2 NUTRITION-ACROSS-THE-LIFESPAN-pregnancy

NUTRITION ACROSS THE LIFESPAN
A. Nutrition in Pregnancy
Pregnancy is a period from conception to delivery. Also called gestation.
Diet for Pregnancy

Description of the diet
- Dietary intake should be increased for optimal pregnancy outcomes.
Characteristics of the Diet

- Diet for pregnant women varies according to nutritional status of the
mother pre- and during conception; as well as which trimester both mother
and children are in.
Weight gain in Pregnancy

- There are three components to maternal weight gain:
1. The Maternal body composition whose changes include increased
blood and extra cellular fluid volume.
2. The maternal support tissues such as increased size of the uterus and
breasts, and
3. The products of conception, including the fetus and the placenta. In
appropriate weight gain by the mother suggest that she may not have
received adequate nutrition during pregnancy.
- Poor weight gain may lead to intrauterine growth retardation in the infant.
There is strong evidence that the pattern of weight gain is just as
important as the absolute recommended weight gains shown in the table
below.
- New recommendations for Total and Rate of Weight Gain during
Pregnancy, by Pre-Pregnancy BMI.
Rates of Weight Gain*

Pre-pregnancy BMI+ (kg/m²) Total Weight gain
2nd and 3rd Trimester
BMI (WHO) Range (lbs)
(Mean Range in lbs/week)
1
Underweight <18.5 28-40
(1-1.3)
1
Normal weight 18.5-24.9 25-35
(0.8-1)
0.6
Overweight 25.0-29.9 15-25
(0.5-0.7)
Obese (includes 0.5
≥30.0 11-20
all classes) (0.4-0.6)
* Calculations assume a 0.5-2 kg (1.1-4.4 lbs) weight gain in the first trimester (based
on Seiga-Riz et. Al. 1994; Abrahams et. Al., 1995; Carmicheal et. al., 1997)
To identify the weight gain,
 Calculate the pre-pregnancy Body Mass Index (BMI)

 Subtract her Pre-pregnancy weight from actual weight
 Locate weight ranges according to her pre-pregnancy BMI
Example : 21 years old at 39 weeks gestation, 5’2” tall, actual weight is

155 lbs and her pre pregnancy weight is 128 lbs
Step 1 get the BMI = 23.41 normal
Step 2 subtract = 155 lbs – 128 lbs
= 27
Step 3 locate from
weight ranges = adequate weight gain / normal weight
gain
Diet Principles:
- Caloric intake should be increased by an average of 300 kcal/day to
achieve an appropriate weight pain.
- A level of 27 g/day of protein in excess of the RENI for the non-pregnant
state is advised to provide the amino acids needed for Fetal and placental
growth, for expansion of blood volume, and for increase in size of breasts
and uterus.
- An additional 5.1 milligrams of zinc which the increase in protein helps to
provide is recommended during pregnancy.
- The RENI for iron during pregnancy is +10 mg for the first trimester, 34 mg
for the second trimester and 38 mg for the third trimester for expansion of
maternal blood volume and for synthesis of fetal and placental tissues.
This requirement cannot be met by the habitual diet, so it is recommended
that 30 to 60 mg of iron per day as ferrous sulfate be prescribed.
- Dietary source of folic acid is adequate to achieve, thus a daily
supplement of 200 µg should be provided to protect the fetus and to
maintain maternal stores.
 Estimating the Calorie or Total Energy Requirement (TER)/day for

Pregnancy
 First Trimester = no change

 2nd Trimester and
3rd Trimester = increase or add 300 kcal
TER/day = Normal requirement + 300 kcal (2nd and 3rd trimester)
Food Plan for 1800kcal (First Trimester of Pregnancy)
Food group Exchange Amount

Veg A 2 2 cups raw / 1 cup cooked
Veg B 2 1 cup cooked
Fruit 2 2 servings
Milk (WM) 1 1 cup
Sugar 5-8 5-8 tsp
Rice 10-12 5-6 cups cooked rice
Meat 3 3 matchbox sizes
(LF) + (MF) (1)+(2)
Fat 6-8 6-8 tsp
*WM- whole milk, *LF-low fat, *MF-Medium fat
Meal Pattern and Sample Menu for 1st Trimester
BREAKFAST SAMPLE MENU

