Chapter 7

Normal weight gain in pregnancy of a healthy woman

3-5 lbs in the first trimester; 15-25 lbs total

Choline

Helps with brain and spinal cord development of a baby. It also contributes to normal neural tube formation. 

Food sources of choline

Meat, poultry, fish, dairy foods, pasta, rice, & egg-based dishes

Folic Acid

prevents neural tube defects and helps with neurological development. 

Food sources of folic acid

fruits, vegetables, whole grains

calories should increase by _______ for pregnant women

300 per day because the energy requirement increases

Physical Activity for Pregnant Women

Women should remain physically active as long as no complications arise.

Activity should be safe and appropriate

Iron

• DRI increases by 50% to support increase in maternal blood volume and provide iron for fetal liver storage.

• Meats, eggs, leafy greens, enriched breads, and dried fruits.

• Consuming foods high in vit. C aids in the absorption.

• Take a supplement of 27-30 mg daily to assure adequate intake

Pregnancy and fish & shellfish

• Mercury can be toxic to developing fetal brain tissue.

• Fish – good source of omega 3 fatty acids, important for fetal brain & eye development.

• Limit albacore tuna to 6 oz/week.

• Avoid tilefish, shark, swordfish, marlin, & king mackerel due to mercury.

• Limit weekly consumption of seafood to 12 oz.

Nausea

• Eat dry crackers, toast, and salty or tart foods.

• Avoid alcohol, caffeine, fats, and spices.

• Avoid drinking fluids with meals, and do not take medications to control nausea without checking with the provider.

Constipation

• Increase fluid consumption and include extra fiber in the diet.

• Fruits, vegetables, and whole grains contain fiber.

• Regular physical activity can minimize or prevent this.

Maternal phenylketonuria (PKU)

• Genetic disease in which high levels of phenylalanine pose danger to the fetus.

• Start diet at least 3 months prior to pregnancy & continue throughout pregnancy.

  • The diet should include foods low in phenylalanine.

  • Foods high in protein (fish, poultry, meat, eggs, nuts, dairy products) must be avoided due to high phenylalanine levels.

• Blood phenylalanine levels should be monitored during pregnancy.

• Interventions will prevent fetal complications (intellectual disability, behavioral problems).

Growth and Development during Infancy

• Muscles

• Brain

• Coordination

• Simple speech and noises

• Self-feeding

• Chewing and swallowing foods of different consistency

Breast milk or formula should be the only thing given for

6 months

Nutrients for Infancy

• Begin to supplement with foods appropriate for their development around 6 months of age.

• Start with pureed foods with a smooth consistency, move to finger foods, and slowly add foods that require more chewing.

• Do not feed infants honey, cow's milk, or anything posing a choking hazard

Growth during Infancy

• Growth rate during infancy is more rapid than any other period of the life cycle.

• Birth weight doubles by 6 months and triples by 1 year of age.

• The need for calories and nutrients is high.

• Semisolid foods at 6 months of age to coincide with the development of the GI system, head control, ability to sit, and the back‑and‑forth motion of the tongue

Iron in Infants

• Gestational ________ stores begin to deplete around 4 months, supplementation is recommended for infants who are exclusively fed breast milk.

• Once solid foods are introduced, iron-fortified cereal is a good source.

Cow’s Milk

• Not introduced until after 1 year of age because protein and mineral content stress the immature kidney.

• A young infant cannot fully digest the protein and fat contained in it

one food every ______ to access allergies

5-7 days

Early Childhood Energy Requirements

• needs are high

• portion sizes vary based on age and activity level

• in general, a portion size for a child is ½ that of an adult.

  • ½ slice of bread, ½ cup of fruits and vegetables etc.

Specific needs in early childhood

Iron, Calcium, Zinc

Physical Activity in Early Childhood

• 60 minutes per day

• Does not need to be structured

• Encourage play

  • Nature walk, playing games, skip, etc.

Important foods in early childhood

• whole fruits with a rainbow of colors

• limit fruit juice

• red, orange, and dark green vegetables

• dairy options with less sugar or unflavored

• half of grains should be whole grains

• protein: seafood, lean meats, poultry, beans, and eggs

At age 1

should be able to hold a cup

at age 2

• able to use utensils and spill little of their food

• should eat most of the same foods as the rest of the family with precautions taken to avoid choking.

  • the typical daily pattern is 3 meals and 2 to 3 snacks.

Choking

• risk until 4 years old

• food: hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, and candy

15 months

may develop food jags as a normal expression of autonomy

food jags- periods when a child intensely craves and consumes a limited range of foods, often to the exclusion of other options

At the end of the second year of age

• Can completely self-feed and can seek food independently.

• Picky eating is a normal behavior.

Middle Childhood

• Physical growth slows in this stage.

• Cognitive changes increase in preparation for adolescence.

  • Adjusting to school activities

  • Being more social outside of the home

  • Complex thinking skills

Energy requirements in middle childhood

• Energy needs decrease because growth generally slows at this time.

