PREGNANCY AND LACTATION

GESTATION A major reason that the mother's pre-pregnancy

● Is the period from conception to birth
● That is 38 to 42 weeks or 9 months
pregnancy
● Divided into 3 trimesters
● Has 3 events or periods
nutrition is so crucial is that it determines whether
her uterus will be able to support the growth of a
healthy placenta during the first month of gestation.
Other responsibilities of the placenta:
a. It actively gathers up hormones, nutrients,
and protein molecules such as antibodies
and transfers them into the fetal
bloodstream
b. It produces a broad range of hormones that
act in many ways to maintain pregnancy
and prepare the mother's breasts for
lactation.

HABITS TO ESTABLISH IN PREPARATION FOR

A HEALTH PREGNANCY
1. IMPLANTATION PERIOD
1. Achieve and maintain a healthy body weight
● Fertilized ovum implants itself in the uterus
2. Choose an adequate and balanced diet
and begins to develop
3. Be physically active
● occurs during the 1st 2 weeks of conception
4. Avoid harmful influence
● Source of nourishment:
○ uterine substances (UTMP) (Uterine
Alcoholic fetal syndrome is condition of a baby as a
Milk Protein)
result of a pregnant mother drinking alcohol
○ glands in the endometrium (the
lining of the uterus) will secrete
1. Achieve and maintain a healthy body weight
UTMP
Underweight Pregnant
○ progesterone will stimulate the
- If the pregnant mother is underweight she is
glands to secrete UTMP
a high risk of giving birth a low birth weight (LBW)
○ estrogen causes endometrium to
infant
thicken to produce UTMP
- LBW – infants have impaired growth and
● Adverse Influences are:
development
○ smoking, drug abuse and
- Prone to infection and disease
malnutrition
- Will have lower adult IQ
○ these will result to failure to implant
○ Neural Tube Defect (NTD )
Overweight or Obese Pregnant
1. Birth defects
2. ORGANOGENESIS
a. heart defects and neural tube
● period of organ formation
defects (NTDs)
● occurs from 2 to 8 weeks after conception
2. Problems with diagnostic tests
or next 6 weeks
a. too much body fat leads to
● critical period when organs are formed and
inaccurate ultrasound results
most vulnerable to adverse influences
3. Macrosomia
● Source of nourishment:
a. The fetus is larger than normal
○ At about 8 to 12 weeks into
b. Baby have a greater chance of being
pregnancy glands in the uterine
obese later in life
lining secrete glucose, which it
4. Premature Birth – obese pregnant may
stores as glycogen (the source of
developed preeclampsia, may lead to a
nourishment for the baby)
medically indicated preterm birth
a. With preeclampsia, you might have
3. RAPID FETAL GROWTH
high blood pressure, high levels of
● the last 7 months
protein in urine
● characterized primarily by growth in the
5. Stillbirth - the higher the woman’s BMI, the
number of cells and size of the organs until
greater the risk of stillbirth
it can support extra uterine environment
a. A stillbirth is the death or loss of
● Source of nourishment
baby before or during delivery
○ Placenta
b. A stillbirth is the death of a fetus in
- Simple diffusion-passive
the uterus after a week 20 of
process in which nutrients
pregnancy. May be caused by
move from high
problems with the placenta or
concentration in the maternal
umbilical cord, high blood pressure,
blood to lower concentration
infections, birth defects, or lifestyle
in the fetal capillaries until
choices.
equilibrium, is reached.
- O2, CO2, FA, Steroids,
Recommended Weight Gains Based on
Nucleotides, electrolytes, and
Pregnancy Weight
Fat soluble vitamins

NCM 205 LEC Nutrition & Diet Therapy

by: Tupas &Totesora
 Pre-pregnancy Weight Recommended Weight
Gain

Underweight (BMI < 28 to 40 lb (12.5 to

18.5) 18.0 kg)

Healthy Weight (BMI 25 to 35 lb (11.5 to 16.0

18.5 to 24.9) kg)

Overweight (BMI 25.0 15 to 25 lb (7.0 to 11.5

to 29.9) kg)

Obese (BMI >_ 30) 15 lb minimum (6.8 kg

minimum)

NUTRITIONAL REQUIREMENT
ENERGY
- Normal TER + 340kcal on the start
of 2nd semester
- Normal TER + 450 kcal on the 3rd
trimester
- Choose nutrient – dense food
RATIONALE
2. Choose an adequate and balanced diet - To supply the increase fuel,
- malnutrition reduces fertility and impairs the demanded by the enlarged
early development of an infant metabolic workload
- placental development, implantation, and
early critical periods of embryonic and fetal CARBOHYDRATES
development depend on maternal nutrition - 60 % of TER/day
before and during pregnancy RATIONALE
1. Necessary to fuel the fetal brain.
Dietary Management: 2. Fiber in CHO rich foods such as
- pinggang pinoy whole grains, vegetables, fruits will
- the basic food groups help alleviate constipation
3. To spare CHON for added
tissue-building requirement.
Resting metabolic rate, increases during pregnancy
as a result of increased body mass, PROTEINS
pregnancy-associated physiological changes, i.e., - + 25g to normal CHON
cardiac output, and the growing fetus. requirement/day
Some of the changes in maternal physiology during RATIONALE
pregnancy include: increased maternal fat and total 1. For baby’s rapid growth
body water, decreased plasma protein 2. For the development of the placenta
concentrations, especially albumin, increased 3. Due to the increase in maternal
maternal blood volume, cardiac output, and blood blood volume
flow to the kidneys and uteroplacental unit, and 4. Needed in the synthesis of Hgb and
decreased blood pressure. plasma CHON
Low blood pressure during pregnancy happens 5. For the formation of amniotic fluid
because the body secretes hormones, and 6. For tissue storage reserve
progesterone in particular, which help to relax the
walls of the blood vessels and increase the flow of VITAMINS SUPPLEMENTATION
blood to the mother and her baby. 1. Vitamin C
a. Al or RDA (according to age)
i. < 18 - 80mg/day
19-50 - 85mg/day
b. Rationale
i. for tissue repair and wound
healing
ii. For Immunity
2. Thiamin - Vit B1
a. Al or RDA (according to age)
i. < 18 - 1.4mg/day
NCM 204 LEC Community Health Nursing
by: Tupas & Totesora
 19 - 50 - 1.4mg/day i. Meats, fish, poultry, liver
b. Rationale ii. Potatoes, legumes,
i. For loss of appetite non-citrus fruits soy products
ii. For increase in metabolic
work load 4. Folic Acid - Vit B9
iii. Prevention of beri-beri a. Al or RDA mcg/day
iv. To prevent leg cramps b. Rationale
c. Richest food source i. For blood volume increase
i. Enriched or fortified whole ii. Development of new cells
grains and products iii. To prevent Neural Tube
Defect (NTD)

FACTORS AFFECTING NTD

○ Inadequate folate
○ NTD on previous pregnancy
○ GDM
○ Use of anti-seizure medications
○ Maternal obesity
○ Exposure to high temperature (fever,
hot tub use)
○ Race/Ethnicity - common among
Hispanic people
○ Low economic socio status

DRY BERI-BERI WET BERI-BERI

2 kinds of NTD
Symptoms: Symptoms: A. Anencephaly
● Difficulty in ● Dyspnea a. An uncommon and always fatal type
walking ● Orthopnea of NTD
● Painful tender ● Increased heart b. Characterized by the absence of a
muscles rate, enlarged brain
● Loss of heart, heart B. Spina Bifida
sensation in failure a. One of the most common types of
hands and feet ● Swelling of the NTD, characterized by the
● Loss of muscle lower legs incomplete closure of the spinal cord
function or ● Wernicke and its bony encasement
paralysis of the -Korsakoff
lower legs syndrome: C. Highest food sources of folate
● Mental ○ Ophthal a. Liver (3 ounces) = 221 mcg
confusion/speec moplegi b. Asparagus (½ cup) = 131 mcg
h difficulties a c. Spinach (½ cup raw) = 131 mcg
● Vomiting and (paralysi d. Avocado (½ cup) = 45 mcg
anorexia s of one e. Orange juice (1 cup) = 74 mcg
or more
extraocu Fortified food sources
l f. Pasta cooked (1 cup) 110 mcg
ar g. Rice cooked (1 cup) 134 mcg
muscles h. White bread (1 slice) 28 mcg
which
are 5. Cobalamin - Vit B12
responsi a. AI or RDA
ble for i. 2.6 mcg
eye b. Rationale
moveme
nts) i. Maturation of RBC
- confusio D. Richest food source
n a. Meat, fish poultry, shellfish, milk,
- coma cheese and eggs
- death if
untreate VITAMIN A or RETINOL
d E. AI or RDA
a. 18 y.o and below = 750 mcg/day
b. 19 to 50 y.o = 770 mcg/day
3. Pyridoxine - Vit B6 F. Functions
a. AI or RDA a. Important for the placenta functions
i. 1.9 mg/day b. For the integrity of the epithelial cells
b. Rationale c. Skeleton formation
i. To prevent nausea and d. Tooth formation and normal bone
vomiting growth
ii. To prevent convulsion G. Food sources
c. Richest Food Source a. Fruits per 100g
NCM 204 LEC Community Health Nursing
by: Tupas & Totesora
 i. Milon = 1285 mcg ○ Soymilk 1 cup = 46 mg of Mg
ii. Tesa = 1235 mcg ○ Yogurt 1 cup = 43mg of Mg
iii. Mango ripe = 1165 ○ Oysters 3oz = 81 mg og Mg
b. Vegetables per 100g ○ Bran cereal 1 cup = 60mg of Mg
i. Malungay = 7945 mcg
ii. Saluyot = 7320 IRON
iii. Upo = 6439 ● AI or RDA
iv. Tanglad = 4205 ○ Conservation of iron during pregnancy
v. Ampalaya leaves 4105 ○ Maintenance of erythropoiesis
vi. Kamote tops = 3195 mcg ○ To prevent anemia
vii. Alugbati = 2350 ○ To have sufficient supply of Hgb
viii. Lettuce = 2350 ● Food sources
ix. Onion leaves = 2065 ○ Clams (steamed) 3oz = 23.8mg
c. Liver per 100mg = 5525 mcg ○ Lean beef steak 30z = 2.6mg
○ Black beans ½ cup = 1.8mg
VITAMIN D ○ Spinach cooked ½ cup = 3.2mg
H. Maintain normal calcium metabolism ○ Beef liver 3oz = 5.24mg
I. Promotes normal bones and teeth formation
J. Prevent tetany during infancy IODINE
a. Tetany ● AI or RDA
i. Syndrome characterized by ○ 220 mcg (18-50 y.o)
abnormal muscle twitching, ■ To increase milk flow
cramps, sharp spasms of ■ To compensate increase in BMR
joints in wrist and ankles ■ To prevent cretinism
K. AI or RDA ● Food sources
a. 5 mcg/day ○ Iodized salt and seaweeds (seafoods)
L. Food sources
a. Fortified milk ZINC
b. Fortified margarine ● AI or RDA
c. Fortified butter ○ 12 mg/day (18 yrs and below)
d. Eggs ○ 11 mg/day (19-50 yrs)
e. Liver ■ Fro CHON synthesis
f. Salmon, sardines ■ For DNA and RNA synthesis
● Food sources
○ Oysters - steamed 3oz = 72 mg
MINERALS ○ Lean beef steak 3oz = 4.9 mg
○ Yogurt 1 cup = 2.2 mg
CALCIUM ○ Shrimp 3 oz = 1.5 mg
● AI or RDA ○ Enriched cereal 1 cup = 3.8 mg
○ 1300mg/day (14-18 y.o) ○ Porkchop 3oz = 2mg
○ 1000mg/day (19-50 y.o)
■ For fetal bone development SODIUM
■ For dentition ● AI or RDA
● Food sources ○ 1500mg/day (18yrs and below)
○ 3 cups of milk = 300mg ○ 1500mg/day (19 to 50 yrs old)
○ Sardines with bones 3oz = 324mg ■ Keep minimal to prevent edema and
○ Tofu ½ cup = 275 mg PIH
○ Cheddar cheese 1 ½ oz = 306mg ● Food sources
○ Broccoli 1 ½ cup = 93mg ○ Table salt, soy sauce, processed foods

