NUTRITION ACROSS THE LIFESPAN

CALCULATING BMI
 Multiply your weight in pounds by 703. Divide that by your height in inches, squared:
 BMI= (your weight in pound x 703) divide (your height in inch x your height in inches)
 For example, if you weigh 120 pounds and are 5 ft. 3 in. (63in.) tall:
 BMI= (120 X 703) divide (63 x 63) or 84, 360 divide 3969 = 21.3

INTRODUCTION
 Nutrition plays a VITAL role in a healthy pregnancy and baby.
 Pregnancy or gestation is the period when the fertilized ovum implants itself in the
uterus, undergoes differentiation and last for a period of 266 to 180 days (37-40
weeks)
 It consists of 3 trimester (3 main phases = implantation, organogenesis , and growth)

1st Trimester (Embryo: Critical Stage)

 Organs develop (4-12 week)
 Central nervous system develops (4-12 weeks)
 Skeletal structure hardens from cartilage to bone (4 weeks)

2nd Trimester (Fetus)

 Growth and development continue (13-40 weeks)
 Teeth calcify (20 weeks)
 Fetus can survive outside womb (24 weeks)

3rd Trimester (To Birth)

 Growth and development continue
 Storage of Iron and other nutrients (36-40 weeks; premature babies often deficient in
Iron)
 Development of necessary fat issue (36-40 weeks)

HOW DOES NUTRITION INFLUENCE THE OUTCOME OF PREGNANCY?

 The mother’s nutrition & health status influences the growth and development of the
fetus, but it can even affect the ability to conceive a pregnancy
 Eg. PCOS (Polycystic ovary syndrome) is associated with reproductive dysfunction.
 Eg. Determination of sex of offspring may even be influenced by diet. In a study of mice,
a diet high in saturated fats but low in CHO, led to birth of more male than female
offspring, whereas, with a high-CHO, low fat intake there were more female offspring.
  Good nutritional status helps reduce the risk of miscarriage.
 Selenium Deficiency has been implicated as a risk factor for recurrent pregnancy loss.
(selenium supplements has resulted in successful pregnancy outcomes in some studies)
 Once pregnancy has been successfully conceived, the 1st trimester is the critical period
of pregnancy
 This period during which EMBRYO (as the fetus is called in the 1st trimester develops.
 Adequate nutrition without excess can help prevent some birth defects.
 Eg. SPINA BIFIDA is associated with inadequate FOLATE intake
 FOLATE (a form of folic acid) needs to be consumed within the 1st weeks of pregnancy
when the spinal column closes all women of childbearing years are advised to include
adequate FOLATE in their diets.

Most women do not know they are pregnant until after the spinal closes. As most women of
childbearing years are advised to include adequate folate in their diets. For this, beginning in
1998 FOOD FORTIFICATION with FOLATE began and resulted in a decrease incidence of
neural tube defects.
 Other nutrients, B VITAMIN CHOLINE, may also contribute to neural tube defects.
 Similar to folic acid, choline is involved in the metabolism of homocysteine to
methionine.
 Risk of neural tube defects was lowest for women whose diets were rich n CHOLINE
(highest sources of LIVER, EGGS, PEANUT BUTTER) Betaine (found in leafy greens) and
amino acid methionine (found in protein foods)
 CHOLINE is important for normal development of the brain and is essential for the
normal function of all body cells.
 In study, those that received choline supplements in utero or during the 2 nd week of life
demonstrated lifelong memory enhancement. It influences neural and cognitive
development
 So, prenatal period is critical time organization of brain function. Deprivation of
CHOLINE during early development leads to impaired cognitive function with decline in
older age.
 Adequate FOLIC intake is important for other positive pregnancy outcomes
 Inadequate FOLIC intake and increased plasma levels of homocycteine are significantly
increased in women delivering a DOWN SYNDROME baby.
 Other associations with hyperhomocysteinemia and folate deficiency include recurrent
FETAL LOSS, infants with Congenital cardiac Malformations and small birth size.
 Prevention of OROFACIAL CLEFTS (abnormal opening of the lips/or palate) appears
related to adequate intake of the B VITAMINS, Folic acid, Thiamin, Niacin, and
Pyrodoxine at the time of conception.
  Other nutrient deficiencies will also potentially cause adverse pregnancy outcomes.
 A well-balance diet will help the fetus grow and allow the mother to stay healthy for
future pregnancies.

