NON MAJOR ELECTIVE-I FOR NUTRITION AND DIETETICS

Unit –IV

NUTRITION IN PREGNANCY

Define the term pregnancy

The period from conception to birth is called pregnancy. After the eggs is
fertilized by a sperm and then implanted in the lining of the uterus, it develops in to
placenta and embryo, and later in to a fetus. Pregnancy usually lasts 40 weeks,
beginning from the first day of the woman’s last menstrual period, and is divided in to
three trimesters, each lasting three months

STAGES OF PREGNANCY

Pregnancy has three trimesters, each of which is marked by specific fetal

developments. A pregnancy is considered full-term at 40 weeks; infants delivered
before the end of week 37 are considered premature. Premature infants may have
problems with their growth and development, as well as difficulties in breathing and
digesting.

First Trimester (0 to 13 Weeks)

 The first trimester is the most crucial to baby’s development. During this period,
your baby's body structure and organ systems develop. Most miscarriages and
birth defects occur during this period.
 Body also undergoes major changes during the first trimester. These changes
often cause a variety of symptoms, including nausea, fatigue, breast tenderness
and frequent urination. Although these are common pregnancy symptoms, every
woman has a different experience. For example, while some may experience an
increased energy level during this period, others may feel very tired and
emotional

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Second Trimester (14 to 26 Weeks)

 The second trimester of pregnancy is often called the "golden period" because
many of the unpleasant effects of early pregnancy disappear. During the second
trimester, likely to experience decreased nausea, better sleep patterns and an
increased energy level. However, may experience a whole new set of symptoms,
such as back pain, abdominal pain, leg cramps, constipation and heartburn.
 Somewhere between 16 weeks and 20 weeks, you may feel your baby's first
fluttering movements.

Third Trimester (27 to 40 Weeks)

 Now reached final stretch of pregnancy and are probably very excited and
anxious for the birth of baby. Some of the physical symptoms may experience
during this period include shortness of breath, hemorrhoids, urinary incontinence,
varicose veins and sleeping problems.
 Many of these symptoms arise from the increase in the size of uterus, which
expands from approximately 2 ounces before pregnancy to 2.5 pounds at the
time of birth.

PHYSIOLOGICAL CHANGES IN PREGNANCY

 The expansion of blood volume is required to allow the circulation of blood

through placenta and allow it carry nutrients and oxygen to the fetus and
metabolic wastes away from the fetus. Blood volume expands by 50 percent
resulting in a decrease in hemoglobin levels, blood glucose values and serum
levels of albumin, other serum proteins and water- soluble vitamins.
 The declined in serum albumin levels contributes to a tendency for extracellular
water to accumulate during pregnancy. The decrease in water soluble vitamin
concentration makes determination of an inadequate intake or a deficient
nutrients state difficult. By contrast, serum concentrations of fat soluble vitamins
and other lipid fractions, such as triglycerides, cholesterol and free fatty acids
increase.

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 There is a decreased ability to taste saltiness. This may infact, be a physiologic

mechanism for increasing salt intake. Increased progesterone level relaxes the
uterine muscle to allow for increased absorption of nutrients. This often results in
constipation. Additionally, a relaxed lower esophageal sphincter can cause
regurgitation and heart burns.
 Increased blood volume produces a high glomerular filtration rate. It appears that
the renal tubules are unable to adjust completely and a percentage of nutrients
that would have been reabsorbed in the non pregnant women are excreted in the
urine. Increased amounts of amino acids, glucose and water soluble vitamins
may appear in the urine.
 The ability to excrete water is lowered and edema in the legs and ankles is
common and normal
 Less than half of the total weight gain in the fetus, placenta and amniotic fluid;
the remainder is found in maternal reproductive tissues, fluid, blood and maternal
stores, a component composed largely of body fat. Gradually increasing
subcutaneous fat in the abdomen, back and upper thigh serves as an energy
reserve for pregnancy and lactation.
 Increased weight gain during pregnancy is associated with increased birth weight
and a progressive decrease in the number of LBW infants. High estrogen levels
during pregnancy promote a gynecoid type of fat distribution

COMPLICATION OF PREGNANCY

About 1, 25,000 women die in India every year from causes related to pregnancy
and child birth. The main causes are anemia, hemorrhage, and toxemia which are often
preventable (2006).

