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News on Vitamins

News on Vitamins. Obesity is associated with Vit D deficiency. Vit D is stored in fat cells and can be unavailable. ↓ BMI = ↑ bioavailability Dark pigmentation ↓ Vit D absorption via skin. Pigmentation acts as UV protection. Daily doses of moderate/excess Vit A can weaken bones.

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News on Vitamins

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  1. News on Vitamins • Obesity is associated with Vit D deficiency. Vit D is stored in fat cells and can be unavailable. ↓ BMI = ↑ bioavailability • Dark pigmentation ↓ Vit D absorption via skin. Pigmentation acts as UV protection. • Daily doses of moderate/excess Vit A can weaken bones. • LDL and polyunsaturated lipids in cell membranes have ↑ chance of free radical damage. Vit E suppresses free radicals. ↑ PUFA=↑ Vit E

  2. Nutrition During Pregnancy and Lactation Ch 10

  3. Energy Needs Increase • Increased fuel demand • Spare protein for added tissue building • ↑ 340kcal/day during 2nd trimester • ↑ 450kcal/day during 3rd trimester • Increase of 15-20% over the energy needs of a nonpregnant women • Sufficient wt gain is vital

  4. Protein Needs Increase • Building blocks for growth of body tissue - ↑ 25g/day • Development of the placenta • Growth of fetus • Growth of maternal tissues • Increased maternal blood volume • Plasma volume increases by 40-50% • ↑ hemoglobin – supply oxygen to growing cells • ↑ albumin – regulate blood volume • Amniotic fluid • Storage reserves for labor

  5. Complete and Incomplete Protein Sources • Complete- ↑ biological value • 1. Egg • 2. Milk • 3. Cheese • 4. Soy • 5. Meat • Incomplete 1. Beans 2. Legumes 3. Grains • Protein rich foods also contribute other nutrients such as: iron, B-vitamins, and Calcium

  6. Vit and Minerals Increase • Minerals • Calcium • Iron, DRI 27mg (non pregnant 18mg) • Vitamins • A • C • B-complex • D (preeclampsia, GDM) *Meet the requirements with 3 cups fortified milk daily • Folate, DRI 600mcg/d (non pregnant 400mcg) • Neural Tube defects – most common: spine ebifida

  7. Question of the DayWhat are good sources of Iron? • Heme Iron: • Best absorbed • Derived from hemoglobin found in animal foods: • Beef or chicken LIVER (3.5mg/serving) • Clams, mussels, oysters (3.5mg) • Cooked beef, sardines, turkey (3.1mg) • Chicken, halibut, salmon, veal, tuna, ham (0.7 mg) • Non Heme Iron • Less efficiently absorbed • Found in plants and fortified foods: • Breakfast cereals, cooked beans, tofu, 1oz pumpkin/sesame seeds (3.5mg) • Lima, kidney, split, chickpeas, dried apricots, backed potato, broccoli (2.1mg) • Peanuts, almonds, walnuts, spinach, green pepper, rice, bread, pasta (0.7mg)

  8. Daily Food Intake • General Guidelines • Regular meals – don’t skip • Eat enough food • Eat fruits and vegetables • Protein sources • Cultural aspects of eating

  9. Rate of Weigh Gain • ~2-4# in 1st trimester • ~ 1#/wk for the remainder of the pregnancy • Sharp wt ↑ may be water retention • Low maternal wt gain ↑ risk of intrauterine growth restriction

  10. Common Problems • N/V (nausea and vomitting) • Hyperemesis Gravidarum [n/v <1st tri] (persisting past 1st trimester) • Constipation • Hemorrhoids • Heartburn

  11. High Risk • Identify as soon as possible • Based on clinical evidence of inadequate nutrition • Patterns that do not support optimal maternal and fetal health 1. Insufficient food intake 2. Poor food selection 3. Poor distribution throughout the day • Teenage pregnancy • Special care must be given • DRI recommendation for ˂18 yo

  12. Special Needs • Age (when having kids as teenagers or < 35yr olds) • High Parity Rate • Alcohol (spectrum of disorders caused by intaking alcohol) [leading cause of preventable disorders – fetal alcohol syndrome] • Smoking [connected to fetal abnormalities]

