NCM 105 Nutridiet Midterm (LEC 7) PDF

NCM 105 NUTRIDIET Nutritional needs should be met at every stage of the life cycle because Understanding Nutrition Throughout the Life nutritional status at one stage influen...

NCM 105 NUTRIDIET Nutritional needs should be met at every stage of the life cycle because Understanding Nutrition Throughout the Life nutritional status at one stage influences Cycle health status in the next ones. ○ Lack of adequate nutrition during pregnancy, for example, can program gene functions for life in ways that set the stage for lifelong metabolic changes that increase the risk of chronic-disease development. Disease prevention and health promotion, rather than repair of health problems, requires a focus on meeting nutritional and other health needs of individuals during every stage of the life cycle. PRINCIPLES OF HUMAN NUTRITION Nutrition during Pregnancy Every field of science is governed by a set of principles that provide the Periconceptional Period foundation for growth in knowledge. The time around conception is These principles change little with time. considered the periconceptional period. Knowledge of the principles of nutrition ○ It represents a critical period of will serve as a springboard to greater time when nutritional and other understanding of the nutrition and health exposures can impact relationships explored in the chapters to conception, pregnancy come. maintenance, and the growth, development, and future health of the offspring. PERICONCEPTIONAL FOLATE STATUS FOLATE Status prior to conception is an important concern because inadequate folate very early in pregnancy is related to the development of approximately 50 percent of cases of neural tube defects (NTDs), such as spina bifida. ○ NTDs develop between the third and fourth week after conception—or before many women even know they are pregnant, and well before prenatal care generally begins. essential nutrient required for DNA replication and as a component of enzymatic reactions involved in amino acid synthesis and vitamin metabolism.  interval of time during which cells of a tissue or organ are genetically programmed to multiply. ○ At this stage, organs being formed are vulnerable to adverse influences. MATERNAL PHYSIOLOGY Conception triggers thousands of complex and sequenced biological changes that transform two united cells into a member of the next generation of human beings. ○ The rapidity with which NUTRITION DURING PREGNANCY structures and functions develop in mother and fetus and the PREGNANCY (GESTATION) timecritical nature of energy and period when the fertilized ovum implants nutrient needs make maternal itself in the uterus, undergoes nutritional status a key element differentiation, and grows until it can of successful reproduction. support extrauterine life. ○ Human Pregnancy lasts for a period of 266 - 280 days (37-40 weeks). 3 STAGES: ○ Implantation ○ Organogenesis ○ Growth WEIGHT GAIN During pregnancy is an important consideration because newborn weight and health status tend to increase with adequate weight gain. ○ All women need to gain weight during pregnancy for fetal growth and maternal health. MATERNAL WEIGHT IMPLICATIONS CRITICAL PERIOD  1. Underweight of meeting maternal and fetal a. high risk of having low-birth needs for protein. weight infants ○ Consequently, less protein is b. higher rates of preterm deaths used for energy and more is and infant deaths used for protein synthesis. Two-thirds of proteins should be of 2. Overweight and Obese animal origin of the highest biologic a. high risk of complications like value such as meat, milk, eggs, cheese, hypertension, gestational poultry, and fish. diabetes, and postpartum infections FAT ALLOWANCES b. Complications of labor and It is estimated that pregnant women delivery consume 33% of total calories on c. Increased likelihood of a difficult average from fat. labor and delivery, birth trauma, ○ Fat consumed in foods is used and cesarean section for large as an energy source for fetal babies growth and development and d. Doubled risk of neural tube serves as a source of fat-soluble defects vitamins. ○ Fat also provides essential fatty CALORIE ALLOWANCES acids that are specifically During the course of pregnancy, the total required for components of fetal energy cost of storage plus growth and development. maintenance (additional work for ○ It is recommended that pregnant maternal heart and uterus and steady women consume 13 grams of rise in basal metabolism) amounts to linoleic acid (an essential fatty approximately 80,000 kcal. acid) daily, and 1.4 grams of the ○ The energy intake should be 36 other essential fatty acid, kcal per kg of pregnant weight alpha-linolenic acid. per day. Energy requirements during pregnancy FOLATE ALLOWANCES increase mainly due to protein and fat Folic acid taken in a supplement without tissue synthesis, and the energy cost of food provides twice the dietary folate maintaining an expanding amount of equivalents as does an equivalent metabolically active tissues. amount of folate from food. ○ On the average, an increase of ○ It is recommended that women 300 calories during pregnancy consume 600 mcg DFE of folate is recommended. per day during pregnancy and ○ As for adults, approximately include 400 mcg folic acid from 45–65 percent of total caloric fortified foods or supplements. intake during pregnancy should ○ The remaining 200 mcg DFE come from carbohydrates. should be obtained from vegetables and fruits. PROTEIN ALLOWANCES ○ These nutrient-dense foods Assuming that 70% of the protein is provide an average of 40 mcg of retained, and additional consumption of folate per serving. 8-9 g per day is recommended for pregnant women. VITAMIN A ALLOWANCES ○ For a Filipino pregnant woman, Vitamin A - key nutrient in pregnancy this is equivalent to 68 g/day. because it plays important roles in ○ For an adolescent pregnant reactions involved in cell differentiation. woman, it is equivalent to 73 ○ Deficiency of this vitamin is rare g/day. in pregnant women in ○ Physiological adaptations in industrialized countries, but it is protein metabolism during a major problem in many pregnancy shift in the direction developing nations.  ○ Vitamin A deficiency that occurs ○ 300 mg is used by the fetus and early in pregnancy can produce placenta. malformations of the fetal lungs, ○ 250 mg is lost at delivery. urinary tract, and heart. ○ 450 mg is used to increase red blood cell mass. VITAMIN D ALLOWANCES Maternal iron stores get a boost after Vitamin D - supports fetal growth, the delivery when iron liberated during the addition of calcium to bone, and tooth breakdown of surplus red blood cells is and enamel formation. recycled. ○ Lack of a sufficient supply of vitamin D during pregnancy IODINE ALLOWANCES compromises fetal as well as Iodine is required in pregnancy by the childhood bone development. mother and fetus for thyroid function and ○ Lack of maternal Vitamin D energy production, and for fetal brain readily compromises fetal development. Vitamin D status. ○ Deficiency of iodine early in ○ Infants born to women with pregnancy can lead to vitamin D deficiency tend to hypothyroidism in the offspring. be smaller than average, more ○ The recommended form of likely to have low blood iodine for supplements is calcium levels potassium iodide (which (hypocalcaemia) at birth, and contains 76 percent iodine). more likely to have poorly Usual iodine intake should not calcified bones and abnormal exceed 1100 mcg daily during enamel. pregnancy. ○ They are also more likely to develop dental caries in SODIUM ALLOWANCES childhood. Sodium plays a critical role in maintaining the body’s water balance. CALCIUM ALLOWANCES ○ Requirements for it increase Calcium - primarily needed in markedly during pregnancy due pregnancy for fetal skeletal to plasma volume expansion. mineralization and maintenance of ○ But the need for increased maternal bone health. amounts of sodium in ○ Approximately 30 grams of pregnancy hasn’t always been calcium (a little over an ounce) appreciated. is transferred from the mother to ○ Sodium restriction is not the fetus during pregnancy. indicated in normal pregnancy ○ Fetal demand for calcium peaks or for the control of edema or in the third trimester when fetal high blood pressure that bones are mineralizing at a high develops in pregnancy. rate. ○ Women should be advised to ○ The additional requirement for consume salt “to taste” unless calcium in the last quarter of contradicted by a medical pregnancy is approximately 300 condition related to salt intake. mg per day and is partly obtained by increased Complications of Pregnancy and Possible absorption and by release of Dietary Modifications calcium from bone. Some of the physiological changes that occur in pregnancy are accompanied by IRON ALLOWANCES side effects that can dull the bliss of Iron status is a leading topic of expecting a child by making women feel discussion in prenatal nutrition because physically miserable. the need for iron increases substantially; ○ Common ailments of pregnancy, women require about 1000 mg (1 g) of such as nausea and vomiting, additional iron for pregnancy: heartburn, and constipation, are  generally more amenable to effects on both mother and fetus, prevention than to treatment, however, when they do occur. but often can be relieved ○ The eating disorder most through dietary measures. commonly observed among pregnant women is bulimia Hyperemesis Gravidarum nervosa, a condition marked by characterized by severe nausea and both severe food restriction and vomiting that last throughout much binging and purging. of pregnancy. ○ Pica is a temporary condition ○ It can be debilitating. wherein pregnant women had ○ In addition to the mother feeling the tendencies to eat non-food very sick, frequent vomiting can items. lead to weight loss, electrolyte imbalances, and dehydration. Fetal Alcohol Spectrum Disorders Alcohol consumed by a woman easily Hypertensive Disorders of Pregnancy crosses the placenta to the fetus. worldwide, leading causeof maternal ○ Because the fetus has yet to mortality. fully develop enzymes that ○ They affect 5–10 percent of break it down, alcohol lingers in pregnancies and contribute the fetal circulation. significantly to stillbirths, fetal ○ This situation, combined with and newborn deaths, and other the fact that the fetus is smaller adverse outcomes of and has far less blood than the pregnancy. mother does, increases the harmful effects of alcohol on the 4 types of hypertensive disorders in fetus as compared to the pregnancy have been identified. mother. Key Points 1. Maternal diet, weight status, and physical activity levels influence the development of healthy pregnancy outcomes and a number of conditions that adversely affect the course and outcome of pregnancy. 2. Nutritional interventions for a number of Gestational Diabetes complications of pregnancy can benefit accounts for 88 percent of all cases of maternal and infant health outcomes. diabetes in pregnancy and is similar in 3. Nutritional interventions during many ways to type 2 diabetes. pregnancy should be based on scientific ○ Women who develop evidence that supports their safety, gestational diabetes tend to effectiveness, and affordability enter pregnancy with insulin resistance, or a predisposition to NUTRITION DURING LACTATION insulin resistance, and impaired insulin production, which is LACTATION expressed due to physiological period of milk production by the changes that occur during mammary glands. pregnancy 2 main hormones responsible for milk production are: Eating Disorders ○ prolactin represent relatively rare conditions in ○ oxytocin pregnancy because many women with The preparation for assuring an such disorders are sub-fertile or infertile. adequate supply of good quality Such disorders can have far-reaching breastmilk must begin at the onset of pregnancy.  