Special Topics in Nutrition Lecture (PDF)

Special Topics FN 1070 in Nutrition Developed by: Leila McBeth, BScFN, MScFN (c) and Rebecca Whitehead BASc, MScFN (c) TABLE OF Contents 01 Maternal Nutrition 02 Weight Bias 03 Sports...

Special Topics FN 1070 in Nutrition Developed by: Leila McBeth, BScFN, MScFN (c) and Rebecca Whitehead BASc, MScFN (c) TABLE OF Contents 01 Maternal Nutrition 02 Weight Bias 03 Sports Nutrition 1 Maternal Nutrition  “Eating for Two” Protein: +25 g/ day First Trimester: +0 kcal/day Second Trimester: +340 kcal/day Third Trimester: +450 kcal/day  Unsafe Foods for Pregnancy Unpasteurized milk, milk products or juices Undercooked eggs, meat, or poultry Raw sprouts Deli meats and hot dogs that haven’t been reheated to steaming hot Limit high mercury seafood Pregnancy Multivitamin 400 ug of folic acid 16 to 20 mg of iron  Neural Tube Development Neural Tube Critical Period: 17-30 days gestation *before most women even realize they are pregnant Folic Acid deficiency Toxins (alcohol, etc.) Preformed vitamin A Wheat Flour Mandatory Fortification in 1998 caused a reduction ______ of the number of Neural Tube Defects babies were born with Common result of NTDs: abortion or stillbirth Spina Bifida Anencephaly  Pregnancy Weight Gain Recommendations 30$ Pre-pregnancy Pre-pregnancy Pre-pregnancy Pre-pregnancy Underweight Average BMI Overweight BMI Obese BMI BMI MONTHLY Add a feature 11.5-16 kg Add a feature 7 - 11.5 kg 5-9 kg 12.5-18 kg Add a feature Twin: 17-25 kg Twin: 14-23 kg Twin: 11-19 kg Twin: Unknown Add a feature  Weight Gain Pattern First Trimester 2.5 kg (Underweight) 1.5 kg (Average weight) 1 kg (Overweight) After First Trimester > 0.5 kg /week (Underweight), < 0.5 kg/ week (Average weight), 1/3 kg / week (overweight) If Women Gain Excessive Weight Increased likelihood of LGA infants.. which has higher risks of: Longer labour and birth Birth trauma Birth asphyxia Caesarean birth Increased perinatal mortality Infant to develop T2DM later in life Infant to become overweight Weight retention up to 3 years postpartum If Women Gain Inadequate Weight Increased likelihood of SGA infants.. which has higher risks for the infant: Health complications after birth ○ hypothermia, hypoglycemia, respiratory distress, jaundice Neonatal mortality Physical disabilities Cognitive disabilities Chronic health problems later in life: T2DM, CVD, and HTN Malnutrition during pregnancy Low Type 2 Low BW + high growth in young birthweight Diabetes in childhood→ high blood pressure infants infants and heart disease  Harmful Pregnancy Practices Herbal Vitamin/ Supplements Mineral Tobacco Illicit Drugs Overdoses Alcohol Caffeine Sugar Lead/Mercury > 500 mg/day Substitues  Diabetes in Pregnancy Pre-existing Diabetes Concerns Gestational Diabetes Concerns Severe hypoglycemia and Labour complications hyperglycemia Infant heart damage Preterm birth Infant limb deformities HTN in pregnancy NTDs LGA infants  Hypertension in Pregnancy Pre-existing HTN Concerns Gestational HTN Concerns Low birth weight infant Sometimes pre-eclampsia Stillbirth from separation of the placenta from the uterus wall Pre-eclampsia symptoms Protein in the urine Swelling of hands, feet, and face Delayed fetal growth Risk: Organ damage and eclampsia (seizures and possible death)  Maternal Discomfort Strategies Nausea Heartburn Constipation rise from sleep slowly eat slowly/ chew well 30$ eat high fibre foods eat dry toast or eat small frequent meals exercise often crackers liquids between meals eat small frequent MONTHLY 8 cups + of liquid daily avoid spicy or greasy meals Add a feature foods Add a feature chew gum or suck eat 3 hours before lying Add a feature hard candies Add a feature down or 2 before carbonated beverages exercise Food Cravings Do Not Reflect Nutritional Needs  Breastfeeding Prolactin Oxytocin for milk for the let- production down reflex Breastfeeding Goals 6 months exclusively Up to 2 years partially Breastfeeding Benefits Immunity against common childhood illnesses Higher intelligence infants Infants less prone to be overweight/ obese Infants less prone to diabetes Mothers