PHOSPHORUS
● AI or RDA Be Physically Active
○ 1250 mg/day (14-18 y.o) ● A woman who wants to be physically active
○ 700 mg/day (19-50 y.o) when she is pregnant, needs to become
■ Involved in fetal skeleton building with physically active before hand
calcium ● staying active during the course of a normal,
● Food sources healthy pregnancy will:
○ All animal tissues ○ Improves the fitness of the mother-to-be
○ Facilitates labor
MAGNESIUM ○ Helps to prevent or manage gestational
● AI or RDA diabetes and gestational hypertension
○ 400mg/day (14-18 y.o) ○ Reduces psychological stress
○ 350mg/day (19-30 y.o)
○ 360mg/day (31-50 y.o) 1. Guidelines for Physical Activity during
■ Involved in bone mineralization Pregnancy
■ Normal muscle contraction ○ Do exercise regularly (most, if not all, days
■ Transmission of nerve impulses of the week)
■ Maintenance of teeth ○ Do warm up with 5 to 10 minutes of light
● Food sources activity
○ Spinach cooked ½ cup = 78 mg ○ Do 30 minutes or more of moderate physical
○ Black beans ½ cup = 60 mg of Mg activity
NCM 204 LEC Community Health Nursing
by: Tupas & Totesora
 ○ Do cool down with 5 to 10 minutes of slow ● Cigarette Smoking
activity and gentle stretching ○ Nicotine and cyanide - toxic to the fetus
○ Do drink water before, after, and during ○ Adverse Effect:
exercise ■ Damage chromosomes - will lead to
○ Do eat enough to support the additional developmental defects, genetic
needs of pregnancy plus exercise disorders and cancer
○ Do rest adequately ■ Limit blood supply that will also limit
○ Don’t exercise vigorously after long periods delivery of O2, nutrients and removal of
of inactivity waste
○ Don’t exercise in hot, humid weather ■ Retard physical development
○ Don’t exercise when sick with fever ■ Cause behavioral or intellectual
○ Don’t exercise while lying on your back after problems
the first trimester of pregnancy or stand ■ LBW
motionless for prolonged periods ● Medical drugs and herbal supplements (Aspirin
○ Don’t exercise if you experience any pain or and Ibuprofen)
discomfort ● Drug abuse
○ Don’t participate in activities that may harm ○ Amphitamines
the abdomen or involve jerky, bouncy ○ Bariturates
movements ○ Cocaine
○ Don’t scuba dive ○ Marijuana
○ Suitable activities during pregnancy include: ○ Opiates
■ Brisk walking ● Environmental contaminants
■ Swimming ○ Lead
■ Indoor stationary cycling ○ Mercury
■ Prenatal yoga ● Foodborne illness
■ Low impact aerobics under the ○ Listeriosis - caused by: bacterium listeria
guidance of a certified aerobics monocytes
instructor ● Vitamins and minerals megadoses
■ Special exercises to prepare for labor ● Dietary - low CHO or FATS can cause Ketosis
and delivery ● Sugar Substitute - allowed as long as with FDA
guidelines
○ Aspartame not recommended with
Phenylketonuria
● Caffeine - coffee and cola beverages may also
result fetal death
● Alcohol - fetus irreversible brain damage
○ Growth retardation
○ Mental retardation
○ Facial abnormalities
○ Vision abnormalities

Avoid harmful influences

● Both maternal and paternal ingestion of harmful
substances (cigarettes, alcohol, drugs, or
environmental contaminants) can alter genes or
their expression
● It can also interfere fertility and will cause
abnormalities

