Nutrition through the

Lifespan:
Pregnancy & Lactation
Nutrition Prior to Pregnancy
• Nutrition prior to pregnancy focuses
primarily on women
– Full nutrient stores prior to pregnancy:
essential to conception & healthy infant
development
– Developmental changes occur during early
weeks of pregnancy—even before the
pregnancy is evident
– Young adults need to nourish & protect
their bodies for their own sakes & that of
future generations
• Habits to establish in 2005 Dietary Guidelines
preparation for • Women of
healthy pregnancy: childbearing age who
– Achieve & maintain a may become pregnant
healthy body weight should:
– Choose an adequate & – Eat foods high in heme-
balanced diet iron &/or consume iron-
rich plant foods or iron-
– Be physically active fortified foods
– Avoid harmful – Consume adequate
influences synthetic folate daily
from fortified foods or
supplements
 Pre-pregnancy Weight
• Appropriate weight prior to pregnancy
benefits pregnancy outcome
– Underweight & overweight both present
medical risks
• Underweight
– Underweight women: higher risk of having
low-birthweight infant
• Low-birthweight infants have increased risk of
acquiring diseases or dying in first month of life
• Impaired growth & development during pregnancy
may have long-term health effects
• Poor nutrition is major factor in low birthweight
– Weight gain prior to pregnancy is advised
• Infant & child
mortality rates
– Nutritional deficiency &
low birth weight
contribute significantly
on worldwide basis
– US infant mortality:
7.0 deaths per 1000
live births (2002)
– Significant public health
efforts to reduce infant
mortality
– Steady decline in last
decades
 Pre-pregnancy Weight
• Overweight & obesity
– Infants (of obese mother)
• May be larger than normal, even when premature
• Twice as likely to be born with neural tube defects
• Incidence of heart defects & other abnormalities
more likely
– Obese women
• More likely to require medication or surgical
intervention for birth
• Increased complications, including gestational
diabetes, hypertension, post-partum infection
– Goal: strive for healthy pre-pregnancy body
weight to minimize risks to mother & infant
Healthy Support Tissues
• Healthy development of the placenta
depends on adequate pre-pregnancy
nutrition
• Support tissues
– Uterus
– Placenta
– Umbilical cord
– Amniotic sac
 Events of Pregnancy
• Fertilization & cell division
– Fertilized ovum (zygote):
single cell that divides at
rapid rate
• Implantation
– Zygote embeds itself in
uterine wall; placental
development begins
– Crucial time of
development, even as
growth is minimal
– Adverse influences can
lead to
• Failure to implant
• Abnormalities, such as
neural tube defects, or
loss of zygote
• Embryonic & fetal
development
– First 6 weeks: rapid physical
changes of embryo
– At 8 weeks
• Complete nervous system,
digestive system
• Well-defined fingers & toes,
beginnings of facial features
– Last 7 months: fetal stage
• Growth stage in weight &
length
• Critical period of cell division
& development of multiple
organs
• Infant birth
– 39-41 weeks for full gestation
– Birth weight of 6 ½-9 pounds
 Events of Pregnancy
• Critical periods
– Each organ & tissue develops in its own
pattern & timing
• Development of each takes place only at specific
time—critical period
• Required nutrients & environmental conditions
necessary during this period
• Malnutrition during period impairs organ
development
• Effects are irreversible
– Effects of malnutrition during critical periods
• Defects of nervous system in embryo
• Poor dental health for child
• Vulnerability as adolescent & adult to infection
• Risks of diabetes, hypertension, stroke, heart disease
 Nutrient Needs during
Pregnancy
• Overall energy requirements
– Vary by stage of pregnancy
• 1st trimester—no additional energy
• 2nd trimester—additional 340 kcalories per day
• 3rd trimester—additional 450 kcalories per day
– Can be met in several ways
• Eat more food
• Reduce physical activity
• Store less food energy as fat
• Select more nutrient-dense foods from the 5 food
groups
 Nutrient Needs during
Pregnancy
• Carbohydrate • Protein
– Nutrient-dense choices
since nutrient need is
greater than increased
energy needs
• Whole-grain breads &
cereals, legumes, dark
green vegetables,
citrus fruits, low-fat
milk & milk products,
lean meats, fish,
poultry & eggs • Fats
– Ideally 175 grams per
day (minimum - 135
grams)
– Fiber can help alleviate
constipation
– RDA - 25 grams higher
than for nonpregnant
women
– Vegetarian women
include several servings
of plant-protein foods
– Protein supplements are
not recommended
– Essential fatty acids
necessary: omega-3 &
omega-6 fatty acids
– Limit saturated fats
 Nutrient Needs during
Pregnancy
• Folate & vitamin B12
– Specific roles in cell reproduction
• New cells laid down as fetus grows &
develops
• Maternal blood volume increases, requiring
increase in red blood cells
– RDAs
• Folate: 600 g per day
• Vitamin B12: 2.6 g per day
 Nutrient Needs during
Pregnancy
• Neural tube defects Folate-rich sources
– Inadequate folate – 400 g of folic acid
intake supplement, fortified
– Incidence of neural tube foods or both (in
defect in previous addition to folate-rich
pregnancy foods)
– Maternal diabetes – Enriched grain products
– Maternal use of – Liver
antiseizure medication – Lentils, chickpeas, pinto
– Maternal obesity beans
– Exposure to high – Asparagus, spinach,
temperatures during beets
pregnancy – Avocado
– Race/ethnicity – Orange juice
– Low socioeconomic
status
 Nutrient Needs during
Pregnancy
• Vitamin B12
– Women who consume meat, eggs or dairy products can
meet all of vitamin B12 needs
– Those who exclude all animal products from diet require
fortified foods or supplements

• Calcium
– Increased demand during pregnancy
– Abnormal fetal bone development may result from
insufficient intakes
– More than 300 mg per day of calcium are transferred to
the fetus during final weeks
– Calcium recommendations are aimed at conserving
mother’s bone mass while supplying fetal needs
 Nutrient Needs during
Pregnancy
• Recommendations for • Fluoride
calcium & vitamin D
– Milk products offer
advantages over
supplements
– Inclusion of calcium &
vitamin D-fortified
foods
– Women <25 years
require more calcium
• Increase intake of
milk, cheese, yogurt,
other calcium-rich
foods
• Less preferable option:
600 mg supplement
daily
– Required for
mineralization of fetal
teeth & bone
development
– Excesses may be
harmful, however
– Supplements not
recommended for
women who drink
fluoridated water
– Fluoride AI during
pregnancy: 3.0 mg/day
 Nutrient Needs during
Pregnancy
• Iron
– Body conserves iron well during pregnancy
• Menstruation ceases
• Absorption of iron increases
– However, needs are so high that stores dwindle
– Iron RDA: 27 mg/day
– Sources
• Liver, oysters
• Red meat, fish, other meats
• Dried fruits
• Legumes
• Dark green vegetables
• Vitamin C-rich foods enhance iron absorption from foods
• Supplement during 2nd & 3rd trimesters
 Nutrient Needs during
Pregnancy
• Zinc
– Required for DNA & RNA (& thus), protein synthesis
– Severe deficiency predicts low infant birth weight
– Zinc RDA: 12 mg/day (≤18 years); 11 mg/day (19-50 years)
– Sources
• Foods of high protein content
• Supplements

