Nutrition and Infant Health

Nutrition Basics

• The risk of dietary deficiency and overdose reactions can be related to nutrient intake, with a U-shaped curve illustrating the balance between low and high intake levels.
• The Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) are important reference points for nutrient intake.
• Adequate Intake (AI) and Tolerable Upper Intake Level (UL) guide appropriate and safe consumption levels.

Carbohydrates

• Simple sugars include monosaccharides like glucose, fructose, and galactose, as well as disaccharides like sucrose, maltose, and lactose.
• Complex carbohydrates include starches (plant form), glycogen (animal form), and fiber.
• Alcohol sugars, such as ethanol, also contribute to carbohydrate intake.
• Recommended carbohydrate intake should comprise 45-65% of total calories.
• Adequate fiber intake is 21-25 grams for females and 30-38 grams for males.

Protein

• Sources of protein include milk, cheese, meat, and eggs.
• The recommended protein intake range is 10-35% of daily calories.

Fats

• Lipids include fats (solid at room temperature) and oils (liquid at room temperature).
• Triglycerides are composed of 3 fatty acids attached to glycerol.
• Essential fatty acids include linoleic acid (parent omega-6 from seed oils) and alpha-linolenic acid (parent omega-3 from sea fish and flax seeds).
• Hydrogenation and trans fats add hydrogen to unsaturated fatty acids, changing the structure of fatty acids from cis to trans.
• Dietary cholesterol is a fat-like, clear liquid found in animal products and is a precursor to vitamin D, estrogen, and testosterone.
• Food sources of cholesterol include egg yolks, meat, milk products, and fats like butter.
• Fats should make up 20-35% of the recommended intake, with no trans fats.

Vitamins & Minerals

• Fat-soluble vitamins include A, D, E, and K.
• Water-soluble vitamins include thiamin, riboflavin, niacin, B6, folate, B12, biotin, pantothenic acid, choline, and vitamin C.
• 15 essential minerals are required for health.
• Examples of essential minerals: calcium, phosphorus, magnesium, iron, zinc, fluoride, iodine, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, chloride.

Water

• Adults are 60-70% water.
• Daily water needs are 15-16 cups for males and 11 cups for females.

Nutrition Assessment

• ABCD's: Anthropometric measures, Biochemical tests, Clinical observations, and Dietary intake.

Preconception

• Begin preparing for pregnancy three months prior to conception.
• Infertility affects 15% of couples, but 44% of these couples eventually conceive.
• 20-25% of otherwise healthy couples will experience a miscarriage in the first 20 weeks of pregnancy.
• Subfertility is a reduced level of fertility, characterized by an unusually long time for conception; it affects 18% of couples.
• Four key hormones influence the female reproductive system: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone.
• The gonadotropin-releasing hormone (GnRH) stimulates the pituitary gland to release LH and FSH.
• Follicle-stimulating hormone (FSH) stimulates the growth of ova.
• Luteinizing hormone stimulates the secretion of progesterone.
• The menstrual cycle typically lasts 28 days and includes the follicular and luteal phases.

Follicular Stage

• The anterior pituitary releases FSH and LH, which travel to the ovaries.
• Estrogen levels rise with increased FSH, which turns off the FSH release and limits the follicles that mature.
• Typically one follicle becomes dominant and matures in each cycle.

Luteal Stage

• This stage occurs 14 days after the Follicular stage.
• Estrogen stimulates release of LH to trigger ovulation.
• An empty follicle becomes corpus luteum which secretes progesterone.
• Progesterone readies the uterus for a fertilized egg.
• Menstruation will occur if the egg is not fertilized.
• Contraceptives that includes estrogen and progestin will suppress LH and FSH thereby preventing ovulation.
• Progestin blocks LH and ovulation and induces a barrier to sperm by causing cervical mucus to become thick and sticky

Obesity/Overweight & Infertility

• Losing 5-10% of body weight can restore ovulation.
• Obesity can cause PCOS (polycystic ovary syndrome), insulin resistance, menstruation problems and ovulation.
• Increased fat tissue enhances steroidal hormones and also increases lipid storage.
• It can cause change in metabolism and excretion of hormones which may lead to ovarian dysfunction.

Diabetes and Infertility

• Type 1, Type 2 and Gestational diabetes can cause infertility.
• High blood glucose levels affect hormone levels and can be managed by carbohydrate counting.

Polycystic Ovary Syndrome (PCOS)

• Affects 5-10% of women.
• High levels of intra-abdominal fat and insulin resistance is the leading cause, also known as hyperinsulinemia.
• Hyperinsulinemia is linked to hyperandrogenemia.
• Insulin acts with LH to produce more androgen and hormones in the ovary.

