Saint Louis University

SCHOOL OF NURSING
Nutrition Lecture

FOODS TO AVOID DURIG PREGNANCY

Eating some foods and drinks during pregnancy may increase the risk of harm to you and your
baby.

Raw or undercooked meat

Avoid undercooked meat, especially sausages or minced meat. Be careful to cook them
thoroughly so there’s no trace of pink or blood. Although the risk is low, you may also prefer to
avoid raw cured meat, such as Parma ham, chorizo, pepperoni and salami. It’s safest to eat well-
cooked meat when you’re pregnant.
Why? There is a risk of toxoplasmosis, a tiny parasite that lives in raw meat, soil and cat poo
and can harm the baby.

Unpasteurised milk and dairy products

All milk sold in shops, supermarkets and restaurants in the UK is pasteurised and fine to drink. If
you are a farmer or use farmers’ markets, however, you might come across unpasteurised milk
and products made from it. You should avoid these. This also applies to goat's milk and sheep's
milk. If you only have access to unpasteurised milk, boil it before using.
Why? There is an increased risk of toxoplasmosis, listeriosis and Campylobacter.

Liver and other foods containing vitamin A

Avoid liver and liver products, such as liver pâté and liver sausage. It's not safe to take
multivitamins containing vitamin A or fish liver oils, such as cod liver oil. Also steer clear of any
foods that have vitamin A added (they may say 'fortified with vitamin A').
Why? Liver has high levels of vitamin A, and too much of this can harm your baby.
Download your free guide to a healthy diet in pregnancy

Pâté

Avoid all types of pâté, including vegetable pâté.

Why? They may contain listeria. These are bacteria that can cause an infection called listeriosis.
Listeriosis can harm a baby during pregnancy or cause severe illness in a newborn. Liver pate
can also have high levels of vitamin A, which is harmful to the baby.
Certain cheeses
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Avoid:
 mould-ripened soft cheeses, such as brie, camembert and others with a similar rind,
including goats' cheese
 soft blue-veined cheeses, such as Danish blue, gorgonzola and Roquefort.
Why? There’s a risk that these cheeses could contain listeria.
Find out more on the NHS website.

Undercooked ready meals

It’s important to follow the cooking instructions on the pack of any ready meals you eat. Also,
check that the meal is piping hot all the way through before you eat it. This is especially
important for meals containing poultry, such as chicken or turkey.
Why? There’s a risk that these could contain listeria.

Raw eggs* or undercooked eggs

It’s important that any eggs you eat are cooked until the yolks and whites are solid all the way
through. Using eggs in cooked recipes is safe but avoid foods that have raw egg in them, such as
homemade mayonnaise or mousse.
Why? There’s a risk of salmonella, a common cause of food poisoning that can harm the baby
and make you very unwell.
*Recent research suggests that there is “very low” risk of salmonella from UK eggs produced
under the Red Lion code and that they are safe to eat in pregnancy. The Food Standards Agency
(FSA) is currently reviewing its advice to pregnant women. Find out more.

Certain kinds of fish

Fish is good for you and you should aim to eat at least two portions a week, including one
portion of oily fish, such as fresh tuna, mackerel or sardines. However, there are some types of
fish you should avoid and some you should limit:
 Avoid shark, swordfish and marlin as they have high levels of mercury, which could affect
your baby’s nervous system.
 Limit tuna to no more than two fresh steaks or four medium cans of tinned tuna a week
because it also has high levels of mercury.
 Limit oily fish (salmon, mackerel, sardines, trout, herring, pilchards) to no more than two
portions a week as they contain pollutants.
 Avoid eating raw shellfish, such as oysters, as they may give you food poisoning. (Cooked
shellfish are fine – these include cold pre-cooked prawns.)
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Top tip
Try to avoid eating from your toddler’s plate or with their knife and fork. It can put you at risk of
a viral infection called Cytomegalovirus (CMV), which is often contracted by young children at
nurseries. The virus is harmless to children but could have harmful effects on an unborn baby.

