1 Kin 110 Ch. Eating Disorders (574-595) Ch. 15 Pregnancy and Breastfeeding (645-667)

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<ul><li> Slide 1 </li> <li> 1 Kin 110 Ch. Eating Disorders (574-595) Ch. 15 Pregnancy and Breastfeeding (645-667) </li> <li> Slide 2 </li> <li> 2 Eating Disorders Eating serves psychological, social and cultural purposes Media bombards us with ideal body types may develop unhealthy relationship with eating, obsessive weight loss and strange rituals around food Food often linked with personal and emotional experiences </li> <li> Slide 3 </li> <li> 3 This Is In In 1998, Mattel overhauled Barbies look for the millennium, giving her slimmer hips, a wider waist, and smaller breasts. Barbies periodic overhauls are meant to fit the fashion of the times. </li> <li> Slide 4 </li> <li> 4 Eating Disorders Disordered eating - temporary or mild change in eating patterns Eating disorders - illness that can seriously interfere with daily activities - persistent inability to eat in moderation The eating disorder continuum </li> <li> Slide 5 </li> <li> 5 Eating Disorders: No Simple Causes Predisposition Social factors Expectations for body size, shape Psychological factors Peer relationships, family expectations, emotional trauma Biological factors Neurotransmitter levels Genetic factors Synthesis and release of leptin, orexin </li> <li> Slide 6 </li> <li> 6 Anorexia Nervosa psychological loss or denial of appetite and self starvation, related in part to distorted body image and various social pressures associated with puberty extreme weight loss, irrational fear of obesity and weight gain Diagnostic criteria Body weight &lt; 85% of expected (BMI 17.5 kg/m 2 ) Intense fear of weight gain Distorted body image Amenorrhea </li> <li> Slide 7 </li> <li> 7 BMI and Underweight </li> <li> Slide 8 </li> <li> 8 Anorexia Nervosa Profile - competitive, obsessive, parents set extremely high standards hypergymnasia - excessive exercise early warning signs - rituals with food cook large meals for others, not self </li> <li> Slide 9 </li> <li> 9 Warning Signs of Anorexia </li> <li> Slide 10 </li> <li> 10 Side Effects of Excessive Weight Loss in Anorexia Nervosa Neuropsychiatric Abnormal taste sensation Depression Impaired thought process Cardiac Loss of cardiac muscle, resulting in a smaller heart Abnormal heart rhythm Increased risk of sudden death </li> <li> Slide 11 </li> <li> 11 More Side Effects Hematological Leukopenia (abnormal decrease of white blood cells) Iron-deficiency anemia Gastrointestinal Delayed gastric emptying Bloating Constipation Abdominal pain </li> <li> Slide 12 </li> <li> 12 The Progression of Anorexia </li> <li> Slide 13 </li> <li> 13 Anorexia Nervosa: Treatment Goals Stabilize physical condition Convert patient into participant Restoring nutritional status Gradual weight gain Psychotherapy Individual Group Family </li> <li> Slide 14 </li> <li> 14 Bulimia Nervosa college age young adults large quantities of food are eaten at one time (binge) and then purged from the body by vomiting, laxatives or other means difficult to recognize, outer appearance is normal, self reported Diagnostic criteria Recurrent binge eating Recurrent purging, excessive exercise, fasting Excessive concern about weight, shape Absence of anorexia nervosa </li> <li> Slide 15 </li> <li> 15 Bulimia Nervosa: Binge/Purge Cycle Binge: large amount of food, short period of time High-calorie, high-fat foods Purge Affects fluid and electrolyte balance Can be life- threatening </li> <li> Slide 16 </li> <li> 16 Bulimia Nervosa: Treatment Medical Nutritional Psychotherapy Antidepressant medications </li> <li> Slide 17 </li> <li> 17 Binge Disorder Compulsive overeating binge episodes without purging at least twice per week may not deal with emotional problems effectively never learned appropriate ways to deal with feelings Should learn to eat in response to hunger avoid sliming diets initially generally require professional help. </li> <li> Slide 18 </li> <li> 18 Binge-Eating Disorder Diagnostic criteria Recurrent binge eating Distress over eating behaviors No recurrent purging Absence of anorexia nervosa Triggers of binge eating Stress Conflict Frequent dieting </li> <li> Slide 19 </li> <li> 19 Binge-Eating Disorder: Treatment Psychotherapy Antidepressant medications Long-term support </li> <li> Slide 20 </li> <li> 20 Preventing eating Disorders Some concern about diet, health and weight is normal some fluctuation in weight and appetite is normal *large changes consult physician Discourage restrictive diets, meal skipping and fasting provide information about the normal changes with puberty correct misconceptions about nutrition, body weight, weight loss </li> <li> Slide 21 </li> <li> 21 Preventing Disorders Carefully phrase weight related comments/recommendations encourage normal expression of disruptive emotions encourage children to eat only when they are hungry provide adolescents with some choices and self- accountability Increase self acceptance