Transcript Chapter 13 - Fernando Haro

Chapter 13
Nutrition Over the Life Cycle
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Learning Objectives
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Explain the benefits of good nutrition to mother and
baby during pregnancy
Identify nutrients of special concern during pregnancy
and their food sources
Explain the possible effects of alcohol, fish, caffeine,
and artificial sweeteners during pregnancy
Plan menus for women during pregnancy and lactation
Describe what an infant should be fed during the first
year, including the progression of solid foods
Learning Objectives (cont’d)
6.
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Give five reasons why breast-feeding is preferable to
bottle feeding
Describe how to ensure enjoyable mealtimes with
young children and teach them good eating habits
Plan menus for preschool and school-age children
Identify the nutrients that children and adolescents are
most likely to be lacking and their food sources
Describe influences on children’s and adolescents’
eating habits
Learning Objectives (cont’d)
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Plan menus for adolescents
Distinguish among anorexia nervosa, bulimia nervosa,
binge eating disorder, and female athlete triad
Describe factors that influence the nutrition status of
older adults
Identify nutrients of concern for older adults and their
food sources
Plan menus for healthy older adults
Describe ways to prevent the development of obesity
during childhood
Pregnancy
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Embryo
Fetus (at 8 weeks)
Amniotic sac
 Placenta
 First, second, and third trimesters
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First Trimester
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Critical period of cell differentiation
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Growing baby is most susceptible to
damage from nutritional deficiencies and
alcohol
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Nutrition Risk Factors for Pregnant
Women
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Pre- pregnancy weight below BMI of 18.5 or a BMI of 25
or higher
Inadequate kcalories intake
Inadequate intake of nutrient(s)
Alcohol use
Teenager
Woman over 35
Chronic disease such as diabetes or high blood pressure
Poverty and/or food insecurity
Multiple Births (twins, triplets, etc.)
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Optimum Weight Gain in
Pregnancy
Pre-Pregnancy Weight
Recommended Weight Gain
Underweight (BMI less than 18.5)
28 – 40 pounds
Healthy weight
(BMI between 18.5 to 24.9)
25 – 35 pounds
Overweight
(BMI between 25 to 29.9)
15 – 25 pounds
Obese (BMI greater than 30)
15 pounds at least
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Components of Weight Gain
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Nutrition During Pregnancy
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340 additional kcal during 2nd trimester and
additional 450 kcal during the 3rd trimester
Protein needs increase 25 grams
Essential fatty acids
Calcium, vitamin D, phosphorus, and
magnesium
 Calcium
may help reduce pregnancy-induced
hypertension
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Nutrition During Pregnancy
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Folate needs increase – needed to prevent
neural tube defects, such as spina bifida, in early
pregnancy. Folate is also critical during the
entire pregnancy.
Vitamin B12 works with folate to make new cells
Iron supplements are needed (make RBCs)
Sodium restriction normally not necessary
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Spina bifida
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Diet-Related Concerns of
Pregnancy
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Nausea/vomiting
Food cravings and aversions
Constipation
Heartburn
Alcohol (fetal alcohol syndrome)
Caffeine & Artificial Sweeteners
Seafood with high levels of methyl mercury
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Guidelines for Eating Fish &
Shellfish
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Do not eat Shark, Swordfish, King Mackerel, or Tilefish
because they contain high levels of mercury
Eat up to 12 ounces (2 average meals) a week of a
variety of fish and shellfish that are lower in mercury
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Five of the most commonly eaten fish that are low in mercury are
shrimp, canned light tuna, salmon, pollock, and catfish
Another commonly eaten fish, albacore ("white") tuna has more
mercury than canned light tuna. So, when choosing your two
meals of fish and shellfish, you may eat up to 6 ounces (one
average meal) of albacore tuna per week
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Menu Planning Guidelines for
Pregnant Women
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Offer a varied and balanced selection of
nutrient-dense foods
Choose some entrees based on legumes and/or
grains and dairy products
Be sure to offer dairy products made with nonfat
or reduced-fat milk
Use a variety of whole-grain and enriched
breads, cereals, rice, etc
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Menu Planning Guidelines for
Pregnant Women
Use assorted fruits and vegetables in all
areas of the menu
 Be sure to have good sources of problems
nutrients: essential fatty acids, calcium,
vitamin D, magnesium, folate, vitamin B12,
and iron
 Use iodized salt
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MyPyramid Plan for Moms
Nutrition and Menu Planning
During Lactation
First 6 months: additional 330 kcal needed
 Second 6 months: additional 400 kcal
 Because lactating mother normally
produce about 25 ounces of milk a day,
they need at least 3-4 quarts of fluids daily
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Nutrition and Menu Planning
During Lactation
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If the lactating mother is not eating properly, this
is more likely to affect the quantity of milk she
makes rather than the quality
Moderate use of caffeine is okay
Regular consumption of alcohol is not advised
Iron supplements are needed to replenish stores
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Infancy: The First Year of Life
Infants double their birth weight in the first
4 to 5 months and then triple their birth
weight by the first birthday
 Infants also grow 50% in length by the first
birthday
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Nutrition During Infancy
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Newborns need a
plentiful supply of all
nutrients
For first 4–6 months –
source of all nutrients
is breast milk or
formula
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Advantages of Breast-Feeding
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Nutritionally superior
Less apt to cause allergic
reaction
Suckling promotes
development of infant’s
jaw and teeth
Promotes a close
relationship
Less likely to be
mishandled
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Helps the infant build up
immunities
May reduce risk of
chronic diseases
Less expensive
Breast-fed babies have
lower rates of hospital
admissions, ear
infections, diarrhea, and
other medical concerns
Breast-fed infants need vitamin D at 2
months of age.
