7. VITAMIN D
1. Maintain normal calcium metabolism
2. Promotes normal bones and teeth formation.
3. Prevent Tetany during infancy
TETANY – a syndrome characterized by abnormal
muscle twitching, cramps, sharp spasms of joints
in wrists and ankles.
1. AI or RDA
5 mcg / day
Food sources :
1. fortified milk 4. eggs
2. fortified margarine 5. liver
3. fortified butter 6. salmon, sardines
MINERALS
1. CALCIUM 2. PHOSPHORUS
AI/RDA
AI/RDA
1,300mg /day ( 14 -18yr )
1,000mg /day ( 19 – 50yr) 1,250mg/day ( 14-18yr )
1. for fetal bone development 700mg/day ( 19-50yr )
2. for dentetion -Involved in fetal skeleton
FOOD SOURCES
building w/ Ca
1. 3 cups of milk = 300mg
2.sardines with bones 3oz= 324mg FOOD SOURCES
3. tofu ½ cup = 275mg 1. All animal tissues
4. cheddar cheese 1 ½ oz = 306mg
5. broccoli 1 ½ cup = 93mg
3. MAGNESIUM
AI/RDA
FOOD SOURCES
400mg /day ( 14-18yr)
350mg /day ( 19-30yr) 1. spinach cooked ½ cup = 78mg
360mg /day ( 31-50yr) 2. black beans ½ cup =60mg of Mg
3. soymilk 1 cup = 46 mg of Mg
1. Involved in bone mineralization
4. yogurt 1 cup = 43mg of Mg
2. normal muscle contraction 5. oysters 3 oz = 81 mg of Mg
3. transmission of nerve impulses 6. bran cereal 1cup = 60mg of Mg
4. maintenance of teeth
4. IRON
AI/RDA = 27mg /day
1. conservation of iron during pregnancy
2. maintenance of erythropoiesis
3. to prevent anemia
4. to have sufficient supply of Hgb
FOOD SOURCES
1. clams ( steamed ) 3 oz = 23.8mg
2. lean beef steak 3 oz = 2.6 mg
3. black beans ½ c = 1.8mg
4. enriched cereal 1cup = 8.1 mg
5. spinach cooked ½ cup = 3.2 mg
6. beef liver 3 oz = 5.24mg
5. IODINE
AI/RDA = 220 mcg ( 18 – 50yr )
1. to increase milk flow
2. to compensate increase in BMR
3. to prevent cretinism

FOOD SOURCES
1. iodized salt and seaweeds
( seafoods )
6. ZINC
AI/RDA
FOOD SOURCES
12mg /day (18yrs and below ) 1. oysters –steamed 3 oz = 72 mg
11 mg/day ( 19 -50 yrs ) 2. lean beef steak 3 oz = 4.9 mg
3. yogurt 1 c = 2.2 mg
4. shrimp 3 oz = 1.5 mg
1. For CHON synthesis 5. enriched cereal 1 c = 3.8mg
2. for DNA and RNA synthesis 6. porkchop 3oz = 2mg
7. SODIUM
AI/RDA = 1,500 mg / day ( 18yr and below )
1, 500mg / day ( 19 to 50 yr old )

1. keep minimal to prevent edema and PIH

FOOD SOURCES
1. table salt , soy sauce , processed foods
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

3.Be physically active

- A woman who wants to be physically active when she is pregnant,

needs to become physically active before hand .

- Staying active during the course of a normal, healthy pregnancy will:

1. improves the fitness of the mother-to-be
2. facilitates labor
3. helps to prevent or manage gestational diabetes and
gestational hypertension,
4. reduces psychological stress.
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
Guidelines for Physical Activity during Pregnancy

Do exercise regularly (most, if not all, days of the week).

Do warm up with 5 to 10 minutes of light activity.
Do 30 minutes or more of moderate physical activity.
Do cool down with 5 to 10 minutes of slow activity and gentle stretching.
Do drink water before, after, and during exercise.
Do eat enough to support the additional needs of pregnancy plus exercise.
Do rest adequately.
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
Guidelines for Physical Activity during Pregnancy

Don’t exercise vigorously after long periods of inactivity.

Don’t exercise in hot, humid weather.
Don’t exercise when sick with fever.
Don’t exercise while lying on your back after the first trimester of pregnancy
or stand motionless for prolonged periods.
Don’t exercise if you experience any pain or discomfort.
Don’t participate in activities that may harm the abdomen or involve jerky,
bouncy movements.
Don’t scuba dive.
 HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
Guidelines for Physical Activity during Pregnancy

Suitable activities during pregnancy include:

- brisk walking
- swimming
- indoor stationary cycling
- prenatal yoga
- low impact aerobics under the guidance of a certified
aerobics instructor
- special exercises to prepare for labor and delivery
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

4. Avoid harmful influences

- both maternal and paternal ingestion of harmful
substances ( cigarettes, alcohol, drugs or environmental
contaminants) can alter genes or their expression.

