Nutrition

Pregnancy - teens

1 in 20 pregnancies l Gain 35# l Teen has own growing needs l More Fe deficiency l Prolonged labor l Higher infancy death rates l $1 billion annually

snacking

1/4 or more of kcal intake l High nutrient l Food Guide Pyramid l Balance fast foods with fruits/veg, fiber l Breakfast l Lean meats for iron

water needs

100 kcal/kg vs 40 kcal/kg for adult l Water content great in infant l Water adequately supplied by breast milk or formula n except in hot weather or N&V

Fetal Alocohol Syndrome

12,000 FAS infants each year l 1 drink/day threatens neurological development l 4 drinks/day ↑'s risk dramatically l Most harmful before 12 weeks gestation l Mom doesn't have to be "drunk" to cause harm to fetus

obesity - childhood

15% of children ages 6 - 19 l 40% chance with 1 obese parent l 80% chance with 2 obese parents

physical activity - ageing

60 minutes of cumulative physical activity l 3 times/wk - 30 to 45 min continuous physical activity

Pregnancy - weight gain

7 1/2# fetus l 1 1/2# placenta l 4# maternal blood supply l 4# inc. fluid volume l 4# inc. uterus and supporting tissues l 2# inc. size of breasts l 2# amniotic fluid l 7# maternal fat stores n Total 30 # Weight Gain

Healthy Habits

Abstinence or moderation of alcohol l Regularity of meals l Weight control l Regular and adequate sleep l Abstinence from smoking l Regular physical activity Healthful Habits (cont) l Ability to bounce back after losses l Control over one's life l Challenging the mind l Formal and informal education l Social connections l Productive activities

Breastfeeding - pros and cons

Advantages of breast-feeding include benefits to the infant and mother. a. Nutritional quality of breast milk is the best for infants. i. Whey protein is more easily digested and absorbed than that of formula. ii. Beneficial proteins in breast milk help protect the infant's health. iii. Lactose promotes nervous system development, provides energy, and prevents ketosis. iv. The fats in breast milk are essential for growth and development of the infant's nervous system and development of the retina. v. The change in fat content during the feeding promotes satiation. vi. Breast milk is a good source of calcium and magnesium and contains an easily absorbed form of iron. vii. As the baby matures, nutrient content of breast milk changes to meet the changing needs. b. Protection from infections and allergies is provided by breast milk. c. Breast-fed babies are less likely to die from SIDS and have reduced risk of obesity and other chronic conditions. d. Physiologic benefits for the breast-feeding mother include: i. quicker return of uterus to pre-pregnancy size and reduced bleeding ii. enhanced weight loss iii. decreased risk of breast and ovarian cancer for those who breast-feed for a year or more iv. suppressed ovulation, which increases recovery time e. Mother-infant bonding is enhanced through breast-feeding. f. Convenience and cost are both benefits of breast-feeding.

Nutrition - child - malnutrion

Affect IQ, growth, sight l School breakfast & lunch l Glycogen stores lasting ~ 4 hr - suggest need for planned snacks l Fe deficiency most common deficiency l Lead toxicity

Pregnancy - malnutrion

Affect fertility in both male and female l Placenta may fail to develop l Problems with under or overweight mothers n Underweight - ↑'d risk of LBW n Obese - ↑'s risk neural tube defects

Pregnancy - incompatible

Alcohol usage l Medicinal drugs w/o MD consent l Herbal Supplements l Street drugs l Tobacco use l Environmental contaminants Foodbourne Illness l Megadoses of vit/min l Caffeine l Weight loss during pregnancy l Limit artificial sweetener n 1 - 2 servings/day

Pregnancy - calorie needs

Average = 300 kcal/day extra, l Extra 1.1 gram of protein/day per kg of body weight l (2 - 4 lbs. weight gain first trimester n About 75 - 150 extra kcal/day l 0.8 lbs./week 2nd and 3rd trimesters n About 350 extra kcal/day)

Nutrition - childhood obesity

Avoid "clean plate club" l Stop when full, not stuffed l Promote activity l Deal with weight through growth l Variety l Child sized portions l Beverages have kcal, too!! l Mild flavors and temperature

