Santillana NCM105 Nutdiet Module2 23-24

;
REPUBLIC OF THE PHILIPPINES

NORTHERN NEGROS STATE COLLEGE OF SCIENCE AND
TECHNOLOGY
OLD SAGAY, SAGAY CITY, NEGROS OCCIDENTAL
(034)722-4169/www.nonescost.edu.com
COLLEGE OF NURSING
AND ALLIED HEALTH
SCIENCES
COURSE MODULE IN
NUTRITION AND
DIET THERAPY
1ST Semester; A.Y. 2023 – 2024
COURSE FACILITATOR: LUDA G. SANTILLANA, RND, MBA
FB/MESSENGER: Ludababes Mercado Ganancial Santillana
Email: ludaganancial@gmail.com
Phone No: 09215163739
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PROGRAM LEARNING OUTCOMES (CMO #15 s.2017)
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Despite of all the happenings around us, there is still so much to be thankful for and one
of these is the opportunity to continue learning.
You are right now browsing your course module in NUTRI 221, Nutrition and Diet
Therapy. As you read on, you will have an overview of the course, the content,
requirements and other related information regarding the course. The module is made up
of 3 lessons. Each lesson has seven parts:
INTRODUCTION- Overview of the lesson
LEARNING OUTCOMES- Lesson objectives for you to ponder on
MOTIVATION- Fuels you to go on
PRESENTATION- A smooth transition to the lesson
TEACHING POINTS- Collection of ideas that you must discover
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ASSESSMENT – To test your understanding in the lesson you discovered

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Course Outline in HENCM105 – Nutrition and Diet Therapy
Course
HENCM105
Number
Course Title Nutrition and Diet Therapy
This course deals with the study of food in relation to health. It covers
nutrients and other substances and their action, and interaction and balance
Course in relation to health and diseases and the process by which organism ingest,
Description digest, absorbs, transport, utilizes and excretes foods substances. It will also
focus in the therapeutic and food service aspects of the delivery of the
nutritional services in hospitals and other health care.
No. of Units 3 units lecture/1 unit lab
Pre-requisites None
1. Apply appropriate principles and techniques to assist clients in maintaining
Course
nutritional health.
Intended
2. Utilize knowledge of diet therapy in assisting clients needing dietary
Learning
modification.
Outcomes
3. Identify changes in nutrient need in specific age group.
Content MODULE 1
Coverage LESSON 1
INTRODUCTION TO NUTRITION
A. Basic Concepts of Nutrition
B. Tools in Nutrition
C. Nutrition Assessment
LESSON 2
MACRO-NUTRIENTS
A. Carbohydrates
B. Protein
C. Fats
LESSON 3
MICRO-NUTRIENTS
A. Vitamins
B. Minerals
MODULE 2
LESSON 1
DIETARY COMPUTATIONS
A. Body Mass Index & Classifications
B. Desirable Body Weight Determination
C. Total Energy Requirement (TER) & Distribution
D. Application to use Food Exchange List (FEL) & Sample Menu
LESSON 2
NUTRITION THROUGHOUT THE LIFE SPAN
A. Pregnancy
B. Lactation
C. Infancy
D. Pre-Schoolers and Schoolers
E. Adolescents
F. Adulthood
MODULE 3
LESSON 1
MEDICAL NUTRITION THERAPY
A. Overview of the Roles of Nursing Staff related to Nutrition Care
B. Nutrition Therapy and Diet Therapy
C. Nutrition Care Process
D. Routine Nutrition Therapy (NDAP Diet Manual, 2010)
E. Disease Specific Diets (NDAP Diet Manual, 2010)
F. Other Diets
G. Characteristics and Indications for use of Different Therapeutic Diets
LESSON 2
NUTRITION SUPPORT
A. Enteral Nutrition
B. Parenteral Nutrition
LESSON 3
DIETARY MANAGEMENT OF COMMON MEDICAL CONDITIONS
A. Nutrition in Weight Management and Eating Disorder
B. Dietary Management of Fevers and Infections
C. Dietary Management of Surgical Conditions
D. Dietary Management of Oral and Gastrointestinal Disorders
E. Dietary Management of Disease of the Liver, Pancreas and Gall
Bladder
F. Nutrition in Cardiovascular Disorders
G.Nutritional Therapy of Diabetes Mellitus
H. Dietary Management of Renal Disorders
I. Dietary Management of Other Metabolic Disorders
J. Nutrition and Cancer
K. Diet in Food Sensitivity and Skin Diseases
L. Nutrition in Diseases of the Musculoskeletal System
M.Nutritional Care in Pulmonary Diseases
N. Nutritional Care in Mental Illness and Disease of the Nervous System
O.Diseases of the Blood and Blood-Forming Organs
P. Pediatric Nutrition Problems
Q.Management of Non Specific Nutritional Problems
R. Emergency Feeding
Iatrogenic Malnutrition
References REFERENCES:
TEXTBOOK:
T1 – Jamorabo-Ruiz, Claudio, Diamonon. 2011. Nutrition and Diet
Therapy for Nursing. Manila, Philippines: Merriam & Webster
Bookstore, Inc.
OTHER REFERENCES:
R1 – Copy of VMGO
R2 – Claudio, Dirige, Jamorabo-Ruiz. 2004. Basic Nutrition for
Filipinos, 5th edition. Manila, Philippines: Merriam & Webster
Bookstore, Inc
R3 – Lagua,Claudio. 2004. Nutrition and Diet Therapy Dictionary
(Philippine Edition). Manila, Philippines: Merriam & Webster
Bookstore, Inc.
R4 – Department of Science & Technology - Food and Nutrition
Researech Institute (DOST-FNRI). 2019. Food
Exchange List For Meal Planning, 4th Edition. DOST-FNRI.
Bicutan Taguig City, Philippines.
R5 – Department of Science & Technology Food and Nutrition
Researech Institute. Medical Nutrition Division. 2005. Diet
Guides For Renal Disease. Manila: FNRI Publication.
Researech Institute. Medical Nutrition Division. 2005.
Nutritional Handbook For Person’s with Diabetes. Manila:
FNRI Publication.
Researech Institute. Medical Nutrition Division. 2005.
Handbook for Nutritional Management of Renal Diseases.
Manila: FNRI Publication.
R9 – The Nutritionist-Dietitians’ Association of the Philippines
Foundation. 2004. Fundamentals in Medical Nutrition
Therapy. Metro Manila, Philippines.
Foundation. 2004. Fundamentals in Public Health Nutirion.
Metro Manila, Philippines.
Foundation. 2004. Fundamentals in Nutrition and
Biochemistry. Metro Manila, Philippines.
Foundation. 1994. Diet Manual, 4th edition. Metro Manila,
Philippines.
ONLINE REFERENCES:
OR1 – www.doh.gov.ph
OR2 – www.fnri.dost.gov.ph
OR3 – www.ndap.org.ph
1. Active class participation (online discussion board, FB Closed group

account)
Course
2. Submit all activities required
Requirements
3. Quizzes
4. Meal preparation – Video Presentation (individual)
Prepared by: Luda G. Santillana, RND, MBA
Reviewed and Approved by:
Subject Area Coordinator : NATASHA KAY V. CHAN, RN, MN
Dean, CONAHS : AILEEN G. SYPONGCO, RN,RM, MN
GAD Director : MARY ANN T. ARCEŇO, LPT, Ph. D.
CIMD, Chairperson : MA. JANET S. GEROSO, LPT, Ph. D.
QA Director : DONNA FE V. TOLEDO, LPT, Ed. D.
VP- Academic Affairs : SAMSON M. LAUSA, Ph. D.

Declaration of Copyright Protection
This course module is an official document of Northern Negros State
College of Science and Technology under its Learning Continuity Plan on Flexible
Teaching-Learning modalities.
Quotations from, contractions, reproductions, and uploading of all or any
part of this module is not authorized without the permission from the faculty-author
and from the NONESCOST.
This module shall be used for instructional purposes only.

MODULE 2
LESSON
1 DIETARY CALCULATIONS
6 HOURS
This module for the midterm deals about the different Dietary computations
such as the Body mass Index, Desirable Body Weight in which we, people from
all walks of life should know what the ideal weight that we should maintain,
Estimating the Total Energy Requirement and Distribution of Total Energy
Requirement into Carbohydrates, Protein and Fats and Application of Food
Exchange List for Meal Planning. Also to enhance awareness and encourage
positive changes in nutrition and health related behavior and create a
community that supports good health practices that empower individuals and
group to take action to facilitate change.
At the end of this module, you are expected to:

1. Explain the importance of BMI and other related formula computation.
2. Apply the use the food exchange list in planning meals.
“Nutrition isn’t just about Eating it’s about learning to live”
Food Matters

A. BODY MASS INDEX – Based Formula.
Body mass index (BMI), computed as weight in kilograms divided by height in
meter squared (W/H2), has been found to be the relative weight index that shows
the highest correlation with independent measures of body fat. The BMI range of
20 to 24.5 is generally considered normal.
 BMI = Weight in kg
Height (m)2
Conversion:
Weight - Lbs to kg = weight in lbs/2.2
Height - inches to meters = height in inches x 2.54
100
1 foot = 12 inches
Example: Hana weighs 125 lbs and stands 5 feet 6 inches. Compute for the BMI.
125/2.2 ----- 56.8
5’6 ( 5x12=60 +6=66 x 2.54 =167.6/100)
56.8 kgs
(1.67)2 = 2.78 the answer is 21.03
Activity 1: Compute your own BMI and identify in which classification you
belong. (20 points). Use the space below and show your solutions.

B. DETERMINING THE DESIRABLE BODY WEIGHT (DBW) – referred to as
reference, ideal or standard body weight. The calculation of diet prescriptions is
usually based on desirable body weight. Some are the methods used in
determining desirable body weight.
1. FOR INFANTS:
a. first 6 months:
DBW (gms) = Birth weight (gms) + (age in mos. X 600)
If the birth weight is not known, use 3000 gms.
Example:
4 month old infant = (not known)
DBW (gms) = 3000 + 2400
= 5400 gms or 5.4 kg
7-12 months:
DBW (gms) = Birth weight (gms) + (age in mos. X 500)
Example:
8 month old infant
DBW (gms) = 3000 + (8 x 500)
= 3000 + 4000
= 7000 gms or 7 kg
b. DBW (kg) = (age in months/2) + 3

Example:
8 month old infant
DBW (gms) = (8/2) + 3
=4+3
= 7000 gms or 7 kg
INFANT’S WEIGHT:
- Doubles at 5-6 months
- Triples at 12 months
- Quadruples at 24 months
HEIGHT OR LENGTH:
- Increases by 24 cm first year
- Increases by 12 cm second year
- Increases 8 cm during third year
- Increases 6 cm every year thereafter up to eight years
Example:
At birth: 50 cm
At 1 year (+24 cm) = 50 + 24 = 74 cm
At 2 year (+12 cm) = 74 + 12 = 86 cm
At 3 year (+8 cm) = 86 + 8 = 94 cm
At 4-8 years (+6 cm every year) = 94 + 6 = 100 cm
2. CHILDREN
DBW (kg) = (Age in years x 2) + 8
Example: 7 year old child
DBW (kg) = (7x2) + 8
= 14 + 8
= 22 kg
+ 2 kgs for every year
3. ADULTS
Desirble Body Weight (DBW, or ideal body weight (IBW) as used in
nutrition and diet therapy refers to the weight for height found statistically to be the
most compatible with the health and longevity. There are several tables or
nomograms which give the DBW of adults of given height. However, in practice, it
is often necessary to compute an individual’s DBW quickly. The following formulas
that can be used:
Method 1: NDAP Formula, which the rule of the thumb easy to remember:
For women: allow 106 pounds for 5 feet and add 4 pounds for every inch
thereafter.
For men: allow 112 pound for 5 feet and add 4 pounds for every inch
thereafter.
Using the formula:

6 feet tall man DBW = 160 pounds
(112 + [12 x 4]) = 160 pounds
5’4” tall female DBW = 122 pounds

(106 + [4 x 4]) = 122 pounds
Method 2: Hamwi’s Method (used by most clinicians)
 For women: allow 100 pounds for 5 feet stature plus 5 pounds for
each additional inch.
 For men: allow 106 pounds for 5 feet stature plus 6 pounds for each
additional inch.
 The values obtained apply to adults with small frame. Add 5 pounds
for medium frame and 10 pounds for large frame.
Method 3: The most easiest way to determine DBW, you can refer to the
FNRI-DOST Height and Weight Tables for Adults. If this table is not available, you
can use NDAP Formula or Hamwi’s Method.
Activity 2: Compute your own DBW using the:

a. NDAP Method; and
b. Hamwi’s Method.
Use the space below and show your solutions. (20 points).

