Nutritional Requirements During Pregnancy

Nutritional Requirements During Pregnancy Related to: • Perinatal Nutrition • Maternal Developmental Stage • Fetal Growth and Development • Growth of Maternal Supporting Tissues • Expansion of Maternal Blood Volume December 8, 2000 Nutrition 1 Impact of Perinatal Nutrition on Fetal Development Maternal Dietary Practices Prior to Pregnancy Nutritional Needs During Pregnancy Adequate intake of nutrients more likely to be achieved Supports Fetal Growth and Development December 8, 2000 Nutrient Reserves At Conception Insurance when intake is compromised e.g., nausea Protects Developing Organs 2 Nutrition Change in Requirements of Selected Nutrients During Pregnancy • Most of increased need occurs in 2nd and 3rd trimesters • Nutrient requirements are increased disproportionately to energy requirements • Reserves are particularly important during 1st trimester or when intakes may not be consistent • Larger increases in requirements may be needed for adolescents or undernourished women 3 Nutrition 3 rg te y in P ro M a V it C gn Fo am al e B la in ciu siu Iro Zi B 1 D m m n nc 2 te 6 0 1 2 E n e x Prepregnancy DRI December 8, 2000 Protein and Energy Requirements • Energy – Sustains metabolic activity – Supports protein synthesis – Reflects fat and carbohydrate intakes after increased protein requirement is included • Protein – Expansion of maternal blood volume – Growth of breast and uterine tissues – Growth of fetal tissues Increase from 0.8 g/kg body weight to 1.1 g/kg Total cost= 55,000 kcal = 28 wks x 7 d +300 kcal/day +10 g/day December 8, 2000 Nutrition 4 Equivalents of 300 kcal Energy and 10 g Protein 48 g protein 360 kcal 1 oz meat = 8 g 1 svg dairy = 7 g 1 svg grain = 2 g 2 g protein 245 kcal 30 g protein 310 kcal December 8, 2000 7 g protein 90 kcal Nutrition 5 Roles for Increased Maternal Nutrient Requirements - 1 of 2 • Cell replication ph vi vi o v ca sp ita co tam tam f lc ho m p zi ola B- ir i i i i nc te 12 on B-6 um ru n D pe n C n A s r – DNA synthesis • Zinc, Folate (& B12), iron – Protein synthesis • Protein & B6 • Fetal skeletal development – Mineral formation • Calcium & phosphorus – Calcium metabolism • Vitamin D & magnesium – Matrix formation • iron, copper, vitamin C, vitamin A, vitamin K, protein December 8, 2000 0 1 2 3 6 x prepregnancy DRI Nutrition Roles for Increased Maternal Nutrient Requirements- 2 of 2 • Energy metabolism e at l fo 6 B n i n ci a l of i n b ri am i th u m i es r n e ag pp m co n o ir n vi a – Electron transport • Iron, copper – ATP synthesis & utilization • Magnesium, thiamin, riboflavin, niacin • Oxygen transport – Hemoglobin synthesis • Iron, copper, B6 – Erythropoiesis • Folate (& B12), iron • Cell replication nutrients 7 0 1 2 3 x prepregnancy DRI December 8, 2000 Nutrition Nutritional Requirements For Lactation Related to: • Biosynthesis of Human Milk • Human Milk Nutrient Composition • Infant Developmental Needs December 8, 2000 Nutrition 8 Nutrient Requirements for Lactation C n i m A a it in V am c it Z in V on Ir 12 B in e m lat a it Fo D V in m a um it V l ci n Ca tei o Pr gy r 0 ne E Pregnancy Lactation 0.5 1 1.5 2 2.5 x Requirements of Nonpregnant/Nonlactating Women December 8, 2000 Nutrition 9 Energy Cost of Lactation Milk Volume Produced = 750 mL/day = 600 mL/day (6-12 mos) Energy Content = 75 kcal/100 mL = 562 kcal/day = 450 kcal/day Energy Intake Equivalent = 562/85% = 661 kcal/day = 450/85% = 529 kcal/day Recommended allowance = + 500 kcal/day Energy Deficit of 150 kcal/day x 7 = 1050 kcal/week = 0.3 lb body fat (3500 kcal/lb fat ) December 8, 2000 Nutrition 10 Effect of Maternal Diet Composition on Nutrient Content of Human Milk NUTRIENT Energy Protein Fat Carbohydrate