Nutrition

SCI228 Storie December 14, 2009 Veronica Martinez-Melero Nutrition Project Case Study # 4 Evangelina is a 30 year old pregnant female 5’11” tall and normally weighs 200 pounds. Evangelina is 5 months pregnant and is moderately active. She plays softball in the outfield position, her and her team practice for 1 hour a day, 3 days a week. Evangelina is also going through a divorce and is worried about losing her house. She uses comfort food to ease her anxiety and nervousness. While being preoccupied with her stressful life she forgets to take her prenatal vitamins which are vital for the fetal development.Evangelina just recently found out that she is lactose intolerant and has gestational diabetes. She was given a cholesterol test and found out that her HDL was low and her LDL was very high. She also has a history of breast cancer in her family. Her mother died of breast cancer at a young age. Nutrition Advice Since Evangelina is a 30 year old woman and pregnant on her second trimester. Evangelina has a Body Mass Index (BMI) of 28.9 which is considered to be overweight. Her normal weight gain on her second trimester should be 1 pound a week. Her total amount of weight gain throughout her pregnancy should be at 15 – 25 pounds. Excessive weight gain can increase the risk of the fetus and will be large for his or her gestational age, increasing the likelihood of trauma during vaginal delivery and of cesarean birth. The more weight gained during pregnancy, the more difficult it is to return to pre-pregnancy weight gain that can become especially problematic if the woman has more children. Evangelina’s considered to be overweight therefore she must eat with moderation and eating the right kinds of fats is important. Being that she is pregnant she needs to limit saturated fat and avoid trans fats because of their negative impact on cardiovascular health. Poly-and monoun-saturated fats should be chosen whenever possible. Omega-3 polyunsaturated fatty acid known as docosahexaenoic acid (DHA) has been found to be critical for both brain growth and eye development. Good sources of DHA are found in oily fish: anchovies, mackerel, salmon, and sardines (fitpregnancy). Evangelina’s Basal Metabolic Rate (BMR) is 1963.44. BMR is the energy we expend just to maintain our body’s basal, or resting, functions. These functions include respiration, circulation, maintaining body temperature, synthesis of new cells and tissues, secretion of hormones, and nervous system activity. The leaner your body mass is the higher the BMR, as lean body mass is more metabolically active than body fat. Physical activity during pregnancy can be a great benefit to a mother-to-be and is recommended for women experiencing normal pregnancies and who are otherwise in good health. Exercise can help keep a woman physically fit during pregnancy, an important asset when enduring the physical stress of labor and delivery. It can also provide the mother-to-be a great mood booster, helping her feel more in control of their changing bodies. Expending additional energy through exercise will also allow intake of compensatory energy when ravenous appetite kicks in. Regular exercise will help keep blood pressure down. Although Evangelina plays softball and is positioned in the outfield, it is recommended that she avoid sports where there is potential for falling or jarring physical contact. Evangelina maximum heart rate is at 70% 133 over her normal heart rate. Since Evangelina cannot produce sufficient insulin or becomes insulin resistant because she has gestational diabetes, exercising, diet, and or medication is a great way to control gestational diabetes. Since breast cancer runs in her family she must do her monthly self exams and make sure she has her monogram exam done as early as 30 years of age. When Evangelina had her cholesterol tested and found out that she had a low HDL, exercise will increase her HDL-cholesterol while lowering blood triglyceride levels. Exercise also helps maintain a healthy body weight and a lower blood pressure and reduces your risk for diabetes. She was also told that her LDL-cholesterol level was very high she can control this by lowering the intake of saturated fat to less than 7% of total energy intake. Decrease cholesterol intake to less than 300mg per day, and keep trans fatty acid intake low. Evangelina has been feeling anxious and nervous and has chosen to comfort herself with ice cream and French fries. This can also be a craving, women who are pregnant more likely, have cravings that are due to hormonal fluctuations or physiological changes or have familial or cultural roots. Or it can also be that she just misses the forbidden foods that she used to eat. People deal with stress in different ways. Some people chose overeating as way to comfort themselves or to help cop. This is the case with Evangelina. This has been a way of coping with her situation at home and with her divorce. A very important way to relieve you from stressful situations is by exercising. In Evangelina’s case she needs to be especially careful to consume adequate amounts of folate, vitamin B12, vitamin C, vitamin A, vitamin D, calcium, iron, and zinc, as well as the adequate amount of proteins and carbohydrates. Since she is not mindful of taking her prenatal vitamins she has to consume the adequate foods, although helpful but not required to take prenatal vitamins. It will be the best option for her since she is lactose intolerant and doesn’t take her vitamins as prescribed by her doctor. Listed below are foods that can be consumed to make up for the vitamin deficiencies. Lactose intolerant is when your body does not produce enough of the enzymes necessary to break down carbohydrates before they reach the colon. Her symptoms of lactose intolerance include intestinal gas, bloating, cramping, nausea, diarrhea, and discomfort. The RDA for folate for pregnant women is 600ug/day, a full 50% increase over the RDA for a nonpregnant female. A deficiency of folate during pregnancy can result in macrocytic anemia (a condition in which blood cells do not mature properly) and has been associated with low birth weight, preterm delivery, and failure of the fetus to grow properly. Good sources of folate include: Primary Sources of Folate in the US Ready-to-eat Cereal Bread Products Other good