FCSN 245
Basic Nutrition
Summer 2006

Virginia Bennett, PhD, RD,  
& David Gee, PhD


Course Syllabus
Grading Policy
David Gee's Home Page
Course Schedule
Assignments
Student Outcomes
Computer Lab Hours
Framingham CHD Risk Calculator
 Lab/Discussion Group Schedule
Nutrient Density Spreadsheet
 
 
 Powerpoint Notes for Obesity and Weight Loss
 Practice Exam 3
 
 Practice Final Exam
Study Guide for Final Exam (Dr. Gee's portion)

MP3 File for Bennett's Electrolyte Lecture

Course Syllabus
 

FCSN 245 - BASIC NUTRITION
 
 
 


Grading Policy
 
 
Exam 1 Wednesday, July 2 100 points
Exam 2 Monday, July 14 100 points
Exam 3 Wednesday, July 23 100 points
Final Exam Thursday, July 31 100 points
Discussion Labs 100 points
TOTAL 500 POINTS

Rescheduling Exam Policy
If you know in advance that you cannot take the exam on the scheduled date, you must provide written documentation of your reason and have it approved in advance.  If you are significantly ill on the day of the exam or have any justifiable reason for missing the exam, you must provide written documentation of your reason. Please call if at all possible.  Exams can be re-scheduled with the department secretary and taken in room 100 Michaelsen Hall.  Note that the exam will be taken in a busy office.

  90% - 100% = A grades
  80% -  89% = B grades
  65% -  79% = C grades
  55% -  64% = D grades
  less than 55% = F

 Extra Credit: Nutrition Study Groups
  To encourage students to study together in groups, study groups of 3 or 4 students can be formed.  How the study group functions is decided upon by its members.  Extra credit is based upon how the group as a whole performs on each exam.  If the average score is between 70% and 79% , then each member of that group receives an additional 1% to each of their scores for that exam.  If the average score is between 80% and 89%, then each member receives an additional 3%. If the average score is between 90% and 100%, then each member receives an additional 4%. No extra credit is awarded if the average score is less than 70%.  Groups must be registered with the discussion/lab group instructor by Friday, June 27  (names and student numbers on a 3x5 card).  Group composition cannot be changed after that date.
 



 
 
 

STUDENT OUTCOMES

1. Students will understand and apply the basic scientific principles underlying the science of nutrition.

2. Students will understand the rationale of the dietary recommendations in the prevention of chronic diseases and
    nutritional  deficiencies and apply them to their own lives.

3. Students will apply the principles of nutrition science to their everyday decisions about food.
 
 
 
 
 


COURSE SCHEDULE
 
 
Week Topic Reading
6/23-7/2 Nutrients Tools -  Standards and Guidelines
Digestion and Absorption of Nutrients (reading only) 
The Carbohydrates: Sugar, Starch, Glycogen and Dietary Fiber
2
3
4
7/3-7/14 The Lipids:  Fats and Oils
The Proteins and Amino Acids
5
6
7/15-7/23 Nutrition and Disease Prevention 
Energy Balance, Weight Control and Physical Activity
11
9
7/24-8/1 Vitamins
Minerals and Water
Life Cycle Nutrition: Mother and Infants
7
8
12

 



Laboratory/Discussion Group Schedule
 
 
Date Class Activity Assignment Due Homework Assigned
6/26-27 Activity 1
Food Guide Pyramid
Activity 2
Nutrition Label Worksheet
Bring a food label Homework 1
Nutrient Density
Homework 2
Computer Diet Analysis
Carbohydrate Intake Assignment
7/10-11 Nutrient Density Discussion
Activity 3
Assessment Using USDA Dietary
Guidelines
Homework 1
Nutrient Density
Homework 2
Computer Diet Analysis
Carbohydrate Intake Assignment
Homework 3
Fat Intake Assignment
Homework 4
Evaluating Weight Loss Programs
7/17-18 Activity 4
Heart Health Assessment
Activty 5
Energy Balance and Body
Weight Assessment
Homework 3
Fat Intake Assignment
Homework 4
Evaluating Weight Loss Programs
Homework 5
Intake of Vitamins and Minerals
Homework 6
Personal Diet Makeover
7/14-25 Evaluation of Weight Loss Programs
Watch Frontline's "Fat" Video
Homework 5
Intake of Vitamins and Minerals
Homework 6
Personal Diet Makeover
Homework 7
Short Reaction Paper to the
"Fat" Video
7/31-8/1 Discuss "Fat" Video
Course Evaluation
Homework 7
Short Reaction Paper to the
"Fat" Video

 



 
 
 
 




 

Nutrition and Disease Prevention
Dr. David L. Gee
FCSN 245 Basic Nutrition
Leading Causes of Death
#1 - Heart Disease
280 deaths/100,000/yr
#2 - Cancers
210 deaths/100,000/yr
#3 - Strokes
60 deaths/100,000/yr
#8 - Diabetes
20 deaths/100,000/yr

Diet and Heart Disease
Incidence
Leading cause of death
1,250,000 myocardial infarctions/yr
750,000 MI deaths/yr
Diet and Heart Disease
Incidence of early heart disease (under age 65)
Males:
300/100,000 fatal MI
80/1,000 MI
Female:
125/100,000 fatal MI
45/1,000 MI

Incidence of early heart disease (under age 65)
Males:
300/100,000 fatal MI
80/1,000 MI
Female:
125/100,000 fatal MI
45/1,000 MI

History of a Heart Attack
Fatty Streaks
hypertension
cigarette smoke
inflammation
other causes?

Low-grade Systemic Inflammation in Overweight Children
Pediatrics, Jan. 2001
cross-sectional epidemiological study
3,561 children, 8-16 yrs old
C-reactive protein linked with development of heart disease in overweight adults
C-reactive Protein in Overweight Children

History of a Heart Attack
Atherosclerosis
“Hardening of the arteries”
Accumulation of lipids (LDL-C) by macrophages forming foam cells
Growth of fibrous cells on inner wall of coronary arteries
Calcification of endothelium of coronary arteries

History of a Heart Attack
Angina
Myocardial Infarction
Thrombosis:
growth of stationary clot
Embolism:
sudden closure by loose clot
Ischemia

History of a Heart Attack
Warning signs
Angina & shortness of breath
Often no warning!
Treatment
Angiogram
Angioplasty
Coronary bypass surgery

Treatment of late-stage CHD Secondary Prevention of CHD
Testing
Stress test
Angiogram
Angioplasty
Balloon angioplasty
stents
Coronary Bypass Surgery
Grafting of healthy veins around diseased coronary arteries

Primary Prevention of CHD
Know your risk factors
Make dietary changes
Start/continue exercise
Stop smoking
Stress reduction
Use medication if necessary

CHD Risk Factors ( * modifiable)
High LDL-cholesterol *
Low HDL-cholesterol *
High blood pressure *
Family history of early CHD
Current cigarette smoking *
Diabetes *
(Obesity *)

