whereas the indicator amino acid oxidation methodology only focuses on oxidation to reflect whole body protein synthesis, explained Elango. Noting that oxidation is a rapid process, and protein synthesis is a good indicator of the body’s needs, Elango stated that the indicator amino acid oxidation approach is a shorter, acute model. From a practical perspective, Redman wondered if increasing the protein DRIs for adequacy would affect birth outcomes. Elango emphasized that protein intake is one of a wide range of factors that affect birth outcomes, so he did not expect significant changes in a well-nourished population. He did, however, raise concerns regarding major shifts in dietary protein quality and amounts [e.g., a sudden shift to a plant-based diet], suggesting that pregnancy was not the time to make such dramatic dietary changes.
A question about placental needs over the course of pregnancy revealed differences in the methodologies for assessing carbohydrate and protein requirements. Redman reminded the audience that the current DRIs for carbohydrate needs were derived using brain glucose utilization estimates; she was unaware of any stable isotope studies that had been conducted in pregnant women to assess whole body oxidation of carbohydrates. By contrast, Elango stated that the benefit of the indicator amino acid oxidation approach was that it accounted for maternal, fetal, and placental protein use. He noted that the contributions of each component to protein needs, however, cannot be determined.
Two questions were raised regarding the practical implications of the existing recommendations. In reflecting on the 2015–2020 Dietary Guidelines for Americans recommendation, Barbara Laraia of the University of California, Berkeley, was concerned that 10 percent of energy from added sugars would be a sizable portion of a pregnant woman’s carbohydrate requirements, and she wanted to know how best to convey this recommendation. Agreeing that the added-sugar recommendation appeared liberal, Redman note that the 2015–2020 Dietary Guidelines for Americans provides an explanation for how it arrived at this value. Nevertheless, Redman thought more stringent added-sugar recommendations were likely needed, given their purported detrimental health effects. “We know that added sugars shouldn’t be there at all. The value should be zero really,” Redman said, although she was unclear how to best to establish added-sugar recommendations. Later, Redman posed a question to Elango, as to whether protein recommendations should be trimester specific or whether they should be static for ease of use. Elango was supportive of the trimester-specific recommendations, an approach that is used by WHO.
Nutrition and Public Health Unit. Research Group on Nutrition and Mental Health [NUTRISAM], Faculty of Medicine and Health Science, Universitat Rovira i Virgili, 43201 Reus, Spain
2
Pere Virgili Institute for Health Research [IISPV], Universitat Rovira i Virgili, 43003 Tarragona, Spain
3
Tarragona-Reus Research Support Unit, Jordi Gol Primary Care Research Institute, 43003 Tarragona, Spain
4
CIBERobn [Center for Biomedical Research in Physiopathology of Obesity and Nutrition], Instituto de Salud Carlos III, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
†
Equal contribution.
‡
The ECLIPSES study group also contributed to this work.
Nutrients 2020, 12[5], 1325; //doi.org/10.3390/nu12051325
Received: 1 April 2020 / Revised: 30 April 2020 / Accepted: 2 May 2020 / Published: 7 May 2020
[This article belongs to the Section Nutrition Methodology & Assessment]
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Pregnancy and post-partum are critical periods in which nutritional intake is essential to maternal and child health. Our aim was to describe dietary intake during pregnancy and post-partum and assess its adequacy. A longitudinal study was conducted on 793 pregnant women. Data about maternal characteristics, health, diet and lifestyle were assessed. Energy and nutritional intake were compared to the Recommended Dietary Allowances [RDA]. The results showed that the intake of energy [82.6%], protein [80.6%] and carbohydrate [99.5%] was adequate [above 80% of RDA] during pregnancy, as were vitamins C, B2 and B12; but vitamin D, iron and folate intake were a long way from RDA [below 35%]. Similar results were observed for the post-partum period although fiber, and vitamins E and C decreased compared to intake during pregnancy. In conclusion, although nutritional requirements increase during gestation, pregnant women did not increase their energy and nutritional intake during pregnancy and postpartum and they had a high risk of deficient intake of vitamin D, iron and folates during pregnancy, and therefore, of developing an unfavorable nutritional status, contrary to health recommendations. These findings underscore the necessity of intensive nutrition programs during and after pregnancy. Keywords:Abstract
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Pregnancy and lactation are an essential stage of the lifecycle during which an adequate diet is crucial in order to meet the increased nutritional requirements of the mother [], respond to the physiological demands of pregnancy and milk production, and ensure the healthy development of the fetus []. Inadequate maternal nutrition, and especially a deficit of essential nutrients, is associated with negative health outcomes in both the mother and the child [,,,]. The key nutrients that are particularly important during pregnancy and lactation include iron, folates, calcium and vitamin D [,]. Poor maternal nutrition is associated with iron deficiency, which can lead to low birth weight [10 mg] during previous months up until week 12, hypersensitivity to egg protein, previous serious illness [immunosuppression] or any chronic disease that could affect nutritional development [cancer, diabetes, malabsorption, or liver disease]. The present study included all pregnant women in the intervention and control groups because our aim was to assess nutritional intake. Therefore, 793 pregnant women were included in the study during the first prenatal visit at week 12 of pregnancy. The data that was collected included the medical and obstetric history, socioeconomic information, lifestyle habits and anthropometric measurements in the first trimester of pregnancy [at the 12th week]. Nutrition was assessed at the end of each trimester of pregnancy [at week 12, week 24 and week 36] and post-partum. Midwives and nutritionists compiled this information during the personal interview and from specific questionnaires. The medical history and socioeconomic information collected included the following: maternal age, ethnicity, education level [primary, secondary, and university studies], estimated date of delivery, planned pregnancy, clinical and obstetric history. The socioeconomic level was calculated by occupational status using the Catalan classification of occupations [CCO-2011] [] and was classified as low, middle, high. Information about lifestyle habits was collected including alcohol intake, smoking habits and physical activity using the short version of the International Physical Activity Questionnaire [IPAQ-S] [] and women were classified as sedentary or active. Anthropometric measures were height [cm] and weight [kg]. Body mass index was calculated and was classified following World Health Organization [WHO] criteria []: Normal weight [BMI 1. Introduction
2.3. Data Collection