NCM 105: NUTRITION AND DIET THERAPY

MIDTERMS
Unit Five. NUTRITION THROUGHOUT THE
LIFESPAN
Chapter 1: Pregnancy
A. Stages
B. Nutritional Problems and Interventions
C. Recommended Diet

Chapter 2: Lactation
A. Common Nutritional Problems
B. Recommended Diet

Chapter 3: Infancy
A. Recommended Diet
B. Factors Affecting Nutritional Status
C. Guidelines in Feeding
D. Nutritional Problems and Intervention

Chapter 4: Toddlers
A. Nutritional Problems and Interventions
B. Guidelines in Feeding
C. Recommended Diet

Chapter 5: Pre-School and Schoolers

A. Nutritional Problems and Interventions
B. Guidelines in Feeding
C. Recommended Diet

Chapter 6: Adolescent
A. Nutritional Problems and Interventions
B. Recommended Diet

Chapter 7: Adulthood
A. Nutritional Problems and Interventions
B. Recommended Diet

Chapter 8: Elderly
A. Nutritional Problems and Interventions
B. Recommended Diet

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 NCM 105: NUTRITION AND DIET THERAPY

MIDTERMS
UNIT FIVE. NUTRITION THROUGHOUT THE LIFESPAN

CHAPTER 4: TODDLERS
A. NUTRITIONAL PROBLEMS AND INTERVENTIONS
Feeding toddlers (ages 1 to 3) can often be challenging. That's because several developmental
changes are happening at this time. Toddlers are striving for independence and control. Their growth
rate slows down and with this comes a decrease in appetite. These changes can make mealtime
difficult. It's important for parents to provide structure and set limits for the toddler. These suggestions
can help manage mealtimes so that your toddler gets the nutrition they need:
• Avoid battles over food and meals.
• Provide regular meals and snacks.
• Be flexible with food acceptance as toddlers are often reluctant to try new things. If your toddler
refuses a food, don't make a big deal out of it. Try again in a few days or weeks.
• Be realistic about food amounts. Portion size should be about one-fourth the size of an adult
portion.
• Limit juice intake. Encourage whole fruit instead.
• Don't use dessert as a reward. Try serving it with the rest of the food.
• Make the food easy for your toddler to eat:
o Cut food into bite-size pieces.
o Make some foods soft and moist.
o Serve foods near room temperature.
o Use ground meat instead of steak or chops.
o Use a child-size spoon and fork with dull prongs.
o Seat your child at a comfortable height in a secure chair.
• Prevent choking by:
o Slowly adding more difficult-to-chew foods.
o Avoiding foods that are hard to chew and/or swallow, like nuts, raw carrots, gum drops,
jelly beans, and peanut butter (by itself).
o Modifying high-risk foods. Cut hot dogs in quarters, cut grapes in quarters, and cook
carrots until soft.
o Always supervising your child when they are eating.
o Keeping your child seated while eating.

B. GUIDELINES IN FEEDING

Healthy food choices

The MyPlate icon is a guideline to help you and your toddler eat a healthy diet. MyPlate focuses on
eating a variety of foods while encouraging the right amount of calories and fat. The USDA and the
U.S. Department of Health and Human Services have prepared the food plate to guide parents in
selecting foods for children ages 2 and older.
The MyPlate icon is divided into five food group categories, emphasizing the nutritional intake of the
following:
• Grains. Foods that are made from wheat, rice, oats, cornmeal, barley, or another cereal grain
are grain products. Examples include whole-wheat, brown rice, and oatmeal. Aim for mostly
whole-grains.
• Vegetables. Vary your vegetables. Choose a variety of colorful vegetables. Include dark green,
red, and orange vegetables, legumes (peas and beans), and starchy vegetables.
• Fruits. Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned,
frozen, or dried, and may be whole, cut up, or pureed. The American Academy of Pediatrics
recommends limiting juice to less than 4 ounces per day for children 1 to 3 years old.
• Dairy. Milk products and many foods made from milk are considered part of this food group.
Focus on fat-free or low-fat products, as well as those that are high in calcium.
• Protein. Go lean on protein. Choose low-fat or lean meats and poultry. Vary your protein routine.
Choose more fish, nuts, seeds, peas, and beans.
Oils are not a food group, yet some, like nut oils, contain essential nutrients and can be included in the
diet. Limit animal fats.
Include exercise and everyday physical activity with a healthy dietary plan.

Nutrition and activity tips

Here are some tips to follow:
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 NCM 105: NUTRITION AND DIET THERAPY
• Try to control when and where food is eaten by your toddler by keeping regular daily meal
times. Provide social interaction and model healthy eating behaviors.
• Involve children in choosing and preparing foods and teach them to make healthy choices by
helping them select foods based on their nutritional value.
• Select foods with these nutrients when possible: calcium, magnesium, potassium, and fiber.
• Most Americans need to reduce the number of calories they consume. When it comes to weight
control, calories do count. Controlling portion sizes and eating nonprocessed foods helps limit
calorie intake and increase nutrients.
• Parents are encouraged to follow the recommended serving sizes for children.
• Parents should try to limit children’s screen time to less than 1 to 2 hours daily. Instead, encourage
activities that require more movement.
• Children need at least 60 minutes of moderate to vigorous physical activity on most days for
good health and fitness. This is also for healthy weight during growth.
• To prevent dehydration, encourage children to drink fluid regularly during physical activity and
drink several glasses of water or other fluid after the physical activity is completed.

