Life Cycle Nutrition - Talks about the nutrition requirements for an individual in each stage of life from fetus to adulthood

© 2010 Pearson Education, Inc.
Life Cycle Nutrition:
Pregnancy

Stages of Pregnancy and Importance of the
Placenta
 During pregnancy, the diet must support the health of a
woman and her growing baby
 Full-term pregnancy averages 38 weeks from conception to
birth (divided into three trimesters)

Figure 17.1
Stages of Pregnancy and Fetal
Development

Placenta
 Nutrients are delivered to and wastes are transported from
the developing embryo through the placenta
• Prevents passage of red blood cells, bacteria, and many
large proteins from mother to fetus
• Alcohol, drugs, and other potentially harmful substances
can cross the placenta
• Releases hormones required to support the physiological
changes of pregnancy

Placenta
 Critical periods impact fetal development
• Periods of rapid cellular activity are highly vulnerable to
nutritional deficiencies, toxins, and other insults
- Famine associated with a high cumulative incidence of
heart disease
- Inadequate iron during early pregnancy associated
with poor cognitive development
• Metabolic or fetal programming may be able to alter
how genes are expressed during critical periods of
development

Figure 17.3
Critical Periods of Development

Quick Review
 A healthy pregnancy lasts 38 weeks and is divided into
three trimesters
 The placenta is the site through which the developing fetus
accesses the mother’s organ systems for respiration,
absorption, and excretory purposes
 Harmful toxins or inadequate nutrition can cause
irreversible damage to the fetus, especially during critical
periods
 Metabolic programming examines the interaction of the
prenatal environment on genetic and other factors to
produce permanent change

Nutrients and Behaviors Are Important
for a Healthy Pregnancy—The Father
 Before conception, fathers-to-be need to eat well for
healthy sperm production
• Smoking, alcohol and drug abuse, and obesity are
associated with decreased sperm production and function
• Zinc, folate, and antioxidants are associated with healthy
sperm

for a Healthy Pregnancy—The Mother
 Before conception, mothers need to adopt a healthy
lifestyle
• Attain a healthy weight before conception
- Obesity and overweight are associated with infertility,
pregnancy complications, potential birth defects
- Underweight women are at risk of delivering low
birth weight or small for gestational age babies
• Get plenty of folic acid–400 micrograms daily
- Reduces risk of neural tube defects
• Moderate fish and caffeine consumption

for a Healthy Pregnancy—The Mother
• Avoid cigarettes, alcohol, and illicit drugs
- Smoking increases the risk of infertility, a low birth
weight baby, stunted growth or intellectual
development, and sudden infant death syndrome
(SIDS)
- Drinking alcohol during pregnancy can lead to fetal
alcohol spectrum disorders (FASD); pregnant women
are advised to abstain completely from alcohol

for a Healthy Pregnancy
• Managing chronic conditions
- Diabetes, hypertension or sexually transmitted disease
can increase maternal and fetal complications if not
controlled before conception
- Medications may be contraindicated during
pregnancy, so prepregnancy counseling is essential

Quick Review
 Good nutrition and healthy lifestyle habits before
conception are important for both men and women
 Factors such as smoking, alcohol abuse, and obesity
decrease sperm production and function
 Conception is easier for women if they are at a healthy
body weight
 Getting plenty of folic acid, avoiding fish high in
methylmercury, limiting caffeine consumption, avoiding
cigarettes, alcohol and drugs, and managing chronic
conditions are essential for a healthy pregnancy
 Proper nutrition and a healthy lifestyle can prevent birth
defects and may reduce future health risks

Nutrition During the First Trimester
 Morning sickness
• Begins during the first trimester and often ends by the
20th week of pregnancy
• Cause is unknown, but estrogen is thought to play a role
• Small, frequent meals, avoiding an empty stomach, high
carbohydrate foods, ginger, and salty foods combined
with sour and tart beverages help manage nausea
• Vitamin B6 may reduce nausea and vomiting
• In rare cases, women experience hyperemesis
gravadarum, severe vomiting which can lead to
dehydration, electrolyte imbalances, weight loss and may
require hospitalization

 Cravings
• Researchers have not found a physiological explanation
for food cravings
• Pica is the abnormal, compulsive intake of nonedible
items such as laundry starch, burnt matches, clay, dirt,
paint chips, and/or baking soda
- More common in African-American women and
associated with low blood levels of iron

 Avoiding botanicals
• Botanicals are parts of a plant believed to have
medicinal or therapeutic effects
• Herbs such as blue cohosh, juniper, goldenseal and
raspberry tea may cause contractions of the uterus
leading to miscarrage or premature labor

Figure 17.5
Components of Weight Gain During
Pregnancy

 Dietary considerations
• 50% increase in needs for folate, zinc, and iron
• Kilocalorie needs are not significantly increased during
the first trimester
• Focus should be on intake of nutrient-dense foods
• A prenatal supplement is necessary
• Vegetarians and vegans should be mindful of meeting
needs for essential fatty acids and vitamin B12
• Drink milk to meet needs for calcium and vitamin D

