Nutrition Chapter 9: Life Cycle Nutrition

Pregnancy

• Tremendous physiological change

  • healthful food and lifestyle choices

• Energy and nutrient needs increase for both the mother and the baby, but calories only increase by a small percentage

  • nutrient-rich food

  • Concern about harmful substances (Ex: Alcohol, drugs, medications, caffeine, food-borne illnesses)

Nutrition before conception

Health care and guidance:

• Screening for risk

  • vitamin status

  • weight status

  • health habits

• Health promotion and education

• Intervention as needed (harmful substance use, disorder patterns of eating, eating disorder)

A healthy weight has beneficial health outcomes

• weight can also have an impact

  • Enough weight, but not too much weight

Vitamins

• Folic acid

  • Prevent neural tube defects

• Vitamin D and iron

  • Iron-deficiency anemia and vitamin D insufficiency increase the risk of low-birth-weight infants, as well as preterm birth

Physiology of Pregnancy: Stages of human fetal growth

• Due date calculated as 40 weeks from the start of the last menstrual period

  • Roughly 10 to 14 days before the actual date of conception

• 40-week period is considered as three trimesters of 13 or 14 weeks each

  • These time divisions do not coincide with specific stages in fetal development

Maternal Changes During Pregnancy

Hormones released throughout pregnancy influence the growth of the baby and alter the way the mother’s organs function.

• Blood volume and red blood cell mass increase

• Hormones promote growth and changes in breast tissue

• Uterus expands

• Heart rate increases by 20%

• Curvature of the spine increases

• fat stores increase

• Gastointestinal motility slows

Physiology of Pregnancy: Maternal Physiological Changes

• Growth of maternal tissue

  • Adipose, breast, and uterine tissues

  • Hormones promote growth and changes in breast tissue to prepare for lactation

• Increase in maternal blood volume

  • Expands by nearly 50%

  • Iron, folate, and vitamin B12 are key nutrients in red blood cell production

• Slower GI motility

  • Greater nutrient absorption

  • Nausea, heartburn, constipation

Maternal Weight Gain

Recommendation depends on BMI

• Higher recommended gain for underweight women, teens, and for pregnancies involving multiple fetuses

• Lower recommended gain for overweight and obese women

• Most gains in the second and third trimesters

• Average gain: 27.5 lbs.

During the first trimester

• gain fewer than 5 pounds.

Over the second and third trimesters

• suggested weight gain is a little less than 1 pound per week.

Approximate weight distribution:

• 1 Ib increased breast size

• 2 Ib increased uterus and muscles

• 5.5 Ib blood and fluids

• 11 Ib fetus, placenta

• 4-8 Ib maternal fat stores

Energy and Nutrition During Pregnancy

Pregnancy Requires Additional:

• Calories

• Protein

• Vitamins

• Minerals

Energy

• Needs increase to support fetus and placenta, as well as increased workload on mother’s heart and lungs

• Support adequate weight gain

Nutrients to Support Pregnancy

• Well-balanced diet meets the majority of nutrient requirements

• Recommended that all women planning on pregnancy take a multivitamin

  • Iron

  • Folic acid

Macronutrients to support pregnancy

• Many women do not need to increase protein intake

  • Protein RDA in pregnancy: 1.1 g/kg/day

• Needs for essential fatty acids during pregnancy are slightly higher

• Very-low-fat diets are not recommended

• Carbohydrates provide the main source of extra calories

  • Can increase fiber substantially

  • AI for fiber increases from 25 to 28 grams per day during pregnancy

Micronutrients to support pregnancy

• Increased needs for most vitamins and minerals

  • Higher amounts of nutrients essential for energy metabolism (e.g., thiamin, riboflavin, niacin, and pantothenic acid)

  • Needs for other B vitamins (except biotin) also increase.

  • Slight increase in vitamin C.

  • Vitamin A increases slightly, but the recommended levels of other fat-soluble vitamins do not change.

  • Highest increase for iron and folate

Food Choices for Pregnant Women: Recommended

• The recommended diet for a pregnant woman is not much different from that of the general adult population.

