NDT LECT MIDTERM  Exposure to sunlight increases endogenous
synthesis of vitamin
Lesson 1
Nutrition During Pregnancy and Lactation
 The mother’s food habits and nutritional status
before conception, as well as during pregnancy,
influence the outcome of the pregnancy.
 Through the food a pregnant woman eats, she
gives her unborn child the nourishment required to
begin and sustain fetal growth and development.
Energy Needs
Mother needs more energy to:
 Supply the increased fuel demanded by the
enlarged metabolic workload for mother and fetus.
 Spare protein for added tissue-building
requirements.
 Increase energy by 300 kcals per day
 Increased complex carbohydrates and protein in
the diet are the preferred sources of energy.
Protein Needs
 Protein serves as the building blocks for growth of
body tissues during pregnancy.
o Rapid growth of the fetus
o Development of the placenta
o Growth of maternal tissues
o Increased maternal blood volume
o Amniotic fluid
o Storage reserves
 Protein intake should increase 25 g per day
 Complete protein foods :
o Milk, eggs, cheese, soy products, meat
 Incomplete proteins:
o Legumes, grains
 Protein-rich foods contribute calcium, iron, B
vitamins
Key Mineral and Vitamin Needs
 Calcium
 Essential for fetal development of bones and
teeth
 Supplements might be needed in cases of
poor maternal stores or pregnancies involving
more than one fetus
 Iron and Iodine
 Iron essential for increased hemoglobin
synthesis
 Iodine essential to produce more thyroxine
 Folate
 Builds mature red blood cells during
pregnancy
 Needed during early periconceptional period
 Recommend daily folate intake of 600 mcg
during pregnancy, 400 mcg per day for non-
pregnant women during childbearing years
 Vitamin D
 Ensures absorption and utilization of calcium
and phosphorus for fetal bone growth
 Daily intake of three to four cups fortified milk
Weight Gain During Pregnancy
 Set weight goals according to mother’s pregnancy
nutritional status and body mass index
o Underweight women: 28 to 40 lbs.
o Normal-weight women: 25 to 35 lbs.
o Overweight women: 15 to 24 lbs.
o Obese women: approximately 15 lbs.
o Teenage girls: 35 to 40 lbs.
o Women carrying twins: 35 to 45 lbs
 Quality of foods consumed to increase weight is
important.
 Weight reduction should never be undertaken
during pregnancy.
 Average amount of weight gain during first
trimester: 2 to 4 lbs.
 1 lb. per week weight gain during remainder of
pregnancy
 2-3 g per day sodium needed.
Daily Food Plan
 Core food plan is designed to meet increased
nutritional needs.
 Ethnic backgrounds, belief systems, lifestyles may
require alternative food plans.
 Pregnant women should avoid alcohol, caffeine,
tobacco, drugs.
 Includes sufficient quantity and regular meals.
KEY CONCEPTS:
 Pregnancy is a prime example of physiologic
synergism in which the mother, fetus, and placenta
collaborate to sustain and nurture new life.
 Through her diet, a breastfeeding mother
continues to provide all of her nursing baby's
nutritional needs.
FUNCTIONAL GASTROINTESTINAL PROBLEMS
Nausea and Vomiting
 Associated with increased levels of HCG
o Peaks at 12 weeks gestation
 Strategies for managing morning sickness:
o Eat small, low-fat meals and snacks
o Drink fluids between meals, avoid caffeine
 o Reduce citrus, spearmint, peppermint o Walking
o Limit spicy and high-fat foods o Dancing
o Avoid lying down after eating or drinking o Biking
o Take a walk after meals o Swimming