Nutrition - ageing

Body composition - muscle/fat l ↓'d metabolism l ↓'d insulin effectiveness l Immune system decline l GI tract - ↓'d motility, achlorhydria l Insomnia l Tooth loss, ill fitting dentures l Eye sight decline - cataracts/ macular degeneration l Dec smell and taste acuity l Fragile bones l Depression, death of family & friends l Forgetfulness l Anxiety l Apathy regarding meal preparation l Socioeconomic changes l Living alone, disconnected socially, loneliness

energy needs - ageing

Decline by 5% per decade n Reduced LBM and activity

Pregnancy - maternal conditions

Diabetes l Gestational diabetes l Transient hypertension l Preeclampsia Eclampsia n (Magnesium adequacy important) l Hyperemesis gravidarum

milk

Do not use until 1 yr of life n Use until at least 2 yr of life, not lowfat/skim n Only source of fat Introduction of Foods (cont) l Whole milk (cont) n Needed for myelin sheath around nerves n Needed for cell wall tissues n GI bleed without enough fat

nutrition - pregnancy

During the first trimester, formation of the limbs and organs occur. a. Nutrient deficiencies at this time lead to irreversible structural or functional damage. b. Exposure to teratogens can also result in fetal malformations. 2. The second trimester is a time during which the fetus continues to grow and mature. 3. The third trimester is a time of remarkable growth and organ maturation for the fetus. 4. Nutrition is one of the most important modifiable variables affecting maturity and birth weight. a. Low birth weight increases the risk of infection, learning disabilities, impaired physical development, and death.

adolscence - growth and development

Female - 10 to 11, peak at 12 n Menarche at 12 1/2 n Put on 6" and 35# l Male - 12 to 13, peak at 14 n Put on 8" and 45#

Fetal Development

Fetal Development stages: n Zygote - up to 2 weeks n Embryo - 2 to 8 weeks n Fetus - 8 weeks to 40 weeks ( 1 gram to 3500 gms -7 1/2 #)

Fluid intake - infant

Fluid intake for infants must be sufficient to prevent dehydration. a. Breast-fed babies do not need supplemental fluid. b. Water is the recommended supplemental fluid and should be limited to four ounces per day. c. In conditions that cause dehydration, a physician should be consulted to determine appropriate fluid choice. 5. Preterm infants thrive on breast milk or special formulas can be used if the infant is mature enough to be fed. 6. What types of formula

Nutrition - adolscents

Influences: n Peers n Media n Body image Growth and Development l Female - 10 to 11, peak at 12 n Menarche at 12 1/2 n Put on 6" and 35# l Male - 12 to 13, peak at 14 n Put on 8" and 45#

nutrient needs - child

Iron - menstruation, inc blood volume l Calcium - building peak bone mass, inc. bone size

Nutrition - before conception

Is nutrition important before conception? 1. Some deficiency-related problems develop extremely early in pregnancy. 2. Adopting a healthful diet prior to conception requires women to avoid alcohol, illegal drugs, and other known teratogens. 3. A healthful diet and appropriate levels of physical activity can help women achieve and maintain optimal weight prior to pregnancy. 4. A balanced and nourishing diet before conception reduces the risk of developing a nutrition-related disorder during pregnancy. 5. The man's nutrition prior to pregnancy is important, as well.

Nutrition - infant / macronutrients

Macronutrient needs of infants differ from those of adults. a. Energy needs are about 50 kcal per pound of body weight per day. b. Forty to fifty percent of an infant's diet should come from fat during the first year of life. c. Although protein needs are higher for infants than adults, no more than 20% of an infant's daily energy requirement should come from protein.