• Variety Key to A Well-Balanced Diet

  • Additional servings of grain, vegetables, fruit, and low-fat milk

  • Little room for empty calories,

• Supplementation

  • Prenatal vitamin

  • Herbal preparations are not recommended

Food Choices for Pregnant Women: Avoid

• Alcohol

• Certain types of fish are high in mercury

• Uncooked meat, seafood, or eggs; unpasteurized juice or milk; or deli meat (due to risk of contamination with Listeria bacteria)

• Caffeine in quantities higher than 300 mg/day

Substance Use and Pregnancy Outcome

Tobacco

• Increases risk for miscarriage, stillbirth, preterm delivery, and low birth weight

Alcohol

• Increases risk for fetal alcohol syndrome

• Physical and mental conditions

• Growth retardation

• No known safe threshold for alcohol use

• The only way to avoid alcohol-related risks to a fetus is to avoid all alcohol during pregnancy

Drugs

• Maternal marijuana use can lead to:

  • Premature birth

  • Low birth weight

  • Physical abnormalities similar to fetal alcohol syndrome

  • Reduced fertility

• Opioid use increases the risk for

  • low birth weight

  • preterm delivery

  • miscarriage

  • birth defects,

  • Infant addiction,

  • nutritional deficiency

Gestational Diabetes

When a woman without diabetes develops high blood sugar during pregnancy

• All pregnant women should be screened between 24 and 28 weeks

Breastfeeding trends

• The AAP recommends that infants be exclusively breastfed for the first 6 months with continued breastfeeding through the first year of life

• WHO recommends continued breastfeeding up to two years or longer

• Health People 2020 goal: to increase the proportion of newborns initially breastfed

Plysiology of Lactation

Change During Pregnancy:

• increase breast tissue

• The structure of glands and ducts becomes more intricate

After Delivery

• Milk production and secretion

• Colostrem: first milk

  • High in protein

Hormonal Controls:

• Prolactin: stimulates milk production

• Oxytocin: stimulates milk release

  • let-down reflex

  • Can be impacted by stress and anxiety

Nutrition for breastfeeding women: General

Good Nutrition in support of lactation is ideal

• Nutrition-rich foods should be emphasized

• Calorie needs do not significantly increase

Nutrition for breastfeeding women: Energy

Energy

• Mobilization of fat stores

• Increase energy intake by 330 kcals/day during the first 6 months of lactation and 400 kcals/day during the second 6 months

• weight stabilizes after 6 months

Nutrition for breastfeeding women: Protein

Protein

• RDA: 1.3 g per kg/day

• Lack of dietary protein uncommon in the United States

Nutrition for breastfeeding women: Vitamins and Minerals

• Vitamins and Minerals

  • Needs higher or the same as during pregnancy

  • Exceptions

    • Vitamins D and K remain the same as in pregnancy

    • Niacin, folate, and iron needs are lower than in pregnancy (but still higher than for women in the general population)

  • When vitamin intake is inadequate, the vitamin content in breast milk can diminish

  • Increased needs for minerals during lactation for all minerals except sodium, chloride, calcium, phosphorus, magnesium, fluoride, and molybdenum.

  • Iron needs decrease.

  • Continue prenatal vitamins

Nutrition for breastfeeding women: Water

• Al for total water = 3.8 liters/day

• Limited caffeine is acceptable

Nutrition for breastfeeding women: Supplementation

• Continue routine prenatal supplementation

• Vitamin B12 may be necessary for vegans

• Vitamin D supplement may be warranted

Practices to Avoid During Lactation

• Alcohol and drugs are transferred into breast milk

• Lactating individuals are encouraged to quit smoking

• Alcohol inhibits the milk-ejection reflex

  • Baby gets less milk with a higher concentration of alcohol

  • The occasional drink is not harmful, but breastfeeding should be avoided for 2 hours after alcohol consumption

• If the parent cannot abstain from illicit drugs, they should not breastfeed

Benefits of Breastfeeding for Infants

• Optimal nutrition

• Protects the infant from infections and illness

• Reduces risk of sudden infant death syndrome (SIDS), obesity, and overweight

• Improves cognitive development

• Convenience

• Other benefits

  • Close bond

  • Reduced risk for some chronic diseases

Benefits of Breastfeeding for the mother

• Enhanced recovery of uterus size

• Can help control blood loss

• Suppresses ovulation

• Convenient, less expensive

• Possible reduced risk of cancer, osteoporosis, and postpartum depression

Contraindications to Breastfeeding

• May be inappropriate due to infant or maternal disease or drug use

• Breast enlargement or reduction surgery, depending on the specifics of the operation