o Wear loose-fitting clothes o Yoga
o Constipation
 Exercises to avoid:
 Hemorrhoids o Downhill Skiing, Scuba Diving, Trampoline
 Heartburn o Contact Sports (Ice Hockey, Basketball,
 Effects of iron supplements Amusement Slides)
o Hot tubs
High-Risk Mothers and Infants
 Identifying risk factors and addressing them early  Warning Signs to stop exercise:
are critical. o Vaginal bleeding, uterine contractions,
 Identifying poor food patterns can prevent decreased fetal movement, fluid leaking from
nutritional problems. the vagina
o Insufficient food intake o Dizziness or feeling faint, increased shortness
o Poor food selection of breath
o Poor food distribution throughout day o Chest pain, headache, muscle weakness, calf
pain or swelling
 Teenage pregnancy
Lactation Trends
 Planning personal care  Breastfeeding has many known health benefits for
o Work with mother in sensitive and supportive infants, children, and mothers and is a key strategy
manner. to improve public health.
o Dangerous practices should be avoided.  Breastfeeding on rise since 1960
o Craving for and consumption of nonfood items  In general, exclusive breastfeeding practices
sometimes seen across the countries are expected to increase from
39% in 2018 to 43% by 2025.
 Special counseling needs o More mothers are informed on benefits.
o Age (adolescents, women 35+) o Practitioners recognize human milk can meet
o Parity (several pregnancies within a certain unique infant needs.
number of years) o Maternity wards and birth centers modified to
o Alcohol abuse leading to fetal alcohol support lactation.
syndrome (FAS)
o Smoking causing placental abnormalities and Exclusive breastfeeding
fetal damage (% of children under 6 months)
o Drug use: medicinal or recreational Country Ranking
o Vitamin abuse by mega dosing also may 1. Croatia 98.13 2008
cause fetal damage. 2. Rwanda 86.93 2015
o Caffeine used in extreme excess may result in 3. Chile 84.50 2006
fetal injury. 4. Burundi 82.33 2017
o Poverty puts pregnant women in danger due to 5. Sri Lanka 82.00 2016
need for resources for financial assistance and
Data for those countries were based on
food supplements
breastfeeding rate estimates from 2010
or more recently.
Complications of Pregnancy
1. Uruguay ranked highest - 98.7%
 Anemia
2. Sweden and Oman - 98%.
 Neural tube defect 3. US - 74.4%
 Intrauterine growth failure 4. France - 63%
 Pregnancy-induced hypertension 5. Ireland - 55%
 Gestational diabetes Note: The high-income countries report
 Preexisting disease
 Breastfeeding is recommended for at least first 12
Exercise During Pregnancy postpartum months.
 Benefits of exercise during pregnancy:  Proper instruction can overcome common
o Helps reduce backaches, constipation, difficulties.
bloating, and swelling  Well-nourished mothers who breastfeed
o May help prevent or treat gestational diabetes exclusively provide adequate nutrition
o Increases energy, improves mood and sleep  Solid foods are added to baby’s diet at four to six
o Improves your posture, promotes muscle tone, months of age.
strength, and endurance
Physiologic Process of Lactation
 Acceptable activities:
 Stimulation of nipple from infant suckling 1. Diet
stimulates milk production. 2. Nutritional state of mother
 Stimulates prolactin: produces milk 3. Emotional and physical state
 Oxytocin: Responsible for let-down reflex 4. Suckling/sucking
 The more mother breastfeeds, the more milk is 5. Use of contraceptives and drug
produced.

