Chapter 11 Power Point

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Chapter 11 Lecture

Chapter 11:Nutrition Throughoutthe Life Cycle

Learning Outcomes

1. Explain why a nourishing diet is important even before conception.

2. Identify the range of optimal weight gain during the three trimesters of pregnancy.

3. Discuss nutrient needs and some common nutrition-related concerns of pregnant women.

4. Discuss the advantages and challenges of breastfeeding.


Learning Outcomes

5. Discuss nutrient needs, timing of introduction to and type of solid foods, and common nutrition-related concerns of infants.

6. Discuss nutrient needs and some common nutrition-related concerns of toddlers.

7. Identify changes in nutrient needs for school-age children, as well as the effect of school attendance on children's nutrition.


Learning Outcomes

8. Explain how adolescents' rapid growth affects their nutritional status.

9. Discuss changes in an older adult's body, functions, and nutrient needs.

10.Identify some common nutrition-related concerns of older adults.


Nutrition Before Conception

• Some deficiency-related problems develop very early in pregnancy.

• Neural tube defects• Related to inadequate level of folate• Affect the embryo in the first few weeks• Adequate folate (400 mg daily) before

conception can reduce the risks.



• A healthful diet before conception includes:• avoiding teratogens: substances that cause

birth defects• Includes alcohol and illegal drugs

• avoiding other possible hazards• Smoking, caffeine, medications, some herbs

and supplements



• A healthful diet before conception reduces the risk of developing nutrition-related disorders during pregnancy, such as:• gestational diabetes• preeclampsia

• A man's diet and lifestyle may also impact sperm quality.


Nutrition During Pregnancy

• A full-term pregnancy lasts 38–42 weeks.• 1st trimester: conception to 13th week• 2nd trimester: 14th to 27th week• 3rd trimester: 28th to 42nd week

• Embryonic stage: 3rd week to the 8th week• After the 8th week, the developing embryo is

called a fetus.



• 1st trimester• Fertilized egg travels through the fallopian

tube and implants in the wall of the uterus• Development of organs, limb buds, facial

features, placenta• Embryos are extremely vulnerable to

teratogens during this time.


Embryonic Development



• 2nd trimester• Continued development of organ systems• More than 10 inches of growth during this

time• Fetus weighs more than 2 pounds by the end

of the 2nd trimester.



• 3rd trimester• Period of considerable growth• Fetus gains 3/4 of its weight in this time.• Brain growth is also extensive.• Lungs become fully mature.• A balanced, adequate diet for the mother is

essential during this time.



• An undernourished mother is more likely to give birth to a low-birth-weight baby.• Low birth weight: any baby born weighing

less than 5.5 pounds• Increased risk of infections, learning

disabilities, impaired physical development, and death in the first year



• Weight gain during pregnancy• Women who do not gain enough weight are

at risk of having a low-birth-weight baby.• Too much weight gain is also risky.• Women should not diet during pregnancy

since this may deprive the fetus of critical nutrients.


Weight Gain During Pregnancy


Weight-Gain Distribution During Pregnancy



• The requirement for nearly all nutrients increases during pregnancy.

• Pregnant women must pay attention to their intake of:• macronutrients• micronutrients• fluids


Macronutrients

• Energy• An additional 350–450 kcal/day may be

required in the 2nd and 3rd trimesters.• Nutrient-dense foods are essential in order to

obtain sufficient nutrients.• Proteins and carbohydrates

• Protein: 1.1 g/day per kg body weight• Carbohydrates: 175 g/day


Macronutrients

• Fat• The percentage of calories obtained from fat

should not change during pregnancy.• Fat is required by the newborn for

temperature regulation and as an energy source.

• DHA (omega-3 polyunsaturated fatty acid) is important in the 3rd trimester.


Micronutrients

• The micronutrients that are most critical during pregnancy include:

Folate Calcium

Vitamin B12 Iron

Vitamin C Zinc

Vitamin A Vitamin D


Nutrient Recommendations


Micronutrients

• Folate• Critical in the first 28 days for development of

the neural tube, which becomes the brain and spinal cord

• Deficiency is associated with spina bifida and anencephaly

• 400 mg/day for sexually active women• 600 mg/day for pregnant women


Micronutrients

• Vitamin B12

• Regenerates the active form of folate• 2.6 micrograms/day during pregnancy

• Vitamin C• Synthesizes collagen, a component of

connective tissue• 85 mg/day during pregnancy


Micronutrients

• Vitamin A• Need increases by 10% in pregnancy.• Deficiency is linked to low birth weight and

preterm delivery.• Vitamin D

• RDA does not increase during pregnancy.• Women with limited sun exposure or who

don't drink milk may need a supplement.