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Breast Feeding
To ensure success, the mother must
breast-feed the child ASAP after delivery
 Colostrum – first secretion from breast,
rich in proteins and antibodies
 Colostrum changes to transitional milk
between 3rd and 6th days
 By the tenth day, major changes are done
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Suckling stimulates milk letdown
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Formula-Feeding
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All formulas must meet nutrient standards set by
the American Academy of Pediatrics
3 forms of formula: ready-to-feed, liquid
concentrate, and powdered
Soy formula is used if baby is allergic to cow
milk-based formulas
Some formulas contain fatty acids: DHA and AA,
which are present in breast milk and may
enhance mental and visual development
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When are babies able to eat
solids?
When the baby can:
 Has doubled his/her birth weight
 Drinks more than 1 quart of formula/day
 Seems hungry often
 Opens his/her mouth in response to food coming
 Can move tongue from side to side without
moving the head
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Introduction of Solid Foods
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4 – 7 months:
Iron-fortified baby cereals
Pureed then textured
vegetables
Pureed then textured fruit
Fruit juice (start at 6
months, dilute at first)
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Introduction of Solid Foods
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8 – 11 months:
Mashed or diced soft fruit
Mashed or soft cooked vegetables
Mashed egg yolk
Finely cut meat/poultry
Mashed cooked beans or peas
Cottage cheese, yogurt, or cheese
strips
Pieces of soft bread
Crackers
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Introduction to Solid Foods
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12 months:
Cut-up table foods
Whole milk
Whole eggs
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Choking Hazards
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Nuts and seeds
Raisins
Hot dogs
Popcorn
Whole grapes
Hard candies
Peanut butter
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Cherry tomatoes
Raw carrots
Many other raw fruits
and veggies
Fruit with pits
Large chunks of any
food
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Additional Concepts
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Baby bottle tooth decay
Pincer grasp
 Palmar grasp
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Allergies
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Milk
Eggs
Wheat
Nuts
Chocolate
Shellfish
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Childhood
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Around age 1, the baby’s growth rate decreases
a lot
Yearly weight gain now averages 4 to 6
pound/year and children grow about 2-3 inches
per year until puberty
After age 1, children start to lose baby fat, and
their legs become longer
By age 2, most children have all their baby teeth
and can drink from a cup
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Energy and Macronutrients for
Children
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Estimated Energy Requirement (EER) and Recommended Dietary
Allowance (RDA) for Protein
Gender and Age Height
Weight
EER
Protein
Male 1 - 3
34 inches 27 pounds 1046 kcal
1.1 g/kg
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Female 1 – 3
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992
1.1
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Male 4 – 8
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1742
0.95
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Female 4 – 8
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1642
0.95
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Children experience growth spurts and
food jags
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Acceptable Macronutrient
Distribution Ranges for Children
Age
Carbohydrate
Fat
Protein
1-3 years
45-65%
30-40%
5-20%
4-18 years
45-65%
25-35%
10-30%
Over 18
45-65%
20-35%
10-35%
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Tactics for Dealing with
Preschoolers’ Food Habits
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Make mealtime as relaxing and enjoyable as
possible
Don’t nag, bribe, force, or cajole a child to eat.
Stay calm
Allow children to choose what they want from 2
or more healthy choices
Let children participate in food selection and
preparation
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Tactics for Dealing with
Preschoolers’ Food Habits
Respect your child’s preferences when
planning meals, but don’t make a quick
peanut butter sandwich if dinner is
rejected
 Have appropriately-sized utensils
 Eat with your child and be a good role
model
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Tactics for Dealing with
Preschoolers’ Food Habits
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Expect your child to reject new foods at least
once, if not many times. Continue presenting
the new food
Serve small portions
Do not use desserts as a reward for eating
meals
Ask children to try new foods often
Be consistent at mealtimes
Pickiness will eventually pass
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Menu Planning for Preschoolers
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Offer simply prepared foods.