Fruit or juice 1 slice Ripe Papaya
Egg or Substitute 1 pc. Fried Egg and ½ pc. Daing na
Bisugo
Rice/Bread with Butter/Margarine or jam 1 cup Rice
Beverage Powdered whole milk: 4 Tbsp in 1cup
water
LUNCH SAMPLE MENU
Soup Clear soup
Meat, Fish, Poultry or Substitute 1 pc. Paksiw na Galunggong
Vegetables 1 cup Mongo Guisado with Malunggay
Rice or Substitute 1 cup Rice
Fruit or Dessert 1 pc. Banana
SUPPER SAMPLE MENU
Soup Broth
Meat, Fish, Poultry or Substitute 1 slice Breaded Pork
Vegetables 1 cup Pinakbet
Fruit or Dessert
SNACKS AM: 1 cup Taho
PM: ½ pc Boiled Camote
1 glass Fruit juice
Food Plan for 1800kcal + 300 kcal for 2nd and 3rd Trimester of Pregnancy

Fruit 2-3 2-3 servings
Milk (WM) 1-2 2 cup
Sugar 6 6 tsp
Rice 11-12 5 ½ -6 cups cooked rice
Meat 5 5 matchbox sizes
(LF) + (MF) (2)+(3)
Fat 4 4 tsp
Meal Pattern and Sample Menu for 2nd and 3rd Trimester of Pregnancy

Bisugo
Beverage Powdered whole mil: 4 Tbsp in 1cup
water
LUNCH SAMPLE MENU
Soup Clam soup with Green Onions
Meat, Fish, Poultry or Substitute 1¼ pc. Paksiw na Galunggong
Vegetables 1¼ cup Mongo Guisado with
Rice or Substitute Malunggay
Fruit or Dessert 1 cup Rice
1 pc. Banana
SUPPER SAMPLE MENU
Soup Broth
Meat, Fish, Poultry or Substitute 1¼ slice Breaded Pork
Vegetables 1 1/3 cup Pinakbet
Fruit or Dessert
PM: 1 pc Boiled Camote
1 glass Fruit juice
 Nutritional Requirements for Pregnancy
Recommended Energy Nutrient Intakes Per day

Vitamins & Vitamins &
Value Value
Minerals Minerals
Energy 300 kcal Folate 200µg/day
Protein +27 g/day Calcium 50* mg DFE/day
Vitamin A +300 µg RE/day Iron +10 mg/day
Vitamin C 10 mg/day Iodine 100 µg/day
Thiamin 0.3 mg/day Zinc +5.1 mg/day
Riboflavin 0.7 mg /day Selenium +4 µg/day
Niacin 4 mg NE/day Vitamin B6 +0.6 mg/day
*Calcium recommendation for pregnant women is for third trimester only.
Tolerable Upper Intake Levels or Upper Limits Per day

During Pregnancy /Lactation
Vitamins & Age group Vitamins & Age group
Minerals 14-18 ≥19 Minerals 14-18 ≥19
Vitamin A 2800 3000 Vitamin C 1800 2000
Vitamin D 50 50 Iron 45 45
Vitamin E 800 1000 Zinc 34 40
Vitamin B6 80 100 Selenium 400 400
Niacin 35 35 Iodine 900 1000
Folate 800 1000 Ca 3000 5000
 Effects of Good Nutrition

- On Mother
1. Increased chances of normal pregnancy leading to normal delivery.
2. Absence or reduced chances of complications during pregnancy
3. Reduced incidence of premature deliveries
4. Reduced incidence of maternal depletion
5. Reduced incidence of morbidity and mortality
6. Increased chance of successful lactations
- On Infants
1. Normal growth and development: normal birthweight and length
2. Reduced incidence of intrauterine growth retardation (IUGR)
3. Reduced chances of stillbirths, congenital malformations and
neonatal deaths
4. Reduced incidence of illness and stronger resistance to infections
5. Adequate nutrient reserves.
Nutrition in Lactation
Lactation – period of production of milk by the mother’s mammary glands to feed

her infant.
Diet for Lactating Women

Description of the Diet
- Diet to meet increased nutrient needs during lactation due to various
physiologic changes.
Characteristics of the Diet