Risk Factors for CHD
High Total Blood Cholesterol
>200 mg/dl: borderline high risk
>240 mg/dl: high risk
High LDL-C
>130 mg/dl: borderline high
>160 mg/dl: high risk

Lowering your LDL-C
Decrease dietary saturated fat
< 10% calories (Step 1)
< 7% calories (Step 2)
Decrease dietary cholesterol
< 300 mg/day (Step 1)
< 200 mg/day (Step 2)

Lowering your LDL-C
Replacing dietary SFA with MUFA
Canola oil, olive oil
Increase dietary fiber
Whole grains, oats, fruits, vegetables

Lowering your LDL-C
Decrease dietary Trans-FA
hydrogenated fats
Medication
Plant stanols/sterols
“Statin” drugs
Bile acid binding resins
Niacin (pharmacological doses)

Risk Factors for CHD
Low HDL-C
< 40mg/dl : high risk
> 65mg/dl : protective

Increasing your HDL-C
Exercise
Alcohol
1-2 servings/d males
1 serving/d females

Risk Factors for CHD
Hypertension
Cigarette smoking
quit/don’t start
Diabetes
lose weight if overweight (type 2)
control blood sugar

Non-modifiable Risk Factors
Age
males over 45
female post-menopause
Family History
premature CHD
males under 55
females under 65

Risk Reduction
 

Hypertension and Stroke
Definition
Diastolic Blood Pressure
 > 90 mm Hg
Systolic Blood Pressue
 > 140 mm Hg
Desirable < 120/80

Hypertension
Prevalence
60 million
 > one third of adults
Risks
500,000 strokes per year
1,000,000 heart attacks per year

Risk Factors
Age
Family History
Obesity
Race

Diet and Hypertension
Weight Loss
Moderate weight loss
Regular exercise
Weight Loss vs. Medication

Diet and Hypertension
Salt and Sodium
50% responsive
Prevention vs Treatment

Diet and Hypertension
Salt Recommendations
WHO:  < 6 g/day
Salt Intake
US: 8 g/day
Asia: 30-40 g/day

Sources of Salt
10% unprocessed foods
15% added by consumer
75% in processed foods

Salt in Processed Foods
Foods prepared in brine
Smoked and cured meats
Salty snacks
Fast foods
Sauces and condiments
Canned and instant soups

Diet and Hypertension
Alcohol
 < 2 servings per day
Potassium
 fruits and vegetables
Fish Oils
Calcium

The DASH Diet
Dietary Approaches to Stop Hypertension
1997 DASH trial -NHLBI
Diet rich in
fruit
vegetable
grain products
Low/non fat dairy, fish and meats

DASH-Na Trial NEJM (1/4/01)
412 mild hypertensive adults
30 day intervention
DASH vs Control Diet
Low, Intermediate, High Sodium
(1200, 2300, 3500 mg Na/d)

The DASH Diet
For 2000  Calorie/day diet:
Grain products: 8 servings (6-11)
Vegetables: 5 servings (3-5)
Fruits: 5 servings (2-4)
LF/NF Dairy: 3 servings (2-3)
LF Meats: 2 servings (2-3)
Nuts, seeds, legumes: 1 serving

DASH-Na Conclusions
DASH diet lowers BP
Sodium reduction lowers BP
Combination of DASH and Na reduction effects greater than separately
DASH+low-Na reduced Systolic BP by:
11.5mm Hg in Hpt subjects
7.1 mm Hg in borderline Hpt subjects

DASH-Na Conclusions
Benefits seen with
men and women
blacks and non-blacks
hypertensive and borderline hypertensive
A 2 mm Hg drop in DBP results in:
17% reduction in Hpt
6% reduction in CHD risk
15% reduction in stroke risk
 

Diet and Cancer
Definitions
Cancer: uncontrolled growth and spread of abnormal cells
Tumor: mass of cancer cells
benign tumor (non-harmful, invasive)
malignant tumor (harmful, non-invasive)
Metastatic Cancer: spreading

Cancer Facts
US men have a 1 in 2 lifetime risk
US women have a 1 in 3 lifetime risk
1,220,000 new malignant cancer cases in 2000
552,000 cancer deaths in 2000

Cancer Trends JNCI, 1999
1990-1996
All cancer incidence declined by 2.2%
 -4.1% males
 -0.5% females

US Male Cancer Death Rates by Site

US Women Cancer Death Rate by Site

Cancer Rates Racial Differences

The Cancer Development Process
Initiation
Alterations in DNA
minutes - days
Causes: Exposure to Carcinogens
radiation
chemical
viruses

The Cancer Development Process
Promotion
“locking” DNA alterations
failure of DNA repair mechanisms
cancerous cells begin to divide
months - years

The Cancer Development Process
Cancer Progression
Uncontrolled growth of cancer cells
malignancy and metastasis
weeks to years

Diet and Cancer Development
Initiation
Dietary sources of carcinogens & pre-carcinogens
aflatoxin mold from peanuts
benzopyrene from charbroiled meats
nitrosamine from cured meats
Protection
antioxidants
dietary fiber

Diet and Cancer Development
Promotion
Fat and PUFA
excess alcohol
vitamins & phytochemicals as anti-promoters
Progression
excess Fat and calories

Diet and Cancer ACS 2000
One third of cancer deaths in US is due to cigarette smoking
One third of cancer deaths in US is due to diet
5-10% of cancers are hereditary

1999 ACS Dietary Guidelines
Choose most of the foods you eat from plant sources.
Five A Day
low in fat and calories
high in folic acid, vitamin C, beta-carotene
high in fiber
high in phytochemicals

Folate and Colon Cancer
Harvard Nurses’ Health Study 1998
89,000 women
If consumed >400 ug folate -> 30% lower risk than those consuming <200 ug folate
If consume folate supplements daily for 15 years -> 75% lower risk
supplements more bio-available
consumed more total folate

ACS Dietary Guidelines
Limit your intake of high-fat foods, particularly from animal sources
dietary fats are cancer promoters
colon, prostate, endometrial cancers
cured and smoked meats

ACS Dietary Guidelines
Be Physically Active: achieve and maintain a healthy weight
Obesity associated with most cancers
Exercise and Dietary Modifications
Mortality Risk  for Cancer and Body Weight

ACS Dietary Guidelines
Limit consumption of alcoholic beverages, if you drink at all.
Associated with:
Breast cancer
Mouth and throat cancers
Liver cancer
Effect of smoking and alcohol are more than additive

Dietary Guidelines
American Heart Association
Heart disease and stroke
American Cancer Society
Cancers
American Diabetes Association
General Agreement !
 