C. ESTIMATING TOTAL CALORIE OR TOTAL ENERGY REQUIREMENT (TER)
PER DAY – the total energy needs of an individual is the composite energy
necessary to replace basal metabolic needs, energy expenditure for physical
activities. The total energy needs of an adult may be determined using one of the
methods shown:
Method 1: the most practical and rapid method of estimating energy needs
based on desirable body weight (DBW) according to the activity level or physical
activity.
ACTIVITY LEVEL MALE FEMALE

Sedentary 35 30
Light 40 35
Moderate 45 40
Heavy 50 --
Example of activities:
Sedentary – secretary, clerk, administrator, cashier, bank teller – mostly sitting.
Light – teacher, nurse, student, lab technician, housewife with maids.
Moderate – housewife without maid, vendor, mechanic, jeepney and car driver.
Heavy – farmer, laborer, cargador, fisherman, heavy equipment operator.
Example:
TER = ?
DBW = 50 kg
Activity = moderate (housewife without maid)
TER = DBW x ACTIVITY LEVEL (FEMALE)
TER = 50 kg x 40
TER = 2,000 Kcal/day
Method 2: Use the Recommended Energy and Nutrient Intakes for

Filipinos. Note the different age groups and physiologic conditions.
Activity 3: Compute your own TER. (20 points). Use the space below and
show your solutions.

D. DISTRIBUTION OF TOTAL ENERGY REQUIREMENTS (TER) INTO
CARBOHYDRATES, PROTEIN AND FAT
A. Determine the distribution of TER into carbohydrates, protein and fats by
percentage distribution.
Carbohydrates - 55-70% of Total Energy Allowance (TEA)
Protein - 10-20% of Total Energy Allowance (TEA)
Fats - 15-30% of Total Energy Allowance (TEA)
NOTE: Percentage levels used may depend upon the diet description or
usual food habits of the patient. Assign a definite percentage of TER contributed
by carbohydrates, protein, and fats.
Example: Distribution of TER into CHO, CHON and FATS by 1,500 Kcal
For normal diet, allot 60% of the total energy allowance for
carbohydrates, 20% for protein and 20% for fat. The corresponding energy
contributions of three nutrients are:
CHO - 1,500 kcal x .60 = 900 Kcal
CHON - 1,500 Kcal x .20 = 300 Kcal
FAT - 1,500 Kcal x .20 = 300 Kcal
Calculate the number of grams of CHO, CHON and FAT by dividing the
calories for each nutrient by the corresponding physiological fuel value:
 CHO (carbohydrates) = 4 Kcal
 CHON (protein) = 4 Kcal
 Fat = 9 Kcal
Example:
CHO - 900 Kcal/4 = 225 grams CHO
CHON - 300 Kcal/4 = 75 grams CHON
FATS - 300 Kcal/9 = 33.3 grams or 35 grams FATS
For simplicity and practicality of the diet prescription (Diet Rx), round off
calories to the nearest 50 grams, and CHO, CHON and FATS to the
nearest 5 grams.
Diet Rx: 1,500 Kcal; 225g CHO; 75g CHON, 35g FATS
B. Calculate the non-protein and protein calories. NOTE: this computation

is used when there is specific/restricted protein requirement. There should be
information on total energy requirement (TER), DBW and protein requirement.
Example:
TER = 2,000 Kcal
DBW = 50 kg
CHON Req.= 1g/kg DBW
a. Determine protein calories:

CHON = 50 x 1g
= 50 g CHON
= 50 x 4 (physiological fuel value)
= 200 Kcal
b. Determine non-protein calories:

Given TER – CHON Kcal = NON-CHON Kcal
2,000 Kcal – 200 Kcal = 1,800 Kcal
c. Divide non-protein calories into CHO (70%) and FAT (30%).

CHO = 1,800 x .70
= 1,260 ÷ 4 (physiological fuel value)
= 345 g CHO
FAT = 1,800 x .30

= 540 ÷ 9 (physiological fuel value)
= 60 g FAT
The Diet Rx should be: 2,000 Kcal; 345g CHO; 50g CHON; 60g FAT
Activity 4:
A. Distribute your own TER into Carbohydrates, Protein and Fats using 60-
20-20 distribution (Diet Rx). (20 points).
B. Calculate the non-protein and protein calories of your own TER. (10
points).
Use the space below and show your solutions.

E. APPLICATION OF FOOD EXCHANGE LISTS (FEL) FOR MEAL PLANNING
How to use the Food Exchange List in meal planning:

Using the example in the preceding section of diet prescription (Diet Rx) 1,500
Kcal; 225g CHO; 75g CHON, 35g FATS: To translate the prescription into food
exchanges, the procedure is as follows:
1. List all the food furnishing carbohydrates with the exception of rice, i.e.,
vegetables, fruit, milk and sugar.
a. It is desirable to allow 2-3 exchanges of vegetables per day.
b. Unless there is need for a drastic restriction of simple carbohydrates,
3-4 exchanges of fruits per day are reasonable allowance
c. The amount and type of milk allowed depends upon the patient’s
needs, food habits and other economic considerations.
d. Allow 5-9 teaspoons of sugar per day unless contra-indicated.
2. To determine how many rice exchanges:
a. Add the CHO from vegetables, fruit, milk and sugar.
b. Subtract this sum from the prescribed CHO.
c. Divide the difference by 23 (g CHO furnished by 1 rice exchange).
d. The nearest whole quotient is the number of rice exchange allowed.
3. To determine how many meat and fish exchanges are allowed:
a. Add the protein furnished by the food groups already listed.
b. Subtract this sum from the prescribed protein.
c. Divide the difference by 8 (g CHON per meat and fish exchange).
d. The nearest whole quotient is the number of meat and fish exchange
allowed.
e. When calculating grams of fat per meat and fish exchange, use the
fat value that best represents the patient’s usual intake. There is no
need to add or subtract fat exchanges if the appropriate meat and
fish category is used in the computation of food allowance.
Normally, for individuals consuming a sufficient varied diet from day to day,
the fat value for medium fat meat and fish exchange may be used as it can
be assumed that the low fat and high fat meat and fish exchange that the
patient uses will balance out to the value of the medium fat meat and fish
exchange. On the other hand, if the patient is on fat restricted diet, use the
low fat meat and fish exchange and instruct patient to limit choices to those
food in the list.
4. Follow the same procedure for fat, using 5 as the divisor since one fat
exchange contains 5 g of fat.
An allowance of ± 5 grams the prescribed amount for protein,

carbohydrates and fat. As well as, ±50 kilocalories for energy are given so
the fractions of servings are avoided.
Distribute the food allowance into breakfast, lunch, dinner and

snacks, depending on the patient’s eating habits.
ENERGY AND MACRONUTRIENT COMPOSITION OF
FOOD EXCHANGES
CHO CHON FATS
FOOD MEASURE Kcal
(g) (g) (g)
Vegetable Varies 3 1 - 16
Fruit Varies 10 - - 40
Milk
Whole Varies 12 8 10 170
Low fat 4 tablespoons 12 8 5 125
Skimmed/Non-
Varies 12 8 - 80
fat/Fat-free
Rice
A. Low Protein Varies 23 - - 92
B. Medium Protein Varies 23 2 - 100
C. High Protein Varies 23 4 - 108
Meat
Low Fat Varies - 8 1 41
Medium Fat Varies - 8 6 86
High Fat Varies - 8 10 122
Fat 1 teaspoon - - 5 45
Sugar 1 teaspoon 5 - - 20
SAMPLE CALCULATION AND DISTRITBUTION

NO. OF CHO CHON FATS
FOOD Kcal
EXCHANGES (g) (g) (g)
Vegetable 3 9 3 - 48
Fruit 2 20 - - 80
Milk (non-fat) 1 12 8 - 80
Sugar
CHO Partial sum = 41
(prescribed CHO) 225 g

(partial sum CHO) - 41 g
184 g ÷ 23
no. of rice exchanges = 8
Rice A 3 69 276
Rice B 5 115 10 500
CHON Partial sum = 21
(prescribed CHON)
75 g
(partial sum CHON)
-21 g
54 g ÷ 8
no. of meat exchanges = 6.75 or 7
Meat
Low Fat 4 - 32 4 164
Medium Fat 3 - 24 18 258
FATS Partial sum = 22
(prescribed FATS)35 g
(partial sum FATS)
-22 g
13 g ÷ 5
no. of fats exchanges = 2.6 or 3
Fat 3 - - 15 135
TOTAL: 227 g 77 g 37 g 1,541 Kcal
An allowance of ± 5 grams the prescribed amount for protein, carbohydrates and
fat. As well as, ±50 kilocalories for energy are given so the fractions of servings
are avoided.
SAMPLE MEAL PLAN

DISTRIBUTION OF EXCHANGES PER MEAL

NO. OF
AM PM
FOOD GROUPS EXCHANGE BREAKFAST LUNCH DINNER
S SNACK SNACK
Vegetable 3 2 1
Fruit 2 1 1
A – Low
3 1 1 1
Protein
Rice
B – Medium
5 2 2 1
Protein
Milk Non-Fat 1 1
Mea Low Fat 4 2 2
t Medium Fat 3 3
Fat 3 1 1 1
Sugar
SAMPLE ONE-DAY MENU

FOOD
NO. OF HOUSEHOLD
MEAL GROUP SAMPLE MENU
EXCAHNGES MEASURE
LIST
BREAKFAST 2 Ginisa, Corned beef, cnd ½ cup
MF Meat
1 Poached Egg 1 pc
Fat 1 Oil, coconut (ginisa) 1 tsp
Rice A 1 Cuchinta 2 pcs
Rice B 2 Boiled rice 1 cup
Milk Non fat 1 Milk, powder, instant 4 Tbsp, level
LUNCH LF Meat 2 Bangus, Sinigang 2 slices
Labanos
Okra
Vegetable 2 1 cup
Sitaw
Kamote, dahon
Fat 1 Oil, coconut (gisa) 1 tsp
Rice B 2 Boiled Rice 1 cup
Fruit 1 Manga, manila super, 1 slice
ripe
PM SNACK Rice A 1 Saging, saba, nilaga 1 pc
DINNER LF Meat 2 Beef Steak 2 slices, MBS
Buttered Veges
Carrots
Vegetable 1 ½ cup
Cauliflower
Sitsaro
Fat 1 Butter (veges) 1 tsp
Rice B 2 Boiled Rice 1 cup
Fruit 1 Strawberry 1 ¼ cup
Activity 5:
A. Using your own computed Diet Rx. Translate the prescription into food
exchanges using the Food Exchange List. (25 points).
B. Make a Meal Plan and Menu For a Day. (25 points).

