Chapter 13 Nutrition for a Life time

1
Chapter 13Nutrition for a Life time
2
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 mothers store of iron if
  intake is low
• Choose nutrient dense foods
• Physical Activity
• Increase kcalories if exercising

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.
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.
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.
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 (0.370.97)
• Beta-carotene vs. placebo RR 0.51 (0.300.86)
• Potential adverse effects of Vitamin A and
  related substances
• Total daily dose gt 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.
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.
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.
9
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 lt 19.8)
• 15 - 25 for high weight (BMI 26-29)
• 15 - 25 lb. for obese (BMI gt 29)

10
Components of Weight Gain
11
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

12
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

13
Pregnant vs. Nonpregnanat
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
14
What about Aspartame

• Harmful for mothers with phenylketonuria (PKU)
• Disrupts fetal brain development
• Moderate use not harmful for women who do not
  have PKU

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 (lt 3 cups coffee/day)

15
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

16
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

17
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)
• ? Carbohydrate40-50 of total calories
• ? Calcium 400-600mg/day
• ? Iron 6-10mg/day
• ? Fluoride, vitamin D, vitamin K

18
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

19
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

20
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- 8020
• whey/casein in formula-1882
• ? 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 (21 vs. 1.51)
• ? Human milk has lower iron concentration but
  iron from human milk is more bio-available

21
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 infants
  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

22
Infant Benefits of Breastfeeding

• ? Protein in breast milk is more easily digested
  that protein in infants 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

23
Breast Milk vs. Cows 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
Cows milk, whole 20.1 1.08 1.60 1,08 3.00 0.01 34.0
Cows 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
24
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

25
Infant and Nutrition
26
(No Transcript)
27
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

28
Baby Bottle Caries
29
What not to Feed an Infant
30
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

31
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
32
School-age Children Daily Food Plan
Food 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 tsp
33
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

34
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

35
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

36
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
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
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

41
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)

42
As we age

• Body Composition
• Total Body Fat
• Muscle Mass
• Total body water
• Bone Mass (with ? potential of fracture)
• Dentition

Body Functions gt dry mouth lt taste / smell lt
thirst (with ? potential of dehydration) ?
anorexia with ? appetite ? T cell and B cell
activity lt GFR lt activity of drug
metabolizing enzymes lt availability of
nutrients via absorption / digestion
43
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

44
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
45
Conclusions for the class

• Eating habits are learned
• Eating is ..
• Nutrition is
• Exercise is