Transcript Food

Nutrition Across the Life Span
Child
•
Infant
Elderly
•
Growth
Development
•
Prevent disease
•
Promote health
•
Role of Nutrition
Adolescence
Prolong life
Pregnancy
Adult
Nutrition in Pregnancy
Stages of Pregnancy & Birth
Terms for Stages surrounding Pregnancy and Birth
Fertilization
Birth
GESTATION
Preterm
0
2
8
20
37
38
28
Postte
rm
Term
40
42 44
Postnatal or
postpartum
Prenatal or
Antenatal
Perinatal
Zygote
Embryo
Preconception = before pregnancy
Fetus
Periconception = 1→3 months before pregnancy to the first 6 weeks after delivery
Infant
Neonate
Physiological Changes during Pregnancy
•
Endocrine
•
Body composition
•
Blood volume & composition
•
Metabolism
•
Cardiovascular
•
Respiration
•
Kidney
•
Gastrointestinal
Nutritional Requirements in Pregnancy
There is increased need for energy and nutrients to support growth of
the fetus, placenta and maternal tissue.
Physiologic changes that cause hemodilution causes changes in nutrient
turnover and homeostasis that affects requirements.
Fetal demands occurs primarily during the second half of pregnancy
when more than 90% of growth occurs.
Energy Needs
China RNI
Energy (Nonpregnant)
Light Moderate Heavy
Energy (Pregnant)
Full activity Reduced
Women 18-55
2100
2100
2350
+285
Women <55
2050
2150
2350
+200
• 1st trimester  additional energy requirement is small
• 2nd / 3rd trimester  + 200 - 300 kcal/day
• Pregnant teenagers, underweight women, physically active women need
more
• Increased energy due to 25% increase in basal energy requirements (growth
of fetus, accessory tissues, maternal supporting tissues) and increased
requirement by mother due to her increased weight
Energy & Related Nutrient Needs
Singapore RDDA
B1 thiamin,
mg
B2 riboflavin, mg B3 niacin, mg
Women 18-30
0.84
1.26
13.9
Women 30-60
0.86
1.29
14.2
Pregnant –full activity
+0.11
+0.17
+1.9
Pregnant –reduced
+0.08
+0.12
+1.3
•
as energy requirement increases  the need
for thiamin, niacin & riboflavin increase
proportionally
•
they are coenzymes in reactions that releases
energy from CHO, protein and fat
Macronutrient Needs
Singapore RDDA
Women 18-30
Women 30-60
Pregnant –full activity
Protein, g
58
58
+9
CHO, g
275
282
+39
Fat, g
56
57
+8
Pregnant –reduced
+9
+28
+6
• Protein essential for:
– synthesis of fetal & placental protein
– increased maternal protein synthesis to support expansion of blood
volume & growth of breasts & uterus
• Vitamin B6 (pyridoxine) required for protein synthesis, therefore increase
requirement during pregnancy
• CHO & fats help make up calories, spare protein
Critical Periods
Vulnerable Periods of Foetal Development

Critical periods = finite periods during development in
which certain events may occur that will have irreversible
effects on later developmental stages

