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Food and nutrition guidelines revised

Media Release 3 May 2006

Ministry releases revised food and nutrition guidelines for pregnancy and breastfeeding

Good nutrition is important for all New Zealanders, but it is even more important for women planning to become pregnant, during their pregnancy, and while breastfeeding, says Ministry of Health spokesperson Dr Ashley Bloomfield.

The Ministry today released Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper. This paper is the result of work to revise and combine two separate 1997 papers - one for pregnant women and the other for breastfeeding women.

The paper is an important part of the nutrition policy base for key New Zealand health strategies, such as Healthy Eating - Healthy Action.

"Maintaining a healthy diet during pregnancy has a positive effect on both the mother and her unborn baby, providing benefits that can set up a child for life," said Dr Bloomfield. "It also prepares the mother to be in the best possible nutritional state to support breastfeeding. "

Dr Bloomfield says breastfeeding is the best and safest way to feed infants. Women and families need to be given all the advice and support possible to assist them in establishing and continuing breastfeeding for at least the first six months of the infant?s life.

The revised guidelines are based on the New Zealand Food and Nutrition Guideline Statements for Healthy Adults, adjusted to cater for the special needs of pregnant and breastfeeding women. These adjustments emphasise the importance of all the food groups, including vegetables, fruit, wholegrain breads and cereals, important food sources of iodine, and food safety.

The guidelines give advice about folic acid supplements for pregnant women. Both the Ministry of Health and the New Zealand Food Safety Authority recommend that all women planning a pregnancy, or who are in the early stages of pregnancy, should take a 0.8 milligram (mg) folic acid tablet each day for at least four weeks before and 12 weeks after conception to reduce the risk of their baby suffering Neural Tube Defects (NTDs) such as spina bifida.

The folic acid tablets recommended are registered medicines that are available over the counter from pharmacies. It is recommended women take only folic acid tablets that are registered as medicines to reduce the risk of NTDs, and not to rely on dietary supplements, for example multivitamin tablets, for their folic acid.

The guidelines recommend women do not drink alcohol, smoke, or use non-prescription drugs unless prescribed during pregnancy and breastfeeding, as these can all affect the growth and development of the baby.

"There is no known safe level of alcohol consumption at any stage during pregnancy. Therefore, the Ministry recommends that, to be on the safe side, it is best that women avoid drinking alcohol at all during pregnancy," says Dr Bloomfield.

Questions and Answers

Why has the background paper Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women been revised?

The previous background papers for healthy pregnant women and healthy breastfeeding women were written in 1997. This revised paper combines the two previous papers and the latest research to provide up-to-date, evidence-based advice on the nutrition, physical activity, lifestyle and special food issues for achieving and maintaining the best possible health for healthy pregnant and breastfeeding women, and the best possible pregnancy outcome - a healthy infant and mother.

Who is the background paper for?

Health practitioners ? including dietitians, nutritionists, midwives, doctors, nurses, primary health care providers, health promoters, educators and caregivers can use the background paper to guide and support them in the practice of healthy nutrition, and as a resource for more detailed information if required. It can also be used by members of the public who are particularly interested in the evidence base for the Ministry?s nutrition policy for pregnant and breastfeeding women. The paper identifies health inequalities relating to nutrition and physical activity, for example, different rates of iron deficiency between different ethnic groups, so that education and support for healthy pregnant and breastfeeding women can be targeted to reduce health inequalities between population groups.

Is there a way I can provide the key information in the background paper for my clients in a user friendly form?

The accompanying health education leaflets, Eating for Healthy Pregnant Women and Eating for Healthy Breastfeeding Women, are a user - friendly way to provide sound advice and support to pregnant and breastfeeding women and their families. It is planned that these leaflets will be reviewed in line with the revised guidelines.

What consultation was undertaken to prepare the revised background paper?

The Ministry consulted the public on the discussion document from June to August 2005 and received 64 submissions. Thirty-three were from health practitioners, 13 from NGOs, nine from policy/research/ academic/education/ training, five from the food industry, three from Mäori or Pacific organisations or individuals, and one from the general public. Revisions have been made to address issues that were raised in the submissions, where appropriate.

What are the Food and Nutrition Guidelines for Healthy Adults that these revised guidelines are based on? 1. Maintain a healthy body weight by eating well and by daily physical activity.* 2. Eat well by including a variety of nutritious foods from each of the four major food groups each day. · Eat plenty of vegetables and fruits. · Eat plenty of breads and cereals, preferably wholegrain. · Have milk and milk products in your diet, preferably reduced or low-fat options. · Include lean meat, poultry, seafood, eggs, nuts, seeds or legumes.