Most of the dietary essentials are increased over and above the requirements during pregnancy to meet the demands of milk production, namely calories, proteins, calcium, Vitamin A, thiamin, riboflavin, niacin, and ascorbic acid. CALORIE ALLOWANCES The actual mechanism involved in the production of the milk does not demand a great expenditure of energy. COLOSTRUM ○ The extra energy required for For the first 3 to 4 days, the milk lactation depends on the contains a substance called amount of milk produced. colostrum. ○ The FNRI recommends an ○ has high protein content, acts as increase of 500 calories above a laxative, and contains the normal requirement for an antibodies which help resist average production of 850 mL of infection. milk, with an energy value of ○ It should be given to all newborn about 600 calories. infants. PROTEIN ALLOWANCES THE RNI provides an additional 23 g protein/day for the first 6 months of lactation; and 18 g protein/day the second 6 months. ○ The extra protein requirement is based on the fact that about 1.2g protein is stored per 100 mL human milk Importance of Breastmilk Mother’s milk is the best food for the baby. ○ It is easily digested, economical, has the right temperature, and is free from harmful bacteria. A mother who wants to breastfeed her baby should follow the basic food groups in meal planning. ○ Too much fried foods, pickles, and highly-seasoned foods and stimulants (drugs, nicotine, caffeine, theobromine, morphine, alcohol) should be avoided. Benefits of breastfeeding for the infant Provides superior nutrition for optimum growth. Provides adequate water for hydration. Protects against infection and allergies. Promotes bonding and development. Benefits of breastfeeding for the mother  Protects mother’s health NUTRITION DURING INFANCY ○ helps reduces risk of uterine bleeding and helps the uterus to INFANCY return to its previous size Rapid growth during the first year of ○ reduces risk of breast and life differentiates infancy from all ovarian cancer other ages. Helps delay a new pregnancy (lactation ○ From birth to 6 months of age, amenorrhea) growth occurs most rapidly than Helps a mother return to pre-pregnancy at any other period in the life weight cycle. ○ Adequate nutrition is required for normal development of the brain. Infancy is a critical period for formation of the brain. ○ During this time, the foundation for cognitive, motor, and socio-emotional skill development is established. ○ These developmental skills will continue to progress through childhood and adulthood. ○ This is also the period when feeding skills and healthful Barriers to Breastfeeding eating patterns are being established. ○ Full brain development is reached at the age of 25. A newborn infant has a functional but physiologically immature kidney that gradually increases in size and capacity to concentrate. ○ The stomach capacity of infants increases from 20-30 mL at birth to 200 mL by one year of age. Key Points 1. With rare exceptions, human milk is the CALORIE ALLOWANCES optimal food for infants, exclusively for 6 At birth, a baby requires about 350 to months and with supplemental foods for 500 calories, and in one year, from 800 a year or longer. to 1,200 calories: 120 calories per Benefits to infants include kilogram body weight from the 2nd to protection from iron deficiency, the 7th month and 100 calories per better gains in cognitive ability, kilogram from 7th to the 12th month. fewer acute respiratory and The average requirement for growth in gastrointestinal illnesses, and the first year is 50 calories per pound of lower risk of sudden infant death expected weight, 2/3 of this amount of syndrome, celiac disease, needed calories being supplied by the inflammatory bowel disease, milk and 1/3 by the added calories. neuroblastoma, allergies, and According to RENI, infants below six asthma. months requires at least 560 calories, 2. Support for breastfeeding women from while infants 6 months old until 12 husbands, mothers, sisters, health care months need at least 720 calories per providers, communities, employers, and day policy makers is critical to breastfeeding success and impacts breastfeeding PROTEIN ALLOWANCES rates in the community.  Allowances of 1.5 to 2.5 g of protein per Fluoride kg in the body weight from 0 to 6 When ingested during the time that months of age, and 1.5 to 2 g per kg in teeth are developing the fluoride will be the body weight from 6 to 12 months of deposited on tooth surfaces. age are recommended by the ○ Fluoride helps to reduce tooth FAO/WHO Expert Group. decay by decreasing the ○ The amount of protein in human solubility of tooth enamel, milk is adequate for the first 6 decreasing the production of months of life even though the acid by oral bacteria, and by protein is less than the infant supporting further formula. remineralization. ○ Dental caries are the most FAT ALLOWANCES common chronic disease of Fat is an essential component in the childhood. diets of infants. ○ It provides essential fatty acids, Vitamin D is a concentrated source of key nutrients in the diets of infants. It energy, and facilitates the has an essential role in bone absorption of fat-soluble mineralization and calcium and vitamins. phosphorus homeostasis, and regulates ○ Fat is especially important in genes associated with immune infancy and early childhood response and cellular growth. because it is essential for 2 forms: neurological development and ○ vitamin D2 (ergocalciferol), brain function. which is from plants and fungi, ○ However, fat absorption varies. ○ vitamin D3 (cholecalciferol), ○ Infants are at higher risk for which is synthesized in the skin essential fatty acid deficiency during exposure to sunlight. related to their rapid growth rate also is found in fatty fish and higher requirements for like salmon and polyunsaturated fatty acids. mackerel. ○ They also have limited stores of body fat. Restrictions of fat and Iron dietary cholesterol are not Iron Infants are at risk for iron deficiency recommended in infancy. because of rapid growth in the first year. ○ From 4 to 12 months of age, an WATER ALLOWANCES infant’s blood volume will Water is an essential component of double. body structure and a solvent for ○ Those with lower iron stores at minerals and other physiologically birth or low intakes of dietary important compounds. iron are also at risk. ○ Infants are vulnerable to water ○ Iron deficiency anemia