Macronutrient needs - pregnancy

Macronutrient needs of pregnant women are modestly increased. a. Energy requirements increase by about 350-450 calories per day in the last two trimesters. b. Protein needs increase to about 1.1 gm per day per kilogram body weight. c. Adequate fiber-rich carbohydrates are important to support fetal and maternal energy needs and promote bowel health. d. Moderate fat intake is essential to development of new cells. i. Docosahexaenoic acid (DHA) is especially important for brain growth and eye development in the fetus.

abuse of alochol, drugs, ect

Marijuana - "munchies" l Cocaine - euphoria, drug over food l Alcohol - preferential metabolism of alcohol over food, empty kcal l Tobacco - inc metabolic rate, need inc Vit C, reduced food and nutrient intakes

Pregnancy - high risk

Maternal weight l Smoking, alcohol, drug abuse l Low socioeconomic status l Age: teens, >35 years l Maternal health: n hypertension, diabetes, chronic disease

Breast feeding difficulties

Mechanical difficulties during initial breast-feeding can be overcome with counseling. b. Effects of drugs and other substances on breast milk can cause symptoms in babies. i. Women using illicit drugs and many prescription medications should formula feed. ii. Caffeine and alcohol enter breast milk and change the baby's disposition. iii. Chemicals and proteins in some foods are distasteful to the infant or cause allergic and other reactions. c. Environmental contaminants can be minimized in breast milk if the mother limits exposure. d. Maternal HIV infection can be transmitted through breast milk; mothers undergoing chemotherapy or anti-tuberculin therapy should not breast-feed. e. Conflict between breast-feeding and the mother's job presents several challenges. i. Many workplaces provide a breast-feeding support program. ii. Women may need to pump breast milk for bottle feeding or provide formula while at work. f. Social concerns can be a barrier to breast-feeding but are easily overcome. 3. What about bonding for fathers and siblings?

Nutrition - infant / micronutrients

Micronutrient needs of infants are high to accommodate rapid growth and development. 3. Do infants need supplements? a. Vitamin D is low in human milk and deficiencies have been seen in infants, especially those with limited sunlight exposure. b. Additional iron after the first 6 months can be obtained from iron-fortified cereal. c. Fluoride supplements are not recommended during the first 6 months but may be needed thereafter, depending on the water supply. d. Vegan mothers who breast-feed may need to give their infants supplements. 4. Fluid intake for infants must be sufficient to prevent dehydration.

Micronutrient needs - pregnancy

Micronutrient needs of pregnant women are different from those of nonpregnant women. a. Folate is necessary for cell division and is critical during the 28 days after conception. i. Folate deficiency is associated with neural tube defects such as spina bifida and anencephaly. ii. Increasing the folate intake of women of childbearing age to prevent neural tube defects is a goal of Healthy People 2010. b. Vitamin B12 is vital to regenerate active folate. c. Vitamin C is transferred to the fetus for synthesis of collagen and connective tissue. i. Vitamin C deficiency in pregnancy increases risk of premature birth, preeclampsia, and rupture of placental membranes. ii. Smoking during pregnancy lowers serum and amniotic vitamin C and increases the requirement. d. Vitamin A deficiency increases the risk of low birth weight, intrauterine growth retardation, and preterm delivery. i. Excessive preformed or supplemental vitamin A exerts a teratogenic effect. ii. A well-balanced diet supplies sufficient vitamin A. e. Vitamin D requirements do not increase during pregnancy. f. Calcium requirements do not increase during pregnancy. i. Calcium from the diet is more efficiently absorbed during pregnancy. ii. Women who are lactose intolerant can meet their needs with calcium fortified foods. g. Iron requirements are increased to accommodate the expanded maternal blood volume, growing uterus, placenta, and the fetus. i. Fetal demand increases during the last trimester when iron is stored for the first few months of life. ii. Inadequate iron intake most often prompts iron-deficiency anemia in the mother. iii. Severely inadequate iron intake can increase the rate of low birth weight, preterm birth, stillbirth, and death of the newborn. iv. The RDA for iron more than doubles during pregnancy and is typically supplemented. h. Zinc requirements are increased to meet the needs for DNA synthesis, RNA synthesis, and protein synthesis. i. Inadequate zinc leads to malformations in the fetus, premature birth, decreased birth size, and extended labor. ii. Supplemental zinc and iron absorption improve when taken with food. i. Sodium requirements remain the same and iodine requirements increase significantly during pregnancy.