Anaemia

 According to WHO/UNICEF/UNO, 1989, a pregnant woman is anemia if the

hemoglobin level is below 11.0 g/dl or haematocrit percent.
 Factors implicated in the etiopathogenesis of anemia during pregnancy and low
birth weight are maternal age, weight, height, parity, literacy, income, infections ,

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pregnancy related complications, nutritional stress, cultural beliefs, taboos and

inappropriate food practice. Too little space between or too many infections and
too little intake of nutrients involved in erthropoiesis pregnancy leads to anemia
 Women with hemoglobin levels below 7g /dl are considered to be severely
anemic. Recommended therapeutic does for women in the reproductive age
group is one tablets of iron thrice daily for a minimum of 100 days. This will
provide equivalent to 180 mg elemental iron and 1500 µg of folic acid per day.
 The demand for float during pregnancy is increased because of increased
cellular proliferation. Megaloblastic anemia results in intensified nausea, vomiting
and anorexia.
 Iron deficiency anemia in the mother may also produce alternations in brain
functions and impaired schooling later. Low birth weight infants have a high
mortality rate and those that survive have greater rates of morbidity and poorer
neurological development
 Regular consumption iron rich food such as green leafy vegetables, cereals such
as wheat, ragi, jowar and bajra pulses and jaggery.

Constipation

 The pressure of the enlarging uterus on the lower portion of the intestine, in
addition to the hormonal muscle relaxant effect of placental hormones on the
gastrointestinal tract may results in constipation.
 Physical inactivity may also make elimination difficult. Increased fluid intake and
use of natural laxative foods such as whole grains, dried fruits, vegetables that
are rich fiber, juices, and usually induced regularity.

Edema

 Mild, physiological edema is usually present in the extremities in the third

trimester. The swelling of the lower extremities may be caused by the pressure of
the enlarging uterus on the veins returning fluid from the legs.
 This normal edema requires no sodium restriction or other dietary changes.

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Hypertension

These can considerable maternal and fetal consequences. Nutritional therapy will
centre on

 Prevention on weight extremes, under weight or obesity

 Correction of any dietary deficiencies and maintenance of optimal nutritional
status during pregnancy and Management of any related preexisting disease
such as diabetes mellitus.
 Sodium intake may be moderate but should not be unduly restricted.

Diabetes mellitus

 During pregnancy glycosuria is not uncommon, because of the increased

circulating blood volume and its load of metabolites. Most of these women revert
to normal glucose tolerance after delivery.
 Hence the management and counselling of women with diabetes in the
reproductive age group should begin prior to conception, with efforts aimed at
achieving HbAIC concentration around 6.5 percent. Glycosylated hemoglobin
measurements are used to aid in the timing of conception.
 Among diabetic’s women with poor control, perinatal mortality ranges from 3-5
percent and major congenital defects from 6-12 percent

Nutritional requirement

 Increase in nutritional requirements depends on the natural metabolic changes of

pregnancy and the nutrition reserve mother ICMR recommended dietary allowed
of an expectant mother

Nutrient Normal adult women Pregnant woman (for

second and third trimester)
Energy kcals
Sedentary 1875 +300
Moderate 2225 +300

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Heavy 2925 +300

Protein g 50 +15
Fat g 20 30
Calcium mg 400 1000
Iron mg 30 38
Retinol µg 600 600
β carotene µg 2400 2400
Thiamine mg
Sedentary 0.9 +0.2
Moderate 1.1 +0.2
Heavy 1.2 +0.2
Riboflavin mg
Sedentary 1.1 +0.2
Moderate 1.3 +0.2
Heavy 1.5 +0.2
Niacin mg
Sedentary 12 +2
Moderate 14 +2
Heavy 16 +2
Pyridoxine mg 2.0 2.5
Ascorbic acid mg 40 40
Folic acid µg 100 400
Vitamin B12 µg 1 1

Energy:

 Energy needs during pregnancy increase because of the

 Growth and physical activity of the fetus.
 Growth of the placenta and maternal tissue,