less prone to breast and ovarian cancers Weight loss for mother  Lactation Nutrition Drinking Water: First 6 months: +330 kcal/day ~13 cups Second 6 months: +400 kcal/day 2 Sports Nutrition Benefits of Fitness Restful sleep Enhanced body composition Bone density improvement Immunity Better circulation Better lung function Lower risk of cardiovascular disease, some cancers, type 2 diabetes, and gallbladder disease Mood improvement Longevity and quality of life  Physical Activity Processes Fuel use during activity depends on: During rest: ATP + creatine → creatine phosphate Training Status During activity: Creatine phosphate → ATP + creatine Diet Activity Intensity/ Duration  Diet and Endurance Fat and protein diet 57 min Normal mixed diet 114 min High-carbohydrate diet 167 min  Macronutrient Use in Exercise Glucose Fat Protein First 20 min of 30$ > 20 min of Athletes use more moderate activity= MONTHLY protein for fuel moderate activity= moreAddfat use, less glycogen a feature Add a feature glycogen Add a feature use More so for muscle Add a feature building, not energy Protein Recommendations for Active People g/kg/day RDA for adults 0.8 Power athletes (strength/ speed) 1.2-1.7 Endurance athletes 1.2-1.4 Iron oxygen transport “sports anemia” extra iron loss from physical activity higher risk groups for IDA Calcium & Vitamin D bone health muscle contraction stress fracture risk Other B vitamins for creating energy from macronutrients Antioxidants to help combat high intensity free radical levels Fluid Replacement via Hydration Athletes can lose 1.5L + per hour of physical activity Hot weather slows water absorption Athletes to hydrate days in advance Plain and cool water 2-3 cups for 2-3 hours before activity 1-2 cups for 15 minutes before activity 0.5-1 cup for every 15 minutes during activity 2 cups every 20-30 minutes post-exercise for every 0.5kg lost Electrolyte Losses Training improves electrolyte retention Sweat causes loss of sodium, potassium, chloride, and magnesium Caution on salt tablets Regular diet is usually sufficient to replenish Hyponatremia: decreased blood sodium concentration ○ higher sweat loss ○ overhydration ○ don’t restrict salt during the days before an event  Sports Drinks Hypotonic: Isotonic: formulated to quickly replenish fluids lost during have concentrations of salt and sugar similar exercise to those found in the human body They have a very low carbohydrate content and They are designed to rapidly replace fluids lost contain lower levels of salt and sugar compared to during exercise while also providing a boost of the body’s natural concentration carbohydrates. Hypertonic: designed to boost the body’s daily carbohydrate intake by providing high levels of carbohydrates to maximize energy absorption best drank after exercise higher concentration of salt and sugar than the human body  Enhanced Water What is it? Enhanced water is water that is Can include: fortified with vitamins, minerals, electrolytes or other functional ingredients to vitamins improve things including taste minerals and nutritional profile natural or artificial flavors botanicals sweeteners  caffeine is quickly absorbed into the bloodstream, Caffeine in ○ peak levels after 30-120 minutes caffeine levels remain elevated for 3-4 hours before gradually decreasing Sports fat burning: ○ caffeine may enhance the body’s ability to break down fat through a process known as lipolysis, which is the breakdown of fat stored in fat cells muscles: ○ caffeine may boost muscle functions by stimulating the central nervous system, although the precise mechanisms behind this effect are not fully understood PRE-GAME MEALS 4-hours pre-game 1 hour pre-game meal high in whole grain snacks high in carbohydrate, lean carbohydrate protein, and healthy fat avoid foods high in example: protein or fat ○ grilled chicken, sweet ideas for snacks: potato, and ○ fruit vegetables ○ granola bar ○ pretzels or crackers POST-GAME MEALS help to replenish glycogen (energy) stores and electrolyte imbalances eat 15-30 minutes after game has ended ○ this time frame is optimal for the body as it is