Alcohol

It's safest to avoid alcohol completely during pregnancy, especially in the first three months. If
you do choose to drink after that, keep it to a maximum of one or two units, no more than once
or twice a week.
Why? Alcohol can harm you and your baby, and experts cannot be sure that any amount of
alcohol is safe.
Find out more about alcohol in pregnancy.

Caffeine

Drinking a lot of caffeine in pregnancy has been linked to miscarriage and low birth weight.

Caffeine is found in:

 tea and coffee
 cola and other soft drinks
 chocolate

You should limit your caffeine intake to no more than 200mg a day during your pregnancy.

A can of cola has around 40mg of caffeine, a mug of tea has around 75mg, a bar of plain
chocolate has around 50mg, a cup of instant coffee has around 100mg, a mug of filter coffee has
around 140mg.

It can add up quickly - you will reach your limit with, for example:
 one bar of plain chocolate and one mug of filter coffee
 two mugs of tea and one can of cola
Work out how much caffeine you have each day with this counter.

Can I eat peanuts during my pregnancy?

Doctors used to say you shouldn’t eat peanuts or peanut butter if you or your baby’s dad have
asthma, eczema or allergies. This was because it was thought that eating peanuts might make the
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

baby more likely to be allergic to them. But the latest research has shown no clear evidence that
eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.

What if I've already eaten something risky?

Don't panic. If it didn't make you ill at the time, it's unlikely to have affected you or your baby.
Talk to your doctor or midwife if you're worried about something you've eaten.

Nutritional Requirements throughout the Life Cycle

We need essential amino acids, carbohydrate, essential fatty acids, and 28 vitamins and minerals
to sustain life and health. However, nutritional needs vary from one life stage to another. During
intrauterine development, infancy, and childhood, for example, recommended intakes of
macronutrients and most micronutrients are higher relative to body size, compared with those
during adulthood. In elderly persons, some nutrient needs (e.g., vitamin D) increase, while others
(e.g., energy and iron) are reduced.
The National Academy of Sciences has published recommendations for Dietary Reference
Intakes (DRI)[1] that are specific for the various stages of life. It should be noted, however, that
the DRIs are not designed for individuals who are either chronically ill or who are at high risk for
illness due to age, genetic, or lifestyle factors (e.g., smoking, alcohol intake, strenuous exercise).
Clinicians must make their own judgments regarding nutrient requirements in such cases based
on available information (See table).
In this chapter, we will examine nutrient needs throughout the life cycle. Two major themes
emerge:
First, the predominant nutritional problem in developed countries is overnutrition. It has led to
unprecedented epidemics of obesity and chronic diseases. Clinicians can assist patients in
making the dietary shifts necessary to prevent overnutrition and its sequelae.
Second, a renewed emphasis on vegetables, fruits, whole grains, and legumes can help prevent
weight problems and chronic illnesses, including cardiovascular
disease,[2] ,[3] diabetes,[4] ,[5] and cancer,[4],[6] among others.[7] Plant-based diets meet or
exceed recommended intakes of most nutrients and have the advantage of being lower in total
fat, saturated fat, and cholesterol than typical Western diets,[8] with measurable health
benefits.[9]
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Excess Calorie Intakes: A Risk Factor Common to All Age Groups