- it can also interfere fertility and will cause

abnormalities
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

4. Avoid harmful influences

PRACTICES TO AVOID IN PREGNANCY
1.CIGARETTE SMOKING
Nicotine and cyanide – toxic to the fetus
ADVERSE EFFECTS
1. Damage chromosomes – will lead to developmental defects,
genetic disorders and cancer.
2. Limit blood supply that will also limit delivery of O2 ,
nutrients and removal of waste
3. Retard physical development
4. Cause behavioral or intellectual problems
5.LBW
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY

4. Avoid harmful influences

PRACTICES TO AVOID IN PREGNANCY

2. MEDICAL DRUGS AND HERBAL SUPPLEMENTS

ASPIRIN AND IBUPROFEN.
3. DRUG ABUSE
1. AMPHITAMINES 4. MARIJUANA
2. BARITURATES 5. OPIATES
3. COCAINE
4. ENVIRONMENTAL CONTAMINANTS
1. LEAD 2. MERCURY
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
4. Avoid harmful influences
PRACTICES TO AVOID IN PREGNANCY

5. FOODBORNE ILLNESS
1. LISTERIOSIS - caused by : BACTERIUM LISTERIA MONOCYTES
6. VITAMINS AND MINERALS MEGADOSES
7. DIETARY – LOW CHO or FATS can cause Ketosis
8. SUGAR SUSTITUTE – allowed as long as with FDA guidelines
- ASPARTAME not recommended with PHENYLKETONUREA
HABITS TO ESTABLISH IN PREPARATION FOR A
HEALTHY PREGNANCY
4. Avoid harmful influences
PRACTICES TO AVOID IN PREGNANCY

9. CAFFEINE – coffee and cola beverages may also result to fetal death

10. ALCOHOL – fetus irreversible brain damage

- growth retardation
- mental retardation
- facial abnormalities
- vision abnormalities
 Dietary Management For
Common Maternal Discomforts
1.Nausea and vomiting – Morning sickness
- most popular theory is that morning sickness is the body's reaction
to the pregnancy hormone, human chorionic gonadotropin (hCG) and
progesterone and estrogen.

DIETARY MANAGEMENT
DIET
1. HICHO , LOW FAT DIET
- eat dry toast or crackers , jellies ,candies ,and gums.
2. CHEMICALLY BLAND DIET
- avoid excessive spices and no offensive odors
- Cold or frozen drinks can be better tolerated in morning sickness.
- do not drink juice, water, milk, coffee or tea when nauseated.
MANAGEMENT
1. On waking , get up slowly
2. Eat small frequent meals whenever hunger strike
3. Room should be in proper ventilation
4. Fluid between meals.

2. HEARTBURN
- acid reflux
- acidic stomach, causing burning sensation
- a pain felt in the chest by a burning sensation in esophagus
which located close to where the heart is.
- the growing fetus weakens the LES ( lower esophageal sphincter)
which is the main barrier of gastric reflux from the stomach to
esophagus.
DIET
1. Chemically bland diet
- avoid spicy and greasy foods
- foods that may help reduce the symptoms are:
* vegetables, ginger, oatmeal, non-citrus fruits, lean meats,
seafoods, eggwhites, healthy fats
MANAGEMENT
1. Relax and eat slowly
2. Eat small frequent meals
3. Drink liquid between meals.
4. Sit up while eating.
5. Wait 1 hour after eating before lying down.
6. Wait 2 hours after eating before exercising.
3. CONSTIPATION
- due to the pressure exerted by the developing fetus on the
digestive tract.
- due to the increase of hormone progesterone during pregnancy
DIET
1. HIFIBER DIET – more fruits and vegetables
2. INCREASE FLUID INTAKE – at least 8 glasses of liquids per day.

MANAGEMENT
1. Exercise daily
2. Respond promptly to the urge to defecate
3. Use laxative only as prescribed by a physician
4. EDEMA
– caused by the pressure of the enlarging uterus on the veins that
return fluid from the legs.
DIET
1. Moderate sodium ( 2000mg/day )
- less consumption of salty foods such as ; sauces, condiments and
gravies canned goods ,processed foods with preservatives
- consume natural sodium containing foods
- because sodium contributes to water retention cause it attracts water.
MANAGEMENT
1. Enough rest
2. Lying down position when sleeping to mobilized extra vascular fluid
and activation of urination process.
5. LEG CRAMPS
1.There is a sudden contraction of gastrocnemius muscle.
2.This is due to decline in serum Ca levels related to Ca – Mg
imbalance or caused by calcium or magnesium deficiency.

DIET
1. Give Ca rich foods
2. Give P rich foods
3. Give Mg rich foods

MANAGEMENT
1. Stretch your calf muscles, stretching before bed
2. Stay active. Regular physical activity
3. Stay hydrated.
4. Choose proper footwear.
6. RAPID WEIGHT GAIN OR LOSS

DIETARY MANAGEMENT
1.Obese
- rapid weight gain may result from excess food intake and lack
of physical activity.
- No addition of calories and CHON
- Give more on nutrient density rather than energy density foods,
give complex CHO.
- make your cravings constructive
- eat balanced meals and refuel often

2.Underweight
- Additional calories and CHON must be followed.
- Give nutrient – energy density food
7. PREGNANCY-INDUCED HYPERTENSION (PIH)
- or the gestational hypertension in which rapid weight gain is one of
the main causes.
- high blood pressure during pregnancy may cause intrauterine growth
restriction.