pregnancy - nutrition concerns

Morning sickness is nausea and vomiting during pregnancy. a. Staying hydrated and consuming food as tolerated are the goals of treatment. b. In severe cases, hospitalization or in-home IV therapy may be necessary. 2. Cravings and aversions can occur during pregnancy. a. Cravings are more likely a result of hormonal changes than nutrient deficits. b. Pica is craving nonfood substances and may be rooted in culture or a symptom of iron deficiency. c. Food aversions are common during pregnancy and may originate from social or cultural beliefs. 3. Heartburn and indigestion are common during pregnancy and can be minimized with simple changes. 4. Constipation and hemorrhoids are common during pregnancy and may be avoided with: a. increased fibrous foods b. plenty of fluid c. regular physical activity 5. Gestational diabetes is a temporary condition in which a pregnant woman is unable to produce sufficient insulin or becomes insulin resistant. a. Strict control of blood glucose levels through diet, physical activity, and/or medication prevent any ill effects on the mother or fetus. b. If uncontrolled, it may cause preeclampsia, larger babies, trauma during delivery, and increased risk for type 2 diabetes when the child reaches adolescence or adulthood. c. Women who develop gestational diabetes are at greater risk for developing type 2 diabetes later in life. 6. Hypertensive disorders in pregnancy account for almost 15% of pregnancy-related deaths. a. Preeclampsia is characterized by sudden, high maternal blood pressure, swelling, excessive and rapid weight gain unrelated to food intake, and protein in the urine. b. If left untreated, preeclampsia can progress to eclampsia, a life-threatening medical condition characterized by seizures and kidney failure. c. The cause of these disorders is unknown, but there appears to be a genetic and nutritional connection. i. Deficiencies of protein, vitamin C, vitamin E, calcium, and magnesium seem to increase the risk. ii. Management of preeclampsia includes management of blood pressure, bed rest, and medical oversight. 7. Adolescent pregnancy is subject to greater nutritional risk than pregnancy for adult women. 8. Preexisting medical conditions and excess weight may complicate pregnancy for older mothers with such problems as gestational diabetes and preeclampsia. 9. Vegetarianism can be compatible with a healthy pregnancy if care is taken to get all required nutrients. 10. Dieting to lose weight is not advisable during pregnancy. 11. Consumption of caffeine should be limited to no more than the equivalent of two cups of coffee per day to reduce risk of miscarriage, preterm delivery, and low birth weight. 12. Consumption of alcohol should be avoided during pregnancy to prevent a variety of birth defects. a. Heavy drinking throughout pregnancy results in fetal alcohol syndrome, characterized by malformations of the face, limbs, heart, and nervous system. i. Infant mortality rate is high. ii. Those who live usually suffer with some degree of mental retardation. b. Frequent drinking or occasional binging during pregnancy increases the risk of miscarriage, stillbirth, low birth weight, preterm birth, and sudden infant death syndrome. i. Timing of fetal exposure to alcohol influences the risk of FAS and other complications. c. More subtle consequences of alcohol consumption are known as fetal alcohol effects. i. FAE is a milder set of alcohol-related abnormalities manifested in the child as developmental or behavioral problems. ii. Even small amounts of fetal alcohol exposure can result in more aggressive and delinquent behaviors in children. 13. Maternal smoking greatly increases the risk of poor outcomes of pregnancy. 14. Any use of illegal drugs could harm the development and growth of the fetus. 15. Food safety is a concern for pregnant women and they should avoid: a. foods made with unpasteurized milk b. raw or partially cooked eggs, raw or undercooked meat, fish, and poultry c. unpasteurized juices and raw sprouts d. excessive consumption of large fish and tuna 16. Exercise can enhance the health of a pregnant woman. a. Women should avoid elevating heart rate above 140, unduly elevating body temperature, and the potential for falling or jarring physical impact. b. Certain conditions require that a pregnant woman limit exercise. 17. Low socioeconomic status is a strong predictor of poor pregnancy outcome. a. WIC is a federal program designed to meet the nutritional needs of low-income pregnant women and their young children. b. WIC provides supplemental food, nutrition education, and referrals to the clients it serves. c. WIC has successfully reduced the incidence of low birth weight and infant mortality as well as health care costs among its service population.

pregnancy - suplements

Most health care providers recommend prenatal supplements to help meet all the increased needs. b. Vegans, adolescents, and others with low intakes are usually encouraged to take supplements. 4. Fluid needs of pregnant women increase and help combat fluid retention, constipation, and urinary tract infections.