2. Practices to Avoid in Pregnancy

NCM 204 LEC Community Health Nursing

by: Tupas & Totesora
 NUTRITION IN INFANCY
INFANCY
● an infant grows faster during the first year
than ever again
● Promotes normal growth and development
● Facilitates academic and
performance
● Helps prevent obesity, HD, Cancer and
degenerative disease in adulthood
● Early nutrition affect later development
● Early feeding sets the stage for eating
habits that will influence nutritional status for
a lifetime
METHODS OF FEEDING INFANTS
1. Breastfeeding
● Breastfeed infants exclusively from 0
to 6 month and add complementary
feeding on the 4th or 6th months
while continuing breastfeeding up to
2 years and beyond
● Immature stomach and intestine can
digest milk sugar but not starch
NUTRIENT CONTENT OF BREASTMILK
● ENERGY
○ Has a balance of energy and make
the most nearly perfect food
● CHO
○ Lactose in breastmilk is easily
digested and will enhance Ca
absorption
● LIPIDS
○ Will provide the main source of
energy
○ Contain generous proportion of EFA
■ Linoleic acid or omega 3
■ Linoleic acid or omega 6
■ DHA
● CHON
○ ALPHA - LACTALBUMIN
■ a CHON a human infant can
easily digest
○ LACTOFERRIN
■ An iron gathering compound
that helps absorb iron into
the infant’s bloodstream
■ It also acts as an
antibacterial agent
● VITAMINS
○ Vitamin D - concentration in
breastmilk is low
○ Vitamin C - abundant in supply
● MINERALS
○ Calcium - ideal for infant’s bone
growth and highly absorbable
○ Sodium - low in sodium
○ Iron - in limited amount but highly
absorbable
○ Zinc - highly absorbable due to the
presence of a zinc-binding CHON
IMMUNOLOGICAL PROTECTION OF
BREASTMILK
1. Have unsurpassed protection against
infection it has protective factors that
includes:
a. Antiviral agents
b. Antibacterial agents
c. Other infection inhibitors
2. Contains colostrum
- a thick yellowish breastmilk
- Present on the 1st two or three days
physical of lactation
- A pre-milk substance containing
antibodies and white blood cells
from the mother’s blood
3. Breastmilk also contain:
a. BIFIDUS FACTORS
- Bacterium Lactobacillus
Bifidus, this favors the growth
of friendly bacteria in the
infant’s intestinal tract
b. LACTADHERIN
- A CHON in breastmilk that
attacks diarrhea causing
viruses
c. Immuno-globulins (IgA) a certain
kind of CHON that allows a mother
to pass immunity to her baby
OTHER POTENTIAL BENEFITS OF
BREASTMILK
1. Contain several enzymes and several
hormones
a. Thyroid hormones
- Small amounts of
triiodothyronine (T3) and
thyroid-stimulating hormone
(TSH) have been identified in
breast milk
- Believes to protect a
breastfed newborn from
hypothyroidism
b. Prostaglandins
- Hormone that are derived
enzymatically from the fatty
acid (arachidonic acid)
- Immunoreactive
prostaglandin were detected
in all fresh human milk
samples, but not in cow’s
milk-based formulas
- Protect and maintain
intestinal epithelial cell
integrity in developing babies
c. Enzymes - since the pancreas of the
baby is still immature of the
following:
1. Lipase - LPL (Lipoprotein
Lipase) from breast milk will
help milk fat synthesis
2. Protease from BM will
release peptides that
provides important
assistance to digesting milk
proteins
3. Amylase - amylase from
breastmilk is used to digest
the CHO in BM
2. Protects common illnesses of infancy like:
a. Middle ear infection
b. Respiratory illness
3. Offer protection against the development of
CVD
4. Have lower blood cholesterol in adult years
NCM 204 LEC Community Health Nursing
by: Tupas & Totesora
5. May also have + effects on intelligence later
in life
METHODS OF FEEDING INFANTS
2. Infant milk formula
1. Cow’s milk protein-based formulas
● Most infant formula is made
with cow’s milk that’s been
altered to resemble breast
milk
● The formula has the right
balance of nutrients and
makes the formula easier to
digest
2. Soy-based formulas
● Can be useful if you want to
exclude animal proteins from
the baby’s diet
● Also be an option for babies
who are intolerant or allergic
to cow’s milk formula or to
lactose, a carbohydrate
naturally found in cow’s milk
3. Protein hydrolysate formulas
● These types of formulas
contain protein that’s been
broken down (hydrolyzed)
partially or extensively into
smaller sizes than are those
in cow’s milk and soy-based
formulas
● These are meant for babies
who don’t tolerate cow’s milk
or soy-based formulas
● Extensively hydrolyzed
formulas are an option for
babies who have a protein
allergy
4. Specialized formulas
● Are available for premature
infants and babies who have
specific medical conditions
● Example of Specialized
Premature formulas:
THREE FORMS OF INFANT FORMULAS
1. Powdered formula
● Is the least expensive. Each scoop
of powdered formula must be mixed
with water
2. Concentrated liquid formula
● This type of formula also must be
mixed with water
3. Ready-to-use formula
● Is the most convenient type of infant
formula
● It doesn’t need to be mixed with
water
● It’s also the most expensive option
INFANT FORMULA STANDARD
● All infants formulas must meet the nutrient
standards set by the PFDA
● EO 51 popularly known as the Philippine
Milk Code of 1986 (Labeling and Marketing
MF)
● Although manufactures might vary in their
formula recipes, the PFDA requires that all
formulas contain the minimum
recommended amount of nutrient that
infants need through Fortification and
Enrichment
1. Fortification
- Add extra vitamins and minerals that
are not naturally found in milk in
significant amounts
- Should be added with iron, linolenic
acid, vitamins D and E, and taurine
2. Enrichment
- Add amounts of nutrients normally
present in the product or not
normally present or that have been
removed or lost during processing
- Some infant formulas are enhanced
with docosahexaenoic acid (DHA)
and arachidonic acid (ARA)
- DHA and ARA are for infant eyesight
and brain development
- Enhanced also with Pre and
Probiotic to mimic the immune
benefits of BM
● Infant formula is generally recommended
until age 1
● Followed by whole milk until age 2
● Reduced-fat or skim milk generally isn’t
appropriate before age 2 because it doesn’t
have enough calories or fat to promote early
brain development
METHODS OF FEEDING INFANTS
3. Mixed Feeding
● Is when the mother supplement
breastfeeding with infant formula
● Milk formula (MF) is given to
complement breastmilk if it is
insufficient in supply
● Might help some babies who need
extra nutrition
● MF is given when mother is away
part of the day
4. Introducing Solid Foods
A) When to give solid foods
1. The infant can sit with
support
2. The infant is 4 or 6 months
old
NCM 204 LEC Community Health Nursing
by: Tupas & Totesora
 B) Things to consider in giving solid ● Foods may be seasoned slightly. Salt
foods should not be added to the diet of the infant
1. The infant’s nutrient needs before the age of 1 year, since the baby’s
2. The infant’s physical maturing kidneys cannot handle sodium
readiness to handle different efficiently
kind of foods ● When baby is able to chew, gradually switch
3. The need to detect and to finely chopped vegetables, fruits, fish and
control allergic reaction meats. Do not continue soft smooth food for
C) Give foods that will provide Fe and too long
vitamin C ● A mother’s dislike for a particular food must
1. Cereal that are iron fortified not reflect in the choice of food for the baby
2. Meats and nuts alternatives
such as legumes COMPLEMENTARY FEEDING GUIDE
3. Fruits and vegetables that
are rich in vitamin C to
COMPLEMENTARY FEEDING GUIDE
enhance iron absorption
D) Dietary Guidelines
Appropri Age of Method Exampl Amounts
1. Infants should not eat or
ate food Introduct of e
drink unpasteurized milk,
(s) ions preparati
milk products, raw or
(months) on
undercooked eggs, meat,
selfish, fish and raw bean
sprout Cereals 6 Cooked, Thin ½ cup
E) Feeding Guidelines (first months well rice, thin gruel
1. Feed with love. Will grow semi-soli strained gruel, 2-3
both in height and weight d foods oatmeal tablespoo
than babies fed with same given to cooked, ns
food in an emotionally the baby mashed
negative climate root
2. Discourage an acceptable crops
behavior
3. Let the baby explore and 8 cooked Thick ¾ cup
enjoy food months gruel, thick
4. Do not force the food on soft gruel
babies cooked 1 cup
5. Limit sweets strictly rice

IMPORTANCE OF COMPLEMENTARY FOODS 10-12 cooked Soft 1 cup and

AT 6 MONTHS months cooked 1 piece
Starting other foods in addition to breastmilk at 6 rice
completed months helps a child to grow well. sliced
However, giving complementary foods before 6 bread
months may increase risk of illness because of less and
consumption of the protective factors in breastmilk. biscuits
It may also take the place of breastmilk, making it
difficult to meet the nutritional needs of the child. Fruits 6 mashed Ripe 2 ½ tbsp
On the other hands, delaying introduction of months banana,
complementary food will affect growth and papaya
development and may cause malnutrition since the and
child does not receive the nutrients required to mango
meet his growing needs.
Ways to Introduce Complementary Foods 8 Cut into Soft fruit 3 tbsp
months small
● Introduce one new food at a time. Continue pieces
with the same foods for 3 to 4 days
● Start with small amounts of any food 10-12 Cut Any fruit 4 tbsp
(teaspoonful or less) months finger
● Use thin puree consistency when starting size
solid foods. Gradually shift to a thicker pieces
consistency of food with higher nutrient
Vegetabl 7 Cooked Carrots, 1 tbsp
density
es months very soft sayote,
● Never force an infant to eat
squash,
● If baby objects to taking some food, mix it
abitsuel
with other foods he likes until he becomes
as,
accustomed to the flavor
potatoes
● If after several trials, the baby refuses to eat
,kamote
a particular food, omit it for a week or two,
tops,
and try again. If the dislike persists, omit
kangkon
entirely and substitute with another food of
g tops,
similar nutritional value
pechay,

NCM 204 LEC Community Health Nursing

by: Tupas & Totesora
 and
malungg
ay
leaves

8 Cooked All 1 tbps

months and vegetabl
finely es
chopped

10-12 Cooked All 1-2 tbsp

months and vegetabl
coarsely es
chopped

Meat 7 Cooked Chicken ½ egg

and months egg yolk
alternativ
es, Egg 11 Cooked Chicken ½ egg
months egg

meat/fish 6 to 11 Debone Minced 1⅓

/poultry months d, meat, servings
or cooked fresh or
legumes, well, dried 1 serving
dried mashed fish or cooked WHAT ARE COMMON FOOD-RELATED
beans or minced meat PROBLEMS IN INFANCY
ground chicken, =30g Colic
mashed ● Is the abdominal discomfort caused by
monggo 1 piece swallowing air.
medium ● To prevent colic, the baby should be burped
fish = 35g after each feed.
¾ cup ● Hold the baby next to the shoulder or put
cooked the baby on his stomach over the lap and
dried pat his back until he burps.
beans Regurgitation
● Is the effortless expulsion of gastric
10-12 Debone Meat, 1⅓ contents caused by gastrointestinal reflux.
months d, fresh or servings ● To minimize regurgitation, position the infant
cooked, dried at a 40-60 degree angle after a feed.
chopped fish, Diarrhea
well or chicken, ● Is the frequent passage of loose, watery
flaked monggo and unformed stools.
● Breastfeeding should be continued during
Milk 6 Whole 2 cups the episodes. Plenty of fluids.
months milk ● If necessary, an oral rehydration solution
up made with table salt and sugar in water or
commercial preparations such as those
Other 8 Steame Custard 1 tsp given by the health center, should be
foods months d, baked s, provided
up simple ● Food such as banana hasten the
pudding, development of formed stools and may be
plain included in the diet if the baby is old enough
gulaman ● A physician should be consulted if diarrhea
or jello continues for more than a day
Food Allergy
Fts and 6-11 Margari 4 tsp ● Is a hypertensive state resulting from the
oils months ne, interaction of an allergen with an antibody
cooking within the body. It may be manifested in
oil various ways suchas diarrhea, skin rashes,
eczema, etc.
Sugar 6-11 3 tsp ● The offending food should be eliminated
months and acceptable substitutes should be
offered. It is best to consult a physician or a
health care-provider if food allergy is
suspected

PREMATURE INFANTS
● Are babies who are born too early, before
37 weeks of pregnancy
● May not be fully developed at birth
NCM 204 LEC Community Health Nursing
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 ● Infants born earlier (32-34 weeks) may have
more health problems and may need to stay
in the neonatal intensive care unit (NICU)
longer than babies born later
● Their digestive system may not be fully
developed so they may experience feeding
difficulties such as
Problems establishing nipple feedings at breast
or with the bottle
● Because the sucking reflex has not
developed yet, the infant can’t suck and
swallow properly.
Gastric Residuals
● Occurs when babies don’t completely empty
their stomachs from a previous feeding
Gastroesophageal Reflux
● Occurs when a small amount of stomach
contents including stomach acid, refluzes or
regurgitates into the esophagus
● This can be painful to the infant and when
severe, may cause signs of distress such as
apnea
● A condition in which a baby temporarily
stops breathing
Abdominal Distention
● Is an abnormal enlargement or swelling of
the stomach
● Distention may be a sign of a more severe
GI problem
FEEDING PREMATURE BABY
1. Gavage/ Enteral Tube Feeding
● Given to babies born before 32-34
weeks of pregnancy
● A feeding tube is used for infants
who do not have strength or muscle
coordination to breastfeed or drink
from a bottle
● A tube placed through the baby’s
nose (NGT) or mouth into their
stomach
● Breastmilk/milk formula is used to
feed the baby
TOTAL PARENTERAL NUTRITION
● Given to preterms less than 32 weeks or
infants with limited enteral intake.
● This method is used when an infant cannot
or should not receive feedings or fluids by
mouth and bypasses the GI
● Used for extremely premature infants or
very sick newborn infants
● Nutrients such as glucose, protein, fat
solutions, electrolyte, vitamins and minerals
are given directly into the baby’s
bloodstream intravenously
Indications for TPN
1. Preterm infant < 30 weeks of gestation and
< 1000 gm birth weight
2. Severe IUGR (intrauterine growth
restriction)
3. Necrotizing Enterocolitis (NEC)
4. Gastrointestinal tract anomalies
NEC
● A devastating disease that affects mostly
the intestines of premature infants.
● The wall of the colon is invaded by bacteria
(clostridium perfringens) which cause local
infection and inflammation that can
ultimately destroy the wall of the intestine
● Happens when there is low oxygen at birth
STRATEGIC THRUST - FIRST 1000 DAYS
RA 11148
● A full slate of health and nutrition services
will be provided from the prenatal period to
the immediate postpartum period, the
newborn period, and up until children reach
2yrs old
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● This bill also sets a strategy to prioritize
mothers and children in areas with high
prevalence of undernutrition, as identified by
the National Household Targeting System

