Nutrition Exam 2

The Events of Pregnancy

*zygote *embryo *fetus *baby

Healthy Eating Patterns

1.Healthy U.S. - Style Eating Pattern •Based on types and proportions of foods Americans typically consume but in nutrient dense forms and appropriate amounts •Reduce: meat and poultry •Marginal or less in RDA for Vitamins D & E, potassium and choline 2.Healthy Mediterranean - Style Eating Pattern •Modifies the U.S. pattern to resemble a traditional Mediterranean diet •Based on positive health outcomes •More oils, fruits, and seafood; less dairy •Low in calcium and Vitamin D 3.Healthy Vegetarian Eating Pattern •Modified U.S. pattern to resemble self-identified vegetarian diets •Higher in soy, legumes, nuts, seeds and whole grains; no meat, poultry or seafood •Lower in Vitamin D compared to "U.S. pattern"

Food Labels Must Include Nutrition Facts

1.Ingredients listed in order of weight 2.Calorie-contributing foods 3.Non-calorie nutrients: •Vitamins A & C •Calcium & Iron •Fiber 4.Allergen information •Wheat, soy, nuts, milk (gluten-free info, too)

Pregnancy: The Impact of Nutrition on the Future

At no time is nutrition more critical for the well being of an individual than during fetal development. •Prenatal healthcare check-ups help to ensure a future, healthy member of our society. •Fetal development is a time of •rapid cell multiplication •cell differentiation •physical growth •The fetus requires all the essential nutrients to develop properly.

What should be avoided?

Avoid Herbal supplements •Avoid Alcohol •Avoid foodborne Illness

How many kcal from

Carbohydrates? à 30 g x 4 kcal/g = 120 kcal Protein? à 4 g x 4 kcal/g = 16 kcal Fat? à 7 g x 9 kcal/g = 64 kcal Total = 200 kcal

November 2019

E.coli out break grow due to romaine lettuce 67 people reported sick in 19 states:

What percentage kcal from:

Fat? à 64 kcal / 200 kcal = 0.32 x 100 = 32% Carbohydrates? à 120 kcal / 200 kcal = 0.60 x 100 = 60% What is % Daily Value for carbohydrate? à 30 g / 300 g = 0.10 x 100 = 10% Why is % Daily Value different from the %kcal?

What is normal weight gain?

For normal weight mothers: Approximately 3.5 pounds (total) during 1st trimester Approximately 1 pound per week after that Where does all that poundage go? ~25 % to baby 75% to mom Additional weight is nearly all essential tissue

Food Labels

Must require product information for these components. %Daily Values based on 2000 kcal dietàmost useful for comparing foods, not deciding intake

Underlying concepts of Healthy Eating

Nutrient Density, Portion Sizes, •Limit on Calories for Other Uses, Variety

REVIEW CASE STUDY

Sarah is 28-years-old and 7 months pregnant with her third child. Her other children are aged 2.5 years and 1.5 years. She had uncomplicated pregnancies and deliveries. Sarah is 5'6", weighed 142 pounds at the beginning of her pregnancy (BMI 23). She has gained 24 pounds so far. Prior to her first pregnancy, her BMI was 20 (124 pounds). She is unhappy about her weight gain, but the stress of having two young children and being a stay-at-home mom made losing weight impossible. She went online for her MyPlate plan, which recommends she consumed 2400kcals/day. She doesn't think she eats this much because she seems to have constant heartburn. She take a prenatal supplements so she feels pretty confident that she gets the nutrients she needs. Her typical day's intake is: 1.Does she have any risk factors for a high- risk pregnancy?1.Low-risk. Only risk is subsequent pregnancies at short intervals (less than 18 months) 2. How much total weight should she gain?1.Her BMI is normal, she should gain 25-35 pounds. At 7 months, she has already gained 24 pounds and with recommended gain of 3-4 pounds in first trimester, she should gain an additional 6-8 pounds. This would bring her total to 30-32 pounds, which is fine. 3. Based on a 2400 kcal/day meal pattern. What should Sarah eat more of? What is she eating too much of? What would you recommend she modify to decrease her heartburn?Sarah has low intake of whole grains, vegetables, fruit. Her intake is too high in refined grains, sugar, dairy, oils, added sugars. To minimize heartburn she should reduce her fat intake (more fruits over desserts, fat-free milk, lean meats), drink beverages before or after meals (not during). Eat smaller meals. Avoid lying down or bending over after eating 4.What would you tell her about weight gain during pregnancy? What strategies would you suggests after the birth to help her regain a healthy weight?Sarah should strive to gain 6-8 more pounds through the rest of her pregnancy. Increase fruits and vegetables. Follow these guidelines after birth as well, also breastfeeding will more likely lead to weight loss over formula feeding 5. Is her attitude about supplements appropriate? What would you tell her about supplements?Sarah's attitude about prenatal supplements offer a false sense of security. Supplements contain a limited number of nutrients, not all that are important for health like protein, fiber, trace minerals or phytochemicals