Diet Recommendations for PCOS

• Lean proteins, whole grains, fruits and vegetables, non-dairy, and low-glycemic index carbohydrates.

Underweight and Infertility

• Low BMIs may develop anovulation and amenorrhea
• Reduced hypothalamic production of gonadotropic releasing hormone
• To increase BMI, eat more food
• Hypothalamic amenorrhea
  • Loss of menstrual cycles due to absence of ovulation
  • Deficits of energy and nutrients
• Anorexia nervosa and bulimia nervosa are linked to hypothalamic amenorrhea
• More likely to miscarry, have preterm delivery, and deliver low birthweight infants
• Theory of nutritional infertility
  • Low fuel detected by neuron cells
  • Release neuropeptide Y and catecholamines
  • Work on hypothalamus to block GnRH so that no ovum or sperm will grow

Negative Energy Balance

• Female athletic triad
• Energy intake is 30% less than required
• Decrease in LH, FSH, and estrogen
• Treatment includes
  • Correction of negative energy balance
  • Restoration of ovulation
  • Bone mass accretion

Vitamin and Mineral Deficiencies & Infertility

• Untreated Celiac Disease

  • Folate- lactose maldigestion, intolerance
  • Vitamin B12- weight loss
  • Vitamin A- anemia
  • Vitamin D- osteoporosis
  • Vitamin E- Subfertility
  • Vitamin K- growth failure, irritable bowel disease
  • Calcium and Iron

• Treat celiac disease by eliminating foods that have gluten and replacing them with rice, soy, corn

• Nutritional recommendations During Conception

• Women need folate, iodine, DHA, multivitamins

• Men need zinc and antioxidants

• Iron

  • Creates hemoglobin which attaches to red blood cells and delivers oxygen throughout the body
  • 27 mg per day
  • Iron supplements

• Iodine

  • Thyroid function
  • Drink water, iodized salt, seafood
  • Reduce stress, increase exercise
  • Multivitamin
  • Prenatal vitamin

• Coffee

  • No more than 200 mg
  • Caffeine contributes to miscarriage and low birth weight

Pregnancy Outcomes

• Low birthweight (2500 g), preterm delivery, infant mortality
  • 8% (66% of infant deaths) LBW
  • 11.4% born preterm
• Reducing infant mortality and morbidity
• Desirable birth weight: 3500-4500 grams (7lbs 12oz- 10lbs)
  • Less likely to develop heart and lung diseases, diabetes, and hypertension

Physiology of Pregnancy

• Gestational age is assessed by doctors and starts at the date of conception (38 wks)
• Menstrual age is assessed from the first day of last period (40 wks)

Pregnancy Phases

• Maternal anabolic phase: the first 20 weeks of pregnancy is when mothers body builds capacity to deliver all blood, oxygen, and nutrients to fetus for the 2nd half of pregnancy.

  • Mothers symptoms: increases appetite, anabolic hormones, and decrease exercise tolerance.

• Maternal catabolic phase: the last 20 weeks of pregnancy where stored nutrients is mobilized.

  • Mothers symptoms: increase in catabolic hormones, increase in exercise tolerance.

Insulin During Pregnancy

• Insulin levels will significantly rise but cant maintain glucose levels
• Placenta development:
  • large endocrine organ that develops in uterus in first several weeks of conception.
  • secretes vital hormones and fights infections and exchanges nutrients & O2 from mother to fetus.

Hormones

• The mother body relies on specified hormones
• Progesterone, estrogen, human chorionic gonadotropic (hCG), leptin, and human chorionic somatomammotropin

The Body In Pregnancy

• Body water increases to 7-10 L
• Building Blood & Tissues occurs first trimester
• First few Weeks: 50 ml during 10th week to 800 mL 20th week of gestation
• Material Nutrition metabolism during pregnancy
• Calcium metabolism occurs with bone turnover and reformation
• Increased levels of body, water, & tissue synthesis require sodium and other materials.

Embryonic and Fetal Growth & Development

• Hyperplasia
• Hyperplasia and Hypertrophy
• Hypertrophy
• Maturation
• Insulin-like growth factor (IGF-1) is the main fetal growth stimulator.