 Foodborne illness
• The immune system is weakened during pregnancy, so
mother and baby are at greater risk
• Listeria monocytogenes may cause miscarriage,
premature labor, low birth weight, developmental
problems, or infant death
• Pregnant women should avoid raw or undercooked
meats, fish, or poultry; unpasteurized milk, cheese, and
juices; and raw sprouts

Quick Review
 Women commonly experience morning sickness and
cravings during the first trimester of pregnancy
 Recommended weight gain during pregnancy depends on
prepregnancy weight
 The needs for many nutrients are increased during
pregnancy, but most can be met with a balanced diet
 It is difficult to consume adequate iron from foods during
pregnancy, so a supplement is often prescribed
 Pregnant women should avoid excess amounts of
preformed vitamin A and D
 Risk of foodborne illness is increased during pregnancy, so
women should handle raw foods carefully and avoid certain
raw, undercooked, or unpasteurized foods

Nutrition During the Second Trimester
 Consume adequate kilocalories, carbohydrate, and protein
• An additional 340 kcals daily is needed during the
second trimester
• Need a minimum of 175 grams carbohydrate per day
• Protein needs increase 35% to about 71 grams daily

Activity During the Second Trimester
 30 minutes or more of moderate exercise on most days is
recommended
 Low-impact activities pose less risk for injury to mother or
baby
 Must take care to avoid significant increases in body core
temperature and drink plenty of fluids to avoid dehydration

Complications During the Second
Trimester
 Potential complications: gestational diabetes and
hypertension
 Gestational diabetes occurs when a woman develops high
blood glucose levels during her pregnancy
• May result in macrosomia, jaundice, breathing
problems, birth defects, or hypoglycemia after birth
• Eating healthfully, maintaining a healthy weight, and
exercising regularly can reduce risk

Complications During the Second
Trimester
 Pregnancy-induced hypertension includes three
categories
• Gestational hypertension – occurs early in pregnancy in
women with no history of hypertension
• Preeclampsia – characterized by hypertension, severe
edema and protein losses in the urine; deprives fetus of
oxygen and nutrient rich blood from the placenta
• Eclampsia – can cause seizures and is a major cause of
death of women during pregnancy
 The only cure for preeclampsia and eclampsia is to deliver
the baby

Quick Review
 Pregnant women need to consume an additional 340 kcals
during the second trimester
 Exercise can provide numerous benefits during pregnancy,
but should be limited to low-impact activities to reduce risk
of injury to Mom or baby
 Complications that often appear during the second trimester
of pregnancy include gestational diabetes and pregnancy
induced hypertension; women with these conditions should
be closely monitored by a health care professional

Nutrition During the Third Trimester
 Eating frequent small meals and a high-fiber diet can help
with heartburn and constipation
• An extra 450 kcals are needed during the third trimester
• The growing baby exerts pressure on the Mom’s
intestines and stomach which can cause heartburn
• Hormonal changes slow movement of food through the
GI tract which may cause constipation

Special Concerns of Younger or Older
Mothers-to-Be
 Teenage mothers
• Still growing, therefore nutrient needs are even higher
than an adult woman, yet more likely to have an
unbalanced diet
• More likely to develop pregnancy-induced hypertension,
iron-deficiency anemia, and deliver premature babies
 Older mothers
• Higher risk for complications including gestational
diabetes and pregnancy-induced hypertension
• Babies are more likely to have Down syndrome or other
developmental disabilities

NUTRIONAL NEEDS DURING LACTATION

Breast-Feeding
 Lactation
- A physiological process of female mammals that occurs right
after pregnancy when a mother’s breast secrets milk and
suckles the offspring
• The “breast is best” when nourishing an infant

Figure 17.8
The Letdown Response

Composition of Breast Milk
 Nutrients
Breastmilk contains all the nutrients the infant needs for proper growth
and development
 Free water
 Proteins – Protein accounts for 75% of the nitrogen-containing
compounds and the non-protein nitrogen substances include urea,
nucleotides, peptides, free amino acids and DNA.
 Fats – Essential fatty acids and long-chain polyunsaturated fatty
acids
 Carbohydrates – The principal carbohydrate of human milk is
lactose.
 Minerals, vitamins, and trace elements.

Key Nutrients Found in Breastmilk
Component
Mean value for mature breastmilk (per
100mL)
Energy (kJ) 280
Energy (kcal) 67
Protein (g) 1.3
Fat (g) 4.2
Carbohydrate (g) 7.0
Sodium (mg) 15
Calcium (mg) 35
Phosphorus (mg) 15
Iron (mcg) 76
Vitamin A (mcg) 60
Vitamin C (mg) 3.8
Vitamin D (mcg) 0.01
Source: NHMRC Dietary Guidelines for
Children and Adolescents in Australia,

Composition of Breastmilk
 Non-nutritional components such as:
• Antimicrobial factors
• Digestive enzymes
• Hormones and growth factors
• These are important for passive protection against
infections and immune-mediated diseases and modulate
immunological development

Composition of Breastmilk
 Immune-related components and growth factors
include:
 Secretory IgA – Predominant immunoglobulin in breast
milk
 Bioactive cytokines – Including transforming growth
factor-b (TGF-b) 1 and 2 and interleukin-10 (IL-10)]
 Others – leukocytes, oligosaccharides, lysozyme,
lactoferrin, adiponectin, interferon-g, epidermal growth
factor (EGF) and insulin-like growth factor (IGF)-1.

