Perfil alimentar de transplantados cardíacos de um centro transplantador brasileiro - Atuação da enfermagem neste cenário / Perfil alimentario de los trasplantes de corazón en un centro de trasplante brasileño - Desempeño de la enfermería en este escenario / Food profile of heart transplants in a brazilian transplantation center - Nursing performance in this scenario

Objetivo- Descrever o perfil alimentar de pacientes pós transplante cardíaco (TC) tardio de um centro transplantador brasileiro. Método- Estudo observacional transversal com delineamento descritivo. O estudo ocorreu em uma instituição de ensino público de Minas Gerais. A coleta de dados ocorreu no período de 2017 a 2019. Resultados-. A amostra do estudo foi composta por 62 indivíduos transplantados entre os anos de 2006 a 2016. Aproximadamente 63% era do sexo masculino. A média de idade foi de 46,53 anos. O consumo de carboidratos e gorduras foi adequado em 46,77% e 59,68% da amostra, respectivamente. Já o consumo de proteínas foi acima do recomendado em 77,42% e o consumo de fibras abaixo do recomendado em 79,03%. Conclusão- Houve a predominância do sexo masculino. Os indivíduos apresentaram um consumo adequado somente de carboidratos e gorduras. Não houve na literatura estudos descrevendo a atuação do enfermeiro no processo de nutrição neste cenário(AU)

Objective- To describe the dietary profile of patients after late heart transplantation (HT) from a Brazilian transplant center. Method- Cross-sectional observational study with descriptive design. The study took place in a public education institution in Minas Gerais. Data collection took place from 2017 to 2019. Results-. The study sample consisted of 62 individuals transplanted between 2006 and 2016. Approximately 63% were male. The mean age was 46.53 years. The consumption of carbohydrates and fats was adequate in 46.77% and 59.68% of the sample, respectively. The consumption of proteins was above the recommended in 77.42% and the consumption of fibers below the recommended in 79.03%. Conclusion- There was a predominance of males. The individuals presented an adequate consumption of only carbohydrates and fats. There were no studies in the literature describing the role of nurses in the nutrition process in this scenario(AU)

Objetivo- Describir el perfil dietético de pacientes después de un trasplante cardíaco (TC) tardío de un centro de trasplante brasileño. Método- Estudio observacional transversal con diseño descriptivo. El estudio se llevó a cabo en una institución de educación pública en Minas Gerais. La recolección de datos se llevó a cabo de 2017 a 2019. Resultados-. La muestra del estudio estuvo compuesta por 62 individuos trasplantados entre 2006 y 2016. Aproximadamente el 63% eran hombres. La edad media fue de 46,53 años. El consumo de carbohidratos y grasas fue adecuado en el 46,77% y 59,68% de la muestra, respectivamente. El consumo de proteína estuvo por encima del nivel recomendado en un 77,42% y el consumo de fibra por debajo del nivel recomendado en un 79,03%. Conclusión- Hubo predominio del sexo masculino. Los individuos presentaron un consumo adecuado de solo carbohidratos y grasas. No hubo estudios en la literatura que describieran el papel del enfermero en el proceso de nutrición en este escenario.(AU)

Intervención de enfermería en la nutrición de los pacientes ostomizados / Nursing intervention in nutrition of ostomates

Este artículo tiene por objetivo proporcionar información básica acerca de la intervención enfermera en la nutrición de los pacientes portadores de un estoma, ya sea digestivo o urológico. Conocer los efectos que la cirugía, en la que se construye una ostomía digestiva, tiene en la digestión y la absorción de los alimentos, es básico para poder plantear una dieta individualizada a los pacientes ostomizados. La fase más importante es el postoperatorio inmediato, dado que se deben seguir las recomendaciones de adaptación a la resección intestinal en las ostomías digestivas. Cuando se ha completado el tratamiento y la ostomía funciona con normalidad, la mayoría de las personas ostomizadas pueden volver a una dieta normal o a su dieta habitual y si es necesario, con alguna restricción. La dieta en las ostomías urológicas es más sencilla de manejar, pero es importante conocer qué alimentos y qué nutrientes van a ser favorables para un buen funcionamiento y para evitar complicaciones

