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Nutrition

  • Clinical Updates in Women's Health Care CU
  • July 2014

ABSTRACT: The nutritional status of women is critical for the health of future generations and in reducing the burden of disease. Obstetrician–gynecologists have a unique opportunity to provide nutritional assessment and counseling to women throughout the life cycle, from early adolescence through older adulthood. Ensuring the optimal health of women before conception, during pregnancy, and during the postpartum period establishes the cycle of health for the next generation. A considerable proportion of global disease can be attributed to poor nutrition; not only the effects of undernutrition and deficiencies in micronutrients but also risk factors associated with diet, such as excess weight, hypercholesterolemia, hypertension, and low intake of fruit and vegetables. An optimal diet can lead to an increased life expectancy and improved quality of life.

This monograph is designed to provide a basic understanding of nutrition for women throughout the life cycle. In the section “Basic Science Update,” fundamental nutrition concepts are explained, such as types of nutrients, nutrition facts labels on food products, and the current national recommendations for optimal diet and physical activity. In the section “Common Nutritional Problems,” several health issues associated with poor nutrition that obstetrician–gynecologists may encounter in their practices are described. In the section “Screening and Prevention,” tools are provided that can facilitate health care provider–patient conversations regarding healthy lifestyle choices and that can help identify risk factors for disease. In the section “Evaluation and Diagnosis,” methods for measuring adiposity, vitamin D, hemoglobin A1C, and iron status are outlined. The “Management” section includes specific evidence-based suggestions on how to identify and provide support to patients with common nutrition-related problems.

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Figures & Tables

Fig. 1. Dietary reference intakes. The estimated average requirement (EAR) is the intake at which the level of inadequacy of a nutrient is 0.5 (50%) to an individual. The recommended dietary allowance (RDA) is the intake at which the level of inadequacy is 0.02–0.03 (2–3%). The Adequate Intake does not bear a consistent relationship to the EAR or the RDA because it is set without the estimate of the requirement. At intakes between the RDA and the tolerable upper intake level (UL), the risks of inadequacy and of excess are both close to zero. At intakes above the UL, the risk of adverse effects may increase. (Reprinted with permission from Otten JJ, Hellwig JP, Meyers LD, editors. DRI, dietary reference intakes: the essential guide to nutrient requirements. Institute of Medicine. Washington, D.C.: National Academies Press; 2006.)

Fig. 1. Dietary reference intakes. The estimated average requirement (EAR) is the intake at which the level of inadequacy of a nutrient is 0.5 (50%) to an individual. The recommended dietary allowance (RDA) is the intake at which the level of inadequacy is 0.02–0.03 (2–3%). The Adequate Intake does not bear a consistent relationship to the EAR or the RDA because it is set without the estimate of the requirement. At intakes between the RDA and the tolerable upper intake level (UL), the risks of inadequacy and of excess are both close to zero. At intakes above the UL, the risk of adverse effects may increase. (Reprinted with permission from Otten JJ, Hellwig JP, Meyers LD, editors. DRI, dietary reference intakes: the essential guide to nutrient requirements. Institute of Medicine. Washington, D.C.: National Academies Press; 2006.)

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Fig. 2. MyPlate. (United States Department of Agriculture. Getting started with MyPlate.gov . Washington, DC: USDA; 2014. Available at http://www.choosemyplate.gov/downloads/GettingStartedWithMyPlate.pdf . Retrieved May 28, 2014.)

Fig. 2. MyPlate. (United States Department of Agriculture. Getting started with MyPlate.gov . Washington, DC: USDA; 2014. Available at http://www.choosemyplate.gov/downloads/GettingStartedWithMyPlate.pdf . Retrieved May 28, 2014.)

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Fig. 3. Understanding nutrition facts labels. (Food and Drug Administration. Nutrition facts label images for download. Silver Spring [MD]: FDA; 2014. Available at: http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm114155.htm . Retrieved May 28, 2014.)

Fig. 3. Understanding nutrition facts labels. (Food and Drug Administration. Nutrition facts label images for download. Silver Spring [MD]: FDA; 2014. Available at: http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm114155.htm . Retrieved May 28, 2014.)

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Table 1. Definitions and Examples of Essential Nutrients

Table 1. Definitions and Examples of Essential Nutrients

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Table 2. Recommended Intakes for Nonpregnant Women Aged 14 Years and Older

Table 2. Recommended Intakes for Nonpregnant Women Aged 14 Years and Older

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Table 3. Recommended Intakes for Pregnant and Lactating Women Aged 19–50 Years

Table 3. Recommended Intakes for Pregnant and Lactating Women Aged 19–50 Years

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Table 4. Equations for Calculating a Woman’s Daily Energy Needs

Table 4. Equations for Calculating a Woman’s Daily Energy Needs

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Table 5. Physical Activity Guidelines

Table 5. Physical Activity Guidelines

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Table 6. Weight Status Categories for Adolescents and Adults

Table 6. Weight Status Categories for Adolescents and Adults

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Table 7. Institute of Medicine Guidelines for Weight Gain During Pregnancy by Prepregnancy Body Mass Index

Table 7. Institute of Medicine Guidelines for Weight Gain During Pregnancy by Prepregnancy Body Mass Index

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Table 8. Serum 25-Hydroxyvitamin D Concentrations and Vitamin D Deficiency

Table 8. Serum 25-Hydroxyvitamin D Concentrations and Vitamin D Deficiency

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Table 9. Classification of Iron Deficiency Anemia by Hemoglobin and Hematocrit Values in Nonpregnant and Pregnant Women

Table 9. Classification of Iron Deficiency Anemia by Hemoglobin and Hematocrit Values in Nonpregnant and Pregnant Women

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Table 10. Dietary Choices That Contain Folate or Folic Acid* †‡

Table 10. Dietary Choices That Contain Folate or Folic Acid* †‡

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Table 11. Examples of Healthy Snacks for a Pregnant Patient in the Second Trimester*

Table 11. Examples of Healthy Snacks for a Pregnant Patient in the Second Trimester*

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Nutrition

Nutrition

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