Nutrition Through the Life Cycle – Chapters 10 to 14 Comprehensive Exam Notes

Chapter 10 – Pregnancy

• Caloric requirements
• 1st trimester (wks 0–13): no extra kcal; expected maternal wt-gain ≈ 2–4\text{ lb} total.
• 2nd trimester (wks 14–27): +340 kcal·d⁻¹; expected wt-gain ≈ 1\text{ lb wk}^{-1}.
• 3rd trimester (wks 28–40): +450 kcal·d⁻¹; expected wt-gain ≈ 1\text{ lb wk}^{-1}.

• Macronutrient highlights
• Protein: ↑ ≈ 20\% over pre-pregnancy requirement → supports rapid fetal tissue accretion & maternal tissue expansion.

• Micronutrients
• All water-soluble vitamins ↑.
• Folate: critical for DNA synthesis & rapid cell division; deficiency → neural-tube defects (spina bifida, anencephaly). Supplementation recommended before conception & throughout pregnancy.
• Iron: ↑ need due to expanded maternal blood volume & fetal hemoglobin synthesis.

• Fluids
• Daily intake target 2000–3000\,\text{mL} (≈ 8–12\text{ cups}) to cover elevated metabolic & renal demands.

• Substance & supplement cautions
• Caffeine crosses placenta; cap total intake <300\,\text{mg d}^{-1} – ≈ 2 × 8-oz filtered coffees (∼140\,\text{mg} each).
• Vitamin A: do NOT increase; hypervitaminosis A → teratogenic effects (cleft palate, cardiac defects, cognitive disability).

• Common pregnancy concerns
• Nausea ("morning sickness"): hormone-mediated; typically resolves after 1st trimester.
• Severe, prolonged form = hyperemesis gravidarum → risk of dehydration & malnutrition; may require hospitalization & parenteral nutrition.
• Gestational diabetes mellitus (GDM): usually resolves postpartum but increases risk of macrosomia & neonatal hyperglycemia; managed with CHO distribution (3 small meals + snacks) & RD oversight.
• Pica: craving of non-food substances (soil, starch, ice); often signals mineral deficiency (Fe, Zn). Evaluate labs & replete accordingly.

• Lactation nutrition
• Energy: +400–500 kcal·d⁻¹.
• Fluids: match output; ad-lib water intake supports supply.

• Breast-feeding physiology & practice
• Milk composition adapts to infant age (colostrum → transitional → mature milk).
• Immunologic factors: secretory IgA, lactoferrin, lysozyme, macrophages, bifidus factor, etc. bolster infant immunity.
• Establishment: feed q ≈2 h; 15–20 min/breast initially → 5–10 min/breast once efficient (supply–demand feedback).
• Adequacy clues: ≥6 wet diapers & 1–2 BM/day; appropriate growth-chart trajectory; maternal breast softening post-feed.

Chapter 11 – Infancy

• Normal growth milestones
• Weight doubles by 6 mo; triples by 12 mo.

• Bottle guidelines
• Never put baby to bed with bottle (milk or juice) → risk of early childhood caries (“bottle rot”).

• Conditions requiring altered nutrition

1. Prematurity (<37 wk gestation): possible immature suck, low wt, limited fat reserves, incomplete lung/GI/bone maturation.
   • Breast milk ideal (bioactive factors). Specialized preemie formulas available.

2. Failure-to-thrive (FTT): wt-for-length <5th percentile.
   • Etiologies: mis-mixed formula, congenital dz, chronic infxn (e.g., HIV), abuse/neglect.
   • Interventions: assess suck–swallow, caregiver feeding patterns, formula prep.

3. Cystic fibrosis: thick mucus blocks pancreatic enzyme delivery → fat malabsorption.
   • Diet: high-fat (25–40 % kcal), pancreatic enzyme replacement, fat-soluble vitamin supplements, possible nocturnal enteral feeding.

• Inborn Errors of Metabolism (IEM)
• Rare genetic defects in specific metabolic pathways for CHO, protein, or fat; require tailored medical nutrition therapy.

Chapter 12 – Childhood (1–12 yr)

• Nutritional influence spans physical growth, emotional well-being, cognitive development.

• Key guidelines & concerns
• Fat not restricted <2 yr; whole milk recommended → supports myelination & brain growth.
• Most common food allergy: peanuts; peak prevalence in preschoolers.
• Iron-deficiency anemia → developmental delays; encourage Fe-rich foods (lean red meat, poultry, seafood, egg yolk).
• Fiber goal (4–8 yr): 25\,\text{g d}^{-1} for bowel health & satiety.

• Ellen Satter’s Division of Responsibility
• Parent: decides what, when, where food is offered; role-models.
• Child: decides whether & how much to eat among offered foods. → fosters self-regulation & positive food relationship.