This article aims to provide basic information on the nurse intervention in the nutrition of patients with a stoma, whether digestive or urological. Knowing the effects that surgery, in which a digestive ostomy is constructed, has on digestion and food absorption is essential to propose an individualized diet to ostomized patients. The most important phase is the immediate postoperative period, as the recommendations for adaptation to intestinal resection in digestive ostomies should be followed. When the treatment has been completed and the ostomy works normally, most ostomized people can return to a normal diet or to their usual diet; if necessary, with some restriction. The diet in urological ostomies is easier to handle, but it's important to know what foods and nutrients are going to be favorable for proper functioning and thus avoid complications

Prevalência de fatores de risco cardiovascular no mundo e no Brasil / Prevalence of cardiovascular risk factors worldwide and in Brazil

A doença cardiovascular é a primeira causa de morte em todo o mundo e também no Brasil. Entretanto, um ponto fundamental é que, apesar da mortalidade elevada, ela é altamente passível de prevenção. A relação dos fatores de risco com a doença cardiovascular é um processo em constante evolução. Isso justifica a necessidade de reavaliação dos fatores de risco ao longo do tempo para que as estratégias de prevenção também possam adequar-se a essas mudanças no perfil dos fatores de risco. O artigo analisa a prevalência dos fatores de risco de doenças cardiovasculares no Brasil e no mundo utilizando quatro cenários diferentes: Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), "Global Burden of Diseases", Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) e Pesquisa Nacional de Saúde (PNS). Em todos esses cenários, destaca-se a queda da prevalência de tabagismo no mundo e particularmente no Brasil. A presença de desigualdade social associou-se à prevalência maior dos fatores de risco nos menos escolarizados e nas faixas de menor renda. Todos os outros fatores de risco associados à doença cardiovascular apresentam frequências elevadas que podem colocar em risco a queda da mortalidade associada a doenças cardiovasculares no Brasil e no mundo em futuro próximo.

Cardiovascular disease is the leading cause of death worldwide and also in Brazil. Ho-wever, a key point is that despite elevated mortality, it is highly preventable. The relationship between risk factors and cardiovascular disease is a constantly evolving process. This justifies the need to reassess risk factors over time so that preventive strategies can also be adapted to these changes in the profile of risk factors. The article analyzes the prevalence of cardiovascular disease risk factors in Brazil and worldwide, using four different scenarios: Surveillance system for risk and protective factors for chronic diseases by telephone survey (VIGITEL), Global Burden of Diseases, Longitudinal Study of Adult Health (ELSA-Brazil), and National Health Survey (PNS). The declining prevalence of tobacco smoking in the world and particularly in Brazil stands out in all these scenarios. The presence of social inequality was associated with a higher prevalence of risk factors among the less educated and in lower income brackets. All other risk factors associated with cardiovascular disease are highly common, a fact that may jeopardize the decrease in mortality associated with cardiovascular disease in Brazil and worldwide in the near future

Limiting FODMAP consumption for patients with IBS.

Irritable bowel syndrome (IBS) is a chronic disorder affected by stress and dietary habits. This article explores the role of diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in reducing IBS symptoms.

Providing self-management education to patients with type 2 diabetes mellitus: Addressing basic nutrition and hypoglycemia.

NPs and other primary care providers will continue to encounter a growing population of patients with type 2 diabetes mellitus. Helping patients engage in self-care behaviors is essential to achieve blood glucose control and prevent diabetes-related complications. This article explores opportunities to provide education to patients with diabetes mellitus on the important self-care topics of nutrition and hypoglycemia during a primary care visit.

[Nutritional self-care promotion in community-dwelling older people: a protocol of mixed method research]. / La promozione del self-care in ambito nutrizionale nella persona anziana: protocollo di ricerca con metodo misto.