Composition of Breastfeeding
- colostrum contains antibodies and white blood cells which protect
the newborn from infections
- Breast milk also contains bifidus factors, which favor the growth
of the “friendly” bacterium Lactobacillus bifidus in the infant’s
digestive tract, so that other, harmful bacteria cannot become
established
- It also protects against allergies

Benefits of Breast-Feeding
 Breast-feeding provides nutritional and health benefits for
infants
• Nutritional composition of breast milk changes as the
infant grows
• Colostrum is lower in fat, higher in protein, vitamin A,
minerals, and antibodies
• Breast milk is high in lactose, fat, B vitamins and lower
in fat-soluble vitamins, sodium, and other minerals
• The American Academy of Pediatrics recommends
supplementing breast-fed babies with vitamin D drops to
meet needs

Benefits of Breast-Feeding
 Breast-feeding protects against infections, allergies, and
chronic disease and may enhance brain development
• Provides beneficial compounds including antioxidants,
hormones, enzymes, and growth factors
• If continued beyond six months, may reduce risk of
childhood obesity
• Breast milk is rich in docosahexaenoic acid (DHA) and
arachidonic acid (AA) which are important for
development of vision and the central nervous system

Benefits of Breastfeeding for Mother
 Contracts the uterus
 Delays the return of regular ovulation, thus
lengthening birth intervals (is not, however, a
dependable method of contraception)
 •Conserves iron stores (by prolonging amenorrhea)
 May protect against breast and ovarian cancer and
reduce the risk of diabetes (type 2)

Benefits of Breastfeeding
 Cost savings from not needing medical treatment for
childhood illnesses or time off work to care forthem
 Cost savings from not needing to purchase formula
(even after adjusting for added foods in the diet of a
lactating mother)
 Environmental savings to society from not needing
to manufacture, package, and ship formula and
dispose of the packaging
 Convenience of not having to shop for and prepare
formula

Duration of Breastfeeding
 Breastmilk can be provided exclusively for around the first
6 months, meeting all of the Infants nutritional needs
 Once complementary foods are introduced breastmilk
continues to provide important nutrients and growth factors
up to 2 years.
 The WHO recommends breastmilk continue to be part of
the young child’s diet, to 2 years of age and beyond.

Maternal Energy and Nutrient During
Lactation
 Energy Intake
• A pregnant woman produces about 600ml of milk
each with variation from woman to woman and in
the same woman from time to time, depending
primarily on the infants demand for milk
• To produce adequate supply, a woman needs extra
energy – about 500Kcalories above her regular
needs during the first six months of lactation

Maternal Energy Needs During Lactation
To meet this need:
 She can eat extra 330Kcalories of food each day and let
the fat reserves accumulated during pregnancy provide
the rest
 Energy Nutrients
 Protein and fatty acid intake remain the same during
lactation as during pregnancy
 Nursing mothers need additional carbohydrate to
replace the glucose used to make lactose in the breast
milk
 Fibre intake also increases by 1 gram

Maternal Vitamin and Mineral Needs During
Lactation
 Calcium - Vitamin A:
 1200mcg
RDA :1300mg RDA: 1200mcg
 Potassium -Vitamin C
RDA : 5100mg RDA: 115mg
 Zinc
RDA: 14mg
 Iodine
290mcg

Nutritional Needs During Lactation
 Water
 A mother who drinks more fluids does not produce more
milk but to prevent dehydration
 She must drink a glass of water, juice or soup at each
meal or anytime the baby nurses
 Particular foods
 A nursing mother can eat whatever nutritious foods she
chooses
 But she can eliminate foods that cause discomforts to
babies

Factors Affecting Lactation
 Maternal Weight:
 Women who are obese prior to pregnancy have
difficulty initiating and continuing breastfeeding and
producing sufficient milk
 Difficulty getting infants to latch on adequately to
breast and positioning them properly to feed
 Low milk supply due to inadequate release of prolactin
 Cesarean deliveries delay first suckling

 Maternal Age
 Infants breastfed by adolescents mothers may grow more
slowly than infants of older mother
 Teens can breastfeed their infants successfully by ensuring
that their nutrient needs and that of their infants are
adequately supplied
 Maternal Eating Patterns
 A nutritious diet is the best choice for a breastfeeding mother
and her infant