Micronutrients

• Calcium• 1000 mg/day, same as for nonpregnant adult

women, for women age 19 and older• Pregnant women absorb calcium better.

• Zinc• Critical for making proteins, DNA, RNA• Need increases 38% during pregnancy.


Micronutrients

• Iron• Increased need for red blood cells increases

the need for iron by 50%.• Fetal need for iron increases in 3rd trimester.• Fetus will take iron from mother, causing

iron-deficient anemia.


Fluids During Pregnancy

• The need for fluids increases to 2.3 liters (10 cups) per day in order to:• allow for the increase in the mother's blood

volume• regulate body temperature• produce amniotic fluid to protect and

cushion the fetus


Nutrition-Related Concerns

• Nutrition-related concerns during pregnancy can include:

Morning sickness Caffeine

Food cravings Alcohol

Gestational diabetes Smoking

Preeclampsia Illegal drugs

Adolescent pregnancy Food safety

Vegetarianism Exercise


Morning Sickness

• Morning sickness: nausea and vomiting associated with pregnancy• Can occur at any time; often lasts all day• High levels of pregnancy hormones may be

the cause.• No cure, but symptoms can be reduced


Food Cravings

• Most women crave a certain type of food (sweet, salty) rather than a specific food.

• Pica: a condition of craving a nonfood item (ice, chalk, clay, dirt, coffee grounds, etc.)


Gestational Diabetes

• Gestational diabetes: insufficient insulin production or insulin resistance that increases blood glucose levels during pregnancy• Condition resolves after birth occurs.• Risk of delivering a large baby• Uncontrolled blood glucose levels may lead

to preeclampsia.


Preeclampsia

• Preeclampsia: pregnancy-induced hypertension• Can be fatal if left untreated• Deficiencies in protein, vitamins C and E,

calcium, and magnesium increase the risk.• Treatment focuses on managing blood

pressure and often includes bed rest.• Often resolves after birth of child


Adolescent Pregnancy

• The nutritional needs of pregnant adolescents are higher than those of adult women.

• Adolescent bodies are still growing and changing, which adds to the nutritional needs of pregnancy.

• Pregnant adolescents are more likely to have preterm babies, low-birth-weight babies, and other complications.


Vegetarianism

• A vegetarian consuming eggs and dairy products has the same nutritional concerns as a non-vegetarian.

• A complete vegetarian (vegan) must carefully watch her intake of:

vitamin D calcium

vitamin B6 iron

vitamin B12 zinc


Caffeine Consumption

• Caffeine is a stimulant that crosses the placenta and reaches the fetus.

• One to two cups of coffee per day will likely cause no harm.

• More than two cups of coffee may slightly increase the risk of miscarriage and low birth weight.


Alcohol Consumption

• Alcohol is a known teratogen that crosses the placenta and is associated with various birth defects.

• Fetal alcohol syndrome (FAS): variety of characteristics associated with prenatal exposure to high quantities of alcohol• Malformations of face, limbs, heart• Many developmental disabilities


Smoking

• 18–19% of pregnant women smoke.• Adolescents are more likely to smoke during

pregnancy.• Smoking greatly increases the risks of:

miscarriage preterm delivery

stillbirth low birth weight

placental problems poor fetal growth


Illegal Drugs

• Most drugs pass through the placenta to the fetal blood.

• The fetal liver is too immature to break down these drugs.

• There is no safe level of use for illegal drugs during pregnancy.


Herbal Supplements

• Herbal supplements may not be tested for purity, safety or effectiveness.

• Pregnant women should consult their healthcare provider.


Food Safety

• Foods unsafe for pregnant women may include:• unpasteurized milk• raw or partially cooked eggs• raw or undercooked meat, fish, poultry• unpasteurized juices• raw sprouts• some cheeses from unpasteurized milk


Exercise and Fitness

• Exercise during pregnancy:• keeps a woman physically fit• is a great mood booster• helps compensate for an increased appetite• helps keep blood pressure down• makes it easier to lose weight after the

pregnancy


Breastfeeding

• Breastfeeding is the ideal method of infant feeding because of the nutritional quality and health benefits of breast milk.

