NUTRITION IN THE LIFE

STAGES
Nutritional Requirement of Pregnanc
y
1. Nutritive Needs – the recommended increase over
the normal need of the woman to meet the
demands of pregnancy varies from one nutrient
to another (refer to the RENI)
a. to meet the normal requirement of the mother;
b. to meet the nutrient needs of the growing fetus and
other maternal tissues; and
c. for building reserves in preparation for delivery and
lactation
2. Energy – an additional 300 kcal/day during the
2nd and 3rd Tri
 for the growth of the fetus and maternal tissues; ↑
BMR; better CHON utilization

3. Protein - ↑ by 9g/day
 for the growth and support of maternal tissues

4. Vitamin A – RNI of 800μgRE/day

- for the health of epithelial tissues
- excess of vit A causes birth defects such as
hydrocephaly, microcephaly, MR, ear and eye
abnormalities, cleft lip and palate, heart defects
5. Vitamin C – an extra 10mg/day
- to maintain the integrity of fetal membranes and tissue
structure; develop collagen and ↑ absorption of Fe

6. B1,2,3 – additional 0.3mg, 0.6mg and 4mg

respectively
- important in metabolism and RBC production

7. Folate – 600μgDFE/day or additional 200μg/day

- promotes normal fetal growth (DNA synthesis), RBC
maturation, prevention of neural tube defects
8. Calcium – additional 50mg/800mg in total
- promote adequate mineralization of fetal skeleton and
decidous teeth of fetus; for blood clotting and muscle
action

9. Iron – supplementation is needed due to ↑ blood

volume
 to allow build up of Fe stores; allow expansion of RBC
mass; provide for the needs of the fetus and placenta 2

10. Iodine – additional of 50μg/day

- prevent cretinism
E. Concerns During Pregnancy

1. Mild Nausea and Vomiting – occurs during the 1st

Tri due to ↑ hormone production
- if persists, rarely causes hyperemesis gravidarum
- Remedy: ↑ CHO foods such as dry crackers or toast
before rising; eat small frequent meals; fluid taken in
between meals not with meals; avoid foods with
offensive odors
2. Constipation – result of ↓ muscle tone and
motility of GIT and pressure of the fetus on the
lower portion of the intestines
- Remedy: High-Fiber foods; liberal water intake; ↑
mobility; responding immediately to the urge to
defecate

3. Heartburn – due to hypomotility; as fetus grows,

it pushes the stomach upward
- Remedy: small frequent meals; avoiding spicy or greasy
foods; liquids in between meals; rest for 2 hours before
exercising or lying down
4. Hyperemesis Gravidarum – severe and prolonged
vomiting throughout pregnancy; characterized by
dehydration, acidosis, weight loss, avitaminosis,
and jaundice
- Remedy: TPN or EN if tolerated

5. Pica – general craving for non-food items;

Amylophagia (pica for raw rice)
- may limit intake of nutritious foods and/or interfere
with absorption of nutrients; items may contain toxins
or MCQs
- Remedy: identify the item ingested and reason; stress
the importance of an adequate diet and dangers of pica
6. Anemia – condition caused by an insufficiency of RBC, Hgb, or
blood volume; usually caused by Fe and folate deficiency
a. Microcytic hypochromic anemia – deficiency of Fe needed in Hgb
formation; due to ↑ in blood volume
- Remedy: Fe supplementation and Fe-rich foods
b. Megaloblastic anemia – folic acid deficiency; characterized by too
few and large, immature RBC
- Remedy: folic acid supplementation and folic acid-rich foods

7. Neural Tube Defects (NTD) – develops into the spinal cord 18 to 26

days after conception fails to close
a. Ancephaly – errors at the top of the tube affects the brain causing
infant death
b. Spina bifida – errors at the lower end of the spinal cord;
characterized by incomplete closing of the bone surrounding the
spinal cord
- Remedy: eat a balanced diet; multivitamin with folic acid
8. Inadequate Weight Gain – associated with ↑ risk of a LBW
infant
- Remedy: make appropriate diet modifications

9. Excessive Weight Gain - ↑ risk of complications during labor

and child birth; ↑ risk of hypertension or gestational diabetes
- Remedy: dietary counseling and exercise

10. Pregnancy Induced Hypertension (PIH) – formerly called

toxemia or eclampsia; characterized by ↑ BP, proteinuria, and
edema
a. Preeclampsia – HPN with proteinuria, edema, headache,
blurred vision and/or sudden weight gain
b. Eclampsia – extension of eclampsia with convulsive seizures
- Remedy: treatment depending to severity; attention on CHON, E°
and Na
11. Gestational Diabetes- intolerance to CHO that
appears during pregnancy; characterized by ↑
fasting and postprandial glucose concentration
- 40% ↑ risk of developing DM Type 2 in later life of
mother; ↑ risk of physical or mental defects in infant,
stillbirth and macrosomia (BW over 9 lbs)
- Remedy: ↓ E° intake for overweight and obese women
to improve insulin sensitivity; adequate food intake;
blood glucose monitored regularly and urinary
ketones; insulin therapy as required
1. Nutritive Needs – based on amounts supplied by milk

