Preconception Nutrition Part 2

BMI measures are not representative of healthy people who are

individuals with more muscle mass (athletes), less muscle mass, dense large bones, de or overhydration

caloric cause of obesity

caloric intake is greater than expenditure

etiology of obesity

caloric intake, limited f/v, 2 days per week of exercise, and sleepig less than 7 hours per day

thyroid hormone and obesity

decrease in metabolism by hypothyroidism

insulin and obesity

increase synthesis and storage of fat

leptin and obesity

increase satiety

ghrelin and obesity

more intake, decrease in metabolism and fat use

nutrition intervention for obesity; successful weight management

realistic goals, calorie deficit, stress management, slow mindful eating, regular exercise

BMI calculation equation

weight in kg / height in meters squared

1 kg

2.2 lbs

1 m

100 cm

1 inch

2.54 cm

1 ft

12 inches

candidates for bariatric surgery

BMI over 40, over 35 with co morbidities

registered dietitians counsel on adherence to

strict eating guidelines, supplement prescription, reduction of portion sizes, eating instruction

3 main types of bariatric surgery

gastric band, roux en y, LSG

gastric band surgery

restricive procedure

roux en y surgery

gold standard; malabsorptive procedure

LSG

new; laparscopic sleeve gastrectomy; 75% of stomach removed and too risky

bariatric surgery can reverse the condition if

BMI is over 35 and diabetic

y configuration bariatric surgery musts

avoid large portions and high fat, high sugar foods (dumping syndrome)

rate of bariatric surgery

increased for weight loss

bariatric weight rapidly lost due to

limited food intake, fat malabsorption, dumping syndrome

deficiencies of many nutrient stores; pregnancy after bariatric surgery

thiamin, vitamins D and B12, folate, iron and calcium

pregnancy after gastric bypass

fetility restored in many women; avg time for delivery 27 post op

common in pregnant women who have had gastric bypass

gestational diabetes and pregnancy induced hypertension

male infertility via increased leptin and estrogen levels

no GnRH, FSH, or LH released; decreased testosterone and sperm count

male infertility via increased infulin over 40

cause DNA damage in sperm; no SHBG increases free estrogen and prevents sperm maturation

male infertility via inflammation

damages sperm

female infertility via increased leptin and estrogen

no GnRH, FSH, or LH released; negative feedback less estrogen, eggs not maturing

female infertility via increased insulin over 35

increased testosterone from ovaries; no SHBG increases free testosterone and prevents follicle maturation

female infertility via increased inflammation

damages eggs

central body fat and fertility

central obesity increases time required to coneive

weight loss and fertility

should be first fertility therapy for obesity; loss of 7-22 lbs in women and 100 lbs in obese men increases fertility

metabolic syndrome is diagnosed if

3 of 5 conditions exist

metabolic syndrome tests

waist circumference, blood triglycerides, HDL cholesterol, blood pressure, and fasting blood glucose

metabolic syndome prevalence

around 39% of US adults

consequences of metabolic syndrome

increased risk of CVD and type 2 diabetes

metabolic syndrome therapies

dietary modification, weight reduction, exercise

hypothalamic amenorrhea

cessation of menstruation related to changes in hypothalamic signals that maintain secretion for ovulation hormones

cause of hypothalamic amenorrhea

deficits in energy and nutrients; common in those exposed to social stress or intellectual professionals

nutritional management of hypothalamic amenorrhea

weight gain by eating healthful diet; 6-11 pound gain typically restores fertility

RED S stands for

relative energy deficiency in sports

RED S is cause by

athletes not consuming enough calories to support activity levels

not enough calorie consumption in athletes can result in

amenorrhea, performance decline and fatigue, low bone density, risk for injury, psychological issues