• Nutrient supplements
– Prenatal supplements provide more folate, iron & calcium than
regular supplements
– Especially indicated for women
• With inadequate diet
• Carrying multiple fetuses
• Who smoke cigarettes, or are alcohol or drug abusers
 Food Assistance Programs
• WIC Program • Other programs
– Special Supplemental Food – Food stamp program
Program for Women, Infants
& Children – Community food &
educational assistance
– Federal program for low- programs
income pregnant & lactating
women & their children – American Dietetic &
American Diabetes
– Foods provide nutrients that Association, others
are often lacking provide nutritional
• Milk, cheese, iron-fortified information
cereals, fruit or vegetable
juices, carrots, eggs, dried
beans, tuna, peanut butter
• Iron-fortified formula for
bottle-fed infants
– Encourages breast feeding,
offering incentives to
mothers who do
 Weight Gain
• Fetal & maternal well-being depend on weight
gain during pregnancy
– Ideally, healthy weight at start of pregnancy
– More important, weight gain within recommended
range, based on prepregnancy BMI
• Patterns of weight gain
– For normal-weight woman: about 3 ½ lb gain
during 1st trimester, then 1 lb/week
– Weight gains within recommended ranges
associated with fewer surgical births, greater
number of healthy birthweights, other positive
outcomes
2005 Dietary Guidelines
Pregnant women should
ensure appropriate weight
gain as specified by a health
care provider
 Weight Gain
• Dieting during pregnancy • Weight gain is nearly all
not recommended (even lean tissue
obese women should gain – Placenta
at least 15 lb) – Uterus
– Essential for healthy – Blood
pregnancy – Milk-producing glands
– Pregnant adolescent needs – Fetus
weight gain to
accommodate for her own • Fat gain needed later for
growth, as well as that of lactation
fetus • Physical activity can help
– Women with multiples to cope with extra weight
require still more gain
• Sudden, large weight gain
is danger signal for
preeclampsia
 Physical Activity
• Staying active during
course of pregnancy
– Improves fitness of
mother-to-be
– Aids to carry extra weight
– Eases upcoming childbirth
– Helps prevent or manage
gestational diabetes
– Reduces psychological
stress
– Associated with fewer
discomforts during
pregnancy
– Helps with loss of weight
& regaining fitness after
delivery
• Choice of activity
– Low-impact
– Avoidance of sports where
falls or trauma is risk
– Frequency, duration &
intensity of activity affects
benefits & risks
– Avoid activities that will result
in high internal body
temperature & dehydration
• 2005 Dietary Guidelines
– Moderate-intensity activities
– 30 minutes or more most, if
not all days
– Avoid activities with risk of
falling or abdominal trauma
 Common Nutrition-Related
Concerns of Pregnancy
• Food cravings & aversions
– Individual cravings do not seem to reflect real
physiological needs
– Cravings & aversions probably due to
hormone-induced changes in taste &
sensitivity to smells
– Pica: non-food cravings
• Cravings for items such as laundry starch, clay or
soil, ice
• May be practiced for cultural reasons; common
among African-American women
• Often associated with iron deficiency
 Common Nutrition-Related
Concerns of Pregnancy
• Morning sickness Measures to alleviate
– Usually benign • On waking, get up slowly
condition • Eat dry toast or crackers
• Chew gum or suck hard
– Ranges from mild candy
nausea to • Eat small, frequent meals
debilitating problem whenever hunger strikes
– May be aggravated • Avoid foods with offensive
by smells odors
• Avoid citrus juices, water,
– Cause: increased milk, coffee, tea when
hormonal changes nauseated
early in pregnancy
 Common Nutrition-Related
Concerns of Pregnancy
• Heartburn Relief measures
– Burning sensation in • Relax & eat slowly
lower esophagus, near • Eat small, frequent meals
heart • Drink liquids between
– May also cause burning meals
sensation in throat • Avoid spicy & greasy foods
– Common, benign • Sit up while eating
condition
• Wait an hour after eating
– Cause: reflux of before lying down
stomach acid as fetus
grows & exerts pressure • Wait 2 hours after eating
against woman’s before exercising
stomach
 Common Nutrition-Related
Concerns of Pregnancy
• Constipation Relief measures
– Cause: hormones alter • Eat foods high in fiber
muscle tone, growing • Exercise daily
infant crowds intestinal • Drink at least 8 glasses of
organs liquids a day
– Harmless, benign • Respond promptly to urge
condition to defecate
• Use laxatives only as
prescribed
• Avoid mineral oil
 Problems in Pregnancy
• Gestational diabetes
– Pregnancy-related form of
diabetes Risk Factors
– Usually resolves after infant is •Obesity
born •Personal history
– Some women develop type 2 •Family history
diabetes later, especially if •Glucose in urine
overweight
– Can lead to fetal or infant Racial & Ethnic Tendency
sickness or death •Hispanic American
•Native American
– Early diagnosis & management
•Asian American
reduces risks
•African American
– May result in surgical birth & •Pacific Islander
high infant birth weights
– American Diabetes Association:
all women should be assessed
for risk at first prenatal
examination
 Problems in Pregnancy
• Preexisting chronic
• Hypertension hypertension
– Complicates pregnancy – Common associated risks
– Effect on outcome • Low-birthweight infant
• Premature separation of
depends on when placenta from uterine wall,
problem develops & resulting in stillbirth
how severe it becomes – Ideally, BP should be under
– Associated with health control before pregnancy
risks of heart attack & • Transient hypertension of
stroke pregnancy
– May be warning sign for – Increase in BP, usually
preeclampsia occurring during second half
of pregnancy
– Usually mild, with little
adverse effect on pregnancy
– BP usually returns to normal
within few weeks after
childbirth
 Problems in Pregnancy
• Preeclampsia
– Serious complication; may Eclampsia
progress to more serious – Severe complication
eclampsia
– Associated with
– Characteristics convulsions
• High blood pressure – Common cause of
• Protein in urine maternal mortality
• Fluid retention (edema) of – Treatment focused on
entire body
controlling
– Incidence preeclampsia
• Affects <10% of women • Regulating blood
• Usually during first pressure
pregnancy, after 20 weeks • Preventing
gestation convulsions
– Symptoms usually regress
within 48 hours after
delivery
– Affects almost all organs
Warning Signs of Preeclampsia
– Hypertension
– Protein in urine
– Upper abdominal pain
– Severe & constant headaches
– Swelling, especially of face
– Dizziness
– Blurred vision
– Sudden weight gain (1 lb/day)
 Practices to Avoid
• Cigarette smoking
– Effects
• Damage to fetal chromosomes
• Restricts blood supply to fetus
• Limits delivery of oxygen &
nutrients, removal of wastes Parental
• Slows growth smoking can
• May cause behavioral or intellectual kill an
problems
• May complicate birth otherwise
• Low infant birth weight healthy fetus or
• Has been linked to SIDS newborn
• Exposure to environmental tobacco
smoke (ETS, or second-hand
smoke) creates risk, even in non-
smoking mother
 Practices to Avoid
• Medicinal drugs & herbal
supplements
– May result in serious birth
defects
– All OTC or non-prescribed
drugs should be avoided
– Herbal supplements may not American Dietetic
Association website lists
be safe alternative
more than 100 herbal
• Limited testing for safety & supplements that may not be
efficacy during pregnancy safe to use during pregnancy
• All should be avoided unless
safety during pregnancy has
been ascertained
 Practices to Avoid
• Drugs of abuse
– Abuse of drugs may cause
serious health
consequences for fetus
– Easily cross placenta
– Impair fetal growth &
development
• Low birth weight
• Heartbeat abnormalities
• Pain of withdrawal
• Death
• Fetal effects of abused
drugs
– Nervous system damage
(amphetamines)
– Behavioral abnormalities
(amphetamines)
– Drug withdrawal symptoms
(barbiturates, opiates)
– Uncontrolled jerking
movements or paralysis
(cocaine)
– Permanent mental &
physical damage (cocaine,
opiates)
– Irritability at birth
(marijuana)
– Permanent learning
disabilities, ADD, ADHD
(opiates)
 Practices to Avoid
• Environmental contaminants
– Lead & mercury
• Readily cross placenta
• May cause fetal nervous system damage
• May result in impaired mental development
– FDA & EPA advisory regarding mercury concentrations in
fish
• Avoid large ocean fish
• Eat up to 12 oz a week of safer fish & shellfish: canned
light tuna, salmon, pollock, catfish, shrimp
• Smaller portions for children
• Albacore tuna contains more mercury than light tuna;
limited to 6 oz or less per week
• Check local advisories about safety of fish from lakes,
rivers & coastal areas
 Practices to Avoid
• Food borne illness
– Vomiting & diarrhea from
food borne illness may
cause fatigue & dehydration
– Listeriosis: more
threatening
• May cause miscarriage,
stillbirth, severe brain
damage, infections in fetus
or newborn
• Pregnant women more
likely than other healthy
adults to acquire listeriosis
• Prompt treatment to
prevent fetal or newborn
infection
2005 Dietary Guidelines
– Pregnant women should
not eat or drink
unpasteurized milk,
milk products, juices;
raw or undercooked
eggs, meat or poultry;
raw sprouts
– Pregnant women should
only eat certain deli
meats & frankfurters
that have been
reheated to steaming
hot
 Practices to Avoid
• Vitamin-mineral
megadoses
– Many vitamins & minerals
toxic when taken in excess
• Vitamin A closely linked
with birth defects
• Additional vitamin A not
recommended during
pregnancy
• Dieting
– Weight loss dieting, even
short term, is hazardous
to pregnancy
– Low carbohydrate intake
deprives fetal brain of
needed glucose; may
impair development
• Sugar substitutes
– Considered acceptable to use
if within FDA guidelines
– Still wise to use in moderation
& within nutritious, well-
balanced diet
– Women with PKU should not
use aspartame
• Caffeine
– Crosses placenta
– Fetus has limited ability to
metabolize
– No limit available, heavy use
may increase risk of fetal
death (studies show)
– Limit to 1 cup of coffee or two
12-oz beverages per day
 Practices to Avoid
• Alcohol • These facial traits are
– Fetal alcohol syndrome typical of fetal alcohol
(FAS)—spectrum of syndrome
symptoms
• Irreversible brain damage
• Growth & mental retardation
• Facial & vision abnormalities
• Other health problems
– Most severe impact in first 2
months of pregnancy
– American Academy of
Pediatrics: women should
stop drinking as soon as they
plan to become pregnant
– “Safe” alcohol intake limit
during pregnancy has not
been established
 Adolescent Pregnancy
• Special case of intense nutrient needs associated
with adolescent pregnancy
– Hard to meet nutritional needs for rapid growth &
development during adolescence
– Many teens enter pregnancy with multiple deficiencies—
putting both mother & fetus at risk
• Vitamins A & D, folate
• Iron, calcium, zinc
– Higher incidence of miscarriage, premature births,
stillbirths, low-birthweight infants, infant death
– Adequate nutrition—indispensable component of
prenatal care for adolescents
• Weight gain of about 35 lb (BMI in normal range before
pregnancy)
• Adequate kcalorie intake
Breastfeeding
 Breastfeeding
• American Academy of • A woman who decides to
Pediatrics & American breastfeed offers her infant
Dietetic Association a full array of nutrients &
recommendations protective factors
– Exclusive breastfeeding for
first 6 months
– Breastfeeding with
complementary foods for
at least 12 months
• Breast milk—unique
nutrient composition &
protective factors promote
optimal infant health &
development
• Iron-fortified formula is
only acceptable alternative
to breast milk
Nutrition during Lactation
• General guidelines for lactating women
– Continue to eat nutrient-dense foods
– Do not restrict weight gain unduly
– Enjoy ample food & fluids at frequent
intervals
• Energy
– Milk production requires about 500 kcalories
per day over regular need during first 6
months
• Add extra 330 kcalories per day
• Remaining 170 kcalories can come from fat stores
 Nutrition during Lactation
• Weight loss
– Breastfeeding for 3+ months may accelerate weight loss
– Also affected by percentage of body fat & weight gain
during pregnancy
– General loss of 1-2 pounds per month for first 4-6
months
– Moderate weight loss does not affect quality or quantity
of breast milk
– Diet & physical activity will improve weight loss & fitness