 


Proteins and Amino Acids in Nutrition
 

Protein Structure
o Polymer of amino acids
- amine group (N)
- acid group
- side chain

Protein Structure

Proteins are unique among energy nutrients
They contain NITROGEN
Composed of 20 different amino acids
9 amino acids are essential, other 11 are not essential
Proteins are strands of amino acids
linked by a peptide bond with next amino acid

Protein Structure

Primary Structure
Amino acid sequence or strand
like a strand of pop-beads or pearls
Secondary Structure
coiling of the strand
like a slinky: positive and negative parts attract each other

Protein Structure

Tertiary or third level of structure
Folding back of coil
The slinky gets messed up
Quaternary or fourth level of structure
Subunits fit together
Hemoglobin has four subunits the make the functional molecule

Protein Structure

SHAPE DETERMINES FUNCTION
The shape of the protein molecule determines if the molecule is functional
the shape of the lipase molecule determines if it will actually help breakdown a lipid
Change of shape is called DENATURATION
What causes change of shape?
acid (like the stomach low pH) or base(high pH)
alcohol
mechanical agitation(beating an egg white)
heat(heat an egg white) or heavy metals(mercury)

Cellular Protein Synthesis

DNA: in nucleus: acts as a template for mRNA
mRNA moves out of nucleus to cytoplasm
Carries instruction for an amino acid sequence for a specific protein to a ribosome
Ribosome 'reads' the mRNA which dictates which amino acid is next
tRNA carries the correct amino acid to the mRNA
Cellular Protein Synthesis

tRNA's line up one after the other with amino acids
Amino acids form peptide bonds to make the primary sequence of the protein
Protein then coils to form the secondary and tertiary structure
SHAPE DETERMINES FUNCTION

Heredity Factor
o Sickle cell anemia
o cystic fibrosis
o hypercholerolemia
- LDL-receptor

Protein Digestion

Stomach
Denaturation
Pepsin induced breakdown into shorter 'peptides'
Small Intestines
duodenum: peptidases or proteases enter from pancreas thru the common bile duct
breakdown proteins to aa's, dipeptides and tripeptides

Protein Digestion

Cells of small intestine
complete digestion of proteins so that only amino acids remain
cells of S.I. absorb amino acids and a few larger peptides and release them into the blood for circulation

Protein Function
o Structure proteins
o Muscle fiber protein
o Connective proteins

Protein: Function

Supporting Growth and Maintenance
body needs amino acids to grow new cells and replace cells that are worn out
Building Enzymes, Hormones, and other Compounds
amino acids used to make enzymes (e.g.. lipases for digestion)
amino acids used to make some hormones(e.g.. insulin for glucose metabolism)

Protein: Function
Building Antibodies
antibodies are formed from amino acids to defend against foreign proteins and substances in the body
Maintaining fluid and electrolyte balance
Proteins act like magnets and hold water in the blood vessels and also electrolytes like sodium

Transport Proteins

Cellular content differ from the contents of the surrounding environment: fluids and electrolytes
Protein Membrane carriers provide a 'pump' to maintain this difference
Sodium-Potassium Pump

Protein: Function

Maintain acid-base balance
proteins buffer the blood against big changes in pH so body remains pretty neutral
Providing Energy
When insufficient CHO and Fat are eaten, the body takes apart Protein for energy
Nitrogen portion removed from A.A. and the rest is oxidized for energy. Nitrogen ends up in the urine as urea.

Amino Acid Possibilities
Can be added to other A.A.'s to make a protein
Can have Nitrogen removed
then it can be oxidized for energy or
made into glucose (glucogenesis) or
made into fat (lipogenesis)
The diet needs to supply the 9 essential amino acids and 0.8 grams protein/kg wt.

Protein Quality, Use and Need
Protein Quality
the amino acid assortment greatly influences a protein's usefulness to the body
Measuring Protein Quality
the amount of the essential amino acids present in the protein
If all are well represented, the protein will support growth and maintenance: COMPLETE PROTEIN
If not, it won't support growth: POOR QUALITY PROTEIN

Protein quality

Complete or good quality proteins
soy beans, milk protein, animal flesh
Poor quality proteins
grains (missing lysine, an essential amino acid)
many legumes(beans, missing methionine)
Mutual Supplementation or complementing proteins
mix grain and legume and get a good quality protein eg: corn tortilla and refried beans

Types of Vegetarian Diets

Non-red meat vegetarian
poulty, fish, dairy, eggs O.K
no special nutritional problems, may be high in fat, saturated fat
Lacto-ovo vegetarian
milk and eggs O.K.
no special nutritional problems
may be high in fat, saturated fat

Vegetarian Diets: Types

Strict Vegetarian: Vegan
no animal products
protein quality-complement
calcium
iron
vitamin B 12

Vegetarian vs Meat eaters
o Vegetarian
o reduced risk
- obesity
- diabetes
- hypertension
- heart disease
- digestive disorders
- cancer
o Meat eaters
o growth
o support during critical times.

Protein RDA: 0.8 grams/kg

Nitrogen balance studies
negative balance= more out in urine than coming in from the diet
protein is being broken down faster than it is replaced
who is in this predicament? elderly, bedridden
positive balance=more in the diet than going out in the urine
protein is being made into tissue faster than it is taken apart

Protein Intake (Fat Intake)

1 cup Frosted Mini Wheats 3 g(<1 g)
1 cup Skim milk 8 g(0 g)
1 banana 1 g(1 g)
1 Arby's Turkey Sand Delux 20 g(6 g)
1 cup Skim milk 8 g(0 g)
1 cup lentil chili 19 g(3 g)
green salad/dressing 1g (6 g)
garlic bread 4g (10)
64 grams Protein(27 grams Fat

Protein Intake (Fat Intake)

5 cup Granola 7g (10g)
1 cup 2% milk 8 g (5g)
Arby's Roast Beef Dlx 25g (22g)
1 vanilla milk shake 11g (12g)
6 oz steak 45.5g(17g)
baked potato/marg/sour 6g (16.5g)
.5 cup green beans 1 g (0)
103 grams Protein (83 grams fat)

Protein Intake (Fat Intake)

154# (70 kg)
RDA = 70 x .8g/kg = 56 grams
Athlete 1 to 1.5 g/kg (ADA)=
70 to 105 grams Protein/day

Allergies vs Intolerance

Protein Allergy
protein gets across from digestive system to blood without being digested to its amino acids
this causes a sensitization and an allergic reaction
whole body reaction: itching, swelling, etc

Allergy vs intolerance
Lactose intolerance
lack the enzyme to break down lactose
causes digestive track upset
gas production, bloating, diarrhea

Too little Protein

Kwashiorkor: Protein deficiency
true definition: what happens to the first child when the second child is born
symptoms: edema, ascites(swollen belly)
immune system failure so many infections
loss of pigmentation
Phenylalanine to Tyrosine to Melanin is blocked
Fatty Liver
no lipoproteins to carry fats and accumulate in liver

Protein Problem

Determine your RDA (0.8 gram/kg)
(wt in lb/2.2 lb per kg)x0.8=RDA for PRO
From BMR activity, determine total energy expenditure & % from protein
males (1 x kg x 24) x activity factor= total
females(.9xkgx24) x activity factor= total CAL per day

Protein Problem

American Heart Association
less than 30% from fat
55 to 60% from CHO
10-15% from Protein
Total Cal x .15 = _______ 15% Cal from PRO
Pro Cal/4 Cal per gram = Grams of PRO
How does this compare to your RDA for PRO?