Vitamins Minerals Water December 8, 2000 MILK CONTENT 75 kcal/100 ml 5% of total energy Whey > Casein Amount and type varies with intake Lactose Depends on vitamin Fixed Fixed Nutrition MATERNAL DIET Decr milk volume Decr milk volume CHO = MCFA; FAT = 6 or 3 LCFA No influence Varies up to a maximum Depletes reserves Decr milk volume 11 Human Milk Fat Composition Omega-6 Fatty Acids • Types – Linoleic acid (18:2) – Arachidonic acid (20:4) Omega 3 Fatty Acids • Types – Linolenic acid (18:3) – Eicosapentanoic acid (20:5) – Docosahexanoic acid (22:6) • Functional Roles – Eicosanoid synthesis – Satisfy essential fatty acid requirements • Functional Roles – Eicosanoid synthesis – Nerve & retina activity • Sources – Vegetable seed oils (LA) – Meat (AA) December 8, 2000 • Sources – Flaxseed, nuts, soybean (LNA) – Fish (EPA/DHA) – Alga (DHA) Nutrition 12 Infant Nutritional Requirements Related to: • High Growth Velocity • Neurological Development • Vulnerability to Dehydration • Developmental Immaturity – Digestive tract – Renal function December 8, 2000 Nutrition 13 Average Weight and Height Birth to 36 months 16 14 12 Kilograms Weight (kg) Height (cm) 120 100 80 60 40 20 0 0 6 12 18 24 Age in Months Nutrition 10 8 6 4 2 0 30 36 December 8, 2000 Centimeters 14 Energy Requirements By Age Light to Moderate Activity 120 kcal/kg body weight 108 98 102 90 70 50 37.5 30 100 80 60 40 20 0 0-6 mos 6-12 mos 1-3 yrs 4-6 yrs 7-10 yrs 11-18 yrs* 21-50 yrs* 51+ yrs * Average for males and females December 8, 2000 Nutrition 15 Protein Requirements by Age 2.5 g/kg body weight 2.2 1.6 0-6 mos 6-12 mos 1-3 yrs 4-6 yrs 7-10 yrs 11-18 yrs* Adult* 2 1.5 1 0.5 0 1.2 1.1 1 0.9 0.8 * Average for males and females December 8, 2000 Nutrition 16 Primary Roles of Nutrients During Infancy: 0-12 Months • Growth – Cell replication – DNA & protein synthesis • Brain/nervous system development – Structural Components • Skeletal development – Mineral & matrix formation – Calcium metabolism • Long chain PUFA, B12, vitamin E, galactose – Cognitive development • Maintenance of Fluid Balance – High metabolic rate – High surface area/volume ratio • Iron • DHA* *Requirement not established December 8, 2000 Nutrition 17 Relative Size of Body Water Compartments: Infants and Adults Adult Woman Adult Man One year Term Preterm Fat/Dry Solids ICW ECW Total Water 0 50 100 Percentage of Body Weight December 8, 2000 Nutrition 18 Developmental Factors Affecting Infant Nutrition Digestive Tract – – – – – – Low lipase levels and bile salt concentration Low disaccharidase activity except lactase Low saliva production Low pancreatic amylase activity Small stomach volume (10-20 mL) Low gastric acidity • Renal System – Low urine concentrating capacity (700 mOsm/L) • Immune system – Intestinal epithelium permeable to macromolecules December 8, 2000 Nutrition 19 Reconciling Developmental Barriers to Infant Feeding Developmental Factor Addressed by:  pancreatic lipase activity, Bile salt-stimulated lipases Medium chain triglycerides bile salt concentration  saliva, pancreatic Simple sugars > Starch amylases  gastric acid  intestinal permeability  urine concentrating capacity Whey > Casein Solid food introduced when epithelial closure occurs Limit protein, Na+, K+, Cl-, PO4-2 intakes December 8, 2000 Nutrition 20 Comparison of Human Milk to Cow’s Milk and Soy Formulas Nutrient/Source Energy Protein/Source Human Milk 20 kcal/oz 1.1 g/dL lactalbumin 60: 40 3.6 g/dL Human fat (AA & DHA)* 7.2 g/dL Lactose Cow’s Milk Formula 20 kcal/oz 1.5 g/dL nonfat milk + whey 60:40 + whey 18:82 - whey 3.6-3.8 g/dL butterfat, coconut, soybean, palm oils 7.0-7.2 g/dL Lactose Nutrition Soy Formula 20 kcal/oz 1.8-2.1 g/dL soy pro isolate + met, taurine Whey:Casein 