2005 Dietary Guidelines

•Moderate weight reduction is safe & does
not compromise weight gain of nursing
infant
•Neither acute nor regular exercise
adversely affects mother’s ability to
successfully breastfeed
 Nutrition during Lactation
• Vitamins & minerals
– Women generally can
produce milk with
adequate protein,
carbohydrate, fat, folate,
most minerals
• Milk quality maintained at
expense of maternal
stores
• Some nutrients decline in
response to long-term
inadequate intake of
vitamins (especially
vitamins B6, B12, A, D)
• Water
– Volume of milk produced
depends on infant
demands—not amount of
fluid mother drinks
– Still recommend fluid
intake of about 13 cups
per day
• Particular foods
– Some infants are sensitive
to foods in mother’s diet
– If food causes discomfort,
it can be eliminated from
diet to evaluate problem
 Contraindications to
Breastfeeding
• Alcohol
– Enters breast milk
– Adversely affects production, volume, composition & ejection
– Overwhelms infant’s immature alcohol-degrading system
– May alter taste & result in less consumption
• Caffeine
– Can result in wakefulness & jitteriness in infant
– Consumption should be moderate
• Cigarette smoking
– Results in less milk production & lower fat content
– Exposes infant to nicotine & other chemicals in breast milk;
sidestream smoke
– May result in array of health problems
 Contraindications to
Breastfeeding
• Medications & illicit
drugs • Maternal illness
– Medications may be
secreted in breast milk – Contraindications to
breastfeeding
• Breastfeeding should
be withheld during • Active, untreated
period of medication tuberculosis
treatment • Administration of
• Sustain flow of milk by radioactive isotopes
pumping breasts & • HIV & AIDS infections
discarding milk
• Some medications may
have no effect on
infant, but should only
be taken with
physician’s direction
– Use of illicit drugs may
result in infant addiction
– Contraceptives may or
may not affect breast milk
 Nutrition in Practice—Successful
Breastfeeding
• Many health care • Increasing rates of
organizations recommend breastfeeding initiation &
exclusive breastfeeding for duration is goal of Healthy
first 6 months People 2010
– Exclusive = infant – Increase proportion of
consumption of human mothers who breastfeed
milk with no immediately after birth,
supplementation (no for 6 months; preferably 1
water, other type of milk, year
juice, other foods) – Increase proportion of
– Exception: vitamins, mothers who breastfeed
minerals & medications exclusively
– Continue breastfeeding for • Despite recommendations,
at least 1 year & percentage of women who
thereafter breastfeed continues to be
low
 Nutrition in Practice—Successful
Breastfeeding
• Deterrents to breastfeeding
– Public advertising of infant formula
– Medical community’s failure to encourage
• Information & instruction especially
important during prenatal period when
decision is being made
– Nurses, other professionals play crucial role
– Encouragement & assistance need to be
provided in hospital & after discharge
 Nutrition in Practice—Successful
Breastfeeding
• Teaching mothers about breastfeeding
– Preparation
• Discontinue use of soaps & lotion on breasts toward
end of pregnancy & throughout lactation
• Acquire at least 2 nursing bras before delivery
• Begin breast feeding immediately after delivery, or as
soon as possible
– Continuation of successful breastfeeding
• Learn how to relax & position self & infant
• Stimulate rooting reflex
• Support breast & position nipple
• Allow nursing for 10-15 minutes on each breast
• Feed on demand, rather than rigid schedule—
averaging 8-12 feedings per 24-hour period during
1st month
Nutrition in Practice—Successful
Breastfeeding