LESSON
2 NUTRITION THROUGHOUT THE LIFESPAN

6 HOURS
Aging is a continuous process from conception until death of a person. It

proceeds slowly, but can proceed faster by one’s lifestyle like poor nourishment,
illness, stress factors and adverse environmental conditions. Starting with infancy,
the building-up processes exceed the breaking-down processes, so that the net
result is growth and development. Growth refers to the increase in size and
number of body cells. Development is the maturation of cells to perform activities
for a living organisms. Once the body reaches the adulthood, the rate of breaking-
down processes is greater than the building-up. Degenerative changes occur
more rapidly as an adult approaches the geriatric age. Genetics plays an
important part in the aging process. The aging process is not just a matter of
aiming for a longer life span, but the quality of life is the ultimate goal of living. The
role of proper nutrition throughout life stages to achieve this goal is elaborated in
the next sections, starting with pregnancy.
After studying this lesson, the students will be able to:
1. Identify nutritional needs during pregnancy and lactation

2. Described nutritional needs of pregnant adolescents
3. Modify the normal diet to meet the needs of pregnant and lactating mother
4. State the effect inadequate nutrition has on an infant
5. Discuss positive aspects of breastfeeding and bottle feeding
6. Described when and how foods are introduced into the baby’s diet
7. Described inborn errors of metabolism and their dietary treatment
8. Identify nutritional needs of children ages 1 to 12 and of adolescents
9. States the effect of inadequate nutrition during the growing years
10. Described eating disorders that can occur during adolescents
11. Discuss the consequences of obesity in childhood
12. Identify the nutritional needs of young adults and the middle aged
13. Explain sensible, long range weight control for this aged-group
14. Discuss the importance of exercise in weight control
15. Discuss the diet-related diseases that can be prevented by good nutrition at
this age osteoporosis, heart disease and diabetes
16. Explain the nutritional and calorie needs of people 65 and over
17. Explain the development of given chronic diseases
18. Identify physiological economic, and psychosocial problems that can affect an
older adult’s nutrition.
NUTRITION FOR PREGNANCY AND LACTATION
Definitions of Pregnancy
 Period from conception to delivery;
 Condition having a developing embryo (the developing organism
from eight weeks of gestation when most of the cell differentiation
takes place) into a fetus (the developing human from three months
after conception to birth) after the fertilization of an ovum with a
sperm (the fertilized egg, called a zygote), within the uterine
environment.
 Also known as gestation.
 The period of pregnancy which about:
 266 days (measured by ovulation age) or
 280 days or 40 weeks (measured by a menstrual age)
Parturition – the act of giving birth, delivery of the fetus from the mother.
 Low-birth-weight (LBW) infants: babies weighing less than 2500
grams (less than 5.5 pounds)
 Small for gestational age (SGA) infants: full term babies who weigh
less than 2500 grams (5.5 pounds)
 Premature infants: babies born less than 37 weeks of gestation; also
called preterm infant.
 Intrauterine growth retardation (IUGR): depressed growth of the
fetus due to inadequate nutritional environment in utero.
Factors contributory to IUGR are:
 Inadequate maternal nutritional status before
conception.
 Short maternal stature (due to undernutrition).
 Poor maternal nutrition during pregnancy (low
gestational weight gain).
 Intrauterine infection.
 Small/inefficient placenta.
 Maternal smoking, alcoholism, drug addiction.
 Postmature infants: babies born after 42 weeks or more of gestation.
Physiological Stages of Pregnancy

 Period of implantation: the first two weeks of gestation when the
fertilized ovum becomes embedded in the wall of the uterus and
begins to grow.
 Nourishment comes from the secretion of the uterine gland
called uterine milk.
 Also called period of the ovum.
 Period of organogenesis: six-week period following implantation;
characterized by cell differentiation, formation of organs and
structure of the fetus.
 Nourishment comes from within the uterine environment and
the maternal tissues; absence of certain nutrients during this
stage may be crucial to the growth of the developing fetus.
 At the end of the period, the embryo weighs approximately
one ounce, measures more than an inch long and shows
many features of a newborn.
 Period of growth: the remaining seven months of pregnancy when
the fetus continues to grow until it reaches a functional size capable
of supporting extrauterine life (life after birth). Also called period of
the fetus or fetal period, the differentiated tissues are nourished
through the placenta.
 The palcenta is the tissue embedded on the wall of the uterus
through which the two independent maternal and fetal
circulatory systems come in close contact with one another.
 It weighs from 450-1000 gms at birth.
 Purpose of the placenta:
 Supplying fetus with nutrients and oxygen
 Storing nutrients particularly vitamins
 Synthesizing hormones
 Removal fetal waste product
Nutrients Needs during Pregnancy

 Nutritive need: the recommended increase over the normal
nutrient need of the woman to meet the demands of pregnancy
varies from one nutrient to another; nutritional requirements are
increased during pregnancy.
 To meet the normal requirements of the mother.
 To meet the nutrient needs of the growing fetus and other
maternal tissues.
 For building reserves in preparation for delivery and lactation.
 Rationale for increasing specific nutrients requirements:
 Energy: additional energy is required during pregnancy
for the:
 Growth of the fetus, placenta and maternal tissues and
their maintenance.
 Increase in BMR; better utilization of dietary protein
and good pregnancy outcome.
The addition of 300 kcal/day during the second and third
trimesters of pregnancy is recommended; this amounts to the
total of 56,100 Kcal for the entire pregnancy which is close to
the total cost of pregnancy found in a Philippine study.
 Protein: increase by an average of 8 g/day throughout
pregnancy to:
 Meet the needs of the developing maternal issues;
support the growth of the fetus and the placenta.
 Protect the pregnancy course and outcome against
risk associated with low protein intakes.
 Vitamin A: essential for the health of the epithelial tissues
including the skin and the membranes that like glandless
ducts and passages of the gastrointestinal, urinary and
respiratory tracts; the RNI of 800 ug RE/day for the pregnant
woman also accounts for vitamin A storage in fetal tissues.
 Vitamin C: an extra 10 mg/day is recommended for the
pregnant woman to maintain the integrity of fetal membranes
and tissues structure.
 Thiamine, Riboflavin, and Niacin: are important during
pregnancy particulary with reference to carbohydrates,
protein and lipid metabolism; additional amount of 0.3 mg
and 0.6 mg and 4 mg NE/day for thiamine, riboflavin, and
niacin respectively, are recommended throughout pregnancy.

 Folate: the recommended intake for the pregnant
woman which is a total of 600 ug DFE daily or an additional
200 ug/day is bases on folacin’s role in promoting normal
fetal growth (DNA synthesis) and in erythrocyte maturation,
and preventing neural tube defects.
 Calcium: an additional allowance of 50 mg or a total of
800 mg is recommended to promote adequate mineralization
of fetal skeleton and deciduous teeth of the fetus.
 Iron: the daily requirement for pregnant women is higher
than what can be provided by the usual diet alone, thus,
supplementation is recommended; this amount is needed to:
 Allow for build-up of iron stores
 Allow for the expansion of the red cell mass
 Provide for the needs of the fetus and the placenta
Infants are born with high hemoglobin levels and with a
supply of iron stored in the liver at the expense of maternal
iron reserves if the mother’s iron intake is low.
 Iodine: an additional allowance of 50 ug/day is
recommended so as not to compromise the development of
the fetus; iodine deficiency in pregnancy has been known to
result in cases of cretinism.
 Other minerals and vitamins:
 Zinc: the increase in zinc requirement is minimal
during the first trimester of pregnancy (o.6 mg/day),
but by the third trimester the requirement is more than
twice that of the non-pregnant woman (4.5 mg/day) to
provide the needs for maternal and embryonic or fetal
tissue growth.
 Selenium: the recommended amount of 35 ug/day
during pregnancy should allow for accumulation of
enough selenium by the fetus tpo saturate it
selenoproteins.
 Vitamin B6: a total of 1.9 mg/day throughout the
pregnancy will take care of the fetal, placental and
maternal needs and its bioavailability in food.
 Water and Electrolytes
 Water: an additional 300 ml/day is recommended
because of the expanding extracellular fluids, the
needs of the fetus and the amniotic fluid.
 Sodium: the increase in extracellular fluids calls for
an increase in body sodium, thus restriction of sodium
intake is not recommended as a routine procedure;
sodium restriction stresses the renin0angiotensin
aldosterone mechanism in order to main homeostasis;
the additional needs in pregnancy is 69 mg/day.
Nutritional Care during Pregnancy

 To satisfy the increased energy and nutrient needs in pregnancy,
careful choices of foods need to be done. The pregnant woman
should eat variety of foods from all food groups and should choose
nutrient dense foods. The food guide indicates the recommended
amounts of foods for a Filipino pregnant woman and should be used
to plan the daily diet.
 Specific recommendations for nutritional care during pregnancy
include the following:
 Energy intake must allow a weekly gain of about 0.4 kg
for the last 30 weeks of pregnancy.
 Protein intake must be increased by an additional 10
g/day preferably from food sources with high biologic
value.
 Sodium intake is at least 2000 mg/day.
 Minerals especially iron and folic acid requirements
which are difficult to be provided by usual diets need
supplementation under the physician’s care.
 Alcohol consumption is omitted due to adverse results
to the fetus; its consumption is associated with fetal
alcohol syndrome.
 Caffeine intake is limited or restricted to 200 mg/day (2
cups of coffee or equivalent in other caffeine-containing
drinks).

Effects of Good Nutrition
 On the mother:
 Increased chances of normal pregnancy leading to normal
delivery.
 Absence or reduced chances of complications during
pregnancy.
 Reduced incidence of premature deliveries.
 Reduced incidence of maternal depletion.
 Reduced incidence of morbidity and mortality.
 Increased chance of successful lactation.
 On the infant:
 Normal growth and development: normal birth weight and
length.
 Reduced incidence if intrauterine growth retardation (IUGR).
 Reduced chances of still births, congenital malformations and
neonatal deaths.
 Reduced incidence of illness and stronger resistance to
infections.
 Adequate nutrient reserves.
Fetal and Maternal Nutrition

 Fetal growth and development is dependent upon the utilization by
the fetus of adequate energy and nutrients, the gene expression of
the factors promoting tissue growth and hormonal framework. The
failure of the maternal-placental nutrient supply to match fetal
nutrient demand causes restriction of fetal growth.
 “Fetal origins of adult disease” hypothesis or Barker hypothesis that
maternal dietary inadequacies at critical periods of development in
utero can trigger an adaptive redistribution of fetal resources,
including growth retardation. These adaptaitons affect fetal structure
and metabolism, and predispose the individual to later
cardiovascular and endocrine disease.

 The consequences of being born undersnourished/low-birth-weight
extended into adulthood. Nutrition challenges continue throughout
the life stages.
Problems during Pregnancy and Dietary Intervention

 Mild nausea and vomiting: during the first trimester of pregnancy due
to increased hormone production resulting in disturbed physiologic
and biochemical processes which may be related to hypoglycaemia,
decreased gastric motility, relaxation of the cardiac sphincter, or
anxiety. Loss of appetite usually accompanies nausea and vomiting.
 High carbohydrate foods such as crackers, jelly, and
dry toast before arising is prescribed.
 Frequent small meals/feeding are preferable with fluids
taken between meals rather than at meal time.
 Avoid liquids 1-2 hours before and after eating.
 Consume adequate liquids throughout the day.
 Avoid odors that cause aversions and nausea.
 Eat higher amount of protein.
 Avoid high fat and fried foods; these delay gastric
emptying.
 Try salty or sour foods.
 Avoid highly spiced foods.
 Constipation: may occur due to the decreased muscle tone and
motility of the GI tract and the pressure of the fetus on the lower
portion of the intestines.
 The diet should provide liberal allowance of fruits and
vegetables with adequate fluid intake.
 Regular elimination, sleep, and exercise are
recommended.
 Heartburn: may result from the reversal of the stomach contents to
the esophagus brought about by hypomotility; it is characterized by
epigastric pain just below the sternum. Regurgitation of acid and
presence of gas in the stomach. This is caused by increased levels
of progesterone and the growing fetus that places pressure on the
stomach.
 Frequent small meals/feeding rather than heavy meals
are recommended.
 Eliminate liquids immediately before and after meals to
avoid gastric distension.
 Limit or avoid coffee, greasy and spicy foods.
 Rest an hour without reclining after eating.
 Drink nourishing less acidic liquids between meals.
 Hyperemesis gravidarum: or severe and prolonged vomiting
throughout pregnancy can be life threatening if not controlled; it is
characterized by dehydration, acidosis, weight loss, avitaminoses,
and jaundice.
 Intravenous feeding may help prevent dehydration and
provide nutrients.
 It tolerated, enteral feeding of an appropriate formula
through nasogastric tube may be given and this can be
followed by a dry diet in six small feedings with clear
liquids between feedings.
 Cravings and Aversions (Pica): refers to the compulsion for
persistent ingestion of unnatural foods or non-food items such as
clay, starch, ice, charcoal, etc.; ingestion of pica substances cam
limit intake nutritious foods and/or interfere with absorption of
nutrients; some pica substances may also contain toxic compounds.
Pica for raw rice is known as amylophagia.
 Determine what is being ingested and why.
 Stress the importance of an adequate and the potential
dangers of pica.
 Anemia: mainly due to iron and folic acid deficiencies; occurs
frequently in pregnancy.
 Microlytic hypochromic anemia is produced by a
deficiency of iron, the mineral needed for haemoglobin
synthesis.
o Prevention/treatment is by iron supplementation
and by including foods rich in iron in the diet.
 Megalobastic anemia can be caused by folic acid
deficiency but is more commonly found in association
with lack of iron.
o Prevention/treatment of folic acid
supplementation and emphatic selection of food
rich in folic acid in the diet.
 Neural Tube Defects (NTD): occurs when the neural tube,
which develops into the spinal cord 18-26 days after conception fails
to close. Errors at the top of the tube affects the brain (anencephaly)
causing infant death. Errors at the lower end of the spinal cord result
spina bifida characterized by incomplete closing of the bone casing
surrounding the spinal cord.
 Eat a balanced diet; pay attention to leafy, green
vegetables, legumes, nuts, citrus fruits, and whole
grains cereals.
 If needed, take a daily multivitamin with folic acid.
 In adequate weight gain: may occur secondary to poor appetite
related to nausea, vomiting, heartburn or smoking, or from an
inadequate food intake, low weight gain in pregnancy is associated
with increased risk of having a low-birth-weight infant.
 Depending on the cause, make appropriate diet
modifications to improve the appetite and cultivate
good eating practices.
 Set weight gain goals based on recommended rate and
amount of weight gain associated with optimal
maternal and infant health.
 Excessive weight gain: in pregnancy it increases the risk of
complications during labor and delivery as well as postpartum
obesity. Overweight and obese women have an increased risk for
complications during pregnancy including hypertension and
gestational diabetes.
 Dietary counselling and exercise for weight reduction.
 Limit the rate of weight gain without compromising
nutrient intake.
 Pregnancy-induced hypertension (PIH), or eclampsia: initially known
as toxaemia which is misnomer since blood toxin or blood poisoning
in neither a cause nor a symptom of the condition; later, it was called
eclampsia which means sudden development; a hypertensive
syndrome induced by pregnancy.
 The two stages of eclampsia are:
o Preeclampsia: hypertension with proteinuria,
edema, headache, blurred vision and/or sudden
weight gain.