Critical Period

a finite period during development during which certain events must occur

Common effects of pregnancy

nausea and vomiting constipation heartburn

nursing bottle caries

tooth decay that is the result of prolonged nursing after the infant has been put to bed (when milk, juice, or other fluid is allowed to bathe the teeth)

Common issues: Diabetes Mellitus

•"Gestational diabetes" = glucose intolerance diagnosed in the second-third trimester of pregnancy. Affects 2-10% of pregnancies •Glucose test early in pregnancy •Greater risk of "large for gestational age" infant (which can increase risk of prolonged labor, cesarean shoulder dystocia, birth trauma, fetal hypoxia, and intrauterine death). Infant also more likely to develop diabetes, obesity, metabolic syndrome, asthma, and cancer later in life. •Increases risk of mother developing Type 2 DM after pregnancy (5-10% shortly after pregnancy; 35-60% chance in the next 20 years). •Risk factors include obesity, family history, physical activity and some ethnicities •Treating GDM resulted in less preeclampsia, shoulder dystocia, and macrosomia (but does not necessarily impact health of infant later on. •Treatment: Less than 45% of calories from carbohydrates, but at least 175g of carbohydrates to prevent fetal ketoacidosis; less glucose at breakfast, exercise

What are teratogens?

•"an agent or factor which causes malformation of an embryo" Placenta has permeability

Avoid Herbal supplements

•(including teas) during pregnancy and lactation •Can cross placenta or into breast milk •Not enough studies know the effects of many herbs (and some can cause smooth muscle contractions)

Diets of Blacks/African Americans

•13.2% of U.S. population (2014) •Many can trace ancestry to West Africa, Caribbean, Central America, or East African countries as a result of the slave trade •"Soul food" describes traditional Southern African American foods and cooking techniques evolved from West African, slave, and postabolition cuisine •African Americans' food habits reflect their socioeconomic status, geographic location, and work schedule more so than their African or Southern heritage.

children's nutrition Calories and Nutrients

•3 meals and 2-3 snacks = 1000 calories •Little known about actual caloric needs from 1-2 years so emphasis is on: •Variety •Nutrient density •Appropriate amounts •At 1 year old, child should be drinking from a cup and eating mostly what the family eats (with modifications for choking which is a greater risk up to 4 years old). •Cow's milk: •1-2 years = whole milk (no more than 3 cups; milk anemia) •At 2 years = gradual transition to 2% milk, and eventually fat free milk •New foods may take 15-20 exposures to be accepted by child (picky, picky, picky!)

embryo

•3rd to 8th week •Most major organs and body systems develop

fetus

•9th week to birth •Refinement of organs and body systems

Children and Adolescents

•A lot of factors can affect caloric needs during childhood •Females usually increase growth rate from 10-11 (peak at 12); Males usually increase around 12 and peak at 14 years and stature growth stops around 21 years. •Activity levels affect caloric needs •DRIs for children the same until age 8; then divided by biological sex. •Nutrient requirements reach adult levels between 14-18 •Supplements of calcium and iron are common Estimated calorie needs per day for males and females ages 3 to 18 years.

Food Biotechnology

•A process that involves taking a gene with a desirable trait from one plant and inserting it into another with the goal of changing one or more of it characteristics; genetically modified organism (GMOs) •Has been done for centuries within agriculture with positive outcomes: •Healther crops and greater yields •Greater resistance to severe weather •Longer shelf life and increased freshness •Higher nutritional value •Healthier composition •Better flavor •Improved characteristics •New food varieties Potential to alleviate world hunger

Minimum categories of race/ethnicity as defined by U.S. Office of Management and Budget

•American Indian or Alaska Native (origins from North or South America) •Asian (Originating from Far East, Southeast Asia, or Indian subcontinent) •Black or African American (origin of black racial groups of Africa) •Latino or Hispanic (people of Cuban, Mexican, Puerto Rican, South or Central Amerca, or other Spanish culture or origin) •Native Hawaiian or Other Pacific Islander (people having origins in Hawaii, Guam, Samoa, or other Pacific Islands) •White (people having origins from Europe, the Middle East, or North Africa)

Physical Activity and Weight Gain

•As is true outside of pregnancy, there is a link between physical activity and lower risk of chronic diseases (cardiovascular, diabetes, and obesity) •Exercise alone may be enough to lower weight gain during pregnancy •Many women decrease activity levels during pregnancy •Why? - Tired, nauseous, hormones, worried it will harm the baby •In those who were active before pregnancy, there is minimal risk of continuing activity into pregnancy. •Healthy women encouraged to engage in aerobic and strength-training during pregnancy. •Recommend 20-30 minutes of moderate exercise most days before, during, and after pregnancy •What to avoid later in pregnancy •Activities with fall risk - biking, rock climbing, tight-rope walking •Avoid supine positions during second and third trimesters (can constrict large vessels)

If people choose to take supplements?