Physiology of Milk Production Lesson 2

Nutrition During Infancy

INFANCY:
 The first year of life
 Extends from birth to age 12 months;
 Neonatal specifically refers to the first 28 days of
life.
 A healthy full term has moist skin, elastic and not
wrinkled

Normal Newborn Appearance

 Acrocyanosis – body pink, extremities blue
 Pallor – white discoloration of the skin
 Harlequin sign – immaturity of circulation [side of
the body lying down will appear pink]
 Mongolian spot – slate gray patches at the
buttocks
 Lanugo – fine downy hair that covers the
shoulders.
 Desquamation – drying of the newborns skin
Nutritional Needs for Lactation  Petechiae on face and neck – due to intravascular
 Milk production requires 800 kcals per day. pressure during delivery
 Need for protein during lactation is 25 g per day  Milia – unopened sebaceous gland found in the
more than woman’s average need. nose chin and cheeks; disappears in 2-4 weeks.
 About 3 L per day of water, juices, milk, soup  Vernix caseosa
contribute to necessary fluids.
 Rest, moderate exercise, relaxation are necessary Primitive Reflexes
 First observable reflex.
Advantages of Breastfeeding  Essential to NB survival.
 Fewer infections  Not learned; involuntary and necessary for
 Fewer allergies and intolerances survival.
 Ease of digestion
 Convenience and economy Locomotor Reflexes
 Improved cognitive development  Present at birth or shortly thereafter.
 Higher lactose than cow’s milk  Relates to body movement or locomotion
 Bottle feeding may cause malformation
of dental arch
Flashes of light
 Cow’s milk protein causes allergy Blinking Close both eyes
or puff of air
Breastfeeding Misconception
1. A mother sick with TB cannot breastfeed Sole of foot Fans out toes,
Babinski
2. Breast milk is not good if mother has stayed stroked twist foot
long under the sun.
3. Mother cannot breastfeed during pregnancy Palmar Attempt to grasp
Grasping
4. Mother cannot breastfeed with only one Plantar finger
breast if the other breast is painful
5. Mother cannot breastfeed if she has cold, flu, Moro (Startle) Loud noise Flings out arms
or diarrhea
6. Breast milk is not good if mother has been Turns head &
Rooting Cheek stroke
caught in a sudden shower opens mouth
Moves feet as if
Benefits of breastfeeding to mother Stepping Infant head
to walk
 Less incidence of breast cancer
 Less incidence of blood clot formation Object touching Sucks
 Fast return of uterus to its original size Sucking
mouth automatically