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 NUTRITION IN CHILDREN
TOPIC
● Pinggang Pinoy age range
○ 3 to 5 years old
○ 6 to 9 year old
○ 10 to 12 years old
● Food pyramid age range
○ 1 to 6 years old
○ 7 to 12 years old
IMPORTANT ROLE OF NUTRITION TO
PRESCHOOL AND SCHOOL CHILDREN
● Furnishing energy needed for the vigorous
activity of this age
● Helping to maintain resistance to infection ‘
● Providing building materials for growth
● Providing adequate nutrient stores to assist
in adolescent stage
PINGGANG PINOY
Daily Nutritional Guide Pyramid for
Filipino Children (1 to 6 years old)
Daily Nutritional Guide Pyramid for
Filipino Children (7 to 12 years old)
● Parents should encourage their child to eat
varied diet that includes:
○ A glass of milk daily to meet the
need for calcium, protein, and
B-vitamins
○ Foods fortified with vitamins
(especially vitamin A or
beta-carotene and vitamin C) and
minerals (especially iron and iodine)
○ A good breakfast each day. The
breakfast meal can be any
combination of body-building,
energy-giving and regulating foods.
Generally, a good breakfast provides
¼ to ⅓ of the RENI of the PDRI
2015
○ Nutritious snacks. Children are not
able to take enough food at main
meals to meet their nutrient needs
because of the small capacity of
their stomachs. During periods of
high nutrition needs such as growth
spurts, snacks are essential. Snacks
should be well timed and given in
small portions so as not to lessen
the appetite for the next meal.
Well-planned school lunch and
snacks should provide ⅓ of the
child’s daily food requirement
Special Nutritional Concerns During
School age years
● For school-age children, common eating
problems are:
○ Inadequate meals
■ Breakfast ideally should
provide 1/4 to 1/3 of the daily
nutrient allowances.
Breakfast is often missed or
hurriedly taken.
■ Lunch can also become a
dietary problem when
children have to take their
lunch away from home. The
"baon" may be nutritionally
inadequate, unappetizing,
boring or repetitive and
"lunch swapping" among
youngsters at school may be
to the disadvantage of the
one who swaps his
well-prepared balanced lunch
for someone else's meal
which is not nutritious. These
problems may be avoided by
preparing not only nutritious
meals but one that is
appetizing and easy to eat,
and ensuring a variety of
food from day to day.
■ With regard to the problem of
hurried meals, sufficient time
for meals should be allowed
by waking children early
enough for breakfast and
requiring a certain amount of
time to be spent for meals at
table
○ Poor appetite
■ Demanding school work,
tiring extra-curricular
activities, excitement of new
experiences outside the
home coupled with poor
eating practices, e.g.
consumption of calorie-rich
snack products proving little
or no vitamins and minerals,
especially close to meal
times, are factors that take
away a child's relish for food.
Thus, a balanced program of
class work, play and rest
should form the activities of a
child. The child should be
guided in the proper food
selection at home and in
school to encourage good
food habits
■ Although craving for sweets
may somehow satisfy a
NCM 204 LEC Community Health Nursing
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 growing body's need for extra
calories, sweets may create
an environment favorable for
the growth and development
of microorganisms that cause
tooth decay. Sweets should
not be taken close to
mealtime. In addition,
children should be taught to
brush their teeth and wash
their mouth after eating
sweet foods
DIETARY MANAGEMENT
KWASHIORKOR
● Causes of kwashiorkor
○ Is accused by a diet low in protein
○ It can also arise due to infections,
parasites, or other conditions that
interfere with protein absorption from
the GI
○ It is most common in children living
in areas hit by drought and famine
○ It can also be related to the dietary
changes to milk allergies in infants,
fad diets, poor nutritional education,
or a chaotic home life
● Diets
○ Use soya oil and cotton-seed oil, oil
based substitutes as source of fats
these will provide nutrients and
calories from fat that are essential
for protein synthesis, cost efficient,
also allows for an increase in the
intake of calories
○ Avoid fats or oils from animal
sources. These are associated with
excessive amounts of fats in the diet
leading to bowel and intestinal
dysfunction
○ Once energy demands are met,
proteins are incorporated into the
diet, along with essential vitamin and
mineral supplements
○ Should consume foods containing
proteins such as meat, fish, poultry,
eggs, soybeans, and legumes. Milk
and milk products are also rich in
protein
○ For children suffering from
kwashiorkor with lactose-intolerance
may need lactase enzyme
supplements to digest milk, yogurt
and cheese
○ Give CHONs that are high quality
value such as lean meats, eggs,
white meats and substitutes
○ Give Ready to Use Therapeutic
Foods (RUTF) these have been
proven most efficient and effective
for treatment of kwashiorkor

What is Ready-to-Use-Therapeutic Food

(RUTF)?
○ HICAL
● An inexpensive mixture of ground peanuts,
○ HICHON
powdered milk, sugar, oil, and vitamins and
● Management
minerals
○ Calories need to be increased slowly
● Energy-dense and highly nutritious, filled with
because the patient’s diet lacked
micronutrients and antioxidants
any significant nutrition for a long
● It needs no cooking or refrigeration
period
● Best of all, toddlers can eat RUTF in their own
○ The child’s diet must be introduced
homes, thus avoiding the need for an expensive
slowly but should be fed ad libitum to
stay at a distant hospital. A mother or sibling can
limit potential problems associated
feed the malnourished child with RUTF as often
with the change in cellular and organ
as 8 to 10 times a day
function due to inadequate diet
● Because of all these advantages, leading
○ A gradual introduction of
organizations – UNICEF, Doctors Without
carbohydrate foods such as fruits,
Borders, and the WHO – have declared RUTF
starchy vegetables, breads, and
an “essential medicine”
cereals to provide calories
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● They advocate that all the world’s malnourished ■ respiratory infections
children have access to this revolutionary ■ intellectual disability
treatment ■ -stunted growth
● Gives the child the chance for the normal ○ Seriously malnourished children may look
development of their brains and bodies – and older and have little to no energy or
the hope for a healthy adulthood enthusiasm for anything