CHAPTER 5: PRE-SCHOOL AND SCHOOLERS

A. NUTRITIONAL PROBLEMS AND INTERVENTIONS

Preschool-age children (ages 3 to 5) are still developing their eating habits and need encouragement
to eat healthy meals and snacks. These children are eager to learn. They will often imitate eating
behaviors of adults. They need supervision at mealtime as they are still working on chewing and
swallowing skills.
These are some helpful mealtime hints for preschool-age children:
• Make meals, give regularly scheduled snacks, and limit unplanned eating.
• Discourage poor behavior at mealtime. Focus on eating, not playing with food, or playing at
the dinner table.
• Running or playing while eating can cause a child to choke. Have your child sit when eating.
• Keep offering a variety of foods. Have the attitude that, sooner or later, your child will learn to
eat almost all foods.
• Make mealtime as pleasant as possible. Don't put pressure on your child to eat. Don't force your
child to "clean" his or her plate. This may lead to overeating, which can cause your child to gain
too much weight. Children will be hungry at mealtime if snacks have been limited during the
day.
• Provide examples of healthy eating habits. Preschoolers copy what they see their parents doing.
If you have unhealthy eating habits, your child will not learn to eat healthy.

B. GUIDELINES IN FEEDING
Nutrition and activity tips
Here are some tips to follow:
• Try to control when and where food is eaten by your children by providing regular daily meal
times. Include social interaction and demonstrate healthy eating behaviors.
• Involve children in the choosing and preparing of foods. Teach them to make healthy choices
by helping them to pick foods nutritious based.
• Select foods with these nutrients when possible: calcium, magnesium, potassium, and fiber.
• Most Americans need to cut the number of calories they consume. When it comes to weight
control, calories do count. Controlling portion sizes and eating nonprocessed foods helps limit
calorie intake and increase nutrients.
• Parents are encouraged to provide recommended serving sizes for children.
• Parents are encouraged to limit children’s screen time to less than 2 hours daily. Instead,
encourage activities with that call for more movement.
• Children and adolescents need at least 60 minutes of moderate to vigorous physical activity on
most days for good health and fitness and for healthy weight during growth.
• To prevent dehydration, encourage children to drink fluid regularly during physical activity and
drink several glasses of water or other fluid after the physical activity is completed.

C. RECOMMENDED DIET
Healthy food choices
The MyPlate icon is a guideline to help you and your child eat a healthy diet. MyPlate can help you
and your child eat a variety of foods while encouraging the right amount of calories and fat.
The USDA and the U.S. Department of Health and Human Services have prepared food plates to help
parents select foods for children age 2 and older.
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 NCM 105: NUTRITION AND DIET THERAPY
The MyPlate icon is divided into 5 food group categories, emphasizing the nutritional intake of the
following:
• Grains. Foods that are made from wheat, rice, oats, cornmeal, barley, or another cereal grain
are grain products. Examples include whole-wheat, brown rice, and oatmeal. Aim for mostly
whole-grains.
• Vegetables. Vary your vegetables. Choose a variety of colorful vegetables. These can include
dark green, red, and orange vegetables, legumes (peas and beans), and starchy vegetables.
• Fruits. Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned,
frozen, or dried, and may be whole, cut up, or pureed. The American Academy of Pediatrics
recommends no more than 4 ounces of juice per day for children 1 to 3 years of age, and 4 to
6 ounces per day for children 4 to 6 years of age.
• Dairy. Milk products and many foods made from milk are considered part of this food group.
Focus on fat-free or low-fat products, as well as those that are high in calcium.
• Protein. Go lean on protein. Choose low-fat or lean meats and poultry. Vary your protein routine.
Choose more fish, nuts, seeds, peas, and beans.
Oils are not a food group, yet some, like nut oils, have essential nutrients and can be included in the
diet. Animal fats, which are solid fats, should be avoided.
Encourage exercise and everyday physical activity with a healthy dietary plan.

• This is the most difficult stage in feeding a child since the appetite tapers off corresponding to the
lower rate of growth.
Foods to Give the Pre-School Child:
1) Mildly flavored foods
2) Plain foods is acceptable than mixed foods.
3) Fruits, puddings, custard, ice cream and gelatin may be given

Sign of Good Nutrition in Pre-School Child

– Alert, vigorous and happy
– Endurance during activities
– sleeps well
– Normal height and weight for age
– Stands erect, arms and legs straight
– Clear, bright eyes, smooth healthy skin, lustrous hair
– Firm and well developed muscles
– Not irritable and restless
– Good attention

NUTRITION FOR SCHOOL CHILD

Feeding Problems
Limited time for eating
Poor Eating practices
Unbalance program of activities & rest
Recommended Solutions:
allow sufficient time for meals
Encourage child to eat more fruits & vegetables
Provide child with properly selected snacks Regulate the activities
Guidance in proper food selection

Nutrition in Children
– Children’s nutrition affects physical, emotional, and intellectual development
– Once developed, poor eating habits difficult to change
– Poor eating habits can exacerbate emotional and physical problems

Children Ages 1 to 12
– Appetites often vary according to rate of growth
– Likes and dislikes change
– New foods should be introduced gradually
– Children should be involved in food selection and preparation
– Fats should not be limited before age 2
– Fat intake recommendation:
– 30 to 35 percent of calories for 1- to 3-year-olds
– 25 to 35 percent of calories for 4- to 18-year-olds
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– Whole milk recommended until age 2
– Low-fat or fat-free milk served starting at age 2
– Calorie needs depend on rate of growth, activity level, body size, metabolism, and health
– Nutrient-dense snacks needed every two to three hours
– Forcing a child to eat can cause eating disorders
– Choking prevalent in young children
– Calorie and Nutrient Needs of Young Children
– From age 1 to 10, caloric needs decrease
– But nutrient needs increase
– Use MyPyramid for meal planning for kids
– Need 2 to 3 cups of milk or equivalent in terms of calcium per day
– Calorie and Nutrient Needs of Young Children
– Limit sweets and sweetened fruit juices
– Need 1 mL of water per calorie
– Introduce fiber slowly