• Problems associated with

breastfeeding
– Sore nipples
– Engorgement
– Mastitis
 Nutrition through the
Lifespan: Infancy, Childhood
& Adolescence
Nutrition of the Infant
 Nutrient Needs during
Infancy
• 1st year of life period of phenomenal growth &
development; infants grow faster during 1st
year than ever again
• Early nutrition affects later development
• Early feeding sets stage for eating habits that
influence nutrition status throughout life
• In developed countries, type of milk infant
receives & age at which solid foods are
introduced have most effect on infant’s
nutrition status
• Growth of infants & children is important
parameter in assessing nutrition status
 Nutrient Needs during
Infancy
• Nutrients to support
growth
– Rapid growth & metabolism
require ample supply of all
nutrients
• Infants double weight by
6 months & triple it by a
year
• Slows considerably by
end of the 1st year
• Proportionate to weight,
basal metabolic rate is
high
– Energy nutrients, vitamins &
minerals critical to growth
process are most important
• 100 kcalories/kg per day
• Vitamins A & D; calcium
– By about 6 months,
growth rate begins to
slow—but activity level
increases
• Energy needs increase
less rapidly
• Some energy saved by
slower growth is used
for increased activity
• As growth slows,
infants spontaneously
reduce energy intakes
 Nutrient Needs during
Infancy
• Water
– Important nutrient need for infants, as for
everyone
– The younger the child, the more of body
weight that is composed of water
– Breast milk or infant formula provides enough
water to replace fluid losses for healthy infant
• However, water is easy to lose
• Conditions that cause rapid fluid loss (i.e. vomiting or
diarrhea) require administration of an electrolyte
solution formulated for infants
 Breast Milk
• Energy nutrients
– Carbohydrates – Protein
• Lactose is carbohydrate
found in breast milk &
infant formulas
• Easily digested; enhances
calcium absorption
– Lipids
• Main source of energy in
both breast milk & infant
formulas
• Breast milk contains
generous proportion of
linoleic acid & linolenic
acid
• Also contains their
derivatives arachidonic
acid & docosahexaenoic
acid (DHA)
• Mainly alpha-lactalbumin
& lactoferrin
• Easily digested
• Lactoferrin benefits iron
nutrition & acts as
antibacterial agent
• Helps absorb iron into
bloodstream & keeps
intestinal bacteria under
control
Breastfeeding offers
benefits to both
mother & baby &
should be encouraged
whenever possible
• Research studies & arachidonic acid & DHA
– Found abundantly in developing brain & retina of the eye
– Studies show higher scores on visual & mental
development tests for breast-fed infants, compared to
formula-fed infants
– Infants fed formula with added DHA & arachidonic acid
had better visual function at 1 year than those fed
standard formula
– Results mixed regarding mental development & addition
of DHA & arachidonic acid
 Breast Milk
• Vitamins & minerals – Mineral content
– Vitamin content of • Calcium content ideal for
breast milk is ample, if bone growth; well-
mother is well absorbed
nourished • Low in sodium
– Exception: vitamin D • Iron & zinc are highly
• Deficiency impairs absorbable
bone mineralization – Supplements may be
• Deficiency most likely prescribed
in infants who: • Vitamin D
– Are not exposed to • Iron
sunlight daily
– Have darkly • Fluoride (after 6 months)
pigmented skin American Academy of Pediatrics
– Receive breast milk •Keep infants out of direct sunlight
without vitamin D •Vitamin D supplement for infants
supplementation who are breastfed exclusively
 Breast Milk
• Immunological protection
– Unsurpassed protection against infection
– Protective factors
• Antiviral agents
• Antibacterial agents
• Other infection inhibitors (i.e. enzymes, hormones &
lipids)
– Colostrum
• Premilk substance produced for first 2-3 days of
lactation
• Contains antibodies & white cells from mother’s blood
• Contains maternal immune factors that inactivate
harmful bacteria within the digestive tract
• Breast milk also delivers immune factors, but not to
the extent of colostrum
 Breast Milk
• Immunological • Other potential benefits
protection (con’t) – Protection against
obesity in childhood &
– Breastfed babies are later years
less prone to stomach &
– Protection against
intestinal disorders development of cardio-
during first few months; vascular disease &
less vomiting & diarrhea increased cholesterol
– Protects against other levels
common illnesses of – May have positive effect
infancy on later intelligence
• Middle ear infection
Studies related to
• Respiratory illness
these potential
benefits are
inconclusive, however
 Infant Formula
• Mothers who bottle • The infant thrives on
feed can still provide formula offered with
closeness, warmth & affection
stimulation to infant

• Infants must receive

breast milk or infant
formula for 1st year
– Cow’s milk of any kind
is not appropriate for
infants
– Breastfed babies who
are weaned before 1
year must be weaned to
infant formula
 Infant Formula
• Infant formula composition
– manufactured to be similar in content to breast
milk
– Formulas do not contain protective antibodies,
however
– Immunizations & reliable health measures can
minimize this disadvantage
• Infant formula standards
– National & international standards
• In US, based on AAP recommendations
• FDA mandates quality control procedures to ensure
standards are met
– Therefore, all standard formulas are
nutritionally similar
 Infant Formula
• Special formulas
– Some infants
cannot tolerate
standard formulas
• Premature infants
• Infants allergic to
milk protein
• Lactose intolerant
• Other needs
Soy & other alternatives to
milk-based formulas are also
useful for vegetarian families
• Risks of formula feeding
– Unavailability of formula
in some developing
countries & poor areas of
US
– Overdilution in attempt to
save money
• May result in malnutrition
& failure to grow
– Preparation with
contaminated water
• Often causes infections,
diarrhea, dehydration,
failure to absorb nutrients
• When sanitation is poor,
breastfeeding should take
priority over formula use
 Infant Formula
• Iron in formula
– AAP recommends iron-fortified formula for
all formula-fed infants
– Increased use of iron-fortified formula in
recent decades is credited with decline in
iron-deficiency anemia in US infants
• Nursing bottle tooth decay
– Dentists advise against putting infant to
bed with a bottle as a pacifier
• Salivary flow diminishes as infant falls asleep
• Prolonged sucking pushes jaw line out of shape
• Prolonged sucking on bottle of formula, juice,
milk bathes upper teeth in carbohydrate-rich
fluid, contributing to tooth decay
 Transition to Cow’s Milk
• AAP advises against cow’s milk in 1st year
– Whole cow’s milk in younger infants can cause intestinal
bleeding
– Higher protein concentration in cow’s milk stresses
infant kidneys
– Cow’s milk is poor source of iron; higher in calcium &
lower in vitamin C, both reducing iron absorption
• After 1st year, children between 1-2 years need
fat of whole milk
• Between 2-5 years, gradual transition from whole
to lower-fat milks can start—without excessive
restriction of dietary fat
2005 Dietary Guidelines
During 1st year, infants need children 2-8 years should
breast milk or iron-fortified consume 2 cups fat-free or
infant formula low-fat milk or equivalent milk
products
 Introducing First Foods
• Changes in body organs during 1st year affect
readiness for solid foods
• When to introduce solids
– AAP recommends exclusive breastfeeding for 6 months
– Infants usually developmentally ready for
complementary foods between 4-6 months
Considerations concerning
introduction of food
Infants’ nutrient needs
Physical readiness for different forms of
food
Need to detect & control allergic reactions
 Introducing First Foods
• Foods to provide iron & • Foods such as iron-fortified
vitamin C cereals & formulas, mashed
– Infant storage of iron is legumes, & strained meats
depleted by end of 1st year provide iron
– Sources of iron:
• Breast milk & iron-fortified
formula
• Iron-fortified cereals
• Meat or meat alternatives
– Vitamin C enhances iron
absorption; needs to be
added to diet
• Fruits & vegetables provide
best source
• Juices poor choice due to
possible effects & excessive
kcalories
 Introducing First Foods
• Physical readiness • Allergy-causing foods
for solid foods – Introduce new foods
– Ability to swallow singly & at intervals
• Allows for detection of
foods (4-6 months)
allergies &
– Able to sit with identification of
support & control offending food
head movements • Offer food for several
days & observe for
– At age 6 months allergic response
• If allergic response,
discontinue offending
food before introducing
another
 Introducing First Foods
• Choice of foods • Foods to omit
– Commercial baby foods – Sweets, including baby
generally have high desserts convey few
nutrient density nutrients, high in
– Alternative is to kcalories
blenderized small – Canned vegetables
portion of table food contain too much
– Foods should be free of sodium
added salt & sugar – Honey & corn syrup
carry risk of botulism
2005 Dietary Guidelines – Foods that present
Infants & young children should not eat or choking hazard
drink unpasteurized milk, milk products,
juices; raw or undercooked eggs, meat,
poultry, shellfish or fish, or raw sprouts
 Introducing First Foods
• Foods at 1 year
– Cow’s milk provides major source of nutrients
• 2-3 cups per day
• Excess milk contributes to iron-deficiency anemia
– Other foods—in variety & amounts sufficient to
round out total energy needs
• Meat & meat alternatives
• Iron-fortified cereal
• Enriched or whole-grain bread
• Fruits & vegetables
– By 1 year, child will sit at table
• Able to eat many of same foods as rest of family
• Drinks liquids from cup, rather than bottle
 Looking Ahead
• Major emphasis during 1st year is to encourage
eating habits to support continued normal weight
as child grows