• Colostrum: first milk produced; rich in proteins, antibodies, vitamins, minerals


Breast Anatomy


Breastfeeding

• The benefits of breastfeeding include:• high-quality nutrition for the infant• immunologic protection (e.g., from allergies

and infections)• assisting post-delivery maternal weight loss• suppressing ovulation• bonding enhancement• convenience and cost-effectiveness


Breastfeeding


Breastfeeding

• Many harmful substances are passed into breast milk, including:• illegal drugs• caffeine and nicotine• prescription drugs and over-the-counter

medications• HIV (virus)


Breastfeeding

• Milk production requires 700–800 kcal/day.• Lactating women should consume an extra

330–400 kcal/day.• Increase protein intake by 15–25 g/day and

carbohydrate by 80 g/day.• Lactating women need to consume an extra

quart (about 1 L) of fluid per day.• Iron needs decrease to 9 mg/day.


Formula Feeding

• Most formula are based on modified cow's milk.• Cow's milk (unmodified) should not be given to

infants (under 1 year old).• Be careful not to overfeed.• Do not allow infants to fall asleep with a bottle

due to baby bottle syndrome.


Infant Nutrition

• Infants' nutritional needs are unique because:• their energy needs are high to support rapid

growth• their digestive tracts and kidneys are still

immature• they are small in size


Infant Nutrition

• Infants need:• 40–50 kcal per pound of body weight per day• about 40–50% of calories from fat• no more than 20% of calories from protein• vitamin K injection at birth• may require Vitamin D supplementation• breastfed infants may require fluoride and

iron supplementation after 6 months• 2 ounces of fluid per pound of body weight


Infant Nutrition

• An infant's digestive system and kidneys must develop to maturity before solid food can be introduced.

• Breast milk or formula should be supplemented with solid food beginning at 4 to 6 months.


Infant Nutrition

• Infants should NOT eat:• foods they could choke on• corn syrup or honey• goat's milk• cow's milk• large quantities of fruit juice• too much salt or sugar• too much breast milk or formula after 6

months


Infant Nutrition

• Nutrition-related concerns for infants include:• allergies• colic• gastroesophageal reflux• iron-deficiency anemia• dehydration


Infant Nutrition

• Allergies• Solid food should be introduced one at a time

for a week to watch for allergies.• Colic

• Uncontrollable crying that can last for hours• Precise cause is unknown.


Infant Nutrition

• Gastroesophageal reflux• Occurs in about 3% of infants; common in

preterm infants• Anemia

• Infants are born with enough iron for only 6 months.

• Anemia can develop after that.


Infant Nutrition

• Dehydration• Extremely dangerous for infants• Caused by diarrhea, vomiting, inadequate

fluid intake• Pediatric electrolyte solution may be used.


Toddlers

• Age 1 to 3 years• Rapid growth rate of infancy begins to slow.• Gain 5.5 to 7.5 inches and 9–11 pounds• Higher energy expended for increased

activity level


Toddlers

• Macronutrients• Estimated energy requirement (EER) is

about 1,000 kcal/day.• Up to 40% of total kcal from fat• 1.1 grams of protein per kg weight per day• 130 grams of carbohydrates per day


Toddlers

• Fluid needs• About 4 cups per day• Encourage water, milk, and soy milk• Limited amounts of diluted fruit juice


Toddlers

• Nutritious food choices• Toddlers have an innate ability to match their

intake with their needs.• Keeping a nutritious variety of foods available

encourages a healthful diet.• Food should not be forced on a child.• Portions should be small, and toddlers should

eat every 2 to 3 hours.


Toddlers

• Allergies• Continue to watch for food allergies.• Introduce one new food at a time.

• Vegetarian families• A diet including eggs and dairy can be a

healthful diet.• A vegan diet may lack essential vitamins and

minerals.