Protein Problem

How does the amount of protein in your diet (three day diet record) compare to the RDA?
Too little?
Too much? What happens to extra Protein?

Too Much Protein

Dehydration
100 Cal of extra protein takes 350 grams(12 oz) of water to clear( this is how many grams of protein?)
100 Cal of extra CHO or Fat only takes 50 grams of water to clear
Coupled with heavy workouts may result in dehydration

Protein needs of Athletes

May be up to 1.7 for power athletes
May be up to 1.4 grams/kg for endurance athletes
Tour de France, marathoners, triathletes
They may need every available source of energy they can get their hands on

Protein Rich Foods

Animal products
also high in vitamin B12, iron, and zinc
lacking in vitamins C and folate
often high in fat
Legumes
soy protein almost "complete"
high in fiber, many B vitamins, iron, calcium
low in vitamins A, C and B12
 
 
 
 



 
 
 

Digestion and Absorption of Nutrients
Dr. David L. Gee
Amy Spall, RD
FCSN 245-Basic Nutrition
Digestion
To break nutrients into smaller molecues
Physical Digestion
Mechanical breakdown of food particles
Chemical Digestion
Enzyme catalyzed breakdown of nutrient molecues
Absorption
Movement of digested nutrients through intestinal wall into:
Blood (water soluble nutrients)
Lymphatic system --> blood (fat soluble nutrients)
Journey through the GI Tract: The Mouth
Physical digestion by chewing
Saliva production
Salivary amylase
Journey through the GI Tract: The Esophagus
Function
Peristalsis
Lower esophageal sphincter
Journey through the GI Tract: The Stomach
Physical Digestion
Hydrochloric Acid
Pepsin
Pyloric valve
Journey through the GI Tract: The Upper Small Intestine
Duodenum
Biliary secretion
Bile Acids
Liver synthesis
Gall Bladder
Journey through the GI Tract: The Upper Small Intestine
Pancreatic Secretions
Bicarbonate
Pancreatic Enzymes
Amylases
Lipases
Proteases
Journey through the GI Tract: The Lower Small Intestine
Jejunum & Ileum
Major site of absorption
Structures to increase surface area
folds
villi
microvilli
Journey through the GI Tract: The Large Intestine (Colon)
Water absorption
Fermentation of undigested carbohydrate (soluble fiber)
Storage of fecal waste
 
 


Energy Balance and Weight Control

Energy Balance and Weight Control
Dr. David L. Gee
FCSN 245-Basic Nutrition

Energy Balance
EB = E(in) - E(out)
E(in) = dietary intake of energy
E(out) = energy expenditure

Energy Balance
When E(in) = E(out)
no weight change
When E(in) < E(out)
weight loss
When E(in) > E(out)
weight gain

How many calories in:
Starbucks White Chocolate Mocha (venti, 20 oz)
Order of Cheese Fries w/Ranch Dressing
9 fried mozzarella sticks
Order of Bloomin’ Onion with dipping sauce

How many calories in:
Starbucks White Chocolate Mocha (venti, 20 oz)
600 Calories (more than a Big Mac!)
Order of Cheese Fries w/Ranch Dressing
3010 Calories
9 fried mozzarella sticks
830 Calories, 51 grams fat
Order of Bloomin’ Onion with dipping sauce
2130, 163 grams of fat

Energy (in)
Calories =
energy required to heat 1 kg water by 1 degree C.
Bomb Calorimeter

Measurement of E(out)
Direct Calorimetry
measures heat directly
bomb calorimeter (for food)
room calorimeter
Indirect Calorimetry
measures oxygen consumed or
carbon dioxide produced

Energy Out
Components of E(out):
Basal Metabolic Rate (BMR)
Activity (Act)
Thermic Effect of Food (TEF)
E(out) = BMR + Act + TEF

Basal Metabolic Rate
Energy essential for life support
Circulation
Respiration
Temperature Maintenance
Nerve Transmission
Kidney Function, etc

Basal Metabolic Rate
Estimation of BMR:
BMR = 1 Cal / kg BW / hr
Example:
120 lbs / 2.2 lbs/kg = 55 kg
BMR = 55 x 1 x 24hr/d
BMR = 1320 Cal / day

Basal Metabolic Rate
Factors affecting BMR
Age
BMR declines 2% per decade
Height
BMR related to body surface area
Growth
BMR highest during periods of growth
Body Composition
Lean tissue has higher metabolic rate than fat tissue

Basal Metabolic Rate
Factors affecting BMR
Fever
Increases by 7% per degree F.
Stress
Increases with physical stress (disease/trauma)
Undernutrition
Decreases with low calorie intake

Energy for Activity
Sedentary (25-35% of BMR)
Light (35-50%)
Moderate (50-70%)
Heavy (>70%)
Example: Light activity
Activity = 40% x 1320 = 530 Cal

Thermic Effect of Food
Increased energy expenditure after a meal.
5-10% of BMR
Cost of digestion, absorption, & assimilation of nutrients
Ex: 5% x 1320 = 60 Cal

Estimation of E(out)
E(out) = BMR + Act + TEF
Example:
E(out) = 1320 + 530 + 60 = 1910 Cal
BMR = 69% of E(out)
Act = 28% of E(out)
TEF = 3% of E(out)

Healthy Weight and the Non-Diet Approach
 

Ethnicity and Overweight Prevalence

Epidemic Increase in Childhood Overweight, 1986-1998 JAMA 286:2845-2848 (2001)
National Longitudinal Survey of Youth
1986-1998
8,270 children, aged 4-12 yrs
Prior studies show it took 30 years for overweight prevalence to double.  Current study show doubling time to be less than 12 years.
Rate of increase particularly high in African American and Hispanic children
Epidemic Increase in Childhood Overweight, 1986-1998 JAMA 286:2845-2848 (2001)

Genes/Biology vs Environment
Overweight is a result of both
Adoption studies
Animal studies
genetically obese rats and mice
Migration studies
Japanese

Genes/Biology vs Environment (cont.)
Dietary Change Studies
SW Native Americans
Native Hawaiians/Polynesians
Pima Indians

Mexican Pima Indians
subsistence farming & ranching
20% fat diet, 40 hrs/wk physical work

Arizona Pima Indians
mechanized agriculture, sedentary lifestyle
40% fat diet

Pima Indians
Arizona Pima Indians are:
1 inch taller
57 pounds heavier
70% obese
50% with diabetes by age 35

Nauru Islanders
8 square miles covered with guano
once subsistence lifestyle with high vegetable, fruit, fish diet - low obesity
today, wealthy due to fertilizer sales
1987 65% males, 70% females obese
33% of population are diabetic

Genes vs Environment: Conclusions
Genes for weight gain predisposes some individuals towards weight gain.
Environment determines which of those individuals actually gain weight.