Enhance tolerance for diversity in body weight and shape Emphasize that thinness is not necessarily associated with better athletic performance </li> <li> Slide 22 </li> <li> 22 Eating Disorders: Related Issues Males: an overlooked population Fewer instances than females Men involved in sports, modeling, entertainment Pressure for certain weight, shape Anorexia athletica Sports-related eating disorders Body size/shape important in competition Pressure from coaches </li> <li> Slide 23 </li> <li> 23 Other Eating Disorders Female Athlete Triad high percentage of female athletes exhibit disordered eating patterns coupled with irregular menstruation ammenorhea loss of bone mass - osteoporosis treatment - decrease preoccupation with food increase meals rebuild body establish regular menstruation </li> <li> Slide 24 </li> <li> 24 Eating Disorders: Related Issues Vegetarianism and eating disorders Smoking and eating disorders Baryophobia Infantile anorexia </li> <li> Slide 25 </li> <li> 25 Scary Statistics About 5 million Americans have anorexia nervosa, bulimia, or binge- eating disorders. Researchers estimate that 15 percent of young women have disordered eating attitudes and behaviors. Every year an estimated 1,000 people die from anorexia nervosa. </li> <li> Slide 26 </li> <li> 26 ADA: Nutrition Intervention It is the position of the American Dietetic Association (ADA) that nutrition education and nutrition intervention, by a registered dietitian, is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS) during assessment and treatment across the continuum of care. </li> <li> Slide 27 </li> <li> 27 Pregnancy Overview Special considerations for time of life illustrates larger importance of nutrition on body functioning Important to plan pregnancy modification of lifestyle adequate nutrition prevent fetal and infant problems + 300 kcal per day milk, meats and alt. Iron, calcium, and folate (600ug/day) breastfeeding </li> <li> Slide 28 </li> <li> 28 Pregnancy Nutrition before conception Risk assessment, health promotion, intervention Weight Maintain a healthy weight Vitamins 400 micrograms supplemental folic acid/day in addition to folate intake in diet total of 600ug recommended Avoid high doses of retinol Substance use Eliminate prior to pregnancy Photo Photodisc </li> <li> Slide 29 </li> <li> 29 Pregnancy Physiology of pregnancy Stages of human fetal growth Blastogenic stage: first 2 weeks Cells differentiate into fetus, placenta Embryonic stage: weeks 38 Development of organ systems Fetal stage: week 9delivery Growth nourished until birth by placenta organ formed in mothers uterus oxygen and nutrient exchange fetal waste removal release of hormones of pregnancy </li> <li> Slide 30 </li> <li> 30 Early Growth Hyperplasia increase in cell number Hypertrophy increase in cell size 3 weeks specialized organs and body parts begin to form * many women still do not know they are pregnant* 13 weeks heart is functional, most organs formed, fetus can move </li> <li> Slide 31 </li> <li> 31 First Trimester 9 months broken into three sections, trimesters first trimester is critical time spontaneous abortion, ~1/3 miscarriage genetic defects or fatal error in fetal development very important to avoid harmful substances and maintain adequate nutrition nutritional deficiencies transferred through placenta </li> <li> Slide 32 </li> <li> 32 Second Trimester Fetus weighs ~ one ounce at beginning of second trimester limbs fully formed, has ears and begins to form tooth sockets fetal heart beat can be detected with stethoscope begins to look like infant, formed bones, can kick, suck its thumb mothers breast weight inc. 30% under nutrition can impair ability to breast feed </li> <li> Slide 33 </li> <li> 33 Third Trimester Weighs 2-3 lbs. At beginning Fetus will deplete iron stores and blood glucose of mother infants born after 26 weeks have a good chance of survival in nursery difficulties suckling and swallowing 9 months 7-9 lbs. (3-4 kg) 50 cm long soft spot where skull bones will fuse (12-18 months) </li> <li> Slide 34 </li> <li> 34 Pregnancy Physiology of pregnancy Maternal changes Growth of adipose, breast, uterine tissues Increase blood volume Slower GI motility </li> <li> Slide 35 </li> <li> 35 Nutrient Needs emphasis is on increased nutritional requirements individual assessment of requirements and counselling Energy Needs + 300 kcal / day in 2nd and 3rd trimesters ( 2 cups low fat milk and piece of bread) nutrient dense foods, increased nutrient requirements vs kcal vitamin and mineral needs increase 20-100%; kcal 15 % </li> <li> Slide 36 </li> <li> 36 Weight Gain If active, add extra kcal for exercise to total intake Walking, cycling, swimming recommended activities specific precautions Weight gain one of best predictors of pregnancy outcome 2 - 4 lbs. in first trimester .75 - 1 LB per week, 2nd and 3rd total gain 25-35 lbs. (BMI ~20-26 kg/m 2 ) Depends on BMI - Table 15.3 fig 15.7 Requires regular monitoring weekly record, allows for adjustments </li> <li> Slide 