Nutrition - ageing

Multivitamin & mineral - one- a- day type l Antioxidants l Omega 3 fatty acids l Unproven remedies to be avoided What Can Good Nutrition Do? l Risk Reduction l Lack of it will decrease immune system and brain functions l May not be able to stop aging, but lack of it will decrease quality of life at any age

Hyper behavior

NOT caused by sugar l Too much TV l Overstimulation l Lack of regular activity or sleep l Lack of regular meals l Lack of regular routine l Caffeine

Pregnancy - problems

Nausea l Constipation & Hemorrhoids l Heartburn l Food cravings & aversions l Nonfood cravings

Pregnancy weight gain

Normal wt at conception n 25-35 # (upper end for teens) l Underweight at conception n 28 - 40# l Overweight at conception n 15 - 25#

Breast feeding - nutrients

Nutrient recommendations for breast-feeding women are increased to produce milk. a. Milk production requires about 700 to 800 kcal per day. i. Calories should be increased by 330 above pre-pregnancy need. ii. The remainder of the required calories come from the mother's fat stores. iii. Through nursing and physical activity a gradual weight loss will occur in the mother. b. Protein and carbohydate requirements differ from those of pregnancy. c. The need for several micronutrients increases over the requirements of pregnancy. i. Increased vitamin needs are for A, C, E, riboflavin, B12, biotin, and choline. ii. Increased mineral needs include copper, chromium, manganese, iodine, selenium, and zinc. iii. Folate needs decrease after pregnancy. d. Iron requirements decrease significantly during lactation because there is little iron in breast milk. e. Recommended intake of calcium is unchanged as in pregnancy. 2. Do breast-feeding women need supplements? a. Omega-3 fatty acids should be supplemented or consumed in food. b. Multivitamin/mineral supplementation, especially calcium, is good insurance. 3. Fluid recommendations for breast-feeding women are increased by about one liter per day

Nutrition concerns - infants

Nutrition-related concerns for infants can be frustrating. 1. Allergies can be reduced by breast-feeding, introducing new foods in isolation, and avoiding cow's milk. 2. Colic, or inconsolable crying spells, may have a number of causes and can be treated if necessary. 3. Gastroesophageal reflux results in spitting up and can be avoided by not overfeeding and keeping the infant upright after feeding. 4. Anemia in an infant is treated with specially formulated supplements or iron-fortified formula. 5. Dehydration is life-threatening in infants and must be treated immediately. 6. Nursing bottle syndrome causes tooth decay from prolonged contact of high carbohydrate liquids in the mouth. 7. Lead poisoning can occur if an infant consumes water from lead pipe fittings or lead paint chips.

Mealtimes

Parents are Models l Honor child's preferences l Participation in meal preparation l Avoid power struggle l Avoid foods that may cause choking Division of Responsibility Parent: l Procure, prepare, present the food Child: l Decide how much and even if they are going to eat the food Model Behavior l Schedule meals and snacks l Eliminate interference l Create a pleasant atmosphere for eating l Sit down and eat with the children l Practice good table manners l Eat the same food as the children Model Behavior (cont.) l Prepare and serve a variety of foods l Be aware of portion sizes l No one needs to finish everything l Place no special merit on dessert

Pregnancy - healthful habits

Prenatal care l Balanced diet l Prenatal supplements l Gain healthy amount of weight l Exercise l Avoid: n Smoking n Alcohol n Drugs n Herbs l Limit: n Caffeine n Sugar subs

food choices - amounts

Pyramid plus one serving: n Bread and cereal 7 - 11 n Fruit 3 - 4 n Vegetables 4 - 5 n Milk 3 - 4 n Meat 3

pregnancy - weight gain

Recommendations for weight gain vary according to a woman's weight before she became pregnant. a. Women who have a low pre-pregnancy weight or gain too little weight during pregnancy risk a low-birth-weight or preterm infant and depleting their own nutrient supply. b. Excessive pre-pregnancy weight or gain during pregnancy may result in trauma to the infant during delivery, higher risk of childhood obesity, and difficulty for the mother to lose weight gained during pregnancy. 2. The pattern of weight gain is important, as well. a. Weight gain need during the first trimester is small, increasing to about one pound a week thereafter. b. Weight loss during the pregnancy can affect the successful outcome of the pregnancy. 3. Weight gained during pregnancy includes extracellular fluids, increased blood volume, fat, amniotic fluid, placenta and other tissues as well as the fetus.