What is a “Healthy Weight”?
A broad range of weight  which allows for minimal risks for chronic diseases.
Goes beyond using only body weight as a criteria for good health.

Determination of your "healthy weight".
Step 1.  Body Mass Index
BMI = BW(kg)/Ht2(m2)
5'5" = 65" x 0.0254(m/in)= 1.65m
170lbs / 2.2(lb/kg) = 77.3kg
BMI = 77.3/(1.652)=77/2.72
        = 28.3

BMI Classifications
BMI = 19 - 25 => Low Risk
BMI = 25 - 30 => Some Risk
BMI = 30 - 35 => Moderate Risk
BMI = 35 - 40 => High Risk
BMI > 40        => Very High Risk

Healthy Weight (cont.)
If your BMI > 25, then consider presence of other health risk factors.

Healthy Weight (cont.)
Body Fat Distribution
upper body fatness associated with higher health risks
Waist : Hip circumference ratio
males: W/H > 0.95 are at risk
females: W/H > 0.8
Waist Circumference (1998 NIH)
>35” F, or 40” M (1998 NIH)

Healthy Weight (cont.)
Hyperlipidemia
TC > 240 mg/dl
LDL-C > 160 mg/dl
HDL-C < 35 mg/dl
TG > 200 mg/dl

Healthy Weight (cont.)
High Blood Pressure
Systolic BP > 140 mm Hg   or
Diastolic BP > 90 mm Hg

Healthy Weight (cont.)
Hyperglycemia (Diabetes)
FBG > 126 mg/dl
IGT >110 mg/dl
Gestational Diabetes
Family History of Diabetes

Healthy Weight Summary
If your BMI is 19-25, you are at a Healthy Weight.
If your BMI is > 25 and you have no other risk factors, you are at a Healthy Weight.
If your BMI is > 25 and you have one or more risk factors, you are NOT at a Healthy Weight.

A Prospective Study of Weight Change and Health-Related Quality of Life in Women
JAMA Dec. 1999
Nurse’s Health Study
40,098 women, 4 yr longitudinal study
Weight changes
Quality of life questionnaire

A Prospective Study of Weight Change and Health-Related Quality of Life in Women
Conclusions:
…support US guidelines for women of all BMI levels to avoid weight gain.
Weight maintenance and , in cases of overweight, weight loss are desirable and likely to be beneficial for physical function, vitality, and bodily pain.

A Prospective Study of Weight Change and Health-Related Quality of Life in Women
Conclusions (Dr. Gee’s)
If you are at a “healthy weight”
(BMI = 19=25)
and you lose weight...
Decline in:
physical function, freedom from pain, & vitality scores
Mental health score

Jane Fonda: “ It took me 62 years to learn how to say this is good enough.”
Oprah Winfrey: “I may never fit inside a size 5 dress, but this is the best I can be.”

The Non-Diet/Healthy-Diet Approach
Losing weight is NOT the  primary goal.
Becoming healthy is the goal.

The Non-Diet/Healthy-Diet Approach
The non-diet/healthy diet approach requires changes in:
Your attitude about food.
Your attitude about exercise.
Your attitude about yourself.

Food Attitudes
Food as a friend.
Food as a drug.
Am I hungry?
Do I want it?
I can have it.  I am in charge here!

Eat a Healthy Diet
Use the Food Guide Pyramid
Eat plenty of bread, cereals, vegetables and fruit.
Limit consumption of fatty foods.
Don’t become obsessive about your food choices!
Enjoy food! This is your diet for life.

If you must “diet” to lose weight:
Balanced hypocaloric (lower) diet
Follows food guide pyramid
Reduces caloric intake by ~500 Cal/day

Hi Protein/Low Carb diets
Atkins’ Diet
Will result in short term weight loss
Long term success rate ??
Long term safety ??

For more severe weight loss:
Drugs
For those with BMI > 30 or
For those with BMI >27 and risk factors
Meridia
Suppresses appetite
Sibutramine
Inhibits fat absorption
Long term success and risks

For those with Severe Obesity
Surgical Methods
For those with BMI >40
Gastroplasty
Reduces size of stomach by banding or stapling
Gastric Bypass Surgury
Reduces size of stomach
Bypasses much of the small intestine

Exercise Attitudes
Exercise for the fun of it.
Exercise to relieve stress.
Exercise to be in control.
Any exercise is good (“Just do it”)
Move all day long.

Exercise (cont.)
Duration first, intensity second.
Be consistent!
Make it a priority.

Attitudes about Yourself
Make yourself a priority
Make taking care of yourself a priority
Being happy requires being healthy

Defining Successful Weight Loss/Maintenance
Success is becoming healthy.
Success is being able to make choices for better health.
Success is being flexible about your choices.
Attaining a healthy weight may not be easy, but little in life worth attaining ever is.

Tips from the National Weight Control Registry (est. 1994)
>3000 people
kept >30 lbs off > 1year
80% female
average wt loss = 30 kg, 10 BMI
average time for wt loss = 5.5 yrs

many had “bad” genes
overweight as children
46% by age 11
46% w/one or both parents overweight
any age
average age 45 yrs

Tips from the National Weight Control Registry
Failed to lose weight in the past
Don’t view past failures as signs you can’t succeed
Found process difficult
No pain, no loss
Made smaller lifestyle goals
Planned indulgences

How they lost weight
89% w/ diet + exercise
10% w/ diet only
1% w/ exercise only
used many types of diets

How they maintained their weight loss
Low fat diets
Watched calories
Daily exercise
averaged + 2600 Cal/week, ~ 1 hr/day
70% walked or walked + other exercise
20% weight training
20% bicycling
18% aerobic dance
avg 3 hrs/week of TV

Tips from the National Weight Control Registry
Do what you want, not what you should
 
 
 
 



 
 
 

The Vitamins

 Vitamins
Dietary Supplement Use (USA)
$4,300,000,000 for vit/min in 1995
$1,400,000,000 for herbs
$31,000,000,000 total for dietary supplements and functional foods in 1999
42% adults regular users (27% 1989)
females>males
66% multi vit/min
37% vitamin C
19% vitamin E
23% herbal supplements (13% 1995)

Do we need supplements?
Dietary Supplement Use: Pros
Supplements prevents dietary deficiencies
calcium
folic acid
Amounts used in some studies not attainable with dietary sources
antioxidants
Relatively low cost

Dietary Supplement Use: Cons
False sense of security
folic acid and pregnancy
Does not contain all potentially useful chemicals in foods
plant phytochemicals
Toxicity almost only due to supplement use
Costs significant to low income

Vitamin/Mineral Deficiency Worldwide
1 in 5 adults malnourished
1 in 4 children malnourished
3 million children severe vitamin A deficiency
blindness
stunted growth
275 million with mild deficiency