• Energy required mostly for maintenance

physical activity in middle childhood

• 60 minutes per day is recommended

• Ability to participate in extra-curricular physical activities increases

specific needs in middle childhood

iron, fiber, calcium, vitamin D

teenage years (physical)

Sexual maturation, increased height/weight, accumulation of muscle mass, and changes in body composition

psychosocial changes in teens

increased awareness of body image and peer influence

cognitive changes in teens

Young adolescence have egocentric thinking and impulsive behavior and then move into more abstract reasoning

energy needs _______ in teenage years

increases

physical activity in teens

60 minutes a day

health compromising patterns in teens

Meal skipping, unconventional or non-nutritive supplements, and fad dieting

specific nutrient requirements in teens

Folate • Vitamins A, B6, C and E • Iron • Zinc • Magnesium • Phosphorus • Calcium • Fiber

dietary sources for teens

follow myplate (1/2 fruits & veggies, ¼ protein, ¼ grains)

Nutrition in teens/adolescents

• Calorie needs and appetite increase to support the rapid rate of growth.

• Consumption of vegetables, fruit, dairy, whole grains, and seafood are below recommended levels of intake.

• Refined grains, added sugar, saturated fat, and sodium above recommended levels.

• Both girls and boys: inadequate intake of fiber, choline, vitamin C, vitamin D, vitamin E, potassium, and magnesium.

• Girls have inadequate intakes of vitamin A, calcium, and iron.

• Assess for eating disorders in this age group

Growth and development occurring during adulthood

• The brain finishes maturing around age 25

• Body continues to gain bone density until 25, and muscular strength peaks around 25-30 years

Energy requirements during adulthood

• Energy (calorie) needs decrease

• Exact calorie needs vary based on age, gender, and physical activity level

• Metabolism and energy requirements generally decrease by 2% each decade

Physical activity during adulthood

• Successful weight management comes through healthy lifestyle practices

• 150 minutes of moderate activity is recommended each week

Specific nutrient needs during adulthood

Necessary to maintain muscle, bone, metabolism, digestive, and mental health.

• Fiber

• Vitamins A, D, and E

• Folic acid

• Calcium

• Potassium

• Iron
  

Growth and development during senior years

• Loss of muscle mass

• Change in taste, ability to chew

• Thirst declines

• Hunger and satiety cues are weaker

• Decline in physical ability and sometimes cognitive as well

Specific nutrient needs during senior years

• Vitamins A, D, E, and K
• Choline
• Potassium
• Magnesium
• Calcium

energy needs during senior years

Metabolism and energy needs generally decrease

physical activity during senior years

Maintain activity as much as possible to maintain physical strength. Health problems can make physical activity difficult.

Nutrition and Health Concerns for Older Adults

• malnutrition

• frailty

• sarcopenia

• Alzheimer's disease

malnutrition

impairs quality of life and is a strong predictor of short-term mortality in older adults.

s/s of malnutrition

• Confusion

• Fatigue

• Weakness

  • often attributed to other conditions and are misdiagnosed or unrecognized

contributing factors of malnutrition

• The quality and quantity of food intake

• Food insecurity

• Acute or chronic physical or mental health conditions

• Loss of appetite is a key predictor of this

frailty

Medical syndrome with multiple causes and contributors that is characterized by

• diminished strength, endurance, and reduced physiological function

  • increases an individual’s vulnerability for dependency and/or death

• Weight loss can be partially prevented or treated with protein-calorie supplementation

• Vitamin D supplements may reduce the risk of:
  • Falls, hip fractures, mortality and improve muscle function

sarcopenia

• A progressive and generalized skeletal muscle disorder characterized by an accelerated loss of muscle mass and functional decline

• Adverse outcomes include:
  • physical disability
  • frailty
  • falls resulting in fractures
  • poor quality of life
  • death

Alzheimer's Disease

• Irreversible, progressive brain disorder that gradually destroys memory and cognition

• The MedDiet and MIND diets may decrease the risk of cognitive impairment and _________________.

MedDiet

The mediterranean diet which is a plant based diet. It includes foods like fruits, vegetables, whole grains, olive oil, nuts, and fish.

MIND diet

Foods like vegetables, whole grains, berries, grains, beans, nuts, olive oil,  and fish. This diet excludes red meat, butter, and fried foods.

Effects of Alzheimer's Disease on Nutrition

• Impairments in memory and judgment may make shopping, storing, and
  cooking food difficult

• May forget to eat or may forget that they have already eaten and consequently may eat again

• Changes in the sense of smell may develop; a preference for sweet and salty foods may occur

• Agitation & fidgeting increase energy expenditure, making weight loss common

• Choking may occur if the client forgets to chew food sufficiently before swallowing; may hoard food in the mouth

• Dysphagia is common

• Eating of nonfood items may occur

• Eventually, self-feeding ability is lost

• Clients in the latter stages no longer know what to do when food is placed in the mouth. The use of other means of nutritional support becomes necessary