A critical period is usually a period of rapid cell division i.e.
embryonic/fetal development
Neural Tube Defects & Folate Supplements
• The neural tube is the embryo's precursor to the CNS. About 20- 28 days
after conception, the neural tube closes to form the brain and the spinal
cord. If this tube fails to close, a NTD occurs
• Folic acid plays an essential role in cellular division. It is also needed for
the proper closure of the neural tube
• NTDs occur between the 20 - 28th day after conception, before most
women know that they are pregnant. Because about half of all
pregnancies are unplanned, it is important to include at least 400 mcg of
folic acid in every childbearing age woman's diet. (US RDA)
Critical Periods
Critical periods occur early in development.
An adverse influence occuring early can have a much more severe
& prolonged impact than one occurring later on.
Teratogen
Teratogen = any substance, agent or process that induces the
formation of developmental abnormalities in a fetus
e.g. Thalidomide, alcohol, German measles, cytomegalovirus,
irradiation with X-rays, ionising radiation
•1957 to 1962 in UK, Canada, Germany, Japan - not FDA approved prevented
morning sickness
•12,000 babies who survived, with phocomelia (flipper-like arms or legs)
Assessing Nutritional Status In Pregnancy
Anthropometric measurements
• weight, height, BMI, fatfolds, waist circumference??
Biochemical parameters
• blood test, urine test – levels of vitamins, minerals, protein??
Clinical assessment
• skin, glands, muscle, bones & joints, cardiovascular,
gastrointestinal, nervous system??
Dietary intake
• 24 hr recall, dietary history, food records, FFQ??
Maternal Weight & Weight Gain
 Optimal pregnancy outcome (appropriate infant birth weight
and well being of both infant & mother) reflects an interaction
between gestational weight gain and the pregravid weight
status of the mother
 Underweight mothers – inadequate nutrient reserves to support the
critical period of organogenesis & continued fetal growth &
development
 high risk of birth defects, growth restriction (SGA), preterm, foetal
& neonatal mortality, maternal complications like antepartum
hemorrhage, premature rupture of the membranes & anemia
 Solution: gain sufficient wt pre-conception & extra wt during pregnancy
 Overweight mother  high risk of medical complications (pregnancy
induced hypertension, diabetes mellitus, thromboembolic disease),
complicated delivery, post-term birth, late foetal deaths, poor
developments in infants
 Solution: achieve healthy weight pre-pregnancy & avoid excessive weight
gain during pregnancy. Postpone weight loss until after childbirth
Maternal Weight & Weight Gain
Prepregnancy Weight Status BMI
Low
Recommended total weight gain ranges
<19.8
12.5-18 kg
Normal
19.8-26.0
11.5-16 kg
High
26.0-29.0
7.0-11.5 kg
Obese
>29.0
> 6.0 kg
Mitchell (2003). Nutrition Across the Lifespan. Saunders
Mothers underweight before pregnancy had the lowest perinatal mortality
when they gained at least 16 kg while obese women had the lowest perinatal
mortality when they gained only 7 kg
Maternal Weight & Weight Gain
If BMI is
Weight Status
(non-pregnant)
Expected Total Weight
Gain
> 20
Underweight
12 to 18kg
20 ~ 25
Normal healthy weight
11 to 15kg
25 ~ 30
Overweight
6 to 11kg
<30
Obese
6 to 9kg
Taken from Eating for a Healthy Baby – Food & Nutrition Department, MOH, 1997
Quality of Weight Gain


Components of weight gain during pregnancy

64%: maternal tissue & fluid accumulation

25%: foetus

5%:
placenta

6%:
amniotic fluid
wt gain should be the result of a high-quality diet
 gradual & consistent gains in weight throughout pregnancy

foods consumed should be nutritious
Special Nutritional Requirements Prior To Pregnancy

Good nutritional status before pregnancy is important for
successful outcome.

Severe undernutrition superimposed on previous marginal nutrition
: low fertility rates & if conception occurs – birth defects, preterm
births & neonatal deaths

Undernutrition that occurs later part of pregnancy less likely to
result in birth defects but causes fetal growth restriction & LBW
Malnutrition & Foetal Growth & Development

After fertilisation:

zygote stage (0 - 2 wks)

embryonic stage (2 - 8 wks): Hyperplasia (↑in cell no)

fetal stage (8 - 38/42 wks): Hyperplasia & hypertrophy (↑ in cell size)

Effects of malnutrition depends on the stage of gestation & also duration

Malnutrition early in gestation : teratogenic effects during organogenesis e.g.
folate with NTDs

Malnutrition in last trimester : not teratogenic but restrictions can have serious
effects as the fetus gains 2/3 of its full term weight in 3rd trimester - accretion of
fat, EFA, calcium, iron, vit E  LBW, poorly developed muscles, no
subcutaneous fat