Vitamin/Mineral Deficiency Worldwide
Iodine deficiency
Goiter: enlarged thyroid gland, lethargy
Cretinism: severe mental and physical retardation in infants of deficient mothers
Iron deficiency
Anemia: fatigue, apathy in adults, poor academic performance in children

The Discovery of Vitamins
The Germ Theory of Disease
Scurvy: Disease of sailors
Beri-Beri: Disease of poor Asians
Rickets: Disease of poor Northern European children
Pellagra: Disease of poor corn eating cultures

The Discovery of Vitamins
The Vitamin Theory of Disease
Scurvy: Vitamin C deficiency
Beri-Beri: Thiamin deficiency
Rickets: Vitamin D deficiency
Pellagra: Niacin deficiency

Vitamins: Definition
Organic compound found in foods
Required in small amounts
Required in the diet (essential)
Proven to be required for health, growth, and reproduction
deficiency syndrome identified

Water Soluble Vs. Fat Soluble
Water Soluble:
Vitamin C, and the B vitamins
Fat Soluble
Vitamins A,D,E,K

Vitamins: Support Staff
What can’t they do?
They can’t be used as an energy source.
What can they do?
They are usually in supporting roles in the body.
e.g.: many of the B vitamins are co-enzymes that help breakdown glucose for energy

The differences between water and fat soluble vitamins
Absorption from digestive system
fat soluble: into the lymph with chylomicrons
H20 soluble: into blood
Transport
fat sol: carried by lipoproteins
water sol: free in blood

Water Vs Fat Soluble
Storage and Excretion
Fat Sol: stored with fat in cells and adipose tissue, excesses stored
Water sol: not held firmly by cells, excesses excreted
Potential for Fat soluble to build up and perhaps reach toxic levels
Potential for water soluble to excrete extra amounts, not as prone to toxicity

Fat soluble Toxicity
Fat soluble vitamins may be toxic with too high of an intake
Water soluble vitamins are less likely to be toxic with high intake

B Vitamins
Correct names and common names
Thiamin B1
Riboflavin B2
Niacin nicotinic acid
B6 pyridoxine
folacin folate, folic acid
B12 cobalamin

B vitamins: Correct names
pantothenic acid no other
biotin no other

B vitamins act as coenzymes
Help to complete the correct shape of the molecule
Many help to metabolize glucose to release energy

B Vitamins
Coenzyme function
Prosthetic Group: physically become part of an enzyme complex
Others are more loosely attached
May be part of the active site in the enzyme.

Niacin
Part of NAD+
helps metabolize glucose
without Niacin, this breakdown of glucose stops
Slows energy release: 4 D’s of Niacin deficiency (called pellagra):
Dermatitis: skin inflammation
Diarrhea: poor absorption
Dementia: no energy to think
Death: if untreated

Other B vitamin deficiencies
Thiamin: beriberi
symptoms: mental confusion, muscle weakness and wasting, edema, enlarged heart
Riboflavin:
symptoms: personality changes, cracks at the corners of your mouth(cheilosis), tender tongue(glossitis)
Folacin:
Symptoms: megaloblastic, macrocytic anemia,

Vitamin B deficiencies
B12 called pernicious anemia
Symptoms: nerve damage, peripheral weakness, death

B vitamin Toxicities: Rare
B6
Symptoms: with very high doses sensory nerve disorders; may interfere with nerve impulses and heart beat
Niacin
Symptoms: skin flushing, nausea, jaundice, liver dysfunction
Some individuals with high serum cholesterol are treated with pharmacological doses of niacin

Fortification and Enrichment
Enrichment:
Adding back to flour riboflavin, iron, thiamin and niacin lost during processing
Fortification
Adding nutrient never found at that level to a food
eg : calcium fortified orange juice

Vitamin C Functions
Collagen Formation
antioxidant
reduce cancer risk
helps absorb iron from food
Reduces risk of colds?????
probably not
Linus Pauling’s study

Vitamin C
Deficiency: called scurvy
poor formation of collagen in blood vessels
weak vessels result in hemorrhages
can be severe and result in lots of blood loss and death
Toxicity: may result in
kidney stones
rebound scurvy
Destruction of B12
Problems with acid/base balance

Vitamin C: RDA 60 mg/day
Foods rich in vitamin C:
1 cup fresh squeezed orange juice: 124 mg
1 cup canned o.j.: 84 mg
Smoker’s RDA = 100 mg/day
Some of vitamin C is sacrificed in reducing the oxidants of cigarette smoke

Vitamin A Functions
Vision: helps with conversion of light energy to electrical energy in eye
Maintenance of linings:
helps produce the CHO normally found in mucous
Immune system
Bone growth:
helps with remodeling growing bones

Vitamin A Deficiency
One year supply in fat and liver of most people: So deficiencies are rare
Impaired night vision and day vision
Linings deteriorate
GI tract: diarrhea
Respiratory tract: infections
urogenital tract: infections, kidney stones
Bone growth and remodeling problems
shape changes

Vitamin A Toxicities
Bones:
decalcification, joint pain
Nervous system
loss of appetite, irritability, muscle weakness
Liver enlargement
jaundice
Blood: RBCs loose hemoglobin
Bleeding induced easily

Vitamin A Toxicity
Vitamin A RDA= 800 RE for females; 1000 RE for males.
RE= Retinol Equivalent
Retinol is the active form of vitamin A
Other molecules can be metabolized to make Retinol, thus retinol equivalents
e.g.: beta carotene can be modified to make retinol
beta carotene is found in carrots and other deep orange and green vegetables
1 RE= 1 microgram of retinol
1 RE= 3.3 IU retinol
1 RE = 6 micrograms of beta carotene

Vitamin A and Beta Carotene Rich Foods
1 medium carrot = 2025 REs; about 2.5 times the RDA
1 cup butternut squash = 1400 REs
1 sweet potato = 2000 REs
1/2 cup cooked spinach = 700 REs
1 cup cooked broccoli = 250 REs
1 cup milk = 140 REs

Vitamins and Losses with Environmental Exposure
Heat Losses:
Vitamins A, D, E , C, B6, thiamin, riboflavin, folacin, pantothenic acid, biotin
Light losses:
Vitamin A, D, E, K, B6, Riboflavin, folacin, B12
Air losses:
Vitamin A, D, E, C, B12, thiamin, riboflavin, folacin

Vitamin D Functions: Helps bone grow
Works in three ways:
1. Increases Calcium Absorption from the G.I. tract
2. Helps to withdraw calcium from bone
3. Increases calcium retention in the kidney.