The major nutritional problems encountered in developed countries are excess macronutrient
intake (especially saturated fat, protein, and sugar) and insufficient intake of the fiber and
micronutrients provided by vegetables, fruits, grains, and legumes.
Overnutrition begins early. Pregnant and lactating women are encouraged to eat more because
they are “eating for two.” While it is true that an expectant mother must provide nutrition for
both herself and her developing baby, the increased energy requirement of pregnancy amounts to
no more than about 300 calories per day.[1] Excessive nutrient intake may result in overly rapid
weight gain, conferring a greater risk for labor induction, cesarean section, higher birth weight,
and other complications of pregnancy and delivery.[10] ,[11]
Overfed infants and children may develop dietary habits and perhaps even metabolic
characteristics that have lifelong consequences.[12] [13] [14] Higher-than-recommended energy
intakes at 4 months of age have been shown to predict greater weight gain before 2 years and risk
for obesity in childhood and adulthood.[15] ,[16] Therefore, caretakers should select foods
conducive to healthy body weights and restrain their desire to promote child growth through
overfeeding.
Adolescents face a similar problem. Many teens consume higher-than-recommended amounts of
fat, saturated fat, sodium, and sugars, thereby increasing the risk for adolescent and adult obesity,
among other health problems.[17] The increased prevalence of excess body weight in
adolescents is correlated with escalating risk for type 2 diabetes.[18] This does not mean that
adolescents are well nourished, however. In spite of their higher energy intake, adolescents
frequently fail to achieve required intakes of essential micronutrients (e.g., vitamins A and
C),[19] and under-consume fiber[20] . This problem is compounded by the fact that roughly 60%
of female and more than 25% of male adolescents are dieting to lose weight at any given time,
and between 1% and 9% report using maladaptive habits, such as purging, to do so.[21] ,[22]
Adults in developed countries are at particular risk from excess energy intake. While a
significant percentage of North Americans (5%-50%) have an inadequate intake of essential
micronutrients[23] and fiber,[22] energy balance is typically far in excess of needs. In Western
countries, dietary staples (e.g., meat, dairy products, vegetable oils, and sugar) are more energy-
dense than in traditional Asian or African cultures, where grains, legumes, and starchy
vegetables are larger parts of the diet. This problem is aggravated by increases in food portion
sizes and in the availability and consumption of calorie-dense, nutrient-poor fast foods.[24] As a
result, this age group is experiencing an epidemic of obesity-related diseases, including coronary
heart disease, hypertension, diabetes, and cancer. The metabolic syndrome, often triggered by
obesity, is a common problem in elderly persons and is associated with greater risk for premature
mortality.[25] These circumstances indicate a need for diets that are micronutrient-dense while
modest in fat and energy.
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Fertility

The role of nutrition in fertility has been the subject of a limited body of research focusing
particularly on the role of antioxidants, other micronutrients, and alcohol. However, while
nutritional and lifestyle factors may affect fertility directly, they also influence risk for several
diseases that impair fertility, including polycystic ovarian syndrome, endometriosis, and uterine
fibroids (See relevant chapters).
In females, some studies suggest a potential role for high-dose (750 mg/d) vitamin C and
combinations of antioxidants, iron, and arginine supplements in achieving pregnancy.[26] Celiac
disease, an immune-mediated condition triggered by gluten, can also impair fertility in women
by causing amenorrhea, inducing malabsorption of nutrients needed for organogenesis, and
resulting in spontaneous abortion. In affected individuals, fertility may be improved by a gluten-
free diet.[27] Obesity is also associated with decreased fertility in women.[28]
In males, infertility may occur by disruption of the normal equilibrium between the production of
reactive oxygen species by semen and oxygen-radical scavengers. This may occur through
smoking, infection of the reproductive tract, varicocele,[29] and perhaps through poor diet as
well. The result is oxidative damage to sperm. Controlled studies of high-dose combinations of
supplementary antioxidants (vitamins C,> 200 mg/d; vitamin E, 200 to 600 IU/d; selenium, 100
to 200 μ g/d) found improved sperm motility and morphology and increased pregnancy rates,
particularly in former smokers.[24]
Carnitine is concentrated within the epididymis and contributes directly to the energy supply
required by sperm for maturation and motility.[30] Treatment with carnitine or acetylcarnitine
(1.0-2.0 g/d) increases the number and motility of sperm and the number of spontaneous
pregnancies.[24],[25]
Alcohol consumption is associated with decreased fertility in both women[31] and men.[32] In
males, alcohol consumption contributes to impotence and to a reduction of blood testosterone
concentrations and impairment of Sertoli cell function and sperm maturation.[27]