o Eclampsia: extension of preeclampsia with
convulsive seizures.
 Treatment varies depending on the severity of the
symptoms; attention sufficient protein, energy and
sodium in order to control symptoms and maintain
nutritional support are necessary.
 Gestational diabetes: is an intolerance to carbohydrates that
appears during pregnancy; characterized by higher fasting and
postprandial plasma concentration of glucose. The condition may be
an extreme manifestation of the normal insulin resistance of
pregnancy or may reflect a predisposition to type-2 diabetes.
 Lower energy intake for overweight and obese women
to improve insulin sensitivity and reduced risk of infant
macrosomia.
 Adequate food intake (diet therapy) is essential to
prevent ketone formation and promote proper weight
gain.
 Monitoring of blood glucose and urinary ketones is
necessary; insulin therapy needed if FBS is greater
than 5 mmol/L.
 TORCH infections: TORCH is an acronym for
Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex. If
any of such infectious disease occur during pregnancy, the
developing fetus suffers harmful effects.
 An adequate balanced diet helps provide the nutrients
needed to fight infections.
Effects of Cigarettes, Alcohol and other Potentially Harmful Food

Components
 Cigarette smoking: limits fetal development and lowers birth weight
in directly relation to the number of cigarettes smoked. This may be
due to the reduced food intake of the mother and to the effects of
carbon monoxide and nicotine on placental perfusion and oxygen
transport to the fetus.
 Alcohol: excecssive alcohol consumption causes adverse
effects on fetal development known as fetal alcohol syndrome (FAS).
Infants with FAS exhibit:
 Facial defects
 Growth retardation
 Abnormalities of the central nervous, cardiac, and
genitourinary systems.
Although low to moderate alcohol consumption has been shown to
have some health benefits for certain individuals, it is best for
pregnant woman not to drink during pregnancy.
 Narcotics: can damage and addict the fetus: an increasing
number of common medicines and illegal drugs taken by pregnant
woman can cross the placental barrier and affect fetal growth and
development. Cocaine abuse has been linked to premature labor
and to fetal physical and mental malformations. Some narcotics can
also be antagonists to vitamins.
 Caffeine: among rats, mice and rabbits, massive doses of
caffeine appear to be teratogenic while studies in humans do not
provide convincing evidences; however, it is still recommended for
pregnant woman to use caffeine in moderation. Caffeine
consumption should be limited to less than to 300 mg/day (about 2-3
cups of coffee or 4 cups of tea or 6 cola drinks).
 Food contaminants: some contaminants found in food may
adversely affect pregnancy course and outcome, e.g.
 Lead is embryotoxic, toxicity of which is associated
with abortion.
 Mercury is embryotoxic, toxicity of which is associated
with brain damage.
Teenage Pregnancy
 Adolescent growth and pregnancy make competing demands for
nutrients, thus both the mother and child will be affected.
 Adolescent pregnancies are at increased risk of
complications because of biological, psychological and
economic factors. Pregnant adolescents:
 With a gynecologic age (age at conception
minus age of menarche) of less than 4 years are
at high nutritional risk.
 Are more likely to be emotionally, financially,
and socially immature.
 Give low priority to nutrition and tend to have
erratic eating patterns and practices.
 Seek prenatal care later.
 Are more likely to be pretty, have low birth
weight infant and more complications/problems.
 Proper health and nutrition counselling and encouragement should
be given to teenage mothers.
 Realistic goals for weight gain should be set.
 Healthy lifestyle – adequate diets, plenty of exercise
and rest, and no to smoking, alcohol drinking and use
of drugs – should be practiced.
 Emotional and socioeconomic care and support be
given.
Nutrient Need during Lactation

 The increase in the nutritive needs is for mother to meet her own
needs and that of the infant.
 Nutritive needs during lactation far exceeds those
during pregnancy because of the high demand for
growth and physical care that the breastfed infant
makes on the mother; the mother also provide for her
own needs to prevent nutrient depletion in her tissues.
 The RNI during lactation are based on an average daily
production of 750 and 600 ml for the first and second
six months respectively, and the average energy and
nutrient content of milk.
 While analyses of human milk shown variations in
composition not only among women but also in the
same woman over time; the total energy, protein, fat
and carbohydrates content of breastmilk in general is
constant; if maternal intake of energy or protein is
lacking, milk quantity (volume) rather than milk quality
will be reduced.
 Rationale for increasing specific nutrient requirements:
 Energy: the energy cost of lactation is the energy
content of the milk secreted plus the energy required to

produced it; an additional 500 Kcal/day throughout
lactation is recommended considering these factors:
 Average milk volume during the first six months
is 750 ml/day and decreases to 600 ml/day in
the second six months.
 Average energy content of breastmilk is 0.72
Kcal/ml.
 Efficiency of conversion of dietary energy to milk
energy is 80%.
 Maternal fat reserves and patterns of activity are
taken into consideration.
 Protein: an increase of 23 g/day during the first six
months and 18 g/day in the second six months of
lactation are recommended considering the following:
 Milk volume is stated above.
 Average protein content of breastmilk and
efficiency of conversion of dietary protein to milk
protein of 70%.
 Allowance for mothers who are capable of
producing more milk of +2SD.
 Protein quality of the Filipino diet.
 Vitamin A: although most infants have vitamin A
stored in the liver at birth, human milk becomes the
main source of vitamin A and related to carotenoids.
 An increased intake of 400 ug RE in the first
year of lactation allows production of milk with
sufficient vitamin A to meet the needs of the
infant.
 Vitamin C: the concentration of vitamin C in
breastmilk reflects maternal intake, thus, the
recommendation is an increase of 35 and 30 mg/day in
the first and second six months, in order to maintain a
good level of vitamin C in breastmilk.
 Thiamin, Roboflavin, and Niacin: the increase in
requirements of 0.4 mg, 0.6 mg and 3 mg NE/day,,
respectively are needed to cover the B complex
vitamins secreted in the milk and increase in maternal
requirement.
 The amount of thiamine in human milk reflects
almost immediately he amount in the mother’s
diet, therefore, if the mother’s diet is insufficient
in thiamin, the thiamine level in breastmilk will
also be low.
 Folate: an additional allowance of 100 ug/day
takes care of the folacin content in breastmilk and the
additional metabolic requirement of the lactating
mother.
 Calcium: studies indicate that the reduction in bone
mass during lactation is due to lack of estrogen rather
than increased demands of milk production. The loss of
calcium during lactation is not prevented by increased
intake and the calcium lost is regained after weaning
thus the intake of 750 mg/day is sufficient.
 Iron: a total intake of 27-30 mg/day is
recommended for the first six months, respectively, to
compensate for the iron in breastmilk, iron loss from
childbirth and later, for menstruation, and allow
adequate iron stores for future needs.
 Iodine: because of the role of iodine in
metabolism, an additional intake of 50 ug/day is
recommended.
 Other nutrients:
 Zinc: taking into account the mean zinc content
of breastmilk, the recommended increase is 7
mg/day or a total of 11.5 mg/day.
 Sodium: the requirement increases since
human milk has about 7.8 m Eq of sodium (180
mg/L). the daily milk secretion of 750 ml requires
135 mg sodium/day.
 Water: approximately 87% of the volume
of breastmilk is water, an additional intake of
750-1000 ml/day is recommended to avoid
dehydration.
Food Guide for a Lactating Woman

 Although the nutrient content of the diet varies with the food
choosen, the use of the Daily Food Guide for Lactation helps ensure
an adequate intake. Lactating women should eat a variety of foods
daily and should take 2½ - 3 liters of fluids daily preferably in the
form of water, milkm fruit juices and soup instead of carbonated
drinks and caffeine – containing beverages.

Activity 6: What nutritional advice is recommended for a healthy pregnancy?
Lactation? (10 points)
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NUTRITION DURING INFANCY
Nutritional Requirements in Infancy
 Nutritive needs: requirements for infants may be based on
estimates of amounts supplied by breastmilk or amounts laid down
during growth, or extrapolated from adult requirements. From birth to
less than six months, RNI for infants may be delivered from the
adequate intakes of fully breastfeed babies, based on a breastmilk
volume of 750 ml multiplied by its nutrient content. For older infants,
the RNI is based in the amount of nutrient provided by both the
breastmilk and complementary foods. If this is not available, the RNI
is extrapolated from the AI of younger infants or from adult
requirements, based on metabolic body weight.
 Rationale for nutritional requirements in infancy:
 Energy: the energy requirement per unit of body
size in an infant’s first few months of life is very high
but declines as the rate of growth decreases.
 The energy requirement per unit of body rate is
high because of the larger body surface area of
infants compared to adults.
 The early months are characterized by a high
need of energy for growth and increased
activity.
 Breastmilk will adequately meet the needs of
infants below six months of age, after which
complementation with other foods become
necessary.
 Protein: the need for protein during the period of
rapid skeletal and muscle growth of early infancy is
relatively high; infants’ amino acid requirements are
higher than those adults.
 In addition to eight essential amino acids for
adults, histidine is essential for infants.
 No adjustment for NPU are made for infants,
since the dietary recommendation is in terms of
breastmilk.
 Fat soluble vitamins:
 It is assumed that a healthy newborn enters life
with a reserve of vitamin A in the liver.
 The RNI of 375 mg RE/day is adequate to meet
the infants need for growth and allows for
building liver stores of vitamin A.
 The adequate intake for infants is based on the
dietary intake of vitamin D associated with and
mean serum 25(OH)D concentration greater
than 27.5 nmol/L and assumes no exogenous
source from sunlight exposure.
 Vitamin K supplementation is usually given at
birth as a protection against haemorrhage since
the infant’s inside gut us sterile and unable to
synthesize vitamin K because of the absence
intestinal bacteria. The RNI of vitamin K for
infants is based on the 1 mg/kg BW/day
recommended by the FAO/WHO (2002) for
adults.
 Water-soluble vitamins: breastmilk usually provides
the RNI of water-soluble vitamins if the mother’s diet is
adequate.
 The recommendation of 30 mg vitamin C/day
provided an adequate margin for safety.
 For older infants, the vitamin C content of
complementary foods must be considered.
 Also, the thiamine content of breastmilk
depends on the mother’s thiamine intake. An
adequate maternal diet ensures an adequate
thiamine intake of the baby from breastmilk.
 Mineral: because of the rapid rate of calcification
of bones in infancy, calcium and phosphorus are
needed, while the rapidly expanding blood volume
requires an adequate supply of iron.
 The desirable Ca:P ratio is 1.3:1; in general,
milk is capable of meeting the infants need; the
presence of vitamin D enhances the utilization
and retention of calcium.
 Provided maternal intake and reserved are
adequate during pregnancy, the iron content of
a normal infant at birth is 75 mg/kg; the biggest
portion of which is found in the red cells and the
infant can maintain satisfactory haemoglobin
levels with breastmilk feeding alone for the first
six months because of stored iron.
 Iron is accumulated in utero, in proportion to
body size, thus, low birth weight infants have
limited reserves at birth that are quickly depleted
during rapid growth.
 Water: infants need about 1.5 mL/Kcal of energy
expenditure; this need corresponds to the water-to-
energy ratio in human milk. The minimum daily
requirement for water is 800 and 1000 mL in the first
and second six months of life, respectively.
 Attention should be given to the infant’s (six
months older and beyond) need for water
because of the evaporation losses from the skin
and the lungs which become higher during hot
weather.
Methods of Feeding the Infant