in imbalance because of greater infancy is associated with short demand for insensible water and long-term consequences, and their renal concentrating including poor cognitive and ability is less than that of adults. motor development. Water intoxication (increase in the volume of free water in the body) results Low Birth Weight Infants in restlessness, nausea, vomiting, Refers to an infant weighing less than diarrhea, polyuria or oliguria and 2500 g. hyponatremia (less than normal ○ These infants, aside from concentration of sodium in the blood). prematurity, are vulnerable to experiencing failure to thrive OTHER NUTRIENT AND NON-NUTRIENT which is a delay in weight gain NEEDS which may be caused by illness, poor feeding technique, severe  food allergy, infections, diarrhea, FEEDING THE INFANT dysphagia, vomiting, and respiratory problems. Supplements for Infants Specific supplements are recommended FEEDING THE INFANT for breastfed infants in the United States and Canada, under certain Breastfeeding circumstances: The AAP and the Academy of Nutrition ○ Fluoride supplementation - and Dietetics (AND) recommend that recommended starting at 6 optimal nutrition for infants be provided months of age for infants by exclusive breastfeeding for the first 6 residing in communities with low months of life and continuation of levels of water fluoridation. breastfeeding for the second 6 months. ○ Iron supplementation - it is a key public health strategy for recommended for exclusively improving infant health and reducing breastfed term infants starting at morbidity and mortality in the first 12 four months of age at a dose of months. 1 mg/kg/d, and continued until iron-containing complementary Formula Milk (Cow’s Milk) foods are introduced in the diet. The American Academy of Pediatrics Meat as an early and the Academy of Nutrition and complementary food for Dietetics Pediatric Practice Group breastfed infants has recommend that whole cow milk, skim been associated with milk, and reduced-fat milk not be used in improved iron and zinc infancy. status. ○ Iron-deficiency anemia has ○ Vitamin B12 supplementation been linked to early introduction may be needed for breastfed of whole cow’s milk. vegan infants if the maternal ○ Low iron availability may result diet is inadequate. from gastrointestinal blood loss There are no unfortified or the lack of other iron-rich plant food that contain foods. significant amounts of the active form of Complementary Feeding vitamin B12. The goals of infant feeding are to meet Fermented soy products all nutritional needs, to enhance are not reliable sources mother-infant bonding, to assist the of the active form of this infant in initiating the transition from a vitamin. primarily liquid diet to a predominantly solid food diet in childhood, and to Common Disorders and Nutritional Issues establish routines of eating in during Infancy moderation. ○ Complementary foods are Colic solid foods and fluids other condition of irritability, and excessive, than breast milk and formula. inconsolable crying in healthy, well-fed infants. ○ It can occur from early infancy up to 4 or 5 months of age, and can have a pattern of onset and duration. ○ The association of colic symptoms, gastrointestinal upset, and infant feeding practices has been studied, but no definitive cause of colic has yet been identified.  most common allergic reactions are Iron-Deficiency and Iron-Deficiency Anemia respiratory and skin symptoms Iron deficiency - most common (wheezing or skin rashes) micronutrient deficiency throughout the ○ Although food allergies can start world. in infancy, they are confirmed by ○ Both iron-deficiency anemia specific laboratory tests after (IDA) and iron deficiency without infancy. anemia(ID) during infancy are of ○ True allergies can present as an major significance because of array of reactions building up their relationship with over time, so that it may take neurodevelopment and several years for the initiating behavior. cause to be identified. ○ Iron deficiency is associated While there is no cure for a food allergy, with poor cognitive, motor and food desensitization offers the best socio-emotional development in alternative. This process is called oral infancy, and in laterchildhood immunotherapy treatment (OIT), an with poor cognition and school approach that desensitizes your body to achievement. the allergen, allowing you to eat the food without the chance of an allergic Diarrhea and Constipation reaction. Diarrhea - passage of three or more loose, watery stools per day or a stool Key Points volume greater than 10 grams per 1. Infancy is a unique time when feeding kilogram of body weight in infants. skills and eating behaviors are ○ The cause of diarrhea during emerging. infancy may or may not be It is an opportune time for identifiable. families and caregivers to foster ○ Diarrhea may result from viral healthy eating and mealtime and bacterial infections, food behaviors. intolerance, or changes in fluid 2. Parents’ ability to read their infant’s intake. signals of readiness, hunger, and satiety ○ Excessive intake of fruit juice promote successful feeding may be a cause of diarrhea in relationships and development of older infants. healthy eating habits. Constipation - changes in the 3. Common nutrition problems in the first frequency, size, consistency, or easy of year (colic, diarrhea, constipation, passing stool. among others) may be resolved with ○ Difficulty with defecation is a parental education, dietary common occurrence ininfancy interventions, and medical approaches. and childhood. ○ The problem is often short in Nutrition during Childhood Years duration and of little consequence. Children’s Health ○ Recommendations for the infant extent to which individual children or with constipation focus on groups of children are able or enabled to normal fluid and fiber intake. a) develop and realize their potential Early Childhood Caries (EEC) / Bottle caries b) satisfy their needs and baby bottle caries and baby bottle tooth c) develop the capacities that allow decay them to interact successfully Feeding