Childhood Obesity
– Child overweight if above 95th percentile for body mass index (BMI) by sex and age
– Many factors contribute to this epidemic:
– Genetic
– Behavioral
– Environmental

– Genetic Factors
– Not sole factor for childhood obesity
– Increased risk in children with one or both obese parents
– Behavioral Factors
– Large portions of food and beverage
– Snacking on energy-dense foods
– High sugar intake
– Lack of physical activity at home, school, or day care
– Excessive sedentary activities:
– E.g., television, computer, video games
– Environmental Factors
– School foods often high in fat and calories
– Community environment not always safe or conducive to physical activity

What Parents Can Do

– Model healthy food choices and active lifestyle
– Involve entire family for lifestyle change
– Balance calories with snacking and portion control
– But no dieting
– Promote healthy food, snacks, and drinks
– Remove calorie-rich temptations
– Engage in 60 minutes of physical activity daily as a family
– Limit sedentary time
– Ensure child gets enough sleep
– Never tell child that he or she is too fat
– Understand devastating effects of social discrimination on obese children
– Never provide food as comfort or reward
– But do not forbid food
– Eat only at table and at designated times
– Give water rather than juice, soda, or sweetened drinks
– Eat slowly
– Use 20-minute technique
– Determine reasons for eating

Toddlers
– Age 12 months to 36 months
– Rapid growth rate of infancy begins to slow
– Gain 5.5 to 7.5 inches, average 9 to 11 pounds
– Higher energy expended for increased activity levels
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– Increased nutrient needs are based on their larger body size
– Macronutrients:
– Estimated Energy Requirement (EER) varies according to the toddler's age, body weight,
and level of activity
– 30−40% of total kcal from fat
– 1.1 grams of protein per kg body weight
– 130 grams carbohydrates per day (most of the carbohydrates should be complex)
– 14 grams fiber per 1,000 kcal/day
– Micronutrients:
– Ensure adequate intake of the micronutrients obtained from fruits and vegetables,
including: vitamins A, C, E, calcium, iron, zinc, potassium
– Vitamin D supplements recommended for some children
– Until age 2, drink whole milk for calcium
– Iron-deficiency anemia is the most common nutrient deficiency in young children
– As toddlers become more active, they lose more fluids through sweat
– An active toddler may need more fluids

Childhood
– Nutritional Concerns of Childhood
– Malnutrition and hunger
– Food insecure households
– Low food security
– Federal assistance programs
– WIC
– National School Lunch
– Breakfast and Summer Food Service Programs Summer Food Service
– Nutrition Concerns of Childhood
– Food and behavior
– Foods associated with hyperactivity
– Childhood and Teenage Obesity
– 16-33% of children and adolescents obese
– Overweight children likely to become overweight adults
– The Path to Obesity
– Most commonly begins between ages 5-6 or during adolescence
– What Causes Obesity?
– Genetic, biological, behavioral, and cultural factors
– 80% chance for children with two obese parents
– Risks and Complications
– Increased risk of heart disease
– High blood pressure
– Diabetes
– Breathing problems
– Trouble sleeping
– Management
– Start a weight-management program
– Change eating habits
– Plan meals and make better selections
– Control portions
– Increase physical activity
– Limit snacking

– Nutrition and chronic disease

– Dietary Guidelines for Americans
– Screening children with family history of high lipid levels
– Lead toxicity
– Slow growth
– Iron-deficiency anemia
– Damage to brain and CNS
– Low-iron, calcium, and zinc intakes increase lead absorption
– Vegetarianism
– Nutrients to emphasize
– Calcium
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– Iron
– Zinc
– Vitamin B12
– Vitamin D

Nutritious Food Choices

– Most are able to match intake with needs
– Healthful variety of food available
– Food should not be forced on a child
– Frequent, small meals for small stomach
– Developmentally appropriate foods
– Small portions, limited healthful alternatives
– Role modeling is important
– Preschool and School-Age Children
– Growth slows: average gain 2–4 in./year
– Encourage physical activity
– EER varies according to age, body weight, and level of activity.
– From age 4 through 8, values for most nutrients increase
– Sexual maturation begins ages of 8 and 9: DRI values are separately defined for boys and girls
beginning at age 9

Macronutrients
– Total fat intake should gradually drop to a level closer to adult fat intake
– 25−35% of total energy from fat
– 130 grams carbohydrate per day
– 14 grams fiber per 1,000 kcal
– 0.95 grams protein per kg body weight

Micronutrients
– Consuming adequate fruits and vegetables in the diet continues to be a concern (vitamins A,
C, and E, fiber and potassium)
– "Milk displacement"—low-calcium diets also tend to be low in other nutrients
– RDAs for iron and zinc also increase
– If fluoride is not available in municipal water supply, fluoride supplements may be needed
– Fluid
– Children: about 5 to 8 cups of beverages each day, including water
– Exact amount depends on activity and weather
– Beverages should be free of caffeine and added sugars
– USDA Daily Food Plan meets the nutrient requirements for preschoolers

Nutrition-Related Concerns
– Nutritious food choices
– Iron-deficiency anemia
– Food insecurity and hunger

Nutritious Food Choices

– Peer pressure encourages unhealthful food choices
– Body image plays an important role
– Families who plan, prepare, and eat meals together are more successful at promoting good
food choices
– Frequent family meals reduce the risk for disordered eating, substance abuse, and depression

Iron-Deficiency Anemia
– Higher among children from Mexican-American and low-income families
– Children with very poor appetites or erratic eating behaviors may need iron supplements
– If left untreated, iron-deficiency anemia can lead to behavioral, cognitive, motor delays, and
impaired immunity

Food Insecurity and Hunger

– 16 million children faced with food hunger and insecurity
– Without adequate breakfast, children can't concentrate or pay attention
– Impaired nutrient status can blunt children's immune responses.
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– Psychosocial health associated with food insecurity
– Government and private programs can provide nutrition benefits
– Role of School Attendance
– School breakfasts: optimize nutrient intake and avoid behavioral and learning problems from
hunger in the classroom
– No monitoring for adequacy of food eaten
– Soft drinks and snack foods in school
– School lunches: what's actually eaten (not planned/served) tends to be higher in fat
– Options to entice healthful selections

Energy and nutrient needs during childhood

– Energy and protein
– Total energy requirements gradually increases
– Kilocalories and grams protein per kg decrease from infancy
– Vitamins and minerals
– Variety of foods needed
– Assess iron intake
– Need for supplements?

