Nutrition throughout the lifecycle: Maternal, foetal and infant health

Question 1

Why is nutrition during pregnancy and lactation important?

Answer 1

1. Mother’s and infants are one of the most nutritionally vulnerable groups
2. All women need to eat a healthy balanced diet and gain weight to sustain a healthy preganany and childbirth
3. A fetus’s weight doubles in the first 6 weeks
4. Infant doubles in weight from birth to 4-5 months
5. Barker hypothesis - poor nutrition in utero may increase risk of chronic disease later in life.
6. Fetus has limited ability to compensate for limited supplies.
7. Growth depends on a supply of nutrients via placenta and then breatmilk
8. Marginal nutrients are more important in developmental peroid than steady state (adulthood)

Question 2

What is the Barker Hypothesis?

Answer 2

It is an hypothesis concerning how early nutrition can affect health outcomes in adult life. It proposes that there is a correlation between in-uterine growth retardation, low birth weight and premature birth and developing hypertension, CHD and Type 2 diabetes in adult life.

Question 3

What is Barker’s hypothesis proposed mechanism?

Answer 3

• Peroids of rapid post-natal growth (high E intake, Western dietary pattern)
• Transgenerational epigenetic inheritance (peroid of nutritional deprivation)

Question 4

What is the drawback of Barker hypothesis?

Question 5

A overview of nutritional needs during pregnancy

Question 6

Are you eating for two during preganany?

Answer 6

• Nutrients for two
• 10% extra energy
• Nutrient rich diet recommended

Question 7

Preganant wo have an healthy weight should gain

Answer 7

Between 11.5- 16 kg

Question 8

Prégnant women who are underweight should gain

Question 9

Prégnant women for are obese should gain

Answer 9

between 7pm 11.5 kg

Question 10

Summary of macronutrient needs during preganany

Answer 10

Energy needs:

First trimester: no change

Second trimester: increases 340kcal/day

Third trimester: increases 452 kcal/day

Protein needs: increases from 46g/day to 71 g/day

Question 11

Iron needs in preganany

Answer 11

increased need for iron in diet:

• increased blood volume
• develpoing fetus draws enough iron to last 0-6 months
• iron loss reduced but overall need for iron much greater
• RDI=27 mg

Question 12

Calcium in pregnancy:

Answer 12

Foetus retains about 25-30g calcium (predom. 3rd trimester).
‒ RDI = 1000 mg same for non-pregnant as calcium absorption increased in pregnancy
‒ Dietary calcium does not appear to influence maternal bone mass inpregnancy
‒ Support concept of maternal adaptive mechanism

Question 13

Vitamin A needs in preganany

Question 14

Why should pregnant women be wary about some types of fish?

Answer 14

mercury in fish: pregnant women and women planning pregnancy should avoid fish with high levels of mercury such as billfish, gemfish, southern blue fin tuna

-should safely eat 2-3 meals of fish each week though, but choose the type of fish carefully.

Question 15

Why are vitamin supplements in preganancy controversial?

Answer 15

not usually recommended but may be needed for:

• vegetarians
• teenagers who have inadequate food intake
• substance abusers
• obese women who are restricting their energy intake to prevent large weight gains

Question 16

What was the impact of mandatory folate fortification in Australia?

Answer 16

• NTDs fell by 14%
• NTDs fell by 74% for Indigenous Australians
• NTDs fell by 55% among teenagers giving birth

Question 17

What was the impact of mandatory iodine fortification?

Answer 17

Iodine intakes by children increased by 29%

-Iodine intake in women of childbearing age increased by 52%

Question 18

Why is the nutritional status of the father important?

Answer 18

Age of father is associated with reduced sperm quality:

• May lead to structural defect
• increased DNA fragmentation
• more gene mutations
• more children carrying heritable genetic defects

Question 19

What are the advantages of breatfeeding for the mother?

Answer 19

Involution of uterus, decreased haemorrhage risk

• Return to pre-pregnancy weight more quickly
• More hygienic, less hassle
• Amenorrhoea – recoup iron stores, increased time to next pregnancy
• Beautiful experience and bonding with infant

Question 20

What are the advantages of breastfeeding for the infant?

Answer 20

• Breast milk design for optimal growth of infant
• Supply determined by demand – rare to be overfed
• Breast milk adjusted to needs of infant
• Iron in breast milk more easily absorbed

• Formula fed babies may be more likely
to develop obesity later in life

Question 21

What are the nutritional needs of infants 0-6 moths?

