Transcript Vitamins

NUTRITION
Level 4, Academic Year (AY) 1435—1436 H
Ahmad Albalawi, MSN
Lecturer
Learning Objectives:
• Identify the nutritional needs of pregnant women,
lactating women, infants, children, adolescents and adults
and patients with health problems;
• Prepare a flyer/pamphlet or any health education material
and deliver actual health education on proper diet to a
certain client
• Do web search and present evidenced-based studies about
effects of diet and/or effective diet therapy.
• Demonstrate teamwork in meal planning, in making health
education material and in research presentation.
• Demonstrate the essential role of a nurse in health
promotion, disease prevention and complication
prevention through proper diet planning
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Topic Outline
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Nutrition during Pregnancy and Lactation
Nutrition during Infancy
Nutrition during Childhood
Nutrition during Adolescents
Nutrition During Adulthood
Energy and Nutrient Needs during
Pregnancy
• Nutrient needs during
pregnancy and
lactation are higher
than at any other time.
• To meet the high
nutrient demands of
pregnancy, a woman
will need to make
careful food choices
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Energy and Nutrient Needs during
Pregnancy
• Energy
– Second trimester- +340 cal
– 3rd trimester-+450 cal
• Represents about 15-20% in 2000-kcal daily
intake
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Energy and Nutrient Needs during
Pregnancy
• Suggested foods: whole-grain breads and
cereals, legumes, dark green vegetables,
citrus fruits, low-fat milk and milk products,
and lean meats, fish, poultry, and eggs.
• CHO- 135- 175 grams or more per day is
necessary to fuel the fetal brain.
• Sufficient carbohydrate ensures that the
protein needed for growth will not be broken
down and used to make glucose
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Energy and Nutrient Needs during
Pregnancy
Protein
• + 25 grams per day higher than for nonpregnant
women.
• Suggested food sources: meats, milk products,
and protein-containing plant foods such as
legumes, whole grains, nuts, and seeds.
• Use of high-protein supplements during
pregnancy may be harmful to the infant’s
development, it is discouraged.
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Energy and Nutrient Needs during
Pregnancy
Essential Fatty Acids
• essential long-chain polyunsaturated fatty
acids are particularly important to the growth
and development of the fetus
• brain is largely made of lipid material, and it
depends heavily on fatty acids for its growth,
function, and structure
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Energy and Nutrient Needs during
Pregnancy
Sources of Omega-3 and Omega-6 Fatty Acids
• Omega-6
• Vegetable oils (corn, sunflower, safflower, soybean,
cottonseed), poultry fat, nuts, seeds, Meats, poultry,
eggs (or can be made from linoleic acid)
• Omega-3
• Oils (flaxseed, canola, walnut, wheat germ, soybean)
Nuts and seeds (butternuts, flaxseeds, walnuts,
soybean kernels) Vegetables (soybeans), anchovy,
herring, lake trout, sardines, tuna) (or can be made
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Energy and Nutrient Needs during
Pregnancy
Nutrients for Blood Production and Cell Growth
• folate, vitamin B12, iron, and zinc- important
in the synthesis of DNA and new cells.
• Folate RDA during pregnancy: 600 μg/day
• Vitamin B12 RDA during pregnancy: 2.6
μg/day
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Energy and Nutrient Needs during
Pregnancy
• Folate sources: from a combination of
supplements, fortified foods, and a diet that
includes fruits, juices, green vegetables, and
whole grains
• Vitamin B12 sources: meat, fish, eggs, or milk
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Energy and Nutrient Needs during
Pregnancy
• Iron RDA during pregnancy: 27 mg/day
• daily iron supplement - second and third
trimesters- 30 to 60 milligrams
• taken between meals or at bedtime and with
liquids other than milk, coffee, or tea, which
inhibit iron absorption
• Vitamin C or orange juice can enhance
absorption
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Energy and Nutrient Needs during
Pregnancy
• Zinc RDA during pregnancy:12 mg/day (18 yr);
11 mg/day (19–50 yr)
• required for DNA and RNA synthesis and thus
for protein synthesis and cell development.
