45
Chapter 13 Nutrition for a Life time

Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Embed Size (px)

Citation preview

Page 1: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Chapter 13Nutrition for a Life time

Page 2: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Energy Needs During Pregnancy

• 1st trimester

– Balanced and adequate diet

• 2nd and 3rd trimester

– 350-450 extra kcal per day

3rd trimester

Transfer of fat, calcium, and iron to fetus during the last month Fetus may deplete mother’s store of iron if intake is low

• Choose nutrient dense foods

• Physical Activity

– Increase kcalories if exercising

2

Page 3: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

3

Folic Acid

Strong evidence that folic acid prevents preconceptionally recurrent and first occurent neural tube defects

Increasing evidence that folic acid reduces risk of some other birth defects

Improves the hematologic indices in women receiving routine iron and folic acid

USPHS/CDC recommends for US women

400 g/day: All women in childbearing age 1 mg/day: Pregnant women 4 mg/day: Women with history of neural tube defect

deliveries take folic acid 1 month prior to conception and during first trimester

Czeizel 1993; Czeizel and Dudas 1992; Mahomed et al 1998; MRC Vitamin Study Research Group 1991.

Page 4: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

4

Iron Supplementation

Iron requirements:

Average non-pregnant adult:

– 800 g iron lost/day– + 500 g iron lost/day during menses

Pregnant woman: Increased need

– Expanded blood volume– Fetal and placental requirements– Blood loss during delivery

Routine vs. selective iron supplementation:

Prevalence of nutritional anemia Routine iron and folate supplementation where nutritional

anemia is prevalent Recommended dose: 60 mg elemental iron + 5 g folic acid

Mahomed 2000b; WHO 1994.

Page 5: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

5

Iodine Supplementation

Iodine deficiency is a preventable cause of mental impairment

Iodine supplementation and fortification programs have been largely successful in decreasing iodine deficiency conditions

Population with high levels of mental retardation (e.g., some parts of China):

Supplementation may be effective at preconception up to mid-pregnancy period

Form of iodine supplementation (iodinating food or oral/injectable iodine) depend on:

– Severity of iodine deficiency– Cost– Availability of different preparation

Enkin et al 2000; Mahomed and Gülmezoglu 2000.

Page 6: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

6

Vitamin A Indications for vitamin A supplementation:

Vertical transmission of HIV (ongoing) Infant survival Maternal anemia: Positive interaction with iron in reducing

anemia Infection Maternal mortality:

– Vitamin A vs. placebo RR 0.60 (0.37–0.97)– Beta-carotene vs. placebo RR 0.51 (0.30–0.86)

Potential adverse effects of Vitamin A and related substances:

Total daily dose > 10,000 IU before 7th week of gestation associated with birth defects: craniofacial, central nervous system, thymic cardiac

Overall effectiveness and safety of vitamin A supplementation needs to be evaluated

Rothman et al 1995; Suharno et al 1993;

West et al 1999.

Page 7: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

7

Other Micronutrients: Calcium

Association between reduction in pregnancy induced hypertension (PIH) and calcium supplementation

Reduction of incidence of PIH Routine supplementation likely beneficial in women at high risk

of developing PIH or have low dietary calcium intake High calcium doses (2 g/day) not associated with adverse

events Need adequately sized and designed trials in different settings

to confirm beneficial effects Recommend increase in calcium intake through diet in women at

risk of hypertension or low calcium areas

Bucher et al 1996; Kulier et al 1998; Lopez-Jaramillo et al 1997.

Page 8: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

8

Calcium Supplementation: Conclusions

Calcium decreases risk of hypertension, pre-eclampsia, low birth weight, and chronic hypertension in children

Recommend for high risk women with low calcium intake, if pre-eclampsia is important in the population

Calcium has other health benefits not related to pregnancy:

Maintaining bone strength Proper muscle contraction Blood clotting Cell membrane function Healthy teeth

Atallah, Hofmeyr and Duley 2000.