Pregnancy and Lactation

Pregnant and lactating women have increased requirements for both macronutrients and
micronutrients. The failure to achieve required intakes may increase risk for certain chronic
diseases in their children, sometimes manifesting many years later.[10],[33]
Protein requirements in pregnancy rise to 1.1 g/kg/d (71 g) to allow for fetal growth and milk
production. The source of protein may be as important as the quantity, however. Some evidence
suggests that protein requirements can be more safely met by vegetable than by animal protein.
Meat is a major source of saturated fat and cholesterol; it is also a common source of ingestible
pathogens[34] and a rich source of arachidonic acid, a precursor of the immunosuppressive
eicosanoid PGE2.
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Pregnant women also should not meet their increased need for protein by the intake of certain
types of fish, such as shark, swordfish, mackerel, and tilefish, which often contain high levels of
methylmercury, a potent human neurotoxin that readily crosses the placenta.[35] Other mercury-
contaminated fish, including tuna and fish taken from polluted waters (pike, walleye, and bass),
should be especially avoided.[36] There is no nutritional requirement for fish or fish oils.
Vegetable protein sources, aside from meeting protein needs, can help meet the increased needs
for folate, potassium, and magnesium and provide fiber, which can help reduce the constipation
that is a common complaint during pregnancy.
Pregnant and/or lactating women also require increased amounts of vitamins A, C, E, and certain
B vitamins (thiamine, riboflavin, niacin, pyridoxine, choline, cobalamin, and folate). Folate
intake is especially important for the prevention of neural tube defects and should be consumed
in adequate amounts prior to conception; evidence shows that average intakes are onl y~ 60% of
current recommendations.[37] Folate intakes were noted to be poorest in women eating a typical
Western diet and highest in women eating vegetarian diets.[38] Pregnant women also require
increased amounts of calcium, phosphorus, magnesium, iron, zinc, potassium, selenium, copper,
chromium, manganese, and molybdenum.[1] Prenatal vitamin-mineral formulas are suggested to
increase the likelihood that these nutrient needs will be met.

Infancy and Early Childhood

Requirements for macronutrients and micronutrients are higher on a per-kilogram basis during
infancy and childhood than at any other developmental stage. These needs are influenced by the
rapid cell division occurring during growth, which requires protein, energy, and nutrients
involved in DNA synthesis and metabolism of protein, calories, and fat. Increased needs for
these nutrients are reflected in DRIs for these age groups,[1] some of which are briefly discussed
below.
Energy. While most adults require 25 to 30 calories per kg, a 4 kg infant requires more than 100
cals/kg (430 calories/day). Infants 4 to 6 months who weigh 6 kg require roughly 82 cals/kg (490
calories/day). Energy needs remain high through the early formative years. Children 1 to 3 years
of age require approximately 83 cals/kg (990 cals/d). Energy requirements decline thereafter and
are based on weight, height, and physical activity.
As an energy source, breast milk offers significant advantages over manufactured formula.
Breast-feeding is associated with reduced risk for obesity,[39] allergies, hypertension, and type 1
diabetes; improved cognitive development; and decreased incidence and severity of infections. It
is also less costly than formula feeding.[40] ,[41]
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six
months of life, followed by continued breastfeeding as complementary foods are introduced.
Breastfeeding may continue for one year or longer.[42] Parents often introduce solid foods to
their infants before six months, of even before four months of age.[43] Parents should be
encouraged to delay introduction of solid foods until six months of age to all for optimal infant
nutrition, growth and development.
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Protein. Older infants, aged 7-12 months have an Recommended Daily Allowance (RDA) for
protein of 1.2 g/kg/d, or 11 g/d of protein. Children aged 1–3 years have an RDA o 1.05 g/kg/d
or 13 g/d of protein and children aged 4–8 years have an RDA of 0.95 g/kg/d or 19 g/d of
protein.[44]
Water. Total water requirements (from beverages and foods) are also higher in infants and
children than for adults. Children have larger body surface area per unit of body weight and a
reduced capacity for sweating when compared with adults, and therefore are at greater risk of
morbidity and mortality from dehydration.[45] Parents may underestimate these fluid needs,
especially if infants and children are experiencing fever, diarrhea, or exposure to extreme
temperatures (e.g., in vehicles during summer).
Essential fatty acids. Requirements for fatty acids on a per-kilogram basis are higher in infants
than adults (see below). Through desaturation and elongation, linolenic and alpha-linolenic acids
are converted to long-chain fatty acids (arachidonic and docosahexanoic acids) that play key
roles in the central nervous system. Since both saturated fats and trans fatty acids inhibit these
pathways,[46] infants and children should not ingest foods that contain a predominance of these
fats.