sources of Folate are: Liver Spinach Lentils Oatmeal Asparagus Romaine Lettuce The RDA for vitamin B12 for pregnant women is 2.6ug/day. Deficiency causes general symptoms of macrocytic anemia, including pale skin, diminished energy and exercise tolerance, fatigue, and shortness of breath. Neurological symptoms include tingling and numbness of extremities, abnormal gait, memory loss, dementia, disorientation. Vitamin B12 is only found in the following foods: Vitamin B12 Dairy Products Meats Poultry Vitamin B12 Supplements Or by injections The RDA for vitamin C is increased by a little more than 10% over the RDA for nonpregnant women (from 75mg to 85mg per day). A deficiency of vitamin C during pregnancy increases the risk for infections, preterm birth, and other problems. Although she drinks plenty of water and get plenty of nutrient by drinking water she still needs vitamin C, she has to drink orange juice or any citrusy juices to make up for vitamin C deficiency. Vitamin C is also an antioxidant. It enhances our immune response, protecting us from illness and infection. Vitamin C is found in the following foods 5 to 9 servings a day is recommended: Vitamin C Citrus Fruits Citrus Juices Potatoes Strawberries Tomatoes Kiwi Broccoli Spinach Leafy Greens Cabbage Red Peppers Cauliflower The RDA of vitamin A for pregnant women needs increase during pregnancy by 10%, to 770ug/day. Excess preformed vitamin A can cause fetal abnormalities, particularly in the kidneys and nervous system, even when not consumed in extremely high quantities. Provitamin A is in the form of beta carotene it can be found in the following foods, recommended amount of servings are 5 to 9 fruit and vegetables per day: Vitamin A (Beta-Carotene) Tomatoes Carrots Cantaloupe Apricots Kale Spinach Pumpkin The RDA of vitamin D for pregnant women does not increase; it remainsat 10ug/day. Pregnant women should avoid consuming excessive vitamin D from supplements; it can cause developmental disabilities in the new born. Pregnant women who receive adequate exposure to sunlight do not need vitamin D supplements. You can get vitamin D by having normal activities out in the sun. Calcium Skim milk Low-fat cheeses Nonfat yogurt Ice cream Regular cheese Whole milk Green leafy vegetables Kale Turnip Greens Broccoli Cauliflower Green cabbage Brussels sprouts Chinese cabbage The RDA for iron for pregnant women is 27mg per day compared to nonpregnant women which is 18mg per day. It represents a 50% increase. During pregnancy, the demand for red blood cells increases to accommodate the needs of the growing uterus, placenta, and the fetus. Fetal demand for iron is needed more towards the last trimester, when the fetus stores iron in the liver for use during the first few months of life. When deficient in iron, this can potentially be harmful to the fetus, resulting in an increased rate of low birth weight, preterm birth, stillbirth, and death of the newborn in the first weeks after birth. Good sources of iron are found in the following foods: Iron Clams Oysters Beef liver Cereals Breads Tomato paste Turkey giblets cooked Chili con carne The RDA for zinc is 11mg per day for pregnant women increases by 38% over nonpregnant women. Zinc plays a very import role in DNA synthesis, RNA synthesis, and protein synthesis, it is imperative that the adequate zinc status be maintained during pregnancy to facilitate proper growth and development of both maternal and fetal tissues. Inadequate amounts of zinc can lead to malformation in the fetus, premature delivery, and extended labor. When supplements are taken during pregnancy, it is good to take with food or with a good vitamin C source to enhance the absorption of both zinc and iron. Good sources of zinc are found in the following foods: Zinc Oysters Kellogg’s Products 19 cereal Pork & Beans Beef, chuck roast Beef, ground Beef liver fried Barley Pork sholder Refried beans Dark meat of Poultry The RDA for sodium and iodine in pregnant women is 220ug per day for iodine and 1500mg per day for sodium. It is easy to consume iodine, since it is achieved by using a modest amount of iodized salt. When you consume too much sodium it is associated with fluid retention and bloating, as well as high blood pressure, increased fluids are a normal and necessary part of pregnancy. Evangelina’s pregnancy has deficiencies in proteins and carbohydrates; the RDA for proteins is increased up to 10 to 15 grams of protein per day. The RDA for carbohydrates is also increased by for daily physical activity. The carbohydrate deficiency can be met by consuming a sensible diet but should be verified in each individual case. Not only are these good sources of proteins and carbohydrates but they’re also a source of fiber. The followings foods may be consumed for the proper proteins and carbohydrate intake: Dairy products Meats Eggs Soy products Legumes Whole grains Nuts Seeds Carbohydrates Whole-grain breads and cereals Brown rice Fruits Vegetables Legumes I have provided additional information where you can visit these web-sites and it will provide you with your Dietary Reference Intakes, Food Guide Pyramid, Helpful ideas on how to get the adequate vitamins and minerals while being pregnant. You can also talk to Professional Organizations that provide reliable nutrition information: The American Dietetic Association (ADA) The Society for Nutrition Education (SNE) American College of Obstetricians and Gynecologists http://www.acog.org National Institutes of Health Office of Dieting Supplements http://ods.od.nih.gov/factsheets/folate.asp>. The Journal of Prenatal Education What's a Pregnant Woman to Eat' A Review of Current USDA Dietary and My Pyramid http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876595/>. Trustworthy experts educated and credentialed for example: Registered Dietitian or RD Licensed Nutritionist Professional with an advanced degree MA or MS or doctoral degree (PhD) in nutrition Medical Doctor Work Cited "National Institutes of Health Office of Dieting Supplements." http://http://ods.od.nih.gov/factsheets/folate.asp. "NutritionData." http://www.nutritiondata.com/yourpregnancy/40731387.html. "What should I eat during my pregnancy'" Netdoctor. http://www.netdoctor.co.uk/health_advice/facts/pregnantdiet.htm. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876595/.