ADVANCED DIPLOMA IN PRINCIPLES OF NUTRITION

@ShawPhotoTomCourse Educators: Thomas Woods, William Eames

BY AMANDA BRODERICK BSc ANutR

BSC HONS Sports Biomedicine and Nutrition

BY AMANDA BRODERICK LESSON: 1

Course Educator:

Amanda Broderick Course Educator

B.A. (Hons.)

Semester 1: Nutrition Through the LifecycleLesson 1

@ShawNutritionA amandabroderick@shawacademy.com

Optimum Nutrition for Mother and Baby

Lesson 1

• Course Agenda- Semester 1

• Optimum Nutrition for Mother and Baby

• Nutrition for Children

• Nutrition for Teenagers

• Optimising Nutrition as we age

• Summary

• Course Interaction

• Q & A

• Lack of understanding of technical capabilities

• Lack of confidence in skills and knowledge

• Inability to fulfil creative vision

Why learn about Nutrition for mother and baby?

All information in this course is intended for educational purposes and is based on current nutritional guidelines

for healthy people. Neither the Shaw Academy nor its employees warrant that the course will be error-free. Shaw

Academy does not take into account your personal circumstances and the information provided in this course is

in no way medical advice, nor is it a substitute for professional advice, diagnosis, and treatment of any disease or

condition. You should consult your physician or health care practitioner before beginning any nutrition or exercise

programme. Any application of the recommendations or use of the information within this course is at your

discretion and sole risk, and you specifically waive any right to make any claim against the Shaw Academy or its

employees as the result of the use of such information. Providing people with nutritional advice is both rewarding

and challenging. You must be aware of the risks of providing nutritional advice to others. Shaw Academy accepts

no responsibility for your actions or advice. With ever changing information in the field of nutrition you

understand and accept that it is your responsibility as the student to remain up to date with recommended

nutritional guidelines by carrying out ongoing study. You agree to always provide information based upon

scientific research and government accepted nutritional guidelines. The Shaw Academy does not assume any

liability for the information provided herein. This course does not provide you with the right to call yourself a

registered Dietitian as this is a protected title which requires university level study. It is your responsibility as the

student to familiarise yourself with laws regarding nutrition titles within the country where you will be working.

Upon completion of this course you will be qualified to provide general healthy eating advice and weight loss

advice in line with current recommended nutritional guidelines. By undergoing Shaw Academy’s Personal

Nutrition course you agree to terms of this disclaimer.

Course Disclaimer

Amanda Broderick

• BSc (Hons) Sports Biomedicine and Nutrition

• Registered Nutritionist • Performance Nutritionist• Competitive GAA camogie player• Likes all things GAA, rugby, surfing,

traveling and reading

Feel free to email me throughout the course

Meet the Course Educator

Assignments

12 MCQs- 1 each week- not graded

One final online Multiple choice questionnaire of 150 questions –graded

Accredited diploma can only be acquired after completing final MCQ test

No end date whilst a member

NUTRITION COURSE TOOL KITINCLUDED:

Full course manual

Webinar Slides for every lesson

Nutrition Resources

ONLY €19.99

Bonus Study Material

Importance of nutrition:

Pre-pregnancy

Pregnancy

Weaning

Lesson 1 Learning Outcomes

Nutrition Pre-Pregnancy

Healthy Weight Pre-Pregnancy

Aim to achieve a healthy weight BEFORE trying to conceive

Dieting while trying for a baby or while pregnant NOT recommended

Women with BMI 20-25kg/m² have a higher rate of pregnancy than those with a higher or lower BMI

Obese women twice as likely to have large baby-complicates birth

Obese women are at increased risk of developing gestational diabetes

Neural Tube Defects: group of birth defects

involving the spine or brain

Spinabifida

Anencephaly

Encephalocele

Neural Tube Defects

Neural Tube Defects: group of birth defects

involving the spine or brain

Spinabifida

Anencephaly

Encephalocele

Neural Tube Defects

What Causes NTDs?

Lack of folic acid- when neural tube is forming

Insulin dependent diabetes in the mother

Certain medications i.e. to control epilepsy

Maybe elevations in body temperature when the neural tube is forming- fever, sauna, hot tubs

Genetic conditions- may consult a genetic counsellor if concerned

Folic acid- B vitamin

Take 0.4mg or 400mcg 12 weeks prior and post conception

50% pregnancies unplanned so women of child bearing age recommended to take a supplement

Note: dosage may be increased where there is a family history of NTDs, epilepsy, diabetes…see GP

Importance of Folic Acid

Folic acid:

Well-tolerated

Found in fortified foods and supplements

Folate

• Occurs naturally in food

• Green leafy veg, avocado,

cereals, meat, beans and

lentils

Folic Acid

• Synthetic form

• Well tolerated

• Found in fortified foods

and supplements

V

V

Do you know the difference?