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Energy and Nutrient Needs during
Pregnancy
Nutrients for Bone Development
• Vitamin D and the bone-building minerals calcium,
phosphorus, magnesium, and fluoride are in great demand
during pregnancy.
• The AI for vitamin D and calcium does not increase during
pregnancy
• Sources: Regular exposure to sunlight and consumption of
vitamin D–fortified milk, cheese, yogurt, and other
calcium-rich foods.
• Less preferably, they may need a daily supplement of 600
milligrams of calcium.
• Vitamin D plays a vital role in calcium absorption and
utilization
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Energy and Nutrient Needs during
Pregnancy
• The recommended intake of fiber for pregnant
women is 28 g/day
• No need to increase vitamin A.
• Vitamin E requirement increases for all ages
(from 8 to 10 g).
• Vitamin K requirement remains the same for
women 25 and older (65 g), but dramatically
increases for girls 11-14 (from 45 g to 65 g).
• Requirements for all the water-soluble vitamins
are increased.
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Maternal energy and Nutrient during
Lactation
• Energy
requirement during
lactation:
• 1st 6 mo: +330
kcal/day
• 2nd 6 mo: +400
kcal/day
Fiber- + 1 g
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Maternal energy and Nutrient during
Lactation
• See figure on Comparison of Nutrient
Recommendations for Nonpregnant, Pregnant,
and Lactating Women (Understanding Nutrition by Whitney and Rolfes)
• See figure on Dietary Reference Intake for
lactating women (Understanding Nutrition by Whitney and Rolfes)
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M
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Post-Lecture Evaluation
1. Energy needs during pregnancy increase by
about:
a. 100 kcalories/day.
b. 300 kcalories/day.
c. 500 kcalories/day.
d. 700 kcalories/day.
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Post-Lecture Evaluation
2. Pregnant women should not take
supplements of:
a. iron.
b. folate.
c. vitamin A.
d. vitamin C.
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Nutrition During Infancy
• During the first year, the normal child needs
about 100 kcal per kilogram of body weight
each day.
• Infants up to 6 months of age should have 2.2
g of protein per kg of weight each day; age 612 months should have 1.56 g of protein per
kg of weight each day.
• This is satisfactorily supplied by human milk or infant
formulas
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Nutrition During Infancy
• Iron-fortified cereal is usually started at about
6 months.
• A vitamin K supplement is routinely given
shortly after birth.
• Infants should not be given an excess of
vitamin A or D. Vit A can damage the liver and
cause bone deformities, Vit D can damage the
cardiovascular system and the kidneys
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Nutrition During Infancy
• minimum of 30g of fat per day
• Human milk contains generous amounts of
essential fatty acids
• water intake -1.5 ml/kcal/day
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Nutrition During Infancy
• Essential vitamins and minerals can be
supplied in breast milk, formula and food
except for Vitamin D |(it is necessary to
expose infants to sunlight on a regular basis).
• Vitamins: Vitamin C- human milk, fortified
formula; Vitamin K- given shortly after birth
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Nutrition During Infancy
• Guidelines in Feeding
– Breastfeeding
• Breast should be offered every 2 hours in the first few
weeks.
• The infant should nurse 10-15min on each breast.
• Growth spurts occur at about 10 days, 2
weeks, 6 weeks, and 3 months; infant may
nurse more frequently.
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Nutrition During Infancy
• Indications of adequate nutrition include:
– The infant has six or more wet diapers per day.
– The infant has normal growth.
– The infant has one or two mustard-colored bowel
movements per day.
– The breast becomes soft during nursing
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Nutrition During Infancy
• Bottle Feeding
– The infant should be cuddled and held in an
upright position.
– He should be burped to prevent regurgitation.