Influences on childhood food habits and intake

– Usually temporary
– Caregivers have increased role in the development of child’s health and nutrition habits
– Kids are responsible for when and how much to eat
– External factors
– Television
– Environment

Conclusion
– Nutrient needs vary as children grow and develop
– Gradually increase

CHAPTER 6: ADOLESCENT
Adolescents
– Adolescence continues to 18 years
– Puberty: secondary sexual characteristics develop; capacity for reproduction
– During this developmental phase, they may be less responsive to parental guidance
– Most adolescents navigate the challenges into mature and healthy adults
– Average 20−25% increase in height
– Average girl reaches almost full height by the onset of menstruation (menarche); boys can
continue to grow during early adulthood
– Skeletal growth ceases closure of the epiphyseal plates
– Weight and body composition also change
– Physical growth and development
– Adolescent growth spurt
– Boys: begins between 12 and 13 years
– Gain about 8 inches in height, 45 pounds in weight
– Girls: begins between 10 and 11 years
– Gain about 6 inches in height, 35 pounds in weight
– Changes in body composition
– Energy and protein
– Highest total calories and protein grams per day
– Vitamins and minerals
– Nutrients of concern
– Vitamin A
– Calcium
– Iron

A. NUTRITIONAL PROBLEMS AND INTERVENTIONS

Nutrition-Related Concerns
– Nutrition-Related Concerns for Adolescents
– Fitness and sports
– Provide catalyst for learning about nutrition and improve daily habits
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– Acne
– Investigating the connections between diets and acne
– High-glycemic-index foods, fat intake, and fatty acid composition
– Eating disorders
– Become preoccupied with weight, appearance, and eating habits
– Adolescent Obesity
– Increased risk for
– Developing high blood pressure
– Abnormal blood glucose tolerance and type 2 diabetes
– Breathing problems, joint pain, and heartburn
– Poor self-esteem
– Metabolic syndrome
– Adolescence
– Tobacco, alcohol, recreational drugs
– Period of experimentation
– Alcohol and drug use may take priority over adequate food intake
– Teens who use drugs are usually underweight and report poor appetites
– Staying Young While Growing Older
– Age-related changes
– Weight and body composition
– Add fat; lose lean body mass
– Physical activity
– Reduced muscle and skeletal strength
– Immunity
– Decline in defense mechanisms
– Taste and smell
– Decline in sensitivity
– Gastrointestinal changes
– Reduced acid secretion; reduced motility

– Adequate calcium intake maximizes bone calcium uptake and bone mineral density
– Disordered eating and eating disorders can begin in these years
– Acne is not caused by diet, but a healthy diet can optimize skin health
– Cigarette smoking, alcohol, and illegal drugs can have an impact on nutrition

Pediatric Obesity
– Overweight: BMI above the 85th percentile of the same age and gender
– Obese: BMI above the 95th percentile

Higher risk of health problems:

– Exacerbates asthma
– Causes sleep apnea
– Impairs the child's mobility
– Leads to intense teasing
– Low self-esteem
– Social isolation
– Greater risk for type 2 diabetes, high blood lipids, high blood pressure, gallstones, depression,
and other medical problems
– Higher risk of becoming overweight adults
– Reversal of pediatric obesity can be accomplished through an aggressive, comprehensive
nationwide health campaign
– Early tendency during toddler years
– Monitor if >80th percentile for weight
– Encourage physical activity
– Limit foods with low nutrient density
– Early intervention is often the most effective measure against lifelong obesity

Role of the Family

– Provide nutritious food choices
– Encourage a healthful breakfast
– Sit down to a shared family meal each evening, or as often as possible
– No television at mealtimes: encourage attentive eating, enjoyment of the food
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– Parents should retain control over the purchasing and preparation of food

Role of the School

– Federal school lunch program: limit the amount of fat, sugar, and sodium served
– Many schools sell foods and beverages that exceed federal guidelines
– Nutrition education programs: health departments, Dairy Councils
– Consistent and repeated school-based messages on good nutrition

Physical Activity
– Institute for Medicine recommends aerobic physical activity for at least an hour each day
– Physical Activity Guidelines for Americans: bone- and muscle-strengthening activities at least 3
days each week
– Encourage noncompetitive, fun, and structured activities in ways that allow self-pacing

Physical Activity (cont.)

– Parental and adult role models
– Shared activities: ball games, bicycle rides
– Television/electronic games: ≤ 2 hours/day
– Electronic games: virtual tennis, step aerobics, dancing, other active simulations
– Overweight children can "catch up" to their weight as they grow taller without restricting food
(nutrient) intake
– Acquire motor skills and muscle strength
– Establish good sleep patterns
– Develop self-esteem; lower stress
– Optimize bone mass
– Enhance cardiovascular and respiratory function
– Physically fit children:
– Have improved behavior
– Are more attentive
– Are more focused
– Have higher levels of academic achievement
– Parents, healthcare providers, and community members can work with school boards to
optimize opportunities for physical activity

Pediatric Obesity Treatment

– Stage 1: lifestyle modifications to improve dietary intake while decreasing energy intake, and to
increase physical activity
– Stage 2: consultations with a Registered Dietitian Nutritionist, self monitoring, and monthly visits
with healthcare provider
– Stage 3: care team expands to include behavioral health an exercise specialist, and weekly
visits with healthcare provider