practices established in infancy with their biological, physical, may increase risk of EEC. and social environments. Food Allergies Childhood period of life from 1 to 12 years of age. Toddlers  ○ children between the ages of 1 ○ After that, the requirement on a and 3 years weight specific basis declines to characterized by a rapid an adult level of 25-30 kcal/kg. increase in gross and fine motor skills with PROTEIN ALLOWANCES subsequent increases in About 1.5 to 2g/kg of body weight is independence, required. exploration of the ○ The child’s protein requirement environment, and is relatively higher in relation to language skills. body weight than that of an Preschool-age children adult. ○ between 3 and 5 years of age. ○ The RENI indicates that the changes occur in protein need per kilogram of children’s rate of growth body weight decreases. and development which ○ The protein requirements are includes continuing relatively high for periods of maturation of fine and rapid growth and lower during gross motor skills. periods of slow growth Characteristics of this stage of development Vitamins and Minerals include increasing DRIs for vitamins and minerals have autonomy; experiencing been established for the toddler and broader social preschool-age child. circumstances, such as ○ Most children from birth to 5 attending preschool or years are meeting the targeted staying with friends and levels of consumption of most relatives; increasing nutrients, except for iron, language skills; and calcium, and zinc. expanding ability to control behavior. Childhood Middle childhood Importance of Nutrition ○ term that generally describes During preschool age, idiosyncratic children between the ages of 6 food choices are common. and 12 years ○ Likes and dislikes may change characterized by a more from day to day and week to quiet, stable changes week. compared with the ○ Appetites are usually erratic and extremes of growth and unpredictable. development seen in ○ The child may eat veraciously at infancy and one meal and refuse to eat the adolescence next. It is relatively stable as CALORIE ALLOWANCES compared to the Energy requirements must take into preschool and consideration basal metabolism, rate of adolescent years, with growth and activity. regards to growth rate ○ Dietary energy must be and behavior. sufficient to ensure growth and Preadolescence spare protein from being used ○ ages 9–11 years for girls and as a source of energy. ages 10–12 years for boys. ○ The average energy Both these stages of requirement for basal growth and metabolism during the first development are also 12-18 months of life is 55 referred to as kcal/kg DBW. school-age.  There are differences changes during which a child between boys and girls, develops into an adult. with boys having more ○ Physical, psychosocial, and lean body mass per cognitive maturity are largely centimeter of height accomplished during this life than girls. stage Girls go through this Girls tend to gain fat at period earlier than boys. a slightly higher rate 3 STAGES: than boys. 1. Prepuberty (prepubescence) This nutritional 2. Puberty (Pubescence) phenomena is termed 3. Postpuberty as adiposity rebound. (Postpubesecence) CALORIE ALLOWANCES Allowances decline to about 80 to 90 kcal/kg for children 7 to 9 years old and 70 to 80 kcal/kg for children aged 10 to 12 years old. PROTEIN ALLOWANCES Approximately 37 g of protein is recommended daily for children 7 to 9 years old and 43 to 48 g for children aged 10 to 12 years. ○ This is almost 1.4 g/kg of body Changes in Weight, Body Composition and weight. Skeletal Mass As much as 50 percent of ideal adult Key Points body weight is gained during 1. Periodic and accurate measurements of adolescence. a young child’s growth are important ○ Among females, peak weight indicators of the child’s nutritional status. gain follows the linear growth Adequate andappropriate spurt by 3–6 months. growth is the ultimate outcome ○ During the peak velocity of indicator of adequate nutrition weight change, which occurs at and health. an average age of 12.5 years, 2. The types of foods offered to children girls will gain approximately 18.3 and methods of feeding are based on an lb (8.3 kg) per year. individual child’s growth and ○ Weight gain slows around the development. time of menarche, but will 3. Food habits are learned behaviors. continue into late adolescence. 4. Common nutritional problems such as ○ Adolescent females may gain as iron deficiency anemia, dental caries, much as 14 lb (6.3 kg) during and constipation in a healthy child can the latter half of adolescence. be addressed through adjustments in ○ Peak accumulation of muscle the child’s diet. mass occurs around or just after the onset of menses. Nutrition during Adolescence Among males, peak weight gain coincides with the timing of peak linear Adolescence growth and peak muscle mass transition period of human development accumulation. that occurs between childhood and ○ During peak weight gain, adulthood. adolescent males gain an ○ period of life between 11 and 21 average of 20 lb (9 kg) per year. years of age. Body fat decreases in males ○ time of profound physical, during adolescence, resulting in emotional, and cognitive  an average of approximately 12 ○ Teens report that food percent by the end of puberty. preferences, accessibility of Almost half of adult peak bone mass is foods, cost, busy schedules, accrued during adolescence. and social support from family ○ By age 18, more than 90 and friends are key factors in percent of adult skeletal mass their food choices. has been formed, thus adolescence is a critical time for osteoporosis prevention. The growth spurt that occurs during adolescence includes rapid bone growth, increased muscle mass, and increased body fat. ○ It is the 18 to 24 month period when growth rate is fastest but its occurrence varies among individuals. Psychosocial and Cognitive Development During this stage of biological changes, Unhealthy Food Choices young adolescents experience the Adolescents lead busy lives. Many are development of body image and an involved in extracurricular