WHAT NUTRITIONAL ADVICE IS RECOMMENDED DURING PREGNANCY?

CALORIE ALLOWANCE
 Total energy cost of storage + maintenance (additional work for maternal heart and
uterine & a steady rise in basal metabolism) amount to approximately = 80,000Kcal.
 Energy cost of pregnancy then is bout 300 Kcal/day
 Energy intake should be 366 Kcal/kg of pregnant wt./day

WEIGHT GAIN
 Major determinant of fetal outcome during pregnancy is MATERNAL WEIGHT GAIN.
Adequate wt. gain improves fetal growth.
 Woman who is underweight before pregnancy needs to gain more weight than is
typically recommended to best promote growth of the products of conception
especially the PLACENTA because it transfer maternal nutrients to the fetus.
 However excess gain weight needs to be avoided for the health of the mother and the
growing fetus.

IDEAL WEIGHT GAIN

 25-35 lbs for normal weight women (BMI of 20 to 26)
 28-40 lbs for an underweight woman (BMI <20)
  15-20 LBS FOR AN OVERWEIGHT WOMAN (BMI >26) with an average wt. gain of about
1lb/week in the 2nd and 3rd trimesters of pregnancy.
 A GRID can be used to plot weight throughout the pregnancy.

MATERNAL WEIGHT
 UNDERWEIGHT
A. High risk of having low birth weight infants
B. Higher rates of preterm deaths and infant deaths
 OVERWEIGHT AND OBESITY
A. High risk of complications like HTN, GDM, and post-partum infections
B. Complications of labor and delivery
C. Large newborns increase the likelihood of a difficult labor and delivery, birth
trauma, and CS
 D. May double the risk of Neural tube defects.

PROTEIN ALLOWANCES
 Additional protein during pregnancy takes into account the increased nitrogen content
of the fetus and its membranes, maternal tissues and the added protection of the
mother against complications
 Normal woman = 1.1 gm/kg BW
 Normal pregnant woman= 9.5gms/day or a total of 900 to 950 gms for 9 months
gestation period.

REASONS FOR ADDITIONAL PROTEIN

 To provide for the storage of nitrogen
 To protect the mother against many of the complications of pregnancy
 For the growth of the woman’s uterus, placenta and associated tissues
 To meet the needs for the fetal growth and repair
 For the growth of the mammary tissues

SOURCES OF PROTEIN
 2/3 of the protein should be of animal origin of the highest biologic value such as:
 Meat
 Milk
 Eggs
 Cheese
 Poultry
 Fish

CALCIUM ALLOWANCE
 Some calcium and phosphorus deposition take place early in pregnancy, but the
amounts are small.
 During the half of pregnancy the intake and retention of calcium are increased. The
quantity retained is more than what can be accounted for by the fetal utilization.
 It represents the establishment of a reserve supply which may be availed of during
emergencies.
 An adequate supply of Vitamin D is essential in the use of calcium and phosphorus
needed to calcify the fetal bones and teeth.
  If the diet of the pregnant woman is INADEQUATE in calcium, she will have to sacrifice
the calcium of her bones in favor of the developing fetus.

Recommendation of calcium
 Calcium and phosphorus retained in the fetus during last 2 months of pregnancy is 64 to
65% total body content of the full term fetus.
 To satisfy this additional needs daily intake of calcium must be increased from 0.5 to 0.9
to that of the non-pregnant adult daily allowance.
 Phosphorus is less likely to be deficient in the average diet. If the protein requirements
and other dietary principles are observed, the need for phosphorus will be met.

IRON ALLOWANCES
 700 to 1000 mg of Fe must be absorbed and utilized by the mother throughout her
pregnancy.
 Of this total about 240 mg are spared by the cessation of the menstrual flow.
 The remainder must be made available from the diet.
 Rate of absorption is increased therefore in the 3rd trimester when the needs of the
fetus are highest.