- The diet is designed to encourage and support milk production of the
mother
- The RENI specify a 500 kcal increase per day in the diet to normalize
body composition progressively and to provide for adequate lactation.
- An increase of protein by 27 g/day during first six months and 18 g/day in
the second six months are recommended; human milk contains about 10
g protein. Dietary protein is converted to milk protein with 70% efficiency.
- An additional intake of 750-1000 kcal ml/day of fluids is recommended to
avoid dehydration.
- Vitamin and mineral needs ordinary will be supplied from these additional
foods.
TER/day = Normal requirement + 500 kcal
Food Plan for 1800kcal + 500 kcal (Lactating Women)

Fruit 2-3 2-3 servings
Milk (WM) 1-2 1-2 cups
Sugar 6 6 tsp
Rice 12-14 6-7 cups cooked rice
Meat 4½ 4 ½ matchbox sizes
(LF) + (MF) (1)+(3 ½ )
Fat 7 7 tsp
Meal Pattern and Sample Menu for Lactating Women

Bisugo
Beverage Powdered whole mil: 4 Tbsp in 1cup
water
LUNCH SAMPLE MENU
Soup Clam soup with Green Onions
Meat, Fish, Poultry or Substitute 1 ½ pc. Paksiw na Galunggong
Vegetables 1¼ cup Mongo Guisado with
Rice or Substitute Malunggay
Fruit or Dessert 1 ¼ cup Rice
1 pc. Banana
SUPPER SAMPLE MENU
Soup Broth
Meat, Fish, Poultry or Substitute 1 ½ slice Breaded Pork
Vegetables 1 ¼ cup Pinakbet
Rice or Substitute 1 ¼ cup Rice
Fruit or Dessert
1 glass Fruit juice
 Nutritional Requirements for Pregnancy
Recommended Energy Nutrient Intakes Per day

Vitamins & Vitamins &
Value Value
Minerals Minerals
Energy 500 kcal Folate 150µg/day
Protein +27 g/day Calcium 50 mg DFE/day
Vitamin A +400 µg RE/day Iron +2 mg/day
Vitamin C +35 mg/day Iodine 100 µg/day
Thiamin 0.2 mg/day Zinc +7.0 mg/day
Riboflavin 0.6 mg /day Selenium +9 µg/day
Niacin 3 mg NE/day Vitamin B6 +0.7 mg/day
B. Nutrition in Infancy
- Newborn: about 6-7 pounds (2.7 to 3.2kg) and 18-20 inches (45-51cm)
- First year: fastest growth until adolescence; birth weight is doubled by five
to six months, tripled by 12 months; birth length is increased by 24 cm, by
end of the first year.
Diet for Infants (One to Six months)
Description and Characteristics of the Diet

- The main food for infants is milk. Breastmilk is best and breastfeeding
should be encouraged at all times. Infants should be exclusively breastfed
up to 6 months, and then, give appropriate foods while continuing
breastfeeding. Exclusive breastfeeding means that nothing (except
medicines and water by dropper, spoon or cup) is fed to the infant other
than breastmilk.
- Human milk or breastmilk has specific characteristics suited to the
nutritional needs and physiological development of the infant, among
these are the following:
 Except for Vitamin D, breastmilk provides the necessary energy
and nutrients needs of the infant for the six months of life.
Breastfeed infants should be exposed regularly to sunlight.
Adequate sun exposure for 30 min/week if clothed in diaper only or
20 hrs/week if fully clothed (no hat) is sufficient to meet vitamin D
needs. Infant formulas made from cow’s milk or soybean are only
approximations of breastmilk; none can claim to be its perfect
substitute.
 The colostrum (the thick yellow fluid that is produced in the first
three days after delivery) in human milk contains antibodies and
anti-infective factors that are not present in infant formulas.
Therefore, incidence of infection is lower in breast feed infants than
in formula fed infants.
 It contains a generous amount of the essential fatty acids which is
important in visual acuity and brain development of the infant.
Population-based and meta-analysis studies indicate that
breastfeeding benefits cognitive development.
 It provides optimum nourishment that is easily digested and
absorbed by the infant.
 It is clean and readily available at room temperature. Thus, an
infant is less likely to get diarrhea.
 Breastmilk has no additives that can cause adverse reactions such
as allergies in infant. Allergic reactions to human milk protein are
rare.
- Breastfeeding also promote emotional boding as it fosters a close and
loving relationship between mother and baby. Beneficial effects of
breastfeeding in maternal health is also present such as lower risk of
breast cancer, aids in contraction of the uterus to normal size after
delivery and may provide a natural contraceptive measure, if do
exclusively and frequently with no long intervals for the first 6 months or
continued longer. Breastfeeding is also economical because it is free
flowing from the mother.
- A mother should be encouraged to nurse her infant immediately after birth.
Initially the baby should be breast fed whenever he is hungry and mostly
at the intervals of 2-3 hrs; by 4 weeks, most extend the feeding intervals to
4 hours. By 2-4 months, sufficient maturation has occurred to omit the
night feeding.
- Breastfeeding is adequate, if the baby:
 Is satisfied after 15-20 minutes of feeding.
 Falls asleep promptly after each feeding and sleeps for 3-4 hrs.
 Gains weight satisfactorily from month to month. The baby should
double his birth weight after five to six months of age and triple it at
one year.
 Wetness test: if the infant is exclusively breastfed and urinates six
times a day then he is taking enough breastmilk.
Diet for Infants (After Six Months to Twelve Months)

