Nutrition Issues: Women's Life Stages

Dr. Judith Wylie-Rosett

jwrosett@aecom.yu.edu

Learning Objectives
Identify nutrition issues for a women:
During pregnancy focusing on high risk
In midlife to reduce chronic disease risk

In older age to address multiple medical

and/or social problems
Assess Weight, Activity, Variety and Excess
for each age cycle and determine when refer
for medical nutrition therapy with Registered
Dietitian (RD) is needed.

Weight
Pregnancy: 1-2 lb mo 1st trimester; 0.5-2 lb week in 2nd & 3rd Trimester

Midlife: Weight distribution & risks relate to metabolic syndrome.

Older Age: Unintentional weight loss > 10 lb at risk

Activity
Pregnancy: impact weight-baring activity > fetal distress.
Midlife: Weight-baring activity risk of osteoporosis.
Older Age:. Assess for unsteady gait.
Variety
Pregnancy: Calcium iron, protein, fiber/water, and folate
Midlife: Metabolic syndrome, N-3 fatty acids; calcium intake, vegetables
Older age: Absorption/nutrient requirements; Calcium/Vit D, Vit B-12, and
zinc supplements may be needed.
Excess
Pregnancy: Screen for cravings, EtOH intake,
Midlife: CHO & lipids, meat & calcium excretion
Older Age: Food/EtOH behaviors to cope with loneliness.

American Dietetic/Diabetes Association

Exchange System Overview
Exchange

Calories

CHO

Protein

Fat

Starches (1/2 C 1 oz)

80

15 g

2g

trace

Fruit (1/2 C)

60

15 g

0g

12 g

8g

Tr-8 g

5g

2g

Milk (8 oz)

90-160

Vegetables (1/2 C)

25

Meat (per oz)

55-100

0g

7g

3-8g

Fat (tsp)

45

0g

0g

5g

FREE FOOD < 15 calories per serving

Quick Carbohydrate Counting

One Carbohydrate choice = 15 grams
based on the ADAs Exchange system
Exchange groups included are:
- Starch (1/2 cup, slice of bread)
- Fruit (1/2 cup)
- Milk (1 cup)
- Other Carbs (varies by concentration)

Glycemic Indexing Issues

Typical GDM Carbohydrate

(~35-40% of Energy)
Breakfast
Morning snack
Lunch
Afternoon snack
Dinner
Night Snack

15-20 grams
10-15 grams
45-60 grams
10-15 grams
45-60 grams
10-15 grams

GDM Carbohydrate ~35-40% of Energy

Meat, Cheese, Vegetables- not measured
Breakfast

15-20 grams - 1 starch + milk

1 sl Bread or 1/c hot cereal + 4 oz milk

Morning
snack

10-15 grams - 1 milk or 1 starch (or of

each)
8 oz milk or 4 oz milk + 2 crackers

Lunch

45-60 grams - 2 starch, 1 milk, 1 fruit

bread
Sandwich, milk, fruit and salad

Afternoon
snack
Dinner

10-15 grams - 1 milk or 1 fruit

Diet yogurt or small apple

45-60 grams - 2 starch, 1 fruit, 1milk

1 cup potatoes, vegetables, small apple, 8 oz milk

Night Snack 10-15 grams 1 milk

Diet yogurt

Weight Gain Recommendations

for Pregnant Women
(Overweight Cuts Weight Gain Rx in Half)

Normal weight
3-5 pounds per month
1st trimester

1-2 pounds per

week 2nd and
3rd trimesters

Overweight
11/2 - 21/2
pound per month
1st trimester
1/2 -1 pound per
week in 2nd and
3rd trimesters

Dietary Approach to Stop Hypertension

DASH Daily Recommendations
7-8 Serving - grains, emphasis on whole grains
4-5 Serving - vegetables
4-5 Servings - Fruits
2-3 Servings - low-fat dairy products
< 2 Servings - Meats
2-3 Servings Oils
* Eat 4-5 servings of nuts, seeds and dried bean per week
Limit intake of sweets to 5 per week