Pregnancy Weight Gain

• Normal Weight Gain 25-35lbs.
• 1/3 of weight gain goes to the fetus
• Increase body fat helps meet nutritional needs of mother and fetus
• 30,000 calories
• Nutrient Needs 45-65% cabs , no alcohol, increase protein, 33% Fats

Carbohydrate and Protein Metabolism

• Glucose is preferred fuel for fetus (50-80%)
• Early Pregnancy: High estrogen and progesterone stimulates insulin need more glucose need to coverision to glycogen and fat
• Late pregnancy: Human chorionic somatotropin (hCS) + Prolactin will inhibit conversion of glucose to glycogen and fats
• Maternal proteins accumulates in blood , uterus, breats fetus , placenta , aminoic fluid

2nd & 3rd Trimester

• Need high amounts for ratipid growth of maternal fetal tissues
• Natural decline in total nitrogen- Fat Metabolism
• Blood lipids level increases which can cause increase cholesterol used for steroid hormones and by the fetus for nerve and cell membrane
• Does not in crease risk of atherosclerosis

Vitamins & Minerals

-Vitamins & Minerals During Pregnancy -Folate -Iron -Vitamin A -Vitamin D -Calcium -Sodium -Water

• 300 mL /Day
• Help with edema's prevention

Diet Considerations During Pregnancy

• Sweetners FDA approved for these artificial sweetners -AcesUlfame K --Asparatme -Saccharin --sucralose -splenda

• Consume in moderation with other sweetners

• Lead Experiosures

• Impacts kid's cognitive function

• Elevatrd blood levels can be toxic to brain

• Interferes with calciumm and iron aborpsition -Slow growth and shorterm stature

• Gastro

• Distrubances

• Nuseua and vomitting, diarrhea, & constipation -nausea and vomitiing -6th week stop around 12tt week

• fluid intake

• Cause from infections, edications, food poisoning, lactose fruccrose, sobriol & manital intoralbility, IBD ibs

• High fiber diet to toold buking agents and adquate fluid

• Rehydrate and electrolytes

• Heatburn

• Relaxtion of gl muscles secondary to increasein estrogen and progestrone

  • Sttomack contesnt mves into esophagus casuing heartn burn OR move heartn burn and severe gernd ( gastro esohagcal reefux disease
  • Pressure from feterus and fetus can cause heartn burn
  • Imapact of fuctuating hermons on the function of the lower esoghacal sphinctir
  • Triggers ar elatin before bad ,intrakee fatty foor of spice foods & side ffects of mediccatition, caffime, Mint , chocolate, and side ffects of mediccatition

• constipations

  • third Tirmestrs

-INcrcase fibroess fluid and not ttakes laxatvires

• Pregann womnes need ST 30 min of ofexercize 5 ttimes are week orr 150 min
• anxiety and depression mostt communs meatl heathisssue

Nutrition During Pregnancy

• During Preganncy Vitamines minerals --foilate

• -metabolic Reactions --Decfincies lead to congenital Abinromaities

• -checkl flate status by assessd bt cerum and ree cell

• Fotae levels vegetables aand fructl Neural Tube defescts

• Lack of foilac acud or vitamin b1b magnesesium ziinc -Obestity -Glucose Intolorance

• MTHFER genptype

• Woman Womnes Wto take anti seizzure drug vaprote widhout wpporpirataed foilac wcida Supplmentatioon

• 1 mg ofood foliate

• .06 micgf foilac acud is conisumned & taken with food

• 0.S micy fooilai Acud Takkan as supplment on an empty stomach

Pregnancy Hormones

• Vitmaine AA Needed for baby's embryionic growth, including the development of the heart, lungs, kidneys eyes and bones as well as the circulatory, respiratory, and central nervous systems
• Helps postpartum tissue repair
• Helps maintain normal vision, fights infection, supports your immune system and helps with fat metabolism -4000 IUS – no more than 8000 IUS- RDA;4SO MG
• needed for baby's embryos, including the developmnents; heart, lungs, kidneyeyees & bone & crculator/eepsiriatir/ centural nervouous systems

Vitamin D

• Suppports fetal growth --RDA; 15 mcgs
• Upper limit: 4000UI -Declency leads to smalelr bones poorly cacifierd bones s admnormal enamel and dental cavitivies
• Highher wisk for percelmpsiao preterm brith and matneral icffection; obesese and Veggan is at risk
• Needs for fetal skeletralsl minerlization and Maternal Bones Calcium- needs and sources three cups of milk or calcium fortifed soy milk or otter
• For fetus-