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 Normal increase in maternal body size,

 Additional work involved in carrying the weight of the fetus and extra maternal
tissues and
 Slow but steady rise in basal metabolic rate during pregnancy.
 BMR Increase by about 5 percent during the first and second trimester and by
about12 percent during the third trimester
 For a reference Indian woman, whose body weight is 50kg, the total energy cost
of pregnancy is around 73,000kcals and the energy during expenditure during
normal pregnancy would be 23,000kcals.
 In addition calories are required for the deposition of fat which would be lactation.
Expert committee recommended an additional intake of 300kcal/day during the
second and third trimester of pregnancy.
 Hence ICMR recommended energy requirement of pregnant woman follows
 Sedentary worker: 1875+300=2175
 Moderate worker: 2225+300=2525
 Heavy worker: 2925+300=3225

Protein

 The normal protein requirement of an adult woman is 50g/day. ICMR prescribed

for a pregnant woman 65g /day. Additional protein is essential for
 Rapid growth of the uterus, mammary glands and placenta
 The enlargement of the uterus, mammary glands and placenta
 Increase in maternal circulating blood volume and subsequent demand of
increased plasma protein to maintain colloidal osmotic pressure and circulation of
tissue fluids.
 Formation of amniotic fluid and storage reserves for labor, delivery and lactation.
 The transfer of amino acids from the mother to fetus (up to 20 weeks all amino
acids must be provides to the fetus as it cannot oxidize amino acids as a source
of energy.
 Protein requirement during pregnancy has been compute d on the basis of N
accretion based on the body weight gain 12kg in a normal healthy well nourished
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pregnant woman, the daily N deposited during the three trimesters is estimated
to be 0.1,0.5 and 0.9 g respectively.
 After increasing by 50 percent to convert the factorial value into physiological
value for N accretion, and 25 percent for individual variation, the safe level of
intake in terms of a high quality protein during the three trimesters will be
1.2,6.0,10.5 g respectively. After adjusting for the dietary protein quality of NPU
65, the safe intake during the latter half of pregnancy recommended by the
nutrition expert committee is15 g/day.

Essential fatty acids

 The requirement of linoleic acids during pregnancy is 4.5 en%. If invisible fat is
12.5 en% to meet EFA, visible fat is to be 30g/day. Essential fatty acids relax
muscles and blood vessels of the uterus and makes delivery easier. Essential
fatty acids deficiency adversely affects pregnancy outcome.
 Corn, cotton seed, safflower and soybean oils are good source of linoleic acids.

Calcium

 ICMR calcium requirement of adult woman is 400mg/ day. Requirement increase

during pregnancy to 1000mg/day.
 The pregnant woman routinely exhibits adjustments in calcium metabolism,
largely as result of the influence of hormonal factors. Human chorionic somato m
mammotropin from the placenta progressively increase in rate of bone turnover.
Estrogen also largely derived from the placenta, inhibits bone reabsorption,
provoking a compensatory release of parathyroid hormone, which maintains the
serum calcium level while enhancing intestinal absorption. The net effect of these
changes is the promotion of progressive calcium retention to meet progressively
increasing fetal skeletal demand for mineralization.
 Two-third of fetal calcium is transferred from mother to the fetus to the fetus after
30th week of pregnancy at the rate 300mg per day radio isotopic studies reveled
that nearly 80 percent calcium of skeleton and mother were obtained from the
mother’s diet and the rest was obtained from maternal reserves.

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 Pregnant woman usually absorb not less than 40 percent of the calcium available
in their diet. Calcium retention by pregnant woman is of 2 to 5 times the amount
needed by the fetus in the 6th and 7th months of pregnancy indicating the
maternal reserves are being built up at this stage.

Iron

 Normal iron requirement of an adult woman is 30mg/day. ICMR requirements

during pregnancy are 38mg/day.