sports or increased awareness of sexuality are academic activities, others are central psychosocial tasks during this employed, and many must care for period of life. younger children in a family for part of ○ The dramatic changes in body the day. shape, size, and composition ○ These activities, combined can cause a great deal of withthe increased need for ambivalence among social contact and approval, and adolescents, often leading to the increasing academic demands development of poor body as they proceed through school, image and sometimes leading to leave little time for adolescents disordered eating if not to sit down to eat a meal. addressed by family or health ○ Snacking, skipping meals, care professionals. and eating foods that are Eating disorders cheap and quick, such as ○ serious cases, often vending machine snacks and psychological in nature, which fast foods, are commonplace develops as a result of the behaviors among adolescents overanxious adolescent, who report a lack of time as a especially with young females, major barrier to healthy eating. who are so afraid to get fat. Peer pressure or “pakikisama” or Physical Activity belonging to a gang any bodily movement produced by ○ can influence either good or bad skeletal muscles, which results in behaviors. energy expenditure. ○ This definition is distinguished Health and Nutrition During Adolescence from exercise, which is a Eating patterns and behaviors of subset of physical activity that is adolescents are influenced by many planned, structured, and factors in addition to peer attitudes and repetitive and is done to behaviors, including parental modeling, improve or maintain physical food availability, food preferences, cost, fitness. convenience, personal and cultural Physical fitness beliefs, mass media, and body image. ○ set of attributes that are either health- or skill-related.  the ages of 13 and 15 and the Dietary Requirements, Intakes and Adequacy plateau by ages 16-19. among Adolesce ○ Growth acceleration during sexual maturation period CALORIE ALLOWANCES increases iron requirements The reference 44-kg boy between 13 primarily for hemoglobin and 15 years old needs 310 kcal more production. than what the girl of the same wight and More iodine should be supplied in the age does. diet in the form of iodized salt to ○ This is due to the higher energy compensate for the increased thyroid expenditure brought about by activity associated with growth. intense physical activity. ○ As a consequence, thiamine, Health and Nutritional Conditions among riboflavin, and niacin allowances Adolescents are also increased. ○ Around 0.5 mg/1,000 calories is Overweight and Obesity the set allowance for thiamine The increase in the prevalence of and riboflavin and 6.6 niacin overweight and obesity among equivalent for every 1,000 kcal. adolescents has nearly doubled during the past two decades. PROTEIN ALLOWANCES ○ Exact reasons for this increase The protein needs are high among have not been identified. teenagers because of the accelerated ○ Environmental factors, or growth and development. interactions between genetic ○ Protein allowances for and environmental factors, are adolescents aged 13 to 15 the most likely causes of the years is 59 grams for both boys dramatic rise in overweight and and girls. obesity. ○ However, for those aged 16 to ○ Inadequate levels of physical 19 years, protein allowance fort activity and consuming diets he reference 55-kg boy high in total calories and added increases to 65 grams while that sugars and fats are behavioral of a reference 48-kg girl remains risk factors common among a the same. significant proportion of adolescents. VITAMIN ALLOWANCES ○ These environmental factors Allowance for Vitamin A is the same for increase the risk of developing all levels. obesity if an adolescent is ○ Vitamin C allowance is genetically predisposed to constantly higher among boys obesity than among girls aged 16 to 19 years. Substance Use ○ Compared to their female The use of substances such as counterparts, the older male tobacco, alcohol, and recreational adolescent have higher drugs can affect the nutritional status recommended allowance for of adolescents. Vitamin A, thiamine, riboflavin, ○ Recent data on the effects of niacin and Vitamin C. substance use on eating behaviors have focused MINERAL ALLOWANCES exclusively on the risk for The recommended calcium allowance of disordered eating behaviors, the 13 to 15 age group is higher particularly on bulimia (700mg) compared to the 16 to 19 age nervosa and binge-eating group (600mg). disorder. ○ This difference reflects the spurt ○ Disordered eating is seen more of bone development between frequently among females who  report smoking cigarettes, drinking alcohol, and using inhalants. ○ It is believed that substance use may result in depleted stores of vitamins and minerals, including thiamin, vitamin C, and iron. ○ Chronic ingestion of alcohol and drug use can result in a reduced appetite, leading to low dietary Key Points intakes of protein, energy, 1. Rapid rates of physical growth and vitamins A and C, thiamin, development experienced by calcium, iron, and fiber. adolescents significantly increase their needs for energy, protein, vitamins, and Iron-Deficiency Anemia minerals. most common nutritional deficiency 2. Body composition changes dramatically noted among children and adolescents. during puberty, with the percentage of ○ Several risk factors are body fat increasing among females but associated with its development decreasing among males. among adolescents, including 3. Adolescents will not fully develop rapid growth, inadequate dietary abstract reasoning and critical thinking intake of iron-rich foods or foods skills until late in adolescence or early high in vitamin C, vegan diets, adulthood; therefore, nutrition education calorie-restricted diets, meal messages should be simple and skipping, participation in concrete, and should relate to activities strenuous or endurance sports, common in their current everyday lives. and heavy menstrual bleeding. 