  13. Special Needs (con’t) • Drug Abuse [goes through the placenta] • Caffeine [goes through the placenta as well] • Pica [cravings for non-food products] • Social economic problems

  14. Complications of Pregnancy • Anemia [more prevalent in poor women] Women need more iron or anemia will occur • IUGR (inter uterine growth restriction) – leads to more chronic disease. Just read the damn book • PIH (pregnancy induced hypertension) – spilling out proteins in urine? • Gestational Diabetes – diabetes during pregnancy

  15. Pre-Existing Conditions • DM – diabetes mellitus • PKU – unable to absorb phenyl alanine urea • Food Allergies • Celiac (disease) – limits the food you can eat • Lactose Intolerance – most high Ca foods come from dairy

  16. Breast Feeding • Best nutrition for baby for 1st 6 months • Milk production • Prolactin – stimulates milk production • Oxytocin – release of milk

  17. Breast Milk Composition • Colostrum – 1st milk – yellow • Mature milk – occurs in a couple of days (protein is higher in the 1st couple of days then decreases) • Hind milk – has essential fatty acids • Cows milk is not appropriate for infants under one year of age • (Too harsh for the baby in the early years)

  18. Nutrition Needs for Lactation • Prenatal Supplements should continue • Energy needed for process and product • 330 kcal/day in first 6 months • 400 kcal/day last 6 months • ↑ 25g protein/day • Fluid intake ~3/L day

  19. Question of the Day • Prenatal MVI’s for non – pregnant women • It’s OK if you need the nutrients • Look at overall diet then make a decision • Fat Souble vitamins are stored in tissue, not needed everyday • Absorption is best with food • If its for hair and nails decide if this is what you want long term • Costly • Weigh out benefits/long term effects unknown/continual usage/cost • *Excessive Vitamin A over time make weaken bones • *Vitamin E supplementation may slightly ↑ mortality

  20. Benefits of Breastfeeding Infant: • Decrease in severity or incidence of infectious dx • Increase cognitive performance • Decrease rate of SID syndrome, DM 1 and 2, lymphoma, leukemia, obesity, hypercholesterolemia, asthma Mother: • Earlier return to pre pregnancy weight • Decreased risk of breast cancer, ovarian cancer, osteoporosis

  21. Nutrition During Infancy Childhood and Adolescence • Ch 11

  22. Measuring Growth • Infancy • WHO growth chart (birth to 24 months) • Head circumference • Childhood/Adolescence • CDC growth chart (2-18) • BMI

  23. Energy and Nutrient Needs Premature: 110-130kcal/kg 1-3 yo: 80-120kcal/kg • Adult 30-40kcal/kg bodyweight Macronutrients • Carbohydrates are main energy source and spare protein • Protein for the 6 months of life: 1.5g/kg • Adults: 0.8g/kg • Fat is necessary for growth • Back up source of energy

  24. Nutrient Needs • Water • Infant consumes 10-15% body weight in fluid • Adult 2-4% • Vitamins • Needed in supplement form: Vitamin D (400 iu) and vitamin K • Minerals • Ca – bone development • Fe – hemoglobin synthesis (cognitive and behavioral performance)

  25. Age Group Needs Premature: ˂2500g • TPN ˃ Enteral ˃ Trophic feeds ˃ Oral feeds • Breast milk with fortification is optimal • Premature BM is higher in nutrients • Donor milk Term Infants • Iron fortified foods added ~6 months of age (early introduction of meat) • Bottle feeding • AA based formulas/Fat malabsorption

  26. Age Group Needs (con’t) • Childhood (1-3) • Energy needs are still high • Food preferences • 19g fiber/day to prevent constipation Preschool- Aged (3-5) • Patterns and food jags (food jags are very particular food) • Food variety, appropriate portion, role model • Growth is in spurts

  27. Age Group Needs (con’t) • School Aged (5-12) • Growth is irregular • Reserves occur 1-2 years before adolescence • Girls growth bypasses boys • Food preferences and new stimuli • Food choices at school Nutritional Problems • FTT • Anemia (milk anemia) – no iron in milk • Obesity • Lead poisoning

  28. Age Group Needs (con’t) • Adolescence (12-18) • Final growth spurt • Timing of sexual maturation • Eating habits • Eating Disorders – more commonly found in girls

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