3. Prepare foods or choose pre-prepared foods, drinks and snacks: · with minimal added fat, especially saturated fat · that are low in salt; if using salt, choose iodised salt · with little added sugar; limit your intake of high-sugar foods. 4. Drink plenty of liquids each day, especially water.

5. If choosing to drink alcohol, limit your intake.

6. Purchase, prepare, cook and store food to ensure food safety.

* At least 30 minutes of moderate intensity physical activity on most if not all days of the week and, if possible, add some vigorous exercise for extra health and fitness.

How are the guidelines for healthy pregnant and breastfeeding women different to the guidelines for healthy adults?

The guideline statement about alcohol for healthy pregnant and breastfeeding women is very different to the guideline for healthy adults. It is recommended that it is best not to drink alcohol during pregnancy. The numbers of servings per day recommended for the four food groups (vegetables and fruits, breads and cereals, preferably wholegrain, milk and milk products, lean meat, poultry, seafood, eggs, nuts, seeds or legumes) are higher for pregnant and breastfeeding women than for healthy adults to cater for their increased energy and nutrient requirements.

How much weight should I gain during pregnancy?

The recommended weight gain depends on the pre-pregnancy body weight. A woman whose pre-pregnancy weight was in the healthy range should gain between 11.5 and 16 kg. Thinner women may need to gain more weight while women with a higher pre-pregnancy body weight should aim for a smaller weight gain.

How does the background paper relate to Healthy Eating-Healthy Action?

Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper supports three of the key population health objectives in the New Zealand Health Strategy. Along with the other background papers in the series of population group-specific background papers, they form an important technical basis for implementing Healthy Eating ? Healthy Action.

Why have the recommended intakes of some nutrients been increased?

New Zealand had since 1991 been using where practical the 1990 Australian RDIs and these were used in the 1997 papers. The revised background paper uses the recently released the Nutrient Reference Values (NRVs), which include the new recommended dietary intakes (RDIs) for New Zealanders. RDIs refers to the average daily intake level of a particular nutrient that is sufficient to meet the requirements of nearly all healthy individuals in a particular life stage and gender group. The new NRVs are based on the recent US/Canadian review of Dietary Reference Intakes, other recent international recommendations, and the scientific literature. For some nutrients, the scientific evidence has meant that some of the new RDI values are higher than the previous values, and some are lower. The NRVs are available on the Ministry of Health website, www.moh.govt. Are women going to be able to achieve the new recommended intakes, especially for folate and iodine?

The numbers of servings per day recommended for the four food groups are higher for pregnant and breastfeeding women than those for healthy adults to cater for their increased requirements for energy and nutrients. However, it may still be difficult for women to meet the recommended intakes for folate and iodine.

Folate-rich foods include leafy, green vegetables, citrus fruit, wholegrain breads, legumes, and foods fortified with folic acid such as breakfast cereal and juice. Regardless of dietary intakes of folate, it is still recommended that all women planning a pregnancy, or who are in the early stages of pregnancy, should take a 0.8 milligram (mg) folic acid tablet each day for at least four weeks before and 12 weeks after conception to reduce the risk of their baby suffering Neural Tube Defects (NTDs) such as spina bifida.

Food sources of iodine include iodised salt, low-fat milk products, eggs, fish, seafood and seaweed. Supplements containing seaweed and kelp are not recommended for pregnant or breastfeeding women. The iodine supplements currently available in New Zealand are not recommended for pregnant or breastfeeding women. However, if an oral iodine preparation becomes available as a registered medicine, it may be appropriate for pregnant or breastfeeding women to take this.

Voluntary fortification of food with folic acid is an option for New Zealand food manufacturers but to date there is only a limited range of foods fortified with folic acid. The Ministry is contributing to work being done on mandatory fortification of food with folic acid. Mandatory fortification of food with iodine is also being considered.

How can I get a copy of the background paper and health education resources?

You can download a copy of the background paper from the website: www.moh.govt.nz , search for food and nutrition guidelines or contact: Wickliffe Press PO Box 932 Dunedin Phone: (04) 496 2277 Email: moh@wickliffe.co.nz When ordering this book from Wickliffe, please quote HP 4232.

The health education leaflets Eating for Healthy Pregnant Women and Eating for Healthy Breastfeeding Women can be downloaded from www.healthed.govt.nz and are available in hard copy from your local Public Health Unit.

ENDS

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