Summary Chapter 3
-Pages 72-73; 75-79
Obesity and fertility
-In the US., the rate of obesity is 23.3 % (in men) and 27 % in women for the 20-39 years old.
Fertility is affected by excess body fat.
Ethnic groups have different rates of obesity, with the Hispanics/latinos man having the higher
rates(32.4) compared to other male ethnic groups and black females being at the highest rate of all
Severe obesity = BMI over 40 kg/m²
Obesity causes Infertility in men
Reasons: 1. Low sex hormone binding globulin, 2. Low testosterone, 3. High leptin, 4. High FSH, 5. High
estrogen, 6. Decreased sperm count, motility and sperm malformation, 7. Increased oxidative stress
Obesity causes infertility in women
Reasons: 1 High estrogen, 2. High Free testosterone, 3. High Leptin
4. Low sex hormone binding globulin, 5. Insulin resistance (see below)* 1), 6. Oxidative stress and
inflammation (see below)*2)
*1)Insulin resistance affects fertility by having insulin binding to specific receptors on the ovary and
stimulate testosterone production, which suppress follicular growth and ovulatory dysfunction.
*2)Chronic inflammation can damage developing eggs and maturing sperm. It is caused by low levels of
vit. D that is often seen in obese.
In women, obesity will cause:
irregular or anovulatory menstrual cycles, which will lead to poor prenatal care as the women may not
know she is pregnant.
higher rates of metabolic syndrome, polycystic syndrome, gestational diabetes, hypertension, fetal
overgrowth, caesarean delivery and still birth.
Metabolic syndrome, definition: a cluster of abnormal health indicators. It is diagnosed in 1 in 4 adults
in the U.S. Leads to an increased risk for heart disease and diabetes and chronic inflammation that
promotes oxidation. Diagnosed when 3 of the 5 are present:
1. High waist circumference (over 40 in men, over 35 in women)
2. Elevated Triglycerides
3. Low HDL
4. High blood pressure
5. High fasting blood glucose
Therapy: diet, exercise and weight loss
Central body fat and fertility:
When waist circumference is over 40” in men and 35” in women, fertility goes down. A study showed
that only half as many of the women became pregnant when central body fat was present.
Weight loss and fertility: Weight loss is related to the return in fertility in both men and women.
Diets for weight loss: should be healthful, balanced, and provide all recommended nutrients. Should
also address prior deficiencies and finally, should be planned around foods that the person prefers.
The female athlete triad and fertility:
High physical activity+ negative calorie balance=female athlete triad.
1. Amenorrhea (happens when total calorie is about 30% less than needed* and it is the main
manifestation of anorexia)
2. Disordered eating
*Energy deficit causes a decrease in luteinizing hormone, estrogen production, and causeshormonal
changes. These changes results in decreased bone density and higher risk for stress fractures.
Nutritional management of the female athlete triad:
Correct energy deficit, correct associated eating disorder and restore bone mass accretion. (Peak bone
mass is attained before age 30). Vit. D and calcium may be needed for bone development.
Eating disorders and fertility
Anorexia Nervosa and bulimia nervosa are related to menstrual irregularities and infertility.
In anorexia, it is caused by an irregular release of GnHR and low levels of estrogen. Infertility may
persist even if weight is back to normal. In bulimia it is caused by low FSH and LH levels
3-5% of young women
Up to 10% of young women have related symptoms.
Oligomenorrhea (little bleeding) often occurs in bulimia nervosa.
Nutritional management of women with anorexia/bulimia nervosa
For anorexia: normalization of body weight, through long-term multidisciplinary services.
For bulimia: normalization of eating behaviors through cognitive-behavioral therapy and sometimes
DM prior to pregnancy
High blood glucose levels during the first two months of pregnancy is teratogenic (produces
malformation in fetuses) and is associated with 2-3X increase in malformations(pelvis, Central nervous
system, heart) and higher rates of miscarriages.
Four in 5 U.S. adults with type 2 diabetes are overweight or obese and now even children are dignosed
with type 2 because of obesity.
Management in blood glucose depends on the type of diabetes (type 1 versus type 2).
Nutritional management for type 1 DM:
-Carbohydrate (CHO) controlled diet because it increases blood glucose levels more than protein and
-Diabetes exchange system
-encouraged to use artificial sweeteners over simple sugars
-Encouraged to eat low GI foods and high in fibers (esp. Soluble fiber) as well as brightly colored fruits
and veggies, seeds and nuts, low fat meat and dairy, fish and dried beans
-Reduced calorie plan for overweight patients
-Physical activity as it normalizes blood sugar Nutritional management for type 2 DM
Some patients might control their diabetes with diet and exercise alone, others will need insulin or
medication that either increase insulin production or sensitivity
Diet must be tailored to each individuals as blood levels response vary from one person to the other
Guidelines of the American Diabetes Association
-weight loss of body weight of 7% or more
Protein: 15-20%, fat: less than 30%, CHO: around 50%
-Saturated fats under 7%
-Lowest possible trans fat
-less than 200mg of cholesterol a day
-14g of fiber/1000g
-50% of grains should be whole grains
-use of low GI foods are encouraged
Sucrose can be substituted for other CHO foods in meal plan. Restrictions should be based on scientific
Abnormally high blood glucose levels. Type 1 and type 2 are both chronis and require lifelong treatment.
1.Type 1: Insulin producing cells of the pancreas are destroyed. Insulin is required. 10% of all cases of
diabetes. It is an auto-immune disease.
2.Type 2: the body doesn’t make enough insulin or doesn’t use it normally. 90% of all cases of diabetes.
People with type 2 are usually obese and have insulin resistance, from the metabolic changes initiated in
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