Module 10 and 11 Flashcards
What kind of changes do we see in the body during pregnancy?
- Cardiovascular
- electrolyte and fluids
- endocrine
- fetus
- GI
- hematological change
- immune system
- metabolism
- renal system
- respiratory
- skin and CT
How does pregnancy affect cardiovascular and respiratory changes?
cardiovascular: increased cardiac output, blood volume and blood flow to uterus
respiratory: thoracic cage and diaphgram shift, sweating at lower temp
how does pregnancy affect metabolism changes
metabolic shift: increased gluconeogenesis and insulin secretion, rising insulin resistance and lypolysis
metabolism: max amount of sugar pulled from blood for fetus, insulin resistance increases since all the glucose is going to baby
how does pregnancy affect the renal and immune system
renal: increased renal blood flow, and sodium+water retention
immune: extra protection against infections
how does pregnancy affect endocrine and hematological changes
endocrine: elevated levels of hCG, progesterone, estrogen, thyroid function
hematological: increased BV, haemodilution, clotting
how does pregnancy affect GI, skin and fluid balance
GI: slower motility and improved nutrient absorption
Skin: loosens for birth
electrolyte: altered management
What are some benefits to physical activity during pregnancy
- increased cardiopulmonary reserve (how much it can pump)
- glucose regulation
- improved well being
- regulated weight gain
- fetal and placental adaptations
what are some suggestions for physical activity for pregnant women
- all woman should exercise (unless there are complications), at least 150 minutes a week, 3 times a week, both aerobic and resistance
What pre pregnancy factors influence pregnancy energy requirements
- BMI
- body weight change
- level of PA
What can excessive weight gain during pregnancy lead to
- gestational hypertension
- gestational diabetes
- C section
- birth defects
- child obesity
What is healthy weight gain for certain BMI classes?
underweight = 12-18kg
normal = 11-16kg
overweight = 7-11kg
obese = 5-9 kg
explain the distribution of weight in a pregnant woman
total weight gain = 25-35 pounds
breast = 1-2 pounds
baby = 6-8 pounds
placenta = 1-2 pounds
uterus = 1-2 pounds
amniotic fluid = 2-3 pounds
what are the energy needs for each trimester
1 trimester = no additional calories required
2nd trimester = +350kcal/day, since metabolic rate increased by 15%
3rd trimester = +450kcal/day
what are the macronutrient needs for pregnant woman
same as normal, but increase protein by 25 grams in second half of pregnancy
What micronutrient needs increase in pregnancy
- vitamind B
- folate +600mcg/day
how does folate deficiency affect pregnancy
deficiency leads to birth defecs in brain and spinal cord
How does vitamin D deficiency affect pregnancy
- low birth weight
- rickets
- asthma
- type 1 diabetes
What are calcium needs during pregnancy
1000mg/day??
what changes do we see in calcium demands/absorption during pregnancy
- more demand placed on calcium stores
- intestinal absorption increases
- breast milk is high in calcium
- gut becomes more sensitive to it
What changes in iron needs do we see in pregnancy
- RDA increases to 27mg
- supplementation recommended
- increased requirements due to increased blood volume
Why is omega 3 important in pregnancy
- positively associated with lower risk of preterm birth
- DHA essential for visual and neurological development
What is the RDA for omega 3 during pregnancy
200-300mg/day. supplementation can be considered with health care team
what are some dietary considerations for pregnant woman>
- pica: wierd cravings
- caffeine - limit to 200-300 mgs/day
- avoid certain foods
what foods should be avoided by pregnant women
- undercooked eggs or meat
- cured meat
- raw fish
- soft cheese
- pate
- mercury rich foods
- unwashed produce (ecoli)
What is gestational diabetes
a form of diabetes that occurs during pregnancy, roughly 3-20% of them
how can gestational diabetes form
hormonal changes in pregnancy lead to insulin resistance
how can we diagnose gestational diabetes
- glucose challenge test - drink 50g of glucose in 5 minutes, then in one hour draw blood (<7.8mmol)
- oral glucose tolerance test - after GCT, drink 75 g glucose and 2 blood draws
what are the risks of gestational diabetes
- maternal short term = increased BP and preeclampsi
- maternal long term = risk of type 2 diabetes later in life
- fetal macrosomnia= larger than normal baby
- fetan neonatal hypoglycaemia= baby may have low blood sugar after birth
- fetal obesity/diabetes= increased risk
how can we manage gestational diabetes
- dietary changes
- exercise
- monitor blood glucose
why is veganism/vegetarianism good in pregnancy
- high fibre and healthy microbiome
- healthy weight gain
why is veganism/vegetarianims bad in pregnancy
- if inexperienced, means their body is not well adjusted, and can be deficient in protein, iron, calcium, DHA, zinc and B12
why is intake of sufficient calories important?
its important for growth, development and maturation
why is hydration really important in adolescents?
they have a higher surface area to body mass ratio, so more of their body is exposed to heat.
they sweat less (fewer glands and less mature thermoregulatory system)
they’re really bad at hydrating
why is physical activity important in seniors?