COMPLEMENTARY FEEDING
Description and Characteristics of the Diet

- The introduction of the solids foods into an infant’s diet begins the
weaning process in which the infant transitions from a diet of only
breastmilk to a more varied one. Weaning should proceed gradually and
be based on the infant’s rate of growth and developmental skills.
- Complementary foods or transitional foods are the foods to be provided in
addition to breastmilk. They should be certainly chosen to meet the
nutrient needs of the infant, promote appropriate nutrient intake
(supplementation of iron fortified cereals and infant formula to prevent iron
deficiency anemia after 12 months of age), and maintain growth.
- In general, at about 6 months of age, the infant is ready for solid foods.
Breast milk is still best for babies at this age and mothers should be
encouraged to continue breastfeeding for up to two years (as
recommended by UNICEF) or as long as they can. Never introduces of
any complementary food reduces breastmilk production and contributes to
increased rates of infant’s morbidity and mortality. On the other hand,
delaying introduction of complementary food beyond one year will affect
growth and development and may cause malnutrition.
Indication for Use

- This diet is designed for infants after 6 months to 12 months. The infant’s
individual growth and development pattern is the most suitable guide to
determine when to introduce semisolid and solid foods as well as how
much to introduce.
- Indications of readiness for complementary feeding are the following:
 Baby’s weight doubles his/her birth weight
 Baby can hold head straight when sitting up.
 Baby opens mouth when food approaches.
 Baby is interested in foods when others eat.
 Baby is able to transfer food from the front of the tongue to
the back.
 Baby is able to swallow.
Food Selection Guide

- Complementary foods should be added to the infant’s diet in the order
given in the following guide.
Age of
Appropriate Method of
Introduction Example Amounts
Food(s) Preparation
(in months)
Thin rice gruel, ½ cups thin
oatmeal gruel
After 6 Cooked, well
Cooked
months strained
mashed 2-3 tbsp
Cereals
rootcrops
()semi-solid
Thick gruel, soft ¾ cup thick
foods given 8 months Cooked
cooked rice gruel
to the baby
Soft cooked
1 cup
rice
10-12 months cooked
Sliced bread,
1piece
biscuits
Ripe Bananas,
After 6
Mashed ripe papaya, 2 ½ tbsp.
months
ripe mango
Cut into small
Fruits 8 months Soft fruit 3 tbsp
pieces
Cut into
10-12
finger sized Any fruit 4 tbsp
months
pieces
Carrots, sayote,
squash,
abitsuelas,
Cooked very potatoes,
7 months 1 tbsp
soft, chopped kamote tops,
pechay,
Vegetables malunggay
leaves
Cooked and
8 months finely All vegetables 1 tbsp
chopped
Cooked
10-12 months coarsely All vegetables 1 tbsp
chopped
7 months Cooked Chicken egg ½ eggyolk
Meat and 11 months Cooked Chicken egg ½ egg
alternatives After 6-11 Deboned, Minced meat, 1 1/3
Eggs months cooked well fresh or dried servings
mashed or fish or minced
ground chicken, 1 serving
mashed cooked meat
monggo = 30 g or .3
Meat/Fish/ cm cube; fish
Poultry or 2 pcs.
Legumes (Medium size
55-60 g
each),
About 16 cm
long
1 1/3 cups
cooked
beans/nuts
dried beans preferably
taken 3 times
a week
Deboned, Meat, fresh or
cooked; dried fish or
10-12 months
faked or chicken,
chopped monggo
Whole
milk/follow
on formula 12 months 2 cups
(if not
breastfed)
Custard, simple
Others
8 months up strained pudding, plain 1 tsp
foods
gulaman or jello
After 6-11 Margarine,
Fats and oils 4 tsp
months cooking oil
After 6-11
Sugar 3 tsp
months
Food Plan for 720 kcal (Infants > 6 months to 1 year)

