1
Dr. Samar
Clinical assessment of nutritional status
C BMI = Kg/(L)2
C Normal = 18.5 – 24.9 Kg/M2
C Demi span = sternal notch middle finger.
C Knee height.
C West circumference at level of umbilicus.
C Hip circumference at level of greater torcher.
West/ hip? Android or gyencoid obesity.
Skin fold thickness body fat content over triceps at mid arm circumference.
Muscle mean = midarm – skin fold.
Nutrition during pregnancy:-
Assessment women history:
͏ Weight status.
͏ Dietary practice.
͏ Use of harmful substance.
͏ Excessive use of vitamins & minerals (vit, A).
͏ Folic acid
͏ Insulin affects blood glucose.
͏ Increase total plasma volume.
͏ Physiological drop in hemoglobin levels.
͏ Fuel required 3th trimester CHO 70%, aa 20%, fat 10%.
Rate of weight gain & total weight recommendation.
Prepergnancy weight & maternal weight gain during pregnancy influence the birth
weight of infant.
2
12 - 18
Low BMI > 19.8
11.5 - 18
Normal BMI 19.8 – 26.0
7 – 11.5
High 26.1 - 29
Fetal weight gain:
] Growth rapid during the second half of pregnancy.
] Fatal weight 25% of maternal weight gain.
] Placenta 5%.
] Amniotic fluid 6%.
Others: weight of uterine ,mammary tissues, expansion of maternal blood volume
,extra cellular flood & fat stores.
Nutrient needs during pregnancy:-
L Energy & protein need: 200 - 300 kca/ day above non pregnant ,during 2
nd
& 3
rd
trimesters.
L Additional 10 – 12 g/day of protein during last half of pregnancy.
Mineral & vitamins:
_ Iron is need for manufacturing of HB. In both maternal, fetal & maternal RBC.
_ Dec. iron cause anemia in mother not fetus lead to inc. CO lead to physiological
stress so:
_ 30 mg iron/day from 12 wk of pregnancy, if <11 g/dl during the first & third
trimester or less than 10 – 15 during 2
nd
trimester: 60 to 120 mg or iron daily.
Calcium:
W
1200 – 1500 mg/day: diary product if not ,need 600 mg/day of calcium.
W
Zinc :
15 – 25 mg of zinc if deficiency , congenital malformation.
W
Folic acid very important 0.5 .
3
Implantation of nutritional guidelines:
M Variety of foods.
M Good source of calcium, iron.
M Vitamin C.
M Exercise.
M Sodium only restricted, if redirected before pregnancy.
A Moderate to heavy use of caffeine, 2nd & 3
rd
trimester lead to abortion.
A Alcohol: no alcohol consumtiom.
A Drugs : to ba co must ovoid.
Dietary treatment:
m All previous recommendation.
m Color distribution 40% CHO, 20% protein, 40% fat.
m Several meals & snacks perday.
m Avoid concentrated sweets.
m Aim of treatment.
- Achieve normal glycerin
- Prevent ketosis.
- achieve
Special consideration:
D Pia: persistent compulsive ingestion of substances having little or no nutrition
value.
1- Replacing nutrition food.
2- Interfere with absorption of nutrients like iron.
3- Contain toxic compounds.
4- High calories lead to obesity.
Cause?
Nausea, vomiting, anemia?
History?
Sara Abdulbasit
Noora shakir