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NCBI Bookshelf. Optimal maternal and fetal outcomes of pregnancy are contingent upon nutrient intakes sufficient to meet maternal and fetal requirements. Energy is the major nutrient determinant of gestational weight gain, although specific nutrient deficiencies may restrict that gain.

Clinical and public health interventions designed to improve gestational weight gain may be directed at energy intake or expenditure see Figures and in Chapter 2. Effective dietary intervention, however, requires an understanding of the energy requirements of pregnancy and the relationship between energy intake and gestational weight gain.

The subcommittee reviewed energy intakes in the context of gestational weight gain, the effectiveness of energy supplementation on weight gain, and net energy balance during pregnancy.

Extra energy is required during pregnancy for the growth and maintenance of the fetus, placenta, and maternal tissues. Basal metabolism increases because of the increased mass of metabolically active tissues; maternal cardiovascular, renal, and respiratory work; and tissue synthesis.

Energy requirements are greatest between 10 and 30 weeks of gestation, when relatively large quantities of maternal fat normally are deposited. No allowance was made for the increased energy cost of moving a heavier maternal body mass; it was assumed that this expenditure was compensated by a reduction in physical activity.

The validity of these estimates has been challenged, as described later in this chapter. Hytten suggested that the increased needs of pregnancy could be met by reductions in physical activity. Tables A and B list studies in which the relationship between energy intake and gestational weight gain was described. Longitudinal studies of well-nourished pregnant women indicated a slight, although not always statistically significant and not universal, increase in energy intake during pregnancy.

In an Australian study, energy intake did not increase during pregnancy Truswell et al. Minor, but not consistent, changes in energy intake have been reported in other studies of well-nourished pregnant women King et al.

Failure to detect significant trends in energy intake may be due to the substantial variability in food intake, the cross-sectional design of many studies, and measurement sensitivity and error.

Results of energy intake studies in pregnant women subsisting on low energy intakes in developing countries are inconsistent. In one study from Thailand, energy intake progressively increased during pregnancy Thongprasert et al. In studies conducted in the Philippines and Mexico, a slight, but insignificant, decline in energy intake was observed in the third trimester Hunt et al. If energy intake does not increase in chronically undernourished women during pregnancy, fetal and maternal tissue accretion may be restricted to that which can be achieved by adjustments in nutrient utilization.

Statistically significant correlations between energy intake and gestational weight gain have been reported by some investigators Beal, ; Haworth et al. Thomson cited a correlation coefficient R of. In a large sample, Haworth et al. Picone et al. Association between energy intake and weight gain were evident in other studies, but no correlation analyses were reported Anderson and Lean, ; de Benoist et al.

The relatively weak correlation may accurately reflect or may underestimate the actual relationship between energy intake and gestational weight gain. Assessment of the relationship between these two variables is problematic Kramer, Precise and accurate measurement of energy intake is difficult, particularly over the 9-month gestational period.

High variability in food intake by pregnant women, as is found in general in the United States, was reported in all studies. The relationship between energy intake and weight gain is confounded by intervening variables such as physical activity and body size. Because weight gain or loss is determined by net energy balance, an evaluation of the impact of energy intake on weight gain requires information about or control of energy expenditure.

An accurate measurement of energy expenditure by indirect calorimetry throughout pregnancy is technically difficult. Application of the doubly labeled water method to pregnant women should refine estimates of the energy available for weight gain. The energy cost of weight gain may be overestimated by excessive extracellular fluid expansion, which occurs at negligible energy cost to the pregnant woman.

Toward the end of pregnancy, the rate of weight gain often decreases; thus, differences in the length of gestation between individuals may be confounding.

Imprecise quantification of energy intake, gestational weight gain, and modifiers such physical activity would decrease the probability of detecting a statistically significant relationship, even if one exists. Alternatively, the actual association between energy intake and gestational weight gain may be weak. Variation in energy intake among pregnant women is determined largely by body size and the level of physical activity—not by gestational weight gain.

The failure to achieve statistical significance in the majority of studies reviewed in Tables A and B may have been due to insufficient statistical power.

The sample size required to detect a significant correlation of. Gestational weight gain is unquestionably a function of energy intake, although the strength of the relationship is confounded by intervening factors. Maternal weight gain, skinfold thickness, and birth weight have been reduced by iatrogenic dietary restriction during pregnancy Campbell and MacGillivray, Acute maternal deprivation during the Dutch famine of — in the western part of The Netherlands provided a dramatic demonstration of the impact of energy intake on the course and outcome pregnancy Stein and Susser, a,b.

The limited data indicate that postpartum maternal weight declined 4. Some studies, particularly those conducted in nutritionally vulnerable populations, have shown that energy supplementation results in increased gestational weight gain birth weight Bhatnagar et al. Energy intake is one of determinant of pregnancy outcome amenable to experimental intervention; studies that evaluated the effectiveness of energy supplementation on weight gain during pregnancy and on birth weight are summarized in Tables A and B.

