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Chapter 13

Nutrition Over the Life Cycle

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Pregnancy

Embryo Fetus (at 8 weeks)

Amniotic sac Placenta First, second, and third trimesters

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First Trimester

Critical period of cell differentiation.

Growing baby is most susceptible to damage from nutritional deficiencies and alcohol.

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Nutrition Risk Factors for Pregnant Women

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

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

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

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. 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

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 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

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

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

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.

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.

Suckling stimulates milk letdown.

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Formula-Feeding

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

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

8 – 11 months:Mashed or diced soft fruitMashed or soft cooked vegetablesFinely cut meat/poultryMashed cooked beans or peasCottage cheese, yogurt, or cheese stripsPieces of soft breadCrackers

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Introduction to Solid Foods

12 months: Cut-up table foods

Whole milk

Whole eggs

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Choking Hazards

Nuts and seeds Raisins Hot dogs Popcorn Whole grapes Hard candies Peanut butter

Cherry tomatoes Raw carrots Many other raw fruits

and veggies Fruit with pits Large chunks of any

food

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Allergies

Milk Eggs Wheat Nuts Chocolate Shellfish

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Childhood

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

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

Female 1 – 3 34 27 992 1.1

Male 4 – 8 45 44 1742 0.95

Female 4 – 8 45 44 1642 0.95

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

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

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

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

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

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

PubertyGirls: starts at age 10 or 11Boys: 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

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

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

Female Athlete Triad Disordered eating No menstruation Osteoporosis

Treatment for Eating Disorders includes: Individual psychotherapy Family therapy Cognitive-behavior therapy Medical nutrition therapy Medications

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Older Adults

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

Disease Less muscle mass Activity levels Dentition Functional disabilities

(interfere with doing daily tasks)

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

Cognitive functioning

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

Nutrients of concern:Water Vitamin B12 and folateVitamin DCalciumZinc

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Modified Food Pyramid for Adults Age 70 and Over

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Menu Planning for Older Adults

1. Offer moderately sized meals and/or half portions

2. Emphasize complex carbohydrates and high-fiber foods such as fruits, vegetables, grains, and beans.

3. Moderate the use of fat.

4. Dairy products are important sources of calcium and other nutrients.

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Menu Planning for Older Adults

5. Offer adequate protein but not too much.6. Moderate the use of salt.7. Use herbs and spices.8. Offer a variety of foods.9. Fluid intake is critical.10. Intake of these vitamins and minerals may be

inadequate: vitamin B6, B12, folate, vitamin D, calcium, and zinc.

11. 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

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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Copyright ©2007 John Wiley & Sons, Inc.