Nutrition Issues: Women's Life Stages Learning Objectives Identify nutrition issues for a women:...
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Transcript of Nutrition Issues: Women's Life Stages Learning Objectives Identify nutrition issues for a women:...
Nutrition Issues: Women's Life Stages
Learning Objectives
• Identify nutrition issues for a women:
– During pregnancy focusing on high risk
– In midlife to reduce chronic disease risk
– In older age to address multiple medical and/or social problems
• Assess Weight, Activity, Variety and Excess for each age cycle and determine when refer for medical nutrition therapy with Registered Dietitian (RD) is needed.
Pregnancy Issues
Weight
• Pregnancy: 1-2 lb mo 1st trimester; 0.5-2 lb week in 2nd & 3rd Trimester
• Midlife: Weight distribution & risks relate to metabolic syndrome.
• Older Age: Unintentional weight loss > 10 lb at risk
Activity
• Pregnancy: impact weight-baring activity > fetal distress.
• Midlife: Weight-baring activity risk of osteoporosis.
• Older Age:. Assess for unsteady gait.
Variety Pregnancy: Calcium iron, protein, fiber/water, and folate
• Midlife: Metabolic syndrome, N-3 fatty acids; calcium intake, vegetables• Older age: Absorption/nutrient requirements; Calcium/Vit D, Vit B-12, and
zinc supplements may be needed.
Excess • Pregnancy: Screen for cravings, EtOH intake, • Midlife: CHO & lipids, meat & calcium excretion • Older Age: Food/EtOH behaviors to cope with loneliness.
American Dietetic/Diabetes Association Exchange System Overview
Exchange Calories CHO Protein Fat
Starches (1/2 C 1 oz) 80 15 g 2 g trace
Fruit (1/2 C) 60 15 g 0 g 0
Milk (8 oz) 90-160
12 g 8 g Tr-8 g
Vegetables (1/2 C) 25 5 g 2 g 0
Meat (per oz) 55-100 0 g 7 g 3-8g
Fat (tsp) 45 0 g 0 g 5g
FREE FOOD < 15 calories per serving FREE FOOD < 15 calories per serving
Quick Carbohydrate Counting
One Carbohydrate choice = 15 grams based on the ADA’s Exchange system
Exchange groups included are:
- Starch (1/2 cup, slice of bread)
- Fruit (1/2 cup)
- Milk (1 cup)
- Other Carbs (varies by concentration)
Glycemic Indexing Issues
GDM Carbohydrate ~40-45% of EnergyMeat, Cheese, Vegetables- not measured
Breakfast 30 grams: 1 starch + 1 milk
½ cup oatmeal and 1 cup milk
Morning snack
15 grams: 1 milk or 1 starch or ½ of each
4 oz milk and 2 crackers
Lunch 45-60 grams: 2 starches, 1 milk and 1 fruit
Sandwich, 1 cup of milk and a piece of fruit
Afternoon Snack
15 grams: 1 milk or 1 fruit
1 diet yogurt or 1 piece of fruit
Dinner 45-60 grams: 2 starches
1 cup of pasta (with meat) vegetables, small apple and 1 cup of milk
Night Snack
15-30 grams: 1 milk and 1 starch
Crackers (with cheese) and milk
Recommended Weight Gain based on Prepregnancy BMI*
• BMI< 19.8 kg/m2 28-40 pounds
• BMI 19.8-26 kg/m2 25-35 pounds
• BMI > 26 kg/m2 15-25 pounds
*American Diabetes Association Guide to Medical Nutrition Therapy
Weight Gain Recommendations for Pregnant Women
(Overweight Cuts Weight Gain Rx in Half)
Normal weight
3-5 pounds per month 1st trimester
• 1-2 pounds per week 2nd and 3rd trimesters
Overweight• 11/2 - 21/2
pound per month 1st trimester
• 1/2 -1 pound per week in 2nd and 3rd trimesters
Nutrition-Related Pregnancy ProblemsRates in the United States
• Hypertension ~ 12-22%• Preeclampsia ~ 6-8%
• Gestational Diabetes~ 2-14% • Anal fissures/external hemorrhoids disease
occur ~ 35% of pregnancies. • Postpartum Iron Deficiency rates:
30% if < 130% of poverty level
7% if > 130% of poverty level • Neural tube Defects ~ 4000 annually
Tight Glucose Control in GDMReduction in Adverse Outcome
GDM Non-diabetic Neonatal Outcome Conventional Intensive Control
N = 1316 1145 4922 Macrosomia > 4000 g 13.6% 7.1% 8.1% Intensive Care 25%
4.4 days 6.3%
2.8 days 4.7%
2.8 days Polycythemia 12% 0.7% 1.4% Hypocalcemia 4.0% 0.3% NA Hypoglycemia 20.0% 3.8% 2.5% Respiratory Support 4.2% 1.4% 0.5% Shoulder Dystocia 1.4% 0.4% 0.5% Langer O, et al. Am J Ob Gyn 1994;170:1036-46.