IODINE ALLOWANCES
 Iodine is especially important during pregnancy to meet the needs of fetal development.
 An adequate intake of iodine may result in goiter in the mother or the child.
 Increased need for iodine can be met by the regular use of iodized salt in food.
 Vitamin allowances
 Thiamin (Vitamin B1) and Niacin (Vitamin B3) allowances are increased in proportion to
the calorie increase.
 Riboflavin (Vitamin B2) allowances are increased according to the higher protein level.
 Vitamin D is increased during pregnancy to make easier the utilization of greater
amounts of calcium and phosphorus.
 Ascorbic Acid (Vitamin C) vital in tissue structure and is required in considerably
increased amounts.
VITAMIN ALLOWANCE
 Vitamin A (Retinol) important in the epithelial cells during organogenesis and is needed
to ensure good vision.
 Folic Acid and Vitamin B12 (Cobalamin) are important in the synthesis of RBC.
 Vitamin B6 (Pyrodixine) requirement has been observed to be greater during pregnancy.
It has been found to have much value in preventing severe nausea and vomiting
associated with childbearing.
 Vitamin allowances
 Vitamin K (Menadione) during early days of life, the infant often has low blood
prothrombin levels until intestinal synthesis of Vitamin K is fully established.
  Vitamin K may be given to the mother at 2 to 5 mg parenterally before the birth of the
baby to stabilize the prothrombin level of the infant until synthesis take place.
 Otherwise, 1 to 2 mg can be given to the infant after birth.
 The use of Vitamin K supplement during the course of pregnancy is therefore not
necessary.

FOOD ALLOWANCE
 1 oz. or 30 gms of meat or its equivalent and an extra pint of milk to the normal diet
 Daily consumption of whole grain cereals, enriched bread, rice, leafy, green and yellow
vegetables, fresh and dried fruits
 Include liver at least once a week
 Egg in the daily diet
 Fortified milk with Vitamin D or fish liver oil
 6 t0 8 glasses of water daily
 Complications of Pregnancy and possible dietary modifications
 Nausea, vomiting, improper body weight, toxemia are among the many conditions that
complicate the normal course of pregnancy.
 Early in pregnancy the most common discomfort “morning sickness” because nausea
and vomiting usually occur immediately after getting up in the morning.
 If this condition is accompanied by lack of appetite such as condition leads to
malnutrition and loss of weight thus resulting in decrease in calorie intake.
(Hyperemesis gravidarum)

Recommendation:
 small frequent feedings instead of three (3) large meals and high carbohydrate, low fat
foods such as crackers and jelly to overcome the above complications.
 Liquids are better taken between meals rather that at mealtime.
 Rapid weight gains or loss
 Sudden increase in weight after about the 20th week of gestation is a cause for
suspecting that water is being retained at an inordinate rate and should be regarded as
a warning sign of impending Eclampsia.
 For obese pregnant patients are advise on moderate calorie restriction with limited
weight loss.
 Fallacy: Because a pregnant woman is “eating for two” she should eat twice as much.
 2nd person is very small (7 lb at birth), overall caloric need increases by only 15%,
amounting to an extra 150 kcal/day during the 1st trimester and an additional 350
kcal/day for the remainder of the pregnancy.
  Therefore, it is important that a pregnant woman consume mainly nutrient-dense foods
(foods that have a lot of nutrients for the number of Kcals.

Heartburn
 Caused by increased levels of progesterone, causing relaxation of GIT with rise of gastric
secretions into esophagus and increased fetal size where fetus places pressure on
stomach, pushing gastric secretions into the esophagus.

Recommendation:
 Consume small frequent meals
 Avoid drinking liquids immediately before or during meals
 Avoid coffee, high fat or spicy foods, wait at least one hour before reclining after a meal
 Toxemia
 Rapid weight gain, edema, high blood pressure, excretion of albumin in the urine and
convulsions are clinical manifestation of toxemia.

Classifications:
1) Acute toxemia of pregnancy: onset after the 24th week
o Pre-exclampsia – HTN with proteinuria and or edema.
o Exclampsia – convulsions or coma; usually both when associated with
hypertension, proteinuria, edema

2) Chronic hypertensive (vascular) disease

 Cravings and Aversions
 Client may experience cravings for certain foods and possibly non-nutritive substances.
 Cravings for non-nutritive substances called PICA, occurs in all some cultures believe if a
woman does not ingest these substances, harm will come to developing embryo/fetus.
Substances include commonly dirt and clay.
 Encourage clients to refrain from ingesting non-nutritive substances; they replace
essential nutrients and may interfere with their absorption.