Allergy Watch
– Continue to watch for common food allergies: wheat, peanuts, cow's milk, soy, citrus, egg
whites, seafood
– Introduce one new food at a time and monitor for allergic reactions
– Vegetarian Families
– Eggs and dairy: part of a healthful diet
– Vegan diet may be low in protein, minerals (calcium, iron, zinc), vitamins (D and B 12)
– High fiber may impair iron and zinc absorption and promote a premature sense of "fullness" at
mealtimes
– Fortified foods and supplement use to ensure adequate nutrition

Childhood Type 2 Diabetes

– In the past, disease of adults only
– Now found in obese children
– Need education from diabetes educator
– Only prevention:
– Healthy nutrition and exercise

Osteoporosis and Cardiovascular Disease

– Osteoporosis linked to poor calcium intake in childhood and young adulthood
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– Cardiovascular disease linked to excess fat in diet
– Teenagers typically consume too much saturated fat and soda and not enough milk
– Nutrition education crucial
– Adolescence
– Period of rapid growth and physical changes
– Cause increased calorie needs
– Typically enormous appetites
– Often substitute popular low-nutrient-dense foods
– Food choices affected by peer pressure and busy schedules

Adolescent Problems Related to Nutrition

– Anorexia nervosa
– Bulimia
– Overweight

Anorexia Nervosa
– Psychological disorder
– Causes client to drastically reduce calories consumed
– Causes altered metabolism
– Distorted body image and fear of being fat
– Often exercise excessively
– May result in hair loss, low blood pressure, weakness, amenorrhea, brain damage, and even
death

Treatment for Anorexia Nervosa

– Individual and family counseling
– Self-acceptance
– Nutrition therapy
– Close supervision
– Time and patience

Bulimia
– Syndrome when client alternately binges and purges by inducing vomiting and using laxatives
and diuretics to rid of ingested food
– Fear of being overweight
– Often binge on high-calorie foods
– Usually not life-threatening, but can irritate esophagus and cause electrolyte imbalances,
malnutrition, dehydration, and dental caries

Treatment for Bulimia

– Eating only at mealtime
– Portion control
– Close supervision after eating
– Psychological counseling

Overweight
– Contributing factors:
– Heredity, overfeeding as infant or child, and psychological issues
– Treatment:
– Evaluation by health care provider
– Change in unhealthy eating habits
– Exercise

Stop and Share

– Consider the following question:
– Being overweight is particularly difficult during the adolescent period. What makes being
overweight during adolescence especially difficult?
– Apt to diminish self-esteem
– Can exclude from normal social life of teen years
– Further diminishing self-esteem
– Makes adolescent prone to being overweight as adult

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Fast Foods
– Nutrient charts often available at restaurants
– Excessively high in fat, sodium, and calories
– Limited in minerals, vitamins, and fibers
– Often used as snacks by teens
– Adds extra calories
– Should be used with discretion in balanced diet

Alcohol
– Contains 7 calories per gram but few nutrients
– Depressant with serious side effects
– Affects absorption and normal metabolism of glucose, fats, proteins, and vitamins
– Causes excess water and mineral loss
– Alcohol and the Adolescent
– Alcoholism
– Abuse or overuse of alcohol
– Excessive long-term drinking can lead to liver cirrhosis, high blood pressure, and damage to
heart muscle

Alcohol and the Adolescent

– Teenagers often ignore dangers
– Drinking teens prone to accidents and random acts of violence

Marijuana
– Use continues to increase among teens
– Increases appetite, especially for sweets
– Marijuana cigarettes more harmful to lungs than tobacco cigarettes
– May lead to use of other drugs

– Cocaine
– Highly addictive and extremely harmful
– Weight loss very common due to decreased appetite
– Crack
– Form that can be smoked
– Half of crimes against property in U.S. related to use of crack cocaine

Tobacco
– Addictive
– Can influence appetite, nutritional status, and weight
– Smokers need more vitamin C
– Smoking alters its metabolism
– Increases risk for lung cancer and heart disease
– Other Addictive Drugs
– Amphetamines cause heart, breathing, and blood pressure rates to increase
– Methamphetamine
– Most potent form of amphetamines
– Symptoms:
– Dry mouth, difficulty swallowing, dilated pupils, and depressed appetite
– As drug wears off, fatigue and depression common

Other Addictive Drugs

Inhalants
– Physically and psychologically addictive
– Symptoms:
– Depression, apathy, nosebleeds, headaches, eye pain, chronic fatigue, heart
failure, loss of muscle control, and death

Nutrition for the Athlete

– Need additional water, calories, B vitamins, sodium, potassium, iron, and protein
– Increase in calories depends on activity and its length
– Plain water recommended liquid for rehydration
– Electrolyte drinks useful after athletic event
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– But not during one
– Glycogen loading sometimes used for long activities
– Also known as carbo-loading
– Begins six days before event
– Regimen of diet and exercise to maximize amount of glycogen in muscles
– May result in abnormal heart rate and some weight gain
– Should maintain good eating and health habits

Considerations for the Health Care Professional

– Young children may have poor appetites, and parents may have related anxiety
– Be most helpful by exhibiting patience and understanding and by listening to client and parents
– Considerations for the Health Care Professional
– Working with adolescent clients with disordered eating can be challenging
– Should consult with client’s psychological counselor
– Parents of clients with disordered eating must be included in counseling