MARASMUS Dietary Management of Marasmus

● Three Phases of Management
○ Initial Treatment
■ Life threatening problems
identified and treated
■ Specific deficiencies/
metabolic abnormalities
corrected
■ Feeding begun
○ Rehabilitation
■ Intensive feeding
■ Emotional and physical
stimulation
■ Mother and caregiver training
○ Follow-up
● Is a form of severe malnutrition. It can occur ■ Prevention of relapse
in anyone who has severe malnutrition, but ■ Assure continued
it usually occurs in children. You can get development
marasmus if you have a severe deficiency ● INTENSIVE FEEDING
of nutrients like calories, proteins, ○ Reintroduction to food should be
carbohydrates, vitamins, and minerals. It is gradual
more common in developing countries, like ■ To allow time to reverse
in some areas of Asia and Africa. People in adaptations to starvation
these nations are prone to having poor ■ Because pancreatic digestive
access to food, making it difficult to get enzymes are low
enough nutrients. A risk of certain infectious ■ Because glucokinase levels
diseases can cause marasmus if left are low
untreated ■ Because hemoglobin levels
● Causes of marasmus are low
○ Poor diet ○ Low CHO diet
■ A poor diet that lacks ■ <40% of TER
essential nutrients, you may ■ Minimizes insulin surge and
be at risk of developing the resulting hypokalemia,
marasmus hypophosphatemia and
○ Food shortages hypoglycemia
■ More common in developing ○ RUTF
countries that have high ● Follow - up management Phase
poverty and lack of food. ○ Diet: HICAL
These regions also have ○ For infants:
frequent famines and natural ■ 24 to 30 kcal/oz
disasters, resulting in food ■ Encourage nutritious, and
shortages fortified fluids
○ Insufficient breastfeeding ■ To increase nutrient density
■ If mothers are malnourished, ○ For older children:
they are unable to feed their ■ Suggest fruit smoothies
infants enough milk during using whole milk and ice
breastfeeding cream
○ Infections and diseases are caused ■ Refeed the malnourished
by viruses, bacteria, parasites, and child with caution, monitoring
other pathogens that can cause loss electrolytes, calcium,
of appetite. This can lead to a low magnesium, and
intake of essential nutrients in phosphorous daily or more
infected children and adults frequently if abnormal
● Symptoms of marasmus ■ Gradually increase nutrients,
○ The main symptom of marasmus is being and use small, frequent
underweight. Children with this condition feedings with adequate fluids
have lost a lot of muscle mass and to ensure hydration
subcutaneous fat. Subcutaneous fat is the ■ Monitor intake and output
layer of fat just under the skin. Dry skin and ■ Maintain high-nutrient diet
brittle hair are also symptoms of marasmus. until weight is appropriate for
○ In children with marasmus, the following can height
also occur: ■ Advise family that some
■ chronic diarrhea nutritional intervention will be
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 continued until appropriate
height for age is reached
Celiac Disease
● A.k.a. Celiac sprue, non-tropical sprue or
gluten-sensitive enteropathy
● Is a digestive and multisystem disorder
● A complex immune-mediated disorder, one
in which the immune system causes
damage to the small bowel when affected
people eat gluten (a protein in some grains
such as wheat, barley, and rye)
● Sympathology:
● RECOMMENDED DIET
○ Gluten-free
■ Avoid all foods that contain
gluten
○ Management
■ Wheat, rye, and barley and
their products are not
allowed
● So, as a basic rule, you would need to
develop the habit of checking the back
labels of items to make sure gluten is not
found anywhere in the ingredients of the
food you are buying
● Watch out for stealth gluten, which are not
as easy to spot
○ Example:
■ Milo chocolate drink - a malt
drink commonly made from
barley that has energy giving
properties and will enhance
flavor and color
■ Hydrolyzed vegetable protein
or hydrolyzed wheat protein,
that is used as a flavor
enhancer in processed food
like soups, gravies, and
some meat products like
hotdogs
● Watch out for bakery products that are
made of wheat such as white bread and
whole wheat bread
● Choose variety of alternatives which use
other types of flour, such as brown and
white rice flour, and cassava starch. Breads
like these are safe and available in
gluten-free specialty shops
● Give food items that are naturally gluten
free such as eggs, unprocessed meats,
fruits, vegetables, all natural cheeses and
dairy, and other starches such as potato
and rice
Phenylketonuria
● A.k.a PKU
● A disease in which an individual lacks the
enzyme Phenylalanine hydroxylase
● Without the enzyme necessary to process
phenylalanine (amino acid), a dangerous
buildup can develop
● High levels of phenylalanine in the blood are
toxic to brain tissue, and can result in
mental degradation and possible death
● RECOMMENDED DIETS
○ LOW CHON
○ PHENYLALANINE-FREE /
RESTRICTED
NCM 204 LEC Community Health Nursing
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 drinks cordials,
puddings and
chewing gums, as
well as some tablet
Dietary Management of Phenylketonuria and granulated
● A sweeteners.
○ Meat, fish, cheese, eggs, and nuts ○ Amber - Go cautiously! These foods
are rich in protein and therefore can be eaten in controlled amounts
phenylalanine, so they are not ■ Examples
allowed ● proteinBasic list of
○ Other foods which contain some foods with 50mg PHE
protein such as potato, milk and per exchange - these
cereals are given in small measured items should be
quantities so that the blood measured accurately
phenylalanine, which is measured or weigh food after
regularly, is kept within safe limits. cooking unless
These measured foods are spread otherwise stated.
out between the day’s meals ● Potatoes
○ Most fruit, some vegetables and ○ Boiled and
salads can be taken in normal mashed 80g
quantities but avoid excess use. ○ Roast 55g
Sigar, jam, syrups, and fats such as ○ Chips-frozen,
butter, lard and cooking oil can be fresh, oven,
used freely 45g
○ As high protein foods cannot be ○ Instant
eaten these have to be replaced by mashed
a special protein mixture from which potato 10g
the phenylalanine has been ● Broccoli tops, fresh,
removed. These protein substitutes boiled 30g
are all available on prescription and ● Brussels sprouts,
will provide the essential “safe” boiled 35g
protein for growth and development ● Peas - fresh, frozen &
○ Vitamins and minerals should also petit poise 25g
be supplemented into the diet. Some ● Spinach, boiled 25g
protein substitutes include these, but ● Sweet corn kernels &
if they are not, the vitamin and baby corn, canned
mineral supplements are available drained.35g
on prescription ● Corn on the cob, raw
○ Specially formulated low protein 55g (4cm)
wheat based products are available, ● Sweet potato, boiled
including bread, flour, biscuits and 60g
pasta. Some of these are available ● Avocado, flesh only
on prescription, others can be 55g
purchased through your pharmacy ● Cornflakes 15g
or at specialist stores ● Bran Flakes 10g
● B. Traffic light system for PKU food ● Oatmeal (raw) &
Sources: rolled oats 10g
○ Red - STOP! Do not eat these foods. ● Rice (raw) white or
■ Examples: brown 15g
● Meat-all kinds of read ● Rice (boiled) white or
meat, poultry and brown 45 g
offal ○ Green - Go! These foods may be
● Fish - all kinds eaten in normal quantities
including oily, white ■ Examples:
and shellfish and fish ● Fruits
products ○ Apple
● Eggs ○ Blackberries
● Cheese-all kinds ○ Cherries
including cheese ○ Grapefruit
spreads. ○ Jicama
● Nuts & seeds beans, ○ Orange
peas, legumes ○ Pineapple
● Wheat ○ Raspberries
products-ordinary ○ Apricot
bread, flour, cakes, ○ Blueberries
biscuits, pasta. ○ Cranberries
● Soya and soya ○ Grapes
products ○ Kiwi
● Aspartame an ○ Peach
artificial sweetener ○ Pumpkin
found in some fizzy ○ Strawberries
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 ○ Banana
○ Cantaloupe
○ Honeydew
○ Jackfruit
○ Mango
○ Pear
○ Plum
○ Watermelon
● Vegetables
○ Cabbage
○ Celery
○ Green beans
○ Mushrooms
○ Onions
○ Pumpkin
○ Tomatoes
○ Carrots
○ Cucumber
○ Leek
○ Okra
○ Parsley
○ Radishes
○ Turnips
○ Cauliflower
○ Eggplant
○ Lettuce
○ Olives
○ Peppers
○ Spinach (raw
only)
○ Yucca
● Miscellaneous
○ Sugar
■ White, brown, caster, icing;
glucose. Jam, honey,
marmalade, syrup, treacle,
boiled sweets, rock, candy,
sherbet, barley sugar, candy
closs
○ Food essences and colorings
■ Vanilla, peppermint, almond
essence
■ Salt and pepper, herbs and
spices, curry powder,
■ vinegar, mustard
■ Baking powder, bicarbonate
of soda, cream of tartar
○ Special formulated low protein
products
■ Low protein bread, flour,
biscuits, pasta, etc.
○ Beverages
■ Water, soda water, mineral
water, fizzy drinks
■ Examples:
● Lemonade, coke, fruit
cordial and squash,
instant tea, black
coffee, pure fruit
juices

