Nutrition during Pregnancy
Nutritional requirements of the pregnant mother
The nutritional requirements during pregnancy depend on pre–pregnancy nutritional status of the pregnant mother. A woman who has been well nourished before conception, begins her pregnancy with reserves of several nutrients.

In such cases 300 calories and 15 gm protein more than usual pre–pregnancy requirement is adequate during pregnancy. The requirement of other nutrients too is higher during this period. Use of a daily food guide may be helpful for selecting proper foods to meet these additional requirements. In case of mothers who have not been well nourished during pre–pregnancy period, special care is required to yellow fruits & vegetables: Source of proteins provide additional nutrients during pregnancy.

Proteins
Additional nutritional requirements of pregnant mother:
Two servings from the protein group of daily food guide, preferably milk, fish, eggs or poultry, which provide protein of high biological value. In addition, one serving of green leafy vegetables or yellow orange vegetables or fruits and 1 to 2 servings of citrus fruits is recommended in addition to usual balanced diet.

Indications of sufficient food intake during pregnancy
Normally, weight gain during pregnancy indicates food adequacy. About 1 to 1.5 kg weight gain during first trimester and 450 gm/per week thereafter during remaining period of pregnancy is normal. This means a total non–edematous weight gain of 10 to 12 kg during entire period of pregnancy. What needs to be carefully observed is the abnormal weight gain, which could be due to excess water retention.

Dietary considerations during pregnancy
Small and frequent feeds:

• During initial period of pregnancy the mother experiences nausea and loss of appetite and during later part, to avoid discomfort after large meals due to pressure of enlarged uterus on other organs in abdominal cavity.
• Nutrient dense foods help in providing required nutrients in smaller quantity.
• Adequate amount of soluble and insoluble fiber to avoid constipation.
• Plenty of fluid helps eliminating all excretory products.
• Regular and steady level of food intake to help steady weight gain, proper digestion and elimination.
• Avoid fatty, rich food, fried food, excessive seasoning, coffee in large quantity, and strongly flavored food.

Lactation
Nutritional needs of a nursing mother
Milk Nutritional requirements of a nursing mother are higher than pregnant mother as the child’s demand for milk increases. Nursing mother needs more protein, minerals, vitamins and calories. Additional diet requirement. Since the additional requirements of nursing mother are for production and secretion of breast milk, it can be continued as long as the mother is feeding the baby. Requirement may be reduced progressively as milk output is reduced.

Milk Suggest the foods to get the additional nutritional requirements 4 additional servings of protein foods, 2 out of which should be of milk to provide additional requirement of calcium and riboflavin. A serving each of dark green, or yellow orange vegetable/fruit and one to two citrus fruits to provide vitamin A and C. 2–3 servings from cereal group and 15–20 ml of oil to provide essential fatty acid sand additional energy. Number of feeds need to be increased to accommodate extra food.

• Select nutrient dense foods.
• Consume more fluids to compensate total breast milk output.
• Lacteous ( almonds, garden cress seeds, poppy seeds, fenugreek seeds, garlic etc.) may be included in the diet to stimulate milk production. Sufficient rest for mother, freedom from anxiety and desire to nurse baby are also essential for successful lactation.

Nutrition in Obesity
An individual is considered obese when there is a generalized accumulation of excess fat in the body resulting in weight 20% more than the desirable level. Excess body weight predisposes a person to diseases like angina pectoris, coronary thrombosis, hypertension, stroke, diabetes mellitus, gall bladder diseases or osteoarthritis of weight bearing joints. It may lead to obstetrical risk, psychological disturbances & also may result in low life expectancy.

Assessment of obesity
Various indices have been developed such as body weight, body mass index (BMI), measurement of body fat, ponderal index, waist to hip ratio, etc. Drugs are absolutely useless in reducing regimen except in specific glandular deficiencies. Appetite reducing drugs like amphetamines, diuretics or purgatives are harmful and are no substitutes for a low calorie diet.Crash diets are not advisable in normal circumstances. Only in emergencies should one go on a crash diet but that too under medical supervision. Even in that case, critical follow up in order to maintain a desirable body weight is necessary.

