Transcript Chapter 13

Chapter 13
Nutrition Over the Life Cycle
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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)
Smoking
Alcohol use
Drug 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 to 35 pounds
Overweight
(BMI between 25 to 29.9)
15 to 25 pounds
Obese (BMI greater than 30)
15 pounds at least
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Components of Weight Gain
During the first 13 weeks of pregnancy, weight gain is only
2–5 pounds. After that, about 1 pound/week is normal.
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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
Nausea/vomiting
 Food cravings and aversions
 Constipation
 Heartburn
 Alcohol (fetal alcohol syndrome)
 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 and Lactating Women
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Offer a varied and balanced selection of nutrientdense 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 and Lactating 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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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 breast
cancer for the mother.
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:
 Can sit up and open his/her mouth.
 Has doubled his/her birthweight.
 Seems hungry often.
 Opens his/her mouth in response to food
coming.
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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
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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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, calcium,
iron, 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.
Teenagers makes 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 reduced-fat milk.
Offer margarine.
Have nutritious foods for on-the-go eating.
Emphasize quick and nutritious breakfasts.
Emphasize foods with fiber, vitamin E, calcium,
potassium, 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
1.
2.
3.
4.
Offer moderately sized meals and/or half
portions
Emphasize complex carbohydrates and highfiber 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
5.
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10.
11.
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.
Intake of these vitamins and minerals may be
inadequate: vitamin B6, B12, folate, vitamin D,
calcium, and zinc.
Serve soft foods if chewing is a problem.
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Food Facts: Creative Pureed
Foods
Many cooks are using thickeners to help
shape pureed foods so they look like the
original foods.
 Use standardized recipes to ensure that
pureed foods are nutritionally adequate,
are the right consistency, look and taste
good, and are not too expensive.
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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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