– Introduce variety of nutritious foods, offered in inviting

way
– Do not force infant to finish bottle or entire jar of food
– Avoid concentrated sweets, empty-kcalorie foods
– Encourage physical activity
– Avoid use of food as reward or comfort for unhappiness;
do not associate food deprivation with punishment
– Select nutrient-dense, low-kcalorie foods that satisfy
appetite because of bulk
– Begin dental health activities
– Avoid fat-modified diet
 Mealtimes
• Developmental & nutritional • Ideally, a 1 year old eats
needs should be considered many of the same healthy
during mealtimes foods as the rest of the
– Discourage unacceptable family
behaviors by removing child
from the table to wait until
later to eat
– Let the child explore &
enjoy food
– Don’t force food on children
– Limit sweets strictly
• Exploring & experimenting
are normal behaviors during
1st year
Early& Middle Childhood
 Energy & Nutrient Needs
• After 1st year, growth rate slows, but
dramatic changes in the body continue
• Children’s appetites
– Appetite declines markedly around the 1st
birthday, consistent with slowed growth rate
• After this point, appetite fluctuates
• Not a point of concern: child will need & demand
more food during periods of rapid growth
– Although food energy intake varies from meal
to meal, total daily energy intake remains
fairly constant
– Children need to be directed in selecting right
foods, however
 Energy & Nutrient Needs
• Energy
– Individual children’s energy needs vary widely,
depending on growth & physical activity
• At 1 year: child needs approximately 800 kcal/day
• 6 years: active child needs twice that, 1600 kcal/day
• 10 years: active child needs about 2000 kcal/day
– Total energy needs increase gradually with age,
while energy needs per kilogram of body weight
decreases
– Physically active children require more energy due
to amount of energy expenditure
– Inactive children can become obese even when
they eat less food than the average
– Strategies to prevent obesity must focus on 2005 Dietary
balancing energy intake with energy expenditure Guidelines
Children should
engage in 60
minutes of
physical activity
most days of
the week
 Energy & Nutrient Needs
• Nutrients
– Steady growth necessitates gradual increase in
intake of most nutrients
– Children accumulate nutrient stores before
adolescence
• During adolescent growth spurt, nutrient stores help
keep pace with the demand
• Especially true of calcium
– Eating patterns influence nutritional health
during childhood, the teen years & throughout
the lifespan
 Energy & Nutrient Needs
• Food patterns for children
– Meals & snacks should include variety of foods
from each food group
• Amounts suited to child’s appetite & needs
• Higher-kcalorie choices are more appropriate for
active older children
– Nutrition concerns for US children
• According to surveys, majority of children between 2-
9 years consume a diet ranked “poor” or “needs
improvement”
• By 15-18 months, french fries is most commonly
consumed vegetable
• Infants & toddlers need greater variety of nutrient-
dense vegetables & fruits at meals & snacks
 Energy & Nutrient Needs
• Children’s food choices
– Parents & other caregivers can foster the
development of healthy eating habits in
children
– Nutrients should be delivered in meals &
snacks that are nutritious & appeal to the child
– Candy, cola & other concentrated sweets
should be limited
• Preference for sweets is innate
• Children need direction in selecting appropriate foods
 Malnutrition in Children
• Hunger & malnutrition prevalent in
some groups—even in US & Canada
– Low-income families more likely to be
hungry & malnourished
– Estimated 13 million US children
affected by food insecurity
Food insecurity:
Limited or uncertain
access to foods of
sufficient quality or
quantity to sustain a
healthy & active life
 Malnutrition in Children
• Effects of hunger
– Short-term & long-term hunger exerts
negative effects on behavior & health
– Short-term
• Impairs attention & productivity
• Causes irritability, apathy & disinterest
– Long-term
• Impairs growth & immune defenses
– Food assistance programs designed to protect
against hunger & improve health
• WIC
• School Breakfast programs
• National School Lunch programs
 Malnutrition in Children
• Hunger & school performance
– Children who eat nutritious breakfast do better
than their peers who miss breakfast
• Poor or no breakfast results in poor intake of several
nutrients
• Likely to be associated with
– Overweight
– Poor performance on tasks requiring concentration
– Shorter attention span
– Lower scores on tests
– Increases in absences & tardiness
• Chronically underfed children are affected the most
– Nutritious breakfast is central feature of
nutrition & health
 Malnutrition in Children
• Iron deficiency &
behavior
– Common problem, – Some manifestations
despite efforts to correct • Shortened attention
– Important roles of iron span
• Involved in carrying • Reduction in overall
oxygen in blood intellectual
performance
• Part of large molecules
that release energy in • Poor performance on
cells tests
• Key roles in brain & • Conduct disturbances
nervous system function – Children who were iron
– Deficiency usually not deficient as infants are
diagnosed until long after likely to continue to
effects on child’s brain perform poorly, even
after problem is
corrected
 Malnutrition in Children
• Preventing iron deficiency
– Children’s foods must deliver 7-10 mg of iron
daily
– Iron-rich foods
• Lean meats, fish, poultry, eggs, legumes
• Whole-grain or enriched breads & cereals
• Other nutrient deficiencies
– Often result in behavioral & physical symptoms
as well
– Any departure from normal healthy
appearance & behavior is sign of possible poor
nutrition
 Lead Poisoning in Children
• Two-way interaction
– Lead poisoning can cause
an iron deficiency
– Iron deficiency can impair
the body’s defenses
against lead absorption
• Mild lead toxicity has non-
specific effects
– Diarrhea
– Irritability
– Reduced ability of blood to
carry oxygen
– Fatigue
– Symptoms reversible if
exposure stops soon
enough
• Higher levels of exposure
result in more pronounced
symptoms
– Loss of general cognitive,
verbal & perceptual
abilities
– Development of learning
disabilities & behavioral
problems
• Severe lead toxicity results
in
– Irreversible nerve damage
– Paralysis
– Mental retardation
– Death
 Lead Poisoning in Children
• Incidence
– Efficient absorption of lead during periods of rapid
growth make fetuses, infants & children most vulnerable
– Most prevalent in children under 6 years
– Blood concentrations usually peak around age 2 due to
exploration of the environment & “hand to mouth”
activities
• Helping to eradicate the problem
– Bans on use of lead in fuel
– Elimination of lead in paints, lead-soldered cans
– Nationwide monitoring system, aggressive community
programs for testing & treating
 Food Allergies
• Asymptomatic & symptomatic allergies
– Allergies affect approximately 6% of children
– Generally diminish with age
– “True” food allergy occurs when food protein
elicits an immunological response
• Always involve antibodies (antigen-antibody
response)
• May or may not produce symptoms
• Once diagnosed, therapy requires strict elimination of
offending food
• Food intolerance is problem resulting from food
exposure, but does not involve immune system
 Food Allergies
• Allergy symptoms
– Symptoms depend on location of reaction
• Digestive tract: nausea or vomiting
• Skin: rashes
• Nasal passages & lungs: inflammation or asthma
• Generalized, systemic: dangerous all-systems shock
reaction—anaphylactic shock
• Immediate & delayed reactions
– Immediate reactions occur within minutes after
exposure to antigen
– Delay reactions may occur after several, up to 24 hours
after exposure
– Immediate reactions are easiest for identification of
causative factor; delayed reactions more difficult to
pinpoint
 Food Allergies
• Anaphylactic shock
– Life-threatening allergic
reaction
– Common offending foods
• Peanuts or tree nuts
• Milk
• Eggs
• Wheat or soybeans
• Fish or shellfish
– Eggs, milk, soy & peanuts
cause majority of problems
– Peanuts most life-threatening
• Protecting against reaction
– Pack lunches & snacks
– “No swapping” policy
– Teach child to recognize
symptoms
• Symptoms of impending
anaphylactic reaction
– Tingling sensation in mouth
– Swelling of tongue & throat
– Irritated, reddened eyes
– Difficulty breathing, asthma
– Hives, swelling, rashes
– Vomiting, abdominal
cramps, diarrhea
– Drop in BP
– Loss of consciousness
– Death
 Food Allergies
• Food labeling • Other adverse reactions
– Must announce to foods—not true
presence of common allergies
allergens, in plain – Reaction specific to MSG
language
– Reaction to chemicals in
– Clearly identify foods
potential cross-
contamination during – Symptoms of digestive
production diseases are aggravated
by eating specific foods
– Enzyme deficiencies (i.e.
lactose intolerance)
– Psychological reactions
 Food Allergies
• Food dislikes
– Should be considered seriously
• Food aversions may be natural protection
from allergic or adverse reaction
– Allergy testing & nutritional knowledge
can help to make decisions in diet
alterations
 Hyperactivity
• Affects behavior & learning in about 5-10% of
school-aged children
• Untreated, interferes with social development &
ability to learn
• Treatment focused on relieving symptoms &
controlling associated problems
– Behavior modification
– Special educational techniques
– Psychological counseling
– Drug therapy, if indicated
• No evidence of link between specific foods &
hyperactivity
– Dietary alterations do not resolve problem
 Food Choices & Eating
Habits
• Food choices & physical activity
– Promote healthy growth
– Help prevent degenerative diseases of later life
– Early childhood provides opportunity to
influence food choices made by children
• Mealtimes at home
– Feeding requires blend of nutritious foods and
nurturing of child’s self-esteem & well-being
– Challenge to prepare foods that appeal to
child’s tastes & provide needed nutrients
– Child’s preferences should be treated with
respect
 Food Choices & Eating
Habits
• Honoring children’s • Eating is more fun
preferences when friends are there
– Preferences seem full of
contradictions
– Prefer to eat at small
tables & be served
smaller portions
– Enjoy company of
peers—tends to
increase food intake
– Environment should be
free of anxiety &
negative emotions
 Food Choices & Eating
Habits
• Avoiding power
struggles
– Problems over food often
arise as child begins to
assert independence (2nd or
3rd year)
• Child is developing
ability to regulate or
determine his own likes
& dislikes
• Children who are coerced
(or bribed) to eat specific
foods are less likely to
try them again
• Children more likely to
try foods again when left
to decide for themselves
• Strategies
– Introduce new foods one
at a time & in small
portion
– Present several times to
expose child to new taste
– Present new food at
beginning of meal
– Allow child to make
decision to accept or
reject
Parent is responsible for what child
is offered to eat; child is
responsible for how much or even
whether to eat
(Ellyn Satter, dietician & family therapist)
 Food Choices & Eating
Habits
• Television’s influence
– Watching TV adversely affects
children’s nutritional health Average child
• Contributes to overweight & inactivity sees about
• Less likely to eat fruits & vegetables 30,000
commercials
• Snack on kcalorie-dense snacks that a year
are advertised
– Commercials often focus on foods
that add sugar, fat, salt to diet &
displace foods that provide
needed nutrients
– Parents can teach children to
evaluate food ads & make
healthy choices
 Food Choices & Eating
Habits
• Preventing choking
– Parents must be alert to dangers of
choking
• Adult should be present when child is eating
• Child should sit when eating
Choking child is
• Play first a silent child

