malnutrition can adversely affect the health of the mother and fetus

1. Nutritional supplement
Is there a role ?
Moderators
Veerendrakumar C M
Vinayaka Khedkar
1

2. Panelists
Aradhana singh
Bindu K M
Guruprasad K
Meeta Bilagi
Oby Nagar
Seema Mehtha
Urmila Patel
Vijayashree
2

3. India is passing through the phase of economic
transition
undernutrition continues to be a major
problem,
overnutrition is emerging as a significant
problem
3

4. Why a typical Indian woman
require a nutritional
supplementation ?
Do you think Indian diet
contain RDA of nutrients ?
4

5. Energy inadequacy is 70% and protein inadequacy is 27%
5

6. Do you think there is adequate balanced production
of food in India ?
6

7. Unfavorable distribution of food production ?
Production of cereals and millets adequat
e
Pulses production and availability is declinin
g
30% vegetable production is declined
Milk consumption less than world average
National institute of nutrition 2011
7

8. 1. Eat variety of foods to ensure a balanced diet.
2. Ensure provision of extra food and healthcare to pregnant
and lactating women.
NIN dietary guidelines 2011
8

9. Nutrition supplements in
pregnancy
9

10. Definition of nutritional
supplementation
10

11. • Nutritional supplements are any dietary
supplement that is intended to provide
nutrients that may otherwise not be consumed in
sufficient quantities:
for example vitamins, minerals, protein, amino acids
or other nutritional substances.
11

12. Nutritional supplementation
or
Dietary supplementation?
What is the difference ?
12

13. a dietary supplement must be labeled as a
dietary supplement and be intended for
ingestion and must not be represented for use
as conventional food or as a sole item of a meal
or of the diet.
The Dietary Supplement Health and EducationAct of
1994
13

14. FDA-approved drugs cannot be ingredients in dietary
supplements.
Supplement products contain vitamins, nutritionally essential
minerals, amino acids, essential fatty acids and non-nutrient
substances extracted from plants or animals or fungi or bacteria,
or in the instance of probiotics, are live bacteria.
all products with these ingredients are required to be
labeled as dietary supplements.
14

15. How do you classify foods with regard to nutrition
supplementation
15

16. 16

17. What is fetal programming? and
effect of nutritional supplementation
on this ?
(In utero origin of adult onset disease)
17

18. The mother’s health before and during pregnancy may be
affected by genetics, as well as malnutrition,acute and chronic
disease, exposure to environmental toxins, and a number of
other factors. The fetal origins hypothesis proposes that
certain genes in the fetus may or may not be “turned
on” depending on the environment that the mother is
exposed to while pregnant (Hampton, 2004)
18

19. Epigenetics Is Everywhere.
What you eat, where you live, who you interact with,
when you sleep, how you exercise, even aging –
can eventually cause chemical modifications around the
genes that will turn those genes on or off over time.
Additionally, in certain diseases such as cancer or
Alzheimer’s, various genes will be switched into the
opposite state, away from the normal/healthy state.
19

20. Fetal risk of developing adult- onset diseas
e
Determined by
at least in part, by maternal nutritional status at
conception, during pregnancy, and in early infancy.
20

21. FETUS RESPONDS BY LIMITING THE GROWTH
WITH LESS NUMBER OF CELLS ESP IN HEART
AND NEPHRONS
CHARACTERISED BY HYPERINSULIN RESPONSE
LATER IN LIFE PRONE FORTYPE 2 GM, CVD,
CARDIAC FAILURE
Barker dj, placenta, 2013
ADULT ONSET OF DISEASE IS PROGRAMMMED BY
MATERNAL NUTRITIONAL STATUS.
21

22. What are the lessons learnt from Dutch famine ?
1944-45
(Episodes of famine in otherwise well
nourished population )
22

23. Higher rates of adult-onset disease in the offspring including
impaired glucose tolerance
obesity
coronary heart disease
atherogenic lipid profiles
hypertension
microalbuminuria
schizophrenia,
antisocial personality and affec- tive disorders
addictive disorder in men.
Am J Psychiatry. 2000, Eur J Epidemiol. 2006 ,J Hypertens. 2007
23

24. Is there any difference on fetal outcome based on
nutrition deficiency at different gestational age
24

25. nutrient deficits early in the pregnancy may lead to compromised
organ development,
deficits later in pregnancy may lead to an LBW infant with
normal organ function
25

26. Conflict of interest
Chemical communication
between mother and fetus
Fetus evaluates the nutritional
environment and adjusts its
growth for its survival
In the event nutritional
deficiency placenta limits
nutrition supply to the fetus
26

27. • Maternal nutrition must be optimized before conception
Preimplantation and early differentiation environment is ready
to support early fetal and initial placental development.
Maternal nutritional status influences nutrient partitioning to
the placenta or fetus, which subsequently affects disease risk.
27
Therefore …..

28. What are the recommended
calories and protein intake
during pregnancy and lactation ?
28

29. ICMR
29

30. Is it really essential to supplement with the
micronutrients ?
30

31. When compared with iron and folate alone, multiple
micronutrients can significantly lower the incidence of SGA
infants
.
Regular consumption of fortified cereal grains appears to be an
effective source of all but B vitamins, iron, and folate.
31

32. Gestation weight gain
recommendations ??
32

33. IOM guidelines(2009)
33
IOM guidelines 2009

34. Obese pregnant women who gained less than 15lb had lowest
rate of PE,DM , LGA babies and CS rates
Kiel 200
7
34
Maternal weight gain positively correlated with
birthweight.