Question 22

What is the prevalence of breastfeeding in Australia

Answer 22

• 90% of women commence breastfeeding
• 50% by 6 months
• Almost 39% exclusively breastfeed to 4 months

Question 23

What is the Australian National Breastfeeding strategy?

Answer 23

‐ Aims to support all mothers, fathers/partners and babies in Australia by providing support for mothers to breastfeed their infants.

‐ Provides framework for integrated, coordinated approach to other local policies and
programs

‐ The strategy is evidence based

‐ DoH will establish and advisory committee to oversee implementation of strategy

Question 24

How frequently do you need to breastfeed and how long?

Answer 24

• Breast is best fo rythme young baby but as they get older, milk alone is not enough to meet nutrient needs
• Continued breastfeeding recommended to 18 months-two years along with complementary foods
• Frequent feeding (4-5 times a day) in addition to breast milk ensures sufficient energy and nutrients.

Question 25

First foods

Answer 25

- First foods are usually introduced at around 6 months to meet increasing nutritional requirements. - At this age most babies are developmentally ready for first foods and the feeding relationship takes on new dimensions. - Breast milk or formula continues to be the main source of nutritio

Question 26

What are the types of first foods?

Answer 26

- cooked potato - mashed smooth foods - grilled chicken or meat - banana

Question 27

Solid foods for toddlers:

Answer 27

Children’s appetite begin to decrease around 12 months age – then will vary intake to coincide with growth patterns Children’s intake also varies from meal to meal – but total average intake over a few days is usually constant Individual needs vary widely depending on growth and activity levels

Question 28

What is the parents role in feeding a toddler

Answer 28

Toddlers can explore and enjoy food Parents role is to continue offering a wide selection of food from the five food groups – their choice is whether to eat or not. Rejecting new foods is normal – acceptance is more likely as become familiar with food through repeated opportunities to taste them Sweet foods should be limited

Question 29

What are the factors affecting children’s growth?

Answer 29

Question 30

How is a child’s growth monitored?

Answer 30

NHMRC recommends children's growth should be monitored at regular intervals Each state and territory in Australia has health monitoring schedules for infants and young children when growth measures are taken and plotted on the relevant charts. These schedules are for otherwise healthy children and allow for early detection of altered growth should it occur. Children with ongoing health concerns may need to have their growth monitored more frequently.

Question 31

Growth monitoring is especially important during infancy for:

Answer 31

* Detecting slow or excessive growth * Checking the impact of illness and response to treatment * Screening for high risk individuals

Question 32

What are the four main nutritional issues in childhood?

Answer 32

- Poor growth - Obesity - Anaemia - Dental caries

Question 33

How is poor health measured?

Answer 33

The best indicator of poor growth in children is weight and /or length tracking downwards on percentiles on the weight and / or length for age growth charts Other popular, but less reliable definitions in the past included: • 'weight dropping percentile lines on weight for age growth chart‘ • 'weight and length are more than 2 percentile lines apart on the weight and length for age growth charts‘ • 'weight or length for age below the 3rd percentile'

Question 34

Childhood obesity facts

Answer 34

Usually formally diagnosed if body weight is \>120% of expected weight for age - Other, similar reference points used - BMI\>age see-specific reference standards (85th and 95th percentile) Major health issue in many developed countries, increasing incidence in Australia (-25% Australian children o/weight or obese)

Question 35

Micronutrients: iron deficiency

Answer 35

- Most common nutritional deficiency of early childhood - Full-term infants have sufficient stores for the first 6 months - Iron intake needs to be sufficient in order to support growth

Question 36

WHAT are the major concerns of iron deficiency in childhood?

Answer 36

- retardation in mental and physical development - Associated with decreased resistance to infections and increased morbidity (particularly pre-school)

Question 37

Micronutrients: vitamin D deficiency

Answer 37

Sévère deficiency uncommon in developed countries, however increasing cases of rickets occurring (particularly in dark skin groups) -Less severe vit D deficiency becoming apparent : (lower bone density, increased infection, cancer heart disease)

Question 38

Micronutrients: iodine deficiency

Answer 38

Severe deficiency mostly in developing countries Less severe (however, sufficient to affect cognition) cases seen in Australia. Iodized table salt decreased prevalence in Australia, however, recurrence observed Mandatory Iodine fortification Australia 2009

Question 39

Dental caries and diet facts

Answer 39

Affects all ages and socioeconomic backgrounds - Bacteria in mouth cause plaque formation