Food Group Exchange Amount
Vegetables 2 2 servings: ½ cup cooked per
serving: one should be leafy
green or yellow
Fruits 1-2 1-2 servings; one should be
vitamin C rich
Milk 1-2 1-2 servings: ½ cup evap milk, 4
tbsp non-fat or low fat milk
Rice or substitute 2-4 1-2 cups cooked rice
Meat, fish, egg or 2-3 2-3 matchbox sizes: liver or
substitute glandular organs once a week,
egg twice a week, ½ cup cooked
dried beans mybe used in place
of one meat and fish exchanges
Fat 5-6 5-6 tsp
Sugar or sweets 4-5 4-5 tsp
Meal Pattern and Sample Menu

Fruit or juice Fresh fruit in season
Rice/Bread with Butter/Margarine or jam Iron fortified cereal
Beverage Milk
LUNCH SAMPLE MENU
Meat, Fish, Poultry or Substitute Chopped meat or well-cooked mashed
legumes
Vegetables Vegetables
Rice or Substitute Noodles
Fruit or Dessert Fresh fruit in season
SUPPER SAMPLE MENU
Meat, Fish, Poultry or Substitute Chopped meat or well-cooked mashed
legumes
Vegetables Vegetables
Rice or Substitute Rice or potato
Fruit or Dessert Fresh fruit in season
SNACKS AM: Sliced toast
PM: Biscuit with butter
Whole milk
Complementary Feeding of Infants 7 months onwards

What Foods and How to Prepare Them
The best way of planning a nutritious complementary food is to use a mixture of
ingredients designed to complement each other to ensure the intake of all essential
nutrients. the basic principle in planning complementary foods is that “the wider the
range of foods included and the greater the variety, the less the likelihood of having
nutritional deficiency.
With this principle in mind, three types of mixture can be considered. All are built
around the staple, with addition of one, to or three other foods. These multimixes are
known as double mixes, triple and quadrimixes, respectively.
Multimixes
Type of Mixture Ingredients
Staple + legume
(or)
Double mix Staple + animal protein
(or)
Staple + dark green leafy vegetable (DGLV)
Staple + legume + animal protein
(or)
Triple mix Staple + legume + DGLV
(or)
Staple + DGLV + animal protein
Quadrimix Staple + legume + animal protein + DGLV
Double mixes. These consist of the local staple (rice, camote, or potato)
together with the most suitable legume, or animal protein or dark green
leafy vegetable.
Triple mixes. Sometimes, it may be possible, if only for an occasional
preparation to reinforce a “double mix” of staple and legumes with small
amounts of animal protein thereby converting it into a “triple mix.”
Quadrimixes. If local food resources and local practices permit, the
staple, legume and animal protein “triple mix” can be converted into a
“quadrimix” by adding small quantities of dark green leafy vegetables
which are sources of vitamins as well as of protein and iron.
Ideally, a multi-mix complementary food has four basic ingredients:

1. A staple as the main ingredient
2. A protein-rich food from plant or animal source
3. A vitamin and mineral-rich food coming from fruits and vegetables
4. An additional energy-rich food (in concentrated form) coming from fat,
oil or sugar
When these four ingredients are used together in suitable proportions,
they form a complete meal.
The Food Square

Breastmilk is still in the middle because it is a complete food in itself. The
square has four parts------one for staple, one for protein which may include
legumes and animal protein, vitamin and mineral foods and additional energy
foods.
A B
Staple Protein food
Cereals, tubers or supplements
roots Legumes, animal
products
Breastmilk
C D
Vitamins/Minerals Energy
food Supplements Supplements
Vegetables/fruits Fats, oils and
sugar
 Estimating the Desirable Body Weight for Infants
a. First 6 months:
DBW (gms) = Birth weight (gms) + (age in months’ x 600)
If birth weight is not known, use 3000 gms
Example: 4 months old infant =