Midlife Issues
Dietary Approach to Stop Hypertension DASH Daily Recommendations
7-8 Serving - grains, emphasis on whole grains
4-5 Serving - vegetables
4-5 Servings - Fruits
2-3 Servings - low-fat dairy products
< 2 Servings - Meats
2-3 Servings Oils
* Eat 4-5 servings of nuts, seeds and dried bean per week
Limit intake of sweets to 5 per week
Midlife CVD Risk for WomenMetabolic Syndrome
Synonyms
• Insulin resistance syndrome
• (Metabolic) Syndrome X
• Dysmetabolic syndrome
• Multiple metabolic syndrome
Metabolic Syndrome Therapeutic Objectives
• To reduce underlying causes– Overweight and obesity– Physical inactivity
• To treat associated lipid and non-lipid risk factors– Hypertension– Prothrombotic state– Atherogenic dyslipidemia (lipid triad)
Specific Dyslipidemias:
Possible Causes of Elevated Triglycerides
• High carbohydrate diets (>60% of energy intake)
• Several diseases (type 2 diabetes, chronic renal failure, nephrotic syndrome)
• Certain drugs (corticosteroids, estrogens, retinoids, higher doses of beta-blockers)
• Various genetic dyslipidemias
• Lipoprotein pattern: atherogenic dyslipidemia (high TG, low HDL, small LDL particles)
• Baseline triglycerides: 200 mg/dL– Lifestyle option:
• Weight loss EtoH and Carbohydrate
– Supplement options:• Niacin• Omega-3 fatty acids
• LDL-cholesterol goal: <100 mg/dL
Diabetic Dyslipidemia
Older Age Issues
Older Age Assessment of Nutritional Risk
• Unintentional weight loss or BMI < 22 kg/m2
• Serum Albumin < 3.5 mg/dL• Unintention reduction in cholesterol or < 150 mg/dL• Reduced calorie or protein intake• Difficult swallowing and/or gastric reflux• Decreased appetite or ability to eat/obtain food• Depression• Economic Issues
Treatment Options for Low Weight in Older Adults
• Liquid suppmements
• Medications that stimulate appetite and weight gain
• Vitamin/mineral supplementation
• Referral to RD and social service
• Use enteral nutrition before considering TPN
Congestive Heart FailureNutritional Evaluation
• Fluid retention (pedal edema or ascities)
• All blood levels in relation to fluid retention
• Serum electrolytes (high sodium and low potassium)
• Hypotension
• Protein (risk of cardiac cachexia)
Treatment of Congestive Heart Failure
• Reduce sodium to < 2400 mg; DASH diet
• Check adequacy of protein and calorie intake
• Check fluid status daily (sign of edema and daily weights)
• Stablize before surgery and invasive medical procedures monitor afterwards
Nutrition Referral Issues
• Integrate nutrition into your overall workup by briefly assessing weight, activity, variety and excess.
• Refer women to RD for in-depth Medical Nutrition Therapy consultation if: 1. You identify a nutrition-related problem
and
2. Patient is ready to address the problem.