Factors affecting milk secretion

Nutritional Requirements
Energy (Calories)
 Caloric requirements 650 kcal/day and gradually
decrease from birth to age 1.
Protein
 Protein requirements are highest during the first 6
months of life. Requirements are adjusted to
infant’s size and growth.
Lipids
 Fats should comprise 30% - 50% of an infant’s
total daily caloric intake. It is a form of Linoleic
acid.
 Human milk and cow’s milk provide 48%-54%
calories while commercial infant formulas 36%-
38%
 Newborns tend to eat 2 to 3 ounces of breast milk
or formula at a time every two to three hours a day
 1-month-olds may be eating about 3 to 4 ounces
every two to four hours a day.
 2-month-olds may consume 4 to 5 ounces of
breast milk or formula every three to four hours a
day.
Water Intake
 Infants have greater need than adults; obtains it
from breast milk and commercial infant formula.
 Newborns tend to eat 2 to 3 ounces of breast milk
or formula at a time every two to three hours a day
o 1-month-olds may be eating about 3 to 4
ounces every two to four hours a day.
o 2-month-olds may consume 4 to 5 ounces of
breast milk or formula every three to four hours
a day.
o 3-month-olds may consume about 4 to 5
ounces of breast milk or formula every three to
four hours.
Breastfeeding
 Most preferred form of nutrition in full term infants.
 Three types of breast milk:
o Colostrum first milk with high level
immunoglobulin
o Transitional milk replaces colostrum contains
high level of fat, lactose, water-soluble
vitamins and calories.
o Mature milk the final milk produced contains
high percentage of water and provides 20kcal
per oz.
Bottle Feeding
 Contains mostly saturated fatty acids, differing
amounts of amino acids and higher protein,
calcium, sodium and chloride levels than breast
milk.
 Formula designed to match the ratio of breast milk
composition
 May meet the needs of working mother
 Must be prepared under clean conditions and
sterilized to prevent contamination
Why can’t infants drink cow’s milk?
- Infants’ digestive system does not contain the
enzyme to digest cow’s milk therefore it can cause
intestinal bleeding.
Advantages of Bottle Feeding
 Provides a suitable alternative to breast feeding
 Less restrictive to the woman than BF
 Allows more accurate assessment of infants intake
 May be indicated for infant with congenital
anomaly
 Necessary if infants require a special formula
Disadvantages Of Bottle Feeding
 More difficult for infant to digest than Breast milk.
 More expensive and more time consuming to
prepare
 Mixed feeding is a combination of breast and bottle
feeding.
Two methods of formula preparation:
1) Aseptic method
o sterilized separately for at least 25 min.
2) Terminal method
o formulas are poured into clean bottles and
sterilized together
 Disadvantage: Scum formation can clog the nipple
holes.
Nursing Implications:
Teach mother of a bottle-feeding infant to:
 Investigate various types of formulas available and
their preparation.
 Make sure the hole of the nipple is large enough
for milk to drip out.
 Hold infant position similar to that used for breast-
feeding.
 Hold infant during feeding do not prop the bottle.
 Point nipple directly to the infant’s mouth
 Feed infant usually every 4 hours
 Make sure infant retains 3-4 oz. of milk each feed
 Hold infant upright against the shoulder for burping
 Burp infant at regular intervals
 Discourage overfeeding
 Discourage unscheduled feeding.
Solid Foods
 May be added in the diet 4-6 mos
 Should not be delayed beyond ages 7-9 mos
 Should be strained, pureed or mashed
 Each meal should progress ¼ to ½ cup as infant
grows
 Can start eating “finger foods” at 6-7 mos
 Can start eating chopped table foods at 9-12 mos
Feeding Infants 4-6 months
 Breast milk and formula provide main source of
nutrition
 4-month-olds usually consume 4 to 6 ounces of
breast milk or formula every four to five hours a
day.
 5-month-olds may be eating 6 to 7 ounces of
breast milk or formula every four to five hours a
day.
 6-month-olds can eat 7 to 8 ounces of breast milk
or formula every four to five hours a day, as well
as 1 to 9 tablespoons of solids such as cereals,
fruits and vegetables.
 Cereal (rice) can be eaten in bowl with baby spoon
 Add vegetables (cooked, soft, mashed) if baby
tolerates cereal
 Introduce new foods one at a time
Feeding Infants 7-9 months
 Breast milk and formula
 Cooked or soft vegetables
 Cooked or soft fruit
 Well-cooked, strained or finely mashed meats
 Egg yolk
 Finger foods
 7 and 8-month-olds may be eating about 24 to 36
ounces of breast milk or formula each day (four to
six nursing sessions, if you're breastfeeding), plus
4 to 9 tablespoons of cereal, fruit and vegetables
daily as well as 1 to 6 tablespoons of
meat/proteins.
 9 to 10-month-olds may be eating about 24 to 30
ounces of breast milk and/or formula a day (three
to five nursing sessions, if you're breastfeeding),
along with 1/4 to 1/2 cup each of grains, fruit,
vegetables, dairy products and meat/protein foods.
How to know if baby is ready to use a sippy cup?
- When the baby is able to sit up and hold objects
on his own.
Finger Foods
 Dry cereal
 Pancakes or French toast cut into strips
 Cooked rice and chopped noodles
 Banana cut into small pieces
 Cooked fruit or chopped canned fruit or vegetables
 To prevent choking, give your baby foods that
soften in the mouth and cannot be swallowed in
chunks.
Feeding Infants10-12months
 Breast milk and/or Formula given in sippy cup
 Water, 100% fruit juice in sippy cup
 Don’t give high sugar drinks
 Chopped or soft table foods
 11-month-olds may be taking 16 to 24 ounces a