 Maternal Health and Infant Health
Breastfeeding may be ruled out by certain medical conditions in either
the infant of mother
 HIV Infection and AIDS
 Mothers with HIV infections are advised not to breast feed their
infants
 Transmission of HIV to infants is reduced when HIV exposed
mothers and their infants receive antiretroviral drugs
 Breastfeeding may be detrimental to infants with inborn errors of
metabolism such as phenylketonuria and galactosemia

Maternal and Infant Health
 The compatibility of chronic and infectious diseases with breastfeeding
must be considered because medications and infectious agents can be
transmitted to the baby via the mother’s milk
 Serious infectious diseases tuberculosis and hepatitis C can be life
threatening and so it may be safer if nursing is eliminated
 Chronic diseases incompatible with nursing include cancer being treated
with chemotherapy and psychiatric conditions treated with lithium
 Breast surgery may affect a woman’s ability to produce milk or secrete it

Maternal Lifestyle Choices Incompatible with
Lactation
 Alcohol Consumption:
 This may alter flavour of breast milk
 Infants metabolize alcohol inefficiently and low doses can
suppress feeding and cause sleepiness
 Alcohol may interfere with lactation by inhibiting the
hormone oxytocin

Maternal Lifestyle Choices Incompatible with
Lactation
 Medicinal Drugs
 Nursing mothers must consult their physician prior to taking any drug
including herbal supplements
 Illicit drugs
 Can cause irritability, tremors, hallucinations and even death in infants
 Smoking
 Cigarette smoking reduces milk production
 Breast milk produces by smokers contain nicotine which alters its
smell and flavour
 Infants of smokers gain less weight

Life Cycle Nutrition: Infancy

Learning Objectives
By the end of the lecture, students should be able to:
 Understand physiologic developments that occur during
infancy
 Relate the physiological developments to nutrient needs of
infants
 Explain the principles of complementary feeding
 Plan four star diets for infants

Physiologic Development
 The first two years of life is a time of rapid growth and
development
 Many changes occur that affect feeding and nutrient intake
 A healthy infant’s birthweight doubles by 4 to 6 months of
age and triples by one year
 The length of an infants is increased by 50% in the first year
and doubled by 4 years

Physiological Development
 The stomach of an infant increases from a range of 10ml to
20ml at birth to 200ml by 1 year, enabling them to consume
more food at given time and at less frequent intervals as
they grow
 The length of gestation, the mothers prepregnancy weight
and mothers weight gain during pregnancy determine an
infants birth weight
 After birth, the growth of an infant is influenced by
genetics and nourishment

Nutrient Requirements
 Energy
 Not only do infants grow rapidly, but their energy
requirement is remarkably high
 A new born baby requires about 450 kcalories per day
 Carbohydrates provide energy to all the cells of the body,
especially those in the brain, which depend primarily on
glucose to fuel activities
 An infant’s brain uses relatively more glucose than the
other parts of the body—about 60 percent of the day’s total
energy intake
 Carbohydrate should provide about 30% to 60% of energy
intake of infants

Energy Requirements
 Fat provides most of the energy in breast milk and standard infant
formula
 Infants younger than 1 year should consume 30g of fat per day
 Its high energy density supports the rapid growth of early infancy
 Protein is very essential to the growth of infants
 All of the body’s cells and most of its fluids contain protein
 It is the basic building material of the body’s tissues
 Excess dietary protein can cause problems, too, especially in a
small infant. Too much protein

Energy Requirements
 Too much protein stresses the liver and kidneys, which
have to metabolize and excrete the excess nitrogen
 The adequacy of an infants energy intake is determined by
monitoring gains in weight, length, head circumference and
weight-for-length for age plotted on growth charts
 Energy requirements
- Age Calculation
0-3 months (89×weight of infant (Kg)- 100) + 175

Energy Requirements
Protein Dietary Reference Intake for infants
Age Grams/Day Grams/Kg/day
0-6 months 9.1 1.52
6- 12 months 11 1.2

 Water
- 0.7L/day for infants up to 6 months
- 0.8L/day from 6 months to 12 months of age
- Total water includes all water contained in foods, beverages
and drinking water
 Calcium
- Adequate intake is 200mg/day for 0 to 6 months infants
- 260mg/day for 6 to 12 months infants
 Fluoride
- Upper levels of 0.7mg/day for infants 0 to 6 months
- - 0.9 mg/day for infants 6 to 12 months

Feeding Infants
 Human Milk
- Breast milk excels as a source of nutrients for infants
- Its unique nutrient composition and protective factors promote
optimal infant health and development throughout the first year of
life
 Frequency and Duration of Breastfeeding
- Breast milk is more easily and completely digested than formula, so
breastfed infants usually need to eat more frequently than formula-
fed infants do
- During the first few weeks, approximately 8 to 12 feedings a day,
on demand

Breastfeeding
 Energy Nutrients
-The carbohydrate in breast milk (and infant formula) is the
disaccharide lactose
- In addition to being easily digested, lactose enhances calcium
absorption
- The amount of protein in breast milk is less than in cow’s
milk, but this quantity is actually beneficial because it places
less stress on the infant’s immature kidneys to excrete the
major end product of protein metabolism, urea
- Much of the protein in breast milk is alpha-lactalbumin,
which is efficiently digested and absorbed