Building Strong bones

1,000mg/day if considering getting pregnant

Preparing for pregnancy includes building healthy bones

Three servings of milk or other dairy products each day equals about 1,000 milligrams of calcium.

Calcium Pre-Pregnancy

Iron Pre- Conception

Many women have low iron stores pre-conception due to monthly menstruation

Important to build iron stores to meet iron need’s of the foetus

Good sources:

Meats such as beef, pork, lamb, liver andother organ meats

Poultry such as chicken, duck and turkey Fish and shellfish including sardines, anchovies,

clams, mussels and oysters (avoid those high in mercury) Leafy greens of the cabbage family such as broccoli,

kale, turnip greens and collards Legumes such as lima beans and green peas,

dry beans and peas such as pinto beans and black-eyed peas and canned baked beans

Whole grain breads and iron-enriched cereals

Caffeine Pre-Pregnancy

Begin to wean yourself off caffeine

>200-300mg caffeine/day may reduce fertility

>200mg caffeine/day can increase the risk of miscarriage

Caffeine also affects the body’s ability to absorb nutrients such as iron and calcium

Sources: soft drinks, tea, hot chocolate, coffee, medications

Nutritional Guidelines When Planning a Pregnancy

Eat a well balanced diet

Supplement diet with

0.4mg folic acid

Limit alcohol to 1-2

units/week

Eat fish twice a week

Eat plentiful iron

Nutrition During Pregnancy

Placenta

Carries oxygen and nutrients to your baby

Removes waste products that baby produces in womb

Does not protect baby from harmful substances such as alcohol and nicotine from crossing to baby

The growth and potential development of the foetus

The health of mother and baby

Reduces the risk of chronic diseases in adulthood

“Barker Hypothesis” first described the link between foetal development and later development of chronic diseases

Maternal Nutrition at Conception and During Pregnancy influences:

Importance of Nutrition for Pregnancy

Obesity

CVD

Type 2 diabetes

Most mothers overestimate how much extra they need to eat!

Adequate energy intake essential to promote optimal growth of the foetus and energy for mother

Energy requirements vary by individual Increased requirements usually compensated

for by decreased activity

5% extra in first trimester 10% in second trimester 25% in third trimester

Energy During Pregnancy

Most mothers overestimate how much

extra they need to eat

Based on a well-nourished woman with a normal BMI this intake equates to an additional 70kcal per day in the 1st trimester, 260 kcal per day in the

second and 500kcal a day in the third trimester (EFSA, 2013).

Weight Gain During Pregnancy

Recommendations based on pre-pregnancy BMI(Institute of Medicine, 1990)

Pre-pregnancy BMI Healthy weight gain

>26 <11.5kg

19.8-26 11.5-16kg

<19.8 17-18kg

Excessive weight gain during pregnancy can lead to obesity in mothers long-term

Eat according to appetite Monitor weight gain

Healthy Eating Across The Globe

Healthy Eating Across The Globe

Food Groups

Foods and Drinks high in fat, sugar and salt should be avoided

Fruit and Vegetables

Carbohydrates

Milk and Dairy Products

Meat, fish, eggs and alternatives

Fats and Oils

Healthy Eating Across The Globe

Carbohydrates- 6-11 portions/day

1 serving =

1 slice bread2 dessert spoons

mashed potatoes

3 dessertspoons or ½ cup boiled

pasta, rice, noodles

1 medium or 2 small potatoes

2 breakfast cereal wheat or

oat biscuits

3 dessert spoons dry porridge

oats

2-3 crackers or crisp breads

4 dessertspoons flake type

cereal

Protein Requirements During Pregnancy

Functions:

Development of healthy baby

Forms structural basis for all new cells and

tissues

Ensure adequate balance of protein:

energy

Who is at risk of insufficient protein?

2 portions usually sufficient

Women from lower socioeconomic groups

Who is at risk of insufficient protein?

Women suffering from nausea and vomiting

Vegetarians

Women from lower socioeconomic groups

So how much do they need?

Long chain Omega 3 PUFA recommended

Docosahexaenoic acid (DHA)Helps in the development of foetusLinked to improved retinal developmentForms an important part in the grey

matter of the brain tissuePlay a role in reducing risk of maternal

depression Improving mood Reducing risk of allergy in infants Improved cognitive and visual abilities

Fat Requirement During Pregnancy

Functions:

Important energy source

Provision and aids in the absorption

of fat soluble vitamins

EFSA recommend:

700-1400mg/week of DHA in addition

to the requirement of 1750mg/week

combined EPA and DHA

Achieved in 1-2 portions of oil rich

fish/week

I Heard You Should Avoid Fish?!