•Ask critical questions beforehand (evidence? Side effects?) •Check with the FDA website for consumer advisories on supplements to avoid •Discuss supplement use with physician •Take only single supplement products and keep dose small to prevent side effects or drug-supplement interactions •Take supplements at different times from prescription medication •Discontinue supplements if adverse side-effects occur •Avoid herbs and other botanical supplements if you are pregnant or lactating woman or children under 6 years old.

Estimated Average Requirements (EAR)

•Average requirements for a population or group (usually life stage and gender) •Used by scientists and policymakers to: •Set RDAs •Design experiments •Assess the nutrient intakes of populations •Ex: Used to develop & evaluate nutrition programs for groups such as school children or military personnel

Various Religious food customs

•Christianity •Roman catholics: do not eat meat on Ash Wednesday or on Fridays of Lent. Eating/drinking avoided before communion is taken •Eastern Orthodox Christians: numerous feast and fast days throughout the year •Mormons do not use coffee, tea, alcohol or tobacco and limit meats and consume mostly grains. Fast 1 day/month. •Seventh-Day Adventists are lacto-ovo vegetarians; no coffee, tea, or alcohol; 5-6 hours between meals (no snacking); no strong seasonings •Judaism •Orthodox, Conservative, and Reform •Kasrut = list of dietary laws adhered to by Orthodox Jews •Kosher Animals = cattle, sheep, goats, chicken, turkey, goose, and certain ducks. •Nonkosher animals = birds of prey, pork, fish without scale or fins (shellfish), catfish, swordfish, underwater mammals, reptiles, or egg yolks containing blood •Blood is not allowed. Animals slaughtered must be supervised by a rabbi to ensure all blood is removed. •Meat and poultry cannot be consumed in the same meal, dairy not allowed within 1-6 hours after eating mead or poultry (individual dependent) •"Pareve" = dairy free •Most consumers of Kosher foods in America are not Jewish •Islam •Eat as a matter of faith and good health •Basic guidance in Quran from Allah to Muhammed •11 general rules of halal (permitted) and haram (prohibited) •Kosher and halal animals allowed (not allowed = pork, carnivorous animals with fangs, birds with sharp claws, land animals without ears, sharks, products with gelatin •Blood is not allowed •Proper methods for slaughter •Decaying carcasses not allowed •Intoxicants forbidden (including pure vanilla and wine vinegar) •Certain hygienic practices (washing before and after eating; frequent teeth cleaning) •Hinduism •Love of nature and live a simple life •Generally avoid all foods that are believe to inhibit physical and spiritual development •Dairy products are seen to purify the spirit and will improve the purity of impure foods. •Many are vegetarians and adhere to ahimsa (nonviolence applicable to foods) •Jainism is a branch of Hinduism that promotes a nonviolent doctrine are complete vegetarians and avoid eating some vegetables because their harvest may cause death to insects.

Guidelines in Other Countries

•Core recommendations remain similar •Shape of graphic may differ based on country •Sources of proteins or fresh fruits and vegetables may differ based on location

Organically grown foods

•Crops: Grown without synthetic fertilizers and pesticides •Livestock: organically produced feed must be used for some time of gestation, vitamin and mineral supplements are OK, but NOT growth hormones or antibiotics/medications •Organic foods will: •Expose people to fewer synthetic chemicals from pesticides and fertilizers •Reduce antibiotic resistance in humans •Cost more, for now •Organic foods will NOT: •be more nutritious than conventional foods •Have health benefits within milk, or be affected by growth hormones.

