Transcript Jump-Starting IYCF… - Nutrition at the Center

Jump-Starting IYCF:
Infant nutritional status
depends on the mother’s
status
Starting in Pregnancy?
Or Before?
Nutrient status of the mother
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Pre-pregnancy diet
Pre-pregnancy nutritional status
Pre-pregnancy work load or activity level
Spacing between pregnancies
Measuring Adult Nutritional Status
Body Mass Index
BMI = weight (kg) / height (m)2
60.5 kg / (1.6 m x 1.6 m) = 24
Effects of Maternal Nutrition
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Ability to nourish in-utero starting at conception
Ability to provide quality breastfeeding without
depleting her own nutrient stores
Maintenance of her quality of life, productivity
and capacity to care for child
Changes in Nutrient Needs
Nutrient
PrePregnancy
During Pregnancy by Trimester
During Lactation
!st
2nd
3rd
0-6 mos.
>6 months
+0
+240
+452
+500
+400
Energy
2200 kcal
Protein
46 g
+25
+25
+25
+25
+25
700 RAE
+70
+70
+70
+600
+600
Iron
18 mg
+9 mg
+9
+9
+0
+0
Folate
400 ug
+200
+200
+200
+100
+100
Iodine
150 ug
+70
+70
+70
+140
+140
1000 mg
+0
+0
+0
+0
+0
8 mg
+3 mg
+3 mg
+3 mg
+4 mg
+4 mg
Vitamin A
Calcium
Zinc
Physiological changes during
pregnancy
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40% increase in blood volume and 25% increase
in red blood cell mass
Increase in lung ventilating capacity and rate
Fat deposition during first half of pregnancy
Rapid growth of fetus and placenta during
second half of pregnancy
Synthesis of large quantities of new protein
tissue - also require energy
Energy Intake during Pregnancy
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Increase roughly 200-300 kilocalories/day
during second and third trimester
Depends or pre-pregnancy BMI
Underweight women may need more kcal
Active women must also decrease physical
activity
Weight Gain During Pregnancy
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Average weight gain is 10 to 12 kg:
Fetus, placenta, amniotic fluid
 Maternal blood
 Maternal tissue fluid
 Uterus, breasts
 Maternal adipose tissue
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5 kg
1 – 1.5 kg
1 – 1.5 kg
1 – 1.5 kg
4 kg
Energy Needs during Lactation
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Increase by up to 500 kilocalories per day
Fat stored during pregnancy can be used to
satisfy this energy requirement
Increased energy intake does not result in
increased milk production in adequately
nourished women
Sufficient amount of milk can be produced by
women with low energy intake
Why so much energy for lactation?
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Human milk is about 70 kcal/100 ml
Maternal energy is converted with about 80%
efficiency to milk energy
~85 kcal of maternal energy needed to produce
100 ml of breast milk
An average milk secretion of 750 ml per day,
requires 640 kcal/day
Some of this can come from stored fat
Nutrient Quality of Breast Milk
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Energy, protein, and some mineral content is
not affected by maternal dietary intake or stores
Vitamin C, thiamine, riboflavin, B6, B12,
Vitamin A, iodine and selenium are dependent
on maternal intake or stores
Maternal intake has minimal effect on content
of zinc, iron, folate, Vitamin D, calcium and
copper content of breast milk
Protein
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About 925 g of new protein are synthesized and
deposited in mother and fetus
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Average breast milk production per day - 750 ml
with protein content of 1.25 g/100 ml
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Adequate energy intake from carbohydrates is
essential to assure new protein synthesis
Iron-deficiency anemia
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50% of anemia is from iron deficiency
Absorption may be as important as low dietary
intake
Inhibitors
 Heme vs. non-heme
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Other major causes of anemia:
Malaria
 Helminthes
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Efficacy of Iron Supplementation
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World Bank review found that distribution was
the limiting factor not utilization
Counseling on purpose is as important as
counseling on controlling side effects
Some concern that iron inhibits zinc and copper
absorption
Actions to Prevent Anemia
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Promote intake of iron-rich foods, especially animal
products and fortified foods
Provide iron supplementation to pregnant women
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Continue supplementation for 3 months post-partum in areas
with anemia prevalence >40 percent
De-worming of pregnant women after first trimester,
and lactating women, according to WHO protocol
Prevent and control malaria
Vitamin A
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Provide post-partum high-dose vitamin A
supplementation to women
If breastfeeding, within 8 weeks of delivery
 If not breastfeeding, within 6 weeks of delivery
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Promote consumption of vitamin A-rich foods,
including liver, fish, egg, and red and yellow
fruits and vegetables
Promote consumption of vitamin A-fortified
foods
Iodine
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Sufficient iodine intake in pregnancy and
lactation is essential in prevention of maternal
and fetal hypothyroidism
Insufficient iodine intake in pregnancy may have
an adverse effect on fetus as early as 8-10 weeks
of gestation
Iodine content of breast milk depends on iodine
intake by lactating mother
Calcium
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about 30 g of Ca is accumulated in pregnancy to
meet fetal needs and demands of lactation
absorption of Ca increases up to two times in
the second half of pregnancy thus reducing
needs for increased intake
• Ca content of breast milk does not depend on
calcium intake
Zinc
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Some data suggest that Zn deficiency may cause
intrauterine growth retardation of fetus
Zn levels in maternal serum decline during pregnancy
(dilution effect)
When Zn intake is low (less than 7.3 mg/day)
absorption of Zn increases;
This may be sufficient to meet maternal needs without
extra Zn supplements
• Zn absorption is decreased by Fe supplements
Folic Acid
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Folate deficiency during pregnancy may cause
megaloblastic anemia
Deficiency of folate in pregnancy is related to
occurrence of neural tube defects in fetus
The critical period for preventing neural tube
defects is often before pregnancy is diagnosed
Folate in foods is destroyed by boiling
Essential Nutrition Actions
4. Prevention of vitamin A deficiency for women
5. Promotion of adequate intake of iron and folic acid for women
7. Promotion of optimal nutrition for women:
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Consume more food during pregnancy and lactation
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Pregnancy: 285 extra kcal/day
Lactation: 500 extra kcal/day
Increase protein intake during pregnancy and lactation (e.g. pulses, animal
source foods, oilseeds)
Provide iron/folic acid supplementation for pregnant women
Treat and prevent malaria
De-worm during pregnancy in areas where helminths are a determinant of
anemia
Provide post-partum vitamin A supplementation
Promote consumption of iodized salt
What to do in the field?
At the Community Level:
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BCC: incorporate maternal nutrition messages at key contact points
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Promote increased caloric consumption of pregnant and lactating women and
decreased physical activity
Promote improved dietary diversity among all women of reproductive age
Promote consumption of fortified foods
Engage spouses and in-laws during home visits
Promote uptake of key maternal nutrition services
Home Food Production of nutrient-rich animal foods, fruits and vegetables
Food supplementation to food insecure households
Food fortification: vitamin A, iron/folic acid, and iodine
With the Health Services
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Micronutrient supplementation: vitamin A and
iron/folic acid
Complementary maternal health services
Malaria prevention and treatment
 Helminth prevention and treatment
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Develop and strengthen referral systems
When intervention is urgent:
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>10% of adult population has a BMI <18.5
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For women, based on pre-pregnancy weight
>15% of newborns are LBW (<2500g) = high
public health concern
Thank-you