4. Risk factors for iron deficiency anemia, The effects of iron-deficiency anemia the most common nutrition deficiency include delayed or impaired growth and among adolescents, include rapid development, fatigue, increased growth, low dietary iron intake, meal susceptibility to infection secondary to skipping, dieting, athletic participation, depressed immune system function, and heavy menstrual bleeding. reductions in physical performance and endurance, and increased susceptibility Nutrition during Adulthood to lead poisoning. Adulthood Hypertension and Hyperlipidemia period of life when one has attained Blood pressure can be high, normal, or full growth and maturity (between 21 low, but over time and with age, blood and 50 years of age). pressure rises. ○ Adulthood marks a long period ○ The walls of large arteries between the active growth and become more rigid and the development phases of infancy, small blood vessels become childhood, and adolescence and narrower. the older adult phases where a ○ Because of these changes, the concern is sustaining physical heart has to generate a greater and mental capacity. force to keep blood flowing ○ subdivided into the following around the body. segments: ○ This leads to an increase in early adulthood blood pressure. (twenties) ○ Hypertension is defined as midlife (forties) blood pressure that is later adulthood (early consistently higher than 140/90 sixties). mm Hg (systolic, diastolic, or both blood pressures). Early Adulthood  The twenties generally involve greater attention to physical activity and becoming independent, leaving the nutrition. parental home, finishing formal ○ While many are schooling, entering regular employment “empty-nesters,” significant and starting a career, developing numbers have children living at relationships, and choosing a partner. home and/ or have ○ Planning, buying, and preparing responsibilities as guardians food are newly developing skills and caretakers of grandchildren, for many. parents, or others. ○ The thirties could be ○ Food choices and lifestyle characterized by increasing factors may take on added responsibilities to and for others, significance for those who are including having children, dealing with a chronic disease. providing for and caring for family, building a career, and involvement in community and civic affairs. ○ There may be renewed interest in nutrition at this time “for the kids’ sake.” Midlife The forties are a period of active family responsibilities (that may include nurturing children and teenagers and, for some, building new relationships and blending families), as well as expanding work and professional roles. Reference Man or Woman ○ Managing schedules and meals The Philippine RENI makes use of the becomes a challenge. concept of a Reference Man and a ○ Sociologists say that this is a Reference Woman time of reviewing life’s The reference man is between ages accomplishments and beginning 20 and 39 and weighs 56 kg. to recognize one’s mortality. ○ He is healthy, working, The phase around the fifties is referred adequately clothed and to as the sandwich generation. housed and whose weight is ○ Many, especially women, are not necessarily ideal but multigenerational caregivers consumes an adequate diet who juggle the roles of caring and is neither gaining nor for children and aging parents losing weight. while maintaining a career. The reference woman is the same as ○ Work and career continue to be above but weighs 49 kg priorities for most adults. ○ In the fifties, health concerns Physiological Changes during the Adult frequently are added to the Years picture. ○ Dealing with a chronic disease Bone or managing identified risk Bone shape is modified in response to factors to prevent diseases is an physiological influences and mechanical added responsibility forces. ○ The ongoing process of bone Later Adulthood remodeling preserves bone By their early sixties, many adults are strength and mineral (calcium making the transition to retirement, have and phosphorus) homeostasis. more leisure time, and are able to give  ○ Around age 40, men and 1. Eat a variety of foods. women begin to gradually lose 2. Maintain the ideal weight (18.5 bone mass. to 24.9 kg/m2) ○ The risk of developing 3. Avoid too much fat, saturated fat osteopenia (low bone mineral and cholesterol. density) and osteoporosis 4. Eat foods with adequate starch (weak, porous bones with high and fiber. risk for fracture) depends on the 5. Avoid too much sugar. peak bone mass achieved in the 6. Avoid too much sodium. late twenties. 7. Drink alcohol moderately Adiposity Key Points Positive energy balance typical 1. Individual choices as well as external between ages 20 and 64 results in factors strongly influence the course of weight gain and storage of excess health and wellness for adults. energy in adipose tissues. 2. There are significant disparities in the ○ Storage begins with hypertrophy incidence and prevalence of disease of subcutaneous fat cells, then across population groups. shifts to deposits in the central Social and economic and intra-abdominal space disadvantage, along with other (visceral fat) and other tissues factors, are important such as heart, blood vessels, determinants of nutritional and liver, and muscle (ectopic fat). health outcomes. ○ Obesity and visceral fat are 3. Beginning early in the adult years, bone strongly related to development mass begins to decline, and there is an of inflammation and metabolic increase in body fat that is associated disturbances, which are with increased risk of chronic diseases. connected to insulin resistance, 4. Various eating patterns can be healthful, diabetes, gallbladder disease, provided energy intake is not excessive, hypertension, stroke, and recommended amounts of nutrients are coronary artery disease. consumed over time, and nutrients are balanced to support their interdependent Gut Microbiome functions. The composition of gut microbiota (formerly called gut flora) determines Nutrition during Elderhood the balance between beneficial and harmful actions in the gut lumen. Elderhood ○ Healthy gut microbiota functions period of being past middle age. The