B. RECOMMENDED DIET

The best nutrition advise to keep your adolescent healthy includes encouraging her to:
• Eat a variety of foods
• Balance the food you eat with physical activity
• Choose a diet with plenty of grain products, vegetables and fruits
• Choose a diet low in fat, saturated fat, and cholesterol
• Choose a diet moderate in sugars and salt
• Choose a diet that provides enough calcium and iron to meet their growing body's requirements.
Macronutrients
– EER for adolescents is based on gender, age, activity level, height, and weight
– 25−35% of total energy from fat
– ≤10% of total energy from saturated fat
– 45−65% of kcal from carbohydrates
– 0.85 grams protein per kg body weight
– 26−38 grams of fiber per day
Micronutrients
– Calcium intakes must be sufficient for achieving peak bone density: 1,300 mg/day
– Iron needs are relatively high: 11 mg/day for boys, 15 mg/day for girls
– Vitamin A is critical for supporting rapid growth and development
– Supplement should not be considered a substitute for a balanced, healthful diet
– Fluid Recommendations
– The need to maintain fluid intake is increased with higher activity levels
– Boys: 11 cups/day
– Girls: 10 cups/day
– Importance of including water

Nutritious Food Choices

– Parents can act as role models
– Strong influence of peers, mass media, personal preferences
– Encourage whole grains, fruits, vegetables, and milk or calcium-rich beverages

– Calorie requirement increases

– Except for vitamin D, all nutrient needs increase
– Menstruation in girls creates greater need for iron
– DRIs for many nutrients higher for boys than girls

Conclusion
– Anorexia nervosa, bulimia, and obesity are problems of weight control that can occur during
adolescence
– Alcohol and drug abuse can be serious problems during adolescence

CHAPTER 7: ADULTHOOD
Diet during Young and Middle Adulthood
Objectives
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 NCM 105: NUTRITION AND DIET THERAPY
– Identify nutrient needs of young and middle-aged adults
– Explain sensible, long-range weight control
– Discuss importance of exercise in weight control
– Discuss diet-related diseases that can be prevented by good nutrition:
– Osteoporosis, heart disease, and diabetes

Adulthood
– Broadly divided into three periods:
– Young adulthood
– Age 18 to 40
– Middle period
– Age 40 to 65
– Late adulthood
– Over age 65

Nutrient Requirements
– Growth usually complete by age 25
– Nutrient requirements of healthy adults during these years change very little
– Iron requirement for women higher than men until after menopause
– Daily protein requirement:
– 0.8 g per kilogram of body weight
– Current daily calcium requirement for age 19 to 50:
– 1,000 mg
– Daily vitamin D requirement:
– 5 g
– Both calcium and vitamin D essential for strong bones
– Three glasses of milk per day nearly fulfill calcium and vitamin D requirements
– Bone loss begins slowly around age 35 to 40

Stop and Share

– Consider the following scenario:
– You are teaching a class about rheumatoid arthritis to a group of middle-aged adults. A
participant asks the following question: “What diet changes can I make to prevent
rheumatoid arthritis?” How do you respond?
– Determined by research that diet changes have no effect
– Maintain healthy diet that includes adequate calcium and protein
– Take multiple vitamin containing vitamin D and a calcium supplement daily
– Discuss omega-3 fatty acids with physician
– Helpful in reducing inflammation
Calorie Requirements
– Begin to diminish after age 25 when basal metabolic rate decreases
– Determined primarily by activity and amount of lean muscle mass
– Weight gain occurs if calories exceed one’s need

Special Considerations for the Adult

– Concerns about weight, cost of food, or time may lead to nutrient deficiencies
– Selection of food often based on convenience and flavor
– Rather than nutritional content of food
– Fast foods and prepared meals lead to excess consumption of fat, sugar, salt, and calories
– Weight control
– One of the top concerns of adults in U.S. today
– Excess weight can lead to diabetes mellitus, metabolic syndrome, and hypertension
– Overweight people:
– Poor risk for surgery
– Live shorter lives
– Prone to social and emotional problems
– Most common cause of being overweight:
– Energy imbalance
– Other causes of being overweight:
– Genetics
– Hypothyroid condition
– Excess of 3,500 calories results in weight gain of 1 pound
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 NCM 105: NUTRITION AND DIET THERAPY
– Best solution for weight control:
– Increased exercise combined with reduced caloric intake
– Healthy eating plan should follow MyPyramid guidelines

Considerations for the Health Care Professional

– Young and middle years of life busy
– Many responsibilities
– Most people feel they have too many things to do and too little time to accomplish them
– Health problems during these years can be psychologically devastating

A. NUTRITIONAL PROBLEMS AND INTERVENTIONS

‘Discretionary choices’ are called that because they are not an essential or necessary part of our
dietary patterns. Discretionary foods are high in kilojoules, saturated fat, added sugars, added salt or
alcohol.
If chosen, they should be eaten only sometimes and in small amounts.
Examples of discretionary choices include:
• Sweet biscuits, cakes and desserts
• Processed meats and sausages
• Ice-cream, confectionery and chocolate
• Meat pies and other pastries
• Commercial burgers, hot chips, and fried foods
• Crisps and other fatty and/or salty snacks
• Cream and butter
• Sugar-sweetened cordials, soft drinks, fruit drinks and sports drinks
• Alcoholic drinks
Guideline 1:
To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food
and drinks to meet your energy needs.
• Older people should eat nutritious foods and keep physically active to help maintain muscle strength
and a healthy weight.
Guideline 2:
Enjoy a wide variety of nutritious foods from these five food groups every day:
• Plenty of vegetables of different types and colors, and legumes/beans
• Fruit
• Grain (cereal) foods, mostly wholegrain and/or high cereal fiber varieties, such as breads, cereals,
rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
• Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat
And drink plenty of water.
Guideline 3:
Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
a. Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed
meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savory snacks.
• Replace high fat foods which contain predominately saturated fats such as butter, cream, cooking
margarine, coconut and palm oil with foods which contain predominately polyunsaturated and
monosaturated fats such as oils, spreads, nut butters/pastes and avocado.
b. Limit intake of foods and drinks containing added salt.
• Read labels to choose lower sodium options among similar foods.
• Do not add salt to foods in cooking or at the table.
c. Limit intake of foods and drinks containing added sugars such as confectionery, sugar-sweetened
soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks.
d. If you choose to drink alcohol, limit intake. For women
who are pregnant, planning a pregnancy or
breastfeeding, not drinking alcohol is the safest option.
Guideline 4:
Encourage, support and promote breastfeeding.
Guideline 5:
Care for your food; prepare and store it safely.