 Breastfeeding: the best and most natural way of feeding the
infant is when a mother gives her breast to the infant.
 Substitutes for breast feeding are needed when the
mother is unwilling, or unable to beastfeed or dies.
 The wet nurse is a lactating woman who breastfeeds
an infant deprived of his/her own mother’s milk;
contemporary form of wet nursing is referred to as
cross-nursing, that is, mothers agree with other nursing
mothers to baby-sit with breastfeeding as part of the
agreement.
 Artificial feeding or bottle feeding: when an infant is fed on a
formula from the bottle, when a mother is incapable of breastfeeding.
 Mixed feeding: feeding the infant partially from both the breast
and the bottle; there are two types:
 Supplemental feeding: when bottle feeding is
substituted for breastfeeding; this is usually used when
the mother has to be away part of the day during
feeding time.
 Complemental feeding: when a bottle is given after the
breast to complete a feeding; this is used when the
mother does not have enough milk to satisfy the baby.
Considerations Favoring Breastfeeding

 Nutritional factors
 The nutrient composition of the milk of each species is
best suited to the growth needs of its offspring; both
human and cow’s milk are complex liquids.
 For the few days after birth, the mammary glands
secrete colostrums, a thin, yellow, watery fluid;
compared to mature milk colostrums has the following
advantages:
 More protein, beta-carotene and vitamin A
 Less fat
 Higher sodium, potassium and chloride
contents
 Contributes immunity to the infant
 Colostrums changes to transitional milk after few days,
and after two weeks becomes mature milk; nutrients
secreted in human milk vary depends on biochemical
variability among women, diet consumed, stage of
lactation, and length of time the mother has breastfed.
 Breastmilk is the ideal food for the infant during the first
six months of life as it is biologically complete, easily
digested and assimilated, and can support satisfactory
growth and development.
 Energy: the caloric value of human milk
and cow’s milk is similar, as is the fat content;
the lower protein content of human milk is
compensated by higher amount of carbohydrate.
 Fat: the fatty acids in human milk are
less saturated, have more medium chain, and
are utilized more effectively than those in cow’s
milk; human milk also contains more linoleic
acid, the essential fatty acid with the growth and
anti-dermatitis factors. Human milk also contains
lipase.
 Protein: human milk has more lactalbumin
and less casein than cow’s milk; lactalbumin has
an amino acid pattern that resembles body
proteins and forms a soft, flocculent curd that is
more rapidly digested and absorbed by the
infant; it has also more cysteine, taurine, and
peptidase, and less methionine, phenylalanine,
and tyrosine; human milk proteins also do not
cause allergies.
 Carbohydrates: lactose provides
approximately 40% of the energy in human milk
compared to about 30% in cow’s milk; lactose
favors the absorption of calcium, magnesium
and amino acids, and nitrogen retention; it is
also the only source of galactose which is
needed in the formation of myelin which in turn
is essential to nomal nerve function.
 Minerals: human milk has less calcium,
phosphorous and sodium than cow’s milk but
has higher calcium-phosphorus ratio and
zinc/copper ratio; the low sodium content is
advantageous since the kidney is still immature
and has difficulty handling excess sodium; the
iron in human milk is also more available.
 Vitamins: the amount of thiamine and
vitamin C in human milk is completely available
to the infant whereas that in cow’s milk is
reduced because of the action of heat during
pasteurization of milk and sterilization of
formula; levels of vitamin A and E in human milk
are greater than those in cow’s milk.
 Immunological factors
 Lactobacillus bifidus factor: stimulate the growth
of lactobacillus bifidus which depresses the growth of
pathogenic and infective bacteria.
 Lactoferrin: binds iron and inhibits bacterial
multiplication, e.g. staphylococci and E.coli.
 Lactoperoxidase: kills streptococci and enteric
bacteria.
 Lymphocytes: produce interferon and secretory
IgA.
 Lysozyme: lyses bacteria through destruction of the
cell wall.
 Macrophages: engulf and digest bacteria through
phagocytosis, and produce antibodies that work
against poliomyelitis, influenza and diphtheria.
 Peroxidases: weaken bacterial cell membrane.
 Complement:promotes opsonisation (rendering of
bacteria susceptible to phagocytosis).
 Immunoglobulins (IgA, IgM, IgE, IgD, and IgG): acts
against bacteria, viruses, and other pathogens.
 Interferon: inhibits intracellular viral replication.
 B12 binding protein: renders vitamin B12 unavailable for
bacterial growth.
 Economic factors
 The cost of additional food needed to supply the
necessary nutrients for lactation is less expensive than
the commercially prepared formula and the bottle
feeding paraphernalia.
 Economical in terms of time needed or preparation.
 Convenience and safety factors
Breastmilk is always available, convenient, and

dependable, no preparation involved, hence, no errors
in formula calculations.
 Safe: no danger of contamination since there is no
preparation needed.
 Breastmilk is free from harmful bacteria and even
confers immunity to the infant.
 Maternal benefits factor
 Secretion of oxytocin during lactation causes uterine
contractions and involution of the uterus.
 Important in delaying the onset of another pregnancy:
prolactin which stimulates milk production represses
the synthesis of ovarian hormones.
 Other factors
 Extraction of milk from breast is harder than from the
bottle thus the infant’s become more developed and
teeth are less crowded.
 Reduced renal solute load and absence of
hypocalcemic tetany and allergy reactions among
breastfed infants.
 Less colic and lower rate of sudden infant death have
been reported among breastfed infants.
Milk Substitutes for Breastfeeding (if breastfeeding is not possible)

 Milk may come from other sources or in case of allergic reactions to
milk, non-milk sources may be used; regardless of source, it is
important to match the nutrition requirements and digestive capacity
of the infant and the nutritive content, digestibility and physical
properties of the milk formula; examples of breastmilk substitutes
are:
 Cow’s milk
 Goat’s milk
 Mixtures containing milk
 Ways of simulating human milk:
 Dilution with water or cereal water
 Boiling or any process to produced smaller curds
 Addition of weak acid (lactic acid, acetic acid, citric
acid, etc) to produce smaller curds and speed up
protein digestion.
 Proper sterilization is important to ensure that the formula is free
from contamination.
Requirements for a Satisfactory Artificial Feeding

 Sufficient energy for infant’s energy needs.
 Sufficient protein, carbohydrates, minerals, vitamins and water for
growth and regulating body functions.
 Absence of harmful bacteria; proper technique of formula
preparation.
 Easy digestibility; the formula is adapted to the digestive capacity of
the infant.
 Proper temperature.
 Type and amount of formula should be individually prescribed for
each infant.

Milk Formula
 Milk formula is a mixture of milk, water, and some form of
carbohydrates in appropriate proportions to meet the nutritional
requirements of the infant; designed to simulate human milk and is
prepared in the most sterile manner possible to render it safe for the
infant.
 Milk formulas available range from animal and non-animal sources;
the ideal mixture depends on the matching of the infant’s nutritional
needs and the nutritional content of the formula; types of milk are:
 Cow’s milk formula: processed whole cow’s milk.
 Powdered whole cow’s milk: whole milk dried under
controlled conditions.
 Full cream evaporated milk: whole milk with 50-60% of
water content removed.
 Good substitutes for full cream evaporated milk:

o Recombined milk: skim milk powder
reconstituted to the normal fat content of
the whole milk by adding butterfat.
o Reconstituted milk: processed milk to
which water is added to restore its original
water content.
 Substitutes not usually recommended for

infants:
o Evaporated filled milk: cow’s milk from
which butterfat has been removed and
replaced with vegetable oil (94% coconut
oil and 6% corn oil) inadequate in essential
fatty acids needed by the infant for growth
and healthy skin; some studies reveal that
children fed with evaporated filled milk
showed slow growth, problems or
indigestion and infection.
o Sweetened condensed milk: may be full
cream or filled milk but high in sugar
content resulting to a much diluted formula.
 Partially modified milk formula

 Milk constituents are changed to improved tolerance
and acceptance by infants to increase nitrogen
retention, and to supply some essential nutrients.
 Skim milk where butterfat has been removed and
replaced with vegetable oil, e.g. corn oil.
 Completely modified milk formula: protein and mineral content
are adjusted to resemble that of human milk, butterfat is replaced
with corn oil and lactose is used as the sole source of carbohydrate.
 Non-cow’s milk formula, e.g.
 Soy-based or meat based formula intended for infants
with allergy to cow’s milk.
 Goat’s milk has been found to be effective
hypoallergenic milk.
How To Tell if the Baby is Being Fed Adequately

 The baby is satisfied at the end of 15-20 minutes feeding time.
 Falls asleep promptly after each feeding and sleeps for 3-4 hours.
 Gains weight satisfactorily from week to week at about 5-8 oz per
week in the first 5 months and then 4-5 oz per week for the
remaining month of the year.
Philippine Code of Marketing Breastmilk Substitutes (Executive Order

51, 1986)
 In order to ensure that safe and adequate nutrition for infants is
provided, President Corazon C. Aquino issued E.O. 51 on October
20, 1989 adopting a code known “National Code of Marketing of
Breastmilk Substitutes, Breastmilk supplement, and other Related
Products” and penalizing violations thereof, and for other purposes.
 The aim of the Code is to contribute to the provision of safe and
adequate nutrition for infants through the protection and promotion of
breastfeeding and ensuring the proper use of breastmilk substitutes
and breastmilk supplements when these are necessary, on the basis
of adequate information and through appropriate marketing and
distribution.
 The code applies to the marketing and to related practices of the
products listed below, their quality and availability, and information
concerning their use:
 Breastmilk substitutes, including infant formula.
 Other milk products, food and beverages, including
bottle-fed complementary foods when represented for
use as partial or total replacement of breastmilk.
 Feeding bottles and teats.
 For the purpose of implementation and monitoring of the Code, an
inter-agency committee, with the Secretary of Health as Chairman,
and the Departments of Trade and Industry, Justice, and Social
Services and Development as members, if created.
 Sanction in the form of imprisonment and/or fine are given to
violators of the provision of the code or the rules and regulations
issued pursuant to the Code; in the event of repeated violations, the
license permit or authority issued by any government agency may be
suspended or revoked.
Introduction of Complementary Feeding