receptive to energy replacement techniques during this time meal should be high in carbohydrate but should also include protein and fat amount of calories needed is dependent on the duration of the event, body size, and energy expended WEIGHT BIAS  What is weight bias? Weight bias can be defined as “negative weight-related attitudes, beliefs, assumptions and judgement toward individuals who are overweight and obese” this definition can also extend to include individuals of low weight as well  What is weight stigma? Weight stigma refers to the social stereotypes and misconceptions about obesity. these social stereotypes and misconceptions include beliefs that people with obesity are awkward, unintelligent, unsuccessful or lack self-control  Weight discrimination Weight bias and Type of weight Consequences of stigma can lead to discrimination: weight weight discrimination discrimination: verbal or emotional Weight discrimination physical can affect happens when barriers in day-to- individual’s access individuals act on day life to education, their own biases and denial of access to employment, and societal stereotypes healthcare medical care about obesity, resulting in unfair treatment of people with obesity Causes of many different factors can cause weight bias: ○ in education: Weight Bias bullying from peers and teachers ○ in the workplace: harsher disciplinary actions and higher contract termination rates ○ in personal relationships: most common source of stigmatising comments ○ in the media: tv shows, language, underrepresentation, social media LAZY UNMOTIVATED UNDISCIPLINED LACKING WILLPOWER Factors genetic factors ○ genes can contribute to obesity by affecting appetite, satiety (the contributing to sense of fullness), food cravings and body fat distribution obesity environmental & social factors ○ physical activity, food accessibility, socioeconomic status  Weight Bias Activity Open the link: https://implicit.harvard.edu/implicit/ Click “Project Implicit Social Attitudes” Scroll down and press “I wish to proceed” Choose the “Weight (‘Fat-Thin’IAT)” option skip the demographic information by choosing “decline to answer” for each question until “Implicit Association Test” page pops up Activity Reflection What was it like to complete the test? Were you surprised by the results? Impact of physical consequences: weight bias ○ reduces confidence in their ability to lose weight ○ higher risk of health conditions including on health heart disease and diabetes psychological consequences: ○ increased risk of depression, anxiety, suicidal thoughts, and low self-esteem  Weight bias in patient perspective: ○ more likely to cancel appointments ○ avoid future preventative care ○ obese women are less likely to be up to date on procedures including pap smears or mammograms healthcare healthcare professional perspective: ○ may hold strong negative attitudes and stereotypes about people with obesity ○ impact on the care provided ○ poor treatment, judgement Body Mass Index (BMI) What is it? a screening tool that measures the ratio of your height to your weight to estimate the amount of body fat you have BMI does not take into account muscle mass, bone density, overall body consumption, and racial and sex differences BMI UNDERWEIGHT: less than 18.5 RANGES HEALTHY WEIGHT: 18.5 to 24.9 OVERWEIGHT: 25 to 29.9 CLASS 1 OBESITY: 30 to 34.9 CLASS 2 OBESITY: 35 to 39.9 CLASS 3 OBESITY: more than 40 Calculating BMI the formula for calculating BMI is: BMI = kg / m 2 Example: weight: 70kg Solution: height: 1.75 meters BMI = 70 kg / (1.75m)2 what is the BMI? = 70 kg / 3.0625 = 22.86 Healthy weight range: 18.5 to 24.9 Addressing and reducing weight bias What can you do? What is being done in practice? use respectful language education that emphasizes the different speak up if you witness someone in and more complex causes of obesity weight-biased teasing building empathy and understanding educate others in your life different perspectives altering healthcare providers normative beliefs about and expectations of how to behave towards patients with obesity Weight inclusive approach