Page 9: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Recommended weight grain during pregnancy

• 2 - 4 lb. weight gain during 1st trimester

• 0.75 - 1 lb. weekly weight gain during

2nd and 3rd trimester • Total weight gain goal

– 25 - 35 lb. for normal weight women – 28 - 40 lb. for low weight (BMI < 19.8) – 15 - 25 for high weight (BMI 26-29) – 15 - 25 lb. for obese (BMI > 29)

9

Page 10: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Components of Weight Gain

10Nutrition and Micronutrients in Pregnancy

Page 11: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Protein and Carbohydrate need during pregnancy

RDA for protein

– Additional 25 gm/day – Many (non-pregnant) women already

consume recommended amount of protein

• RDA for carbohydrate

– Prevent ketosis – 175 gm/day – Most women exceed this amount

11

Page 12: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Additional Mineral Need • Calcium (1000 mg/day)

– Adequate mineralization of fetal skeleton and teeth Iron (27 mg/day)

Increased hemoglobin Iron stores for the fetus Iron supplement between meals

• Possible effects of iron-deficiency anemia

– Preterm delivery – Low-birth weight – Fetal deaths

• Zinc (11 mg/day)

supports growth and development

12

Page 13: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Pregnant vs. Nonpregnanat

13

Energy/Nutrient Non-pregnant Pregnant

Protein 46 g/day 71 g/day

Vitamin C 75 mg/day 85 mg/day

Thiamin 1.1 mg/day 1.4 mg/day

Niacin 14 mg/day 18 mg/day

Folate 400 mcg/day 600 mg/day

Vitamin D 5 mcg/day 5 mcg/day

Calcium 1000 mg/day 1000 mg/day

Iron 18 mg/day 27 mg/day

Iodine 150 mcg/day 220 mcg/day

Page 14: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

What about Aspartame Harmful for mothers with phenylketonuria (PKU)

– Disrupts fetal brain development

• Moderate use not harmful for women who do not have PKU

14

What about Caffeine Decreases iron absorption

• May reduce blood flow through the placenta

• Caffeine withdrawal symptoms in newborn

• Risk of spontaneous abortion

– Heavy caffeine use in the 1st trimester

• Risk of low-birth-weight infant

• Limit caffeine intake (< 3 cups coffee/day)

Page 15: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Pregnancy Complications

Gestational Diabetes

– Hormones synthesized by placenta decrease action of insulin – 4% of pregnancies; 7% of Caucasian women – Routine screening at 20 - 28 weeks gestation

• Risks to fetus & mother

– Increased birth weight (C-section), low blood glucose, trauma, malformations

– Usually disappears after birth but is linked to diabetes later in life for mother

15

Page 16: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Pregnancy Complications

Pregnancy-induced hypertension

– High-risk disorder Preeclampsia (mild form) – Eclampsia (severe form)

• Signs:

– Elevated blood pressure, protein in the urine, edema, change in blood clotting

– Convulsions in third trimester – Liver and kidney damage, leading to death

16

Page 17: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Nutrition in Infants

Nutrition in Infancy

Water: 100-150ml/kg/day

Protein: 2-3gm/kg/day

Lipids: 3.8-6.0 gm/kg/day (MCT and EFA)

Carbohydrate:40%-50% of total calories

Calcium: 400-600mg/day

Iron: 6-10mg/day

Fluoride, vitamin D, vitamin K

17

Page 18: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Recommendations for Infants

The WHO recommends human milk as the exclusive nutrient source for feeding full-term infants during the first 6 months after birth

Regardless of when complementary foods are introduced, breastfeeding should be continued through the first 12 months

18

Page 19: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Breast Milk Content

Human milk contains protective antibodies against enteric infections

Caloric density is the same in breast milk and regular infant formulas(20kcal/oz)

Fat absorption is more efficient in breastfed infants when compare to infant formulas

19

Page 20: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Breast Milk/Formula Content Human milk has higher concentration of essential fatty acid

Formula has higher protein concentration (1.5g/dl in formula vs.0.9g/dl in breast milk)

whey/casein in human milk- 80:20 whey/casein in formula-18:82

Whey protein promotes gastric emptying

Whey protein have more lactoferrin and secretory immunoglobulin A

Lactose content is equal in breast milk and infant formula

Calcium/Phosphorus ratio in human milk is higher compared to formula (2:1 vs. 1.5:1)

Human milk has lower iron concentration but iron from human milk is more bio-available

20

Page 21: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Infection and Breast Milk