TYPES OF PICA
 AMYLOPHAGIA- consumption of starch and paste
 COPROPHAGY- eating feces
 GEOPHAGY- consumption of soil, clay and dust or chalk
 HYALOPHAGIA- consumption of glass
 PAGOPHAGIA- consumption of ice
 TRICHOPHAGIA- consumption of hair or wool
  UROPHAGIA- consumption of urine
 XYLOPHAGIA- consumption of wood
 SELF CANNIBALISM- it is the self-eating practice

 Clients may experience cravings of foods that may result in intake of excessive calories
or failure to consume required essential nutrients.
 Clients may experience aversions to certain foods or aromas that can result in an
increase of nausea or alteration of food intake patterns.
 It is important to recognize that aversions are usually self limiting and may even resolve
during the pregnancy, however avoidance may be warranted as long as the client has
these feelings.
 Altered Bowel Patterns

CONSTIPATION is common during 2nd and 3rd trimester

Causes of Constipation:
* Iron in prenatal vitamins
* Enlarging uterus
* Decreased bowel motility
* Decreases in physical activity
* Inadequate fluid or fiber intake

Recommendation:
* consume at least 8 oz glasses of water per day
* Increase consumption of whole grains
* Increase activity levels
* Fluid Retention
* Enlarging fetus places pressure on abdominal blood vessels impairing venous return
from the lower extremities
* Vessels in lower extremities become congested, resulting in fluid shifts into interstitial
spaces that causes ankle edema.
* Hormonal changes increase sodium retention, which causes further fluid retention

Recommendation:
* To reduce edema, elevate feet and legs
* Avoid restrictive clothing
* Encourage side lying position when sleeping or resting
* Courage walking and performing ankle exercises
* Socio-economic and Cultural Factors
* Low income groups tend to have a big families, one reason for the decrease in kind and
amount of food available to the pregnant mother.
 * Unusual eating habits such as frequent snacks rich in CHO, irregular meals, special
cravings such as raw white rice and green mangoes and odd eating habits like chewing
cigarettes, chicken manure and soot of pots, deprive the mother of wholesome foods.
* Fallacies eg. That eating eggplant causes beri-beri in the mother, dark foods result in
dark complexion of babies, and crabs produce physical abnormalities should be ignored
* Alcohol, Caffeine and Nicotine
* Low mean birth weight and increase risk of perinatal mortality = smoking during
pregnancy.
* Smoking affect the conversion of dietary to weight gain. When segments of umbilical
cord from the mothers who smoke were found large areas of swollen and irregular
endothelial cells, it is postulated that smoking increases the mother’s level of
carboxyhemoglobin and nicotine causing a decrease in the oxygenation of the fetus.
* Increasing the FOOD INTAKE of pregnant smokers can compensate for some of the
effects of smoking.
* Excessive maternal blood alcohol ingestion is linked to fetal alcohol syndrome (FAS).
* Its major features are CNS disorders, mental retardation, growth deficiencies and facial
deformities.
* Caffeine crosses the placenta to the fetus very rapidly. Drug metabolizing ability of a
fetus is extremely limited.
* The fetus can metabolize alcohol to a limited extent but not caffeine.
* Alcohol, caffeine and nicotine dramatically increase circulating levels of catecholamine.
* Mother’s Age

Pregnancy in Adolescents
o IDA (iron deficiency anemia)
o Prolonged labor
o Higher rates of stillbirths, preterm birth and low birth weights infants

Pregnancy in Older Women

o HTN and DM
o Higher rates of premature birth and low birth weight
o Birth defects
o Fetal death

Repeated pregnancy
o As parity increases, tendency toward lower nutrient intake also increases
o Gestation in close interval depletes the maternal reserves of nutrients. Since
replenishment of reserves do not take place, the mother’s nutritional status and infant
is greatly affected.
1) Nutritional concerns for the high risk-client
o Preexisting Maternal Disease
o Cardiac History
o Respiratory history
o Immune history
o Neurological History

2) Development of Maternal Disease

o Gestational Diabetes
o Pregnancy Induced Hypertension (PIH)
o Hyperemesis Gravidarum