Avoid casseroles
Present new foods to children
often
Offer at least 1 colorful food
Vegetables are more likely to
be accepted if served raw as
finger foods. (for older
preschoolers)
Provide at least 1 soft/moist
food and 1 crisp/chewy food to
develop chewing skills
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Menu Planning for Preschoolers
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Avoid strong-flavored and highly salted foods
Offer carbohydrate foods such as breads &
cereals: they are easy to hold and chew
No lumpy foods!
Before age 4, serve in bite-size pieces
Serve foods warm, not hot
Minimize choking hazards for children under 4
Serve good sources of iron, vitamin E,
potassium, and fiber
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Menu Planning for School-Age
Children
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Serve a wide variety of foods including children’s
favorites
Good snack choices are important
Balance menu items higher in fat with those
containing less fat
Pay attention to serving sizes
Offer iron-rich foods
Be sure to include some good sources of vitamin
E, potassium, and fiber
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Adolescence
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Puberty
 Girls:
starts at age 10 or 11
 Boys: starts at 12 or 13
During the 5 to 7 years of pubertal
development, adolescents gain about 20%
of adult height and 50% of adult weight
 Males now put on twice as much muscle
as females. Females gain more fat
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Nutrition During Adolescence
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Males now need more kcal, protein, magnesium,
and zinc for muscle and bone development than
females
Females need increased iron due to
menstruation
Females have to pack more nutrients into fewer
kcal than males
Three problem nutrients: vitamin E, potassium,
and fiber
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Nutrition During Adolescence
(cont’d)
Teenagers make more of their food
choices
 Teenagers are influenced by peers, body
image, family, media, etc.
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Menu Planning for Adolescents
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Emphasize complex carbohydrates such as
whole grains and legumes
Offer well-trimmed lean beef, poultry, and fish
Offer non-fat and low-fat milk
Have nutritious foods for on-the-go eating
Emphasize quick and nutritious breakfasts
Emphasize foods with iron, vitamin E,
potassium, fiber, calcium, and magnesium
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Eating Disorders
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Female Athlete Triad
 Disordered eating
 No menstruation
 Osteoporosis
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Treatment for Eating Disorders includes:
 Individual psychotherapy
 Family therapy
 Cognitive-behavior therapy
 Medical nutrition
 Medications
therapy
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Older Adults
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The maximum efficiency of many organ systems
occurs between 20 and 35. After age 35, the
functional capability of almost every organ
system declines
BMR declines as we age. We lose muscle mass.
The functioning of the cardiovascular system
declines with age. Blood pressure increases.
Pulmonary capacity decreases
Kidney function deteriorates
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Factors Affecting Nutrition Status:
Physiological
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Disease
Less muscle mass
Activity levels
Dentition
Functional disabilities
(interfere with doing
daily tasks)
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Decreased sensitivity
to taste and smell
Changes in GI tract
(slowing down,
heartburn)
Medications
Diminished sense of
thirst
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Factors Affecting Nutrition Status:
Psychosocial
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Cognitive functioning
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Social support
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Factors Affecting Nutrition Status:
Socioeconomic
Education
 Income
 Living arrangements
 Availability of federally funded meals
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Nutrition for Older Adults
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Nutrients of concern:
 Water
 Vitamin
B12 and folate
 Vitamin D
 Calcium
 Zinc
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Modified Food Pyramid for Adults
Age 70 and Over
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Menu Planning for Older Adults
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4.
Offer moderately sized meals and/or half
portions
Emphasize high-fiber foods such as
fruits, vegetables, grains, and beans
Moderate the use of fat
Dairy products are important sources of
calcium and other nutrients
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Menu Planning for Older Adults
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Offer adequate protein but not too much
Moderate the use of salt
Use herbs and spices
Offer a variety of foods
Fluid intake is critical
Serve softer foods if chewing is a
problem
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Food Allergies
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A food allergy involves an abnormal immune
system response. If the response doesn’t
involve the immune system, it is a food
intolerance.
Symptoms of food allergy may include hives,
rashes, stomach cramps, vomiting, diarrhea,
wheezing, swelling of the lips or tongue, and
itching lips
The greatest danger in food allergy comes from
anaphylaxis
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Common Sites for Allergic
Reactions
Childhood Obesity
Contributing Factors to Childhood
Obesity
Energy intake
 Physical activity
 Sedentary behavior
Home, child care, school, and
community environments can influence
children’s behaviors related to food intake
and physical activity
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