35. Optimal weight gain helps in proper
maternal adaptation and fetal
development..
35

36. Title Text
BMI and nutritional SUPPLEMENT influence on
pregnancy outcome
36

37. Title Text
37

38. Women with a high pre pregnancy BMI have infants
with higher birth weights,
and heavier babies have a higher body fat mass.
38

39. Increased intake associated with
increased maternal wt gain
hypertension
GDM
heavier babies
obesity associated comorbidites
39

40. Dutch famine 1944-45
An inadequate energy intake
is associated with
• SGA or low birth weight
(LBW <2500grams)
• SGA is associated with an
increased risk of adult
metabolic diseases including
type 2 diabetes
40

41. Whether ‘*eating for two’* adage holds
good during pregnancy??
41

42. Furthermore, given the average caloric intake of many individuals,
there is no need to increase caloric intake in pregnancy, but rather to
shift low-nutritional calories into more nutrient-dense calories.
42
First trimester 90-125kcal/day
Second trimester 286-350kcal/day
Third trimester 466-500kcal/day

43. What is your opinion on carbohydrates intake ?
43

44. High quality carbohydrates 175g/d with low Glycemic
index diet must be chosen
44

45. 45
• Found naturally in whole
foods such as whole
grains, nonstarchy
vegetables, fruits, beans,
peas, lentils, and low-fat
dairy.
• All women, including
pregnant women, should
limit their intake of these
sugars, as well as foods
that have high amounts of
added sugar

46. what is *high calorie malnutrition ?*
46

47. A diet filled with carbohydrates and fats (soft drinks, chips,
etc) can easily lead to satiation before an adequate amount
of protein and other nutrients has been consumed
.
Damage from a low-protein diet includes decreased brain
size, altered fat distribution, increased obesity, shorter
gestation and decreased birth weight, increased stress
sensitivity, decreased sperm quality, altered cardiac energy
metabolism, and changes in muscular tone
.
47

48. Title Text
protein intake recommendations??
48

49. The DRI for protein during pregnancy is
1.1 g/kg per day or approximately 71 g protein
per day starting in the second trimester,
which is approximately 25 g more than what is
recommended for nonpregnant women.
49

50. A diet skewed toward a high-meat, low carbohydrate
intake leads to a higher incidence of hypertension in the
offspring as well as high cortisol levels.
50

51. What are ILL effects of PSMF diet
(protein sparing modified fast diet )
51

52. Protein Sparing Modified Fast die
t
PMSF is a very low calorie type of fad diet
While people often lose weight, they
frequently regain it afterwards.
Health concerns include dehydration, hence
fluids, vitamin and mineral (potassium,
magnesium, sodium, and calcium).
Since PSMF includes little or no fat, the
rapid weight loss may cause gallstones.
It is therefore recommended to consume at
least a minimum amount of fat daily.
52

53. How much fat to be consumed ? Adverse
effects of fat intake on fetomaternal outcome
53

54. total dietary fat intake to between 25% and 35% of total calories.
High-fat diets in pregnancy have been found to increase insulin
resistance.
A high saturated fat intake is associated with development of
glucose abnormalities in pregnancy and an increased risk of GDM
.
Higher intakes of animal fat and cholesterol before pregnancy are
also associated with an increased risk of GDM, as is a higher intake
of saturated fat during pregnancy
. J Acad Nutr Diet. 2014;114:136–153
54

55. What’s your view on PUFA supplementation in non
fish eaters ?
55

56. Docosahexaenoic acid (DHA) and n-3 fatty acids are needed for brain and retinal development throughout the third trimester of gestation and the first year of life. The fetus
needs 200 to 300 mg/d of DHA and 500 mg of DHA plus eicosapentaenoic acid (EPA) per day. Good sources of n-3 fatty acids include fatty fish and seafood recommendation
of 12 oz per week, walnuts, and dietary supplements.
For women who do not eat fish, n-3 PUFA supplementation appears to be associated with a small decrease in preterm birth and LBW infants
Jensen CL. Effects of n-3 fatty acids during pregnancy and lactation. Am J Clin Nutr. 2006;83(suppl 6):1452S–1457S.
CL. Effects of n-3 fatty acids during pregnancy and lactation. Am J Clin Nutr. 2006;83(suppl 6):1452S–1457S.
56

57. What is food pyramid concept ?
as a part of dietary advice
57

58. food pyramid
58

59. The groups most vulnerable to micronutrient deficiencies are
pregnant and lactating women and young children,
mainly because they have a relatively greater need for vitamins
and minerals and are more susceptible to the harmful
consequences of deficiencies
…to meet… … intake of micronutrients is to provide foods
fortified with micronutrients.
Fortified foods, such as corn-soya blend, biscuits, vegetable oil
enriched with vitamin A and iodized salt
59

60. Address both malnutrition
and underlying cause
• Malnutrition may be due to illness, food
insecurity, or other factors
• maximize positive outcomes for both mother
and baby.
60

61. 61

62. Physicians need a better understanding of the role of
diet in shaping fetal outcomes
The physician treating a pregnant woman should be
ready to advise a healthy diet for the benefit of the fetus.
62

63. Effect of nutrition on the offspring and on the
mother should be well understood
63

64. One 2016 analysis estimated the total market
for dietary supplements could reach $278
billion worldwide by 2024.
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65. Thank you
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