- reduces loss of cardio function, muscle strength and bone density
- improves lipid profile
- supports change in body mass and cognition
- reduces insulin resistance
where is creatine synthesized
in the liver and kidney. synthezied from arginine, glycine and methionine (2-3g per day)
What are some foods high in creatine
meat, fish and poultry. 1g/day in omnivorous diet
what is special about creatine
it can cross the blood brain barrier and improves strength
where is most of the creatine in our body
in the muscle - 95%
define food allergy
a consistent adverse immune response to the proteins in a food
what are the types of food allergies
- IgE reaction
- non-IgE reaction
what is an IgE reaction
Immunoglobulin E reaction: B cells make special antibodies for a food protein. it is life threatening and intense
what is a non-IgE reaction
- other parts of the body react, but it does not involve antibodies (believed to be T cell mediated), and is very specific
what are examples of non-IgE reaction
enterocolitis syndrom
eosinophilic esophagitis disorder
what are the major allergens
peanut, tree nut, dairy, egg
why are allergens on the rise?
hygiene hypothesis: cleaner environments means a shift away from fighting germs and towards allergies
how many canadians have allergies
7.5%
- 3-4% in adults
- 6% in children
what are some risk factors for developing a food allergy
age: young children more common
family history
another food allergy
related medical conditions: asthma, eczema or hay fever
how do we diagnose allergies?
- Oral food challenge (gold standard): positive double blind, placebo
- blood: food specific IgE test
- skin prick test
what are the two responses to IgE tests?
class 1 and 2: low level allergy, low clinical reaction
class 3-5: IgE reaction, higher degree of sensitivity
how do we treat allergies?
- avoidance and epi pen
- oral immunotherapy (exposure therapy)
- sublingual immunotherapy = small amounts of food under the tongue, 2mg initially. high risk in older kids
describe the process behind oral immunotherapy as a treatment for allergies
-1-4 weeks = give a small amount of allergic food
- 6+months = up dosing phase every two weeks
- about 80% reach a maintenance dose and are “desensitized”
- 1 year = able to tolerate much higher doses
what is food intolerance
It is a limited ability to digest certain foods. symptoms appear within hours to days, and it is much harder to identify since it involves the digestive system
what are some symptoms of food intolerance
nausea, bloating, abdominal pain, gas and diarrhea
how can we test for food intolerance
- go see naturopath, homeopaths etc.
- requires detection of IgC antibodies
why are there concerns of at home tests for allergies/food intolerances?
- lack of scientific support
- expensive $350-450
- poor counselling can lead to fear and avoidance of foods
how do we treat food intolerances?
- history: eliminate true food allergy
- eliminate common triggers: onion, coffee, gum etc
- work on eating behaviours: pace, chewing, hydration
- Low FODMAP diet
what are FODMAPs?
a collection of short chain carbs that aren’t absorbed properly in the gut and can trigger symptoms in those with intolerance
what does FODMAP stand for
Fermentable
Oligosaccharide
Disaccharide
Monosaccharide
Polyol
what foods are suitable and not suitable for fodmap
low fodmap: banana, blueberries, carrot, celery, grains, lactose free milk
high fodmap: milk, yoghurt, apple, mango, broccoli, onion, garlic, legumes
What are the differences between allergy and intolerance
Allergy: Immune system activated, exposure for symptom really small, symptoms within 1-2 hours, treatment of medicine or avoidance
intolerance: no immune system activation, normal serving size for symptoms, symptoms in hours to days, treatment of limitation, avoidance
what are the type of sweeteners
natural: honey, stevia etc
artificial:
- nutritive: polyols
- non-nutritive: no energy value
what are the 5 tastes
- sweet
- umami
- bitter
- salty
- sour
What are some of the high intensity sugars?
acesulfame-k: 200x table sugar
aspartame: 200x
saccharin: 200-700x
stevia: 200-400x
sucralose: 600x
how are sweeteners regulated?
within acceptable intake, between 5-15mg/kg/bw/day, it does not cause cancer and is pretty safe
How much sweetener should we consume per day
> 50mg/kg/bw/day
do non nutritive sweeteners affect appetite?
no impact yet shown?
do non nutritive sweeteners affect energy intake?
idk. question asked are do they result in lower calorie intake or is the lack of calories compesnated for?
Non nutritive can or can’t help with weight loss
they can! its about reducing calories
do NNS sweeteners affect glucose homeostasis?
so far, no
What sweeteners have correlations with cancer
aspartame - no association
sucralose - weak evidence
acesulfame-K - weak
saccharin - link in rats but not humans