The subcommittee reviewed the findings and limitations of intervention studies conducted in both developing Table A and industrialized countries Table B. The likelihood of demonstrating the effectiveness of energy supplementation during pregnancy is enhanced in nutritionally vulnerable populations.

This explains the focus on developing countries in this review. Although not without exception, the studies in developing countries represented more poorly nourished women than did studies conducted in industrialized countries. The subcommittee focused on the impact of energy supplementation on gestational weight gain and fetal growth. Information regarding other fetal or maternal outcomes was not consistently provided in reports of the supplementation studies. In the following discussion, women are described as chronically undernourished, malnourished, or marginally nourished.

Different investigators used different criteria to categorize the women based on customary dietary intake or anthropometric measurements. Chronically undernourished women from four Guatemalan villages were offered either a protein-energy supplement Atole or a low-energy supplement Fresco Delgado et al.

Initially, the study was designed to test the effect of protein supplementation, but the investigators discarded the initial design on the premise that the effects of energy supplementation might be masked, because no advantage of the Atole over the Fresco supplement was evident. Therefore, post hoc analyses were performed in which women were categorized according to self-selected levels of energy intake Table A.

The mean monthly rate of gestational weight was 1. The greater the level of energy supplementation, the lower the proportion of mothers with low gestational weight gains, defined as less than 0. Birth weight was significantly related to energy intake over the course of gestation g increment in birth weight per 10, kcal from the supplement.

Poor women at risk of undernutrition were randomly assigned to supplementation or control groups for the third trimester of pregnancy Mora et al. The gender-specific effect of supplementation may have been due to the achievement of the greater fetal growth potential in males. Supplementation prior to and during the second pregnancy had no effect on anthropometric measurements gestational weight gain, body weight, or skinfold thickness of these women whose usual diet was only marginally adequate.

Maternal weight gain averaged 7. Comparisons of outcomes of the second pregnancies birth weight, incidence of LBW infants, and fetal deaths revealed no statistical differences between the two groups.

These findings suggest that some infants benefited from maternal supplementation, even though maternal anthropometric measurements did not differ between the supplemented and unsupplemented women.

The weight gain of approximately one-third of all these women during lactation suggested, however, that their usual energy intake was adequate. Weight gain during pregnancy and maternal weight for height my have been almost optimal for these women.

A positive energy balance was maintained throughout gestation and lactation in this group of women who reported low usual energy intakes 1, kcal. Estimates of energy intake were seriously flawed, however. No information was collected on between-meal food consumption or preintervention dietary intake.

Thus, it was impossible to determine the extent to which the feeding program supplemented home diets. The original design to study supplementation of marginally nourished women was not achieved for two reasons: indiscriminate subject selection and failure to quantify the intervention variable. Since all pregnant women in the community were included in the experimental group, it was necessary to use retrospective controls.

Supplementation had no impact on weight gain or fat changes as measured by triceps skinfold thickness in either the wet season, when food shortages and agricultural work caused negative energy balances, or the dry season. Stratification of the mothers by height, weight, or weight for height did not indicate an advantage of supplementation for the more undernourished women.

The proportion of LBW infants decreased significantly from There appeared to be a threshold above which birth weight was protected from the acute effects of malnutrition; birth weight was compromised when the women were in negative energy balance. The mechanism by which birth weight increased during the wet season but maternal weight gain did not change is unclear; the authors suggest that the supplement shortened the otherwise long overnight period when women took no food and thereby increased glucose availability to the fetus.

Theories of adaptation have evolved to explain how these active pregnant women existed on energy intakes that barely exceeded estimated basal requirements.

Subsequent studies on the energy expenditure of pregnant Gambian women, however, have cast doubt on the energy intake records of the earlier investigations Lawrence et al.

In the later studies, mean daily energy expenditures during pregnancy exceeded previous estimates of energy intake by approximately kcal. It is believed that this large discrepancy between energy intake and expenditure resulted from an underestimation of energy intake. Although understanding of the energy balance of these Gambian women is incomplete, the major impact of supplementation on birth weight and the incidence of LBW infants during the wet season was undeniable.

The supplements were distributed from approximately 14 weeks of gestation onward. The relatively high increment in birth weight relative to maternal weight gain g birth weight per kilogram of maternal weight gain may have resulted from the increased supply of micronutrients. Greater rates of weight gain in those with similar energy intakes may have been caused by greater maternal fluid retention and plasma expansion. The lack of randomly assigned unsupplemented controls precluded evaluation of the overall effect of supplementation on weight gain and birth weight.

Supplements were distributed monthly; sharing of part of the supplement with other family members was acknowledged, but the amount was not quantitated. A retrospective matched-pair analysis was performed on pregnant women who had received nutritional counseling and, if it was deemed necessary, dietary supplementation at the Montreal Diet Dispensary Rush, A significant increase in birth weight 53 g more than that of controls was limited to infants born to women who weighed less than 63 kg lb at the time of conception.