The increase in iron by 8 mg/day can be attributed to the following:

 Infants are generally born with high Hb levels of 18-22g/100 ml of blood iron
stores in the liver of the infants lasts from 3 to 6 months. Iron is also required for
growth of fetus and placenta. To achieve these levels mother must transfer 240
mg of iron to the fetus during gestation.
 It is also required for the formation of hemoglobin as there is 40-50 percent
increased maternal blood volume. For this 400 mg of iron is required
 Loss of maternal iron through skin and sweat is about 170mg of iron

Sodium

 During pregnancy there is an increase in the extra cellular fluid which calls for an
80 percent increase in the body sodium. Restriction in the diet can cause a
severe hormonal and biochemical changes.
 When blood sodium levels drops, kidney produces the hormone rennin as result
of which the sodium that is needed for use by the body is retained
 When the system is over taxed it can result in sodium deficiency causing an
increased risk of eclampsia, prematurity and low birth weight in infants.

Iodine

 ICMR recommended additional requirements of 25 µg during pregnancy to the

adult requirement of 100-200 µg. iodine deficiency mother can lead to abortion,
still birth, congenital anomalies, increased prenatal mortality, cretinism and

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psychomotor defects. Mothers who are residing in goiter endemic areas should
ensure that they get enough iodine through iodized salt and other means.

Thiamine

The ICMR recommendation of thiamine RDA for an adult woman is

 0.9 mg for sedentary worker

 1.1 mg for moderate worker.
 1.2 mg for heavy worker.
 The pregnant woman the requirement is increased by 0.2mg/day
 The relationship between thiamine and caloric intake remains the same as
normal adult during pregnancy that is for 1000 calories 0.5 mg of thiamine is
required. The normal urinary excretion of thiamine drops indicating that more is
being retained and used by tissues. In some cases thiamine helps to relieve the
nausea of pregnancy.

Riboflavin

 The ICMR recommendations of riboflavin RDA for an adult woman is

 1.1mg for sedentary worker.
 1.3 mg moderate worker
 1.5 mg for heavy worker.
 In a pregnant woman the RDA is increased by 0.2mg/day. For 1000 calories
intake, 0.6 mg of riboflavin is required.

Folic acids

 ICMR recommendations during pregnancy are 400µg/. The recommended intake

of folacin is based on its role in promoting normal fetal growth and preventing
macrocytic anemia of pregnancy.
 Folic acid is needed for synthesis of essential components of DNA and RNA
which increase rapidly during growth thereby increasing the requirements.

Vitamin –C

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 ICMR recommended of vitamin c during pregnancy is 40 mg same as normal

woman requirements. The fetal requirement is too small and sufficient safety
margin is given for an adult woman and extra allowance may not be necessary
during pregnancy.
 In pregnancy vitamin C can fully cross the placental barrier.
 The vitamin C content of fetal blood is thrice as much as maternal blood. There is
some evidence to shows that the placenta can synthesis vitamin- c

Some suggest recipes during pregnancy

Recipes Reason
Dairy products like milk, curd, khoya, To meet the requirements of protein,
yogurt, and cheese, panner, banana, calcium, and vitamin D and to prevent
green leafy vegetables, whole grain muscle cramps natural laxatives and
cereals prevent constipation
Fruit salad Appetizing and provide many nutrients and
also fiber.
Omlette, boiled egg, scrambled egg, liver Good quality protein and iron
curry
Rice flakes upma, puffed rice ball Good source of iron and easy to digest
Green gram, dhal, pakoda, bread pudding, Nutrient dense foods to be given to meet
carrot halwa increased requirements.
Pickles, rasam, sour foods These foods may give relief from nausea.

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Unit V

NUTRITION DURING LACTATION

Define the term lactation

The process of milk production is called as lactation Human milk is secreted by

the mammary glands, which are located within the fatty tissue of the breast. The
hormone oxytocin is produced in response to the birth of a new baby, and both
stimulate uterine contractions and begins the lactation process.

Colostrums

For the first few hours of nursing, a special fluid called colostrums is secreted
colostrum is especially high in nutrients, fats, and antibodies, to protect the newborn
from infection. Thereafter, the amount of milk produced is controlled primarily by the
hormone prolactin, which is produced in response to the length of time the infant nurses
at the breast.