– Meal should be preceded by activity

• Children eat better following
• Tend to hurry through meal to get to
activity when it follows meal
 Food Choices & Eating
Habits
• Child participation
– Planning & preparing meals
provides learning experience
• Encourages child to eat foods he has
prepared
• Colorful vegetables give opportunity to
learn colors, growing of foods, shapes
& textures
• Even young children can practice
various skills of measuring, stirring,
decorating, arranging foods
 Food Choices & Eating
Habits
• Snacks • Preventing dental
– Frequent snacks reduce caries
hunger for mealtime – Teach children good
dental practices
– Teach child how to
• Brush & floss after
snack; rather than not meals
to snack • Brush or rinse after
– Snacks should be as snacks
nutritious as foods • Avoid sticky foods
served at meals • Select crisp or fibrous
foods frequently
– Easy-to-prepare,
healthy snacks should 2005 Dietary Guidelines
be readily available Reduce incidence of dental
caries by practicing good oral
hygiene & consuming sugar-
and starch-containing foods &
beverages less frequently
 Food Choices & Eating
Habits
• Serving as role models
– Parents are single most important influence on
child’s food habits
– Likes & dislikes are readily communicated to
child
– Mealtime with parents, older siblings, other
caregivers provides opportunity to promote
physical & emotional health at every stage
– Good beginnings will reduce conflicts &
confusion over foods that can result in
nutrition & health problems
 Nutrition at School
• School has important role
• “Schools &
in food & nutrition
behaviors
– School lunches
– Nutrition & food
education
• US government-funded
programs designed to
provide nutritious, high-
quality foods at school
communities share
responsibility to
provide all students
with access to high-
quality foods &
school-based nutrition
services as an integral
part of the total
education program”
American Dietetic Association
 School Breakfast Program
• Research continues to show
positive impact breakfast has
on school performance &
health
• Program available in >80% of
nation’s schools; however
many children still do not
participate
• School breakfast must include
– 1 serving fluid milk
– 1 serving fruit or vegetable or
full-strength juice
– 2 servings of bread or
alternates; or 2 servings of
meat or alternates; or 1
serving of each
School Lunch Program
• Served to over 28 million
children
• Designed to provide at
least ⅓ of
recommendation for
energy, protein, vitamins A
& C, iron, calcium
• Must include specified
numbers of servings from
each food group
• In order to reduce
cardiovascular disease risk,
must follow Dietary
Guidelines for Americans
 Nutrition at School
• Competing influences at school
– Short lunch periods & long lines prevent
some students from eating school lunch,
or rushing through meal
– School lunch programs can be
undermined
• Fast-food restaurants in or near school
• Ala carte choices that are less nutritious
• Snack foods & carbonated beverages from
school store or vending machines
The Teen Years
 The Teen Years

• Complex changes occur during

adolescence
– Physical changes increase nutrient needs
– Emotional, intellectual & social changes makes
meeting needs a challenge
• Teenagers make more choices & decisions
for themselves
– Food choices profoundly affect health
– Social pressures compete with other choices
 Adolescent Growth &
Development
• Abrupt & dramatic increase
in growth rate associated
with onset of adolescence
– Hormones direct intensity
& duration of adolescent
growth spurt
– Profound effect on every
organ of body, including
brain
– Growth patterns of males
& females become distinct
• Female growth spurt
starts at age 10-11
• Male growth spurt begins
around age 12-13
• Duration of spurt is about
2 ½ years
‪ Gender differences during
adolescent growth
• Males
– Increase lean body mass
(muscle, bone)
– Grow 8 inches taller
– Gain about 45 lbs
• Females
– Fat becomes larger
percentage of total body
weight
– Grow 6 inches taller
– Gain approximately 35 lbs
 Energy & Nutrient Needs
• Vary greatly, depending on current rate
of growth, gender, body composition,
physical activity
– Boys’ energy needs may be especially high—
active 15 year old may need 3500+ kcalories
a day to maintain weight
– Girls’ energy needs peak sooner & decline
earlier than males—inactive 15 year old may
need <1800 kcalories to avoid excessive
weight gain
 Energy & Nutrient Needs
• Obesity
– Problem of obesity becomes more apparent
during adolescence
• Estimated 15% of US children & adolescents 6-19
years are overweight
• Most evident in African American & Hispanic children
of both genders
– Consequences & attitudes regarding obesity
increase emphasis to control weight
• Frequent “diets” & unhealthy weight-loss attempts
• Can result in nutritional deficiencies
• Extremely restrictive dieting has dramatic physical
consequences of its own
 Energy & Nutrient Needs
• Vitamins
– Recommendations for
most vitamins are similar
to adult needs
• Iron
– Need increases for both
males & females
• Start of menstruation
increases need in females
• Increase in lean body
mass increases need in
males
• Adolescent growth spurt
also increases need
Iron RDA
• Males
– 9-13 yr: 8 mg/day
– 9-13 yr in growth spurt: 10.9
mg/day
– 14-18 yr: 11 mg/day
– 14-18 yr in growth spurt: 13.9
mg/day
• Females
– 9-13 yr: 8 mg/day
– 9-13 yr in menarche: 10.5 mg/day
– 9-13 yr in menarche & growth
spurt: 11.6 mg/day
– 14-18 yr: 15 mg/day
– 14-18 yr in growth spurt: 16
mg/day
 Energy & Nutrient Needs
• Calcium
– Need for calcium peaks during teens
– Crucial time for bone development
– Low intake common among teens
• 90% of females & 70% of males (aged 12-19) fall
below recommendations
• Teenage girls are most vulnerable—intakes start to
decline as needs are greatest
• Combined with inactivity, bone mass development is
compromised
– Increasing milk products in diet to meet
calcium intake recommendations increases
bone density
– Physical activity helps to increase bone
strength
 Food Choices & Health
Habits
• Busy lifestyle & increased
demands on time result in
irregular eating habits
– Quick snacks & fast foods as
main meal
– Few evening meals with
family
– Missed meals, especially
breakfast
• Snacks
– About ¼ of daily energy
intake comes from snacks
– Can contribute to some of
needed nutrients if selected
carefully
– Often fall short in fiber,
calcium, iron & vitamin A;
high in saturated fat &
sodium
 Food Choices & Health
Habits
• Beverages
– Increased consumption of soft
drinks, at all meals—have
become primary beverage
– Rarely select juices, except at
breakfast, or milk at meals
– Bone density is at risk if soft
drinks displace milk from diet
– Regular soft drink
consumption linked to obesity
– Caffeine in drinks presents
problems as well
– Moderate intake of caffeine
seems relatively harmless;
greater amounts can result in
symptoms associated with
anxiety
 Food Choices & Health
Habits
• Eating away from home
– About ⅓ of meals consumed away from home
– Nutritional welfare is enhanced or hindered by
food choices made
– Many fast food restaurants offer more
nutritious choices—making healthy decisions
easier
• Peer influence
– Peers are integral part of day-to-day life of
teens
– Gatekeepers can set the environment so that
nutritious foods are available—ultimately the
teen will make the choice
 Nutrition in Practice—Childhood
Obesity & Chronic Diseases