Malnutrition throughout gestation : affects wt & ht, size of foetus reduced
proportionally
Risk Factors in Pregnancy
Risk factors present at onset of pregnancy:
• age
• frequent pregnancies
• poor obstetric history
• poverty
• faddist food habits
• abuse of nicotine, alcohol, or drugs
• therapeutic diet required for a chronic disorder
• inappropriate wt (BMI <19.8 or >28)
Risk factors occurring during pregnancy:
• low haemoglobin
• inadequate/excessive weight gain, any weight loss
• medical complications
Planning Meals For A Pregnant Mother
Healthy Diet Pyramid
Adults
18-65
Pregnant
Rice & Alt
5-7
Meat & Alt
2-3
Fruit
2
Veg
2
6
2 + 1 dairy
2
2+1
green leafy
Courtesy of Health Promotion Board
Sample Daily Menu for Mother-to-be
Sample meal plan
No. of servings
Rice & alt
Breakfast :
2 slices wholemeal bread with thin
spread of margarine & jam
1 glass milk
Morning snack:
1 small raisin bun
Lunch:
1 bowl rice
1 small square beancurd cooked
with lean meat & mixed vegetables
¾ mug steamed broccoli
1 wedge papaya
Fruit
Vege
Meat & alt
1
½
½
2
½
1
1
1
Sample Daily Menu for Mother-to-be
Sample meal plan
No. of servings
Rice & alt
Dinner
1 bowl rice
1 piece grilled fish, palm sized
¾ mug stir-fried kangkog
Carrot & potato soup
1 banana
Fruit
Vege
Meat & alt
2
1
1
½
1
Supper
2 wholemeal biscuits
1 glass milk
½
Total servings
6
½
2
3
3
Adapted from “Eating for a healthy baby” - a healthy eating guide for mother-to-be. Food & Nutrition
Department (1997). Ministry of Health, Singapore.
Nutrition during Lactation
Nutrient requirements by lactating women are greater in
amounts when compared to the requirements of non-pregnant
women as lactation is a high priority physiological process.
Milk Component Biosynthesis
• Primary substrates extracted from blood – glucose, amino
acids, fatty acids vitamins & minerals. Some mobilized from
body stores or synthesized de novo
• Quality of milk is maintained at expense of maternal stores
(e.g. fat stores, skeletal calcium stores)
• Throughout lactation, breast milk changes in composition
• Lactation continues as long as adequate suckling
stimulation is maintained
Roles of Hormones
Infant suckling at the breast  message to hypothalamus
hypothalamus stimulates anterior pituitary to release prolactin
(promotes milk production by alveolar cells of mammary glands)
Effect on reproductive organs: prolactin inhibit ovulation
Nutritional Requirements during Lactation
Energy
Singapore
RDDA
Women
Energy (Nonpregnant)
Light Moderate Heavy
Energy (Pregnant)
Full activity Reduced
Energy (BF)
1st 6 After 6
mth mth
18-30
2000
2100
2350
+285
+500
30-60
2050
2150
2350
+200
+500
Macronutrients
Singapore RDDA
Protein, g
CHO, g
Fat, g
Women 18-30
58
275
56
Women 30-60
58
282
57
Pregnant –full activity
+9
+39
+8
Pregnant –reduced
+9
+28
+6
BF 1st 6 mth
+25
+69
+14
BF After 6 mth
+19
+69
+14
Protein: Based on protein content of 11g/l of projected milk volumes. Protein intakes
do not appear to significantly  volumes but severe restrictions may alter content of
some nitrogen-containing compounds
Lipids: dietary alterations do not appear to affect the amount of fat in the milk but
women with low fat stores appear to secrete milk with lower fat content. Important –
type of fatty acids (linoleic, α-linolenic) to support CNS & retina development
Vitamins & Minerals
Singapore RDDA
Ca,
Women 18-30
800
Women 30-60
mg Phos,
mg
Vit D,
mcg
B12,
mcg
Folate,
mcg
Iron,
mg
1200
2.5
2.0
200
19
800-1000
800
2.5
2.0
200
19
Pregnant –full activity
1000
1200
10.0
3.0
400
19
Pregnant –reduced
1000
1200
10.0
3.0
400
19
BF 1st 6 mth
1000
1200
10.0
2.5
300
19
BF After 6 mth
1000
1200
10.0
2.5
300
19
Planning Meals For A Lactating Mother
Healthy Diet Pyramid
Rice & Alt
Meat & Alt
Fruit
Veg
5-7
2-3
2
2
Pregnant
6
2 + 1 dairy
2
2 + 1 green
leafy
Lactating
6-7
2 + 1 dairy
2
3
Adults 18-65
Importance of Preparatory Support to Promote
Breastfeeding
Breastfeeding Support Groups
Breastfeeding Mothers' Support Group (Singapore)
96 Waterloo Street #02-04 SCWO Centre, Singapore 187967
http://www.breastfeeding.org.sg/
http://www.lalecheleague.org/
Breastfeeding Information
The Growing Years
(Infant, Toddler, Pre-schooler, School-aged Children, Adolescent)

Age ranges:
Infant
= birth to 1 yr
Toddler
= 1 to 2 years
Preschooler
= 2 to 6 years
• Dramatic changes in
1st yr
• Period of most rapid
growth
• Changes in food &
feeding abilities
School-age girls = 7 - 10 years
School-age boys = 7 - 12 years