Nutrition for Infants, Children, and Adolescents and why it is important

•Decrease risk of chronic disease and promote nutrition for optimal physical and cognitive development •Nutrient deficiencies are rare and infant mortality has declined over recent decades •1 in 3 children are overweight/obese

Avoid Alcohol

•Dehydrates fetal cells leaving them dead or functionless or causing secondary nutrient deficiencies

Estimated Energy Requirement (EER)

•Designed to maintain body weight •Take into account •Age •Gender •Height & weight •Physical activity level •Discretionary calorie allowance •the difference between kcalories needed to supply nutrients & those needed for energy

two sets of nutrition standards

•Dietary Reference Intakes (DRI) •Daily Values

Combating Misinformation

•EVERYONE has an opinion on nutritional concepts •Change in food philosophy •Prevent deficiencies à optimizing health •Many people now look to food as a "medicine" •Escalating health-care cost, obesity epidemic, increasing age... •Most people get health information from their health care professional, but also family/friends/Gov't/TV/internet •Even media can misinform when trying to convey information too quickly or generalize a scientific study. •Listen and inform without being judgmental and dismissive

The Critical Period Concept

•Each organ and tissue develops during its own critical period. •If proper nutrients and other environmental conditions are lacking, proper development may not occur. •Effect is irreversible, even if nutrient is supplied at a later time period •Example: Neural tube defects resulting from Folate deficiency

Food Irradiation

•Electronic pasteurization - use gamma rays, electron beams, and x-rays to pass through food and destroy bacteria, mold, fungi, and insects.

What is Culture?

•Encompasses the total way of life of a particular population or community at a given time. •In the USA, the cuisine is a mix and adaptation of foods and cooking methods from many other places in the world making the "typical American diet" hard to define.

For groups

•Estimated Average Requirements (EAR) •Tolerable Upper Intake Levels (UL)

Postpartum weight retention

•Excessive weight gain during pregnancy increases risk of weight retention and long-term maternal weight •Weight retention in 68% of women at 12 months postpartum (up to 20 pounds) •Study shows that postpartum weight retention at 6 months, and weight gain from 6-18 months postpartum effect maternal weight, BMI, and waist circumference 7 years later (independent of gestational weight gain and prepregnancy BMI). •Interventions that combine diet with exercise and self-monitoring result in greater postpartum weight loss. Earlier postpartum intervention is better. •BUT THAT IS REALLY HARD TOO!

Dietary Guidelines for Americans (DGA)

•Federal policy published every 5 years by the U.S. Department of Health and Human Services and U.S. Department of Agriculture •Evidence-based recommendations for people over 2 years old •Dictates nutrition in schools, communication, and food assistance programs. •Contains nutritional and dietary information and guidelines for the general public •The 2015-2020 Guidelines focus on a holistic eating pattern (as opposed to singling out particular food groups) •Three styles of "Healthy Eating Patterns" featured in the most recent DGA •Each style lists recommendations for each food group within different calorie ranges

Zygote

•Fertilized ovum •Implants in uterine wall •Placenta begins to grow

What can vary between cultures?

•Food preparation methods (cooking and seasoning) •Different foods have symbolism between cultures (e.g. celebratory or comforting) •Number and timing of meals during the day •How the meal is eaten (chopsticks, utensils, hands) •Cultural values (desirable vs.undesirable behavior) (see next slide) •Health beliefs: where food is used to promote wellness or cure diseases •Hot oregano tea for an upset stomach (Vietnam) •Defining healthy body shapes

•Daily Values

•Found on Food labels used by individuals •Practical standards that allow for comparisons between foods •Based on nutrient and energy recommendations for a 2,000 calorie per day diet

Toddlers and Preschoolers

•From 1 year - puberty, they grow 2-3 inches and 6 pounds per year. •BMI chart usually used to watch child's growth •Early parental influence is associated with a child's relationship with food later in life •Helpful tips: •Present healthy foods in small amounts •Don't force them to eat everything on the plate •Usually 3 meals and 2-3 snacks during the day at even intervals. •Usually need to eat every 3 hours while awake

Infancy: Birth - 1 year nutrition

•Greatest growth during life is during infancy •Length increases about 10 inches in first year •Rates compared to WHO growth charts •Energy requirements of 5 mo infant twice that of 20 yr old male (by weight) •Supplements: •At birth: Vitamin K intramuscular injections •After six months: Vitamin D, iron, and fluoride •Nutrients particularly important for infants •Energy nutrients •Vitamins and minerals for growth (Vit A, D, E, C, iodine) •Growth directly reflects nutritional well-being Infancy: Breast Milk and Formula •Either one (or both) will make up the majority of caloric intake during the first year of life •Breast milk has a special combination of nutrients that can't be duplicated. •Breastfeeding linked with lower risk of many illnesses and disorders •Hard to measure how much infants get, but usually 8-12 feedings/day •Vitamin D is usually recommended as a supplement •Formula is regulated by Infant Formula Act •Milk based •Soy based - for infants with galactosemia, lactase deficiency •Hydolyzed - more broken down proteins (cow's milk allergy) •Specialized - PKU, don't supply full nutrition •Preterm formulas: higher in calories, protein, calcium, magnesium, and phosphorus

How does US & Canada have established standards to help in making decisions?