• Incidence of childhood • Behaviors influence

obesity & onset of development as well—
“adult diseases” has beginning early in life
increased to – Overeating
unprecedented – Physical inactivity
numbers – Cigarette smoking
– Type 2 diabetes
– Hypertension
– Cardiovascular diseases
– Increased blood lipids
• Role of genetics
– Genetics does not seem to play determining
role in development of obesity, CVD,
hypertension, type 2 diabetes
• Individual is not destined from birth to develop them
– Appears to be a permissive role
• If the tendency is inherited, factors in the
environment (poor diet, sedentary lifestyle, cigarette
smoking) may push development of conditions
– Relationship between genes & environment is
synergistic one
• Combined effects are greater than the sum of their
individual effects
• Events during fetal development
– Theory of fetal programming, or fetal origins of
disease—link maternal malnutrition or other
harmful conditions to lifelong effects
– Malnutrition at critical period of fetal
development may increase tendency to
develop obesity & certain diseases
– Infant birthweight considered indicator of fetal
nutrition status
• Lower birthweight increases risk of adult
hypertension
• Postnatal growth also influences adult blood pressure
• This pattern of growth—low birthweight followed by
“catch up” growth—seems to be a link
• Increased prevalence of type 2 diabetes
– On the increase in children & adolescents
– Obesity is primary risk factor
– Most children diagnosed with type 2 diabetes are
obese
– Most diagnosed during puberty
– As incidence of obesity & inactivity increase,
disease is appearing in younger & younger children
• How type 2 diabetes develops
– Body’s cells become insulin-resistant
– Results in reduction of amount of glucose entering
cells from the blood
– Prevention & treatment depend on weight
management & activity
• Development of
CVD – Fatty streaks begin to
– Most CVD involves appear in arteries during
atherosclerosis 1st decade of life
• Begin to turn to plaque
• Accumulation of
during adolescence
cholesterol & other
lipids along arterial • Later calcify & become
walls lesions that block blood
flow, resulting in heart
• Often interferes with
attack or stroke
blood flow to heart,
leading to coronary • Especially occurs in boys
heart disease & young men
• Stroke results when • Dramatic increase in heart
blood flow to brain is disease at about age 45
compromised for men & 55 for women
• Blood cholesterol in
children
– Atherosclerotic lesions
reflect blood
cholesterol
• As cholesterol
increases, lesion
coverage increases
• Cholesterol values at
birth are similar in all
populations
– Changes in cholesterol
levels
• Differences emerge in
early childhood
• Cholesterol tends to
increase as saturated fat
intake increases
• Also correlates with
childhood obesity;
especially central obesity
• In obese children: LDL
cholesterol often too
high & HDL levels too
low
Nutrition though the
Lifespan:
Later Adulthood
 Older Adults in the U.S.
• Population is aging
– Majority of citizens middle-aged
– Ratio of old people to young has increased
– Age 65 considered transition point between
middle & old age
– Fastest growing age group is >85 years

Most urgent nutritional

need in older adulthood
is to have made good
food choices over the
life span!
 • 1940 = 6.8% of population
• Average life expectancy— was ≥65; 1990 = 12.7%;
increased from 47 years 2040 = 21.7%; 2090 =
(in 1900) to 77 years nearly 1 in 4
today

– Advances in medical sciences

largely responsible
– Improved nutrition & food
supply also contributors
– Research may contribute to
further extensions, as well as
slowing or preventing aging
& accompanying diseases

• Study of aging process still

one of the youngest
scientific disciplines
 Nutrition & Longevity

• Questions regarding how & why of human

aging
– To what extent is aging inevitable?
– Can it be slowed by lifestyle & environmental
changes?
– What role does nutrition play in aging?
– Can nutrition play a role in slowing aging?
• Aging seems to be an inevitable, natural
process; however, it is estimated that 70-
80% of life expectancy may depend on
health-related behaviors
• Good nutrition can help maintain health of
the body, ease the aging process in
significant ways & improve the quality of
life in later years
 Slowing the Aging Process
1. Healthy habits
• Profound effect on
health & physiological Physiological age
age Age as estimated from a
– Regular & adequate person’s body’s health &
sleep probable life expectancy
– Regular, well-balanced
meals
Chronological age
– Maintaining healthy
body weight Actual age in years from
– Regular physical activity the date of a person’s birth
– No smoking
– Avoidance (or
moderation) of alcohol
intake
 Slowing the Aging Process
(con’t)
2. Physical activity
• Active older adults
gain many remarkable • Aerobic activities: improve
cardio-respiratory
benefits endurance, blood pressure,
– Better weight control blood lipid concentrations
– Greater flexibility & • Moderate endurance
endurance activities: improve quality
of sleep
– Better balance
• Strength training:
– Better overall health improves posture &
– Longer life mobility
 2005 Dietary • Regular physical activity
promotes a healthy,
Guidelines independent lifestyle
Older adults should
participate in regular
physical activity to
reduce the functional
declines associated
with aging & to
achieve the other
benefits of physical
activity identified for
all adults.
 Slowing the Aging Process
(con’t)
3. Restriction of kcalories
• Physiological responses to moderately restricted
energy intake (10-20% reduction of usual
energy intake), including
– Body weight, body fat & blood pressure drop
– Blood lipids & insulin response improve
• Reduction in oxidative changes occurs with diets
that include antioxidants & phytochemicals
A person with
usual energy
intake of 2000
kcalories might cut
back to 1600-1800
kcalories
 Nutrition & Disease
Prevention
Nutrition alone cannot ensure long, robust life,
but does have role in disease prevention