 Sooner or later, food other than milk is added to an infant’s diet; the
introduction of solid foods is influenced by:
 Nutrition: by six months of age, milk diet alone
cannot provide the energy and nutrients necessary for
the needs of the growing infant.
 Physiological readiness: the ability to handle food
other than milk depends on the physiological
development of the infant.
 Secretion of enzymes for digestion of starch and
emulsified fats.
 Gastric acidity is increased.
 Maturity of the kidney functions to handle
increased renal solute load.
 When the infant is physically and physiologically capable of handling
solid foods, the sequence and timing of giving solid foods is
determined by his nutritional needs; the order of adding solid foods:
 Cereals: the first solid food given to the baby;
usually given at approximately six months; must be
well cooked, well strained; breastmilk or a portion of
the formula may be added to the cereals; crisp toast,
biskotso, graham crackers may be given when teeth
begin to appear.
 Fruits: mashed ripe bananas, ripe papaya, ripe
mango may be given at six month buy consistency may
be coarser as the baby begins to chew.
 Vegetables: cooked very soft, mashed, or passed
through a sieve; added to the baby’s diet at seven
months; e.g. carrots, squash, abitsuelas, sayote,
potatoes, kamote tops, kangkong tops, pechay and
malunggay leaves.
 Eggs: egg yolk may be given at seven months;
whole egg at 11 months.
 Munggo and other dried beans: cooked very soft and
strained; may be given at six months.
 Meat, fish and poultry: strained or chopped very
finely; may be given at six months.
 Other foods: custards, simple puddings, plain
ice cream, plain gulaman or jello may also be given to
babies eight months or older.
 How to give complementary feeding
 Introduce only one new food at a time; allow the infant
to become familiar with one food before trying another;
it is best to introduce new foods at the beginning of the
feeding when the baby’s appetite is still good.
 Give small amounts of any food; teaspoonful or less at
the beginning.
 Use a thin or soft consistency when starting solid food;
gradually the consistency can be made more solid
when the infant learns to push the food back; put food
in middle if his tongue with a small spoon.
 Never force the infant to eat more than he takes
willingly.
 If after several trials, the baby still refuses to eat a
particular food, omit it for a week or two then try again;
if the child refuses the food again, omit the food and
give a substitute.
 Foods should be only slightly seasoned.
 When the baby is able to chew, gradually substitute
finely chopped vegetables, fruits and meats;
discontinue soft, smooth foods.
 If baby refuses to take some foods, mix them with other
foods he likes well until he becomes accustomed to the
flavour.
 Variety in the choice of foods is important.
 Don’t show any dislike for the food you are giving the
baby.
 Previously, weaning connotes changing from breastmilk to other milk
or milk substitute; currently, to wean means to accustoms to foods
other than breastmilk or milk formula; weaning begins the first time
the infants receives complimental or solid nourishment.
 Signals that warrant the introduction of complementary foods earlier
than six months:
 Developmental signal – child is actively reaching for
family food.

 Behavioural signal – child is very restless despite
unlimited breastfeeding.
 Anthropometric signal – child is not growing well.
Criteria of Adequate Nutrition in Infants

An adequately nourished infant:
 Has steady gain in weight and height.
 Has firm flesh, bright eyes and pinkish cheeks and
nails.
 Is happy an active when awake.
 Sleeps well.
 Has normal elimination.

Activity 7: Write as many as you can the different myth and fallacies about
breastfeeding. (20 points)
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NUTRITION FOR YOUNG CHILDREN (EARLY CHILDHOOD, PRESCHOOL)

Nutritional Requirement of Early Childhood
 Nutritive needs of the child differ in many respects from those of the
adults:
 Large requirement for growth: practically all food
eaten must contain protein, minerals and vitamins.
 Higher physical activities so that the daily energy
allowance per unit of weight is higher.
 Food selection and preparation is influenced by the
child’s capacity to chew and digest food.
The child’s diet must provide fuel for muscular activity, supply the
necessary nutrients for building and repair tissues.
 Rationale for nutritional requirements
 Energy: the increase in energy needs is due to
the increase in the energy needed for basal
metabolism, increased activity and increased growth of
muscle and adipose tissue.
 Recommended intake is about 82 kcal/kg, for 1-
3 years old and 74 kcal/kg 4-6 years old.
 Recommended energy intakes makes no
distinction between boys and girls until 10 year
old; however, some studies indicate that boys as
young as 6 have greater energy needs than girls
and that the boys eat more to meet their energy
needs.
 Protein: protein requirement is higher than that of
adults per kg body weight.
 Recommended daily protein intake of 2.15 and
2.0 g/kg for 1-3 and 4-6 year old children,
respectively, will provide for the demands in the

growth of skeletal and muscular tissues and
provide protection against infection.
 Fat soluble vitamins:
 Vitamin A is required for growth, epithelial
integrity and immunity; and essential for the
maintenance of visual purple for vision in dim
light.
 Vitamin D is important in promoting normal
calcification of bones, and stimulates maturation
of cells.
 Vitamin E is necessary for the synthesis of
essential body compounds, and acts as an
antioxidant.
 Vitamin K is necessary for the synthesis of
prothrombin and proconvertin, two essential
factors in blood coagulation.
 Water soluble vitamins: most water soluble vitamins
are involved in energy metabolism.
 Thiamine, riboflavin and niacin act as
coenzymes in the form of thiamine
pyrophosphate (TTP), flavin mononucleotide
(FMN) and flavin adenine dinucleotide (FAD),
and nicotinamide adenine dinucleotide (NAD)
and nicotinamide adenine dinucleotide
phosphate (NADP), respectively, which are
involved in carbohydrate,protein, and fat
metabolism.
 Vitamin B6 dependent enzymes participate in
amino acid metabolism, synthesis of niacin from
tryptophan and formation of antibodies.
 Adequate amounts of folate and pyridoxine are
needed for the proper utilization of iron and
protein in hematopoeisis (blood formation).
 Vitamin C is necessary in the formation of
collagen, the protein that binds the cells
together; it is also important in the formation of
tooth structure.
 Minerals: calcium, phosphorus and fluorine are
necessary for bone growth; as body size increases, the
other systems also increase e.g., cardio vascular
system, musculoskeletal system, etc. thus, the
increased need for nutrients.
 Water: 60% of the child’s body weight is water;
water:
 Serves as a medium for all biochemical
reactions.
 Is important in the regulation of body
temperature.
 Transports vital nutrients to cells.
 Discards waste materials.
 A normal healthy child needs about 4-6 glasses
ro 1000-1500 mL per day.
Feeding Young Children

 Transitional foods: the transition from an infant diet to a
regular adult diet.
 Formation of good eating habits is critical at this stage.
 Children react more to the color, flavour, texture and
temperature, size of serving and the attitude and
atmosphere in which it is presented.
 Growing children prefer mildly flavoured foods over
spicy foods, plain over mixed dishes, soft and moist
food (because at this stage they lack copious supply of
saliva which could be a natural lubricant for
mastication), colourful meals using the natural color of
foods, lukewarm foods, fruits an simple deserts, and
raw vegetables cut into manageable serving pieces.
 Meting the dietary allowance of growing children
 Provide ample amount of body building, energy-giving
and regulating foods.
 Provide meals which include a variety of foods offered
in amounts sufficient to satisfy appetite.
 Use nutrient dense foods served in small frequent
servings.
 Incorporate milk in other foods like custard, pudding,
ice cream, and other beverages like cocoa to
compensate for the tendency of decreasing milk intake.
 Offer nutritious snacks in the middle of the morning and
afternoon especially to active children.
 Feeding Problems
 Food jags: when the child accepts very limited
number of foods and rejects all others; this should not
be a problem if the accepted foods are nutritious and
can provide their nutritional needs. Jags do not last
long so do not make an issue of it.
 Dawdling: when the child lingers or dilly-dallies with
his food during mealtime; reasons for this include: too
large portions given to the child; child is not feeling well
or trying to get attention.
 Gagging: the child feels like vomiting especially
when fed coarse foods; remedies include: encourage
self feeding, provide colourful and easy to handle
utensils, feed in a clean, well ventilated room and if
possible with other children.
 Food dislikes and or refusal to eat: the child may
not like the taste of the food, may be asserting
independence or may want to attract attention. Do not
make an issue of it; combine food with other well liked
foods or prepare the food in different ways.
 Eating too much: may be due to hereditary,
temperament, appetite or mother’s insistence of a
“clean plate”; this problem leads to overweight or
indigestion; the child may be restrained from eating too
much rich foods like cakes, pastries, and candies.
 Feeding Tips
 Offer variety of nutritious food
 Give substitutes
 Introduce new food with familiar favourite
 Make food appetizing: vary shapes, color,
texture
 Use different cooking styles
 Give child-size servings
 Allow mini meals
 Offer foods the child can easily chew and digest
 Use child-size utensils
 Involve your child
 Allow your child to explore foods by touching
 Encourage your child to participate in planning,
buying and preparing foods
 Provide an enjoyable atmosphere
 Make eating comfortable
 Make eating safe
 Set the times for eating
 Keep mealtime pleasant, relaxed and unhurried
 Do not use mealtime as a time for discipline
 Always encourage
 Never force a child to eat
 Do not use food to reward, punish, bribe or
convey love
 Set a good example
 If you want your child to eat a well-balanced diet
and a wide variety of foods, you should do the
same.
Mental and Emotional Feeding

 The child needs sensory stimuli and enriching experiences to attain
the maximum potential for his growth and development.
 The objective of mental and emotional feeding program is to
promote total development of both mind and body of children during
the crucial period from conception to age six.
 Proper care for the growing children is necessary for their total
wellness.
Signs of Good Nutrition in Young Children
 Alert, vigorous and happy (Not irritable and restless)
 Has endurance during activity
 Sleeps well
 Normal height and weight for age
 Stands erect, arms and legs straight
 Clear bright eyes
 Smooth, healthy skin
 Lustrous hair
 Firm and well-developed muscles
 Good attention span
Common Problems and Disorders among Young Children

 Diarrhea: stools contain more water than normal and not well
formed; are often called loose or water stools.
 Dysentery is characterized by diarrhea where stools
contain blood, this will cause dehydration and
undernutrition if uncontrolled.
 The most important factors in the treatment of diarrhea
are:
 To prevent dehydration
 To treat dehydration if present
 To feed the child
The principles of electrolyte absorption are used for

rehydration. Oral rehydration solution can be done at
home. Its ingredients are 1 liter of safe water, 3.5 g
table salt (sodium chloride), 2.5 g baking soda (sodium
bicarbonate), 1.5 g potassium chloride and 20 g
glucose.
 The children should be fed their regular age diets, and
food choices should be guided by individual tolerances.
 Constipation: difficulty of emptying the bowels due to poor muscle
contraction in the GIT and/or lack of the facilitating fluids for
excretion.
 Dietary treatment includes the modification of the diet
to include high fiber foods and increase fluid intake.
 Exercise and physical activity also promote bowel
movement.
 Food allergy: an adverse body reaction after intake of certain foods.
 Food allergies may result to loss of appetite and
diarrhea.
 Allergies to eggs and seafoods may decrease the
intake of protein, in such cases, food substitution
should be made.
 When necessary, nutrient intake should be monitored.
 Lactose intolerance:a deficiency in lactase, an enzyme for hydrolysis
of lactose to glucose and galactose, thus lactose is poorly absorbed
and passes to the large intestine unchanged.
 Milk the only food that contains lactose and is high
source of protein.
 In case of intolerance, milk is substituted with
fermented milk, cheese, low-lactose milk in which
lactose has been enzymatically hydrolysed by bacterial
action, or soybean milk (e.g. Sobee).
 Hyperactivity or hyperkinesis: children are excessively restless
and inattentive, have poor control of their impulses and often
experience learning disabilities.
 Probable causes: etiology is not clear; suggested
causes are genetics, prenatal hypoxia, psychological
and environmental conditions ranging from lead
poisoning to family disruption, singly or in combination.
The role of sugar as an etiological factor has not been
confirmed.
 Therapy: application of central nervous system
stimulants ameliorates the symptoms, elimination of
foods with artificial coloring and flavouring, and those
with naturally occurring salicylates may also improve
the condition.
 Dental caries: the dentin and the enamel is infected by
cariogenic microorganism.
 The strength of the teeth is developed during
conception, hence the pregnant woman must have
adequate diet.
 Factors that influence the development of dental
caries:
 Susceptibility of tooth
 Presence of fermenting carbohydrates on the
mouth