Breastfeeding
- Breast milk contains a generous proportion of the essential fatty
acids linoleic acid and linolenic acid, as well as their longer-chain
derivatives arachidonic acid and DHA (docosahexaenoic acid)
- Arachidonic acid and DHA are found abundantly in both the retina
of the eye and the brain
- Research has focused on the visual and mental development of
breastfed infants and infants fed standard formula without DHA
and arachidonic acid added
- Breastfed infants generally score higher on tests of mental
development than formula-fed infants do

Breastfeeding
 Vitamins
- With the exception of vitamin D, the vitamins in breast milk are
ample to support infant growth
- The vitamin D in breast milk is low, and vitamin D deficiency
impairs bone mineralization
- Vitamin D deficiency is most likely in infants who are not exposed
to sunlight daily, have darkly pigmented skin, and receive breast
milk without vitamin D supplementation
 Minerals
- The calcium content of breast milk is ideal for infant bone
growth, and the calcium is well absorbed
- Breast milk contains relatively small amounts of iron,

Breastfeeding
- Breast milk contains relatively small amounts of iron, but the iron
has a high bioavailability
- Zinc also has a high bioavailability
- Breast milk is low in sodium which is beneficial for immature
kidneys
 Immunological Protection
- In addition to nutritional benefits, breast milk offers immunological
protection
- Not only is breast milk sterile, but it actively fights disease and
protects infants from illnesses

Breastfeeding
- colostrum contains antibodies and white blood cells which protect
the newborn from infections
- Breast milk also contains bifidus factors, which favor the growth
of the “friendly” bacterium Lactobacillus bifidus in the infant’s
digestive tract, so that other, harmful bacteria cannot become
established
- It also protects against allergies

Infant Formula
 Infant Formula Composition
-Formula manufacturers attempt to copy the nutrient composition of
breast milk as closely as possible
 Risks of Formula Feeding
- Infant formulas contain no protective antibodies for infants
- In general, vaccinations, purified water, and clean environments in
developed countries help protect infants from infections
- Formulas can be prepared safely by following the rules of proper
food handling and by using water that is free of contamination
 Contaminated formulas often cause infections, leading to
diarrhea, dehydration, and malabsorption

Infant Formula
 Special Formulas
 -Standard cow’s milk-based formulas are inappropriate for
some infants.
 Special formulas have been designed to meet the dietary
needs of infants with specific conditions such as
prematurity or inherited diseases
 Infants allergic to milk protein can drink special
hypoallergenic formulas or formulas based on soy protein
- soy-based formulas for vegetarians and infants with
galactosemia or hereditary lactase deficiency

Introducing Cow’s Milk
 Whole cow’s milk is not appropriate during the first year
 Children one to two years of age should not be given reduced- fat,
low-fat, or fat-free milk routinely; they need the fat of whole milk
 In some infants, particularly those younger than six months of age,
whole cow’s milk may cause intestinal bleeding, which can lead to
iron deficiency
 Cow’s milk is also a poor source of iron. Consequently, it both
causes iron loss and fails to replace iron

Introducing Solid Foods/ Complementary Feeding
 The addition of foods to an infant’s diet should be governed
by three considerations:
 the infant’s nutrient needs
 the infant’s physical readiness to handle different forms of
foods
 the need to detect and control allergic reactions.

Complementary Feeding
 The process of introducing liquids and foods to infants
along with breast milk when that alone is no longer
sufficient to meet their nutritional requirements
 PRINCIPLES
1. Duration of exclusive breastfeeding and age of introduction
of complementary foods
 Practice exclusive breastfeeding from birth to 6 months of
age
 Introduce complementary foods at 6 months of age (180
days) while continuing to breastfeed.

Principles of Complementary Feeding
2. Maintenance of breast feeding
 Continue frequent, on-demand breastfeeding until 2 years
of age or beyond
3. Responsive Feeding
 An active and interactive process
 Parents pay attention to baby's signals for hunger and
fullness
a) feed infants directly and assist older children when they
feed themselves, being sensitive to their hunger and satiety
cues

Responsive Feeding
b) feed slowly and patiently, and encourage children to eat, but
do not force them
c) if children refuse many foods, experiment with different
food combinations, tastes, textures and methods of
encouragement
d) minimize distractions during meals if the child loses interest
easily
e) remember that feeding times are periods of learning and
love - talk to children during feeding, with eye to eye contact

4. Safe preparation and storage of complementary foods
 Practice good hygiene and proper food handling by:
a) washing caregivers’ and children’s hands before food preparation
and eating
b) storing foods safely and serving foods immediately after preparation
c) using clean utensils to prepare and serve food
d) using clean cups and bowls when feeding children
e) avoiding the use of feeding bottles, which are difficult to keep clean