Breastfeeding

The body prepares for lactation during pregnancy. a. Alveoli and milk ducts are formed. b. Prolactin, the hormone responsible for milk synthesis, increases toward the end of pregnancy. 2. What happens after childbirth? a. Colostrum is the first substance to be released from the breasts and to be ingested by a suckling infant. i. Colostrum is rich in protein, antibodies, and "friendly" bacteria. ii. Colostrum has a laxative effect to help expel meconium. b. Within 2-4 days colostrum is fully replaced by mature milk. 3. Mother-infant interaction maintains milk production. a. Continued milk production is dependent on sucking or pumping. b. The let down of milk is dependent on the hormone oxytocin.

nutrition critical periods

Times of intense development and rapid cell division l May be irreparable l Malnutrition during critical periods can increase risk for specific diseases later in life

Bottle feeding

Tips for successful bottle-feeding include: a. holding the baby close and making eye contact b. never propping the bottle c. choosing a nipple to fit the infant and tilting the bottle d. paying close attention to the infant's cues for hunger and fullness 9. When do infants begin to need solid foods?

Nutrition - child

Total Kcal needs inc, while kcal/kg dec n Appetite dec around age 1 n 1 yr = about 1000 kcal n 3 yr = about 1300 kcal n 10 yr = about 2000 kcal

Nutrition- birth to 1 year

Typical infant growth and activity patterns 1. During the first year an infant grows about 10 inches in length and triples in weight. 2. The primary use of energy during the first 6 months of life is to support growth. 3. Activity gradually increases from the sixth month through the first year. 4. Growth charts are used to track growth and adequate nutrition. 5. Because growth of the brain is most rapid during the first year, infants' heads are proportionately large.

Weight and Activity - infants

Weight doubles in 4 months l Weight triples in 1 yr l Activity ↑'s after first 6 mo, and growth slows l Second year of life gain less than 10# 100 kcal/kg vs 40 kcal/kg for adult l Water content great in infant l Water adequately supplied by breast milk or formula n except in hot weather or N&V

infant foods - DO NOTS

What not to feed an infant includes: 1. foods that could cause choking 2. corn syrup and honey 3. goat's milk or cow's milk 4. large quantities of fruit juices 5. too much sugar or salt 6. too much breast milk or formula

formula

What types of formula are available? a. Most formulas are based on altered cow-milk proteins. b. Soy-based formulas are available for infants who cannot tolerate milk. c. Specialized formulas are available for specific conditions. d. Cow's milk and goat's milk are not suitable for infants during the first year. 7. Formula preparation is minimal to none. a. Formula should be prepared as directed with no extra dilution. b. Cereal should not be added to the formula.

Infants - solid food

When do infants begin to need solid foods? a. Between 4 and 6 months, infants are developmentally and physically mature enough to consume solid foods. b. If an infant is fed solid foods too soon, starches remain undigested, causing distress, and allergies are more likely. c. First foods should be introduced one at a time and after feeding some breast milk or formula. d. Vegetables are often better tolerated if started before fruits. e. Commercially prepared baby foods are convenient and appropriately formulated. f. Home-prepared baby foods should be made without added salt, spices, or sweeteners.

foods and allergies

n 4 - 6 mo n Weight doubled n Ability to swallow solids n Hold up head n Use tongue to move food to back of mouth Introduction of Foods (cont) l Solid Food (cont): n Consumes 8 oz or more of formula and still hungry n Consumes 32 oz or more of formula/day and wants more n Six months old Introduction of Foods (cont) l Order of foods: n Rice cereal, then others, Fe fortified n Vegetables n Fruits n Meat Allergy Foods l Peanuts l Seafood l Milk l Eggs Intolerance or Allergy l Intolerance - NO immune response l Allergy - Immune response, antibodies produced