Human milk may be a source of CMV

Human milk is protective against enteropathogenic E.coli and other GI pathogens. This protection is greatest during the infant’s first 3 months of life and declines with increasing age

Human milk is not protective against HSV

Breastfeeding is contraindicated in HIV infection, except in underdeveloped countries

Human milk does not protect against M.tuberculosis

21

Page 22: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Infant Benefits of Breastfeeding Protein in breast milk is more easily digested that protein in infant’s formula

Human milk protein promotes more rapid gastric emptying

Fat absorption from human milk is more efficient when compared to formula

Many factors in human milk may stimulate gastrointestinal growth and motility as well as enhance the maturity of the gastrointestinal track

Human milk contains specific protein involved in host defense

Infants who are breastfed for at least 13 weeks had significantly less gastrointestinal and respiratory illnesses

Breast milk appears to be protective against some food allergies during infancy and early childhood

Maternal-infant bonding is enhanced during breastfeeding

Improved long-term cognitive and motor abilities in full term infants have been directly correlated with duration of breastfeeding

22

Page 23: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Breast Milk vs. Cow’s Milk vs. Iron-Fortified Formulas

Product Energy (Cal/oz)

Protein (g/oz)

Carbs (g/oz)

Fat (g/oz)

Cholesterol (mg/oz)

Iron (mg/oz)

Calcium (mg/oz)

Human milk

22.5 0.32 2.12. 1.35 4.00 0.01 10.0

Cow’s milk, whole

20.1 1.08 1.60 1,08 3.00 0.01 34.0

Cow’s milk, fat-free

10.8 1.08 1.56 0.03 1.00 0.01 38.0

Similac 20.0 0.41 2.10 1.08 1.00 0.36 16.0

Enfamil 20.0 0.42 2.19 1.07 0.00 .0.36 16.0

ProSobee 20 0.50 2.13 1.07 0.00 0.36 21.0

Isomil 20 0.49 2.04 1.09 0.00 0.36 21.0

Page 24: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Mother Benefits

Postpartum weight loss and uterine involution may be more rapid in women who breastfeed

Exclusive breastfeeding delays the resumption of normal ovarian cycles and return of fertility in most mothers

Epidemiological studies have identified a decreased incidence of premenopausal breast cancer and ovarian cancer in women who have lactated

24

Page 25: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Infant and Nutrition

25Nutrition and Micronutrients in Pregnancy

Page 26: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

26

Page 27: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Dietary Fat

No fat restriction for children less than 2y

Nonfat and low-fat milk not recommended in the 1st 2 years of life

Fat intake should be decreased during toddlers years, to provide 30% of total energy

Lower limit of energy from fat should be 20%

27

Page 28: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Baby Bottle Caries

28

Page 29: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

What not to Feed an Infant

29

Page 30: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Dietary Guidelines in Childhood

Structured 3 meals and 2 snacks

Adults should decide when food is offered

Eating should occur in a designated area with the developmentally appropriate chair

No grazing between meals

For preschoolers offer 1 tablespoon of each food for every year of age

Snacks should be considered mini-meals

30

Page 31: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Children: Daily food Plan

Energy/Food Groups 2-3 years 4-5 years

Calories 1000 1200

Grains 3 oz 4 oz

Vegetables 1 cup 1.5 cups

Fruits 1 cup 1 cup

Milk 2 cups 2 cups

Meat 2 oz 2 oz

Oils 3tsp 4 tsp

31

Page 32: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

School-age Children: Daily Food PlanFood Group

Age 6-7, Girls

Age 6-7, Boys

Age 8 Both

Age 9-10. Girls

Age 9-10, Boys

Age 11-12, Girls

Age 11-12, Boys

Calories

1200 1400 1400 1400 1600 1600 1800

Grains 3 oz 4 oz 4 oz 4 oz 5 oz 5 oz 6 oz

Veg 1.5 cups

1.5 cups

1.5 cups

1.5 cups

2 cups

2 cups 2.5 cups

Fruit 1 cup 1.5 cups

1.5 cups

1.5 cups

1.5 cups

1.5 cups 1.5 cups

Milk 2 cups 2 cups 2 cups 2 cups 3 cups

3 cups 3 cups

Meat 3 oz 4 oz 4 oz 4 oz 5 oz 5 oz 5 oz

Oil 4 tsp 4 tsp 4 tsp 4 tsp 5 tsp 5 tsp 5 tsp32

Page 33: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Adolescent Nutrition