Physiology of lactation

Sucking infant

Stimulates hypothalamus

Stimulates pituitary

Prolactin produced by anterior pituitary stimulates milk

production in
alveolus

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Oxytocin produced by posterior pituitary

Facilities uterus to return to normal size

The process of lactation is also controlled by various hormones. The source of these
hormones and there is summarized in table

Hormone Source Activity

Estrogen Ovary and placenta Stimulates breast development
during pregnancy
Progesterone Ovary and placenta Stimulates breast development
during pregnancy
Prolactin Anterior pituitary gland Stimulates milk production

Oxytocin Posterior pituitary gland Let-down reflex: smooth

muscles surrounding he alveoli of
the nipples contract to allow the
released of milk. In pain,
emotions or embarrassment the
let-down reflex may sometimes
be inhibited. Doubting about the
ability to produce enough milk
can interfere with the let down
reflex. oxytocin counter acts this.

COMPOSITION OF BREAST MILK AND COLOSTRUM

 Colostrum is the breast milk that women produce in the first few days after
delivery.
 It is thick and yellowish or clear in colour.

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 Mature milk is the breast milk that is produced after a few days. The quantity
becomes larger, and the breasts feel full, hard and heavy. Some people call this
the breast milk `coming in'.
 Foremilk is the milk that is produced early in a feed.
 Hind milk is the milk that is produced later in a feed.
 Hind milk looks whiter than foremilk, because it contains more fat. This fat
provides much of the energy of a breastfeed. This is an important reason not to
take a baby off a breast too quickly. He should be allowed to continue until he
has had all that he wants.
 Foremilk looks bluer than hind milk. It is produced in larger amounts, and it
provides plenty of protein, lactose, and other nutrients. Because a baby gets
large amounts of foremilk, he gets all the water that he needs from it. Babies do
not need other drinks of water before they are 4-6 months old, even in a hot
climate. If they satisfy their thirst on water, they may take less breast milk.

Colostrums
Property Importance
Antibody rich Protects against infection and allergy
Many white cells Protect against infection
Purgative Clears meconium helps to prevent jaundice
Growth factors Help intestine to mature prevent allergy, Intolerance
Vitamin A rich Reduces severity of infection prevents eye diseases

 Colostrums contain more antibodies and other anti-infective proteins than mature milk.
It contains more white blood cells than mature milk. Colostrums help to prevent the
bacterial infections that are a danger to newborn babies and provide the first
immunization against many of the diseases that a baby meets after delivery.
 Colostrums have a mild purgative effect, which helps to clear the baby's gut of
meconium (the first dark stools). This clears bilirubin from the gut, and helps to
prevent jaundice from becoming severe.

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 Colostrums contain many growth factors which help a baby’s immature intestine to
develop after birth. This helps to prevent the baby from developing allergies and
intolerance to other foods Colostrums is rich in vitamin A which helps to reduce the
severity of any infections the baby might have
 So it is very important for babies to have colostrums. Colostrums is ready in the
breasts when a baby is born. Babies should not be given any drinks or foods before
they start breastfeeding.
 Artificial feeds given before a baby has colostrums are likely to cause allergy and
infection.

IMPORTANCE OF BREAST MILK

 Breastfeeding helps a mother and baby to form a close, loving relationship, which
makes mothers feel deeply satisfied emotionally. Close contact from immediately
after delivery helps this relationship to develop. This process is called bonding.
 Babies cry less, and they may develop faster, if they stay close to their mothers
and breastfeed from immediately after delivery.
 Mothers who breastfeed respond to their babies in a more affectionate way. They
complain less about the baby's need for attention and feeding at night. They are
less likely to abandon or abuse their babies.
 Some studies suggest that breastfeeding may help a child to develop
intellectually. Low birth- weight babies fed breast milk in the first weeks of life
perform better on intelligence tests in later childhood than children who are
artificially fed.

NUTRITIONAL REQUIREMENTS OF LACTATING MOTHER

 Lactating mother’s nutritional requirements should meet 1) her own daily needs
2) provide enough nutrients for the growing infant and 3) furnish the energy for
the mechanics of milk production. Diet of lactating mother and her nutritional
status during pregnancy affect to a certain extent quality and quantity of breast
milk. RDA of lactating mother is given table.