AIM: To describe a research protocol designed to promote nutritional self-care in older people. The aims of the research are: a) to evaluate the effectiveness of a nutritional education intervention in changing knowledge, attitudes, and behaviors; b) to describe the nutritional self-care ability and activities; c) to identify the promoting factors and barriers that influence the changes in nutritional knowledge, behaviors and attitudes in home-dwelling older people. METHOD: Sequential explanatory mixed method design. The study will enroll 50 people aged 65 years and over. In the first quantitative phase, a pre-test and post-test design will be used to deliver a nutritional intervention aimed to change knowledge, behaviors and attitudes toward nutrition. Using the quantitative study results, the qualitative study phase will be conducted by interviews in sub-groups of older people. In a third phase, the quantitative and qualitative study results will be integrated. Quantitative data will be analyzed using descriptive and inferential statistics and qualitative data will be analyzed through content analysis. RESULTS: The study will provide new knowledge on nutritional self-care in home-dwelling older adults and the factors promoting nutritional self-care. CONCLUSIONS: Nutritional self-care promotion is of pivotal importance for the nursing care provided to home-dwelling older people. Educational programs aimed at the maintenance of proper nutrition in the older adults may reduce malnutrition and the related diseases. Nutrition educational programs should be based on knowledge derived from research to tailor individualized nutritional interventions and to realize effective educational programs.

The Intergenerational Cycle of Obesity and Its Implications for Nursing Care of Childbearing Women.

Despite intensive focus and interventions at societal and individual levels, more than a third of people in the United States are overweight or obese, and childhood/adolescent obesity rates have dramatically increased during the past three decades. Biomedical research has shown a clear link between the prenatal environment and lifetime adiposity. Children born to overweight and obese women with impaired glucose metabolism show cardiometabolic consequences throughout their life spans that, in turn, affect their children's adiposity. Awareness of this intergenerational cycle of obesity can prompt nurses to intervene in the preconception, prenatal, and postnatal phases.

Alimentos relacionados con la novela Don Quijote de la Mancha ¿seguían las recomendaciones nutricionales saludables aconsejadas en la actualidad? / Foods related to the novel ‘don quixote de la mancha’. did they follow the healthy nutritional recommendations which are advised nowadays?

Es conocida la enorme contribución que ha hecho y sigue haciendo la novela Don Quijote de la Mancha, de Miguel de Cervantes, a la literatura universal. Un libro de esta categoría, presenta para su estudio dimensiones múltiples. Una de ellas es la nutrición. El principal objetivo de este estudio ha sido valorar y exponer la alimentación citada en el Quijote y en tiempos de Cervantes en los nutrientes que la constituyen, y comparar la nutrición realizada en La Mancha con la realizada en Cataluña. El cálculo de los nutrientes de la parte intermedia del itinerario, situada principalmente en Aragón, no ha sido objeto de este estudio. Además se ha comprobado si estos nutrientes seguían las recomendaciones actuales de la Sociedad Española de Arteriosclerosis y otros consensos

It is known that Miguel de Cervantes's novel ‘Don Quixote de La Mancha’ has done and is still doing a great contribution to the universal literature. A book that has reached such category and grows in number of its readers, shows multiple dimensions for its study. One of them is nutrition. One of the aims of this study has been to value and expound, according to their own nutrients, the kinds of food cited in ‘The Quixote’ and in the times of Cervantes. This has allowed the comparison made between ways of nutrition in La Mancha and in Catalonia, as well as the regions situated at the beginning and end of the itinerary covered by its main characters Don Quixote and Sancho Panza. The evaluation of the nutrients in the middle part of the itinerary, placed mainly in Aragón, has not been considered in this study. Another purpose has been to check if these nutrients followed the current recommendations of the Spanish Society of Arteriosclerosis and other valid agreements at the moment

Valoración del estado nutricional y consumo alimentario de los pacientes en terapia renal sustitutiva mediante hemodiálisis / Assessment of nutritional status and food intake of patients in renal replacement therapy with hemodialysis

