Download Nutrition and anaemia

Nutrition and Anaemia
- Dr Andrew Lewandowski
Australian South Asian Healthcare
Association (ASHA)
Maternal Health Education Program
Cambodian Nutrition situation – US-AID 2014
• Prevalence of
– Stunted growth <5yo = 40%
• Rural 42%
• Urban 28% - attributed to water/ sanitation access
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Anaemia among children <5 = 55%
Anaemia among women of reproductive age = 44%
Children 0-5mths exclusively breastfed = 74%
Children breastfeeding age 6-24mths getting acceptable diet = 45%
• Undernutrition rates high – and have changed little in the last 10 years
• Micronutrient deficiencies – iron, vitamin A, iodine --> critical
• High rates of anaemia are partly due to high prevalence of thalassemia
(30% in a survey conducted in 1 province)
• Stunted growth is inversely related to maternal education levels!
Prenatal nutritional requirements
• Good nutrition is important at all stages of life and particularly in
pregnancy
• The health and nutritional status of mothers and children are
intimately linked
• Beginning pregnancy with a healthy diet gives the baby the best
possible nutritional advantage.
• A varied diet is vital in supporting the growth and development of
the baby and the maintenance of the woman’s own health.
• Nutritional requirements for most nutrients increase during
pregnancy, particularly folate, iron, zinc, and vitamin C
• There is only a small rise in energy requirements, which can be
achieved by eating for example an extra bowl of rice per day
Top tips for a healthy diet!
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Choose a variety of foods from each of the different food groups.
Ask your doctor about extra supplements if you may not be eating from a particular food
group.
Have 3 regular meals and 2 to 3 light snacks a day.
Include lots of fruit and vegetables, wholegrain cereals, and beans to increase fibre intake.
Drink water regularly – at least 8 glasses a day.
Include other drinks in your diet such as low-fat milk, fresh fruit juices and soup.
Eat one portion of oily fish and one of white fish weekly (avoid shark, swordfish and marlin).
Use vegetable oils such as corn, olive and sunflower oil in your cooking, but use them
sparingly.
Limit your intake of processed and preserved foods as they usually contain high levels of salt.
Reduce your caffeine intake to no more than 4 cups a day.
Limit your intake of sweets, crisps, cakes, biscuits, fats, oils, and sugar. These all provide extra
calories but not much of the nutritional value that you and your child need.
Iron
• Major dietary sources of iron =
Meat / Chicken / Fish
– These are 2-3 times more
absorbable than plant-based
iron foods and iron-fortified
foods
– Vitamin C enhances absorption
– recommended in pregnancy!
(some iron supplements
contain Vitamin C anyway!)
• Vegetarians should eat food
high in iron
– Beans / Lentils / Spinach /
Whole Wheat Breads
– Peas / Apricots / Prunes /
Raisins
Side Effects of Iron
• Oral liquid iron – dilute with
water and a straw to prevent
discoloration of teeth
• Nausea
• Epigastric Pain
• Constipation
• Dark stools
• Management for side effects
include:
– Nausea  take tablets on empty
stomach 1 hr before, or 2 hrs after
a meal
– Commence tablets on a low dose,
and then gradually increase the
amount OR, take smaller doses
more frequently
Vitamin B12
• Sources – dairy, eggs, meat, fish
• Required for synthesis of new DNA – demand increases by
10 fold in pregnancy!
• B12 deficiency uncommon in pregnancy --> often
associated more with infertility
• Causes:
– Inadequate intake- alcohol
– Malabsorption
• Pernicious anaemia, bowel disease
– Generally only deficient in vegetarians / vegans (no meat which
is the main source of B12)
– These women should take supplements during pregnancy
B12 deficiency
• Manifestations of B12 deficiency
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Peripheral neuropathy (numb fingers / toes)
Ataxia (clumsy)
Optic Neuropathy (poor eyesight)
Dementia
Psychosis (rare)
Physical signs
• Sore lips / tongue
• Management
– Check B12 levels early in pregnancy
– Vegetarians = B12 supplementation – during pregnancy
and breast feeding
Folate
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Important for DNA synthesis – demand
increases up to 10 X in pregnancy
Deficiency can cause neural tube defects
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Found later on in pregnancy due to rapidly
growing foetus
Primarily caused by reduced dietary intake
or poor absorption
Recommended intake = 600mcg/day – in
most prenatal vitamins
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Spina bifida
Encephalocoeles (more common SE Asia)
Found in green leafy vegetables, beans,
and orange juice
Women at risk of folate deficiency (e.g.
multiple pregnancy, anaemia, on antiepileptic medications or previous baby
with neural tube defect) should take 5 mg
of folic acid throughout the pregnancy
Anaemia
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Definition
– Low haemoglobin (<110g/L)
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Symptoms
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Tired, short of breath
Reduced energy
Reduced mental performance
WHY IS IT IMPORTANT?
• Severe anaemia
– preterm birth
– low birth weights
– higher risk of maternal mortality (PPH)
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Post Partum anaemia linked to
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depression
emotional instability
stress
lower cognitive performance tests
Causes of anaemia
• Most common causes of anaemia
in pregnancy
– iron deficiency
– folate deficiency
– vitamin B12 deficiency
– hemolytic diseases
– Rare things:
• bone marrow
suppression, chronic
blood loss and underlying
malignancies
• 30-50% of woman become
anaemic during pregnancy,
with iron deficiency being
the most common form of
anaemia ((>90% of cases)
How much do you need?
• Your gut increases iron absorption when the body’s iron stores are low.
• It reduces the absorption when there are sufficient stores.
• Requirement for absorbed iron ranges from
– 0.8mg/day in the first trimester
– 7.5 mg/day in the second trimester
– averaging approximately 4.4 mg/day in pregnancy
• Iron requirements increase rapidly in the second and third trimester due
to fetal growth, however iron absorption in the gut is not sufficient to
meet this increased demand  iron balance depends on maternal iron
stores during this period.
How can we treat it?
• Trial of oral iron should be considered diagnostic for all
pregnant women with suspected iron deficiency anaemia
• Should see results in 2 weeks
– If Hb rises, or symptoms get better – iron should be continued
throughout pregnancy anyway
• If not improving  see Doctor to consider other causes
• Oral iron supplementation is the primary treatment option
– A high iron diet should be recommended, including red meats (if
possible and culturally appropriate), fortified cereals and drinks.
• IV Iron only if severely depleted - should be referred to a
hospital!
In summary…
• Eat a healthy balanced
diet throughout your
pregnancy to ensure
there are enough
vitamins and minerals
to support your baby to
grow.