Weight Gain & Diet

-300 mgs, for fetus and placente

• 250 mgs lost act deilevery

• 400 mgS ford incrrreasesss red bloos cell

• Pregnancy: conditions in interventions conditions is inerventisnn

  -Obesity -several unavorable metabolic changes

  1. incrassed blood glucose 2 increasee bloooed concentraion is s inusiln

Insulin resistance

bloood pressure

High c reactive Proteinn leevels

low HDl

 EFfects ON Moms
 Hyyyyperttenision
 gestinalal dibes
           stoppage

Gestational Diabetes

• Predisposed to insulin resistance and impaired insulin production
• 2-12% (88% of pregnancy diabetes)
• Increased risk of spontaneous abortion, stillbirth, congenital. abnormalities, neonatal death
• Linked to excess body fat, unhealthy diets, low physical activity levels
• Pregnant women with preexisting diabetes
• Hemoglobin A1c > 6.5%
• Fasting plasma glucose> 126 mg/dL
• Management of gestational diabetes

Hypertensive Disoders & Preganancy

• 5-10% pregnancy, stillbirths, fetal and newborn deaths
• Related to chronic inflammation, oxidative stress, nd damage to endothelium of blood vessels
• Impaired blood flow, increased tendency to clot, and plaque formation

Breast Feeding Nutritioan

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Prolactiin

• Hormne that promotes milk productiooon( suckiing oxcitosin Release-Relees responsiblee for ejectionno nilk frofm the mikk gland sucinkig of niple stimlationk

• stages of laactgenis

Colusturm

• Istotonnic -Enegy s
  • .65 Kcal. ML -few calorieas than humaas miljk subititube (IMS) provide halff the calories in hunams milkkk

Human Milk

• Lipids:Provides half the calories in human milk.

• Protein: Lower amount than human milk

• Casein mainn Protien

• Carboshydtratase

• --Oligosachridese medium lennths

• vitamin A

• Colistrume have appmroxiimalty twicee,e the concentrate of vitamin A as mature milk does

-Whaat does wHo recommendd at BIrth

• beign hour after birth

Benefits of Breasfeeding

• Hormonail

increase oxitositin,s Stimualtess Utretuss to Reutrrnnto Pregananc status

phyisucal benfir eject

Contraindications to Breastfeeding

• Infection: HIV, tuberculosis, herpes simplex virus (HSV).
• Medications: Certain medications, such as chemotherapy drugs and some psychiatric medications, may be contraindicated.
• Substance abuse: Alcohol and drug use can be harmful to the infant.
• Infant conditions: Galactosemia, Maple Syrup Urine Disease
• Breast cancer treatment: If undergoing radiation or chemotherapy
• If breastfeeding problems can’t be resolved, or if infant isn’t gaining weight.

Sore Nippless

-Preventred byy propper positioning of bby on breast flat Inverted nipples is is if dfficullt to lach

• is ifficullt to lach
• lettown failure milk doe not ejet the breast
• HyperlactsionsmilkVolumee proceed edxtendendd intakie

Problems During Breast Feeding

EngorggmentBreasat are averfillsd wtih milk. pluggued DudceLocadiced blockal of mikk Resutlong Frome mike staualss. Masitits

• Prevented b compleete Emppting of breeasrse eand chianng Position of infaants whille Feeiln

Medicinal Herbs & Breastfeeding

Evidence suggests combined oral contraceptives may reduce breast milk volume.

• Avoid the use of Ocs fron 6-6 Mendicinaid herbs shouted should shoyled B viewed aas drugs specicic Herbs used in USAA
• Herbal Effects: May have different actions
• Drug interactions: Potential problems with medical conditions
• Dosage: Variable; consult pharmacist before dispensing herbs Alcohol impact on alcahols in lactation decrease oxytosiin and iin letfown
• decress volume consumed by infannt
• iterfer with innfnatt slepp paterrn ::Nicotine::
• Health riskss suchaas otis medias Exiccertiation of Asasthma Respiratiions-
• Inffections and Gasstrol Distruubtion

Drug Abuse & Babies

Drug Metabolism and Elimination

• Rate of Elimination: Depends on half-life
• Effect of Alcohol at Different Points of Elimination

Neonatal Jaundice and Kernicterus

• Neonatal Jaundice

1. yellow cOOoooololor of THe Skin
2. 40 full terrnn and 80 is preterrtmnn
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• Physiological Vrs pathgolo
• phyosulugical A.

Key Actions for Jaundice

AAP guidelines recommend use of photo therapy using flouuoresceetn lgihtis light is assrbd sinbilluribin changes

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• PROttecs of Dermitits and Wzzing

• GENetitticscs, durtattiono f Beeasseetfeddinggg, timet of intodcucctioiin of Otherrrrr foord mattrss is is ismattrneell smooooliiiiioookk

• Fooooor intonellrrrnancccee

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