  • Whether milk ducts and major nerves were cut or damaged

• Infectious or chronic disease (e.g., HIV)

• Prescription and illegal drugs

• Over-the-counter medicines or herbal supplements

Infancy: General

• Period between birth and 1 year

• Nutritional needs are highest due to rapid growth

• Breastmilk/formula provides all nutrients needed

Infancy: Growth and Development

• Birthweight is best predictor of child’s health for the first year

• Weight is double birth weight by 4 to 6 months, and triple by 12 months

• Length and head circumference are more sensitive than just weight for measuring infant growth and nutrition

Infancy: Growth Charts

• Reference data: a large group of healthy, breastfed infants

• Allow comparison of individual children against children in the general population

Energy and Nutrient Needs During Infancy: General

• Requirements based on the composition of breast milk

• Formula based on cow’s milk or soy protein

Energy and Nutrient Needs During Infancy: Energy

• Highest needs of any life stage

• Twice that of adults

• Best diet high in fat and moderate carbohydrate

  • Adequate calories in a small volume

  • Best for brain growth

Energy and Nutrient Needs During Infancy: Protein

• Higher than at any other time in the life cycle

• Both breastmilk and formula provide complete protein

• Human milk protein is easily digested and absorbed

Energy and Nutrient Needs During Infancy: Carbs and fat

• Carbohydrates and triglycerides: major energy source

  • Allows protein to be used primarily for growth

• Nearly all carbohydrates are in the form of lactose

  • Infants digest lactose easily and tolerate it well

• Fats enhance a baby’s sense of fullness

• Human milk is rich in essential fatty acids

  • Roles in neurologic development

Energy and Nutrient Needs During Infancy: Water

• Infants need more fluids

• Human milk or formula satisfies fluid requirements

• Supplemental water not necessary, even in hot weather

Energy and Nutrient Needs During Infancy: Vitamins and Minerals

• Human milk provides the amounts of vitamins and minerals that babies need

  • Reference point for formula

• Breastmilk lower than formula in some vitamins and minerals (e.g., iron, vitamin D), but usually better absorbed from breastmilk

Energy and Nutrient Needs During Infancy: Key vitamins

Key Vitamins

• Vitamin D

  • Infants who lack sun exposure can become deficient in vitamin D

• Vitamin K

  • A dose of vitamin K is usually given to babies at birth to ensure a sufficient supply.

• Vitamin B12

  • Because vegan mothers can have breast milk deficient in vitamin B12, their babies may need a B12 supplement

• Iron

  • By the age of 6 months, breastfed infants need additional iron

• Fluoride

  • Formula-fed infants should consume iron-fortified formula. Human milk is low in fluoride.

Newborn Breastfeeding

• Ideal method of feeding, per AAP

• Should begin as soon after birth as possible through 12 months

• Feedings should occur every 2-3 hours with total of 8-12 feedings per day

• Duration of feedings guided by infant behavior

Alternative Feeding: Infant Formula

• Standard Infant Formula

• When human milk is not available, infants should get iron-fortified infant formula

• Forms:

  • Ready-to-feed

  • Concentrate

  • Powdered

How Much milk should infants get

• Approximately 20 fl oz per day

• Harder to tell when breastfeeding

  • Adequately fed newborn breastfeeds 8 to 12 times daily

  • Regain birth weight in the first 2 weeks

• Best indicators

  • Normal growth

  • Regular elimination

  • Satisfied demeanor

Feeding Technique

• Hold baby close

• Eye contact

• Baby should be burped after

  • 15 minutes

  • 2-3 oz of formula

• Infants signal fullness

  • Fussiness, playfulness, sleep, turning away

  • Parents should respond to cues

Introduction of Solid Foods

Introduce When Infant is Developmentally Ready

• Around 4-6 months of age

Physiological Readiness

• Digestive enzymes

• Ability to maintain hydration

Developmental Readiness

• Lack of the extrusion reflex

  • Infant’s tongue pushes the spoon and food back out

• Head, neck, hand control

• Trying to grasp small objects

Start Healthy Feeding Guidelines for solid foods

• Appropriate age balances physiological and developmental readiness with nutritional requirements