Recommended daily allowances (RDA) for energy based on the median energy intake

Assessment of energy needs should consider appetite, growth, activity and weight gain in relation to deposition of subcutaneous fat

Restricted food intake in physically active adolescents results in diminished growth, drop in basal metabolic rate and amenorrhea

Requirements for energy, calcium, nitrogen and iron determined by increases in Lean Body Mass

33

Page 34: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Nutritional Concerns in Adolescence The low energy intake creates difficulties in planning diets with adequate

levels of nutrients

RDA for energy do not include a safety factor for increased energy needs (illness)

Protein needs correlate more with growth pattern than with chronological age

Due to accelerated muscular and skeletal growth, calcium need is higher

Need for iron is increased to sustain the rapidly enlarging LBM and hemoglobin mass

Iron needed to offset menstrual losses

Zinc is essential for growth and sexual maturation

Growth retardation and hypogonadism have been reported in adolescent boys with Zinc deficiency

34

Page 35: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Nutrition Concerns in Adolescents

Vegetarian adolescents at risk for deficiencies of vitamin D, B 12, riboflavin, protein, calcium, iron, zinc and trace elements

Dental caries are common (low fluoride intake, high carbohydrate intake)

NHANES reports obesity in 14% of adolescent ages 12-19

Chronic disease in adolescent may affect nutritional status

35

Page 36: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Adolescents: Daily Food Plan

Energy/Food Group

13 yo, Girls

14-18 yo, Girls

19-20 yo, Girls

13-15 yo, Boys

16-18 yo, boys

19-20 yo boys

Calories 1600 1800 2000 2000 2400 2600

Grains 5 oz 6 oz 6 oz 6 oz 8 oz 9 oz

Veg 2 cups 2.5 cups 2.5 cups 2.5 cups 3 cups 3.5 cups

Fruits 1.5 cups

1.5 cups 2 cups 2 cups 2 cups 2 cups

Milks 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups

Meat 5 oz 5 oz 5.5 oz 5.5 oz 6.5 oz 6.5 oz

Oils 5 tsp 5 tsp 6 tap 6 tap 7 tap 7 tap

36

Page 37: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

37

Page 38: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

38

Page 39: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

39

Page 40: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

The Elderly Currently Underutilize

Resources To Combat Malnutrition

22% Use Community Services

15% Use Senior Centers

8% Eat Meals at Senior Centers

2% Receive Home Delivered Meals

40

Page 41: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Poorly Nourished Older Adults

Greater morbidity/mortality

Declining functional status

Greater rates of hospital admission/readmission (ALOS +2days; 4x hospitalization rate)

Higher rate of complications (Tenfold increase in nosocomial infection rate)

41Nutrition and Micronutrients in Pregnancy

Page 42: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

As we age

Body Composition

Total Body Fat

Muscle Mass

Total body water

Bone Mass (with ↑ potential of fracture)

Dentition

42

Body Functions> dry mouth< taste / smell< thirst (with ↑ potential of dehydration)↑ anorexia with ↓ appetite↓ T cell and B cell activity< GFR< activity of drug

metabolizing enzymes< availability of nutrients via absorption / digestion

Page 43: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Food Pyramid for Older Adults

Key Considerations

More water/fluids on a daily basis Fewer calories/Encourage physical activity More fiber Consider supplements:

– calcium, vitamin D and B12

43

Page 44: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Older Adults (70+): Daily Food Plan

Energy/Food group Females Males

Calories 1600 2000

Grains 5 oz 6 oz

Veg 2 cups 2.5 cups

Fruits 1.5 cups 2 cups

Milk 3 cups 3 cups

Meat 5 oz 5.5 oz

Oil 5 tsp 6 tsp

44

Page 45: Chapter 13 Nutrition for a Life time. Energy Needs During Pregnancy 1st trimester – Balanced and adequate diet 2nd and 3rd trimester – 350-450 extra kcal

Conclusions for the class

45

Eating habits are learned

Eating is …..

Nutrition is ……

Exercise is ……