Nutritional Requirements in Infancy

2. Energy - E° requirement per unit of body size is greater in an
infant than adults
- E° is sufficiently met with breastmilk in the 1st 6 mos

3. Protein – requirement are relatively high due to rapid skeletal

and muscle growth
- histidine is essential for infants

4. Vitamin D – vit D supplementation is prescribed for infants

insufficiently exposed to sunlight

5. Vitamin K – 1 mg/kg/BW/day
- supplementation maybe needed due to the absence of intestinal
bacteria producing vit K
6. Vitamin A – 375mgRE/day for growth and allow
storage of vit A

7. Vitamin C – 30 mg/day

8. Calcium-Phosphorus Ratio - 1.3:1

9. Iron – iron stores are sufficient for infants until 6

mos

10. Water – 1.5ml/kcal of E° expenditure

Common Problems and Disorders in Infancy
1. Regurgitation – the effortless expulsion of gastric
contents caused by GI reflux
- Remedy: positioning infant at 45 to 60° angle

2. Colic – acute abdominal pain

- Remedy: eliminating milk in mother’s diet; use of
casein hydrolysate in formula milks
3. Diarrhea – characterized by frequent passage of
loose, watery and unformed stools
- Remedy: continue breastfeeding, give plenty of liquids and
electrolytes for oral rehydration

4. Food Allergy – hypersensitive state resulting from the

interaction of an allergen with an antibody
- Remedy: eliminate the allergen

5. Iron Deficiency Anemia - Remedy: breastmilk has

sufficient Fe content
NUTRITION IN EARLY CHILDHOOD
Nutritional Requirements of Early Childhood
1. Nutritive Needs
a. larger requirement for growth: all foods must contain
CHON, minerals and vitamins
b. higher physical activities → ↑ E° allowance per body
weight
c. food selection and preparation subject to child’s
capacity
2. Energy - ↑ E° needs due to E° needed for basal
metabolism, ↑ activity and ↑ growth of muscle and
adipose tissues
- Rx intake is ≈ 82kcal/kg for 1-3 yrs and 74kcal/kg for 4-6 yrs

3. Protein - ↑ compared to adults/kg BW;

providedemands of skeletal and muscular tissues and
provide protection against infection
- 2.15 and 2.0 g/kg BW for 1-3 and 4-6 yrs, respectively

4. Fat Soluble Vitamins

a. Vitamin A – for growth, epithelial integrity ad
immunity; essential for vision
Feeding Young Children
1. Transitional Foods – transition from an infant
diet to a regular adult diet
a. formation of good eating habits is critical
b. children react more to color, texture and temperature,
size f serving and the attitude and atmosphere in
which food is presented
c. growing children prefer mildly flavored foods, plain
dishes, soft and moist foods, colorful meals, lukewarm
foods, fruits and simple desserts and raw vegetable
2. Meeting the dietary allowance of growing
children
a. follow daily food guides for children
b. provide a variety of foods in every meal
c. use nutrient dense foods served in small frequent
feedings
d. incorporate milk in foods
e. offer nutritious snacks at appropriate times of day
3. Feeding Problems
a. Food Jags – child accepts limited number of foods
b. Dawdling – lingers or dilly-dallies with food
- Reasons: too large portion sizes, may not feel well, tries
to get attention
c. Gagging – feels like vomiting
- Remedy: encourage self feeding; provide colorful, easy
to handle utensils; in a pleasing atmosphere
d. Food Dislikes and or Refusal to Eat – Reasons:
may not like the taste; asserting independence;
want to get attention
- Remedy: combine food with other well liked foods or
prepare the food in a different way

e. Eating Too Much – Reasons: heredity;

temperament; insistence of a “clean plate
 NUTRITION IN MIDDLE
CHILDHOOD
Feeding School Age Children
1. Feeding Problems – mainly due to changing
activity patterns
a. Breakfast is Often Missed – it should provide ¼
or 1/3 of daily nutrient allowance
b. Children Take Their Lunch Away From Home –
children may not finish their meals; swap lunch
with others
- Remedy: prepare more nutritious but appetizing, easy
to eat and varied meals
c. Meals Particularly Breakfast are Taken Hurriedly
– Remedy: awaken child earlier

d. Sweet Tooth – Remedy: sweets should not be

taken near mealtime and emphasis on good oral
hygiene
 NUTRITION IN ADOLESCENCE
Concerns about Adolescents Dietary Intake and
Nutrient Utilization
1. Characterized by ↑ level of physical and emotional
growth → anxiety and stress → affect food behavior
and nutrition
2. Emotional instability influences utilization of
nutrients; (-) N and Ca balances have been observed
among those in extreme emotional stress
3. Socio-physiological changes occur and affect their
nutritional behavior which includes:
a. expression of independence
b. need to assert authority
c. peer acceptance and peer pressure
d. concern for body image and/or physical fitness
e. ↑ in physical activities (sports and athletic activities)

