UNIT-1 BSN-2024 (1).pptx

JINNAH COLLEGE OF NURSING A Constituent College Of SOHAIL UNIVERSITY APPLIED NUTRITION Generic BSN 1st Year 2nd Semester COURSE INCHARGE SABEELA NOOR SENIOR LECTURER BIOCHEMISTRY Jinnah Medical & Dental College  UN...

JINNAH COLLEGE OF NURSING A Constituent College Of SOHAIL UNIVERSITY APPLIED NUTRITION Generic BSN 1st Year 2nd Semester COURSE INCHARGE SABEELA NOOR SENIOR LECTURER BIOCHEMISTRY Jinnah Medical & Dental College  UNIT –I MATERNAL NUTRITION  LEARNING OBJECTIVES:  Nutritional need in pregnancy and Lactation.  Pre – pregnancy diet.  Pregnancy and adolescents.  Nutritional risk factors of pregnancy.  Concerns during pregnancy/ weight gain/feeding twins/DM in pregnancy.  Prevalence of Iron deficiency anemia in Pakistani women. Nutrition: Nutrition may be defined as the science of food and its relationship to health. It is concerned primarily with the part played by nutrients in body growth, development and maintenance Nutritional status: is the current body status, of a person or a population group, related to their state of nourishment (the consumption and utilization of nutrients).  WHY IS PRECONCEPTUAL NUTRITION SO IMPORTANT IN PROVIDING A NUTRITIONAL BASELINE FOR BOTH THE MOTHER AND THE DEVELOPING FETUS? An optimal level of nutrition during preconception period ensures that a women begins pregnancy with all necessary nutritional stores to produce substances required to maintain healthy pregnancy and support the developing fetus/embryo. Women who enter pregnancy in optimal nutrition state are more likely to have an uneventful pregnancy & deliver a healthy infant. Double Burden of Nutrition Pre p r e g n a n c y We i g h t f o r H e i g h t Recommended BMI Category gain in b o dy w e i g h t (kg) 500mg/d may impair fertility. Moderate use of coffee and caffeine < 300 mg/d does not appear to pose any risk. High intake should be avoided.  THE IMPORTANCE OF IRON IN PREGNANCY: The RDA for iron increases by 50% during pregnancy. An estimated 27mg/d iron is needed to support the increase in maternal blood volume and to provide iron for fetal liver storage, which will sustain the infant for the first 4-6 months of life. It is often recommended that all pregnant women take an iron supplement everyday from the 20th week of pregnancy. This is not necessary if a woman has a good diet and routine blood tests shows that she is not anemic. Iron supplements may cause constipation. In Pakistan, the prevalence of anemia among ever-married women aged 15 to 44 is reported to be 26% in urban areas and 47% in rural Areas. The prevalence of anemia among pregnant women living in urban areas is similar, ranging from 29% to 50%. IRON DEFICIENCY Causes o ANEMIA Anemia  Why is it important in pregnancy – Pregnancy causes a surge in the volume of blood in the body; the expanded volume may go up by 50%. – To meet the demands of the increased blood volume, iron requirements go up significantly. – Iron is also required for the normal development of the growing baby and the Placenta. On an average, the iron requirement during pregnancy is as follows:- Basal iron = 280 mg Expansion of red cell mass = 570 mg Fetal transfer = 200-350 mg Placental development = 50-150 mg Blood loss at delivery (normal) = 100-250 mg After deducting iron conserved by amenorrhoea (240-480mg), additional 500-600 mg iron is required in pregnancy. If the patient is chronically anaemic, then her iron stores also stand to be depleted. This necessitates an extra supplementation of 500 mg is needed. Thus Total Iron Supplementation Stands At 1000 Mg.  Iron requirements in pregnancy go up from 18 to 27-30 mg per day. Because iron is not easily absorbed from the diet, it is recommended to take an iron supplement Risk profile of an anaemic mother includes- a)Preterm birth. b) Low birth weight. c)Increased blood loss during and after labour. d)Depleted stores.  R I CH S OU R CE S OF I R ON oCooking In An Iron Skillet o Fortified Bread & Breakfast Cereals o Red Meat o Soybean o Poultry o Spinach o Lentils o Beetroot o Beans o Jaggery o Leafy Vegetables o Pistachios o Tofu  Iron is more easily absorbed if it is taken in conjunction with vitamin C –either as a supplement or in citrus fruit or juice. Tea and coffee can interfere with the body's absorption of iron. Dietary sources: Heme source:meat,poultry,fish. Non Heme source: plant foods Absorption enhancers (consumed at same meal); Vitamin c,meat,fish poultry. Absorption inhibitors (polyphenols found in coffee and tea)phytates found in dried peas beans); oxalic acid found in spinach, chocolates.  Basic animal foods: Iron absorption from animal is very efficient from 15% to 35%. Organ meats (spleen,kidney,liver,brain) have a high concentration of iron. Red meat (beef,mutton,lamb,goat,buffalo). Chicken, egg yolk, fish. Basic plant foods: Iron absorption from plant foods may vary from 2% to 20%. animal foods and vitamin c increases bioavailability of iron in plant foods. Black tea and dairy products reduce bioavailability of iron from plant foods.  Dried beans soy bean, red kidney beans, chickpeas). Green, red and purple vegetables Nuts (almond), dried fruit(prunes,apricot,raisins) Whole grains(brown,basmati,roti,b ajra roti)  Why is it important during pregnancy? 