Presence of bacteria causing carbohydrates
fermentation
 To prevent dental caries the mother must develop good
oral hygiene in the child, provide fluoride treatment,
and decrease his sugar intake.
 Protein-Energy Malnutrition: a syndrome comprising a range of
pathological conditions caused by a lack of protein and calories in
varying proportions.
 Frequently occurs among preschool children
 Associated with infection
 Characterized of severe PEM are:
 Body weight is below 60% IBW for age
 Edema
 Loss of body fat and severe muscle wasting
 Treatment id preferably in the hospital
Mild to moderate PEM may be treated with adequate diet and control
of infections which affect nutrition intake and/or utilization.
 Intestinal parasitism: a medical problem leading to nutrition
problems.
 Most of common forms are ascariasis, caused by
Ascaris lumbrecoides and trichinosis, caused by
trichinella spiralis.
 Etiology: ingestion of parasite-infested food such
as raw vegetables (ascariasis) and improperly cooked
pork (trichinosis).
 Nutritional effects: ascaris interferes with the
absorption of iron and fat (fat is carrier of vitamins A, D,
E, and K), lowers the absorption and retention of
nitrogen and ascorbic acid.
 Prevention: observe hygienic food preparation and
personal hygiene.
 Treatment: antihelminthic drugs together with high
energy, high protein diet and iron and ascorbic acid
supplements.
Food Guidelines and Safety Issues

Below is a summary of food guidelines, including safety issues as
suggested by Peckenpaugh and Claudio:
 1-2 years old: provide simple foods; teach them how to wash
hands before eating. Avoid choking hazards. Cut up food in small
pieces and foods easy to swallow. Monitor that the child chews well
before putting more foods in the mouth. Place small servings on the
plate and start teaching how to handle small spoons. Introduce one
new food at a time. Do not force the child to eat.
 2-3 years old: continue with the introduction of new taste/new
look, i.e. color and shape are appetizing. Provide variety and
observe right kind and amount per food pyramid. Make mealtime
enjoyable. The child joins at the family table and taught proper table
manners, like not standing on the chair, chewing quietly and not
talking while mouth is full, which could also cause choking. No nuts
or sticky foods that could stay in the throat. Avoid using food as a
bribe.
 3-5 years old: bring your child in food shopping. Include his
suggestions in meal planning, but guide selections using items in
food pyramid. At this time, he may also be attending nursery school
where the teachers also teach them right food choices and proper
feeding. Young children prefer simple, uncomplicated foods. Foods
from the family meal may be adapted for the child and served in
child-sized portions. Children younger than 6 years old prefer mildly
flavoured foods. Since their stomachs are small, they often become
hungry so that snacks such as fruit or crackers may be offered.
Children should eat their meals at the family table so they will have
the opportunity to learn table manners and interact with family
members. Most children are visual learners; they tend to imitate what
other people are doing therefore, this is good time teach children
healthy eating and a chance for parents to model proper food
behaviours.
Sanitation and Safety Issues

Useful tips are as follows:
 Teach proper hand washing especially before eating, after touching
pets and playing in the ground, and after toileting.
 Do not give food to toddlers that are choking hazards like peanut
butter, nuts, small grapes, hard pieces and stringy fruits and
vegetables, chewing gum, hard small candies, and tough meats.
Inspect fish flakes for bones. Try small amounts with your
supervision when the child is over 3 years old.
 Choose toys, crayons, paper goods, etc, that are safe to handle.
Infants and children tend to put items in their mouth. Manufacturers
label their toys as safe, non-toxic, etc. and ages when they are safe
to play with.
 Let them play in a safe area away from kitchen, bathrooms,
stairways, and garage, to avoid accidents, especially falls.
 Keep chemicals, drugs or medicines locked up.
NUTRITION FOR SCHOOL AGE CHILDREN
Nutritional Requirements in School Age Children

 Nutritive needs: basically the need for energy and nutrients are
the same for boys and girls 7-9 years, but at age 10-12 boys have
higher needs for energy, protein, and riboflavin. Females have
higher iron needs for build-up of iron stores in preparation for
menstruation, and/or to meet the needs of girls with early menarche.
 In addition to the biological functions of diet at this stage: (i.e.,
provide fuel for muscular activity, supply necessary chemical
elements and compounds that child’s body requires for growth and
repair for worn-out tissues and for regulation of body processes) diet
must give pleasure and satisfaction to the child to facilitate the
establishment of good habits.
 Rationale for nutritional requirements:
 Energy: requirement is determined by age, basal
metabolism and activity; must be sufficient to meet
needs of growth and development which continue
although at a slower rate.
 Protein: requirement in relation to body weight is
higher than that of adults.
 All the essential amino acid must be present to
support growth of tissues.
 Vitamins: the rationale for the requirements for
vitamins are basically the same as for other age
groups, i.e. for their functions in regulation of body
processes, and as structural components of certain
tissues.
 Minerals: rationale is basically the same as for
other as groups, but special attention must be given to:
 Calcium, because of the rapid skeletal
development.
 Iron, because of the rapidly expanding blood
volume for both sexes; and to meet the needs of
girls who menstruate early or build-up iron
reserves for girls who are not menstruating.
 Iodine, particular because of its role in mental
development and metabolism.
 Water: fluid intake of a school age child is 6-8
glasses or 1500-1800 mL/day.
Feeding School Age Children

 At this stage, food presentation, choice and variety are important in
developing sound eating habits.
 Meeting the food needs of middle childhood.
 Make available ample amounts of body building,
energy giving and regulating foods.
 Provide meals which include variety of foods offered in
amounts sufficient to satisfy the appetite.
 Incorporate milk in other food like custard, pudding, ice
cream, and other beverages like cocoa to compensate
for the tendency to decrease milk intake.
 Plan the home packed lunch to provide for at least 1/3
of the child’s daily food allowances.
 Plan nutritious snacks as part of daily meals.
 Feeding problems – mainly due to changing activity patterns.
 Breakfast is often missed: it should provide ¼ - 1/3 of
the daily nutrient allowance.
 Children take their lunch away from home: the children
often do not finish their packed lunch or “swaps” his
well-prepared lunch with someone else’s cookie’s or a
bottle of soft drinks, “lunch swapping” may be remedied
by preparing more than just a nutritious menus but
appetizing, easy to eat and a variety of meal daily, as
well.
 Meals particularly breakfast are taken hurriedly. To
solve this problem, awaken the child earlier to have
more time for breakfast. Set time for eating and keep
mealtime pleasant and relaxed.
 “Sweet tooth”: while sweets provide energy, it can
depress the appetite and create a favourable medium
for the growth of tooth decay-causing micro-organisms;
sweets should not be taken close to mealtime and oral
hygiene should be emphasized.
Common Nutritional Problems among School Children and Dietary

Intervention
 The common problems and disorders among school age children
are the same as the preschool children.
Signs of Good Nutrition in School Children

 Well-developed body with normal weight for height.
 Firm and well-developed muscles.
 Good posture.
 Healthy skin, no lesions and dyspigmentation.
 Smooth and glossy hair.
 Clear eyes.
 Alert facial expression and good disposition.
 Sound sleep.
 Good digestion and elimination.
 Good appetite.

NUTRITION FOR ADOLESCENTS
Nutritional Requirements In Adolescence
 The rate of growth is the major determinant, not age and sex alone,
of nutrient needs during the period of adolescence; requirements
increase from childhood levels at the onset of the growth spurt,
reach their maximum at the time of peak, growth, and approach adult
levels as growth subsides.
 Adolescence are categorized by chronologic rather than
maturational development; thus practitioners should use them with
caution particularly for individual assessment.
 Rationale for nutritional requirements
 Energy: energy intak of girls has been found to be
realted to stages of physiologic development
(prepubescent, rapidly growing and postpubescent)
and not to age; the highest energy intake was also
found to occur during growth spurt (peak height
velocity) to support an acceptable rate of growth and
maintain desirable weight, physical activity and other
life-style practices. Current recommendations for
energy requirements are based on energy expenditure
and energy deposition.
 Protein: as in energy, protein correlates with the
growth pattern rather than with chronological age.
 The amount of protein intake will increase with
growth but the amount per kilogram body weight
decreases with age.
 Fat soluble vitamins: vitamins A allowance for
adolescents is extrapolated from adult values. Vitamin
A is an essential micronutrients throughout the life
cycle and is required not only for vision but also for
regulation cell proliferation and differentiation.
 Water soluble vitamins: these vitamins play
important roles in energy metabolism.
 The DRIs for thiamine, riboflavin and niacin for
adolescents are extrapolated from adult values.
 The requirement for Vit. C for these groups are
extrapolated from those of adult males and
females on the basis of relative body weights;
Vit. C levels may be low for those who avoid
fruits and vegetables, those who smoke, and
those are dieting.
 Minerals
 Calcium: intake of 1000mg/day of calcium is
recommended for adolescent of both sexes to
support the formation of bones and increase the
bone mass; there is current thinking that greater
amount is necessary for peak bone mass to
protect against osteoporosis in later life. In
developing countries, 1300 mg/day is
recommended, however, for countries habitual
animal protein intakes are low, the FAO/WHO
recommendation is 1000 mg/day, which is
adopted for Filipino adolescents.
 Iron: since there is an increase in the
volume of blood, iron requirements is increased
to cover basal iron losses, increase in
haemoglobin mass, and increase in tissue (non-
storage) iron. Additional amount is given to
females to replace menstrual iron losses.
 Iodine: to meet needs of greater metabolic
rate, e recommendation of 150 mg/day based
on the iodine intake associated with acceptable
urinary iodine excretion.
 Water: water volume needed per day is the sum
of the losses through the lungs, sweat, feces and urine;
at ordinary temperature this is about 1 ml/kcal of
energy expenditure or about 1500-2250 mL/day (6-9
glasses daily).
Concerns about Adolescents Dietary Intake and Nutrient Utilization

 Adolescence is characterized by a high level physical and emotional
growth that may result to anxiety and stress which in turn affect food
behaviour and nutritive.
 Emotional instability influences the utilization of nutrients; negative
nitrogen and calcium balance have been observed in those under
extreme emotional stress.
 Socio-psychological changes occur and affect their food nutritional
behaviour; these include:
 Expression of independence
 Need to assert authority
 Peer acceptance and peer pressure
 Concern for body image and/or physical fitness
 Increase in physical activities particularly participation
in sports and athletic activities.
 With adolescents, stress the importance of nutrition with physical
development, fitness, and health. Good nutrition is the foundation of
good health. Teenagers should learn to make food choices
consistent with the daily food guide.
 Common feeding problems
 Meal skipping: teenagers tend to skip meals
particularly breakfast; reasons often cited for this are
lack of appetite, lack of time, preference for sleep or
leisure activity, spending time over personal
appearance, and/or fear of becoming fat.
 Snacking: adolescents eat often and
snacking is characteristic of their lifestyle; many of their
food choices are often sweet and high in salt; snacking
may be detrimental if food consumed are those with
empty calorie and if the snacks take the place of
regular meals. Teenagers should be encouraged to
take responsibility for choosing healthy snacks.
 Reliance on fast foods: fast foods tend to be in high
fat, calories, and sodium, and low in fiber calcium and
vitamins with proper choices, fast foods can be
incorporated into a healthy diet.
 Non-traditional eating patterns: adolescents may
manifest unusual eating patterns to express their
independence and for other reasons, e.g., eating
organically grown foods, trying fad diets etc.
Nutrition Related Problems and Disorders in Adolescence