DBW (gms) = 3000 + (4 x 600)
= 3000 + 2400
= 5400 gms or 5.4 kg
7 to 12 months:
DBW (gms) = Birth weight (gms) + (age in months’ x 500)
Example: 8 months 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 (kg) = (8 : 2) + 3
=4+3
= 7 kg
INFANT’S WEIGHT:
- Doubles at 5 to 6 months
- Triples at 12 months
- Quadruples at 24 months
HEIGHT FOR LENGTH: increase by 24, 12 and 8 cm during the

first second and third year, respectively, then by 4 cm every year
thereafter up to the eight year.
At birth: 50 cm Example: 50 cm
At 1 yr: + 24 cm 50 + 24 = 74 cm
At 2 yrs: + 12 cm 74 + 12 = 86 cm
At 3 yrs: + 8 cm 86 + 8 = 94 cm
At 4-8 yrs: + 6 cm every year At 4 yrs.+ 6 = 74 cm
 Estimating the Calorie or Total Energy Requirement (TER)/day for

Infants
Infants: TER/day = 90 – 95 kcal / kg DBW
Example: 4 month old =

TER = 5.4 kg (DBW) x 95 kcal /kg
= 513 or 500 kcal
8 months old =
TER = 7 kg (DBW) x 90 kcal/kg
= 630 or 600 kcal
C. Nutrition in Pre-School Age
Preschool Age
 includes children from 1 to 5 years’ old
 changes occur in children’s rate of growth and development
 continuing maturation of fine and gross motor skills
 personality development influences both the amount of food they consume and
also the foods acceptable to them
 rates of growth decreases, therefore appetite decreases
Growth in Weight and Height

 steady but slow growth rate with more or less equal yearly gains as much
as 2 to 3 kg
 average weight gain of 5-6 lb/year are found mostly in muscle and bones
 characterized by loss in body fat
 average height increase is by 2-3 inches/year
 girls are slightly shorter and lighter than boy.
Body proportions
 growth at this stage is concentrated in legs and trunk, thus creating a taller
and slenderer look.
 Balance is easier with a lower center of gravity.
Internal system and tissues

 In terms of growth rate, body systems low and stabilize
 Changes in fat, muscles and bones tissues
- Body fat decreases
- More muscles and bones among boys and more fat tissues among
girls
- Slow muscle growth
- Cartilage changes to bone as development proceeds
- Twenty baby teeth come out by age 2 ½ to 3
- Adult chest breathing movements
- Larger bladder, thus longer time between bathroom trips and so
baby’s sleep is less interrupted
- ½ of adult stomach capacity.
Brain growth is rapid in the first 3-4 years after birth

 Brain size reaches 75% of its adult weight by age 2 and 90% at the age of
4-6 years.
 New cells are formed, existing cells become more complex.
 Myelinezation continues
 Hand preferences are established by age.
Sign of Good Nutrition in Young Children

 Alert, vigorous and happy
 Has endurance during activity
 Sleeps well
 normal height and weight for age
 stands erect, arms and leg straight
 clear bright eyes: smooth health skin: lustrous hair
 firm and well-developed muscles
 not irritable and restless
 good attention span
Protein-Energy Malnutrition
- The World Health Organization (WHO) defines malnutrition as "the cellular
imbalance between the supply of nutrients and energy and the body's
demand for them to ensure growth, maintenance, and specific
functions." [The term protein-energy malnutrition (PEM) applies to a group
of related disorders that include marasmus, kwashiorkor and intermediate
states of marasmus-kwashiorkor. (https://emedicine.medscape.com)
- Children with kwashiorkor have nutritional edema and metabolic
disturbances, including hypoalbuminemia and hepatic steatosis, whereas
marasmus is characterized by severe wasting. Studies suggest that
marasmus represents an adaptive response to starvation, whereas
kwashiorkor represents a maladaptive response to starvation
- Marasmus is severe form of PEM manifested by extreme wasting caused
by prolonged restriction of both energy and protein.
- Kwashiorkor is due to deficiency of protein but with adequate energy
intake
Estimating DBW of Children
Formula : DBW (kg) = (Age in years x 2) + 8
Example: 7 years old child