•Guides for healthy people's energy and nutrient intakes •Based on scientific studies •Revised as new data become available

Supplement Labels

•Herbs are unapproved drugs •Safety and effectiveness are not proven •Strength not standardized •Dosages are not standardized •Claims on packaging do not require FDA approval •Warnings are NOT required •Supplements are self-prescribed

Tolerable Upper Intake Levels (UL)

•Highest average daily intake level of a nutrient likely to pose no danger to most individuals in the group •NOT intended to be a recommended level of intake •There is no benefit of consuming amounts greater than RDA or AI

Limit or avoid certain Fish and Shellfish

•Increase intake of omega-3 fatty acids •Avoid intake of those potentially high in mercury (tilefish, shark, swordfish, and king mackeral; Limit albacore tuna

Culture and Food

•Individuals within cultures may not adhere to the cultural norms. •Not all Jews practice orthodox food law •Not all Southerners eat sausage, biscuits, and gravy •Cultures have "subgroups" that may practice differently •Culture determines edible vs. inedible •Edible = what makes up an individuals diet •Not nutrient dependent: horse meat or insects •Inedible = what is usually poisonous or taboo •Each culture has a "ranking" for its foods on whether they would be defined as edible or inedible (Figure 10.1 in textbook)

Formula vs. Cow's Milk

•Infant formula •Fortified with iron •U.S. standards •Based on AAP recommendations •FDA: quality control procedures •Special formulas •Soy protein •Hydrolyzed protein • •Cow's milk •AAP advises only after the first year

Adequate Intake (AI)

•Intake level thought to meet or exceed the requirement of almost all members of a life stage and gender group. •Used when there is insufficient data to determine an RDA •Gender & age group specific •also separate values for pregnant and lactating women •Optimal values not minimum requirement

FDA allowed claim: Nutrient content claims

•Label descriptions of the amount of a nutrient provided in a food or beverage

Recommended Patterns vs. Typical Intakes

•Large gap in what is recommended and what Americans typically eat •75% of population doesn't eat enough fruits, vegetables, dairy, and oils •More than 50% of the population meets or exceeds total grain and total protein (but lack whole grains and protein variety) •Most Americans eat too much added sugar, saturated fat, and sodium •Many people consume too many calories

What should be limited?

•Limit Caffeine .•Nonnutritive sweeteners •Limit or avoid certain Fish and Shellfish

QUALIFIED HEALTH CLAIM (Box 9.4)

•Limited and preliminary scientific research suggests •Company must petition FDA to use a claim •Examples: •Decreases cancer risk •Green tea •Selenium •Antioxidant vitamins •Decreases cardiovascular disease risk •Nuts •Walnuts •Omega-3 fatty acids •B vitamins •Corn oil •Unsaturated fatty acids from canola

Avoid foodborne Illness

•Listeria monocytogenes can cause fetal death or other impairments •Unpasteurized milk or products made with it •Undercooked meat or eggs •Smoked seafood •Pates or meat spreads (also usually made of liver) •Unpasteurized cheeses like feta, Brie, bleu, and Camembert •Hot dogs and deli meat (unless cooked until steaming just before serving) •Toxoplasma gondii may cause mental defects, blindness, or hearing loss in fetus •Cook meat thoroughly •Peel or wash fruits and vegetables •Avoid cross contamination Avoid changing cat litter

Birthweight is the single most important indicator of an infant's future health status

•Low birthweight (LBW): <5.5 lbs •Premature infants ->born early but may be right size for their gestational age. •Infants that are small for their gestational age (SGA) •Low birth-weight babies at higher risk of many complications •Nearly 40x as likely to die •Developmental delays •Poor nutrition is not only cause of LBW •Heredity, disease conditions, multiparous pregnancy, smoking, drug and alcohol use •

Preparing for Pregnancy

•Many developmental stages occur very early in pregnancy, even before the individual knows that she is pregnant •Examples: •Placental development •Nervous system development • •Prior to Pregnancy: •Achieve & maintain a healthy body weight •Choose an adequate & balanced diet •Build up nutritional stores •Be physically active •Avoid harmful substances • •Major nutrient deficiencies include folic acid and iron deficiency anemia

Recommendations from other Health Agencies

•Many health agencies publish their own guidelines or recommendations for healthy eating •American Heart Association •American Cancer Society •American Institute for Cancer Research •Similar to each other and DGA •Commonalities: attain healthy weight, choose a nutrient-dense eating pattern, and become more physically active.

Nutrient Density

•Measure of nutrient content provided per calorie of food • •Density is higher closer to harvest, with less processing, and with lower fat, no added sugars, refined starches or salts. • •Can help people identify nutrient-rich foods vs. bulk (filling) foods that are low in calories.