• Appropriate energy intake: helps prevent obesity, diabetes,

related cardiovascular diseases; may influence development of
some cancers
• Adequacy in intake of essential nutrients: prevents deficiency
diseases
• Variety of food intake, as well as adequacy in certain fruits &
vegetables: may protect against certain cancers
• Moderate sugar intake: helps prevent dental caries
• Appropriate fiber intake: helps prevent disorders of GI tract,
possibly colon cancer
• Moderate sodium intake & adequacy intake of potassium, calcium,
other minerals: may help prevent hypertension
• Adequate calcium intake throughout life: protects against
osteoporosis
 Nutrition-Related Concerns
• Cataracts
– Oxidative stress appears related to development
– Antioxidant nutrients & phytochemicals (from fruits &
vegetables) may minimize damage
– Obesity may be related to cataract development
• Macular degeneration
– Leading cause of blindness over 65 years (age-related
macular degeneration—AMD)
– Risk factors include oxidative stress from sunlight
– Supplements of antioxidant nutrients plus zinc, &
carotenoids lutein & zeaxanthin may help protect
– Additional protection possible from diets high in omega-
3 fatty acids from fish
 Nutrition-Related Concerns
(con’t)
• Arthritis
– Leading cause of disability in older adults—osteoarthritis, most
common type
– Overweight is known connection between osteoarthritis &
nutrition
– Weight loss, aerobic activity & strength training offer
improvements in physical performance & pain relief
– No one diet is universally effective for arthritis relief, but
quack & non-effective treatments abound
– Traditional medical treatments include medication & surgery
– Two current supplements may be effective in alleviating pain &
improving mobility—glucosamine & chondroitin
– Rheumatoid arthritis has possible link to diet through the
immune system—certain vegetables, olive oil & omerga-3 fatty
acids may moderate the inflammatory response & provide
relief
 Nutrition-Related Concerns
(con’t)
• Aging brain
– Responds to genetic & environmental factors—enhancing
or diminishing capacities
– Challenge is to distinguish among changes
• Normal, age-related physiological processes
• Disease-related causes
• Causes related to cumulative, extrinsic factors, such as diet
– Nutritional deficiencies now recognized as contributing to
much cognitive loss & forgetfulness
• Controllable extrinsic factors
• Function of neurons dependant on nutrients such as amino
acids (tryptophan), vitamins & minerals
• Recognized link between brain function & nutrients
 Alzheimer’s Disease
• Most prevalent form of • Possible causes
senile dementia – Genetic factors
• Afflicts 4.5 million people – Damage from oxidative
in U.S.—increasing each stress & free radicals
decade – Cardiovascular disease
• Diagnosis based on risk factors may be related
characteristic symptoms: to development of
Alzheimer’s disease
– Gradual loss of memory &
reasoning • Treatment
– Loss of ability to – Care to clients & support
communicate of families
– Loss of physical – Treatment of symptoms &
capabilities associated problems
– Eventual loss of life • Medications to enhance
memory (mild-to-
moderate stages)
• Nutritional support
 Energy & Nutrient Needs
• DRI guidelines consider 2 age categories
for over-50-year population
– 51-70 years old
– 71 years and older
• Research shows differing nutrition needs
in the 2 groups—changes of aging affect
nutrition
• Setting standards difficult
– Variable intake among individuals throughout
lifespan
– Effects of chronic disease
– Effects of medications
 Energy & Energy Nutrients
• Energy needs decline approximately 5% per
decade
– Reduced physical activity
– Declining BMR (approximately 1-2% per decade)
• Optimal nutrition & regular physical activity can
minimize changes in body composition associated
with aging
– Prevent or delay incidence of sarcopenia (loss of muscle
mass)
– Maintain muscle strength & mass
– Increase energy expenditure
– Enhance bone density
– Support other body functions
 Energy & Energy Nutrients
(con’t)
• Less food energy required to maintain weight
– Energy RDA decreases slightly starting at age 51
– Overweight & obesity increase risk for disease &
disability
• Food selection should include mostly nutrient-dense
foods
– Use the USDA Food Guide for selections—
recommended amounts from each food group,
appropriate to energy needs
– Little leeway for added sugar, solid fats or alcohol
– Diet should provide enjoyment as well as nutrients
 Energy & Energy Nutrients
(con’t)
Protein
– Needs about the same as for younger people
• Low-kcalorie sources of high-quality protein
• Lean meats, poultry, fish & eggs
• Fat-free & low-fat milk products
• Legumes & grains
– Underweight & malnourished adults need
protein- and energy-dense snacks
• Hardboiled eggs, tuna fish & crackers, peanut butter
on graham crackers, hearty soups
• Liquid nutritional formulas can boost energy &
nutrient intakes
 Nutrient Needs (con’t)
Carbohydrate & Fiber
• Abundant carbohydrate to protect protein
– Mostly whole-grain breads, cereals, rice & pasta
– Adequate fiber to alleviate constipation
Fat
• Moderation in intake
• Limiting too severely may lead to nutrient deficiencies &
weight loss
Water
• Dehydration a risk for older adults
• Intake of 9 cups a day (total beverages, including water)
recommended for women; 13 cups a day for men
 Nutrient Needs (con’t)
Vitamins & Minerals
• Vitamin D: include vitamin D-fortified foods and/or
supplements
– 10 g a day (51-70 years)
– 15 g a day (>70 years)
• Vitamin B12: people over age 50 should consume vitamin
B12 from fortified foods or supplements (RDA: 2.4 g a day)
• Folate: medications or medical conditions may compromise
folate status (RDA: 400 g a day )
• Iron: low energy intake and other factors may contribute to
iron deficiency (RDA: 8 mg a day)
 Nutrient Needs (con’t)
Vitamins & Minerals
• Zinc: commonly low in older people; deficiency can suppress
appetite & medications may impair absorption (RDA: 11 mg a day
for men; 8 mg a day for women)
• Calcium: important protection against osteoporosis; should be
included in calcium-rich foods and/or supplements (RDA: 1200 mg
a day)
Nutrient Supplements
• Nutrition management & use of supplements should be judged
individually
• Balanced low-dose vitamin & mineral supplement often beneficial
• Food still the best source of nutrients—for all ages
• Supplements should supplement foods—not substitute for them
 Effects of Drugs on
Nutrients
• Use of medications increases with
age (both OTC & prescription)
• Most drugs interact with nutrients
• Alcohol most common drug affecting
nutrition
 Food Choices & Eating Habits
of Older Adults
• Menus & feeding programs must consider
– Food preferences & eating patterns, likes &
dislikes
– Living conditions & economic status
– Medical conditions
• Older adults more likely to eat at home
than other age groups
– Want to maintain independence & control of
own lives
– Food manufacturers should consider
preferences in products
 Food Choices & Eating Habits
(con’t)
• Individual preferences
– Familiarity, taste & health benefits most
influential on food choices
– Familiar foods, especially ethnic foods, are
comforting
– Food selection often indicates recognition of
importance of diet in supporting good health
• Meal setting
– Changes in lifestyle accompany aging
– Living alone or in institutions affects meal
habits, ultimately nutritional status
– Loneliness is directly related to nutritional
inadequacies, especially energy intake
 Food Choices & Eating Habits
(con’t)
• Depression
– Affects food intake & appetite, as well as
motivation to cook or eat
– Grief & sadness at death of spouse, friend,
family member contributes to feelings of
powerlessness
– Support & companionship, especially at
mealtimes, can overcome depression &
enhance appetite
– Health care professionals need to consider
risks of malnutrition in older adults
 Food Assistance Programs
• Older American Act (OAA) provides
services & supports to help older adults
remain independent
• Food assistance programs integral to
promoting health in older adults
– OAA Nutrition Program
– Food Stamp Program
– Meals on Wheels
– Senior Farmers Market Nutrition Program
 Meals for Singles
• Singles of all ages face challenges in purchasing,
storing & preparing food
– Food borne illness
• Risks greater than for other adults
• Consequences more severe
– Spend wisely
• Shopping strategies can cut food bills
• Challenge to purchase adequate amounts without waste
• Personal size products, or those with longer shelf life
• Larger volume purchases are good choice when storage
(i.e. freezer) space allows
– Be creative
• Dividing foods for several meals
• Use of casseroles, stir fry, other preparation methods
• Invite company
Nutrition in Practice—Hunger &
Community Nutrition
• Food insecurity (limited or
uncertain availability of
nutritionally adequate & safe
foods) is major social problem in
U.S.
– Extensive network of federal
assistance programs geared
toward providing nutritious foods
to millions of citizens everyday
– Programs are not completely
successful, but seem to improve
nutrient intakes of participants
– Only small percentage of eligible
individuals participate in available
programs (such as food stamp
program)
• Health care professionals have
role in identifying need and
making referrals for those in need
 Programs Aimed at
Reducing Hunger

• Food Stamp Program: largest federal food

assistance program; administered by U.S.
Department of Agriculture
• National food recovery programs
– America’s Second Harvest: coordinates efforts of over
40,000 food pantries, emergency shelters & soup
kitchens
– Hunger Relief Organizations: collect & distribute good
food that would otherwise be wasted
• Community-based nutrition programs
– Food pantries that provide groceries
– Soup kitchens that serve prepared meals