Characterized into :
- Preeclampsia
- Eclampsia
 Severe preeclampsia or Eclampsia
 headaches
Symptoms :  blurred vision
Mild preeclampsia
 inability to tolerate bright light
high blood pressure
water retention  nausea/vomiting
protein in the urine.  urinating small amounts
 pain in the upper right abdomen
 shortness of breath
 seizures
 convulsion
DIETARY MANAGEMENT
1. Optimum nutrition
2. CHON – HBV( High Biological Value Proteins )
3. Supplementations
1. Fe - dark greeen leafy vegetables
2. Ca - rich foods like dairy products like: milk, curd, soya milk
3. Vitamin A - carrots, egg, pumpkins, spinach, green leafy vegetables.
4. Salt restricted diet
- sodium in salt will stiffen and hardens the blood vessels that
aggravates congestion of blood pathways.
8. ANEMIA
- resulted from the deficiencies of iron and folic acid

DIETARY MANAGEMENT
Iron Supplementation
Folic acid Supplementation
Vitamin C Supplementation

1. Eat foods rich in heme – liver and eggyolk

2. More on dark green leafy vegetable
9. GESTATIONAL DM
- may result as temporary response to stress of pregnancy
and it disappears after the baby is born
- hormone made by the placenta such as estrogen, cortisol,
and human placental lactogen can have a blocking effect on insulin
( contra-insulin effect ) may result to glucose build up in the blood
instead of being use by the cells.
- fetus is at higher risk of glucose-mediated macrosomia.

DIETARY MANAGEMENT
1. Give complex carbohydrates, more in green leafy vegetables
2. Avoid foods that are high in glysemic index
3. HIFIBER diet
4. Avoid products that uses added sugar and trans fats.
ADOLESCENT PREGNANCY
Nutrient deficiencies
1. Vitamins A , D , Folate
2. Minerals Fe , Zn , Ca

RISK IN ADOLESCENT PREGNANCY

- giving birth to LBW babies, Preterm deliveries and Severe Neonatal
conditions
# Because adolescent mother’s physical and mental growth, and
maturity of personality are not completed yet.
# Because the uterus did not reach its full maturity and not capable
to handle pregnancy.
# Because adolescent needs to meet their own nutrients requirement
for their own growth and development.
LACTATION
LACTATION
- the period of milk production by the mammary gland.
- hormones responsible for milk production
1. PROGESTERONE
2. PROLACTIN
3. OXYTOCIN

NUTRITIONAL REQUIREMENT
1.ENERGY
- add 330 kcal /day added to the normal requirement
- if overweight/obese no need for the addition
NOTE: A healthy mother can produce 25 oz of milk/day,
25 oz is = to 500 kcal lost/day that will also have a weight
lost of 1 to 2 lbs / month for the 1st 6 months of lactation
2. CHON
- add 16 grams /day for the 1st 6 mos.
add 12 grams/day for the next 6 mos.
- in every 100ml of human milk there is a lost of 1.2 grams of CHON
from the mother
3. Minerals and vitamins supplementations
1. Ca , Zn and I
2. vitamins A , C and B complex
4. Water and other fluids
- 3.8L/day ( 3.1 L from beverages and rest from other sources ).
NUTRITIONAL REQUIREMENT

1.ENERGY
- add 330 kcal /day added to the normal requirement
- if overweight/obese no need for the addition

NOTE: A healthy mother can produce 25 oz of milk/day,

25 oz is = to 500 kcal lost/day that will also have a weight
lost of 1 to 2 lbs / month for the 1st 6 months of lactation
 is the first milk that is produced after
COLOSTRUM birth. It is a yellowish fluid that is rich
in antibodies, and it gives the infant
his or her first immune boost.

Colostrum contains up to 20% protein, including a large amount of

lactalbumin, more minerals, and immunoglobulins that represent the
antibodies found in material blood. It has less lactose and fat than
mature milk.
BENEFITS OF BREASTFEEDING
BREASTFEEDING CONTRAINDICATIONS
1. Breast cancer
2. HIV
3. Active TB

Problems in breastfeeding
1. inverted nipple
2. baby has narrow mouth
3. sore nipples
4. baby falls asleep during feeding
5. clogged milk duct
TERMS ASSOCIATED WITH BREASTFEEDING
1.Engorgement
– overfilling of the breast with milk
2.Letdown reflex
– the reflex that forces milk to the front of the breast when the
infant begins to nurse.
3. Mastitis – infection of a breast
4. Sucking /rooting reflex
– a reflex that causes an infant to turn toward whichever cheek
is touched in search of a nipple