– Formulas are developed so that they are similar
to human milk in nutrient and kcal values.
Burping a Baby:
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Nutrition During Infancy
• Sterile water must be used to mix formula.
• Infants under one year should not be given
regular cow’s milk.
• Consistent temperature should be used.
• Infants should not be put to bed with bottle.
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Nutrition During Infancy
• Supplementary Foods
• Limit diet to breast milk until the age of 4 to 6 months.
• Cow’s milk should be avoided until after one year of
age.
• Solid foods should not be introduced before 4
to 6 months of age and should be done
gradually.
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Nutrition During Infancy
• The general guidelines for the introduction of solid foods
are as follows:
– Introduce iron-fortified rice cereal at six months and no
younger than 4 months
– Add pureed vegetables and fruits at about 7-8 months
– Add pureed meat at 8-9 months
– Add juice when the infant is old enough to drink from a cup, at
about 9-10 months
– Add foods with more texture and finger foods at 9-10 months
(chopped meats, crackers, etc)
– Add allergenic foods like egg whites, whole milk, wheat
products and orange juice after 1 year
– Honey should never be given to an infant because it could be
contaminated with Clostridium botulinum bacteria
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Nutrition During Infancy
• Indications for Readiness for Solid Foods
– Ability to pull food into the mouth rather than
pushing the tongue and food out of the mouth.
– Willingness to participate in the process.
– Ability to sit up without support.
– Having head and neck control.
– The need for additional nutrients.
– Drinking more than 32 ounces of formula or
nursing 8 to 10 times in 24 hours.
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Nutrition During Childhood
• Nutritional Requirements during childhood
– The suggested intake proportion of energy for children is:
– 50% - 60% carbohydrate
– 25% - 35% fat
– 10% - 15% protein
– Nutrient needs increase because of increase in body size.
– Need 2 to 3 cups of milk or equivalent in terms of calcium
per day.
– Minimize sweets.
– Limit sweetened fruit juices.
– Drink 1 ml of water for each kcal of food.
• Introduce fiber slowly.
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Nutrition During Childhood
• Protein
– The need for protein per kg body weight decreases from
approximately 1.1 g in early childhood to 0.95 g in late
childhood
– Minerals and vitamins
• Fe – children between 1 and 3 years of age are at high risk of
developing IDA
• Ca – 500 mg/day for children 1-3 years, 800 mg/day for children 48 years and 1300 mg/day for 9-13 years
• Zn – an allowance of 3 mg/day for children 1-3 years, 5 mg/day for
children 4-8 years and 8 mg/day for children 9-13 years. Because
thebestsources for Zn are meats and seafood, children usually
have low intake.
• Vit D – the best source of vit D is also from milk. Children living in
tropical areas do not need Vit D supplementation.
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Nutrition During Adolescents
• Except for Vitamin D, nutrient needs increase
dramatically at the onset of adolescence.
• Because of menstruation, girls have a greater
need for iron than do boys.
• Adolescents may prefer to imitate their peers.
• Calculation of caloric requirement:
• 80 kcal/kg of body weight for prepubescent children
• 45 kcal/kg of body weight for active adolescent males
• 38 kcal/kg of body weight for active adolescent females
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Nutrition During Adolescence
• Protein
– Protein intake must be increased to make up for the fast
growth and development of body organs
• Calcium
– The recommended dietary intake of calcium for
adolescents is 1200 to 1500 mg.
– Greater need for boys than girls
• Iron
– All adolescents have high requirement for iron. The buildup of muscle mass in boys is accompanied by greater
blood volume, and girls lose iron monthly with the onset
of menses
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Nutrition During Adolescence
• Zinc
– It is known to be essential for growth and sexual
maturation.
• Vitamins
– Because of tissue synthesis, the body has an
increased demand for vitamin B6, folic acid, and
vitamin B12. It also needs more vitamin D for
rapid skeletal growth and vitamins A, C, and E for
new cell growth.
