LB2882MaternalNutriti+ - Mead Johnson Nutrition

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countries varies considerably (mean 70 to 200 mg/day) and the median intake (30-50 mg/day) 70 is lower than the estimated amount that the fetus accrues daily during the last trimester (~75mg/day of n-3 LCPUFA, mostly DHA). 71 DHA supplementation during pregnancy has been linked to benefi cial outcomes, including slightly longer gestation (within the normal range of gestation) and slightly higher infant birth-weight. 70,72 There is some evidence to suggest that maternal DHA supplementation during pregnancy improves infants’ visual acuity, cognitive development, and immune outcomes. 72,73 Emerging evidence suggests that maternal DHA supplementation may affect infant body composition later in life by lowering adiposity. 70 After delivery, DHA continues to rapidly accumulate in the infant brain during the fi rst 18 to 24 months of life. 74 Human milk contains DHA but the amount varies with maternal intake. 72 Brenna and colleagues 75 reported the worldwide average level of DHA in mature human milk as 0.32 ± 22% (% fatty acids ± SD) with a wide range of 0.06% to 1.4%. Coastal or island populations with high intakes of marine foods had the highest breast milk DHA levels while inland populations and developed countries had the lowest. Supplementing DHA intake of lactating women increases breast milk DHA content but supplementation with the DHA precursor, ALA, does not. 72 Observational studies and intervention trials of breastfed infants indicate that DHA levels in human milk infl uence infant outcomes. 72 In observational studies, higher DHA levels in human milk and/or infant blood have been associated with better infant visual acuity when compared with lower levels. 76 In addition, several intervention trials have found that maternal DHA or DHA+EPA supplementation positively affects neural development of breastfed infants. 76,77 Exact requirements for DHA during pregnancy and lactation have not been determined but in 2010 three groups published recommendations on DHA intakes. The Joint FAO/WHO Expert Consultation on Fats and Fatty Acids in Human <strong>Nutrition</strong> recommended that pregnant and lactating women consume at least 200 mg DHA per day (Table 6). 8 In addition, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) 9 considered DHA to be an essential fatty acid in their update of the French population reference intakes (Apports nutritionnels conseillés or ANCs); they established ANCs for DHA of 250 mg DHA per day for pregnant and lactating women. 9 Also in 2010, the European Food Safety Authority (EFSA), in their Scientifi c Opinion on Dietary Reference Values for Fats and Fatty Acids, established an adequate intake (AI) of 250 mg of EPA + DHA per day for adults. EFSA recommended that 100 to 200 mg of preformed DHA be added to this daily intake during pregnancy and lactation. 10 Previously (2007), a Consensus Statement from the Perinatal Lipid Intake Working Group (on behalf of the European Commission Perinatal Lipid Metabolism [PeriLip] and Early <strong>Nutrition</strong> Programming [EARNEST] research projects, jointly with representatives of seven other international nutrition or medical organizations) recommended that pregnant and lactating women consume at least 200 mg DHA per day. 78 Experts have concluded that there is no evidence indicating that intake of dietary n-6 fatty acids, including ARA, should be increased during pregnancy and lactation. 72 In addition, no recommendation for EPA intake alone during pregnancy and lactation has been made since EPA has only been studied with DHA as a component of fi sh or a fi sh oil preparation 72 (Table 6). TAbLE 6. RECOMMENDED INTAkES FOR LCPUFA DURING PREGNANCY AND LACTATION 8 Recommended Intake Upper Intake Limit DHA 200 mg/day 1.0 g/day DHA + EPA 300 mg/day 2.7 g/day ARA No recommendation 800 mg/day MATERNAL NUTRITION 12
The United States has not established recommended intakes for DHA. The US Dietary Guidelines for Americans 2010, however, recognized the importance of DHA during pregnancy and lactation. 37 The Guidelines state, “Moderate evidence indicates that intake of omega-3 fatty acids, in particular DHA, from at least 8 ounces of seafood per week for women who are pregnant or breastfeeding is associated with improved infant health outcomes, such as visual and cognitive development. Therefore, it is recommended that women who are pregnant or breastfeeding consume at least 8 and up to 12 ounces of a variety of seafood per week, from choices that are lower in methyl mercury.” Cold water, ocean-faring fatty fish, such as salmon and tuna, are among the richest natural sources of DHA. DHA is present naturally in lesser amounts in organ meats, poultry and eggs and is found in DHA-fortified foods (Table 7). The presence of methyl mercury and other neurotoxic chemicals in fish and shellfish is a potential concern for women in their childbearing years. 36 The US Dietary Guidelines for Americans 2010 state that women who are pregnant or breastfeeding should not eat tilefish, shark, swordfish and king mackerel because they are high in mercury. 37 Fortified foods and dietary supplements containing DHA, either derived from single-cell organisms or fish oil that have been processed to remove potential contaminants, are also sources of preformed DHA for pregnant and lactating women who do not eat enough DHA-rich foods. Table 7. Selected Food Sources of DHA Food DHA (mg) Salmon, coho, farmed, 3 oz, cooked 706 Tuna, light, canned, drained, 3 oz 190 Catfish, 3 oz, cooked 116 Blue crab, 3 oz, cooked 57 Fortified eggs, 1 large 57 Chicken, roasted, dark meat, 3 oz 45 Eggs, 1 large 29 Sources: www.nal.usda.gov/fnic/foodcomp/search/. Accessed 09/12 Fortified Eggs: www.egglandsbest.com. Accessed 09/12 Vitamins Recommended intakes of several vitamins increase during pregnancy and lactation. Figure 1 compares recommended intakes of select vitamins for non-pregnant women (19 to 30 years old) with those of pregnant or lactating women of the same age. 13
Page 1 and 2: MATERNAL NUTRITION bY Elizabeth M.
Page 3 and 4: TAbLE OF CONTENTS EXECUTIVE SUMMARY
Page 5 and 6: EXECUTIVE SUMMARY A mother’s nutr
Page 7 and 8: INTRODUCTION A mother’s nutrition
Page 9 and 10: Preconception Care In 2005, the WHO
Page 11 and 12: Nutrient Needs during Pregnancy and
Page 13: During lactation, the U.S. Dietary
Page 17 and 18: Folate and Folic Acid Folate is a g
Page 19 and 20: Vitamin D Vitamin D’s principal r
Page 21 and 22: Iron Iron is vital to the productio
Page 23 and 24: Table 10. WHO Recommended Nutrient
Page 25 and 26: Guidelines for Physical Activity du
Page 27 and 28: FOOD SAFETY ISSUES Fish and Seafood
Page 29 and 30: the recommendations, summarized bel
Page 31 and 32: Women are encouraged to enter pregn
Page 33 and 34: 53. Viswanathan M, Siega-Riz AM, Mo
Page 36: XXXXXX NEW 12/12 ©2012 Mead Johnso

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