0 3.6-3.8 g/dL butterfat, coconut, soybean, palm oils 6.7-6.9 g/dL Sucrose, corn syrup solids 21 Total Fat/Source Carbohydrate/ Source December 8, 2000 *Unique to human milk Weights of Bottle-Fed vs Breast-Fed Infants: Birth to 9 Months 12 10 Weight (kg) Bottle-fed Breast-fed 8 6 4 2 0 0 1 2 3 4 Nutrition 5 6 7 8 9 22 Age (months) December 8, 2000 Preterm and SGA* Infants: High Nutritional Risk • Physiologically immature • Metabolic abnormalities – Fluid and electrolyte imbalances, acidosis hypo- or hyperglycemia • Illness present – Respiratory distress, sepsis, pneumonia, meningitis • Poor nutrient stores – Fat, glycogen, micronutrients • High nutrient requirements – Intravenous (parenteral) feeding often necessary December 8, 2000 Nutrition *Small for gestational age 23 Solid Food Introduction Nutritional Indicators Insufficient nutrient density of milk to meet increasing needs Physiological Indicators • Intestinal epithelial cell closure – prevents entry of whole proteins • Digestive enzyme maturation – Functioning at adult levels – Presence of disaccharidases Milk ~ 1 kcal/g Cereals ~ 2 kcal/g Meat ~ 2-3 kcal/g • • • • • Saliva, gastric acid levels increase Bile concentration increases Urine concentrating ability increased Deciduous teeth erupt Extrusion reflex disappears December 8, 2000 Nutrition 24 Childhood Nutritional Requirements Related to: –Linear growth and weight gain –Cognitive development –Exposure to childhood diseases December 8, 2000 Nutrition 25 Childhood Nutrient Requirements • Linear growth – Cell replication – Skeletal formation and development Energy  10 Protein • Brain development – C20 and C22 fatty acids, B12, vitamin E • Cognitive development – Iron Zinc • Immune function – Iron, vitamin A, vitamin C, protein, zinc, B6 – Cell replication Iron Children Adult Woman Adult Man Vitamin A  10 0 5 10 15 unit/kg body weight December 8, 2000 Nutrition 26 Average Weight Gain Girls and Boys 1-11 years 14 12 Girls Boys Weight Gain (lbs) 10 8 6 4 2 0 0 1 2 3 4 5 6 7 8 9 10 27 Age (years) December 8, 2000 Nutrition Nutrition and Brain Development • Brain growth – EFA are limiting nutrients – LA=3% kcal and LNA = 0.5% kcal • Brain and nerve structure – Vitamin B12 in myelinization – 60% lipid composition • Neural membrane function – C22 in synaptic membranes (signal transduction) – C20 in Ca++ transport (signal activation & reception) – C20 & C22 incorporated selectively December 8, 2000 Nutrition 28 Nutritional Risks in Childhood Nutrient Contributing Cause Milk replaced by soda and fruit juices Compromised Function Linear growth Growth, wound healing, appetite Immune function, skeletal development Calcium Zinc Preference for processed meats and high fat meats Lack of green leafy and yellow-orange vegetables Vitamin A Pyridoxine Insufficient whole grain breads or cereals Diluting effect of high fat meats, sweetened cereals, lack of green leafy vegetables Nutrition Immune function, growth Growth, cognitive development (psychomotor skills) 29 Iron December 8, 2000 Change in Percentage of Overweight Children* Ages 6-11 (1963-1995) 16 14 12 10 8 6 4 2 0 1963-65 1971-74 1976-80 1988-94 Girls Boys *Above the 95th percentile using December 8, 2000 Nutrition 1960 norms- Source: CDCP 30 Adolescent Nutrition (11-18 yrs) Related to: •Rapid linear growth –Addition of 45% of adult skeletal mass –20% of adult height and 50% adult weight •Sexual maturation •Changes in body composition December 8, 2000 Nutrition 31 Energy Requirements During Adolescence 60 kcal/kg body weight 55 47 40 45 50 40 30 20 10 0 Females Males 11-14 yrs 15-18 yrs December 8, 2000 Nutrition 32 Protein Requirements by Age 1.2 g/kg body weight 1 0.8 0.6 0.4 0.2 0 1 1 0.8 0.9 Females Males 11-14 yrs 