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Nutrition During Adulthood
• Nutritional Requirements for adults
– focuses on maintaining health by using food,
particularly plant-based foods and their
constituents, to optimize the function of the
digestive and liver detoxification systems and
other organs in the body including the immune
system.
• The iron requirement for women is higher
than men until after menopause
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Nutrition During Adulthood
• Protein requirement for adults is 0.8 g per
kilogram of body weight.
• Current requirement for calcium for adults
from 19-50 is 1,000 mg.
• Vitamin D requirement is 5 g per day.
• Both calcium and vitamin D are essential for
strong bones, and both are found in milk.
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Nutrition During Adulthood
• Three glasses of milk per day fulfill the calcium
and vitamin D requirements.
• Bone loss begins slowly, at about the age of 35 to
40.
• Kcal requirements begins to diminish after the
age of 25.
• Basal metabolic rates are reduced by 2 to 3% a
decade.
• Determined primarily by activity and amount of
lean muscle mass.
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Nutrition During Adulthood
• Nutritional Requirements for old adults
– Follow a modified food guide pyramid for
individuals 70 and older.
– Protein requirement remains at the average 50 g
per day for women and 63 g for men.
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Nutrition During Adulthood
• This is based on 0.8 g per kg of body weight.
• After age 65, it may be advisable to increase one’s
daily protein intake to 1.0g per kg of body weight.
• Vitamin requirements do not change after the age of
51, except for a slight decrease in the RDAs for
thiamin, riboflavin, and niacin because of decreased
kcal intake.
• The need for iron is decreased after age 51 in women
because of menopause.
• The kcal requirement decreases approximately 2 to 3%
a decade because metabolism slows and activity is
reduced.
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Nutrition During Adulthood
Nutrition Related concerns
• Osteoporosis
– Condition in which the amount of calcium in
bones is reduced, making them porous.
– Bone density scan can be done with a special Xray to determine if one has osteoporosis.
– Sedentary life coupled with a diet deficient in
calcium, vitamin D, and fluoride and estrogen loss
contribute to the condition.
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Nutrition During Adulthood
• Osteoporosis
– Estrogen replacement therapy (ERT), 1,500 mg of
calcium, and exercise are possible preventative
measures.
– Another possible cause of osteoporosis may be a
diet (Sodas, coffee, tea and processed foods)
containing excessive amounts of phosphorus,
which can speed bone loss.
– Good sources of calcium: milk products
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Post-lecture Evaluation
An infant should begin eating solid foods
between:
a. 2 and 4 weeks.
b. 1 and 3 months.
c. 4 and 6 months.
d. 8 and 10 months
Post-lecture Evaluation
To balance the day’s intake, an adolescent who
eats a hamburger, fries, and cola at lunch might
benefit most from a dinner of:
a. fried chicken, rice, and banana.
b. steak, baked potato, and salad.
c. pork chop, mashed potatoes, and apple juice.
d. spaghetti with meat sauce, broccoli, and
milk.
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Post-lecture Evaluation
During adolescence, energy and nutrient needs:
a. reach a peak.
b. fall dramatically.
c. rise, but do not peak until adulthood.
d. fluctuate so much that generalizations can’t
be made.
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Post-lecture Evaluation
On average, adult energy needs:
a. increases
b. Declines gradually
c. remain stable throughout life.
d. rise gradually throughout life.
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References
Whitney, W & Rolfes, SR (2008) Understanding Nutrition (11th
ed), Thomson Higher Education, Belmont, CA, USA.
Caudal, ML . (2008) Basic nutrition and diet therapy textbook
for nursing students /. Rev. ed. Quezon City : C & E Pub.
Grodner, M. et al. (2009). Foundations and Clinical Application
of Nutrition: A Nursing Approach. 4th Edition.
Topic for the Next Session
Unit V. Diet Therapy
• Definition of Diet Therapy
• Diet Therapy Determination (Indications)
and Identification