B. RECOMMENDED DIET

Tips For Choosing Nutritious Foods And Drinks

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 NCM 105: NUTRITION AND DIET THERAPY
Eating for health and wellbeing is about choosing foods from the Five Food Groups every day, while
limiting foods that are not essential to our health.
• Plan ahead and stock up on basic nutritious foods like wholegrain cereals and other grain foods,
reduced fat milk, lentils or other legumes, eggs, and frozen or canned foods without added
sugars or added salt – this way you can eat at home more often and cook meals yourself by
adding fresh ingredients.
• Choose a variety of types and colors of fresh vegetables and fruits that are in season.
• Try new ways of cooking with vegetables like roasting, baking, barbequing and stir-frying.
Add extra vegetables and legumes to your recipes.
• Use fruit for snacks and desserts.
• Lean red meats are important, but a maximum of 455g a week is recommended.
• Include at least 1 or 2 meat-free meals each week – include eggs, legumes such as beans and tofu,
and nuts and seeds.
• Choose reduced-fat varieties of milk, yoghurt and cheese.
• Include small amounts of foods rich in unsaturated fats such as oils, spreads, nut butters/pastes and
avocado.
• Drink plenty of water instead of drinks with added sugars or alcohol.
• Choose carefully when eating out- limit creamy, commercially baked or fried foods.
• Store unused cooked food in the fridge.
• Older people who have trouble with their teeth, may prefer softer textured or cooked vegetables
and fruit, finely milled wholegrain cereal foods and dishes like soups, casseroles or stews.

Conclusion
– Although calorie requirements diminish after age 25, most nutrient requirements do not diminish
– Food must be selected with care as one ages to ensure that nutrient requirements met without
exceeding caloric needs
– Being overweight can cause health problems

CHAPTER 8: ELDERLY
Nutrition during Late Adulthood
Objectives
– Explain nutritional and caloric needs of people age 65 and over
– Of chronic diseases discussed, explain development
– Identify physiological, economic, and psychosocial problems that can affect senior citizen’s
nutrition

Physiological Changes
– Body’s functions slow with age
– Ability to replace worn cells reduced
– Metabolic rate slows
– Bones become less dense
– Lean muscle mass reduced
– Eyes lose focus on nearby objects
– Some people develop cataracts
– Poor dentition common
– Heart and kidneys less efficient
– Hearing, taste, and smell less acute
– Immune system may be compromised if chronic poor nutrition
– Osteoarthritis can be debilitating
– Excess weight and some vitamin deficiencies may affect some forms of arthritis
– Healthy nutrition and exercise can be beneficial for those with arthritis
– No connection between specific food and arthritis
– Digestion affected by decreased secretion of hydrochloric acid and enzymes
– Decrease in synthesis of intrinsic factor leads to deficiency of vitamin B 12
– Reduced intestinal tone causes constipation or, in some cases, diarrhea

Psychosocial Changes
– Psychosocial problems can increase as one grows older:
– Feeling of uselessness
– Loss of self-esteem
– Loss, grief, and loneliness
– Loss of independence
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 NCM 105: NUTRITION AND DIET THERAPY
– Economic changes:
– May affect food choices
– May reduce social activities
– Sidestepping Potential Problems
– Healthy lifestyle and active social life throughout life can prevent or delay physical deterioration
and psychological depression during senior years
– Food-drug and drug-drug interactions can affect nutritional status
– Must be monitored closely

Nutritional Requirements
– Daily protein requirement remains at 0.8 g per kilogram of body weight
– After age 65, may be advisable to increase to 1.0 g
– Vitamin requirements do not change after age 51
– Except for slight decrease in RDAs for thiamin, riboflavin, and niacin
– Need for iron decreased after age 51 in women due to menopause
– Calorie requirement decreases approximately 1 to 2 percent per decade
– Activity often decreases
– Weight gain common if caloric intake not reduced
Nutrient Needs of the Mature Adult
– Energy
– Reduced needs
– Decreased activity; decreased lean body mass
– Protein
– Same needs per kg body weight as younger adults
– Nutrient Needs of the Mature Adult
– Carbohydrate
– More likely to be lactose intolerant
– Fat
– Maintain moderate low-fat diet
– Water
– Reduced thirst response
– Vitamins of concern
– Vitamin D
– Needed for bone health, calcium balance
– Reduced skin synthesis, activation
– Higher needs
– B vitamins
– Reduced ability to absorb vitamin B12
– Folate, B6, B12 may help reduce heart disease risk
– Antioxidants
– Found in fruits and vegetables
– Important to reduce oxidative stress and degenerative diseases
– May protect against damage to the brain
– Minerals of concern
– Calcium
– Bone health
– Reduced ability to absorb calcium
– Zinc
– Marginal deficiencies likely
– May compromise immunity, wound healing
– Iron
Elders may have limited intake

Food Habits of Senior Citizens

– Established food habits may be especially difficult to change
– The following may cause difficulties in food selection and preparation:
– Decreased income during retirement
– Lack of transportation
– Physical disability
– Inadequate cooking facilities
– Grief, loneliness, boredom, or difficulty in chewing can cause anorexia
– Many consume diets deficient in:
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 NCM 105: NUTRITION AND DIET THERAPY
– Protein
– Vitamin C, vitamin D, vitamin B6, vitamin B12, and folate
– Calcium, zinc, and iron
– Calories
– Encourage variety and nutrient-dense foods
– Water important to help prevent constipation, maintain urinary volume, prevent dehydration,
and avoid urinary tract infections