Great diversity in size, age, growth rates & developmental skills

C_____________ = a period between infancy & adolescence
Infant Weight Gain - First 5 Years
15
10
5
0
1
2
3
4
5
Indicators Of Nutritional Status
Developmental problems
 Head circumference-for-age
Stunting/shortness
 Stature/height-for-age
Underweight
 BMI-for-age
 Weight-for-length/stature
Overweight
 BMI-for-age
 Weight-for-length/stature
Risk of overweight
 BMI-for-age
 Weight-for-length/stature
<5th percentile
>95th percentile
<5th percentile
<5th percentile
>95th percentile
>85th to <95th percentile
Sequence of Development of Feeding Behavior
Age
Reflexes
Motor Dev
Feeding Bhv
Food
1-3
mths
Rooting, suck
& swallow
reflexes present
at birth
Poor head control
→→head stable
Hands fisted
→→holds toys
Secures milk with
suckling pattern
→→opens mouth/
anticipates feeding
Breast milk
or infant
formula
4-6
mths
Rooting reflex
fades.
Tongue thrust
present if
spoon feeding
attempted
→→reduced
Palmar grasp – to
bring objects to
mouth
Supported sitting
Suckling strength
increases
Chewing motion
begins (gumming
food)
Mouth open for
spoon, bring hands
to bottle, holds,
sucks & bites cookies
Strained,
pureed or
blenderised
food from
spoon →→
mashed
food
without
lumps
Sequence of Development of Feeding Behavior
Age
Reflexes
Motor Dev
Feeding Bhv
Food
7-9
mths
Gag
reflex
weaker
Bears weight on
legs when held
Sits briefly alone
Holds one object
in each hand
Develop inferior
pincer grasp
Tries to finger feed soft food
Use tongue to move lumps of
food
Holds bottle alone, cup
drinking
Munching/chewing
movements when solid foods
eaten, rotary chewing begins
Mashed
lumpy foods
by spoon,
large pieces
of easily
chewed
finger foods
Tooth eruption
continues,
chewing matures
Bites nipples/teats, spoons
& crunchy foods
Finger feeds with refined
pincer grasp
Continue
addition of
new food
with easy-tochew texture
10 - 12
mths
Nutrient Needs
Rapid growth & major changes in body composition:
 high energy & nutrient demands
o most nutrient needs of infants, in proportion to body weight, is >
double that of adults
o example:
Infant
Adult
 Energy (kcal/kg/day) 90 – 120
 Protein (g/kg/day)
1.6 – 2.2
> 30 – 40
>
0.8 – 1
 impossible to establish a single standard for all infants
o recommendations expressed as ranges e.g. for birth - 6 mths & 6
mths - 1 year
If maternal diet is adequate, breast milk will meet the
major nutrient needs of the baby
Infant Feeding Patterns
3 overlapping stages:
 Nursing period
o
Breast milk/ formula provides complete
for the infant (4 - 6 mths after birth)
nutrition
As physical & developmental capabilities mature,
 Transitional period
o
Specially prepared semi-solid foods are introduced, composition &
consistency progressively
o
Breast milk/ formula continues
 Modified adult period
o
Eating a variety of foods from a mixed diet (1/3 – ½ of dietary
intake)
Recommended Supplementary Food Introductions During The 1st
Year
Food
4-6 mths
6-8 mths
Breast milk/ iron
fortified infant*
formula
4-6 feeds
3-4 feeds
* follow up formula
Rice/Cereals
Iron fortified rice cereals,
potato
Infant cereals – mixed,
teething biscuits
Fruit
Pureed, strained fruits;
juices (diluted)
Mashed/scraped lumpy fruits
Vegetables
Pureed, strained vegetables Mashed/scraped lumpy
vegetables
Meats
Scraped/mashed/finely
minced meats; scraped
/mashed egg yolk, tofu
Food
8-10 mths
10-12 mths
Breast milk/ iron
fortified follow up
formula
3-4 feeds
3-4 feeds
Cereals
Other cereals, plain
crackers, thin porridge
Breads, soft rice, pasta, thick
porridge
Fruit
Soft peeled fruits
(mashed/chopped)
Small pc soft, fresh, canned
fruits (unsweetened)
Vegetables
Mashed/chopped
vegetables
Small pc tender-cooked veges;
raw – finger foods
Meats
Plain baby yogurt;
mashed/finely minced
meats, cooked legumes mashed
Mashed/finely minced
/chop/tender-cooked meats;
mild cheeses
Planning Meals For Older Infants
Healthy Diet Pyramid Guide
7-12 months
Rice & Alt
Meat & Alt
Fruit
Veg
1-2 servings
½ serving
½ serving
½ serving
To include
additional 750 ml
milk
Nutrition in Adolescence
Stages of the life cycle an adolescent has gone
through…
Assessment of Nutritional Status
Three important features of the adolescent growth spurt that must be
considered are time of onset, duration & magnitude
Anthropometry – monitoring of growth /growth velocity is one of the most
sensitive means for evaluation
Assessment
may be complicated by the fact that ratio of LBM and fat to height changes
Crossing from one growth channel to another occurs frequently during this
period of rapid growth – when two or more channels are crossed, further
evaluation is necessary
Assessment of Nutritional Status
Knowing the stage of sexual maturity ratings helps in evaluation of
nutritional significance of growth deviation – e.g. 85th percentile weight &
skinfold for a girl at stage 1 indicates weight & fat accumulation preceeding
pubertal growth spurt for a girl at stage 4 indicates excess body fat that
may continue into adulthood
Clinical – because of their rapid growth, adolescents’ nutrition deficiencies
become apparent more quickly than do adults’. Physical signs reflect
advanced stages of undernutrition
Nutritional Requirements
in Adolescence
High Nutrient Needs
Except for the first 2 years of life, there is no time when growth &
development are as rapid
Onset of puberty & adolescent growth spurt demands for energy,
macronutrients, vitamins & minerals increase markedly
Adolescence may serve as a window of opportunity for compensating for
early childhood growth failure – nutrient intake must be favourable.
However the potential for significant catch-up growth is limited
Planning Meals For Adolescents
Factors to consider:
stage of growth/development
gender & nutritional requirements
Ensure that all nutrients are provided with a variety of foods balanced
among the food groups in the Healthy Diet Pyramid
Appropriate snacks – nutrient dense choices (low fat/skim milk & dairy
products, fresh fruits /vegetables & juices, sandwiches with wholegrain breads
& lean meats/low fat cuts) should be provided
Calcium & iron-rich sources should be emphasized
Planning Meals For Adolescents
Healthy Diet Pyramid
Age
Rice & Alt
Meat & Alt
Fruit
Veg
7-12 yrs
5-6
(this includes 1
serving of whole
grains)
2
(include 250-500 ml in
addition to the 2 svgs
above)
2
2
13-18 yrs
6-7
(this includes 1
serving of whole
grains)
2
(include 250-500 ml in
addition to the 2 svgs
above)
2
2
18-65 yrs
5-7
2-3
2
2
Stages of Adulthood
20 – 30s
40 – 50s
60 – 80s
The Early Years
The Middle Years
The Older Years
55
Dietary Recommendations For The Healthy Adult
Carbohydrate
 Protein
 Fat