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 Nutritional needs exceed during lactation compared to pregnancy. In six months

a normally developing infant doubles the birth weight accumulated in 9 months of
pregnancy.

Energy

 The recommended energy increase is 550 kcal for first six months and 400 kcal
during the next six months, more than the usual adult allowance. The additional
calories are required for the following:
 Milk content: An average daily milk production for a lactating woman is 650ml
though some women may produce as much as 1000ml. calorie value milk is
65/100ml. Hence calorie value of 650ml is 420 calories. Since the efficiency of
conversion of diet calories to milk calories is 60 percent, 700 calories are
required.
 Milk production: The metabolic work involved in producing this amount of milk
requires around 400kcal
 The additional energy needed for lactation is drawn from maternal adipose tissue
stores laid down during pregnancy. Depending on the adequacy of these stores,
additional energy input may be needed in the lactating woman’s daily diet. This is
reason Nutrition expert committee- prescribed additional calories 550 and 400
respectively for 0-6 months and 6-12 months though actually the body may
require more than thousand additional calories.
 Since the output of milk gets reduced after six months an allowance of 400 kcal /
day is recommended.
 Additional energy may be required if the lactating mother is teenager, feeding
more than one child, under weight, or if she is also pregnant.

Protein

 During lactation, protein requirement has been computed on the basis of

secretion of protein in milk. The protein content of human milk is 1.15g/100ml. On
an average a mother secretes 820 ml and 600ml during 0-6 months and 6-24
months of lactation period.

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 Hence 9.4 g of protein per day during 0-6 months and 6.6 g during 6-24 months
are required for lactation.
 Assuming a 70 percent efficiency of conversion of dietary protein in to milk
protein and a 25 percent of individual variation the safe daily intake will be 16.8 g
and 12.0 g during the first six months and during 6-12 months respectively.
 In terms of dietary protein of NPU 65, Safe daily intake would be 26 g and 18.5 g
respectively. The Nutrition Expert Committee has recommended during lactation
an additional daily intake of 25g for the first 6 months of lactation.
 If energy or protein is lacking, there will be a reduction in milk volume rather than
in milk quality. At very low protein intakes the proportion of casein may be
reduced. The availability of more protein or more energy will not enhance the
amount of protein in the milk nor increase the volume of milk.

Fat

 Although the total amount of fat breast milk is not influenced by the mother’s diet,
the composition of the milk fat reflects the composition of the mother’s diet,
 The requirement of linoleic acid during lactation is 6 en %. After taking into
account the contribution from invisible fat, the visible fat requirement of lactating
women is17.5 en%. These supplies a high level of EFA needed.
 This would correspond to a daily intake of 45 g of visible fat. The level of fat in
the diet would provide adequate energy to enhance a nursing woman to meet her
higher energy needs.

Calcium

 Breast feeding is associated with transfer of approximately 200mg/day of calcium

from mother to the infant. Studies have demonstrated that the increased calcium
demand leads to mobilization of this important mineral from the mother’s
skeleton, leading to transient reduction in Bone Mineral Density (BMD) of lumbar
spine and femoral neck regions during 3-6 months of lactation.
 Inspire of low intake and prolonged drain of calcium through breast milk, LS-BMD
(lumbar spine- bone mineral density) continued to rise in better nourished

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mothers, it is possible that conservation of calcium occurred through either

increased absorption or reduced excretion or both.
 But these compensatory mechanisms could offset the breast milk calcium loss
only in mothers with better nutritional status.
 Inspire low calcium intake, the negative effect of lactation may be spontaneously
compensated provided the mothers have better body weights and BMIs.
 The increased amount of calcium that is required during gestation for
mineralization of the fetal skeleton is now diverted into the mother’s milk
production.
 Both during pregnancy and lactation 1000mg has been prescribed by ICMR. The
retention of dietary calcium in lactating women is about 30 percent hence an
extra amount of 600 mg is prescribed. 500 ml of milk or milk products should be
given to lactating mother to meet 1000 mg of calcium.

Iron

 The iron requirement during lactation remains same as adult women 30 mg/day.
The baby is born with a relatively larger reserve of iron since milk is not a good
source o iron. A good allowance of iron in the mother’s diet during lactation does
not convey additional iron to the infant.
 Iron requirement during lactation is the sum of the requirement of the mother and
that basal requirement will be same as in adult woman 14µg/kg.
 Milk levels of selenium and iodine may be low if maternal intake is very low.

Vitamin A

 The quantity of vitamin A present in 650 ml of human milk is 300mcg, so the

ICMR recommends an additional allowance of 350 mcg of retinol.
 This can be achieved by including liver, fish liver oils, egg yolk, milk and green
leafy vegetables in the diet.

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Vitamin B

 As calorie and protein requirements are increased during lactation, B -Vitamin

requirements are also increased. Additional B vitamins are required for the
amounts that are present in human milk.

Thiamine

 The thiamine in breast milk secreted by Indian poor women below 15 µg per 100
ml. The maximum concentration of thiamine in milk can be achieved by
supplementing 20µg /100ml.
 At this concentration with an output of 700 ml of milk 0.14mg of thiamine would
be lost by the mother. Thiamine content of mother’s milk depends on mother’s
diet. Dietary computed on the basis of their energy allowance

Riboflavin

 The riboflavin content of breast milk of Indian poor mothers is about 17µg per
100 ml. with supplements, the concentration can be raised to 30 µg per 100 ml.
the amount of riboflavin lost through milk is 0.23 mg/day.
 Additional allowance of riboflavin corresponding to the increased energy
allowance would be 0.3 mg. RDA for riboflavin during lactation is computed on
the basis 0.6mg per 1000kcal.
 If the diet meets the requirement of protein and calcium the requirement of
riboflavin in would be definitely met. Milk is not only a good source of calcium but
also a good source of riboflavin.

Niacin

 The nicotinic acid content of breast milk of Indian women ranges between 100
and 150µg per 100 ml. the amount lost in milk is between 0.9 and 1.2 mg per
day.
 The dietary allowance for niacin is 6.6 mg niacin equivalents per 1000kcal.

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Folic acid

 The folic acid content of breast milk secreted by Indian women 1.6 µg per 100 ml.
At the higher level, the amount of folate lost by the mother would be about 25 µg
a day.
 An additional allowance of 50 µg of folate should be provided during lactation.

Vitamin –C

 The additional needs during are calculated on the vitamin c secreted in milk.
Assuming a daily milk of 700 ml milk an ascorbic acid content of 3mg/ dl by well
nourished women, the additional requirement during lactation will be 20 mg.
taking into consideration of the cooking losses (50%),
 The Expert Committee recommends an additional intake of 40 mg per day during
lactation.

Fluid

 An increased intake of fluids is necessary for adequate milk production, since

milk, is a fluid tissue. Water and beverages such as juices, soups, butter milk,
and milk all add to the fluid necessary to produce milk. A lactating should take 2-
3 liters of fluid per day.

Lactating mother
Normal adult woman
0-6 6-12
Energy
Sedentary 1875 +550 +400
Moderate 2225 +550 +400
Heavy 2925 +550 +400
Protein g 50 +25 +18
Fat g 20 45 45
Calcium mg 400 1000 1000
Iron mg 30 30 30

20 Nutrition For Women-N. Chellam

NON MAJOR ELECTIVE-I FOR NUTRITION AND DIETETICS

Retinol µg 600 950 950

β-carotene µg 2400 3800 3800
Thiamine mg
Sedentary 0.9 + 0.3 +0.2
Moderates 1.1 + 0.3 +0.2
Heavy 1.2 + 0.3 +0.2
Riboflavin mg
Sedentary 1.1 + 0.3 +0.2
Moderates 1.3 + 0.3 +0.2
Heavy 1.5 + 0.3 +0.2
Niacin mg
Sedentary 12 +4 +3
Moderates 14 +4 +3
Heavy 16 +4 +3
Pyridoxine mg 2.0 2.5 2.5
Ascorbic acid mg 40 80 80
Folic acid µg 100 150 150
Vitamin B 12 1 1.5 1.5

21 Nutrition For Women-N. Chellam