in healthcare recognize that health or health outcomes cannot be predicted based on someone’s weight health promotion without focusing 1. SlidesCarnival on weight for the presentatio template 2.Pexels for the photos understand that body weight is influenced by many factors Case Study Sarah, a 35-year old women with a long history of struggling with her weight, visits her doctor for chronic knee pain. During the appointment, her doctor quickly attributes her knee pain to her “excess weight” and advises her to start a weight loss program, dismissing her concerns when she mentions past struggles with dieting. Feeling judged and unheard, Sarah leaves the appointment without a clear diagnosis or treatment plan. Her pain worsens, and she delays seeking further care. Months, later she sees a different doctor who listens to her symptoms and diagnoses a torn meniscuc, recommending physical therapy. Reflecting on her experience, Sarah realizes that her hesitation to seek further help was due to the judgement she felt during her initial visit. Reflection Questions: What examples of weight bias can you identify in this case study? How did the doctors assumptions impact the care that Sarah received? What could the doctor have done differently to provide unbiased, patient-centered care? How might a weight-inclusive approach have changed the outcome for Sarah? 3 weight bias refers to negative attitudes, beliefs, or stereotypes towards individuals based on their body weight weight bias is widespread in society and is Summary commonly found in personal relationships and healthcare promoting education about the complex causes of obesity beyond can address weight bias actions including encouraging empathy and understanding different perspectives related to weight and health can reduce weight bias  References 1. Hammond, G., O’Connor, C., Piche, L.A., Whitney, E.N., and Rolfes, S.R.. Understanding nutrition (3rd Can ed.). Toronto, ON: Nelson Education Ltd; 2023. 2. Health Canada. Prenatal Nutrition Guidelines for Health Professionals: Background on Canada’s Food Guide [Internet]. Ottawa, ON: Health Canada; 2009 [cited Nov 20, 2024]. 7 p. 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Why people become overweight. Harvard Medical School. [Internet]. Available from: https://www.health.harvard.edu/staying-healthy/why-people-become- overweight#:~:text=Genetic%20influences&text=Genes%20contribute%20to%20the%20causes,way%20to%20cope%20with%20stress 8. Yadav HM, Jawahar A. Environmental Factors and Obesity. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580543/ 9. Cleveland Clinic. (2022). Body Mass Index (BMI). [Internet]. Available from: https://my.clevelandclinic.org/health/articles/9464-body-mass-index-bmi  References cont. 1. World Obesity. (2022). Weight Stigma. [Internet]. Available from: https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma 2. Fulton M, Dadana S, Srinivasan VN. Obesity, Stigma, and Discrimination. [Updated 2023 Oct 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554571/ 3. Fulton M, Dadana S, Srinivasan VN. Obesity, Stigma, and Discrimination. [Updated 2023 Oct 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554571/ 4. Paul, R. (2017). Combating Weight Bias: Why We Need to Take Action. OAC. Available from: https://www.obesityaction.org/resources/combating- weight-bias-why-we-need-to-take-action/#:~:text=Educate%20others%20in%20your%20life,in%20place%20at%20their%20school 5. Soft Drinks Association. Sports Drinks. [Internet]. Available from: https://www.britishsoftdrinks.com/sports-drinks 6. Meta Brand. (2022). 5 Clever Things You Can Learn From Top Enhanced Water Brands. [Internet]. Available from: https://metabrandcorp.com/things-to-learn-from-top-enhanced-water-brands/ 7. Mawer, R. (2021). How Caffeine Improves Exercise Performance. Healthline. Available from: https://www.healthline.com/nutrition/caffeine-and- exercise 8. Nationwide Children’s’. Game Day Fuel Plan for Athletes. [Internet]. Available from: https://www.nationwidechildrens.org/specialties/sports- medicine/sports-medicine-articles/game-day-fueling-plan-for-athletes