Antibiotics in Food

•Medications that can be used to treat illness in animals, but can also be given on a regular basis to prevent disease and promote growth.

Home vs. Away from Home

•Most meals are made at home •Many "convenience" items (e.g. meal kits)are used in combination with "from scratch" items. •Usually higher in sodium, more expensive, serving size is smaller compared to what will satiate people •FAFH (food away from home) usually increases the amount of calories an adult will eat •Decreases intake of fruits, vegetables, whole grains, iron, fiber, and calcium •Increases intake of sodium, saturated fat, alcohol, and added sugar •Your book has recommendations for "healthier" eating out options at common ethnic restaurants. •SURPRISE! - more vegetables and whole grains, fewer meats! •Nothing is off-limits: Convenience items and eating out are meant to be used "in moderation" so they are OK sometimes, but not as the basis of your diet.

Nonnutritive sweeteners

•Most nonnutritive sweeteners have been approved by FDA (same avoidance of aspartame by people with PKU) •Limited studies on safety or in gestational diabetes •No benefits

Pregnancy nutrient requirements

•Most nutrient requirements got up, but not proportionately •Nutrient requirement may be altered by intake of another. •Nutrient absorption from food increases during pregnancy. •Folic acid (DNA synthesis) - increase by 50% during pregnancy (and 25% during lactation) •Iron - increase by 50% during pregnancy (and halved during lactation)

baby

•Neonate (up to 4 wks) •7.5 billion miracles and counting

What is your role?

•Possess specific knowledge about foods habits, preferences, and practices. •Especially among ethnic groups you are likely to encounter where you are working (this includes co-workers!) •Don't assume patients will know which American foods are healthy •Ask questions to understand a patient's food habits. •What are your favorite foods? What foods will you NOT eat? What new foods do you eat? •Respect cultural differences (use an interpreter if you can) and don't overcomplicate explanations •Boxes 10.5 and 10.6 in your textbook offer many suggestions

Introducing Solid Foods

•Provide nutrients no longer adequately supplied by breast milk or formula alone •Factors governing addition of foods •Infant's nutrient needs •Infant's physical/developmental readiness •Need to detect and control allergic reactions (3-day rule) •Foods that provide iron and Vit C are particularly important •Iron: Iron-fortified cereals, meat, legumes •Vit C: Fruits and vegetables •Foods to omit •Sweets •canned vegetables (sodium) •honey and corn syrup (botulism) •Fruit Juices •Foods that might cause choking (hot dogs, whole grapes, chunks of cheese, peanut butters, raw carrots, etc.) •Encourage healthy eating habits (infants are good at knowing if they are hungry!)

•Dietary Reference Intakes (DRI)

•Published by nutrition experts in US & Canada that meet DRI committee goals •Basis for national standards to guide dietary intake of the population •Used by scientists and nutritionists who work in research or academic setting and by dieticians who plan menus for specific populations •Four reference sets: 1.Recommended Dietary Allowances (RDAs) 2.Estimated Average Requirement (EAR) 3.Adequate Intake 4.Tolerable Upper Intake Level

Common issues: Pica

•Purposeful ingestion of nonfood substances such as dirt and clay (most common), starch and ice. •~23% of pregnant women in North/South America do this •Associated with micronutrient deficiencies (unclear why, but perhaps inhibiting absorption) •Pica associated with 2.4 times higher risk of anemia and zinc deficiencies •Women may be reluctant to report this behavior •Treatments: see a dietitian to manage symptoms and have an likely comply to an iron-rich diet/supplement.

Acceptable Macronutrient Distribution Ranges (AMDR)

•Recommended % contribution to total energy for each energy-yielding nutrient •Guidelines for individual diets •Provides adequate energy and nutrients, reduces risk of chronic disease •Meant to apply over time (days or weeks) not for an individual meal. • 45-65% from carbohydrate 20-35% from fat 10-35% from protein

For Individuals

•Recommended Dietary Allowances (RDA) •Adequate Intake (AI) •Acceptable Macronutrient Distribution Ranges (AMDR) •Estimated Energy Requirement (EER)

Food and Religion

•Religion often has a greater impact on food habits than nationality or culture. •Buddhism •Code of morality in Five Moral Precepts •Do Not: 1) kill or harm living things; 2) steal; 3) engage in sexual misconduct; 4) lie; and 5) consume intoxicants like alcohol, tobaccos or mind-altering drugs •Food decisions contribute to spiritual enlightenment •What food is this? - Origin and how it got to me •Where does it come from? - Amount of work necessary to grow, prepare, cook and present food •Why am I eating it? - am I worthy of the food? •When should I eat and benefit from this food? - food is a necessity and healing agent •How should I eat it? - food is used to reach enlightenment •Vary widely •Revolves around nature in two opposing energy systems (yin and yang) •Ahimsa - non killing or harming •many are lacto-ovo vegetarians •Some eat fish; some avoid only beef •Buddhits monks avoid eating solid food after noon hour