day of breast milk or formula a day (three to five
nursing sessions, if you're breastfeeding), though
their diet will include more solids: 1/4 to 1/2 cup
each of grains, fruit, vegetables, dairy products
and meat/protein foods.
 12-month-olds may be taking up to 24 ounces a
day of breast milk or formula (three to five nursing
sessions, if you're breastfeeding), though many will
start weaning from the bottle or breast around now
and start drinking cow’s milk. In addition, they'll eat
1/4 to 1/2 cup each of grains, fruit, vegetables,
dairy products and meat/protein foods.
Nursing Implications:
Teach mother to:
 Mix cereal with breast milk, formula or water
 Offer new foods one at a time
 Start with generally tolerated fruits
 Offer fruit juice on cup not on feeding bottle
 Prepare foods by baking, broiling, steaming or
poaching
 Include organ meats
 Introduced egg in small quantities
 Supervised all meals
 Be aware that candy, nuts grapes, and popcorn
are associated with choking.
 Cook foods until tender, make it easy to chew, and
must be serve in small pieces.
NURSING IMPLICATION FOR COMMON
NUTRITION RELATED PROBLEMS:
REGURGITATION OR VOMITING
 forcible ejection of gastric contents
 Assess for possible GI abnormalities
 Encourage mother to feed infant slowly and to
pause several times during feeding
 Burp infant often
 Hold infant upright position during feeding
 Place infant in his stomach of right side lying
position to prevent aspiration
 Notify the physician if condition persists.
CONSTIPATION
 infrequent bowel movement.
 Assess the amount & frequency of milk and
water feedings
 With physicians approval; encourage mother
to increase feeding and to add high fiber foods
in the diet.
 Provide a quiet, relaxed atmosphere during
feeding
 Notify physician if constipation persist.
DIARRHEA
 frequent loose stools
 Assess amount and character of stools
 Assess infant’s skin turgor as indication of his
hydration status
 Evaluate feeding patterns and suggest
changes as necessary
 Notify physician if diarrhea persist
HICCUPS
 Encourage mother to offer water in between
feedings
 Burp infant often during feedings
 Quiet and relaxed atmosphere
COLIC
 acute paroxysm of pain
 Quiet and relaxed atmosphere
 Feed infant slowly and pause several times
during
 Burp infant often during feeding
  Teach mother measures to promote infant
comfort such, as stroking caressing and
rocking.
FOOD ALLERGY
 Should introduce singly and with intervals [3days]
to allow detection.
 Food that causes allergy should be discontinued
before introducing another food.
 Foods that often cause allergies: eggs, fish, milk,
peanuts, shellfish, soybeans and wheat.
Foods To Be Avoided:
 Too much sweets [has high calories but little
essential nutrients]
 Canned vegetables [often high in salt]
 Raw carrots; honey [risk of botulism]
Lesson 3
Nutrition in Children
TODDLER
 Refers to a child between infancy and pre-school
ages 1-3 years.
 The best time to introduce good food habits.
PRE-SCHOOL
 Refers to a child between 3-6 years old.
 High activity levels but slowed growth rate.
Nutritional Requirements:
Energy
 12-18 months of life is 55 kcal/kg and after that it
declines to an adult level of 23-30 kcal/kg.
Deficiencies: lack of calorie intake that leads to CHON
utilization = PEM and; adequate calorie intake but low
CHON in the diet = kwashiorkor.
Protein
 Increase from age 1-6; recommends some 10%-
15% CHON/kg; 2/3 should be of high biological
value
 For increase skeletal and muscle tissue and
protector against infection.
Lipids
 30-50% daily caloric intake of fats for both toddlers
and pre-schools.
Carbohydrates
 Authorities recommend 50%-60% of the total daily
calories intake be supplied by carbohydrates.
Vitamins
 Requirements for toddlers and pre-schools are
slightly greater than those of infants.
 Vitamin D for proper skeletal growth and calcium
metabolism.
Minerals
 Adequate calcium and phosphorus are needed for
bone mineralization
 Toddler’s daily iron [IDA], calcium and phosphorus
may be difficult to meet due to poor eating habits.
 Calcium requirements remain steady throughout
the two age groups.
Fluids
 Approximately 115ml/kg of fluids daily.
 Exact requirements depend on activity level,
climate and health status.
Functions of Diet for a Child
1. Provide fuel for muscular activity
2. Supply necessary chemical elements and
compounds that the child’s body requires for
building materials and repairing worn out tissues
3. Gives pleasure and satisfaction to the child
Common Nutrition Problems:
 Protein Energy Malnutrition [PEM]
 Iron Deficiency Anemia [IDA]
o decrease hemoglobin and decrease
hematocrit.
o Sometimes due to parasitism
o Lack of Iron S/S : paleness of eyes, lips,
fingernails, palms, skin, reduce ability to learn,
fatigability, irritability.
o Anemic children do poorly in vocabulary,
reading, mathematics, problem solving and
psychological test.
 Vitamin A Deficiency
o Xerophthalmia (dryness of the eyes) Night
blindness, rough dry skin and dry membrane
of the nose and throat; increase susceptibility
to infection.
 Iodine Deficiency Disorder
o S/S mental retardation, deaf mutes, difficulty in
standing and running.
 Obesity
 Dental Caries
o 98% of children has tooth decay; caused by
sticky sugar-containing foods that cling to
teeth.
FACTORS AFFECTING PRE-SCHOOL
NUTRITIONAL STATUS
 FAMILY ENVIRONMENT
o can provide appropriate role models and
reinforcements.
o Set-up at home environment that fosters
development of desirable eating patterns in
young children.
 SOCIAL TRENDS
o some mothers are employed outside the home
and do not have much time to prepare meals
or teach children about good eating habits.

