Nutrient, energy needs and feeding patterns throughout the lifespan

(PREGNANCY) weight gain for normal BMI female (18.5-24.9)

25-35 lbs

(PREGNANCY) weight gain for underweight BMI female (<18.5)

28-40 lbs

(PREGNANCY) weight gain for overweight BMI female (25-29.9)

15-25 lbs

(PREGNANCY) weight gain for OBESE BMI female (≥30)

11-20 lbs

calorie increase during 2nd trimester of pregnancy

+340 kcal DAILY

calorie increase during 3rd trimester of pregnancy

+452 kcal DAILY

calorie increase during lactation (first 6 months)

+330 kcal DAILY

calorie increase during lactation (6-12 months)

+400 kcal DAILY

RDA for protein (pregnant female)

1.1 g/kg/day (~71 g/day)

weight gain pregnancy

1 lb/month - FOR FIRST 3 MONTHS

1 lb/week thereafter

pregnant teen

high risk - needs extra iron, calcium, zinc

Pregnancy supplements

Ferrous sulfate - 30 mg during 2nd and 3rd trimester

Folic acid - 400 mcg (added to 200 from foods = 600 mcg)

AI calcium for pregnancy and lactation

≤18 yrs = 1300 mg
>18 yrs = 1000 mg

Progesterone

hormone that develops placenta after implantation

Linolenic acid (DHA)

1.4 g/day linolenic acid (300 mg DHA)

1.3 g/day lactation

**Needed for development of fetal nervous system

Normal birth weight

2500-4000 g

LBW (low birth weight)

<5.5 lbs, <2500 g

VLBW (very low birth weight)

<3.3 lbs, <1500 g

ELBW (extremely low birth weight)

<1000 g

SGA (small for gestational age)

<10th percentile birth weight for gestational age

AGA (appropriate for gestational age)

10th - 90th percentile

LGA (large for gestational age)

>90th percentile

0-6 months weight

6 kg / 13 lbs

7-12 months weight

9kg / 20 lbs

0-6 months length

24” / 60cm

7-12 months length

28” / 71 cm

kcal for human milk

20 kcal/oz

prolactin

from mom pituitary gland

STIMULATES milk production

oxytocin

think “happy bonding hormone”

moves milk through ducts to “bond” and feed baby

colostrum

• meets infant needs 1st week

• yellowish/transparent

• high in protein

• less fat and carbohydrates

  • had antibodies

human milk composition

%PRO: 7%

%CHO: 38%

%FAT: 55%

** more lactalbumin

**HMOs

cow milk composition

%PRO: 20%

%CHO: 30%

%FAT: 50%

Breast fed infants need:

400 IU vitamin D from birth

0.25 mg fluoride /day after 6 months (if water contains inadequate fluoride

Baby Friendly Hospital Initiative

global effort to increase incidence and duration of breast-feeding (measurable outcomes)

• hospital must show it implements ten steps to successful breast-feeding

infant formula

20 kcal/oz

• more PROTEIN and IRON than human milk, but lacks ANTIBODIES

Cow’s milk = NOOOOO

• tough hard curd

• hard to digest

• less EFA

• increased renal solute load

Hyperbilirubinemia

unconjugated bilirubin levels elevated within first week of life as a result of increased breakdown of red blood cells or decreased intestinal mobility

• encourage 9-12 feedings per day of human milk or formula to promote hydration and intestinal mobility

3-4 months of age

• needs additional iron because fetal iron stores decrease

  • preferably from formula supplemental foods

4-6 months of age

• add solids when sitting posture can be sustained and extrusion reflex diminishes

• Begin with iron-fortified cereal (rice) → then strained vegetables or fruit

6-8 months of age

• add larger finger food (teething biscuits) that can be secured with a palmar grasp

9-12 months of age

• add smaller finger foods (dry cereal) as pincher grasp (thumb and forefinger) develops

Use WHO growth charts for:

birth to 2 years of age

Use CDC growth charts from:

2-20 years of age

stunted

• Low height-for-age

• below 2 standard deviations of the WHO growth standard median

• reflects chronic or long-term undernutrition, often starting in utero or the first 1,000 days

• largely irreversible after about age 2

wasted

• Low weight-for-height

• below 2 standard deviations of the WHO growth standard median

  • severe is below 3 standard deviations

• it reflects acute undernutrition or recent weight loss, such as from illness or food shortage, and is treatable and reversible

Weight for length/stature

• Birth - 24 months (2 years), young children (2-5) 5^th-95^th

  • identifies under/over nutrition, or within normal limits

  • detects short term changes in nutritional status

  • used to distinguish between stunting and wasting

  • <5th percentile may reflect acute illness or wasting; >95th = over-nutrition

Stature/length for age

• 0-24 month recumbent length, 2-20 years height

  • defines shortness/tallness

  • reflects long term nutritional status; determines extent of stunting

  • affected by long term nutritional stress or chronic illness

  • <5^th = short stature

Weight for age

• birth - 24 months and 2-20 years (5^th - 95^th)

  • NOT used to classify under/over weight

  • short term marker of growth; affected by acute nutritional stress or illness

  • CANNOT distinguish between stunting and wasting because it does not include height

  • further evaluation needed if below 5^th or above the 95^th percentile

BMI for age percentiles

• starting at age 2 years: age and sex specific

• underweight: <5th percentile

• healthy weight: 5th - 84th

• overweight: 85th - 94th

• obese: ≥95th or BMI>30

  • Best measure to assess weight in children (includes height, weight, age)

FTT - Failure To Thrive

In infants:

• weight for age that falls below 5th percentile on multiple occasions or weight deceleration that crosses two major percentiles on growth chart

In children:

• may result from acute or chronic illness, restricted diet, poor appetite, lack of fiber leading to chronic constipation, diminished intake

Sugar alcohols

• sorbitol, mannitol, xylitol

• 40-100% as sweet as sucrose

• resistant to digestion

• can be labeled “sugar-free” but NOT “calorie free”

• cavity-preventing (cariostatic) cannot be digested by bacteria responsible for dental carries

• can cause diarrhea, gas, abdominal pain (more slowly absorbed than other sugars)

  • DO NOT consume more than 30 g sorbitol (not recommended)