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 NUTRITION IN ADOLESCENCE
ADOLESCENCE
Nutritional Needs During Adolescence
● are increased because the increased
growth rate and changes in body
composition associated with puberty
● Male and female adolescents have different
needs during this crucial time of growth.
● For teenagers, maintaining a healthy diet
will make the person look and feel better.
● Having a proper diet will make one’s skin
and hair healthier and help achieve one’s
ideal weight
● Eating right helps them look better, feel
better, and stay healthier.
● Teens become stronger and think more
clearly, thus may even perform better in
sports and get better grades
● They will also be less likely to get
depressed or stressed.
Some additional reminders to ensure teen’s
overall health and well-being
1. Eat regular meals, especially breakfast. This
keeps the body fueled and will give the
energy needed for the day.
2. Cut down on high fat and high sugar foods.
One does not have to give up one’s favorite
cookies or cheeseburger. Just eat them less
and eat healthy snacks instead.
= advice children about healthier
alternatives like foods low in sugar
and fats
= try to target fruits and vegetables
= counsel them in choosing healthier
food options
3. Remember to remain active and exercise or
join a sport
=get into activities
=walking, running
4. Get enough rest and sleep
5. Do not smoke and do not drink alcoholic
beverages
=alcoholic beverages don't have
nutritional values
=if teens tend to have alcoholic
beverages it clouds their thinking
skills
=the body of adolescence is still on
the process of development
= too much alcohol may damage
organs
specifically the liver
Follow the Pinggang Pinoy for teens and
these tips will assure that they will have the
adequate energy and nutrients to grow to their full
potential height, be active, healthy and strong.
= reference in eating nutritious foods
SPECIAL NUTRITIONAL CONCERNS DURING
PUBERTY AND ADOLESCENCE
Nutritional concerns during adolescence are:
1. Underweight, Overweight and Obesity
a. Maybe due to eating disorders,
inappropriate food patterns like
skipping meals, use of alcohol and
drugs
b. May resort to the practice of food
fads/fad diets
2. Anemia or IDA
= common condition or nutritional deficiency
encountered in teenagers mostly in females
because of their menstruation. Female
experienced body weakness brought by
anemia, a diet caused by iron.
Green leafy vegetables and liver as
for anemia
3. PMS (premenstrual syndrome)
4. Adolescent Pregnancy
=appear malnourished and appear skinny
Brings a lot of changes in the body of
woman
= adolescence pregnancy is still not
equipped to
carry the effects of pregnancy. Thus, health
teachings and nutritional concerns should
be
carried to them.
1. OVERWEIGHT AND OBESITY
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Overweight : A person may be overweight from
extra muscle, bone, or water as well as from having
too much fat.
Obesity : Is state in which there is a generalized
accumulation of excess fat in adipose tissue in the
body leading to more than 20% of desirable weight
= the accumulation of weight is generalized.
Thus all of the body parts exhibits fats
= All obsese people are overweight but not
all overweight are obese
Factors responsible for obesity
● Inactive lifestyle
= sedentary lifestyle
● Genes and family history
● Junk food and overeating
= stress eating
● Psychological
● Environmental causes
= nutritional practices according to
culture
● Disease
= circulatory or endocrine system
may induced obesity
● Drugs
● Tobacco and alcohol
● Lack of sleep
= Unhealthy sleeping habits
activates certain hormones that cause a person to
have a higher tendency to overeat or have low
satiety level or di madali mabusog. Thus, this tends
to overeat or increase food intake
What you eat and drink is energy intake. What you
burn through physical activity is energy expenditure
Energy Imbalance
More IN than OUT overtime = weight gain
More OUT than IN overtime = weight loss
Energy Balance
Is the equilibrium between energy intake
and energy needs.
To achieve or maintain a healthy body
weight it is important to maintain energy balance at
a level compatible with health and well being
Indicators for Underweight/Overweight/Obesity
1. Weight for Age
2. BMI
3. Waist to Hip Ratio (WHR)
4. Waist Circumference
NNC GOVERNING BOARD
Resolution No.4, Series of 2018
ADOPTING THE NNC POLICY STATEMENT ON
FAD DIETS
RESOLVED FURTHER and to ensure that
this policy statement is disseminated as widely as
possible to the general public, practitioners and
health and nutrition workers and those in the
medical and allied professions; and its
dissemination monitored and reported to the
Governing Board.
1. Fad diets are not recommended for weight
loss as it may pose potential health risk and
dangers
= consult to a dietitian first
2. Instead, the NNC recommends the
adherence to a holistic, sustainable,
adequate, and nutritionally-balanced diet,
complemented by an active lifestyle and
lifelong behavioral modifications
= diet and physical activity should go
together.
Not doing diet alone without exercise
= asthmatic clients are not advised to do
intense
activities such as hiking. Swimming activity
is
recommended.
SOME FAD DIETS
Diet
Very Low Energy Diet (VLED)
Definition/Premise
A diet with extremely low daily food energy
consumption. It only allows 800 kcal/day or less.
Also known as Crash diet. Primarily intended for
obese with BMI >30 for those with risk factors
Positive Impact/Advantage
Results to rapid weight loss (about 1.5 - 2.5
kl/wk)
Negative Impact/Disadvantage
Requires medical supervision. Often
replaces food with low calorie shakes and other
meal replacements. Can encourage binge-eating
and overeating due to restriction. Difficulty
transitioning to regular meals once weight loss is
achieved.
Diet
Ketogenic Diet/Atkin’s Diet
Definition/Premise
Primarily developed as treatment for
epileptic children.
A high-fat, low-carb diet, in which dietary
and body fat is converted into energy
Positive Impact/Advantage
May show promising results for weight loss,
blood glucose control, and decrease in lipid blood
values. Increase satiety due to high-fat
consumption.
Negative Impact/Disadvantage
Multiple complications such as:
Metabolic acidosis, Diabetic ketoacidosis
with
SGLT2 inhibitors, Fatty liver, liver toxicity,
gallstones, acute pancreatitis
Severely low blood sugar, blood potassium levels
“Keto flu”, fatigue, headache, fever
Kidney stones (Nephrolithiasis, hypercalciuria,
hypocitraturia, renal damage)
Bone health impairment
Increased bad cholesterol (LDL Cholesterol)
Low good cholesterol (HDL Cholesterol) levels
Cardiac - heart rhythm problems, dilated
cardiomyopathy arterial stiffness
Micronutrient deficiencies
Brain impairment
Nausea, vomiting, constipation
Bad breath
Leg cramps
Diet
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 Zone Diet - moderate carbohydrates/high
protein diet
Definition/Premise
Specifies the consumption of calories from
carbohydrate and protein in a specified ratio;
recommending eating five times a day to make a
sense of satiety that discourages overeating.
Positive Impact/Advantage
May have anti-inflammatory benefits
Negative Impact/Disadvantage
Achieving macronutrient ratio is challenging
Costly
Frequent eating may not promote fat
burning
Diet
Water Fasting
Definition/Premise
Consuming only water for an extended
period of time
Positive Impact/Advantage
Shown to preserve a greater portion of lean
body mass during weight loss
Negative Impact/Disadvantage
Require drastic changes to eating patterns
May result in hyperphagia
Poor adherence
Nutrient deficiencies
NNC recommends the adherence to a holistic,
sustainable, adequate and nutritionally-balanced
diet, complemented by an active lifestyle and
lifelong behavioral modifications.
A. Nutritionally-balanced diet
- is a diet that contains different kinds
of foods in certain quantities and
proportions so that the requirement
for calories, proteins, minerals,
vitamins and alternative nutrients is
adequate and a small provision is
reserved for additional nutrients to
endure the short length of leanness.
Overweight/Obesity Management
Aim is to lose 1 to 2 pounds (0.5 to 1 kilogram) a
week through a lower calorie diet and regular
physical activity
1. Deduct 500 kcal for obese and 250 for
overweight kcal from the normal TER/day
- to loss 500 to 1000 calories/day,
through a lower calorie diet
2. Change your diet gradually
3. Buy less meat and fatty foods. Eat fish at
least 1 or 2x/week
4. Try to have more servings of fruits and
vegetables per meal
5. Read the food labels, many foods have
hidden quantities of fats
6. Choose whole grains to get added nutrients
as vitamin B
7. if you crave for sweets, try eating dried
foods such as raisins or fresh fruits
8. Take nuts for added potassium, fiber and
zinc
9. Cut down on soft drinks, cakes, pies, candy,
chips, mayonnaise, salad dressing and
gravies, these foods are often high in
calories and poor sources of nutrients
10. Choose foods that have been baked or
broiled rather than fried, frying add calories
11. Put your foods on a smaller plate, it will look
more substantial
12. Eat slowly and chew your food thoroughly
B. Active Lifestyle
- regular physical activity
- is defined by WHO as the bodily movement
produced by skeletal muscles that requires
energy expenditure
- The goal is to burn or expend more energy
from PA and exercise that what is being
taken from food. The greater the energy
deficit created by exercise, the greater the
fat loss.
- All children and adults should set a goal
according to WHO.
Moreover PA is a key determinant of energy
expenditure and thus is fundamental to energy
balance and weight control
TYPES OF PHYSICAL ACTIVITY
1. AEROBIC EXERCISE
- Requires the use of lung muscle or
dependent on oxygen for air.
- Example are: brisk walking, taking a
bicycle ride outdoor or using a
stationary bicycle indoor, jumping
jack
- For Maintenance: 30 minutes/day, at
least 5 times a week
- To lose weight: 60 minutes/day
- To start-up: 5 to 10 minute per day,
then add more minutes/week
2. STRENGTH TRAINING
- Include muscle and bone
strengthening activities such as
push-ups, sit-ups, lifting weights,
climbing stairs, digging in the
garden, running and jumping rope.
- Your feet, legs or arms support your
body’s weight and your muscles
push against your bones. This will
make bones stronger.
3. FLEXIBILITY EXERCISE
- Also called stretching which is a
form of exercise that target muscle
by elongating them to their fullest
length
- Lowers stress and help your bones
flexible and reduce chances of injury
during exercise
- Gentle stretching for 5 to 10 minute
help the body warm-up and get
ready for aerobics activities and to
cool down after an activity.
4. WORK OR LIFESTYLE ACTIVITIES
- To add formal exercise, doing work
or lifestyle activities can keep you
active throughout the day
- Being extra active can increase the
number of calories you burn
- Example:
Get up to change the TV
channel instead of using the
remote control
Take the stairs instead of the
elevator or escalator
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 CPR - it’s a good cardio workout
C. BEHAVIORAL MODIFICATION
- Usually seeks to extinguish, or stop,
an unwanted behavior and replace
that behavior with a desired behavior
- Aims at reducing caloric intake,
increasing physical activity, and
expanding your nutrition knowledge
and food choices
MOTIVATION:
Positive reinforcement
Example: If you will wake up to 6 am to do
your 30 minutes exercise per day
I will buy the shoes that you want.
Negative reinforcement
Example: If you will not wake up early and
will not do your 30 minute exercise per day, I will
deduct your allowance by 15%
D. PHARMACOLOGICAL TREATMENT
- Sibutramine and Orlistat are the only 2
medications currently approved for long
term treatment of obesity. One reduces food
intake; the other reduces nutrient
absorption. It is imperative to consult a
physician before taking any medication.
E. SURGICAL TREATMENT
- Surgical procedures effectively limit food
intake by reducing the capacity of the
stomach and also suppress hunger by
reducing the production of the hormone
Ghrelin. Ghrelin termed as “hunger
hormone” stimulates the appetite, increases
food intake and promotes fat storage.
UNDERWEIGHT MANAGEMENT
1. Add 500 kcal for severely underweight and
250 kcal for moderately underweight to the
normal TER/day
2. Focus on energy-dense foods. Select foods
with MUFA and PUFA
3. Avoid sweets and fatty foods before the
main meals as these may lessen appetite
for more nutritious foods
4. Increase serving portions gradually. This will
offer time to the person to adjust
a. Prevent shock in GI tract
5. Take regular meals and snacks. This will
give opportunity for the body to receive
calories and nutrients necessary for weight
gain and body repair
6. Enjoy milk and fruit juices. This can subtly
increase your energy intake.
7. Observe an exercise routine. Strength
training primarily can foster muscle build-up
8. Do exercise before a meal to stimulate
peristalsis and appetite. Remember to
increase energy intake to support exercise
9. Always include a variety of foods from the 3
basic food groups
10. Seek a medical expert for underlying
conditions which may inhibit your body to
gain weight
2. ANEMIA
Is currently one of the most common group
and intractable nutritional problems globally. It is a
global health problem that affects both developing
and developed countries with major consequences
for human health as well as social and economic
development.
Many more adolescents are in fact suffering
from iron deficiency (ID) with its adverse effects on
health and physical stamina.
Adolescents are at a high risk of Anemia due to:
1. Accelerated increase in requirements for
iron
2. Low dietary intake by adolescents and
bio-availability of iron consumed against the
significant increase in requirements.
3. Adolescent pregnancy
4. Frequent infectious disease and parasitic
infections
Consequences of iron deficiency
Iron deficiency adversely affects attentiveness,
memory and school performance of adolescents,
their school attendance and retention, physical
growth and onset of menarche, immune status and
morbidity from infections, physical capacity and
work performance
Specifically iron deficiency anemia during
pregnancy increases fetal morbidity and mortality,
increases perinatal risks for mothers and neonates,
incidence of low birth weight (LBW), increases
overall infant mortality.
Interventions to prevent and correct iron
deficiency and IDA
Iron supplementation
Since it is difficult to influence dietary
3. PREMENSTRUAL SYNDROME
Is a combination of physical and emotional
symptoms that many women get after ovulation and
before the start of their menstrual period.
Researchers think that PMS happens in the
days after ovulation because estrogen and
progesterone levels begin falling dramatically if you
are not pregnant
PMS symptoms go away within a few days
after a woman’s period starts as hormone levels
begin rising again.
Some women get their periods without any
signs of PMS or only very mild symptoms
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 For others, PMS symptoms may be so
severe that it makes it hard to do everyday
activities like go to work or school. Sever PMS
symptoms may be a sign of premenstrual dysphoric
disorder (PMDD)
PMS goes away when you no longer get a period,
such as after menopause and after pregnancy
PMS might come back, but you might have
different symptoms
Premenstrual Dysphoric Disorder (PMDD)
Is a health problem that is similar
PMS may happen more often in women who:
● Have high levels of stress
● Have a family history of depression
● occur in marginalized communities, commonly
Physical Symptoms of PMS
- Swollen or tender breasts
- Constipation or diarrhea
- Bloating or a gassy feeling
- Cramping
- Headache or backache
- Clumsiness
- Lower tolerance for noise or light
Emotional or mental symptoms of PMS
- Irritability or hospital behavior
- Feeling tired
- Sleeping problems (too much or too little)
- Trouble with concentration or memory
- Tension or anxiety
- Depression, feelings of sadness or crying
spells
- Mood swings
PMS Management
Get regular aerobic physical activity throughout the
month
- Exercise can help with symptoms such as
depression, difficulty concentrating, and
fatigue
Choose healthy foods most of the time
- Avoiding foods and drinks with caffeine, salt,
and sugar in the two weeks before your
period may lessen many PMS symptoms
Get enough sleep
- Try to get about 8 hours of sleep each night
Find healthy ways to cope with stress
- Talk to your friends or write in a journal.
Some women also find yoga, massage
Don’t smoke.
- in one large study, women who smoked
reported more PMS symptoms and worse
PMS symptoms than those women who
didn’t smoke
Calcium.
- Studies show that calcium can help reduce
some PMS symptoms, such as fatigue,
cravings, and depression. Give milk,
cheese, and yogurt, orange juice, cereal,
and bread, and have calcium added
(fortified).
- You can also take a calcium supplement
Vitamin B6
- Vitamin B6 help with PMS symptoms,
including moodiness, irritability,
forgetfulness, bloating, and anxiety. Give
fish, poulty, potatoes, fruit (except for citrus
fruits), and fortified cerelas. You can also
take it as a dietary supplement
Magnesium
- may help relieve some PMS symptoms,
including migraines. Give green, leafy
vegetales
Polyunsaturated
4. Adolescent Pregnancy
Adolescent pregnancies are more likely to
driven by poverty and lack of education and
employment opportunities.
Often, in such societies, motherhood is
valued and marriage or union and childbearing may
be the best of the limited options available.
An additional cause of unintended
pregnancy is sexual violence, which is widespread
withmore than a third of girls in some countries
reporting that their first sexal encounter as coerced.
Social and economic consequences
Social consequences for unmarried
pregnant adolescents may include stigma, rejection
or violence by partners, parents and peers. Girls
who become pregnant before the age of 18 years
are more likely to experience violence within a
marriage or partnership.
WHO response
- the global programs have been achieved
with the application of good science
combined with strong leadership,
management, and perseverance
● repeated uterus scarring can result to
cancer or spontaneous abortion (since di na
makakapit si baby sa uterus)
The Philippines has recorded a total of 180,916 live
births among adolescents aged 10 to 19 in 2019,
according to the data from the Civil Registration
and Vital Statistics System of the Philippine
Statistics Authority
Under Executive Order (EO) 141 issued on June
25, stressed the need to implement measures that
will addressed the root causes of the rising number
of adolescent
Recommendations to improve nutrition among
pregnant adolescents
1) Focus on foods not nutrients
2) Individualize and work within the pregnant
adolescent’s current eating habits
3) Consider the context of family and peer
groups
4) Reward efforts
5) Make it easy
6) Focus on weight gain patterns
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NCM 204 LEC Community Health Nursing
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 NUTRITION IN ELDERLY