 MEDIA
o T.V. affects children request for and attitude
toward food.
o Parents should not be persuaded to buy the
non-nutritious foods seen on T.V.
 Has good attention span for their age, not easily
irritated and restless
 Appetite, digestion and elimination are regular.
 Able to communicate and handle abstract
materials in thinking.
 Social and outgoing, loving and affectionate.

 ILLNESS AND DISEASE

o ill children have decrease appetite and limited Lesson 4
food intake. Nutrition in School Age, Adolescent, Adult
o They require increase fluid intake, CHON and
other nutrients. SCHOOL AGE
 Is generally considered to be 6-12 years old.
 Consistent in maturity but slow in growth rate,
maturation of fine and gross motor skills, gains
 FEEDING PROBLEMS cognitive and social – emotional growth.
o Eating Too Little - as long as the child eats
the right foods, go slow in adding new foods
on the diet start meals with food that they like Nutrient Allowance
best.  Children need more nutritious foods in proportion
to their weight than adults do because they are
o Eating Too Much - due to heredity, growing and developing bones, teeth, muscles and
temperament, appetite or mother’s insistence blood.
on a “clean plate”. The only danger is
overweight and indigestion. Energy
 80-90 kcal/kg 7-9 years old
o Dawdling - child who lingers or dillydallies  70-80 kcal/kg 10-12 years old
with their food is maybe trying to get attention
or may not feel well or are given portion, which Protein
are too large.  35 gm/day 7-9 years old
 45-49 gm/day 10-12 years old
o Gagging - a child who feels like vomiting
especially when being fed by coarse foods. Vitamins & Minerals
Sometimes this is due to negligence in training  Generally, increase and the most important is
the infant to eat chopped foods. Calcium for bone mineralization and prevention of
osteoporosis. And Iron for essential growth and
o Aversion Toward Some Foods - milk and development and prevention of anemia.
vegetable are just two foods being refused by
some children. Fruits are good substitutes for Common Nutrition Concerns
vegetables and for milk they can be given in  Malnutrition and Learning
forms of leche flan, cream soup, cheese and  Iron Deficiency Anemia
cereals.  Obesity
 Dental Caries
o Allergy - food allergy is common especially  Lactose Intolerance
seafoods and eggs decrease the intake of  Allergies
protein rich foods. Chemicals in the air, food  Sports and Fitness
preservatives and dyes are found to worsen  Preventing Chronic diseases
the allergy condition. So nutrient intake must
be monitored and substitutions must be made Feeding problem
when necessary. 1. Inadequate meals
o ex. skipping breakfast, late bed riser, fear of
INDICATION OF GOOD NUTRITION being late in school
 A healthy pre-school child exudes a feeling of well- 2. Poor appetite
being, of interest in all activities usual for their age. o ex. Tired, demanding school work
 Posture is erect, arms & legs straight, abdomen 3. Sweet tooth
pulled in and chest out. o ex. Hungry, rewards from parents
 Head is normal size and shape, skeleton with no
malformation. Factors Affecting Food Intake
 Teeth are straight without crowding in the well-  Family
shaped jaw. [6 years old 24 sets of teeth]  Peers
 Skin is smooth, slightly moist with health glow.  Schools
 Eyes are clean, bright with no signs of fatigue.  Societal Trends
 Hair is shiny, muscles firm; gums light pink, lips
moist and tongue without lesions. Proper Feeding for Schoolers Includes:
 Furnishing energy needed for vigorous activity;
 Helping maintain resistance to infection;
 Providing building materials for growth and
 Providing adequate nutrient stores to assist in
adolescent growth.
SENESCENCE
 The process of growing old or the period of old
age, a person belongs to this period is referred to
as an elderly or a senior citizen.
 A period characterized by disturbed regulatory and
functional mechanism in the body.

GERIATRICS
 A study of the phenomena of old age and the
treatment of its accompanying diseases.

SENILE
 Often clinically associated with an old man with
mental and physical weaknesses, a meaning
which should not be attached to a normal aged
person.

Taste Changes:
 Our sense of taste and smell naturally weaken with
ADOLESCENT age. This often leads to diminished appetite or
 is a transition of human development that occurs adding more salt to foods to try and recover the
between childhood and adulthood. flavor we once remembered. Similarly, our sense
for sweet tastes linger, leading many elderly to
Nutrient Allowance: overindulge.
 Calories
o Boys require 44kg between 13-15 y.o. Loss of Appetite:
o Boys require an average of 2,800 cal. per day  Many factors contribute to loss of appetite in the
o Girls require an average of 2,200 cal. Per day elderly population. While it is true that metabolism
slows as we age, a significant change in weight in
ADULTHOOD a short period of time can be dangerous and
 a period of life when one attained full growth and should be avoided.
maturity
Oral Health & Dental Problems:
Nutritional Management: 1. Dry Mouth: As we age, many people experience
 Energy: 8,400kJ/2,000kcal dry mouth as a side effect of medications or
 2580kcal/day or 44kcal/kg reduced saliva production.
 Total fat: less than 70g
 Saturates: less than 20g 2. III-Fitting Dentures: If you wear dentures, over time
 Carbohydrate: 260g they may become ill-fitting. When dentures are not
properly fitted, one may experience pain with
Feeding the adult: eating or chewing.
To stay healthy, these must be observed and followed:
1. Eat variety of foods. 3. Dysphagia: This condition is where it becomes
2. Maintain ideal weight. more difficult to move food or liquid from your
3. Avoid too much fat, saturated fat and cholesterol mouth to your stomach. Dysphagia can occur at
4. Eat foods with adequate starch and fiber any age, but is most common in older adults.
5. Avoid too much sugar People who experience dysphagia will most likely
6. Avoid too much sodium. need a texture modified diet
7. If you drink alcohol, do so in moderation
4. Compromised Mobility: If you cannot cook or shop
for yourself, eating a balanced healthy diet can
Lesson 5 seem impossible at times. There are many options
Nutrition of the Elderly available to you, so don't get discouraged