Pregnant women should avoid:Marlin

Shark

Swordfish

Limit tuna: 1-2 servings of fresh tuna

(150g) or two cans tinned tuna per

week

Avoid methylmercury

: harmful to

developing

foetus

Fruit and Veg- at least 5 portions/day

1 serving =

½ a grapefruit10-12 berries,

grapes or cherries2 small fruits:

plums, kiwis etc.

1 medium fruit: apple, orange, small banana,

pear

A bowl of homemade

vegetable soup

A bowl of salad-lettuce, tomato,

cucumber

A small glass of unsweetened fruit juice or fruit/veg smoothie (100ml)

1 heaped dessertspoon of raisins or sultanas

Required to provide oxygen for development and growth

Pregnant women need approx. 27mg iron/day WHO recommend 30-60mg of elemental iron/day from

beginning of pregnancy Iron supplement recommend in conjunction with folic

acid Low iron stores before pregnancy are a risk for

developing iron deficiency anaemia Iron absorption from GI tract is increased during

pregnancy Foetus accumulates most of its iron during the last

trimester Iron requirements increase progressively after 25 weeks Must be foetus growth needs as well as mother’s needs Needs are usually met through diet and

supplementation Check iron stores via FBC and serum ferritin

Iron

Sources of Iron

Bioavailability of Iron more important than

actual amount of iron

Haem Iron

Meat

Fish

Poultry

WHO estimate

that 41.8% of

pregnant

women

worldwide are

anaemic

Non-haem iron

Vegetables

Cereals

Eggs

Dried beans

Peas

Lentils

Maternal Iron Status During Pregnancy

Can cause constipation and nauseaHelpful for women with a history of

anaemia

Fat soluble vitamin found in several forms Vitamin A found in foods that come from animals (liver,

whole milk) is called preformed vitamin A- it is absorbed in the form of retinol, which is made into retinal and retinoic acid (other active forms of vitamin A in the body)

Vitamin A that is found in fruit and vegetables is called provitamin A carotenoid, which is made into retinol in the body

Isotretinoin used to treat acne- linked to congenital malformations

Avoid liver and liver products e.g. pate

Vitamin A

Guidance level for safe intake of retinol= 1000ug RE/day (WHO, 1998)

Formation of healthy bones and teeth Extra-cellular fluid Vascular contractions Vasodilation Muscle contractions Neural transmission Glandular secretion IOM recommends 1300mg/day for pregnant and

lactating women. Supplements recommended if diet inadequate

Adequate calcium intake before and during early pregnancy may reduce the risk or severity of pre-eclampsia

Pregnant teenagers need 5 portions dairy/day In populations where calcium intake is low,

calcium supplementation of 1.5-2.0g of elemental calcium/day is recommended (WHO) from 20 weeks gestation until the end of pregnancy

Calcium3 portions per day of dairy or calcium fortified alternatives

Supplement Vitamin D Lipid soluble vitamin important in the metabolism of calcium and phosphorous Promotes calcium absorption and bone mineralisation Increasing prevalence of vitamin D deficiency in pregnant women WHO- Vit D deficiency in pregnancy associated with increased risk of pre-

eclampsia, gestational diabetes mellitus, pre-term birth, small for gestational age infants, impaired foetal skeletal formation and reduced bone mass

Some studies link vitamin D insufficiency with asthma, diabetes, autoimmune disease and certain cancers

Optimum dose pre- and during pregnancy is unknown

Experts believe requirements closer to 1000IU or higher American college of obstetricians and gynaecology recommend daily

consumption of 400-800IU/day

Sources: sunlight, fortified milk, orange juice, cereals, fatty fish, egg yolks, beef liver and cheese

Supplements may be required pre- and during pregnancy as advised by GP

WHO recommend RNI Vitamin D 5ug (200IU)/day

Alcohol and Pregnancy

Advised to avoid alcohol if trying to conceive

Monitor alcohol intake- no more than 1-2 units/day (FSA 2005)

Alcohol crosses placenta and can lead to physical, growth and mental problems in some babies

It is especially important not to drink alcohol at the time of conception and during the first 3 months of pregnancy- the embryo is most vulnerable to the toxic effects of alcohol

Physical Activity

Aids weight loss and weight control

Reduces the risk of type 2 diabetes and aids management of blood glucose levels in type 1 and type 2 diabetes

Lowers LDL cholesterol and increases HDL cholesterol

Keeps blood pressure in check

Study found women who did vigorous exercise 1 year prior to conception were 81% less likely to develop gestational diabetes

Moderate exercisers had a 59% lower risk Benefit was obtained even when woman was

overweight

Also found to lower risk of NTDs by 30-50%

Aim 150mins/ week for weight maintenance and 300mins for weight loss

30mins moderate-intensity activity is recommended during pregnancy (NICE guidelines)