5. Amount of complementary food needed
 Start at six months of age with small amounts of food and
increase the quantity as the child gets older, while
maintaining frequent breastfeeding
 The energy needs from complementary foods for infants
with “average” breast milk intake in developing countries
are approximately:
- 200 kcal per day at 6-8 months of age
- 300 kcal per day at 9-11 months of age
- 550 kcal per day at 12-23 months of age. (WHO/UNICEF,
1998)

6. Food consistency
 Gradually increase food consistency and variety as the infant gets
older, adapting to the infant’s requirements and abilities
 Infants can eat pureed, mashed and semi-solid foods beginning at
six months
 “Finger foods” (snacks that can be eaten by children alone) at 8
months
 Family foods by 12 months
 Avoid foods that may cause choking (i.e., items that have a shape
and/or consistency that may cause them to become lodged in the
trachea, such as nuts, whole grains and nuts, raw carrots, popcorn)

7. Meal frequency and energy density
 Increase the number of times that the child is fed
complementary foods as he/she gets older
 The appropriate number of feedings depends on the energy
density of the local foods and the usual amounts consumed
at each feeding
 For the average healthy breastfed infant, meals of
complementary foods should be provided:
 2-3 times per day at 6-8 months of age

7. Meal Frequency and Energy Density
 3-4 times per day at 9-11 and 12-24 months of age with
additional nutritious snacks (such as a piece of fruit or
bread with nut paste) offered 1-2 times per day, as desired.
 If energy density or amount of food per meal is low, or the
child is no longer breastfed, more frequent meals may be
required.

8. Nutrient content of Complementary foods
 Feed a variety of foods to ensure that nutrient needs are
met.
 Meat, poultry, fish or eggs should be eaten daily, or as often
as possible
 Vegetarian diets cannot meet nutrient needs at this age
unless nutrient supplements or fortified products are used
 Vitamin A-rich fruits and vegetables should be eaten daily
 Provide diets with adequate fat content
.

8. Nutrient Content of Complementary Foods
 Avoid giving drinks with low nutrient value, such as tea,
coffee and sugary drinks such as soda
 Limit the amount of juice offered so as to avoid displacing
more nutrient rich foods

9. Use of vitamin-mineral supplements or fortified products for
infant and mother
 Use fortified complementary foods or vitamin-mineral
supplements for the infant, as needed (esp for vegetarians)
.

10. Feeding during illness
 Increase fluid intake during illness, including more
frequent breastfeeding
 Encourage the child to eat soft, varied, appetizing, favorite
foods
 After illness, give food more often than usual and
encourage the child to eat more

Nutrient Needs from Childhood through
Adolescence

Learning Objectives
By the end of the lecture the student should be able to:
 Enumerate the nutrient needs of children and adolescents
 Safety precautions to implement when introducing
complementary foods
 Outline the causes of obesity in children and how it can be
prevented and managed

Toddlers versus Preschoolers
 Toddlers
• 1–3 years old
• Growth rate is high, but slower than infancy
- Age 2: Gain 3–5 pounds, 3–5 inches
 Preschoolers
• 3–5 years old
• Need same nutrients as adults, but have
- Lower energy needs
- Smaller appetites
- Smaller stomachs

Eating Patterns and Nutrient Needs
 Young children need to eat frequent, small meals and
nutrient-dense foods
• Energy needs: 1,000–1,600 kcal per day
• Appropriate portion sizes
- Child-sized plates and cups
- “Mini”-sized food items

Food Safety
 Avoid choking hazards
• Offer bite-sized pieces of food
• Limit availability of
- Hot dogs
- Nuts or seeds
- Chunks of meat, cheese, or peanut butter
- Whole grapes or raisins
- Hard candy or gum
- Popcorn
- Raw vegetables

Nutrient Needs
 Carbohydrate
• At least half of grain intake should be from whole grains
• Fiber recommendations:
- Ages 1–3 years = 19 grams
- Ages 4–8 years = 25 grams

Nutrient Needs
 Protein
• RDA (toddlers) = 1.1 grams per kilogram of body weight
• RDA (school-age) = 0.95 grams per kilogram of body
weight
 Fat
• Ages 2–3 years old = 30–35% of kilocalories from fat
• Age 4 and over = 25–35% of kilocalories from fat

Nutrient Needs: Calcium and Iron
 Calcium
• Necessary for healthy bone development
• Ages 1–3 years need 500 milligrams per day
- 8 ounces of milk provides 300 milligrams
 Iron
• Necessary during periods of rapid growth
• Good sources of iron for children include lean meats,
beans, and iron-fortified cereals
• Cow’s milk is a poor source of iron

Iron: Deficiency versus Toxicity
 Deficiency (Anemia)
• Most common nutrient deficiency in young children
• Can lead to developmental delays
• Exacerbates attention deficit hyperactivity disorder
• Associated with lead poisoning
 Toxicity
• Leading cause of death in children under age 6
• Occurs because iron can build up in tissues and organs
- Ingesting 200 milligrams of iron can be fatal