Adolescence and Adulthood

The Institute of Medicine recommends higher intakes of protein and energy in the adolescent
population for growth. For most micronutrients, recommendations are the same as for adults.
Exceptions are made for certain minerals needed for bone growth (e.g., calcium and
phosphorus).[47] However, these recommendations are controversial, given the lack of evidence
that higher intakes are an absolute requirement for bone growth. Evidence is clearer that bone
calcium accretion increases as a result of exercise rather than from increases in calcium
intake.[48]
Micronutrient needs in adults 19 to 50 years of age differ slightly according to gender. Males
require more of vitamins C, K, B 1, B 2, and B 3; choline; magnesium; zinc; chromium; and
manganese. Menstruating females require more iron, compared with males of similar age.

Later Years
Due to reductions in lean body mass, metabolic rate, and physical activity, elderly persons
require less energy than younger individuals need. Some DRIs for elderly persons differ from
those of younger adults. For example, in order to reduce the risk for age-related bone loss and
fracture, the DRI for vitamin D is increased from 200 IU/d-400 IU/d in individuals 51-70 years
of age and from 200 IU/d-600 IU/d for thos e>7 0 years of age. Suggested iron intakes drop from
18 mg per day in women ages 19-50 to 8 mg/d after age 50, due to iron conservation and
decreased losses in postmenopausal women, compared with younger women.[1] Although diets
that are modest in protein have been associated with health benefits, including reductions in
diabetes and cancer incidence and overall mortality for people aged 65 and under, for those over
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

aged 65, it remains important to ensure adequate protein intake for older people.[49] Plant
sources of protein are preferable.
Some elderly persons have difficulty getting adequate nutrition because of age- or disease-related
impairments in chewing, swallowing, digesting, and absorbing nutrients.[50] Nutrient status may
also be affected by decreased production of digestive enzymes, senescent changes in the cells of
the bowel surface, and drug-nutrient interactions[40] (see Micronutrients chapter). The results
can be far-reaching. For example, a study in elderly long-term-care residents demonstrated
frequent deficiency in selenium, a mineral important for immune function. In turn, impaired
immune function affects susceptibility to infections and malignancies. The role of vitamin B 6 in
immunity also presents a rationale for higher recommended intakes for elderly persons.[51]
Nutritional interventions should first emphasize healthful foods, with supplements playing a
judicious secondary role. Although modest supplementary doses of micronutrients can both
prevent deficiency and support immune function (see Upper Respiratory Infection chapter),
overzealous supplementation (e.g., high-dose zinc) may have the opposite effect and result in
immunosuppression.[52] Multiple vitamin-mineral supplements have not been consistently
shown to reduce the incidence of infection in elderly individuals.[53] The effects of multiple
vitamin-mineral supplementation on cancer risk may be mixed, with some studies showing
benefit[54] and others showing increased cancer risk related to supplement use (e.g., increased
risk for prostate cancer[55] and non-Hodgkin lymphoma in women).[56] Risks may be specific
to certain nutrients. For example, high calcium intake has been associated with prostate cancer
risk (see Prostate Cancer chapter), while other micronutrients have protective effects.
Alcohol intake can be a serious problem in elderly persons. The hazards of excess alcohol intake
include sleep disorders, problematic interactions with medications, loss of nutrients, and a
greater risk for dehydration, particularly in those who take diuretics. Roughly one-third of
elderly persons who overuse or abuse alcohol first develop drinking problems after the age of 60
years.[57]
It goes without saying that recommendations regarding nutritional interventions in elderly
patients should take patients’ wishes into account, particularly when a limited lifespan reduces
the expected benefit of an intervention.

