Download بسم الله الرحمن الرحيم Community Medicine Lecture - 9

‫بسم هللا الرحمن الرحيم‬
Community Medicine
Lecture - 9 -
Learning objectives
At the end of this lecture student would be able
to :
1-Determine special problem in diet therapy .
2-Outline determining factors for maternal
nutritional requirements .
3-Discuss nutritional requirements during
pregnancy and lactation .
4-Enumerate reasons for increased protein
requirements during pregnancy and lactation .
Special problems in diet therapy
1.Transition from one route of feeding to another.
Transitional feeding refers to the process of return to the
usual feeding pattern after total parenteral nutrition, or
enteral
feeding
by gastrostomy, jejunostomy ,
esophagostomy or nasogastric tube.
After extended periods of disuse , the gut may not
function normally and unless the transition process is
carefully monitored , oral intake and or food absorption may
be inadequate.
2.Adherence to diet
Compliance with therapeutic dietary
recommendations is relatively easy to monitor in
hospitalized patients . However , patient may refuse or
be unable to eat or may miss meals because of
diagnostic tests .
Therefore , nutritional status and patient adherence
should be monitored carefully even in the hospital.
To implement therapeutic diets in outpatients, patient
must be motivated and must understand the diet
instructions and the changes in what to be eaten.
Psychological support ; assistance in learning new
food preparation buying and management skills; help
with eating, are as important as nutritional advice.
3.Assuring the continuity of nutritional care (the team
concept) :
Nutrition is too important to be the sole
responsibility of a single member of the health team.
Nutritional counseling can and does change dietary
habits and each health -care provider has a critical
role in assuring that nutrition is adequate .
Nutrition during pregnancy & lactation
Maternal nutrition is critically important for both
mother and her child .
Several determining factors for maternal nutritional
requirements :-
1.Age & parity
Maternal age to start with pregnancy is very
important e.g. A teenage pregnant need to add her own
growth needs to those imposed by her pregnancy state.
Multiparty also need more nutritional requirements.
2.Pre - conception nutrition
Maternal nutrition and health status before becoming
pregnant has an important impact upon pregnancy
outcome.
3.The complex metabolic interactions of gestation
During pregnancy , woman body , placenta and fetus
will form a unique biological unit with a constant
biological interactions and nutritional requirements.
4.Placenta work in a selective manner
۞Vitamin C concentration in fetal serum is usually 24 times that of the mother.
۞Vitamin A serum level in mother is greater than in
fetus .
۞Placenta conserve much hemoglobin for fetal
construction at the expense of his mother.
5.Maternal weight
Underweight mother tend to add weight at the
beginning of pregnancy on the expense of her child or
fetus . Excessive weight gain can affect fetus and
process of delivery.
Nutritional requirements during pregnancy
۞During pregnancy , the caloric requirements must
be increased by 10-15% of the daily standard needs in
the pre-pregnancy period.
۞About 300-400 Kcal/day is the amount of additional
caloric requirements specially during the second and
third trimesters.
۞An additional 20-30 gms of proteins is
recommended throughout pregnancy.
۞Additional calcium need is about 0.4 gm daily.
۞Daily additional iron requirements is 30-60 mg .
۞A proportional increase in vitamins intake should be
done with the increased caloric requirements.
Note :1.In regard to lactation , additional 40 gms of proteins
is needed daily.
2.Each 100 ml of breast milk require 130 Kacl as an
additional requirement.
About 800 ml of milk is usually produced during 24
hours , thus about 1000 Kcal is the additional caloric
requirements for lactation.
۞During pregnancy , usually there is some discomfort
feeling after taking three main meals , thus it is better
to have 5-6 meals during pregnancy and even during
lactation .
۞In regard to protein source , it is better to advice
pregnant to have plant origin protein with a twice
weekly animal origin proteins for essential amino acids
supplement.
۞It is better to encourage breast feeding practices.
Reasons for increased protein requirements
1.Rapid growth of developing fetus.
2.Placenta development.
3.Maternal breast tissue increase.
4.Increased circulating blood volume by 20-50% .
5.Amniotic fluid formation.
6.Increased storage reserve by about 200-300gm of
nitrogen to be used for labour and during immediate
postpartum period.