Nutrition Through Childhood

• Macronutrients• Total fat intake should gradually drop to a

level closer to adult fat intake.• 25–35% of total energy from fat• 0.95 grams protein per kg body weight• 130 grams carbohydrate per day



• Nutritious food choices• Children are influenced by peers and media

and begin to make their own food choices.• Parents can teach children about healthful

food choices.• Some foods "help us grow healthy and strong."• Involve children in meal planning and food

purchasing decisions.



• Micronutrients• Vitamins and minerals from fruits and

vegetables continue to be a concern.• Vitamins A, C, E, calcium, iron, and zinc are

of special concern.• Vitamin and mineral supplements supplying

no more than 100% of the RDA can be beneficial.



• National School Breakfast & Lunch Program• 99% of public schools participate in at least

one.• Fruits, vegetables, and whole grains must be

offered.• Milk must be low fat or fat-free.• Average weekly calories must be age

appropriate.• Sodium, saturated, and trans fats must be

reduced.



• Nutrition-related concerns for children include:• food insecurity: occurs when the child does

not have a predictable supply of safe and nutritious food

• overweight and obesity



• Obesity in children• 19% of children age 6–11 years are

overweight.• 17% of 12-to 19-year-olds are overweight.• Caused by eating too much and not

maintaining enough physical activity• The Institute of Medicine recommends that

children be very active for at least one hour per day.


Adolescents

• Age 14 to 18 years• Growth spurts begin at age 10 to 11 for girls

and 12 to 13 for boys.• An average 20–25% increase in height is

expected.• Weight and body composition also change.


Adolescents

• Macronutrients• Estimated energy requirements for

adolescents are based on gender, age, activity level, height, and weight.

• 25–35% of total energy from fat• 45–65% of kcal from carbohydrates• 0.85 gram protein/kg body weight


Adolescents

• Micronutrients• Calcium intakes must be sufficient for

achieving peak bone density.• Iron needs are relatively high.• Vitamin A is critical for supporting rapid

growth and development.• A multivitamin can be a safety net, but should

not replace a healthful diet.


Adolescents

• Fluid• The need to maintain fluid intake is increased

by higher activity levels.• Boys: 11 cups/day• Girls: 8 cups/day


Adolescents

• Nutritious food choices• Peer influences and a fast-paced lifestyle can

lead adolescents to choose fast foods.• Parents can act as role models and keep

healthful food choices available.• Adequate fruits, vegetables, and whole grains

should be encouraged.


Adolescents

• Nutrition-related concerns• Sufficient calcium is required to develop peak

bone density.• Adequate physical activity is very important in

reducing obesity.• Disordered eating and eating disorders can

begin in these years.• Acne is primarily hormonal.• Alcohol and tobacco use experimentation

may begin.


Older Adults

• In people age 65 years and older, changes to the body can include:• decreased muscle and lean tissue• increased fat mass• decreased bone density• reduced functioning of kidneys, liver, heart,

nervous system• impaired absorption of nutrients


Older Adults

• Factors that influence the aging process can include:• genetics: genes greatly influence the aging

process• biochemistry: many changes to cells and

tissues occur over time• lifestyle and environmental factors


Older Adults

• Macronutrients• Energy needs usually decrease due to

reduced muscle mass and decreased activity levels.

• Recommendations for fat, carbohydrate, and proteins intakes are the same as for younger adults.

• Older adults can consume slightly less fiber.


Older Adults

• Micronutrients• Calcium and vitamin D requirements increase

due to poor calcium absorption.• Zinc intake should be maintained for

optimizing immune function.• Adequate intake of B-vitamins is a special

concern.


Older Adults

• Fluid• AI for fluid is the same as for younger adults–

at least 8 cups per day.• Older adults are especially susceptible to

dehydration.


Older Adults


Older Adults

• Nutrition-related concerns• Many chronic diseases are more prevalent in

overweight or obese adults.• Underweight may result from illness,

disability, loss of sense of taste or smell, depression, or social isolation.

• Osteoporosis increases the risk of bone fractures. Hip fractures are of great concern.


Older Adults

• Nutrition-related concerns• Cataracts and macular degeneration• Some medications can alter nutrient

absorption or decrease appetite.


Older Adults

• Older adults can receive help from food assistance programs such as:• Supplemental Nutrition Assistance Program

(SNAP)• Child and Adult Care Program• Commodity Supplemental Food Program• Seniors' Farmers Market Nutrition Program• Nutrition Services Incentive Program


Chapter 11 Power Point

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