Introducción: La malnutrición proteico-energética es un hecho frecuente entre los pacientes en tratamiento sustitutivo renal con hemodiálisis y a ello contribuye, además de la propia técnica dialítica, la dieta inadecuada. Objetivos: Valorar la evolución del estado nutricional y la ingesta alimentaria de los pacientes de 3 unidades de hemodiálisis extrahospitalaria, tras una intervención enfermera educativa. Pacientes y métodos: Hemos realizado un estudio transversal en 66 pacientes de 3 unidades extrahospitalarias (44 hombres y 23 mujeres) con dosis de diálisis medida por KT/V > 1,3 .Se hizo una determinación del estado nutricional por métodos convencionales y del consumo alimentario mediante encuesta dietética, determinándose mediante soporte informático el índice de alimentación saludable, identificando los déficits y/o excesos de nutrientes en cada paciente. Se llevaron a cabo intervenciones educativas personalizadas dirigidas a corregir los excesos o déficits de nutrientes detectados en los pacientes, y se volvieron a hacer las mismas valoraciones a los seis meses. Resultados: La prevalencia de desnutrición es leve en el 41% de hombres y 43% de las mujeres y moderada en el 34% de los hombres y 21% de las mujeres. El índice de alimentación saludable era inadecuado en el 37,31% de los pacientes en el análisis basal y postintervención educativa paso al 18,8%. La ingesta media energética es elevada (1398.86 Kcal/paciente/día) con alto consumo de colesterol y déficit de aminoácidos. Se detectó un alto consumo de hidratos de carbono simples (> 20%) y un elevado uso de proteínas de origen animal. El contenido mineral y vitamínico de la dieta es muy deficiente, destacando el bajo consumo de Vitamina D (1.45±2.55 ng) y elevado de fósforo (1052.28±356.23 m/día). Conclusion: Tras una intervención educativa sobre nuestros pacientes, corrigiendo hábitos dietéticos no saludables, hemos conseguido mejorar su estado nutricional, reduciendo la prevalencia de desnutrición en nuestras unidades (AU)

Introduction: Protein-energy malnutrition is a common occurrence among patients on renal replacement therapy with hemodialysis and this in addition to the dialysis technique itself, improper diet contributes. Objective: Assess the evolution of nutritional status and food intake of patients from 3 outpatient hemodialysis units, after an educational nurse intervention. Methods: We conducted a cross-sectional study in 66 outpatient units from 3 patients (44 men and 23 women) with dialysis dose measured by Kt / V> 1.3. It was made a determination of nutritional status by conventional methods and food consumption by a diet questionnaire, determining by computer support the healthy eating index, identifying deficits and / or excess nutrients in each patient.Customized educational interventions designed to correct the excesses or deficiencies of nutrients detected in patients were carried out. The same assessments were made at six months. Results: The prevalence of malnutrition was mild in 41% of men and 43% of women and moderate in 34% of men and 21% of women. The healthy eating index was inadequate in 37.31% of patients at baseline but after the educational intervention was 18.8%. The average energy intake was high (1398.86 Kcal / patient / day) with high intake of cholesterol and amino acid deficiency. A high intake of simple carbohydrates (> 20%) and a high use of animal protein were detected. The mineral and vitamin content of the diet was very poor, highlighting the low consumption of vitamin D (1.45 ± 2.55 ng) and high phosphorus (1052.28 ± 356.23 m / day). Conclusion: After an educational intervention on our patients, correcting unhealthy dietary habits, we managed to improve their nutritional status, reducing the prevalence of malnutrition in our units (AU)

The effects of patient participation-based dietary intervention on nutritional and functional status for patients with gastrectomy: a randomized controlled trial.

BACKGROUND: Patients undergoing gastrectomy because of stomach cancer often face weight loss in the perioperational period, which can lead to malnutrition and negative treatment outcomes. OBJECTIVE: The purpose of this study was to develop a patient participation-based dietary intervention (PPDI) and evaluate its effects on patient outcomes. INTERVENTIONS/METHODS: This was a prospective, randomized controlled trial in which the patients were recruited in a cancer center in South Korea. The participants (N = 56), who underwent gastrectomy with stomach cancer stage I to III, were randomly assigned into either the experimental or the control group. The PPDI, which was given on the day before the hospital discharge, comprised 2 face-to-face and 2 telephone interventions. The outcome variables included body weight, body mass index, muscle mass, the Patient-Generated Subjective Global Assessment, Dietary Symptom Scale, Functional Assessment Cancer Therapy-General, Karnofsky Performance Status, Adherence to Dietary Guidelines Scale, Scale of Dietary Knowledge, Patient Satisfaction Scale, and a 3-day food diary. RESULTS: Participants in the PPDI intervention demonstrated significant (P < .05) reductions in adverse dietary symptoms and significant improvements (P < .05) in functional status, performance status, dietary intake, adherence to dietary guidelines, dietary knowledge, and satisfaction with the intervention as compared with the control group over time. CONCLUSION: The PPDI was an effective dietary intervention for patients undergoing a gastrectomy for gastric cancer and deserves additional study in other populations of patients. IMPLICATIONS FOR PRACTICE: Incorporating patients' perspectives into a dietary intervention after gastrectomy for gastric cancer may contribute to improved patient outcomes and quality care.