= (7 x 2) +8
= 14 + 8
= 22 kg (Add 2 kg every year)
Estimating Total Energy Requirement of Children

a. Using kcal/kg body weight based on PDRI 2015
Example: 7 years old boy with 22 kg body weight

TER (kcal) = 70 kcal/kg x 22 kg
= 1540 or 1500 kcal
Kcal/DBW
Age range (Years)
Boys Girls
1-2 83 80
3-5 77 72
6-9 70 65
10-12 62 55
13-15 56 47
16-18 51 44
b. Using Narins and Weil
Formula: TER/day = 1000 + (100 x age in years)
Example: 7 years old

TER = 1000 + (100 x 7)
= 1000 + 700
= 1700 kcal
c. Using Cooper, Barber, etc.
Age range (Years) CMBRG (Cooper, Barber, etc)

1-3 100
4-6 90
7-9 80
10-12 70
13-15 60
15 years and above 50
Example: 7 years old child with 22 kg DBW
TER/day = 22 kg x 80 kcal/kg
= 1760 or 1800 kcal
Diet for Preschool Children (age 2 to 5 years old)
Description and Characteristics of the diet

 The diet for preschool children is designed to include a variety of foods
with different textures and flavors provided throughout the day. The diet
aims to promote optimal growth and meet the child’s developmental and
behavioral needs.
 Food selection focuses on good sources of vitamins A and C, protein, iron,
and calcium. With variety of foods appropriate amounts is consumed, the
diet will meet the RENI of vitamins and minerals for age.
 Numerous influences determine the likes and dislikes, habits and food
intake of children which are carried through adulthood when change
become more difficult. (major influences like family environment, social
trends, media, illness and disease)
 The following are recommendations to assist children in developing
desirable food patterns:
- All foods should be well prepared and attractive in color, flavor, and
texture so that the child will approach the meal and eat happily.
Children should be given small frequent meals that are mildly
flavored, cooked with moderate amounts of fats and oils or spread
with butter or margarine, cut into manageable pieces lukewarm and
served in small portion.
- Excessive intake of milk tends to reduce the consumption of other
foods.
- Use seasoning in moderation
 The environment for eating should suitable for the ability and comfort of
the child.
 Avoid hard, sticky, and slippery foods which may plug up throat such as
grapes, candy and popcorn.
Indications for Use

 Healthy preschool children aged >1-6 years.
Food plan (1200) for >1-3 years

Vegetables 1 At least ½ serving: ½ cup cooked per
serving: one should be leafy green or green
Fruits 1-2 1-2 servings; one should be vitamin C rich.
Milk 1 1 serving: ½ cup evap milk or 4 tbsp
powdered whole milk
Rice or substitute 3-4 1 ½ - 2 cups cooked rice
Meat or fish, egg 2 2 matchbox sizes: liver or glandular organs
or substitute once a week, egg twice a week, ½ cup
cooked dried beans maybe used in place of
one meat and fish exchange.
Fat 6 6 teaspoons

Fruit or juice ½ slice Ripe Papaya
Rice/Bread with Butter/Margarine or jam ½ pc. Fried Egg
Beverage ½ cup Rice
Powdered whole mil: 4 Tbsp in 1cup water
LUNCH SAMPLE MENU
Meat, Fish, Poultry or Substitute Clam soup with Green Onions
½ pc. Paksiw na Galunggong
Vegetables ¼ cup Mongo Guisado with Malunggay
Rice or Substitute ¼ cup Rice
SUPPER SAMPLE MENU
Meat, Fish, Poultry or Substitute Broth
½ slice Breaded Pork
Vegetables ½ cup Pinakbet
Fruit or Dessert 1 glass fruit juice
SNACKS AM: ¼ cup Taho
PM: ¼ pc Boiled Camote
Food plan (1400 kcal ) for >4-5 years

Vegetables 1 At least ½ serving: ½ cup cooked per
serving: one should be leafy green or green
Milk 1-2 1-2 serving: ½ cup evap milk or 4 tbsp
powdered whole milk
Rice or substitute 6-9 3-4 ½ cups cooked rice
Meat or fish, egg 2-3 2-3 matchbox sizes: liver or glandular organs
Fat 4-6 4-6 teaspoons
Sugar or sweets 5 5 tsp