The proportion of LBW infants was not statistically different. Maternal weight gain and birth weight were greater in the supplemented group than in the matched control group, but the differences were not statistically significant. Reports of intervention trials and evaluations of the Special Supplemental Food Program for Women, Infants, and Children WIC often omit consideration of program effects on gestational weight gain; evaluation of the program effects on birth weight are conflicting.

A fundamental problem germane to these studies is the selection of unsupplemented controls. The use of women enrolled in WIC postnatally as control subjects tends to lead to overestimates of the impact of food supplementation, since one criterion for postnatal WIC enrollment is delivery of an LBW infant.

Alternatively, control subjects recruited from the community tend to be at lower risk of an adverse perinatal outcome compared with WIC recipients. The duration of gestation was 5 to 6 days longer for women who were enrolled for more than 6 months.

How many kilojoules do I need each day?

Do you feel exhausted before the day is over? Too pooped to play on weekends? Can't even begin to think about exercising or sex, or you run out of gas before working up a sweat? Work and school demands, children's needs, money pressures, maintaining a household, caring for relatives, sustaining personal relationships, health concerns—it's amazing that any of us can sleep, let alone get the 7. Or maybe you're able to get the eight hours of sleep that's best for most of us, but you still feel worn out.

Healthy pregnant or breastfeeding women need to get between to additional calories per day to meet their energy needs and support the healthy growth of their baby. During pregnancy or while breastfeeding your baby, be sure to eat a variety of healthy foods.

Go to the store, and you'll see a multitude of vitamins, herbs, and other supplements touted as energy boosters. Some are even added to soft drinks and other foods. But there's little or no scientific evidence that energy boosters like ginseng, guarana, and chromium picolinate actually work. Thankfully, there are things you can do to enhance your own natural energy levels.

7 Reasons You Have Low Energy – and How To Boost It

Victorian government portal for older people, with information about government and community services and programs. Type a minimum of three characters then press UP or DOWN on the keyboard to navigate the autocompleted search results. A kilojoule like a calorie is a measure of energy in food. On average, people eat and drink around kilojoules a day, however we're all different. To lose or gain weight, use your ideal body weight in the calculator below. This will give you an estimated daily kilojoule requirement to help you meet your weight loss or gain goal. You can find your ideal body weight for your height by using this BMI calculator a healthy weight range for an adult is a BMI between 20 and

Balancing energy in and out

Trying to balance the demands of family and work or school—and coping with media pressure to look and eat a certain way—can make it difficult for any woman to maintain a healthy diet. But when puberty begins, women start to develop unique nutritional requirements. And as we age and our bodies go through more physical and hormonal changes, so our nutritional needs continue to evolve, making it important that our diets evolve to meet these changing needs. While women tend to need fewer calories than men, our requirements for certain vitamins and minerals are much higher. Hormonal changes associated with menstruation, child-bearing, and menopause mean that women have a higher risk of anemia, weakened bones, and osteoporosis, requiring a higher intake of nutrients such as iron, calcium, magnesium, vitamin D, and vitamin B9 folate.

Energy is measured in kilojoules kj or calories, so when we refer to 'energy in' we actually mean 'kilojoules in' the kilojoules in the food we have eaten.

Governor Hogan announced that health care institutions in Maryland can start performing elective surgical cases in guidance with the State Department of Health. Learn what Johns Hopkins is doing. That said, there are a few key principles that can give you a boost as you age.

Pregnant or Breastfeeding? Nutrients You Need

NCBI Bookshelf. Optimal maternal and fetal outcomes of pregnancy are contingent upon nutrient intakes sufficient to meet maternal and fetal requirements. Energy is the major nutrient determinant of gestational weight gain, although specific nutrient deficiencies may restrict that gain.

Elisabeth Wilson has a degree in Medicine and for many years she worked in medical media before becoming a journalist. She has written extensively on relationships and sex in the British press with many columns in well-known publications like The Daily Mirror and The Mirror. Currently she is a contributing writing on health and well-being for the magazine She. Account Options Login. Koleksiku Bantuan Penelusuran Buku Lanjutan.

Diet and Nutrition Tips for Women

Does any of this sound familiar? Dozing off on the train to work to grab a few precious seconds of shut-eye; snapping at your colleague because they asked you to repeat something for the third time; yawning in a meeting when you should have been killing it with your ideas? It's not news that in order to get everything done, your energy levels need to stay up. And how do you do that exactly? You just need to acquaint yourself with our step-by-step guide to identifying what is taking away your energy — and then kill them before they kill you. Or just slow you down a bit. Breakfast equals the most important meal of the day, right?

Healthy pregnant or breastfeeding women need to get between to additional calories per day to meet their energy needs and support the healthy.

It is not the best idea to wait until we find ourselves worn out and in the midst of a health crisis before we try to boost our energy levels. These days information is coming at us from all directions. It is tempting to simply turn away, return to our sedentary ways and consider it exercise when we get up to check the mail. You can find simple ways to get more energy at any age and promote healthy aging.

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