15-18 yrs December 8, 2000 Nutrition 33 Average Weight Gain Girls and Boys 11-17 years 16 14 Girls Boys Weight Gain (lbs) 12 10 8 6 4 2 0 10 11 12 13 14 15 16 17 Age (years) December 8, 2000 Nutrition 34 Adolescent Nutrient Requirements • Linear Growth – Cell replication – Skeletal mass and density • Sexual maturation – Gender differences in body composition – Gender differences in reproductive development December 8, 2000 Nutrition 35 Body Composition Changes in Girls and Boys Ages 8 to 18 30 25 20 15 10 5 0 Fat Muscle Nutrition 36 Girls + Boys: 8-11 yrs Girls: 11-18 yrs Boys: 11-18 yrs December 8, 2000 Nutritional Risks of Adolescents Group Adolescents and Children 4-18 yrs Adolescents 11-18 yrs Adolescent Girls Nutrient Deficiency Vitamin A, iron, Ca, zinc, pyridoxine Compromised Function Growth, immune function, wound healing Folate, riboflavin Magnesium, manganese, copper Growth, immune function Energy metabolism, skeletal development December 8, 2000 Nutrition 37 Change in Percentage of Overweight Adolescents* Age 11-17 (1963-1995) 14 12 10 8 6 4 2 0 1963-65 December 8, 2000 Girls Boys 1971-74 1976-80 Nutrition 1988-94 *Above the 95th percentile using 1960 norms- Source: CDCP 38 Adult Nutritional Requirements 18-51 years Related to: •Cessation of linear growth •Increasing sedentary lifestyle •Establishment of chronic disease risk factors •Adjustment to chronic stress December 8, 2000 Nutrition 39 Nutrition Risks of Adults • Macronutrient excesses and micronutrient deficiencies • Diminished activity and high fat intake • Stress-related effects on immune function December 8, 2000 Nutrition 40 Relationship of Disease Risk Factors to Nutrient Intakes Risk Factor Insulin Resistance Disease Type II Diabetes IDDM Atherosclerosis CHD Hypertension Stroke Excess fat, refined sugars, energy sat fat, total fat, cholesterol, energy Deficiency chromium, zinc, vitamin E, B6 folate, B12, B6, vitamin C Dyslipidemia Elevated Blood Pressure Excess Body Fat sodium, potassium energy, fat antioxidants, fat, 6 to 3 FA Ca, Mg, 3 to 6 fatty acids energy expenditure CHD, IDDM, Cancer, HT, osteoarthritis Cancer, Infectious Disease Immune System Incompetence folate, vitamin A, Zn, Fe, B6, vitamin C December 8, 2000 Nutrition 41 Mean Change in Weight by Age U.S. Adults (1971-75 to 1984) 8 Change in weight (lbs) 6 4 2 0 -2 -4 25-34 35-44 45-54 Nutrition Men Women 55-64 42 Age (years) December 8, 2000 Adult Nutritional Requirements 51 yrs and older •Related to: –Physical, emotional, and physiological changes affecting appetite and ability to eat –Medications that may interact with nutrients –Diseases with specific nutritional requirements December 8, 2000 Nutrition 43 Percentage of Malnutrition in Long-term Health Facilities • Contributing Factors – Sensory losses – Sarcopenia – Decline in digestive/absorptive efficiency – Stress – Disease – Medications Percentage of Total Residents 30 25 20 15 10 5 0 M al no ur is he M d ild /M od er at e Se ve r e December 8, 2000 Nutrition 44 Age-Related Changes in Nutrient Requirements Changed Requirement  Energy Rationale  muscle mass Consequence Weight Gain unless activity increased Loss of muscle mass and functional capacity  Protein  Folate, B12, B6  Vitamin E  amino acid pool  absorptive efficiency Cumulative oxidative damage  plasma homocysteine, neurological damage Immune incompetence Accelerated bone loss; immunoincompetence  Ca, Mg. Vitamin D  Zinc  Iron December 8, 2000  bioavailability  availability  losses Nutrition Sensory loss; immune incompetence; delayed wound healing 45 Comparison of Adult Nutrient Requirements 16 14 12 10 8 6 4 2 0 ug mg g Vit am in D B6 2u m lci u Ca Fo lat e B1 mg g 31-50 yrs 51-70 yrs 70+ yrs December 8, 2000 Nutrition 46