Treatment of obesity
There is no substitute for diet and exercise in order to reduce weight. One should resort to a low calorie diet with restricted carbohydrates and fat, normal protein, adequate vitamins and minerals, liberal fluid and high fiber. Low calorie diet should be supplemented by moderate exercise. However both diet and exercise must be done under advice from an expert consultant.

Rate of reduction of weight depends on extent of obesity. Normally, reduction of 2 to 3 kg per month is realistic and can be achieved without any undesirable physical, psychological or emotional effects. Approximate intake of 500 calories less than the daily requirement can result in weight loss of about 2 kg per month.


Nutrition for Diabetics
Diabetes Mellitus is a chronic metabolic disorder which does not allow the body to use glucose completely or partially. High glucose levels in the blood (which is also known as blood sugar) and an alteration in carbohydrates, protein and fat metabolism are typical of this condition.

Causes of diabetes
The causes of diabetes are still not known completely. However, it is known that factors such as genetics, obesity, infection or acute stress, either physical or emotional play an important role in it development. It may also occor as a secondary disease to some of the diseases like pancreatitis, hemochromatosis, carcinoma of pancreas or pancreatectomy. Diabetes may also develop as a side–effect of the treatment of some other conditions due to the intake of Corticosteroids or diuretics like thiozide group.

Type of diabetes:
Insulin Dependent ( IDDM ) or Juvenile onset diabetes
IDDM patients depends on external Insulin. This type of diabetes happens suddenly and usually during childhood (around 10 to 12 years). It is caused by a virus or due to an auto–immunity. The children are usually under–weight when suffering from this condition.
Non Insulin Dependent ( NIDDM ) or Adult Onset Diabetes, AOD
This condition develops slowly. usually milder in nature and more stable. The pancreatic secretions of insulin may be inadequate or the action of insulin is faulty. The pancreas produce insulin in such cases to over come the problem. This type of diabetes can be controlled by diet and exercise. Diabetes if not controlled can lead to complications like vascular diseases like retinopathy, nephropathy as well as cardiac diseases including heart attack. Neuropathy joint and skeletal muscle problems can also occur in uncontrolled diabetes.


Pediatric Nutrition
Infancy being a period of most rapid growth, nutritional requirements are the highest per unit of body weight during this period. Breast milk provides the required nutrients in suitable proportions for rapid infant growth. The decision as to when to start weaning or introducing solid food in infants diet depends on physical & physiological development as well as appropriate nutritional requirement.

Before solid foods are introduced, it is essential that enzyme system in the intestine is ready to digest starches and non–milk proteins. When foods are added to baby’s diet, they should be introduced one at a time. Only small amounts should be given to start with. Mixtures of food should be avoided. The use of sugar, salt and other seasonings should generally be kept to a minimum. A wide variety of foods should be given to develop good eating habits. A child should not be forced to eat more than what he or she wants.

Following chart indicates a general guideline for introduction of various foods to infants:

Orange/Tomato juice (vitamin C)	2nd month
Food	Age for introduction
Well cooked cereals	2 to 4 months
Strained/Pureed Vegetables Fruits	3 to 5 months
Cooked Egg yolk/Fish	6 to 7 months
Pulses along with cereals vegetables	6 to 9 months
Substitution of milk with cereal or pulses etc	6 to 7 months
Complete weaning on family foods	12 months

As far as possible, introduction of commercial baby foods should be avoided. Mother’s milk and natural foods are the best for the good health of infants. Introduction of these baby foods need careful reconstitution and proper understanding on the part of the mother and/or other caretakers. They also involve hygiene and other factors to be taken care of. However, if introduction of these foods is unavoidable due to some reasons, the following points must be noted:

• Commercial weaning foods can be introduced only after 4 months.
• Before that period other milk substitutes or cow/buffalo milk may be used.
• Proper attention should be given to hygiene.
• Proper directions for preparation and feeding be followed and child should not be forced to eat more than what he takes willingly.