My Plate

•Replaced "My Pyramid" in 2011 •Can be used for people 2 years and older •½ plate is fruit and vegetables, ¼ grains, ¼ protein, and 1 cup dairy •www.choosemyplate.gov •Contains info and quizzes, menus, recipes

Recommended Dietary Allowances (RDAs)

•Represent the average daily recommended intake to meet the nutrient requirements of 97-98% of healthy individuals •Recommendations based on specific criteria indicators for estimating requirements, such as: •Plasma and serum nutrient concentrations set high enough for variation in daily intake •When treating individuals with certain disorders, RDA is used as a starting point and then adjusted accordingly

UNQUALIFIED HEALTH CLAIM (Box 9.3)

•Significant scientific agreement (SSA) •Examples: •Decrease cancer risk •Dietary fat •Fruits and vegetables •Fiber-containing grain products •Decreases hypertension risk •Sodium •Decreases neural tube defect risk •Folate •Decreases coronary heart disease risk •Saturated fat and cholesterol •Fruits, vegetables, and grain products with fiber

Nutrient supplements

•Supplements might be necessary for those who: •Have anemia •Have poor eating habits •Are strict vegans •Are dependent on tobacco, alcohol, or other drugs •Have food insecurity •Specific supplements that might be necessary •Vitamin B12 - strict vegans •Calcium - low consumption or absorption •Vitamin D - low sunlight exposure •Zinc - impaired absorption or high supplemental iron

Common issues: Hypertension and Preeclampsia

•Systolic > 140mmHg or diastolic > 90mmHg that develops in second half of pregnancy •More likely in women who are obese before pregnancy •Preeclampsia = toxemia of pregnancy from hypertension + proteinuria or edema (or both) - as it signifies other organ disfunction. •Higher risk in people who are obese, have chronic hypertension, multiple pregnancies, first pregnancy, maternal age over 40, in vitro fertilization, history of diabetes, thrombophilia, and lupus. •Doubles risk of Type 2 DM developing within 20 years postpartum •Managing weight, increasing fruits & vegetable & folate have been found to be protective against preeclampsia

Food Labels & Gov't Regulations

•The FDA regulates food labeling to provide information to consumers •Health claims must be backed up by scientific studies (sort of). •Nutrient claims must follow guidelines. •Nutrient Facts on Labels let us know: •what we are eating •how much we are eating •What foods need to be labelled? •Processed foods •Restaurant foods •Brochures also available for fresh, whole foods

Portion Sizes

•The amount of food usually consumed at one time (3 cups of spaghetti at a restaurant) •Usually larger than a serving size (1/2 cup cooked pasta)

Dietary Acculturation

•The process that occurs as members of a minority group adopt the eating patterns and food choices of the host country. •Caveat about the term "host country" and "immigrant" •In the USA, acculturation is linked to higher risk of chronic disease and obesity, but mixed on diet quality •The patterns seen are inconsistent and variable, so is difficult to generalize what happens to a group. •Changes that occur in foods choices are: 1.New foods are added to the diet 2.Some traditional foods are replaced by new foods 3.Some traditional foods are rejected

Role of Certain Foods

•The ranking of foods is based on cost and availability 1.Core foods - staples; important and consistently eaten and provide the most calories •Complex carbohydrates and starchy vegetables •Vary around the world (for Americans often cereal grains and potatoes, for others rice and plantains) 2.Secondary foods - widespread, but not eaten consistently •Vegetables, legumes, nuts, fish, eggs, and meat •Chinese might use mung beans and soybeans while black beans and pinto beans are consumed more in Latin America 3.Peripheral foods - infrequently consumed and usually based on an individual's preference •Reserved for special occasions like cake in America or milk for Asian Americans.