1. Total calcium concentration falls because of physiologic hypoalbuminemia 2. Free ionized calcium concentration does not change (9-11gm%) 3. The placental produces 1,25-dihydroxyvitamin D, which results in increased intestinal absorption of calcium 4. Calcium is actively transported across the placenta to the fetus, facilitated by parathyroid hormone-related peptide  This increased demand if not met in the diet – Will lead to excessive calcium resorbtion from the maternal bones – Osteoporosis. ❑Involved in mineralization of bones and teeth, energy and cell production and electrolyte acid-base buffering. ❑Fetal bone and teeth calcification primarily occurs in last 2-3 months. (total fetal requirement=) 2 cup full of milk daily or equivalent to supply 1200 mg calcium/1200mg phosphorous daily ❑Excess phosphorous can be a problem. Avoid snack foods, processed meats and cola drinks. Therapeutic calcium supplementation (1200mg/day) should Be in the form of calcium citrate/ calcium gluconate Supplemented with vit -d  R I CH S OU R CE S OF C A L C I U M ▪ Dairy foods - Milk , yogurt, Cheese, Cottage Cheese, Rasgullas. ▪ Leafy & Green vegetables - Broccoli, Spinach, Okra, Horseradish, Watercress ▪ Fruits - Oranges, Bananas. ▪ Beans and Peas – Red kidney beans, Soyabean, Cabbage, Celery. ▪ Peanuts, Peas, Black Beans, Baked Beans ▪ Fish - Salmon, Sardines ▪ Miscellaneous - Sesame Seeds, Blackstrap Molasses, Corn, Almonds, Brown Sugar.  Fortified foods  Why is it important in pregnancy? It helps the body to use calcium that is consumed. Maintain blood calcium & phosphorous levels. Anti proliferative action. RECENT STU D IES INDICAT INCREASED E RISK OF IN IN AUFAN TISMTS W IT H VIT. D DEFICIENCY □ Sunlight exposure □ Fish - Salmon, Tuna, Flounder, Sole. □Milk ᴥ Cereal ᴥ Pork □ Mushrooms □ Riccota Cheese □ cod liver oil Why is it important in pregnancy? Need enough for healthy growth Too much can cause birth defects Formation of Rhodopsin, essential for normal vision Glycoprotein synthesis (epithelial cell function) Maintain normal skin health by switching on genes and differentiating keratinocytes (immature skin cells) into mature epidermal cells. Regulates gene transcription. Anti Oxidant action. Why are they important in pregnancy? They serve as building blocks of proteins. Used in production of DNA, Cell membrane, Haemoglobin, Receptors, Enzymes, Neurotransmitters, Hormones, Antibodies & other Bioactive molecules. Serve as body store of energy after fat stored in adipose tissue.  TE INC P LE OM COM S PL EIN PR ET T OT PRO o u ltry, Pro tei E E INS e a t, P se, ns -M Gr a f ro m , C hee ins r o m - teins f , M ilk ,N L eg Pro , Egg s rt. V e uts, u Yog h u Lac get See mes, Fish tial ko a bl ds, en ne e s n e ess or. e all ni cids am m o r id a i no ee rov ino aci ssent P am ds. ia l Omega-3 fatty acids are fats commonly found in marine and plant oils. They are considered essential fatty acids, meaning that they cannot be synthesized by the human body but are vital for normal metabolism. Though mammals cannot synthesize omega−3 fatty acids, they have a limited ability to form the long-chain omega−3 fatty acids including Eicosapentaenoic Acid Docosahexaenoic Acid α-Linolenic Acid  WHY THE DEVELOPING BABY NEEDS FATS ❖ Babies need a diet high in beneficial fats, as these are their main source of energy. ❖A baby’s brain, which is around 60% fat, uses nearly three quarters of total dietary energy for growth, whereas an adult's uses only a fifth. ❖Once born, they’ll get a lot of essential fats from breastmilk , which contains over 50% of its calories as fat. ❖ But while still in the womb, they rely on maternal fat supply. FAT IS ESSENTIAL FOR VITAMIN ABSORPTION Fats act as carriers for fat-soluble Vitamins such as A, D, E and K. Vitamin D Helps Keep Bones And Teeth Healthy. Vitamin E Protects Cell Membranes By Acting As An Antioxidant Vitamin K Helps Wounds Heal Properly As It Helps With Blood Clotting And Also Helps Build Strong Bones  CARBOHYDRA TES Principle energy yielding food. ‘Digestible Carbs’ – Sugars & Starches. ‘Indigestible Carbs’ – Cellulose, Hemicellulose, Gum, Pectin, Lignin. Foods with carbohydrates in them have a wide range of effect on the blood glucose levels, during digestion. This is known as the ‘Glycaemic Response’ ‘Glycaemic Index’ is the effect of carbs on the blood glucose levels. Rapidly breaking down carbs have high GI, and vice versa.  Too much caffeine is not good during pregnancy Coffee, tea and some pop has caffeine 3 small cups of coffee per day (400-450 mg of caffeine) is safe. Switch to decaf or try half decaf, half regular  NOT ENOUGH WEIGHT GAIN TOO MUCH WEIGHT GAIN Low birth weight baby High birth weight baby Early birth Difficult birth (Feto pelvic disproportion) Baby may not develop properly Higher perinatal mortality Baby may have life-long health problems Mother may develop gestational diabetes Higher perinatal mortality Baby may develop diabetes & cardiac problems in later life Baby may have mental and behavioural problems  Key Contact Points for Improving Maternal Nutrition DELIVE PREGNAN RY CY POSTNATAL AND FAMILY IMMUNIZATI PLANNING ON ICDS Centres THANK YOU