Nutritional Considerations (Lifecycle) PDF

Nutritional Considerations (Lifecycle) UNIT 12 NUTR 1100- Introduction to Nutrition Why? Changes in body over time (life stage) Needs depend on age, physiological condition etc. Stages Pregnancy Infancy: Birth to one year of age Toddler: 2 to 3...

Nutritional Considerations (Lifecycle) UNIT 12 NUTR 1100- Introduction to Nutrition Why? Changes in body over time (life stage) Needs depend on age, physiological condition etc. Stages Pregnancy Infancy: Birth to one year of age Toddler: 2 to 3 years (early childhood) Childhood: 4-8y of age Puberty: 9-13y of age (beginning of adolescence) Older adolescence, adult, seniors Pregnancy Nutrition Nutritional care of pregnancy starts before conception Healthy eating important before & during pregnancy Decreased risk of disease in child Eating patterns (undernourished or unhealthy patterns) Chronic disease risk ↓ Complications at childbirth and C-section, BP, gestational diabetes in mom Before- Fertility and nutrition (male and female) During- Name a key supplement (vitamin) that a woman needs during before conception and during pregnancy? FOLATE (folic acid supplements- 400ug daily) After- Meeting needs for lactating Maternal changes During pregnancy- blood volume increases by 50% Placenta develops (transfer nutrients) Fat increases for energy needs Uterus enlarges, breasts develop (lactation) Pregnancy Weight Gain ‘Normal’ pre- pregnancy weight (healthy BMI) 11 to 16 kg (25-35lbs) 2-4lbs in 1st trimester 1lb/week in 2nd and 3rd trimester Weight gain is 25% infant 75% from tissues, fluids and stores Enlargement of uterus, breasts, ↑ blood volume, ↑fat stores, weight of placenta, change in tissues, ↑ in extracellular fluid Pregnancy and Nutrition Eating for two? Pregnant women are eating for two but they don’t need to eat twice as much Health Canada- 2 to 3 servings per day Pregnancy & Macronutrients Calories 1st trimester: energy needs similar to non- pregnant levels 2nd and 3rd trimesters: 2-3 food servings more Protein: ↑ by 25 g (0.8/kg/d to 1.1g/kg/day) Carbohydrate: ↑ by 45g Fiber: additional 3-5g fibre/day Fat: include essential fatty acids and long chain PUFA’s (linoleic acid, alpha linolenic acid, DHA and arachidonic acid- fish, nuts, seeds, olive oil, eggs) AMDR? – Remains the same Water: 2.7l/day to ~ 3L/day but no change in electrolytes https://www.canada.ca/en/health-canada/services/food-nutrition/canada-food- guide/food-guide-servings-tracker/pregnant-female-aged-19-50.html Pregnancy & Micronutrients For growth of new tissues in both mother and baby- extra food ↑ absorption supplements Folic Acid & Vitamin B12 Spinal cord (closure of the neural tube 21-28 days of pregnancy) synthesis of DNA (cell division) Prevents anemia in mom legumes, green leafy vegetables Supplements should provide 400ug daily B12- Low intake- risk of anemia- vegans need supplements Pregnancy & Micronutrients Calcium & Vitamin D Ca absorption doubles 3-4 dairy servings per day Lactose intolerant women? Vitamin D requirement doubles Dark skinned women Latitude greater than 40 deg north or south Pregnancy & Micronutrients Iron & Zn Iron requirements ↑ by 50% (27mg/day) Well planned diet for vegetarians and vegans Zn requirements are high Zn absorption is inhibited by high intake of Fe Pregnancy and exercise Moderate activity (30 mins per day) Benefits include digestion, mood, stress, prevents excess weight gain, reduces risk of diabetes and high BP, speedy recovery from childbirth Continue routine after physician consultation If inactive before pregnancy- start slow Common issues in Pregnancy Weight gain – for healthy individual 11-16 kg (25-30 lbs) Not as modifiable as we think it is Hyperemesis Gravidarum Morning sickness  dehydration, electrolyte imbalance, weight loss Age of Mother: Adolescents Nutrient needs increased significantly in adolescent pregnancy Socio economic issues Gestational Diabetes Concerns: bigger baby  ↑ risk for childhood obesity  ↑ risk for adulthood obesity Birth Weight Low BW = < 2.5 kg (5.5 lbs) birth complications, defects, contract diseases and death Normal BW = 3 - 4 kg (6.5 - 9 lbs) High BW = > 4 kg (9 lbs) Difficult birth – child and mom complications or Caesarean section  infection Canadian Recommendations for Baby Textbook 401-409 Exclusive breastfeeding for the first 6 months of life (may be exceptions- iron fortified infant formula) All breastfed infants -Vitamin D supplement of 400IU. Should be continued as long as breastfeeding continues. A Healthy Baby Birthweight doubles in 4 months Triples in 1 year Energy needs for first year 100kcal/kg/day 6 months – basal metabolic rate very high. 7-12 months – basal metabolic rate ↓ as activity starts. How to know if growing well Height, weight & head circumference Against standards & same baby Textbook good examples of growth charts.  