Healthy Eating Guidelines

•Translates the science of nutrient needs into evidence-based recommendations for eating patterns to meet those needs. •Prominent characteristics of healthy eating include: •Variety - in color of fruits and vegetables, selections in each group (like protein) and methods of cooking •Balance - reasonable portions of all food groups •Moderation - limited amounts of saturated fat, added sugars, and sodium; moderate amounts of alcohol and coffee for adults •Individually appropriate - calorically, culturally, personally, and economically •No foods are prohibited

•Limit on Calories for Other Uses

•Usually between 9-18% of "leftover" calories after most have been used on nutrient dense foods •Often used on added sugars, fats, starches, or alcohol •Should still limit added sugars and saturated fats to 10% or less each

•Variety

•Variety of different foods within each food group •Focus on variety in whole, nutrient-dense foods •Example: •Variety of vegetables will likely get you to essential nutrients •However a "variety of refined grains" will likely not be nutritionally adequate because processing has similar effect on them

Nutrition during lactation

•WHO recommends exclusively breastfeeding 0-6 months; introducing complementary foods after 6 months and continue breastfeeding to 2 years or beyond. (AAP recommends breastfeeding up to 1 year). •THIS TIMELINE IS NOT REALISITIC FOR MANY WOMEN •Breastfeeding improves infant and maternal morbidity and motality, promote bonding, optimal nutrition, reduces risk in infants of SIDS, chronic diseases, enhances immunity, etc. (Box 11.3 in textbook) •In the US, there has been an increase in breastfeeding since 1979 (formula before that was recommended) •79% at birth; 49% at 6 months; 27% at 12 months •Many factors can affect a woman's decision to breastfeed •Many hospitals are moving to promote breastfeeding practices (Box 11.5) •Nutrition during lactation needs to provide nutrients to breastmilk and energy for producing milk (it burns a lot of calories to do so!) •Usually nutrients will enter breastmilk at the expense of depleting the mother •Exclusive breastfeeding usually requires 450-500 more calories/day •Fluids are important (~100 oz. of caffeine free fluid) •Influences quantity of some nutrients; B6, B12, A, D, and fatty acids

Functional Foods

•Whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels.

Pregnancy weight gain and calories

•Women should not be "eating for two" •Recommend 1-4 pounds in first trimester for all •Caloric increase not necessary until 2nd trimester through lactation. •Most of those calories should be from vegetables, protein, and grains •Allowed small increase in oils and "extras"

Prepregnancy Weight and Diet

•Women who are underweight or had a low birth weight themselves •Greater risk of having a low birth weight baby •Harder to conceive if trying to get pregnant •Gain weight before becoming pregnant •Women who are overweight or obese •Greater risk of high body weight or childhood obesity •Greater risk of gestational diabetes and hypertension •Lose weight before becoming pregnant •50% of women in the United States are overweight or obese (increases risk of defects, preterm delivery, and diseases associated with obesity) •Women overweight and underweight need to be counseled on how to decreases risks associated with prepregnancy weight. •Preconception diet is associated with pre-term delivery. Healthy diet reduces risk of preterm delivery, diet high in refined grains and added sugar increase risk of preterm delivery.

Common issues: Maternal phenylketonuria

•Women with PKU before pregnancy have high levels of phenylalanine in the blood. •Fetal exposure to high phenylalanine can result in microcephaly, growth retardation, and or congenital heart abnormalities •Low phenylalanine diet at least 3 months prior to conception; but low-phen-diets are also low total protein diets which can lead to deficiencies in B6, B12, calcium, folate, iron, and omega-3 fatty acids •Treatment: Elimination of protein foods high in phen; NO aspartame (NutraSweet); PKU-appropriate medical foods (expensive); adequate calorie intake

FDA allowed claim: Health Claim

•a statement that describes a relationship between a food, food substances, or dietary supplement ingredient and a reduced risk of disease or a disease-related claim.

"Critical Period Concept"

•exposure at certain points of development can cause major or minor defects of different systems

Limit Caffeine

•half-life of caffeine increases during pregnancy (3 hours à 100 hours) Less than 200mg/day (16oz. of coffee)

FDA allowed claim: Structure/Function Claim

•statement identifying relationships between nutrients or dietary ingredients and a body function. •Do NOT require FDA approval; used to appear on supplements with a disclaimer - no such disclaimer is needed on foods

Diets of Latino/Hispanic Americans

•~17.4% of U.S. Population (2014) with 63% being Mexican •Generally low-fat, high-fiber; emphasis on corn, corn products, beans, and rice; milk not widely used

Foodborne Illness

•~48 million Americans get foodborne illness each year •~1/2 of all foodborne illnesses linked to leafy green produce (norovirus) •Dairy, leafy vegetables, and poultry (respective order) cause the most hospitalization from illnesses •Contaminated poultry is blamed for most deaths (19%) - Listeria and Salmonella •People at most risk for complications include pregnant woman, infants, elderly, and those with compromised immune systems •Unsanitary food preparation/handling is the major cause.

Diets of Asian Americans

•~5% of U.S. population of 37 different ethnic groups •Two commonalities: •Emphasize rice and vegetables & cooking techniques and preparing ingredients before cooking •High variety of vegetables and proteins (nutrient rich) •Yin and yang forces at play in the body •Low in fat and dairy, high in complex carbohydrates