Food Fads
– Senior citizens may spend money on unnecessary vitamins, minerals, and foods in search of
eternal life or youth

Appropriate Diets
– Based on MyPyramid
– When special health problems exist, adapt normal diet to meet individual’s needs
Federal government provides states with funds to serve senior citizens hot meals at noon in senior
centers
– Transportation for Senior Citizens
– Federal government provides transportation for those otherwise unable to reach senior center
for meals
– Meals-on-Wheels project provides food for homebound individuals
– Participating people pay according to ability

Stop and Share

– Consider the following question:
– What makes this segment of the population susceptible to food faddists?
– Some older people consciously or unconsciously search for eternal life, if not youth
– Food faddists may pick this segment of population to profit from ignorance
– Some older people with chronic disease may hope such products will bring relief

A. NUTRITIONAL PROBLEMS AND INTERVENTIONS

Special Considerations for the Chronically Ill Older Adult

– Osteoporosis
– Arthritis
– Cancer
– Diabetes mellitus
– Hypertension
– Heart disease

Osteoporosis
– Condition in which amount of calcium in bones reduced
– Making them porous
– Can have bone density scan with special x-ray to determine condition
– Contributors:
– Sedentary life
– Diet low in calcium, vitamin D, and fluoride
– Estrogen loss
– Excessive phosphorus in diet
– E.g., sodas, processed foods
– Possible preventive measures:
– Estrogen replacement therapy (ERT)
– 1,500 mg of calcium per day
– Exercise
Arthritis
– Disease that causes joints to become painful and stiff
– Excess weight worsens symptoms
– Aspirin or anti-inflammatory drugs may help
– But may cause gastric bleeding and anemia
– No cure
Cancer
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 NCM 105: NUTRITION AND DIET THERAPY
– Contributors:
– Diet consistently high in fat
– Diet low in fiber and vitamin A
– Research continues about role of nutrition in development of cancer
Diabetes Mellitus
– Chronic disease that develops when body does not produce sufficient amounts of insulin or
does not use it effectively for normal carbohydrate metabolism
– Diet very important for treatment
– Hypertension
– High blood pressure can lead to strokes
– Associated with diets high in salt or possibly low in calcium
– Most Filipinos ingest two to six times the amount of salt needed each day
– Heart Disease
– Heart attack and stroke
– Major causes of death
– Arteries become blocked
– Preventing normal passage of blood
Atherosclerosis
– Plaque accumulates in walls of artery as result of diet high in cholesterol and saturated
fats

Effects of Nutrition
– Cumulative over many years
– Effects of lifetime of poor eating habits cannot be cured overnight
– Prevention should begin in childhood
– Nutrition can be used to help stabilize condition of client with chronic disease

Considerations for the Health Care Professional

– Each client has individual needs
– Important to remember that older clients have feelings worth addressing
– Incapacitation that can accompany old age is terrible indignity
– Deserves special care

Nutrition-Related Concerns of Mature Adults

– Drug–drug and drug–nutrient interactions
– Can affect use of drugs or nutrients
– Possible interactions should be identified and avoided
– Depression
– May reduce food intake
– Alcoholism can interfere with nutrient use
– Anorexia of aging
– Loss of appetite with illness
– Can lead to protein-energy malnutrition
– Arthritis
– May interfere with food preparation and eating
– Dietary changes may improve symptoms
– Bowel and bladder regulation
– Increased risk of urinary tract infection
– Chronic constipation more common with age
– Need for increased fluids and fiber
– Dental health
– May interfere with eating ability or food choices
– Vision problems
– Can affect ability to shop and cook
– Antioxidants may reduce macular degeneration
– Osteoporosis
– Common in elders, especially women
– Maintain calcium, vitamin D, and exercise
– Alzheimer’s disease
– Affects ability to function
– Reduced taste and smell
– Risk for weight loss and malnutrition
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 NCM 105: NUTRITION AND DIET THERAPY

Meal Management for Mature Adults

– Managing independently
– Wise eating for one or two
– Finding community resources
– Services for elders
– Meals on Wheels
– Elderly Nutrition Program
– Food Stamp Program

FACTORS AFFECTING ADEQUATE FEEDING

• Long standing dietary habits

• Loss of teeth
• Loss of taste and smell
• Loss of neuromuscular coordination
• Physical discomfort
• Economic consideration
• Social Factors
• Psychological factors

B. RECOMMENDED DIET

Nutritional Requirements:
• Energy (calories) – decreases in calories because of reduced basal metabolic rate and reduce in
physical activities. A decrease of 7.5% intake after 45 yrs. Of age
• Protein – Protein allowance of 1.12 gms./kg. body weight is maintained
• Necessary for the prevention and tissue wasting and susceptibility to diseases
• Minerals (Calcium) – is maintained to prevent occurrence of osteoporosis
• Iron – Iron allowand for women 50 and above is as low as 7.0 mg/day
• Vitamins – Vit. C is needed for the absorption of calcium and iron. Intake of Vit. E to retard cellular
aging.
• B complex – to maintain good appetite
• Water & Fiber – 6-8 glasses a day. To prevent constipation

Diet Recommendation
1. Eat good breakfast to start the day
2. Eat 4-5 light meals a day
3. Include essential foods (fish, vegetables, fruits)
4. Eat leisurely in pleasant surroundings
5. Eat the heaviest at noon
6. Avoid fatty foods
7. Avoid coffee
8. Drink hot milk before going to bed

Conclusion
– Elderly segment of population continues to increase
– Nutrient needs of elderly a growing concern
– Many chronic diseases of elderly could be delayed or avoided by maintaining good nutrition
throughout life

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