Conclusion

Requirements for energy and micronutrients change throughout the life cycle. Although
inadequate intake of certain micronutrients is a concern, far greater problems come from the
dietary excesses of energy, saturated fat, cholesterol, and refined carbohydrate, which are fueling
the current epidemics of obesity and chronic disease. Clinicians can assist patients in choosing
foods that keep energy intake within reasonable bounds, while maximizing intakes of nutrient-
rich foods, particularly vegetables, fruits, legumes, and whole grains.
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

Change in Nutrient Needs

Life Stage

Increased requirements: energy, protein, essential fatty acids, vitamin A,

vitamin C, B-vitamins ( B1, B2, B3, B5, B6, B12, folate, choline) & calcium,
Pregnancy*
phosphorus,** magnesium, potassium, iron, zinc, copper, chromium,
selenium, iodine, manganese, molybdenum
Increased requirements: vitamins A, C, E, all B-vitamins, sodium,
Lactation* magnesium**
Decreased requirements: iron
Infancy, Increased requirements: energy, protein, essential fatty acids
childhood*
Increased requirements: energy, protein, calcium, phosphorus, magnesium,
Adolescence*
zinc (females only)
Increased requirements for males, compared with females: vitamins C, K;
Early adulthood
B1, B2, B3, and choline; magnesium, zinc, chromium, manganese
(ages 19-50)
Increased requirements for females, compared with males: iron
Middle age (ages Increased requirements: vitamin B6, vitamin D
51-70)*
Elderly (age Increased requirements: vitamin D
70+)* Decreased requirements: energy; iron (females only)
Changing Nutrient Needs through the Life Cycle

* Relative to adult requirements for those 19-50 years of age (and on a per-kg basis for
macronutrients).
** Applies only to individuals under age 1
 Saint Louis University
SCHOOL OF NURSING
Nutrition Lecture

MY REFLECTION
It’s surprising that one period has been passed already and the time really flies so
fast. In past months, I have faced a lot of stress not just only in this subject but to other
major subjects too. But I know, that there are more stressors to come that I need to face
because it is a natural part of a nursing life.
In the lecture, I have learned the different definitions and new things. I really
struggled a lot and doubled my effort to do my self-directed learning. It is very amazing
to learn first about the nutrition lifespan cycle. This topic is really interesting to study
because this is new to me. I learned about the Nutrition during Lactation, Infant Nutrition
, Nutrition in Childhood-School age , Nutrition for Toddlers and Pre-schoolers, Nutrition
in Adolescence , Young and Adulthood Nutrition and Nutrition on Aging/Geriatric. The
most exciting topic for me is about breastfeeding and foods to avoid during pregnancy
such as Raw or undercooked meat, Unpasteurized milk and dairy products, Liver and
other foods containing vitamin A, Raw eggs* or undercooked eggs, Alcohol, Caffeine
and many more.

On the other hand, In terms of the quizzes, I don’t have any problem with it maybe
because I keep on reviewing and reading my notes because of my urge to learn a lot of
things especially those that are new to me. I just hope that I can keep this behaviour and
practice until the semester ends or until I graduate in college.
In terms of assignments, I admire my professor for giving us SDL always that is
really helpful when examinations come.
Overall, my journey through this midterms was a blast. All the SDLs I’ve done
helped me and nourished me about the importance and the roles of being a future nurse. I
am very happy that I am also learning through my own will and effort. This made me also
realized that learning things shouldn’t only from our teachers because we students also
have our parts for us to have a successful learning.