Nutrient Needs
 Vitamin D
• American Academy of Pediatrics recommends
- Ages 1–8 years consume 10 micrograms (400 IU) of
vitamin D per day
- Sources include fortified milk, egg yolk, and some fish
- Two 8-oz glasses of milk only provides half of the
recommended intake
- Supplements or fortified cereals may be needed

Nutrient Needs
 Young children need nutrient-dense beverages
• Fluid recommendations are based on body weight
- Drinking too much fluid may reduce fiber or iron
intake
• Preferred beverages include water and milk
• 100% fruit juice can be provided in moderation
• Soda and sugary drinks should be avoided

Food Behaviors
 Eating habits form early in life
• Children will adapt to foods offered to them
 A variety of food should be offered to young children
• A child may need to be exposed to a new food at least 10
times before accepting it
 Division of responsibility
• Parents = What, when, and where food is offered
• Child = Whether or not to eat, and how much
 “Cleaning the plate” may encourage overeating

Food Preferences
 Parents have strong influence over children’s food
preferences
• Children model after adult behaviors, both healthy and
unhealthy
• Including young children in food shopping, menu
planning, and meal preparation can encourage variety in
their food consumption

Food Preferences
 Picky eating and “food jags” are common in young
children
• Picky eating – not wanting to try new food
• Food jags – tendency to eat only a small selection of
food
- Very common and normal, but also temporary
- Can be identified through a food diary
- Long-term jags increase risk of nutrient deficiency
- Solutions include
- Offering a variety of food items within the
preferred food type
- Gradually weaning the child from the food item

Vegetarianism
 Young children can grow and develop normally on a well-
balanced vegetarian diet
• Vegetarian foods such as beans, nuts, seeds, and whole
grains are high in fiber
- Multiple servings per day may exceed a young child’s
fiber needs
• Good sources of calcium, iron, and zinc need to be
included in the diet
• Supplementation of vitamin B12 may be necessary

School-Aged Children
 Ages 6–12 years
 Are not fully grown
• Each year, gain about 7 pounds and 2.5 inches
 Compared to toddlers and preschoolers they
• Do not eat as many times per day
• Tend to be less hungry (maintain blood glucose longer)
• Can eat more food at each sitting
 Can impact healthy development through dietary choices
 Continue to develop habits based on modeling adult
behaviors

Quick Review
 Toddlers grow at a slower rate than infants, and have
smaller appetites
 Frequent, small meals may be needed to provide adequate
kilocalories, macronutrients, calcium, iron, and vitamin D
 Appropriate beverages include water, milk, and 100% fruit
juice
 Small portion sizes should be encouraged, while “cleaning
the plate” should be discouraged
 A variety of foods should be offered, and parents should
serve as role models for healthy eating
 “Food jags” are normal and usually temporary

Child Obesity
 Body Mass Index (BMI) is the measurement tool used to
determine weight status
• For children, the categories are
- Overweight = BMI ≥ 95th percentile
- At risk for overweight = BMI ≥ 85th percentile

Child Obesity
 What is considered child obesity?
• Condition of a child’s having too much body weight for
his or her height.
• The use of the word “obese” to describe children is
controversial
 What causes child obesity?
• Genetics: Only a small percent of cases
• Environment: Excess kilocalories, inadequate exercise
• Obese parents
• Prenatal overnutrition

Child Obesity: Excess Kilocalories
 Sources include
• Regular soda, candy bars, potato chips
- Many of these products are sold within school
buildings through vending machines or the cafeteria
- Also available in most convenience stores and
shopping centers
- Typically replace healthy options such as milk, water,
or fresh fruits and vegetables
• Increased portion sizes at meals and snacks
- Occurs both within and outside of the home

Child Obesity: Food Preferences
 High sugar and high-fat foods are often preferred by
school-aged children
• This could lead to an excess kilocalorie intake
 These preferences are formed by
• Overexposure to television advertisements featuring
appealing characters or famous spokespeople
• Modeling of parent or sibling eating behavior

Child Obesity: Inadequate Physical
Activity
 Low levels of exercise occur in school-aged children due to
• Increased “screen time” – exposure to a television,
computer, or video games
• Less access to physical education in schools
• Increased use of a car for transportation

Child Obesity: Prevention
 American Academy of Pediatrics recommendations
• Parents must ensure their children receive adequate
nutrients without excess kilocalories
• A variety of healthy food must be offered to children
• “Screen time” must be limited to two hours or less per
day

Child Obesity: Treatment
 Weight loss is not recommended for overweight children
 Weight maintenance allows for healthy growth
 Increased physical activity is encouraged

Figure 18.3
MyPyramid for Kids
 A visual tool for children and parents to understand healthy
eating

MyPyramid for Kids
 Key messages
• Be physically active every day
• Choose healthier foods from each group
• Eat more of some food groups than others
• Eat foods from every food group every day
• Make the right choices for you
• Take it one step at a time