Revisión de evidencias sobre la influencia de la dieta en la evolución de la EPOC / Review of evidence on the influence of the diet on the evolution of COPD

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) ocasiona una importante morbimortalidad, con un gran consumo de recursos sanitarios. La causa principal es el consumo de tabaco. La EPOC es evitable y aunque no es curable, sí es susceptible de mejoría en términos de calidad de vida y aumento de la supervivencia, utilizando los recursos terapéuticos disponibles entre los que se encuentra la rehabilitación y la educación sanitaria. La rehabilitación incluye programas de entrenamiento cuyo fin es mejorar la disnea, el cansancio y la tolerancia al ejercicio. Se compone de programas de entrenamiento físico, educación sanitaria, intervención psicológica, intervención sobre el comportamiento y educación sobre dieta y nutrición. En el presente trabajo se realizó una recopilación bibliográfica de los artículos publicados en los últimos cinco años sobre la educación dietética a los pacientes con EPOC. Se usó la herramienta de lectura crítica CASPE, para seleccionar los de mayor calidad metodológica, con el objetivo de revisar los estudios existentes sobre la influencia de la dieta en los pacientes diagnosticados de EPOC, evaluar las evidencias existentes e incorporarlos a la pauta de actuación ante este tipo de pacientes. La conclusión de esta revisión es que los pacientes con EPOC podrían beneficiarse de una dieta rica en hortalizas, frutas y verduras, soja, fibra y aceite de oliva; mientras que las dietas ricas en azúcares y carnes curadas podrían empeorar su enfermedad. Aunque se recomienda realizar estudios complementarios que corroboren dichas afirmaciones (AU)

Chronic Obstructive Pulmonary Disease (COPD) causes significant morbidity and mortality, with a large consumption of health resources. The main cause is smoking. Despite the fact there is no cure for COPD, it can be avoided resulting in an improvement in the quality of life and an increase the survival rate, through available therapeutic resources, among which are the rehabilitation and health education. Rehabilitation includes training programs designed to improve dyspnoea, fatigue and exercise tolerance. It consists of physical training programs, health education, psychological intervention, conduct intervention and education on diet and nutrition. This study has been performed on an extensive bibliographic compilation of published articles on dietary education patients with COPD in the last five years. In order to get the highest methodological quality articles and perform a review of the existing studies on the influence of diet in patients diagnosed with COPD and evaluate the evidence of those patients, it was necessary to implement a critical reading tool (CASPE), to incorporate them into the pattern of performance against these patients. The conclusion of this review is that patients with COPD may profit from a diet rich in fruit, vegetables, soy, fiber and olive oil, while a diet rich of sugars and cured meat may worsen your condition. However additional studies to corroborate these claims are recommende (AU)

Protocolo de intervenciones en Consejo Dietético Intensivo en Atención Primaria / Intensive dietary advice program in primary care

Las principales causas de enfermedades cardiovasculares, diabetes mellitus tipo 2 y ciertos tipos de cánceres son el sedentarismo y la alimentación inadecuada, provocando una elevada morbi-mortalidad. El Programa Consejo Dietético, diseñado desde la Consejería de Salud de la Junta de Andalucía, tiene como objetivo promocionar hábitos saludables (ejercicio físico y alimentación equilibrada) para prevenir las enfermedades derivadas. Este programa se estructura en 2 partes: Consejo Dietético Básico y Consejo Dietético Intensivo. El presente trabajo describe el protocolo de intervenciones en Consejo Dietético Intensivo, centrado en fomentar cambios en los estilos de vida de manera multifactorial. Este programa se estructura en 2 consultas individuales, 5 sesiones de talleres grupales y consultas de seguimiento, para asegurar el aprendizaje según las características y necesidades individuales de cada persona, a través de contactos personalizados y aprovechando las ventajas de las técnicas grupales. Con este doble planteamiento metodológico, individual y grupal, se pretende obtener una visión global para la transmisión de conocimientos, la adquisición de habilidades, destrezas y actitudes para la modificación de conductas que conlleven a la adquisición de unos hábitos de vida saludables (AU)

