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Chapter 13

Nutrition Over the Life Cycle

Learning Objectives

1. Explain the benefits of good nutrition to mother and baby during pregnancy

2. Identify nutrients of special concern during pregnancy and their food sources

3. Explain the possible effects of alcohol, fish, caffeine, and artificial sweeteners during pregnancy

4. Plan menus for women during pregnancy and lactation5. Describe what an infant should be fed during the first

year, including the progression of solid foods

Learning Objectives (cont’d)

6. Give five reasons why breast-feeding is preferable to bottle feeding

7. Describe how to ensure enjoyable mealtimes with young children and teach them good eating habits

8. Plan menus for preschool and school-age children9. Identify the nutrients that children and adolescents are

most likely to be lacking and their food sources10. Describe influences on children’s and adolescents’

eating habits

Learning Objectives (cont’d)

11. Plan menus for adolescents12. Distinguish among anorexia nervosa, bulimia nervosa,

binge eating disorder, and female athlete triad13. Describe factors that influence the nutrition status of

older adults14. Identify nutrients of concern for older adults and their

food sources15. Plan menus for healthy older adults16. Describe ways to prevent the development of obesity

during childhood

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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) 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

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) Caffeine & Artificial Sweeteners 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 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 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

MyPyramid Plan for Moms

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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 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

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: 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

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 vegetablesMashed egg yolkFinely 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

Additional Concepts

Baby bottle tooth decay

Pincer grasp Palmar grasp

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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, 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

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

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

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 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 much6. Moderate the use of salt7. Use herbs and spices8. Offer a variety of foods9. Fluid intake is critical10. Serve softer foods if chewing is a

problem

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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

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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Copyright ©2010 John Wiley & Sons, Inc.