Growth Chart: Boys Birth to 36 months http://www.who.int/childgrowth/standards/e n / Mom’s Nutritional Requirements while Breastfeeding Fluid milk production = 750 ml-1L / day Water intake – atleast 1L more than pre-pregnancy (~3.7L/day) Energy Milk production = ~700-800 kcal/day Recommended- 500kcal +pre-pregnancy intake Weight loss= 200kcal/day deficit Baby’s First (and subsequent)Foods 6 months Continue Breastfeeding. If formula fed, use iron fortified Solid foods Iron rich foods o Meat, fish, poultry, tofu, legume, egg white) – finely pureed o Iron fortified cereals Single foods… repeat for 3 days – look for signs of reaction No mixed foods that contain foods that haven’t been tried alone Vegetables before fruits Use foods from family table 6-8 months Continue breastfeeding or iron fortified formula Gradually increase number of times a day complementary foods offered Finger foods, Infant breads and crackers/biscuits Baby’s First Foods 9 months Continue Breastfeeding. If formula fed, use iron fortified. 3 meals & 1-2 snacks foods with little → no added sugar, salt Texture important o Breads and cereals from table o Soft cooked vegetables and fruit from the table o Mashed vegetables and fruits and juices o Finely cut meats, fish, poultry, casseroles, tofu, legumes o Cottage cheese, plain yogurt, and pasteurized cheeses can be introduced o Whole milk can be introduced at 9 months Incorporate social aspect of eating - mealtimes w/ family. Water and non-breastmilk/formula should be given in an open cup. Sippy cups do not support development of skills. Bottles for these beverages linked to excessive calorie intake. Baby’s First Foods 10 -12 months Continue to introduce a variety of foods and increase texture. Cow’s whole milk should be limited to 750 ml/d. Transition away from bottle. Should be complete by 18 months at latest. 12 – 18 months Breastmilk can be continued along with foods. Full range of consistencies as child has ability to use all chewing movements. Foods should be a variety of items from Canada’s Food Guide, with balance and moderation. Portion sizes ¼ → ½ adult portion sizes. No honey given before 1 year of age. Parent diet important as they are role models to child. Full strength fruit juice not appropriate. Only 100% juices should be offered, and then diluted significantly. Offer water for thirst. Chocolate milk, sodas, sports drinks, other sweetened beverages & beverages with caffeine not appropriate. Baby’s First Foods 2 years of age 2% or 1% of milk can be introduced - skim milk not appropriate. Pasteurized full fat goat milk can be used if fortified with folic acid & Vitamin D. Unflavoured, full fat soymilk can be used as occasional beverage Fortified plant & nut milks can be introduced. References: Health Canada (2015). Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. (www.hc-sc.gc.ca/fn-an/nutrition/infant- nourisson/recom/index-eng.php) Health Canada (2015). Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. (www.hc-sc.gc.ca/fn-an/nutrition/infant- nourisson/recom/recom-6-24-months-6-24-mois-eng.php) Geriatric Nutrition Diet & exercise to maintain muscle mass (fat mass ↑ as age ↑) Good nutrition Healthy, active, healthy life expectancy Geriatric Nutrition Textbook p. 436-445 Nutritional Concerns of the Older Adult (50 and above) LBM ↓ BMR ↓ & activity ↓ - so energy needs ↓ AMDR ? Stays the same Micronutrient needs stay the same or sometimes increases Vit D, B12, folate, Ca and Iron and adequate fibre Fluid needs stays the same (risk of dehydration) but ↓ thirst & conservation of water is compromised (high loss due to meds) Increased risk of malnutrition (undernutrition, sarcopenic obesity) Physiological changes (Decline in muscle size and strength), frailty (mobility, endurance, risk of falls) acute & chronic/acute illness (kidney disease, BP, heart disease) Geriatric Nutrition: Undernutrition Nutritional Considerations in the Elderly Physical changes Low muscle mass Difficult access or preparing food Reduced activity Aging Loneliness ↑ in acute and chronic diseases Low income Mobility Neurogenerative Confusion / depression Swallowing /chewing issues Poor appetite Multiple prescription medications Alcohol use /abuse ↓ in sensory information Vision, hearing smell and taste Institutionalization Geriatric Nutrition Keep active, involved in community Maintain muscle mass, function and mental health Individualized care Nutrition issues are complex Respect & Dignity Quality of Life (QoL)