Sources of Vitamin D
Body makes it own:
Dehydrocholesterol in the skin exposed to sunlight
Energy transforms it into a pre-vitamin D molecule
Body heat provides energy to change pre-vitamin D into inactive Vitamin D
Inactive Vitamin D activated in two steps
First, in the Liver
Second in the Kidney

Sources of Vitamin D: RDA = 5 - 10 micrograms in adults
In foods:
Fortified milk: 2.5 mcg/cup
1 egg = 0.7 mcg
3 oz shrimp = 3 mcg
1 tsp margarine = 0.5 mcg

Vitamin D Deficiencies
In children: Rickets
malformed bones, bow legs
In adults: osteomalacia
most often occurs in women with low Ca intake, repeated pregnancies, low sun-exposure, and long breastfeeding with infants
loss of Calcium from bone and change of shape

Vitamin D Toxicity:
Most potentially toxic of all vitamins!!!!
As little as 4 to 5 X RDA can be associated with toxic symptoms
minor: diarrhea, headache, nausea
major: calcium deposits in soft tissues of heart, kidney, arteries
Major concern: those who take Vitamin D supplements
If some is good, more is NOT better!!!!!

Vitamin K
Important for blood clotting
Contributes to the modification of prothrombin to thrombin
Thrombin is required in the clotting process to convert fibrinogen, to fibrin with is the clotting material.
Vitamin K produced by bacteria in the gut
Who is at risk for deficiency?
newborns, people on long-term antibiotics

Vitamin E
Functions: Anti-oxidant
Guards against damage to membranes from oxidizing compounds
Deficiency: Rare (premature infants under 3.5 pounds, people unable to absorb fat or metabolize fat properly
Suppresses the immune system because vitamin E protects White Blood Cells

Vitamin E
Toxicity: Rare
Sources: Vegetable oils, nuts and green leafy vegetables

Antioxidants
Substances that are able to neutralize reactive molecules and reduce oxidative damage
Result of metabolic processes and environmental sources
Vitamin C, Vitamin E, beta-carotene, selenium, zinc, copper and manganese

Latest Research
Antioxidants and zinc and macular degeneration
Vitamin E
heart disease
cancer
cataracts
 
 


Water and Minerals
 

Water
Water’s Functions
Carries nutrients and waste products
Actively participates in chemical reactions
Serves as a solvent for minerals, vitamins, amino acids glucose, and other small molecules
Serves as a lubricant and cushion around joints
Acts as a shock absorber(eyes, spinal column, amniotic sac)

Water’s Functions
Aids in maintaining body’s temperature

Body’s Water Balance
Water makes up about 60 % of the body’s weight
A change in the body’s water can bring a change in the body weight
Sweating: water loss during exercise
Edema: water retention during pregnancy

Water Balance
Water loss necessitates water intake
Dehydration can have serious consequences

Water Recommendations and Sources
Hard water is high in calcium and magnesium
Soft water is high in sodium
It also dissolves cadmium and lead from pipes
If a person has lead pipes, this can be a problem with long term use

Body Fluids and Minerals
Electrolytes (sodium, potassium, chloride) help keep fluids in the proper compartments
Intracellular water
Extracellular water

The Major Minerals: Different Definitions
More than 0.1 grams (or 100 mg) required per day in the diet
These include:
Calcium Chloride
Magnesium Phosphorus
Potassium Sodium
Sulfur

Calcium
Roles:
99% in bones and teeth
1 %
Cell membranes: regulates transport of ions into and out of cells
Nerve to nerve transmission
Nerve to muscle transmission
Helps hold cells together
Blood Clotting
Co-factor for several enzymes

Calcium: Blood Levels Highly Regulated: 4 ways
1. Protein-bound Ca released to become available for use by cells
2. Increased Calcium absorption from gut through activation of Vitamin D
3.Increased Calcium released from the bone through parathyroid hormone activation of Vitamin D
4. Kidneys conserve Calcium

Calcium RDA 1000-1200 mg/day for Adults
Foods rich in Calcium:
1 cup milk: 300 mg
1 oz cheese: 200 mg
1/2 cup spinach: 106 mg
1 orange 52 mg
1 cup Yogurt 350-400mg (fat free or low fat)

Calcium Deficiency
Rickets: in children. Same as Vitamin D deficiency
Bow legs, poor bone formation
Osteomalacia: in adults. Same as Vitamin D deficiency
poor bone formation
Osteoporosis: Multiple causes

Calcium and Osteoporosis
Low Calcium intake
Poor Vitamin D status
female family history
small skeleton menopause
smoking high animal protein
drinking alcohol bed rest
white/Asian

Sodium: + ion of table salt (NaCl)
No known human diet lacks sodium
Minimum requirement about 500 mg/day
estimated safe and adequate Daily intake
Average intake in US for men = 3300 mg/day(equal to 8 grams of salt/day)

Trace Minerals: Definition
One definition: less than 0.1 gram(100 mg/day) need in the diet
Some trace minerals:
Iron (Fe)
Iodine(I)
Zinc(Zn)
Fluoride(F)

Iron
Component of hemoglobin and myoglobin
hemoglobin carries oxygen in blood
myoglobin stores oxygen in muscle cells
Deficiency:
RDA set at 18 mg/day for females and 8 mg/day for males
If iron stores exhausted, iron deficiency anemia
microcytic, hypochromic anemia
reduced Hemoglobin synthesis, RBCs are small and pink

Iron Absorption
Most iron we eat doesn’t get absorbed
What helps?
vitamin C
MFP factor: some factor in meat, fish and poultry helps absorb iron
need for iron
What hurts absorption?
tea coffee
Calcium and Phosphorus
phytates and fiber and oxalates

Iron: Method of Absorption
Iron in food
Absorbed into cells that line GI tract
If blood levels of iron are low
iron picked up from cells by the blood and carried to places where RBCs are made
If blood levels of iron are ok
iron stays in cells lining the GI tract
In 3 to 5 days the cells are worn out and fall into the lumen of the GI tract and mix with the remains of digestion

Iron Overload
2 Types of Overload
1. Hereditary Defect: Hemochromatosis
Very efficient absorption
High circulating Fe which is laid down in tissues of liver, heart and causes damage
2. High Iron ingestion: Hemosiderosis
Even with control of absorption, high intake can result in toxic side effects
We don’t have a good mechanism of getting rid of absorbed iron

Iron Sources
4 oz of lean roast = 3 mg
4 oz liver = 7 mg
1/2 cup beans = 4.15 mg
1 cup broccoli = 1.12 mg
1 slice mixed grain bread = 0.8 mg
1 cup raisins = 3.12 mg

Zinc
Part of nearly 100 enzymes
Role in immune function
Absorption affected by zinc status, phytates, iron
Hinders absorption of copper and calcium
Sources: red meat, eggs, vegetables

Fluoride
Becomes part of crystalline deposits in bones and teeth
In teeth, resistant to tooth decay (dental caries)
1 part per million in water supply optimum resistance
Higher than that can result in tooth mottling
Brown coloration on teeth
Much higher (18 ppm) can result in fluoridosis
Bone malformation
 
 
 


Mother and Infant

Measures of a Successful Outcome of Pregnancy
Healthy Baby
Healthy Mother
Baby Survives the First Year of Life

Healthy Baby
Still Birth Ratio or Fetal Death Ration
Early in Pregnancy: difficult to have reliable numbers of death rate
Why?
Later in Pregnancy: numbers are more reliable
About 7.5 stillbirths per 1000 live births

Healthy Mother
7.8 mothers die per 100,000 births.
Big racial difference:
White 5.0
Black 20.8
Others 18.2

Infant Mortality
Infancy: First Year of Life
1998: Infant Mortality Rate in US
7.2 per 1000 live births
Ranked 26nd world-wide
1950 we were ranked 6th world-wide
Why?