INTRODUCTION

Old Age
● Is the closing period in the life span, it is a period
when people “move away” from previous more
desirable periods or times of usefulness
○ Early Old Age - 60 to 70 years
○ Advance Old Age - 70 to the end of life
● Elders desire a life with good health, dignity,
economic, independence and finally a peaceful
death
● Understanding their needs and concerns, will
ensure their good health.
● Lending emotional support to the elders keeps
them jovial, which is inevitably the ideal way to
live a healthy life.
● Biological factors that have a big impact in their
nutrition:
NUTRITIONAL CONCERNS IN ELDERLY
○ Age
○ Gender
CATARACT
○ Growth
● Characterized by gradual progressive clouding
○ Disease States
and thickening of the lens of the eye
○ Genetic Makeup
● Facts:
○ Cause by oxidative stress (is an imbalance
LIFE EXPECTANCY AND LIFE LONGEVITY
between free radicals and antioxidants in
your body)
LONGEVITY
○ Can also be acquired from:
● Long duration of life
■ Exposure to UVL
■ Toxic substances
LIfe Expectancy
■ Injury
● The average number of years live by people in a ■ Viral infection
given society. Filipinos life expectancy is up to ■ Genetic disorder
71yrs old ■ Other trauma
○ Long term obesity can also cause cataract
FACTORS TO ACHIEVE LIFE
EXPECTANCY
● Sleeping regularly and adequately
● Eating well-balanced meals, including eating
breakfast regularly
● Maintaining a healthy body weight
● Engaging in regular physical activity
● No to smoking
● No alcohol or use it moderately DIETARY MANAGEMENT (CATARACT)
● Consistently follow a healthy diet, that is rich in
FACTORS AFFECTING LONGEVITY antioxidant and phytochemicals in colorful fruits,
● Heredity vegetables and whole grains
● Healthy lifestyle: ○ This will minimize the damage and
○ Nutrition decreased risk of cataracts.
○ Physical Activity ● Give food rich in carotenoids, vit. C and vit. E
○ Emotional Management ○ This will prevent early onset of cataract
● Socio Economic status (SES) ● Aerobic activity and strengths training
● Spiritual well-being ○ For the improvement in physical activity and
help reduce weight
○ Avoid fried foods, processed foods and
sugary snacks and soft drinks, all of which
appear to be associated with an increased
risk of cataracts, as well as obesity and
other health problems

MACULAR DEGENERATION (MD)

● Is an eye disease that occurs with aging
● Is when the macula (center part) of the retina
(back part) declines or becomes damaged
● The macula helps you drr images in sharp detail
● When the macula becomes damaged, it causes
blurring or loss of vision in the center of your
eyesight