Nutrition-Related Pregnancy Problems

Rates in the United States
Hypertension ~ 12-22%
Preeclampsia ~ 6-8%
Gestational Diabetes~ 2-14%
Anal fissures/external hemorrhoids disease
occur ~ 35% of pregnancies.
Postpartum Iron Deficiency rates:
30% if < 130% of poverty level

7% if > 130% of poverty level

Neural tube Defects ~ 4000 annually

Recommended Weight Gain

based on Prepregnancy BMI*
BMI< 19.8 kg/m2

28-40 pounds

BMI 19.8-26 kg/m2 25-35 pounds

BMI > 26 kg/m2

15-25 pounds

*American Diabetes Association Guide to Medical

Nutrition Therapy

Tight Glucose Control in GDM

Reduction in Adverse Outcome
Neonatal Outcome

N=
Macrosomia > 4000 g
Intensive Care
Polycythemia
Hypocalcemia
Hypoglycemia
Respiratory Support
Shoulder Dystocia

GDM
Conventional Intensive

1316
13.6%
25%
4.4 days
12%
4.0%
20.0%
4.2%
1.4%

1145
7.1%
6.3%
2.8 days
0.7%
0.3%
3.8%
1.4%
0.4%

Langer O, et al. Am J Ob Gyn 1994;170:1036-46.

Non-diabetic
Control

4922
8.1%
4.7%
2.8 days
1.4%
NA
2.5%
0.5%
0.5%

Midlife CVD Risk for Women

Metabolic Syndrome
Synonyms

Insulin resistance syndrome

(Metabolic) Syndrome X
Dysmetabolic syndrome
Multiple metabolic syndrome

Metabolic Syndrome
Therapeutic Objectives
To reduce underlying causes
Overweight and obesity
Physical inactivity

To treat associated lipid and non-lipid risk

factors
Hypertension
Prothrombotic state
Atherogenic dyslipidemia (lipid triad)

Specific Dyslipidemias:
Possible Causes of Elevated Triglycerides
High carbohydrate diets (>60% of energy
intake)
Several diseases (type 2 diabetes, chronic
renal failure, nephrotic syndrome)
Certain drugs (corticosteroids, estrogens,
retinoids, higher doses of beta-blockers)
Various genetic dyslipidemias

Diabetic Dyslipidemia
Lipoprotein pattern: atherogenic
dyslipidemia
(high TG, low HDL, small LDL particles)
Baseline triglycerides: 200 mg/dL
Lifestyle option:
Weight loss
EtoH and Carbohydrate

Supplement options:
Niacin
Omega-3 fatty acids

LDL-cholesterol goal: <100 mg/dL

Older Age
Assessment of Nutritional Risk

Unintentional weight loss or BMI < 22 kg/m2

Serum Albumin < 3.5 mg/dL
Unintention reduction in cholesterol or < 150 mg/dL
Reduced calorie or protein intake
Difficult swallowing and/or gastric reflux
Decreased appetite or ability to eat/obtain food
Depression
Economic Issues

Treatment Options for Low

Weight in Older Adults
Liquid suppmements
Medications that stimulate appetite and
weight gain
Vitamin/mineral supplementation
Referral to RD and social service
Use enteral nutrition before considering
TPN

Congestive Heart Failure

Nutritional Evaluation
Fluid retention (pedal edema or ascities)
All blood levels in relation to fluid retention
Serum electrolytes (high sodium and low
potassium)
Hypotension
Protein (risk of cardiac cachexia)

Treatment of Congestive Heart Failure

Reduce sodium to < 2400 mg; DASH diet
Check adequacy of protein and calorie
intake
Check fluid status daily (sign of edema and
daily weights)
Stablize before surgery and invasive
medical procedures monitor afterwards

Nutrition Referral Issues

Integrate nutrition into your overall workup
by briefly assessing weight, activity, variety
and excess.
Refer women to RD for in-depth Medical
Nutrition Therapy consultation if:
1. You identify a nutrition-related problem
and
2. Patient is ready to address the problem.