4. Stress the importance of nutrition with physical

development, fitness and health
5. Common Feeding Problems
a. Meal Skipping
b. Snacking – characteristic of their lifestyle; snacks
are often empty caloric
c. Reliance on Fast Foods – fast foods tend to have
empty calories
d. Non-traditional Eating Patterns – eg. eating
organically grown foods, trying fad diets etc
Nutrition Related Problems and Disorders in
Adolescents

1. Iron Deficiency Anemia (IDA) - ↑ risk due to need

for growth and maintenance of body tissues and
for females for menstrual loses
- Remedy: regular monitoring of Fe status and Fe
supplements

2. Iodine Deficiency Disorders (IDD) – teenagers in

endemic region are at ↑ risk
- Remedy: Iodine therapy, eg. iodized sat, iodized oil and
elimination of goitrogens
3. Anorexia Nervosa – psychological disorder more
common in women; a state of emaciation by
voluntary emaciation; emaciation may be in the
form of reducing calorie intake, excessive exercise
- Causes: psychological in nature; inordinate fears of
being fat; some may have been overweight and fears of
regaining lost weight; as means for control; distorted
image to look like fashion models; perfectionist
achievers, which pleases them to deny hunger
- may result in hair loss, low BP, weakness, amenorrhea,
brain damage and even death
- Treatment: Team approach of psychiatric and
nutritional management
4. Bulimia Nervosa – aka Gorge and Purge;
characterized by enormous consumption of food
and then immediately purging or eliminating
food by vomiting or using laxatives and diuretics
- Bulimics have a fear that they cannot stop eating; they
tend to be ↑ achievers who are perfectionist, obsessive
and depressed
- not usually life-threatening but can irritate the
esophagus and cause electrolyte imbalances,
malnutrition, dehydration and dental carries
- Treatment: limiting eating to mealtimes, portion
control, close supervision; psychological therapy
5. Weight Disorders – problems arising from poor
eating habits as a result of a host of factors cited
earlier
- problems range from thinness to over fatness
(adiposity)
- DT: behavioral modification techniques but successful
management depends largely on motivation, maturity
and family support
6. Use of Alcohol, Tobacco and Oral Contraceptives
- alcohol can produce nutritional deficiencies due to ↓
food intake and absorption and altered metabolism of
nutrients
- tobacco can affect food intake and weight status;
smoking alters serum levels of some nutrients eg.
ascorbic acid and ß-carotene
- use of oral contraceptives among female adolescents
may alter serum levels of some nutrients and may ↑
the requirement of folic acid and vit B6
 NUTRITION IN LATER LIFE
Major Nutrition Related Problems
1. Osteoporosis – a bone disease in which the
amount of bone is ↓ but the composition remains
normal
- characterized by ↓ in stature; common among women
in menopausal age
- factors: interplay of hormones, inactivity, dietary,
genetics, and metabolic aspects of Ca, P, CHON, F, and
vit A and D
2. Maturity-Onset Diabetes Mellitus - alteration in
glucose metabolism is observed in aging; glucose
tolerance curve is slower in its return to normal after a
glucose load
- complications are neuropathy, renal disorders and
peripheral vascular disease
- can be controlled by dietary management, weight loss and
oral drug treatment

3. Hypertension – more frequent among adults over 45 y

- if 2°, treatment should be based on underlying cause
- Treatment includes Na restriction and administration of
diuretics and drugs that ↓ BP; if diuretics are used, K
should be monitored
4. Coronary Heart Disease and Atherosclerosis –
result from the interplay of degenerative changes
that occur particularly in the CV system
- cigarette smoking, obesity, HPN and DM ↑ risk to
atherosclerosis and coronary heart disease
- personality type and lifestyle including dietary intake
and physical activity may influence genesis and progress
of the disease
- dietary factors that need to be considered include E°
intake, amount and type of fat, cholesterol and dietary
fiber content
5. Anemia
a. Microcytic, hypochromic or IDA – Fe inadequacy
b. Megaloblastic anemia – Folate Deficiency

6. Food Induced Malnutrition – results from intake of foods

with large amounts of nutrient antagonists; consumption of
alcohol that can affect food intake and impairs nutrient
absorption and utilization

7. Drug-Related Malnutrition
a. Oral Diuretics → (penicillamine) Z depletion → loss of
sense of taste and appetite
b. Aspirin → irritate GI wall and cause bleeding → anemia
c. Antituberculosis drug → (isonazid) antagonist of
pyridoxine
d. Prolonged use of steroids → bone Ca loss → osteoporosis