A sedentary lifestyle and inappropriate eating habits are the main causes of major diseases (cardiovascular diseases, type 2 diabetes, and certain types of cancers), as well as a high morbidity and mortality. The Dietary Advice program was designed by the Andalusian Health Department to promote healthy habits (i.e. physical exercise and a balanced diet) to prevent secondary diseases. This program is organised in two phases: Basic Dietary Advice and Intensive Dietary Advice. This paper aims to describe the interventions protocol on the intensive dietary phase of the program focused on the promotion on changes in people’s lifestyles from a multi-factorial approach. The program consisted of two individual nurse visits, five workshops and nursing follow up clinics. The individual visits ensured that the team learned of each person needs; likewise, the group activities were aimed at improving the transmission of knowledge and the acquisition of skills, abilities and attitudes towards healthier lifestyles (AU)

Dieta pobre en potasio. Gestión por raciones y puntos / Diet low in potassium

Se confirma la alta prevalencia, en nuestra unidad de hemodiálisis, de los diagnósticos enfermeros (DdE): Dese-quilibrio nutricional por exceso o por defecto; Disposición para mejorar la nutrición; y Temor relacionado con las consecuencias de una ingesta excesiva de potasio, manifestados por la inhibición en algunas personas hacia el disfrute de los alimentos. Se decide planificar una estrategia educativa, que más tarde se tradujo en intervención enfermera para dichos diagnósticos. El objetivo fue proporcionar recursos para el seguimiento adecuado de una dieta equilibrada con restricción de potasio. Inspirándonos en la dieta por raciones, así como en reconocidos programas dietéticos de aprendizaje por puntos, decidimos incorporar estas ideas para el diseño de una herramienta didáctica que facilitase a nuestros pacientes la instrucción y seguimiento de su dieta, tanto como la elección de alimentos variados. El resultado ha sido un conjunto de fichas que, incorporando información nutricional de diferente tipo, orientan a nuestros pacientes en diferentes aspectos de la dieta: indican raciones alimenticias apropiadas en medidas caseras, enseñan la correcta manipulación culinaria, incluyen consejos dietéticos para diferentes patologías crónicas y puntúan los alimentos según su contenido en potasio. Juntas forman un juego de mesa disponible durante las sesiones de hemodiálisis y que tiene en cuenta otros aspectos de importancia dada la patología, como estimulación cognitiva, afrontamiento de la enfermedad, mejora del cumplimiento terapéutico o recurso para aumentar la motivación, mientras añade entretenimiento a lo que, en principio, se ceñía a una labor educativa(AU)

After confirming the high prevalence rates in our hemodialysis unit of the following nursing diagnoses: nutritional imbalances– both excesses and shortages, willingness to improve nutrition and fear related to the consequences of excessive intake of potassium and manifested by the inhibition in some people towards the enjoyment of food, we decided to plan an educational strategy which later resulted in a nursing intervention for these diagnoses, with the objective of providing adequate resources for the monitoring of balanced diets with a restriction of potassium. Inspired by dietary rations, as well as recognized dietary programs of learning by points, we decided to incorporate these ideas to design an educational tool to facilitate advice to our patients on how to follow diet plans as well as the choice of appropriate foods. The result was a set of cards incorporating nutritional information of various kinds, aimed at our patients covering different aspects of the diet: appropriate food rations using household measurements, promoting good food preparation, appropriate dietary advice for different chronic diseases and a scoring system of foods according to their potassium content. Together they form a board game available during the hemodialysis sessions that also takes into consideration other issues of importance related to conditions such as cognitive stimulation, coping with the disease, improving the therapeutic performance or resources to increase patient motivation. Although initially it was only an educational exercise, the result has turned out to be both enjoyable and entertaining(AU)

Essentials of healthy eating: a guide.

Enough solid evidence now exists to offer women several fundamental strategies for healthy eating. They include emphasizing healthful unsaturated fats, whole grains, good protein "packages," and fruits and vegetables; limiting consumption of trans and saturated fats, highly refined grains, and sugary beverages; and taking a multivitamin with folic acid and extra vitamin D as a nutritional safety net. A diet based on these principles is healthy through virtually all life stages, from young adulthood through planning for pregnancy, pregnancy, and on into old age.

Maternal nutrition and perinatal outcomes.

Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling.