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      Energy requirements during pregnancy and lactation

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      Public Health Nutrition
      CABI Publishing

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          Abstract

          Objective

          To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production.

          Design

          Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy.

          Setting

          Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues.

          Subjects

          Healthy pregnant and lactating women.

          Results

          The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0 kg, was 321 or 325 MJ, distributed as 375, 1200, 1950 kJ day -1, for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62 MJ day -1 based on a mean milk production of 749 g day -1, energy density of milk of 2.8 kJ g -1, and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72 MJ day -1, resulting in a net increment of 1.9 MJ day -1 over non-pregnant, non-lactating energy requirements.

          Conclusions

          Recommendations for energy intake of pregnant and lactating women should be updated based on recently available data.

          Related collections

          Most cited references67

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          Limitations in the assessment of dietary energy intake by self-report.

          Development of the doubly-labeled water method has made it possible to test the validity of dietary intake instruments for the measurement of energy intake. Comparisons of measured energy expenditure with energy intake from either weighed or estimated dietary records against energy expenditure have indicated that obese subjects, female endurance athletes, and adolescents underestimate habitual and actual energy intake. Individual underestimates of 50% are not uncommon. Even in non-obese adults, where bias is minimal, the standard deviation for individual errors in energy intake approaches 20%. Two investigations of the validity of self-reported dietary records for measuring change in dietary intake also indicate large underestimates of the actual change. Because of bias and imprecision, self-reported energy intakes should be interpreted with caution unless independent methods of assessing their validity are included in the experimental design.
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            Composition of gestational weight gain impacts maternal fat retention and infant birth weight.

            The purpose of this study was to evaluate how changes in gestational weight and body composition affect infant birth weight and maternal fat retention after delivery in underweight, normal-weight and overweight women. We assessed the body composition of 63 women (low body mass index, 17 women; normal body mass index, 34 women; and high body mass index, 12 women) on the basis of measurements of total body nitrogen by prompt-gamma activation analysis, total body potassium by whole body counting, and a multicomponent model based on total body water by deuterium dilution, body volume by densitometry, and bone mineral content by dual energy x-ray absorptiometry (DXA) before pregnancy, at 9, 22, and 36 weeks of gestation, and at 2, 6, and 27 weeks after delivery. Infant weight and length were recorded at birth; infant anthropometry and body composition by DXA were assessed at 2 and 27 weeks of age. Gestational weight gain was correlated significantly with gains in total body water, total body potassium, protein, fat-free mass, and fat mass (P=.001-.003). Gains in total body water, total body potassium, protein and fat-free mass did not differ among body mass index groups; however, fat mass gain was higher in the high body mass index group (P=.03). Birth weight was correlated positively with gain in total body water, total body potassium, and fat-free mass (P<.01), but not fat mass. Postpartum weight and fat retention were correlated positively with gestational weight gain (P=.001) and fat mass gain (P=.001) but not with total body water, total body potassium, or fat-free mass gain. Appropriate, but not excessive, gestational weight gain is needed to optimize infant birth weight and minimize maternal postpartum fat retention.
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              Four-component model for the assessment of body composition in humans: comparison with alternative methods, and evaluation of the density and hydration of fat-free mass.

              1. Body composition was assessed in 28 healthy subjects (body mass index 20-28 kg/m2) by dual-energy X-ray absorptiometry, deuterium dilution, densitometry, 40K counting and four prediction methods (skinfold thickness, bioelectrical impedance, near-i.r. interactance and body mass index). Three- and four-component models of body composition were constructed from combinations of the reference methods. The results of all methods were compared. Precision was evaluated by analysis of propagation of errors. The density and hydration fraction of the fat-free mass were determined. 2. From the precision of the basic measurements, the propagation of errors for the estimation of fat (+/- SD) by the four-component model was found to be +/- 0.54 kg, by the three-component model, +/- 0.49 kg, by deuterium dilution, +/- 0.62 kg, and by densitometry, +/- 0.78 kg. Precision for the measurement of the density and hydration fraction of fat-free mass was +/- 0.0020 kg/l and +/- 0.0066, respectively. 3. The agreement between reference methods was generally better than between reference and alternative methods. Dual-energy X-ray absorptiometry predicted three- and four-component model body composition slightly less well than densitometry or deuterium dilution (both of which greatly influence these multi-component models). 4. The hydration fraction of fat-free mass was calculated to be 0.7382 +/- 0.0213 (range 0.6941-0.7837) and the density of fat-free mass was 1.1015 +/- 0.0073 kg/l (range 1.0795-1.1110 kg/l), with no significant difference between men and women for either. 5. The results suggest that the three- and four-component models are not compromised by errors arising from individual techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                Public Health Nutrition
                Public Health Nutr.
                CABI Publishing
                1368-9800
                1475-2727
                October 2005
                January 02 2007
                October 2005
                : 8
                : 7a
                : 1010-1027
                Article
                10.1079/PHN2005793
                16277817
                b7c59939-e1a7-454e-a9e5-3e2b333928a7
                © 2005

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