 Iron deficiency anemia: risk is higher considering the need for
growth and maintenance of body tissues and for females for the
replacement of iron losses in menstrual blood; regular monitoring of
iron status and use of iron supplements are recommended.
 Iodine deficiency disorders (IDD): teenagers in endemic
region are at risk; the use of iodine therapy e.g. iodized salt, iodized
oil and elimination of food with goitrogens effectively reduce the
incidence of disorder.
 Anorexia nervosa: a state of emaciation that has been
brought on by voluntary starvation.
 Using the word anorexia is a misnomer because there
is no lack of appetite but self-denial or refusal to eat.
 Though the underlying causes re psychological in
nature, the condition results to malnutrition.
 Team approach of psychiatric and nutritional
management is needed.
 Bulimia: also known as “Gorge and Purge”
 Condition is related to anorexia nervosa in the sense
that it is primarily psychological in origin.
 Characterized by enormous consumption of food and
then immediately purging or eliminating the food by
vomiting or taking laxatives.
 Nutritional consequences can be severe if
uncontrolled.
 Weight disorders: problem arising from poor eating habits
as a result of a host of factors cited earlier.
 Problems range from thinness to over fatness
(obesity).
 Eating attitudes may be turning to or against food.
 Management should start from determining the
underlying causes; success has been seen in the use
of behavioural modification techniques but successful
management depends largely on motivation, maturity
and family support.
 Low calcium intakes: low intake of calcium-rich foods during
adolescence compromise peak bone mass development and
increase risk of osteoporosis in later life. Teenagers taking low
calorie diets and softdrinks instead of milk are more at risk for age-
related bone loss.
 Use of alcohol, tobacco, and oral contraceptives
 Alcohol can produce nutritional deficiencies due to
decreased food intake and absorption, and altered
metabolism of nutrients.
 Tobacco can affect food intake and weight status.
Smoking alters serum level of some nutrients, e.g.
ascorbic acid and beta-carotene.
 Use of oral contraceptives among female adolescents
may alter serum levels of some nutrients and may
increase the requirement for folic acid and vitamin B6.
Activity 8: Feeding the School- Age child. (20 points)

The growing body of a school-age child needs nutrients of increased amounts.
However, he/she may be very choosy when it comes to eating packed lunch and
snacks. To ensure physical and mental development, his/her lunch and snacks
should be balanced. It should be simple but palatable and attractive to stimulate
the child’s appetite. Plan a 5 days schedule of packed lunch and snacks for a
school age- child.
5 DAYS SCHEDULE OF PACKED LUNCH AND SNACKS

Day Lunch Snacks
Monday
Tuesday
Wednesday
Thursday
Friday

NUTRITION FOR ADULTS AND OLDER PERSONS
Factors Affecting Food Intake, Nutrient Utilization and Nutrient Needs
 Biological and environmental factors determine dietary intake,
nutrient utilization and requirement.
 The physiological changes that occur with age are major
determinants of dietary intake and nutrient use and need.
 Socio-cultural, psychological and economic factors are as important
considerations as physiological factors; includes:
 Food beliefs, preferences and habits
 Susceptibility to food fads and nutrition misinformation
 Social isolation and emotional stress
 Mental disorientation and depression
 Economic considerations
 Use of drugs and other therapy.
Nutritional Requirement of the Elderly

 Nutritive need: DRI divide the mature adult population into four
age groups: those who are 19-29 years; 30-49 years; 50-64 years,
and those 65 years of age and older. Compared with adults from 19-
49 years of age, the only recommended intakes that differ from older
adults are those of energy, calcium, vitamin A, vitamin B, and Iron
(for women only). The recommended intakes for all other nutrients
remain constant from age 19 throughout adulthood.
 The daily recommended intake are intended to meet the needs of
healthy people and do not take into account effects of diseases or
use of medications.
 The aim is to conserve health and delay the onset of degenerative
diseases.
 Rationale for the nutritional requirements of the elderly
 Energy: the need for calories is decreased
because of reduced BMR, body mass and physical
activity.
 Decrease in 5% of energy allowance is
recommended for each decade between 40 and
59 years and 10% for 60 years and above.
 Protein: DRI is the same throughout adulthood.
 Total amount of protein declines only slightly
with age.
 Intake in excess of the need is undesirable
because of the reduced efficiency of the kidneys
to excrete waste products of protein metabolism.
 Vitamins
 Studies indicate that high dietary and
supplemental intakes vitamin C are associated
with reduced risk of coronary heart disease,
cancer and cataract and an increased life
expectancy. (Blumberg 1992).
 Thiamine, riboflavin, and niacin are reduced
since these are related to energy metabolism.
 Studies have consistently shown that there is a
decline in plasma pyridoxine phosphate among
the elderly and their vitamin B6 intake is below
DRI levels (Blumberg, J. 1992)
o Increase in vitamin B6 to 20-45% higher
than DRI was necessary to restore
immunologic indices.
o Low vitamin B6 showed higher levels of
fasting insulin and plasma glucose and
lowered brain functioning.
 Vitamin D has been recognized as an important
differentiation factor for a variety of cell types as
well as immunoregulatory hormone.
o Older adults maintain lower levels of
serum 1.25 dihydroxyvitamin D than do
younger people due to decrease in milk
intake and outdoor activities.
o Daily vitamin D intake of 5.5 to over 12 ug
appear required by postmenopausal
women to maintain constant serum 25
hydroxyvitamin D and parathyroid
hormone (Blumberg, 1992).
 Vitamin E needs may vary according to dietary
fat content.
- Studies in animals indicate a relational
increase in protection against free radical
pathology and increased Vit. E intake
(Blumberg, 1992).
- High plasma levels of Vitamin E have
been correlated with a reduced incidence
of infectious disease and pharmacologic
dose of 800 mg of alpha tocopherol
enhances parameters of cellular immunity
in healthy elderly.
 Minerals
 Calcium: scientific evidence from other
countries indicate that menopausal and post
menopausal women may need more calcium
than current DRI to minimize osteoporotic
changes.
 Iron: requirement of women is reduced
after menopause; that of men remain the same.
 Water and fiber
 Water requirement remains at 6-8 glasses/day;
some studies indicate that thirst is not always a
good indicator of the amount of extra water
needed to meet the daily requirement.
 Liberal intake of fruits, vegetables and whole
grains in order to supply ample fiber to prevent
constipation which is a common problem due to
reduced intestinal muscle tone and reduced
physical activity.
Feeding Older Adults

 Choose nutrient-dense foods.
 Provide wide variety of foods from all the food groups.

 Limit foods that are energy dense but provide few other essential
nutrients, such as foods high in sugar and fats.
 Give soft, easy to chew, smaller bite-sized are foods for those with
chewing and swallowing problems.
 Small frequent feedings may be preferred.
 Give 6-8 glasses of fluids.
 Increase fiber intake.
 Avoid excessive salt intake; use herbs and spices for seasoning.
 Discourage excessive or frequent use of alcohol.
 Unless prescribed, vitamin and mineral supplements may be
unnecessary.
Major Nutrition Related Problems

 Osteoporosis: a bone disease in which the amount of bone is
decreased but the composition remains normal.
 Characterized by decrease in stature.
 Common among women in menopausal stage.
 Factors: interplay of hormones primarily estrogen
and parathyroid, inactivity or immobility; dietary; and
metabolic aspects of calcium, phosphorus, protein,
fluorine, and vitamins A and D; genetics.
 Maturity-onset diabetes mellitus: often gradual in its development.
 Alteration in glucose metabolism is one of the changes
observed in aging; the glucose tolerance curve is
slower in its return to normal after a glucose load, even
when the plasma insulin level is elevated.
 Complications are neuropathy, renal disorders and
peripheral vascular disease.
 Can be controlled by dietary management, weight loss
and oral drug treatment.
 Hypertension: more frequent among adults over 45 years old.
 If secondary to renal, endocrine or other disease, its
treatment should be based on the underlying cause.
 Treatment includes restriction of salt intake and
administration of diuretics and drugs that lower blood
pressure; if diuretics are administered, potassium
status should be monitored.
 Coronary heart disease and atherosclerosis: may result from the
interplay of the degenerative changes that occur particularly in the
cardiovascular system.
 Cigarette smoking, obesity hypertension and diabetes
increase the risk to both atherosclerosis and coronary
heart disease.
 Personality type and life style including dietary intake
and physical activity may influence the genesis and
progress of the disease.
 Dietary factors that need to be considered include
energy intake, amount and type of fat, cholesterol and
dietary fiber content.
 Anemia:
 Microlytic, hypochromic or iron deficiency anemia is
characterized by feelings of fatigue, anxiety and
sleeplessness; may result from iron inadequacy due to
low intake if impaired absorption of heme iron and/or
vitamin C.

Megaloblastic anemia is due to folate deficicency and

often occurs simultaneously with iron-deficiency
anemia.
 Food-induced malnutrition: results from use of large amounts
of food with substances that act as nutrient antagonist or increase
nutrient need, e.g. high phytate content of oatmeal reduces the
absorption of iron and zinc while drinking excessive amounts of tea
and coffee increases the need for thiamine.
 Extensive use of alcohol not only limits intake of
nutrients but also impairs nutrient absorption and
utilization.
 Drug-related malnutrition: a major concern among the elderly
since the prevalence of chronic disease increases with age.
 Extensive intake of drugs may affect food intake,
interfere with nutrient absorption and utilization and
affect nutrient requirements, e.g.
 Oral diuretics such as penicillamine cause zinc
depletion which in turn result to loss of sense of
taste and appetite.
 Aspirin, an analgesic may irritate the
gastrointestinal wall and cause bleeding, hence
anemia.
 Antituberculosis drug, isoniazid, is an antagonist
of pyridoxine.
 Prolonged use of certain steroids can cause
bone calcium loss, leading to osteoporosis.
 Individuals on prolonged drug therapy (e.g.
diabetes, hypertension, cancer, tuberculosis,
etc.) should be regularly monitored for untoward
effects.
Activity 9: What are the different factors to consider in planning a menu for
the elderly? (10 points).
_________________________________________________________________
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Before going to the next module, a quiz will be sent through google forms about the
topics that we have discussed. A long quiz will be given to you right after taking the
pre-lim exam.
CONGRATULATIONS!
You just finished this module for Pre lim on Nutrition and Dietetics. Now you have the
competency to innovate and generate new ideas in order to improve your client’s health
by teaching them especially mothers the best way to prepare foods that is healthy for
the maintenance of well being.


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REPUBLIC OF THE PHILIPPINES

This document is a property of NONESCOST

SUN-NEGROS: A glocally recognized university offering distinctively – niched academic

programs engaged in dynamic quality instruction, research and extension by 2025.

to contribute to nation – building by providing education, training, research and resource

creation opportunities in various technical and disciplinal areas.

UPGRADEd instruction, research, extension and governance for glocal recognition.

1. Demonstrate logical thinking, critical judgment and independent decision-making on any

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NONESCOST BS Nursing Outcomes:

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INTRODUCTION- Overview of the lesson

LEARNING OUTCOMES- Lesson objectives for you to ponder on

MOTIVATION- Fuels you to go on

PRESENTATION- A smooth transition to the lesson

TEACHING POINTS- Collection of ideas that you must discover

ASSESSMENT – To test your understanding in the lesson you discovered

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1. Active class participation (online discussion board, FB Closed group

Reviewed and Approved by:

Subject Area Coordinator : NATASHA KAY V. CHAN, RN, MN

Dean, CONAHS : AILEEN G. SYPONGCO, RN,RM, MN

GAD Director : MARY ANN T. ARCEŇO, LPT, Ph. D.

CIMD, Chairperson : MA. JANET S. GEROSO, LPT, Ph. D.

QA Director : DONNA FE V. TOLEDO, LPT, Ed. D.

VP- Academic Affairs : SAMSON M. LAUSA, Ph. D.

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This course module is an official document of Northern Negros State

Quotations from, contractions, reproductions, and uploading of all or any

and from the NONESCOST.

This module shall be used for instructional purposes only.

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At the end of this module, you are expected to:

“Nutrition isn’t just about Eating it’s about learning to live”

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b. DBW (kg) = (age in months/2) + 3

Using the formula:

5’4” tall female DBW = 122 pounds

Method 2: Hamwi’s Method (used by most clinicians)

Activity 2: Compute your own DBW using the:

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ACTIVITY LEVEL MALE FEMALE

Method 2: Use the Recommended Energy and Nutrient Intakes for

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B. Calculate the non-protein and protein calories. NOTE: this computation

a. Determine protein calories:

b. Determine non-protein calories:

c. Divide non-protein calories into CHO (70%) and FAT (30%).

FAT = 1,800 x .30

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How to use the Food Exchange List in meal planning:

An allowance of ± 5 grams the prescribed amount for protein,

Distribute the food allowance into breakfast, lunch, dinner and

SAMPLE CALCULATION AND DISTRITBUTION

(prescribed CHO) 225 g

SAMPLE MEAL PLAN

DISTRIBUTION OF EXCHANGES PER MEAL

SAMPLE ONE-DAY MENU

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2 NUTRITION THROUGHOUT THE LIFESPAN