• Adolescence highlights
• Skipped breakfasts, higher fast-food & sweetened beverage intake; peer influence > parental.
• Eating disorders
• Anorexia nervosa: self-starvation, amenorrhea, hypotension, alopecia, brain atrophy; life-threatening.
• Bulimia nervosa: binge–purge cycles → electrolyte disturbances, esophagitis, dental caries, dehydration.

Chapter 13 – Adulthood & Aging

• Energy & protein after growth cessation (≈25 yr)
• Basal kcal needs ↓ with age due to ↓ lean mass & activity.
• Protein RDA calculation example: 1.8\,\text{g kg}^{-1}\times\text{wt(kg)}; after 65 yr add +1.0\,\text{g kg}^{-1} (counter sarcopenia).

• Micronutrient considerations
• ↓ intrinsic factor → ↓ B₁₂ absorption; monitor levels.
• Iron needs unchanged or ↓ (except if blood loss).

• Psychosocial factors: retirement, bereavement, loss of independence can depress appetite → malnutrition risk.

• Community resources
• Congregate meals (senior centers): nutrition + socialization.
• Meals on Wheels (MOW): daily hot meal delivery to homebound elders.

• Osteoporosis
• Early bone loss begins 35–40 yr.
• Risk factors: heredity, inactivity, smoking, low Ca/D, estrogen deficiency, high phosphorus (soda, processed meats).
• Prevention/Tx: weight-bearing exercise, estrogen replacement (if appropriate), 1500\,\text{mg Ca d}^{-1}, adequate vit D.

• Arthritis
• Degenerative joint cartilage changes; obesity exacerbates.
• Symptom relief: wt-loss, NSAIDs, anti-inflammatory diet patterns.

Chapter 14 – Weight Management

• Hunger regulation hormones
• Ghrelin (stomach → hypothalamus): "I’m hungry".
• Leptin (adipose & intestine → hypothalamus): "I’m full".

• Acceptable body-fat % per ACE
• Men: 18–24\%
• Women: 25–31\%

• Behavioral weight-loss strategies
• SMART, realistic goals; food & activity journaling to identify triggers.
• Positive self-talk; non-food rewards; weekly (not daily) weigh-ins.
• Modify obesogenic environment (e.g., no TV snacking).
• Seek social support (friend, group, counselor).

• Bariatric surgery options (reserved for severe obesity)

1. Roux-en-Y gastric bypass: small gastric pouch, intestine re-routing → restriction & malabsorption.

2. Vertical sleeve gastrectomy: removal of gastric fundus → tubular "sleeve" stomach.

3. Biliopancreatic diversion w/ duodenal switch: sleeve + extensive small-bowel bypass.

   • Potential complications: nutrient deficiencies (B₁₂, D, folate, Fe), hair loss, taste changes, lactose intolerance, dumping syndrome.

• BMI formula & categories
• \text{BMI}=\dfrac{\text{weight (kg)}}{\left[\text{height (m)}\right]^2} (alternative: weight lb ÷ height in² × 703).
• Normal: 18.5–24.9; Obesity: ≥30.

• Ideal Body Weight (IBW) formulas (Hamwi method)
• Men: 106\,\text{lb} + 6\,\text{lb}\times(\text{inches over 5 ft})
• Women: 100\,\text{lb} + 5\,\text{lb}\times(\text{inches over 5 ft})
• Baseline reference—doesn’t account for individual muscularity.

• Physical-activity recommendations
• Adults: ≥150 min·wk⁻¹ moderate-intensity (e.g., brisk walking) OR 75 min vigorous.
• Children/adolescents: ≥60 min·day⁻¹.

Ethical, Philosophical & Practical Notes

• Pregnancy & lactation guidelines emphasize preventive ethics: early folate & iron ensure equitable fetal neurological outcomes; caffeine & vitamin-A limits prevent iatrogenic harm.
• Satter’s model upholds autonomy & respect for the child, fostering intrinsic regulation rather than coercive feeding.
• Community nutrition programs (congregate meals, Meals on Wheels) reflect societal commitment to justice—ensuring elders’ right to food security & dignity.
• Bariatric surgery decisions balance beneficence (health improvement) against non-maleficence (surgical risks, lifelong supplementation). Thorough counseling and informed consent are critical.

Quick Formula & Number Sheet (Exam "cheat list")

• Extra kcal: 2nd Tri +340, 3rd Tri +450, Lactation +400–500.
• Folate: prevent NTD; Iron: ↑ blood volume.
• Fluid Pregnant: 2000–3000\,\text{mL d}^{-1}.
• Infant growth: 2× wt @6 mo; 3× @1 yr.
• Fiber 4–8 yr: 25\,\text{g}.
• Protein adults <65 yr: 1.8\,\text{g kg}^{-1}; ≥65 yr add +1.0\,\text{g kg}^{-1}.
• Calcium osteoporosis prevention: 1500\,\text{mg d}^{-1}.
• Exercise: Adults 150 min wk, Kids 60 min day.