50 - 60% of calories
10 - 20% of calories
25 - 30% of calories
Refer to the following:

“Dietary Guidelines 2003 for Adult Singaporeans (18-65 years)”
HPB MOH

Topic 2: Dietary Practices & Meal Planning for Healthy Diet
Pyramid Guide
56
Planning Meals For Adults
Rice & Alt
Meat & Alt
Fruit
Vege
Men
(Light Activities)
7
3
2
2
Women
(Light Activities)
5-6
3
2
2
Young adults should choose heart-healthy
diets to protect themselves against CVD in
later years
For adults on vegetarian or macrobiotic
diets, refer to Topic 2 notes
57
Planning Meals With Less Fat
Mr Lim usually has …
If he orders …
He saves …
Breakfast
2 pc roti prata w dhall curry
Breakfast
2 pc toast w jam
7.6 – 2
= 5.6 g
Lunch
Chicken rice
Lunch
Plain rice
Chicken roasted (skinless)
Stir-fried mix vege
26.0 g – 8 =
18 g
Afternoon Tea
2 pc currypuff, potato
Afternoon Tea
2 pc popiah,
43.9 – 22.4 =
21.5 g
Dinner
Pork chop, 2 pc
Cream of mushroom soup
Black forest cake
Dinner
Broiled pork tenderloin, 6 oz,
lean only
Broth
Fat-free ice cream
66.7 g -10 =
56.7 g
Supper
½ c mixed nuts
Supper
2 pc fresh fruits
27.7 g - 0 =
27.7 g
Saves
129.5 g fat !!
58