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Cause of MD
● The exact cause is unknown
● Md may occur when the retina does not get
enough nutrients (substances needed for
growth)
○ Decreased nutrients cause the supporting
tissues of the retina to break down and
waste material to collect
○ The damaged tissues and waste material
cause drusen to form under the retina
○ The light-sensitive cells of the are then
injured causing blurring in the center of your
sight
● AMD (Age related- Macular Degeneration)
2 Types of MD:
● Dry MD is the most common and slowly causes
mild vision loss.
● Dry MD can sometimes turn into the wet form of
MD.
● Wet MD is more severe and can quickly damage
your vision.
● It occurs when new, abnormal blood vessels
grow in your retina.
● The blood vessels may break open, causing
blood to leak out.
● Small scars may also form.
DIETARY MANAGEMENT (MD)
● Eat fish and a variety of dark, leafy vegetables.
○ These foods support healthy eyes and may
help slow the progression of the symptoms.
○ Diet rich in anti-inflammatory and
anti-oxidant rich foods such as fruits,
vegetables, whole grains, nuts, seeds, fatty
fish, and oils, is associated with decreasing
risk and progression.
● Vitamins A, C, and E are the most effective
vitamins for reducing the risk of macular
degeneration, However, only vitamin A plays an
essential role in the human retinal pigment
epithelial cells, whereas vitamins C and E are
known to act as antioxidants.
● Do not smoke.
○ Nicotine and other chemicals in cigarettes
and cigars can make MD worse.
● Improve the lighting in your home.
○ Increase the amount of light in your home to
help you see objects better.
● Protect your eyes from the sun.
○ Always wear sunglasses with ultraviolet
(UV) protection lenses to protect your eyes
when outdoors to avoid direct sunlight.
● Get regular eye exams.
○ Adults age 40 to 64 should have an eye
exam every 2 to 4 years.
○ Adults age 65 and older should get an eye
exam every 1 to 2 years.
ARTHRITIS
● Is a disease that affects the joints (areas where
the bones meet and move).
● Usually involves inflammation or degeneration
● (breakdown) of the joints. These changes can
cause pain when the joint is use.
● Arthritis is most common in the following areas
of the body:
○ Feet, Hands, Hips, Knees, Lower back.
Important Factors of the Joints
● Joints get cushioned and supported by soft
tissues that prevent the bones from rubbing
against each other.
● A connective tissue called articular cartilage,
helps joints move smoothly without friction or
pain.
● Some joints have a synovial membrane, a
padded pocket of fluid that lubricates the joints.
Most Common Types of Arthritis in the
Elderly
● Osteoarthritis, or “wear and tear” arthritis, which
develops when joint cartilage breaks down from
repeated stress. It’s the most common form of
arthritis.
● Ankylosing spondylitis, or arthritis of the spine
(usually your lower back).
● Gout, a disease that causes hard crystals of uric
acid to form in your joints.
● Psoriatic arthritis, joint inflammation that
develops in people with psoriasis (autoimmune
disorder that causes skin irritation).
● Rheumatoid arthritis, a disease that causes the
immune system to attack synovial membranes in
your joints.
CAUSES:
The exact cause is unknown.
Have certain autoimmune diseases or viral
infections.
● Age:
○ The risk of arthritis increases as you get
older.
● Lifestyle:
○ Smoking or a lack of exercise can increase
your risk of arthritis.
○ Have a job or play a sport that puts
repeated stress on the joints.
● Sex:
○ Most types of arthritis are more common in
women
● Weight:
○ Obesity puts extra strain on your joints,
which can lead to arthritis.
Arthritis can be prevented by:
● Avoiding tobacco products.
● Doing low-impact, non-weight bearing exercise.
● Maintaining a healthy body weight.
● Reducing your risk of joint injuries.
DIETARY MANAGEMENT:
● Foods to Avoid
● Trans Fats can trigger or worsen inflammation
and are very bad for the cardiovascular health.
○ Avoid processed foods such as cookies,
crackers, doughnuts and fast food.
○ On labels, they are referred to as “partially
hydrogenated vegetable oils.”
● Gluten
○ Is a protein found in many grains, including
wheat, barley and rye. It's common in foods
such as bread, pasta, pizza and cereal.
Gluten provides no essential nutrients.
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 ○ Some research suggests that people with
Rheumatoid Arthritis are more likely to have
celiac disease. In people with celiac
disease, eating gluten can cause
inflammation and arthritis-like symptoms.
For these people, eliminating gluten from
the diet can reduce overall inflammation and
improve their symptoms.
● Refined Carbs & White Sugar
○ These exacerbate inflammation, and the
food products that contain they tend to
come with trans fats.
● Processed & Fried Foods
○ Fried foods are overcooked and have had
all or most of their nutrients destroyed.
○ They also contain many known carcinogens.
○ Many foods that come fried also contain a
number of heavily processed ingredients.
○ All of these will cause inflammation by
triggering the body’s defense mechanisms,
which will set of an arthritic flare-up.
● Foods Allowed
● Nuts
○ Nuts are a great source of protein for
vegetarians.
○ They also contain magnesium, zinc,
vitamin-E as well as the immune booster
alpha-linolenic acid.
○ They are also an easy way to get the protein
you need to keep your digestive tract
healthy, and they are very filling.
● Garlic & Onions
○ Loaded with immune-boosting properties,
garlic and onions are the superhero duo of
the produce section. Studies have shown
that those who eat foods in the allium family,
such as garlic and onions, exhibit fewer
signs of osteoarthritis and joint pain.
● Beans
● Another great source of protein and fiber, beans
are an excellent
● way to replace many filer foods that worsen joint
pain and the
● conditions associated with it. Beans are rich in
folic acid, zinc,
● iron and potassium— all of which are known to
have important
● immune-boosting properties.
● Citrus Fruit
● Sweet, refreshing and delicious, oranges,
grapefruits, lemons
● and limes are also valuable allies in the fight
against joint pain.
● Not only are they rich in life-saving vitamin C,
but they are also
● an ideal substitute for those who love sweets.
● 1. Alzheimer's Disease.
● Green Tea
● Known for its many health-promoting benefits,
green tea can
● also help turn the tide against arthritic
conditions. Loaded with
● powerful antioxidants and polyphenols, green
tea reduces
● inflammation and slows the process of cartilage
deterioration.
● Give Low Purine Diet
● Is an eating plan that limits foods with high
purine. Purines are
● a natural substance found in some foods like
shellfish, sweet
● breads, red meat and gravies , these will give off
uric acid when
● breakdown. Uric acid may contribute to gout in
elderly.
●
The following foods are low in purine.
•Eggs, nuts, and peanut butter
•Low-fat and fat free cheese and ice cream
•Skim or 1% milk
•Soup made without meat extract or broth
•Vegetables that are not on the medium-purine list
below
•All fruit and fruit juices
•Bread, pasta, rice, cake, cornbread, and popcorn
•Water, soda, tea, coffee, and cocoa
•Sugar, sweets, and gelatin
•Fat and oil
•Medium-purine foods:
• Meats: Limit the following to 4 to 6 ounces each
day.
• Meat and poultry
• Crab, lobster, oysters, and shrimp
• Vegetables: Limit the following vegetables to 1⁄2
cup
each day.
• Asparagus
• Cauliflower
• Spinach
• Mushrooms
• Green peas
• Beans, peas, and lentils (limit to 1 cup each day)
• Oats and oatmeal (limit to 2⁄3 cup uncooked each
day)
• Wheat germ and bran (limit to 1⁄4 cup each day)
•High-purine foods: Limit or avoid foods high in
purine.
• Anchovies, sardines, scallops, and mussels
• Tuna, codfish, herring, and haddock
• Wild game meats, like goose and duck
• Organ meats, such as brains, heart, kidney, liver,
and
sweetbreads
• Gravies and sauces made with meat
• Yeast extracts taken in the form of a supplement
4. SENILE DEMENTIA
Is the mental deterioration (loss of intellectual
ability) that is associated
with or the characteristics of old age
Senility is an older term used to describe a decline
in an older adult’s
physical and cognitive health.
The three most common types of dementia are:
2. Vascular Dementia.
3. Lewy Body Dementia
The rare type is:
4.Creutzfeldt-Jakob disease (CJD)
1. ALZHEIMER’S DISEASE
- is one type of dementia.
- a progressive degenerative disease that attacks
the brain and impairs thinking behavior and
memory.
- is a terminal illness, and no cure is currently
available.
2.Vascular Dementia.
- is a decline in thinking skills
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causes :
- the flow of the blood is block or reduce to various
regions of the brain, depriving them of oxygen and
nutrients
- narrowing and blockage of the small blood
vessels
- transient ischemic attacks, or TIAs

3.Lewy Body Dementia (LBD)

Is a type of progressive dementia that leads to a
decline in thinking,
reasoning and independent function because of
abnormal microscopic
deposits that damage brain cells over time.
4.Creutzfeldt-Jakob disease (CJD)
Is a rapidly progressive, invariably fatal
neurodegenerative disorder
believed to be caused by an abnormal isoform of a
cellular glycoprotein
known as the prion protein.

Nutrition tips
1. Provide a balanced diet with a variety of foods.
2. Limit foods with high saturated fat and
cholesterol.
3. Cut down on refined sugars.
4 .Limit foods with high sodium and use less salt.
5. Staying hydrated
Possible Causes of Poor Appetite
1. Not recognizing food.
2. Poor fitting dentures.
3. Medications.
4. Not enough exercise.
5. Decreased sense of smell and taste.

Make mealtimes easier

1. Limit distractions.
2. Keep the table setting simple.
3. Distinguish food from the plate.
4. Check the food temperature
5. Serve only one or two foods at a time.
6. Be flexible to food preferences.
7. Give the person plenty of time to eat.
8. Eat together.
9. Encourage independence
10. Make the most of the person's abilities.
11. Serve finger foods.
12. Use a "watch me" technique.
13. Don't worry about neatness.

Minimize eating and nutrition problems

Prepare foods so they aren't hard to chew or
swallow.
Be alert for signs of choking.
Address a decreased appetite.

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NCM 204 LEC Community Health Nursing
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 NUTRITION FOR SPECIAL GROUPS

NICOTINE AND ALCOHOL ABUSE

fish, dairy and
● Going cold turkey
eggs
○ Comes from the Goosebumps people
sometimes get in the days after they quit Lacto Dairy products Poultry, meat,
○ Look like the skin of a cold turkey in the fridge Vegetarian and vegan and fish
○ Because they think it will be easier to stop Diet food
taking the substance right away than to taper
off Lacto-Ovo Vegan food, Poultry, meat,
● Cold Turkey Vegetarian eggs, dairy and fish
○ Abrupt cessation of a substance dependence Diet products
and the resulting unpleasant experience, as
opposed to gradually easing the process
● For smokers, RDA Vitamin C is increased by
35 mg/day BENEFITS
○ Help counteract the oxidative damage from
nicotine ● Lower levels of dietary saturated fat and
● Excessive smoking and drinking can: cholesterol consumption
○ Interfere with bone health because they block ● Lower prevalence of obesity
calcium absorption. ● Better lipid profiles and lower rates of death from
○ Increases fat carried to the stomach which CVD, including ischemic heart disease and
may increase risk for weight related health hypertension
problems ● Lowered risk of renal disease from high
● For those who won't quit smoking glomerular filtration rates as compared with
○ Eat more fruit and vegetables long-term high animal protein intake
○ Lung cancer risk decreases with increased ● Effective management of type 2 diabetes and
consumption of fruits and vegetables. lowering the risk of developing type 2 diabetes
● No dietary supplement can fix and ongoing ● Lowering the risk of some cancers: prostate, GI,
pattern of poor food choices female specific cancer
● Dietary supplements won't protect you from ● Better quality iet as indicated by healthy eating
the harmful effects of smoking and alcohol index
abuse ● Other possible benefits: lowered risk of
● Supplements won't give you instant results dementia, diverticulitis, and gallstones

VEGETARIAN DIETS
RISK AND CONSIDERATIONS
● Includes plant-based foods and eliminates ●
some or all animal-delivered foods

4 BASIC TYPES

● Lacto-vegetarian SUB TOPIC

○ Accepts only dairy products from animal
sources to complement their basic diet of SUB SUB TOPIC
plant foods
● Ovo-vegetarian
○ The only animal foods included in this diet
are eggs
● Lacto-ovo-vegetarian
○ Follows a food pattern that allows for the
consumption of both dairy products and
eggs
● Vegan
○ Strict vegetarian diet
○ Abstains from the consumption of all animal
product

Type of Diet Food included Food excluded

in the diet in the det

Vegan Fruits, All animal

vegetables, sources of
pulses, seeds, food like flesh
and nuts of animal and
dairy products, NICOTINE AND ALCOHOL ABUSE
honey
SUB TOPIC
Prescatarian All vegan Meat and
Diet foods, and Poultry
SUB SUB TOPIC
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NCM 204 LEC Community Health Nursing
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