The Role of Breakfast
 Eating breakfast may be associated with healthy body
weight among children and adolescents
 Many schools with the National School Lunch Program
also offer a school breakfast
 Eating breakfast may benefit
• Cognitive function, including memory
• Academic performance
• School attendance
• Psychosocial function
• Mood

Adolescence
 Developmental period between childhood and adulthood
• Ages 9–19 years
• Physical changes occur, including a growth spurt
- Height increases
- Weight increases due to bone growth and gains in lean
body mass and body fat stores
• Hormonal changes occur including the onset of
menstruation for females
• A healthy diet is necessary at this time to ensure
adequate nutrients, especially kilocalories, protein,
calcium, and iron

Nutrition-Related Behaviors
 Desire for independence and individuality
• Making own food choices
• Having own transportation to access food
 Influence of peers, media, and nonparent role models
• Exposure to unrealistic or unsafe eating practices
• May lead to adoption of damaging habits

© 2010 Pearson Education, Inc. Figure 18.4
Nutrient Needs: Calcium
 ½ of peak bone mass
accumulates in adolescence
 AI for calcium = 1,300 mg
for ages 9–18 years
• Inadequate calcium
intake can lead to low
peak bone mass and is a
risk factor for
osteoporosis

Nutrient Needs: Iron
 Additional iron supports muscle growth and increased
blood volume
• Adolescent females need iron to support menstruation
 RDA for iron
• Females aged 14–18 years = 15 milligrams
• Males aged 14–18 years = 11 milligrams
 Iron deficiency is common in adolescence, especially
among individuals who limit intake of enriched grains, lean
meats, and legumes

Disordered Eating
 Disordered eating patterns are more prevalent in adolescent
females than males
• May be linked with poor body image or low self-esteem
 Teens often adopt unhealthy habits such as
• Skipping meals
• Using food substitutes
• Taking diet pills or nutritional supplements
• Purging through vomiting, laxatives, or diuretics
 Eating family meals promotes healthy eating patterns

Putting It All Together
 Toddlers and preschoolers benefit from eating frequent,
small meals consisting of nutrient-dense meals
 Exposure to a variety of healthy foods is necessary to
promote good nutrition
 Picky eating and “food jags” are common, temporary
behaviors
 In childhood, obesity may result from overconsumption of
kilocalories, especially in the form of soda or candy
 Parents can serve as good role models by choosing healthy
foods for themselves at family meals
 Adolescence is characterized by a growth spurt which
increases calcium and iron needs
 A teenager’s eating habits may be influenced by peers or
the media

Learning Objectives
By the end of the lecture, students should be able to:
 Describe the nutritional needs of adults
 Describe lifestyle behaviours that promote health among adults

Nutritional Needs of Adults
 Adulthood is reached when both physical and emotional maturity are
achieved
 Stages of adulthood:
-Young Adulthood: late teens to mid 40’s
- Middle Adulthood: 45 through mid 60’s
- Older adulthood: 65 and above

Terms
 life expectancy: the average number of years lived by people in
a given society. The life expectancy for Ghanaians is 62.4 years
 life span: the maximum number of years of life attainable by a
member of a species

Nutritional Needs
 Growth and maturation are complete by early adulthood
 The main focus with regards to nutrition is maintaining a healthy and active
life style and preventing diet-related health diseases such as:
- type 2 diabetes
- cardiovascular diseases

Nutrient Needs
 Wise food choices, made throughout adulthood, can support a person’s ability to meet:
- Physical
- Emotional
- mental challenges
- and to enjoy freedom from disease
 Two goals motivate adults to pay attention to their diets:
-promoting health
- slowing aging

 Energy
 Energy needs of adults are based on age, height, weight, gender and physical activity level
 The Harris Benedict Energy Estimation formula
Males: RMR = 66.5 + (13.75 × wt) + (5 × ht) – (6.8 × age)
Females: RMR = 665 + (9.6 × wt) + (1.8 ×ht)- (4.7 × age)
Note: weight is in kilograms, height is in centimeters, age in years
 RMR – Resting metabolic rate

 Protein
 The protein requirement for adults is 0.8g per kilogram body weight
 Carbohydrates
 Most of their carbohydrate intake must be from whole grains
 Fibre recommendations are 25g for women and 38grams for men
 Increasing wholegrains, fruits and vegetable intake will help them meet the
recommendations
 Fats
 Fat should contribute 25 to 35% of their daily energy intake
 Their fat intakes should largely be from the poly and mono unsaturated sources
 Reduce intake of trans fats

 Iron
 The requirement for women is higher than men until menopause
 Folic Acid
 Adult women must consume folic acid supplements
 Calcium
 Requirement for adults 19 to 50years is 1000mg/day
 Vitamin D
 Requirement for adults is 5µg/day

Healthy Habits
Lifestyle behaviors that have great influence on people’s health:
 Sleeping regularly and adequately
 Eating well-balanced meals, including breakfast, regularly
 Engaging in physical activity regularly
 Not smoking
 Not using alcohol, or using it in moderation
 Maintaining a healthy body weight

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