to activate and support the process of growing old or the period of immune system, protect against old age is referred to as senescence opportunistic pathogens, digest characterized by disturbed regulatory food to release nutrients and and functional mechanisms in the body. energy from diet, ferment Ageing nondigestible carbohydrates, ○ natural phenomenon. synthesize vitamins (K, B12, It reflects the biotin, carnitine), stimulate physiological changes renewal of cells of intestinal that the body undergoes lining, control colonic motility over the course of a and transit time, and provide lifetime. regulatory signals through the Many of the changes gut–brain axis. may lead to a decline in resilience, however, Feeding the Adult aging is not all loss or To stay healthy, the following guidelines decline. must be observed by adult men and Rather, healthy aging is women: associated with  continuing benefit from an increased psychosocial, personal, intake. moral, cognitive, and spiritual development Vitamin and Mineral Allowances Aging is a heterogeneous process. Calcium, iron, Vitamin A, and Vitamin C ○ Everyone ages differently. are important minerals and vitamins ○ Genetics, lifestyle, and disease commonly found lacking in the diet for processes all affect the way the aged because of low intake of meat, people age. milk, green leafy vegetables, and fruits. ○ Although older adults are more ○ The B-complex vitamins may be vulnerable to disease because in adequate amounts if enriched of biological changes that occur cereals and breads are over time, aging is not consumed. synonymous with disease. ○ Vitamin and mineral ○ Aging is an ongoing process; supplements may be taken to however, there is no single way further augment the intake in of defining old age. these nutrients. Old has been defined chronologically, biologically, psychologically, and Water and Fiber Allowances socially. About 6 to 8 glasses should be ○ Definition of old age is important consumed daily. for political, economic, and ○ The kidneys can function medical reasons. efficiently in eliminating waste ○ Chronological age is being used solids if there are sufficient most frequently, but one fluids. 80-year-old individual may be ○ Also, water stimulates playing tennis while another peristalsis, combating may be in a wheelchair. constipation. Dietary Requirements, Intakes and Adequacy Physiological Changes during the Elder among the Elder Years CALORIE ALLOWANCES Lean Body Mass (LBM) and Fat A reduction of calories is recommended Of all physiologic changes that occur because of reduced basal metabolism during aging, the biggest effect on and physical activity. nutritional status and physical ○ Statistics have shown by age resilience is due to the shifts in 60, the average adult themusculoskeletal system. accumulates about 7 extra ○ On average, there is a decline in kilograms. fat-free or lean body mass of ○ The recommended decrease in 2–3 percent per decade from calorie intake is as follows: age 30–70, even when weight is stable. 45-55 years = 7.5% decrease ○ This leads to the loss of up to 15 55-65 years = 7.5% decrease percent of muscle mass After 65 years = 10% decrease (sarcopenia). PROTEIN ALLOWANCES Taste and Smell An allowance of 1.1g/kg body weight is Although there is some argument about required. the extent to which aging affects the ○ This is necessary for the sense of taste, there is general prevention of wasting and agreement that taste and smell senses susceptibility to disease and are generally robust until age 60, when infection. they start declining. ○ Older persons who have poor ○ Women retain their sense of dietary habits or illnesses may smell better than men do. Other  than aging, conditions leading to ○ Upon reaching old age, many impaired olfaction include elderly tend to lose interest in congestion, upper respiratory proper grooming, dining out, tract infections, stroke, epilepsy, and other activities they used to medications, and current enjoy with the attitude that “they smoking. are already old for it”. ○ Family support and Chewing and Swallowing reassurance, hopefully, will Poor dietary habits are a modifiable risk change their negative attitude. factor that can contribute to caries and potential tooth loss. Key Points ○ Oral health depends on several 1. Functional ability (the demonstrated organ systems working ability to carry out activities of daily together: gastrointestinal living) is more important than secretions (saliva), the skeletal chronological age in assessing the system (teeth and jaw), mucous health status of older adults. membranes, muscles (tongue, 2. Good nutrition, good health habits, jaw), taste buds, and olfactory environment, access to health care, and nerves for smelling and tasting. genetics contribute to human life ○ Disturbances in oral health and expectancy, which is still significantly tooth loss are associated with, shorter than the potential human life but not necessarily caused by, span. aging. Theories of aging, such as wear-and-tear theories, help to Appetite and Thirst explore which factors contribute Hunger and satiety cues are weaker in most to a longer, disease-free older than in younger adults. life. ○ Elderly people don’t seem to 3. While adults in general consume more notice thirst as clearly as than enough calories and protein, younger people do. clusters of older adults may be lacking ○ Dehydration in adequate dietary protein and energy. occurs more quickly 4. The thirst mechanism of older adults is after fluid deprivation not as sensitive as that of younger and that rehydration is adults, placing them at higher risk of less effective because dehydration. of lower thirst, sensation and reduced renal water-conservation capacity Depression This let-down feeling reduces one’s appetite and the worse stage is when there is a desire to die. ○ A spiritual counselor or sometimes, just keeping the elderly busy with group recreation, low-impact exercising, music therapy, and getting out of the house for sight-seeing, etc. will do wonders! Cultural Patterns play a significant role in determining human behavior.