RED S results in

decreases in luteinizing hormone and lack of estrogen; low hormone levels reduces bone density

nutritional management for RED S

increased calorie to restore energy balance and vitamin D/calcium to facilitate bone development

eating disorder affect

3-5% of young women

disorder that amenorrhea is common in

anorexia nervosa

disorder that oligomenorrhea is seen with

bulimia

for eating disorders, menses resumes with

weight gain

diabetes mellitus

intolerance to carbohydrate with fasting glucose more than 126 mg/dL

types of diabetes

type 1, 2, and gestational

type 1 diabetes

destruction of insulin producing cells; low insulin

type 2 diabetes

body unable to use insulin normally, to produce enough, or both; high insulin

gestational diabetes

onset during pregnancy; diagnosed at 20 weeks or later

number of individuals in U.S. who are pre diabetic

115.2 million

high blood glucose levels during first two months of pregnancy

can be teratogenic; 2-3 fold increase in congenital abnormalities

diabetes prior to pregnancy can cause malformations of

pelvis, CNS, heart; higher rates of miscarriage

insulin

stimulates uptake of glucose from blood to cells; major public health problem

insulin resistant cells

have around 5000 receptors that lower uptake by cell

risk factors for insulin resistance

obesity, central obesity, physical inactivity, and small size at birth

insulin resistance is associated with

PCOS, metabolic syndrome, type 2 diabetes, gestational diabetes, and heart disease

nutrition management of type 2 diabetes

weight loss of over 7% BW, 150 min per week PA, balanced diet, fiber, low GI foods

most received type of medication for diabetes

insulin and oral medication

hemoglobin A1C

form of hemoglobin that measures average glucose

normal A1C

4.5-6%

pre diabetic A1C

5.7-6.4%

estimated avergae glucose/ A1C

7% or 154 mg/dL

glycemic index

rating system from 0 to 100 that measures how quickly carbohydrate containing foods raise blood sugar levels

glycemic load

calculated by multiplying GI of food by grams of carbs contained in amount consumed divided by 100

properties that influence GI (increases)

degree of food processing, cooking time, acid and fat consumption, and heat

high protein intake can

lower GI

other ways to manage type 2 diabetes

diets to lower cholesterol, fish consumption, chromium and magnesium supplements

have positive association with developing diabetes

fruit juice and artificial sweeteners

leading cause of female infertility

PCOS

women PCOS affects

5-10% of childbearing age

many with PCOS are

obese or have high levels of abdominal fat

cause of PCOS

uncertain; strong genetic component or possibly insulin resistance

PCOS

low estrogen, high testosterone

nutritional management with PCOS

adequate vitamin D, omega 3, whole grains, fruits, vegetables

managing PCOS

goal is to increase insulin sensitivity; drugs, hormonal therapy, etc

celiac disease

autoimmune disease in people with genetic susceptibility to gluten found in wheat; causes malabsorption and flattening of intestinal lining

symptoms of celiac disease

diarrhea, cramping, gas, bloating, skin rashes, migrains, joint and bone pain

with celiac disease, plush microvilli becomes

a tile floor; nutrients aren’t properly absorbed

male infertility via celiac linked to

alterations in androgen action, delayed sexual maturation, hypogonadism

female infertility via celiac linked to

amenorrhea, increased risk of miscarriage, fetal growth restriction, LBW deliveries, short duration of lactation

folate deficiency consequence with untrated celiac

lactose maldigestion, intolerance

nutritional management of celiac disease

eliminate gluten for life, search for gf labels, correction of vitamin/mineral deficiencies, visit RD

august 2014 FDA new regulation

all food labeled GF must contain less than one crumb of bread, applies to all but meat/poultry/egg and alcohol

food can still be contaminated during

preparation, storage, transportation

reasons for gluten free

weight loss, ADHD, healtier, autoimmune disease, arthritis, headaches, GI complaints

fodmap

fertmentable oligo di monosaccharide and polyols

what is fodmap

poorly absorbed short chain carbs; wheat, onions, dairy, etc

fodmap diet

can lessen symptoms of IBS but must be followed by an RD; effectiveness are limited

foods suitable on a low fodmap diet

fruits, veggies, grain foods, milk products, other

gluten sensitivity

no damage or inflammation; no antibodies or allergies in blood

wheat allergy

wheat antibodies found in serium

celiac disease

tissue damage/microvilli and inflammtation; gf diet needed