• Crawling babies may self-feed finger foods

• Babies who can stand or walk can have bite-sized pieces and a variety of textures

  • Desire to self-feed

• Cultural practices may dictate the order of foods

  • One at a time in case of adverse reactions

• Cow’s milk should not be the sole source of nutrition

• Be alert to hunger and satiety cues

• Various caregivers may be involved in infant nutrition

Childhood: General

• Age 1 through adolescence

• Gain about 4-6 Ibs and grow 2-3 inches per year

• Three groups

  • Toddlers (1-3 years)

  • Preschoolers (4-5 years)

  • School-age (6-10)

Energy and nutrient needs during childhood

Energy and protein

• Calculated based on sex, age, height, weight, and activity level

• total energy requirements gradually increase with age

Vitamins and minerals

• Variety of foods needed

• Assess iron intake

• Insufficient levels of vitamin D are common

• Supplements recommended for

  • Those with restricted diets due to medical reasons

  • Malnourished children

  • Children with allergies that lead to avoidance of certain food groups

Micronutrients of concern in childhood

• Iron

• Vitamin D

• Vitamin E

• Zinc

• General pop.

  • Potassium

  • Magnesium

Influences on Childhood food habits and intake

• usually temporary

• Caregivers have an increased role in the development of a child’s health and nutrition habits

  • Parents have the largest impact

• Kids are responsible for when and how much to eat

• External factors

  • television

    • advertising

  • Environment

Nutritional concerns of childhood

• Malnutrition and hunger

  • 50% of young child deaths worldwide can be attributed to undernutrition

  • Federal assistance programs

    • SNAP (Supplemental Nutrition Assistance Program)

    • WIC (Women, Infants, and Children)

    • National school breakfast/lunch and summer food service programs

• Food and behavior

  • “Hyperactivity” is a misused term

    • Halloween effect

  • Social excitement not proof of cause-and-effect between food and hyperactivity

  • ADHD

    • Inattentive, hyperactive, and impulsive behavior that is unrestrained and frenetic

    • 5% children worldwide

    • Preservatives and colorings association with ADHS has not been clearly demonstrated

  • Caffeine: effects intensified

Federal safety Net for children

• School Breakfast program

  • Formed to combat stigma

  • Happens within the classroom in the morning

• School lunch program

  • Standards

    • Amounts of nutritions

    • Budget

• WIC

• Summer Food Service program

Childhood Overweight

• 32% of children and adolescents are overweight or obese

• Overweight children are more likely to reach maturity earlier, but at the expense of height

• Major factors include genetics, environment, behavior, and activity goals

• Goal is not weight loss, but allowing height to catch up with weight

• Childhood obesity is on the rise and predisposes children to health problems when they become adults

Factors that contribute to childhood obesity

• Genetics

• Environment

• Behavior

• Poor food choices

• Activity levels

Childhood nutrition and chronic disease

• Early signs of chronic disease can appear

  • Dietary restrictions not appropriate in children younger than 2 years

  • In older kids, dietary choices in line with guidelines are recommended

• Screening children with family history of high lipid levels is needed

  • Lifestyle interventions and medications may be warranted

Adolescence physical growth and development

• Boys: begins between 12 and 14 years

  • Gain about 8 inches in height, 45 Ibs in weight

• Girls: Begins between 10 and 12

  • Gain about 6 inches in height, 35 Ibs in weight

• Changes in body composition

• Changes in emotional maturity

Adolescence nutrient needs

• Energy and protein

  • Energy needs are highest in the lifecycle, except during pregnancy

  • Increased protein needs to support growth

• Vitamins and minerals

  • Higher needs than most other life stages

  • Particular concern for vitamin A, Vitamin D, calcium, and iron

Micronutrients of concern in adolescence

• Vitamin A — Growth

• Calcium and Vitamin D — Strong bones

• Iron

  • Especially in teenage girls to replace iron lost during menstruation

Factors that influence Adolescent food choices

• Peers

• Desire to be healthy

• Fitness goals

• Social practices

• Discretionary Income

Nutrition-Related Concerns for Adolescents

• Fitness and sports

  • Obsession with athletic performance, food intake, and body appearance

• Eating Disorders

  • Becoming preoccupies with wight, appearance, and eating habits

  • Increase prevalence in males

Adolescent obesity

• Contributing factor: Decline in physical activity

• Increased risk for:

  • High blood pressure

  • Diabetes

  • Breathing problems, joint pain, and heartburn

  • Poor self-esteem

• Nutrition education needed

Age-Related changes in adulthood

• Weight and body composition

  • Add fat; lose lean body mass

  • Weight loss can be a disadvantage

• Regular physical activity is needed

  • Sarcopenia: loss of lean mass and muscle strength that contributes to functional disability and loss of independence

• Immunity

  • Decline in defense mechanisms

  • Poor intake of protein and some antioxidant nutritents can supress immunity

• Taste and smell

  • Decline in sensitivity

  • Overconsumption of sugar and sodium

  • Medication can alter both

• Gastrointestinal changes

  • Reduced saliva/acid secretion

  • Reduced mobility

Inadequate protein intake causes and effetcs

• Causes

  • Concern about fat intake

  • Financial constraints

  • Lactose intolerance

  • Poor appetite

  • Difficulty chewing

• Effects

  • Suppressed immunity

  • Decreased muscle mass

  • Slow wound healing

  • osteoporosis

Nutrient needs of the mature adult

Energy

• Reduced needs

  • Due to decreased activity; decreased lean body mass

• Protein

  • RDA: 0.8 g/kg body weight

  • Same needs per kilogram of body weight as younger adults

  • Chronically ill individuals might need more

• Carbohydrate

  • Should make up 45-65% of calories

  • Fiber has many potential benefits

• Fat

  • 20-35% fat

  • limit cholesterol

• Water

  • The “forgotten nutrient.”

  • Reduced thirst response

Vitamins and minerals for mature adults

• Vitamin needs are stable, energy requirements decline

• Nutrient-dense foods are even more important

• Vitamin D

  • Needed for bone health, calcium balance

  • Reduced skin synthesis, activation

  • Higher needs

• B Vitamins

  • May help reduce heart disease risk

  • Reduced ability to absorb vitamin B12

• Antioxidants

  • Important to reduce oxidative stress and degenerative diseases

  • May protect against damage to the brain

• Calcium

  • Bone health/fractures

  • Reduced ability to absorb calcium

• Zinc

  • Marginal deficiencies likely

  • May compromise immunity, wound healing

• Iron

  • Women same as men after menopause

    • 8 mg/day

Supplements for Mature Adults

• Reasons

  • To delay age-related chronic diseases

  • Potential health-promoting effects

• Replacing food with supplements is a poor trade-off

• Hypervitaminosis

  • Large amounts of supplements can be toxic

  • Inform older adults of ULs

Nutrition-Related Concerns of mature adults

Drug-Drug and Drug-Nutrient Interactions

• Can affect the use of drugs or nutrients

• Possible interactions should be identified and avoided

Depression

• Common among institutionalized and low-income individuals

• May reduce food intake

• Alcoholism can interfere with nutrient use

Anorexia of Aging

• Loss of appetite with illness

• can lead to undernutrition or malnutrition

Arthritis

• May interfere with food preparation

• Medications interfere with nutrient absorption

• Dietary changes and weight loss may improve symptoms

Bowel and Bladder Regulation

• Chronic constipation more common with age

• Need for increased fluids and fiber

• Supplementation with prebiotics and probiotics

Dental Heath

• May interfere with eating ability or food choices

• Oral infections affect the whole body

Vision Problems

• Can affect the ability to shop and cook

• Antioxidants may reduce muscular degeneration

Osteoporosis

• Common older women

• Maintain calcium, vitamin D, and exercise

• Long periods of inactivity can promote osteoporosis

  • Being placed on bed rest

  • Illnesses that limit mobility

Alzheimer Disease

• Destroys the ability to obtain, prepare, and consume an optimal diet

• Antioxidants from food may offer some protection

• Overactivity in late stages

  • Drains nutritional reserve and increases calorie needs

• Caregiver must carefully plan the diet

Overweight and obesity ‘‘

• significant consequences for quality of life, health, and well-being

• Affect independence and normal physical functioning

• Weight loss is complicated by other health risks

  • However, additional weight gain discouraged for overweight and obese older adults