37 </li> <li> 37 Weight During Pregnancy Overweight and obese women have increased risks of several problems, including preterm delivery and stillbirth. In addition, obese women are at higher risk for high blood pressure gestational diabetes (a form of diabetes that is associated with pregnancy; it often is controlled through diet alone) preeclampsia (a condition marked by high blood pressure, fluid retention, and protein in the urine) prolonged labor unplanned cesarean section difficulty initiating and continuing breastfeeding </li> <li> Slide 38 </li> <li> 38 Specific Nutrients RDA for protein Increase 10 - 15 g many already over this important to check, role of protein? Carbohydrates 100 g / day to prevent ketosis(avg 200) vitamins most increase slightly - B vit +30% B6 + 45% Folate (RDA 600ug) + 50% synthesis of DNA, rbc formation folate rich fruits and veg, fortified cereals </li> <li> Slide 39 </li> <li> 39 Mineral Needs Iodide - 220 g IRON 2 times the RDA in last two trimesters (30 mg/day) hemoglobin synthesis *fortified breakfast cereals* attention to nausea and absorption (caffeine, dairy can inhibit absorption) With severe iron deficiency, LBW, and risk of fetal death </li> <li> Slide 40 </li> <li> 40 Mineral Needs Calcium adequate mineralization of fetal skeleton and teeth in 3rd tri increase intake with conception 1200 - 1500 mg (milk group) Zinc growth and development Increase 35 % above RDA Protein rich foods in healthy diet should supply this </li> <li> Slide 41 </li> <li> 41 Vegetarian Mothers Lacto ova or lacto should have no special concerns, with earlier recommendations in mind Iron supplementation Vegans focus on protein, vitamins D, B-6, B-12, iron and calcium increase grains, beans nuts and seeds Avoid Ketosis - difficult for fetal brain to utilize need iron and calcium supplementation as these are difficult to absorb from plant sources </li> <li> Slide 42 </li> <li> 42 Pregnancy: GI Distress </li> <li> Slide 43 </li> <li> 43 Activity Recommendations American College of Obstetrics and Gynecology Do not allow HR to exceed 140 Avoid exercise in hot, humid weather Discontinue exercise if discomfort or overheating results Drink plenty of liquids After month 4 do not exercise while lying on your back Avoid abrupt decrease in exertion - must warm down Engage in weight training only if done consistently prior to pregnancy Do not push flexibility training very hard - gentle and relaxing </li> <li> Slide 44 </li> <li> 44 Lactation Physiology of lactation Changes during pregnancy Increased breast tissue Maturation of structure Hormonal controls Prolactin: stimulates milk production Oxytocin: stimulates milk release Let-down reflex </li> <li> Slide 45 </li> <li> 45 Lactation Nutrition for breastfeeding women Energy and protein Higher needs than pregnancy Vitamins and minerals Most are higher or same as pregnancy Iron and folate needs are lower Water Food choices Practices to avoid while breastfeeding Alcohol, drugs, smoking, excess caffeine </li> <li> Slide 46 </li> <li> 46 Lactation Benefits of breastfeeding Benefits for infants Optimal nutrition Reduced incidence of respiratory, GI, ear infections Convenience Other benefits Benefits for mother Convenience Enhanced recovery of uterus size Other benefits </li> <li> Slide 47 </li> <li> 47 Nutrition of Milk Asses adequate intake by monitoring wetness and stool production supplements with formula may be needed and are OK should not start before breastfeeding is well established important differences from cows milk (wait 1 year) casien - protein difficult to digest different minerals and carbohydrates </li> <li> Slide 48 </li> <li> 48 Nutrition of Milk Colostrum first product of breast antibodies compensate for immature immune system promotes intestinal health of infant Mature Milk after a few days, very different from cows milk </li> <li> Slide 49 </li> <li> 49 Mature Milk Main proteins form a soft light curd in GI binds iron and reduces bacterial growth high in essential fatty acids and fats needed for brain development DHA, visual acuity and nervous system development (omega 3) </li> <li> Slide 50 </li> <li> 50 Mature Milk Composition changes increased fat content with feeding, should last 20 min. to get good growth and infant satisfaction can supplement up to 4 ounces of water / day </li> <li> Slide 51 </li> <li> 51 Food Plan and Breastfeeding Only slightly different from pregnancy no longer require iron, folate increased need for energy, vit. A,E and C, riboflavin, copper, chromium, iodide, magnanese, selemium and zinc * increase milk group intake* Especially teens should maintain balanced diet, moderate fat content, maintain fluid intake avoid crash diets </li> <li> Slide 52 </li> <li> 52 Attributes of Breast Feeding Requires ~ 800 kcal /day recommend increase only 500 kcal per day facilitates return to pre-pregnancy weight breast feeding enhances reduction of uterus may prevent breast cancer if maintained for several months Facilitates bonding with infant Establish...</li></ul>