Better Infant Mortality Rates
Japan: 4.4 (4.3)
Singapore: 4.7 (3.8)
Sweden: 4.8 (3.5)
Finland: 4.4 (3.9)
Norway: 5.9 (4.1)
Canada: 6.1 (5.5)
Germany 6.2

Risk of Infant Mortality: Factors
If infant mortality rate was similar to Sweden’s we would save over 40,000 infant deaths per year
Low Birth Weight largest single factor
less than 5.5 pounds (2500 grams)
LBW risk factors:
age socioeconomic poverty
number of pregnancies race

Nutrition Influences on Fetal Growth
Deficiency in Calories
Too few Calories to allow adequate reproduction of cells and decreased development
Deficiency of Nutrients
Too little of some specific nutrient
e.g.: folic acid
spina bifida

Growth Happens in Two ways
Increased number of cells
Increased size of cells
Critical times of increased number of cells
1. Increased number hyperplasia
2. Number and size + hypertrophy
3. Size Hypertrophy

Critical Periods
If an embryo or fetus doesn’t receive the nutrition necessary to help with development, the fetus will suffer
Fertilization of the ovum(zygote) happens
implantation of the ovum in the uterine wall happens in the first two weeks
Critical period: cigarette smoke, malnutrition can keep development from occurring

Events of Pregnancy
Time Event
0-2 weeks egg fertilized and implanted
3-8 weeks Embryo: at end of 8 weeks is 1 inch and has central nervous system, GI tract, limb, buds, etc.
8-40 weeks Fetal period: growth and development

Role of the Placenta
Nutrient and waste product exchange
Hormone production
Estrogen: helps develop the infrastructure of pregnancy
Progesterone:
relaxes smooth muscle
Relaxes the uterus
Relaxes the digestive system: slower movement

Nutrient Needs to Support Pregnancy
Energy:
No increase in Cal for first trimester
Why?: 1. Very small embryo; 2. Increased absorption of most nutrients and Cal due to decreased motility of GI tract due to hormones of pregnancy
300 Cal increase during 2nd and 3rd trimester

Nutrient Needs During Pregnancy
Protein:
Determine pre-pregnancy needs based on RDA: 0.8 grams protein/kg. This is generally around 45 to 50 grams Protein per day.
Add 15 grams to this for pregnancy
Generally around 60 to 65 grams/day is sufficient

Nutrients of Special Interest
Folate: related to neural tube defects and spina bifida
Reduced absorption during pregnancy because of interaction with estrogen
Produces folate deficient women
Interferes with proper formation of spinal column: affects 400,000 births per year
Folate supplements during pregnancy required

Nutrients of Special Interest
Iron: Blood volume increases by 50% during pregnancy
Body conserves Iron during pregnancy
No menstruation
3 time increase in absorption
But still doesn’t keep up with production of red blood cells
Hemoglobin concentration falls: normal above 13 g/dl. In pregnancy may fall below 12 g/dl
RDA up from 18 to 27 mg/day

Special Supplemental Food Program for Women, Infants, and Children
To battle against problems during pregnancy and infancy, WIC was developed to provide supplemental food to low socioeconomic and at risk women and infants.
Nutrition education also provided
Recent study: for each $1 spent, $4 save down the road

Weight Gain During Pregnancy
Based on Pre-pregnancy BMI
Underweight (BMI<19.8) : 28-40 #
Normal weight(BMI 19.8-26) : 25 to 35 #
Overweight(BMI 26-29): 15 to 25 #
Obese(BMI over 29): 13 # minimum

Rate of Weight Gain
First Trimester: 2 to 4 pounds
Second and Third Trimester: 1 pound per week
3 pounds + (26 weeks x 1 # per week) = 29#

Components of Weight Gain
Infant 7.5 # amniotic fluid 2 #
Placenta 1.5 # mother’s stores 7 #
Blood 4 #
Fluid 4 #
uterus 2 #
Breasts 2 #
TOTAL 30 #

Fetal Alcohol Syndrome
Physical and Mental Abnormalities attributed to alcohol consumption during pregnancy
low nasal bridge small head
short nose circumference
short eyelid opening delayed
thin upper lip development
underdeveloped filtrum

Alcohol Effects on Pregnancy
About 1/5 of women continue to during pregnancy
The first few weeks are critical; many women don’t know they are pregnant
Birth defects have occurred in women who consume as little as two drinks per day
No alcohol is the best if planning pregnancy
Fetal Alcohol Effects: internal damage

Maternal Problems of Pregnancy
Gestational Diabetes:
Hormones of pregnancy make mother’s body resistant to insulin
Often shows up at 25 weeks of pregnancy
Needs to be treated to control growth of the fetus
Macrosomia: large baby and delivery complications

Problems of Pregnancy
Edema: most women suffer from water retention: due to large blood volume and decreased protein concentration in blood
Pregnancy Induced Hypertension (PIH)
massive edema, high blood pressure, protein in urine
If untreated can result in fetal and maternal injury or death

Breastfeeding: Best Feeding Method
‘Sole’ food for the first 4 to 6 months
Provides benefits to baby and mother
economic convenience
Nutrition
immune function
bonding
Maternal weight loss

When not to breastfeed?
HIV infected mother
Although WHO says go ahead in developing countries
The risk of infection is less than the harm by not having good nutrition available during early months
Galactosemia: one in 50,000 births
Inability to convert galactose to glucose and developmental problems result

If Breastfeeding is not Chosen?
Infant formula is next best choice:
Most are cow’s milk derived and are produced to be close to human milk in composition
Some are soy based
Others are specialized to meet certain needs
e.g.: PKU babies can’t have very much phenylalanine in the diet: Lofenalac

When to Add Solid Foods?
4 to 6 months: when developmental landmarks are met; Continue breastfeeding or formula
Iron fortified rice cereal
Add one food at a time: several days
See if there is an allergic reaction
Then add a new food

Problems of Infant Feeding
Failure to Thrive:
Baby doesn’t grow as fast as peers
Causes? Often inadequate nutrition
Monitor weight gain
Compare nutrient intake per body weight
A baby needs more than an adult

Problems of Infant Feeding
Baby Bottle Tooth Decay: Also called Nursing Bottle Syndrome
Exposure of teeth to the carbohydrates of formula
General Feeding Rules for Infants and Children
Caregiver is the gatekeeper: What is offered and when
Infant or child decides whether to eat what is offered and also how much