 Good nutrition is important, no matter what your
age. It gives you energy and can help you control
your weight. It may also help prevent some
diseases, such as osteoporosis, high blood
pressure, heart disease, type 2 diabetes, and
certain cancers.
 But as we age, our body and life change, and so
does what we need to stay healthy. We may need
fewer calories, but we still need to get enough
nutrients.
ELDERLY/AGED
5. Reduced Social Activity: Eating with other people
is almost as important as eating a variety of foods,
as it creates a more enjoyable atmosphere around
eating. We tend to eat better if we enjoy meal
times.
Osteoporosis
5 Nutrients for Healthy Strong Bones
1. Calcium
 is not only important for bone strength, but also for
heart, nerves, and muscles. If you don't eat
enough calcium, your body will start to take
 calcium that is stored in your bones to be use in
other places in your body, leaving you with weak
brittle bones
2. Vitamin D
 has many important jobs in the body, and is
needed to help you absorb calcium from the food
you eat. The best way to get vitamin D naturally is
from sunlight, but some foods also provide vitamin
D.
3. Magnesium
 In order for vitamin D to help the body metabolize
calcium, it must first be converted to the active
form. Magnesium is the mineral that is necessary
to convert vitamin D to the active form. Magnesium
Is also important for bone mineralization that
prevents gout and arthritis
4. Potassium
 helps to maintain fluid balances in the body and
protects bones by counterbalancing bone
damaging acids.
5. Vitamin K
 In addition to improving cardiovascular health,
having adequate vitamin K in your diet reduces the
risk of bone fractures in osteoporotic patients by
playing a role in improving bone mineralization.
Alzheimer's and Dementia:
7 Nutrition Tips for Maintaining Brain Health
 Dementia is an overall term that is defined as the
loss of memory, cognitive reasoning, awareness of
environment, judgment, and/or abstract thinking as
well as loss of the ability to perform usual tasks
associated with self-care and day-to-day function
1. Limit Intake of saturated and trans fats Saturated
and trans fats have been associated with
dementia. Saturated fat is found in animal products
like meat, eggs, and dairy while trans fats are
found in many packaged foods. Avoid words like
"partially hydrogenated oil" on food labels
2. Increase your intake of plant based foods
Vegetables, fruits, legumes (beans, peas, and
lentils) and whole grains should become primary
staples of the diet.
3. Increasing plant based foods in the diet will help
you eat less saturated fats from meat and dairy as
well as provide an abundance of phytochemicals.
4. Consume 15 milligrams of vitamin E from foods
every day Vitamin E is an antioxidant which
scavenges toxic free radicals, which may
contribute to cognitive impairment. Eat more
seeds, nuts, leafy green vegetables, and whole
grains to increase vita- 4 min E in your diet
5. Take a B12 supplement Vitamin B12 is important
for healthy nerves and red blood cells. Some
dementia's are caused by a deficiency in vitamin
B12 and are reversible when treated. Choose a
reliable source of B12 such as fortified foods or a
supplement that provides at least the
recommended daily dose (2.4 micrograms for
adults)
6. Avoid vitamins with iron and copper We now know
there is a confirmed link between high levels of
iron and copper and increased risk of Alzheimer's.
If you are using a multivitamin, choose one without
iron and copper and only take an iron supplement
if advised by your physician.
7. Choose aluminum-free products While the details
as to how aluminum contributes to Alzheimer's is
under continuous investigation, it is recommended
to reduce exposure to aluminum. Minimize
aluminum cookware, antacids, baking powder, and
other aluminum containing products
8. Exercise at least 120 minutes each week Aerobic
exercise is associated with a reduced risk of
cognitive impairment and dementia. Walking,
swimming, raking the yard, or any other activity
that increases you heart rate and breathing counts!
Pressure Ulcers
 form when an area of skin is subjected to constant
pressure or friction. However, what many people
don't know is that you can arm yourself from
getting pressure ulcers and heal faster if you are
receiving adequate nutrition.
 Eat enough calories: If you are losing weight or are
eating less than 75% of your daily needs or less
than 75% of you normal intake, consult your
physician or dietitian
 Eat protein at every meal: Your body needs protein
to grow new cells and heal your wounds, or
prevent wounds from occurring. Including one
protein source at each meal will help to make sure
you are getting enough protein
 Drink fluids throughout the day to stay hydrated:
The body is made up of 50-60% water. Water also
moves nutrients where they are needed to help
heal wounds. Aim for 6-8 cups of water each day
 Take a multivitamin with minerals: Unless there is
a known deficiency, there is no need to mega dose
on any particular vitamin or mineral but taking a
daily multivitamin will help you to receive all the
essential vitamins that you need each day.
NUTRITION DURING OLD AGE
 Eating right and staying fit are important no matter
what your age. As we get older our bodies have
different needs, so certain nutrients become
especially important for good health.
Calcium and Vitamin D
 Older adults need more calcium and vitamin D to
help maintain bone health.
 To meet these needs, select calcium-rich foods
and beverages and aim for three servings of low-
fat or fat-free dairy products each day. Other
sources of calcium include fortified cereals and
fruit juices, dark green leafy vegetables, canned
 fish with soft bones, and fortified plant-based Vitamins and Minerals
beverages. Good sources of vitamin D include Impaired GI bioavailability can cause lack of:
fatty fish, such as salmon, eggs and fortified foods o Vit. B12
and beverages. If you take a calcium supplement o Zinc
or multivitamin, choose one that contains vitamin o Calcium
D. o Vit. A
o Iron
Vitamin B12 o Vit. C
 Some adults older than 50 may not be able to
absorb enough vitamin B12.
Due to low intake of meat, green leafy vegetables and
 Fortified cereal, lean meat and some fish and
fruits:
seafood are sources of vitamin B12. Ask your
o Calcium
doctor or a registered dietitian nutritionist if you
o Iron
need a vitamin B12 supplement.
o Vit.B6
Dietary Fiber o Vit.E
 Eat fiber-rich foods to stay regular. Dietary fiber o Vit.B12 And Folacin
also may help lower your risk for heart disease and o Vit. C
reduce your risk for Type 2 diabetes. Eat whole- o Copper
grain breads and cereals, and more beans and o Zinc
peas - along with fruits and vegetables which also o Vit. D
provide dietary fiber. o Thiamin
o Water