About 70% of women suffer from sickness, usually in early pregnancy

Usually disappears by the end of 4th month

To relieve symptoms try: Eat small and frequent meals Avoid strong smells or flavours Try dry toast, crackers, breakfast cereals, fruit,

veg throughout day Eat less fatty and sugary foods

Morning Sickness

35-40% of women suffer from

constipation during pregnancy

Relieve by: Increasing fluid- 6-8 cups/day Increase fibre intake

Stop iron supplements

Constipation

Heartburn

Symptoms usually get worse at the end of pregnancy 30-50% of pregnant women suffer from heart burn

Relieve by: Avoid chocolate, fatty foods, alcohol and mint,

especially Before bedtime - they tend to relax oesophageal

muscle so that Acid from the stomach regurgitates up into the

oesophagus more easily Avoid acidic and spicy foods that may irritate mucosa

(tomato, citrus fruits and juices, vinegar, hot pepper, etc.)

Milk and dairy products can temporarily relieve the symptoms of heartburn

Eat slowly, drink fluids between meals rather than with meals

Eat small frequent meals, do not eat large meals before bedtime

Sleep well propped up, not lying flat

A healthy diet is important even before you fall pregnant

Being overweight and having an unhealthy diet can lead to infertility issues in both men and women

Folic acid is of vital importance both pre- and post conception to help prevent neural tube defects in baby

Iron, calcium and vitamin D as well as 400mg folic acid daily are of importance during pregnancy

Iron, calcium and vitamin D can be obtained via the diet but supplementation may be necessary where stores are low

Alcohol should be avoided during pregnancy and caffeine should be limited

Vitamin A can be dangerous during pregnancy and concentrated sources should be avoided

In Conclusion

Breastmilk is best for baby and is recommended as the sole source of nutrition until age 6 months

Solid foods should be introduced at 6 monthsWeaning guidelines should be followed to

ensure adequate nutrients are being obtainedPre-schoolers have small appetites and should

be given small and frequent mealsDental health is of concern for children

In Conclusion

Nicola has just received confirmation from her Doctor that she is 4 weeks pregnant- the pregnancy was unplanned

Diet and lifestyle:Nicola does not have a very healthy diet. She skips meals, relies on fast food for her meals and drinks 40 units of alcohol a week. She eats a lot of High GI foods. She follows a sedentary lifestyle and works a sedentary job. She never eats fruit and vegetables. She tries not to eat dairy as she is afraid to gain weight.

Case Study 1

Advise Nicola on how she can improve her diet

Please provide a 3 day diet plan with meal suggestions

Provide 2-3 main meal ideas (recipes)What is she at risk of if she does not

improve her diet- health consequences for her and baby

Please outline the main dietary points which will be important for Nicola now that she is pregnant

Answer will be given during Thursday’s practical class

Case Study 1

Try attend all of the sessions live and see your knowledge grow

Assignment 1 will be uploaded on Friday

Practical lesson 1 will cover continue on this topic

Recordings are uploaded within 24 hours of the completion of each live session

Case study 1 answer will be discussed in week 1 practical session

Further reading links are available if you wish to learn more

Next Steps

Further Learning

To expand upon the subjects covered in todays lesson:

• Basic nutrition- Diploma in Nutrition

• Weight loss- Ultimate weight Loss Programme

Advanced Course Resources

• Free Short Videos• Topical Items that Pop Up Frequently• Easy way of communicating that free content is

available without spamming you!!!!

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Keep Learning!

Further Reading

(1) Health Service Ireland- Nutrition for pregnancy http://www.rcpi.ie/content/docs/000001/1180_5_media.pdf

(2) Manual of Dietetics, 4th edition, edited by Briony Thomas and Jacki Bishop

(3) Spina Bifida:http://www.cdc.gov/ncbddd/spinabifida/treatment.html

(4) WHO- vitamin A and pregnancyhttp://whqlibdoc.who.int/hq/1998/WHO_NUT_98.4_eng.pdf?ua=1

(5) WHO- iron and folic acid recommendations for pregnant women:http://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdf

(6) WHO- Vitamin D and pregnancyhttp://apps.who.int/iris/bitstream/10665/85313/1/9789241504935_eng.pdf?ua=1

Further Reading

(7) WHO- Calcium supplementation in pregnancyhttp://apps.who.int/iris/bitstream/10665/85120/1/9789241505376_eng.pdf

(8) Iron and pregnancy WHOhttp://apps.who.int/iris/bitstream/10665/77770/1/9789241501996_eng.pdf?ua=1

(9) American Association of diabetes- gestational diabeteshttp://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html(10) NICE guidelines Pre-pregnancyhttp://www.nice.org.uk/guidance/PH11/chapter/3-Considerationshttp://www.nice.org.uk/guidance/PH11/chapter/4-Recommendations

(11) Eatwell Guide 2016https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/508434/Eatwell-16MAR2016England.pdf