Potassium
 Consuming adequate potassium, along with
limiting sodium (salt) intake, may lower your risk of FACTORS AFFECTING NUTRITIONAL STATUS
high blood pressure. OF THE ELDERLY
 Fruits, vegetables, beans and low-fat or fat-free
dairy products are good sources of potassium.  Psychological Factors
Also, select and prepare foods with little or no o Emotional stress can impair their ability to
added salt. Add flavor to food with herbs and
utilized the ingested nutrients properly:
spices.
1. Anxiety
2. Depression
Know Your Fats
3. Suspicion
 Most of the fats you eat should be polyunsaturated
4. Confusion
and monounsaturated fats, which are primarily
5. Loss of memory
found in nuts, seeds, avocados, vegetable oils and
fish. Choose foods that are low in saturated fat and
 Cultural Factors
trans fat to help reduce your risk of heart diseases.
 Physical Factors
Chronic Degenerative Diseases  Physical discomforts
1. Arthritis is the inflammation of one or more joints,  Socio-Economic Factor
which results in pain swelling and stiffness with  Health Factors
limited movements. o Infections, injuries, GI symptoms, obesity,
diabetes, gout & surgeries
2. Rheumatism is a non-specific term for medical o Chronic diseases + economic &
problems affecting the joints and connective psychological factors = POOR
tissues. NUTRITIONAL STATUS

3. Gout is a kind of arthritis that occurs when uric What is the ideal diet for the elderly:
acid builds up in the joints. - The ideal diet of the elderly person should be
wholesome and nutritious. It should have
4. Coronary heart disease is the narrowing of the carbohydrates, proteins, fats, mineral & vitamins
small blood vessel that supply blood and oxygen to apart from dietary fiber.
the heart. - They should also take plenty of water. It does not
matter whether it is a vegetarian or non-vegetarian
5. Diabetes is a chronic [lifelong] disease marked by diet
high levels of sugar in the blood. - But they should be able to chew their food which
could be easily digested.
Nutrient Allowance - One should keep in mind that elders with high BP
1. Energy high Cholesterol levels, heart disease, obesity or
2. Carbohydrates other problems should alter their diet accordingly.
3. Fats
4. Protein Food that help slow down aging:
 Nuts
  Wheat germ
 Whole bran
 Oatmeal
 Chicken legs
 Spinach
 Pinto beans
 & Sardines
 Red salmon
 Peas
 Lima beans and white beans

Common Problems Among Elderly:

 Difficulty in chewing due to loss of teeth
and not getting used to dentures.
 Lack of appetite
 Unwanted weight and due to lack of physical
activity or to over eating
 Anxiety, confusion, insecurity, loneliness
 Poor digestion leading to constipation,
gas pains or diarrhea.
 Poor absorption leading to anemia and
other vit. deficiencies.
 Difficulty in sleeping

How To Live Longer

 Avoid red meat
 Eat veggies rich in beta carotene,
eat more frequently
 Adhere to low-fat, low-calorie diet
 Avoid preserved foods
 Cut on smoked meats
 Take vitamin supplement daily
 Don’t smoke
 Avoid fats and oils
 Avoid all sugars
 Severely limit salt
 Severely limit cholesterol
 Avoid too much alcohol, black tea,
caffeinated drink
 Freely use whole grains products
 Freely tubers and legumes
 Drink plenty of water
 Eat good breakfast daily