Fruit or juice ½ slice Ripe Papaya
Rice/Bread with Butter/Margarine or jam ½ pc. Fried Egg
Beverage ½ cup Rice
LUNCH SAMPLE MENU
½ pc. Paksiw na Galunggong
Vegetables ¼ cup Mongo Guisado with Malunggay
SUPPER SAMPLE MENU
½ slice Breaded Pork
SNACKS AM: ¼ cup Taho
1 glass milk (4 tbsp powdered milk in 1
cup water)
Nutrition in School Age
School Age
• generally considered to be 6 to 12 years of age
• characterized by stable changes compared with the extremes of growth and
development seen in infancy and adolescence
• shows consistent but slow rate of physical growth, continuing maturation of fine
and gross motor skills
• gains cognitive and socio-emotional growth
• food habits, likes and dislikes continue to be established that form the base of a
lifetime of food intake
• food habits are influenced more by factors outside the home such as one’s peer
group
Growth in Weight and Height

 approximately 2 to 2 ½ inches in height and 3 to 6 lbs in weight are added
each year
 male and female size are comparable until age 9-10 when girls begin to
grow faster than boys
 by age 13 the average girl is taller and heavier than the average boy.
 The faster increase in girl’s foot size is an initial indication of onset of
growth spurt
 Male growth spurt begins between age 12 and 16 years
 Adult height can be predicted based on height in the middle childhood.
Body proportions
 Leg growth accounts for 66% of height increase until adolescence
 Improvement in posture can be observed
 Face takes more adults proportions
 Permanent teeth except for the 2 nd and 3rd molars set in by age 11 or 12;
this is also the period of high susceptibility to dental caries
Internal systems and tissues

 Muscle fat
- Boys have more muscle tissue than girls
- Both males and females double their strength during this time
- Muscles are still prone to injury because of their immunity
- Both sexes accumulate equal amounts of body fat provided that
they have comparable eating habits
 Heart: grows slowly and is proportionally smaller now than at any other
age.
 Skeleton
- Bone growth is concentrated in legs, arms and face
- More flexibility because of less firmly attached ligaments and more
space between bones
 Brain
- Growth of the brain and size of the head is slow
- Brain growth is essentially complete by age 10 – 12.
Perceptual development
 Vision
- Normal 20/20 vison between 9-11
- Binocular vision is established by age 6
- Colorblindness is higher in boys than girls
 Hearing
- Otitis media is the most common cause of loss hearing among
kindergarten and first grade children
- Hearing loss should be treated at once because it affects language
development
 Other systems
- As the gastro-intestinal system matures, the child experiences less
stomach upsets and develops greater stomach capacity
- As lungs continue to grow there is less abdominal breathing: the
capacity of the lungs increases and respiration rate decreases.
- Bowel and bladder control becomes well established; the capacity
of the bladder is greater in girls than boys.
Diet for Preschool Children (age 6 to 12 years old)
Description and Characteristics of the diet
 Growth during the school age period is parallel by a constant increase in
food intake. nutrition plays an important role in:
- Furnishing energy needed for vigorous activity of this age
- Helping to maintain resistance into infection
- Providing building materials for growth
- Providing adequate nutrient stores to assist in adolescent’s growth
 Emphasis on the adequate sources calcium and iron must be attended
since these two minerals may be limiting in their diet
 At all times, parents should encourages their children to eat a varied diet
that includes:
- A good breakfast each day that provides ¼ to ½ of the RENI for
the day
- Nutritious school lunch and snacks.
Indications for Use

 Healthy school children from 6 to 12 years

Vegetables 1-2 At least 1 serving: ½ cup cooked per serving:
one should be leafy green or green
Fruits 2 2 servings; one should be vitamin C rich.
powdered whole milk
Sugar or sweets 5 5 tsp

Rice/Bread with Butter/Margarine or jam 1 pc. Fried Egg
Beverage ¾ cup Rice
LUNCH SAMPLE MENU
1 pc. Paksiw na Galunggong
Vegetables ¾ cup Mongo Guisado with Malunggay
Rice or Substitute ¾ cup Rice
SUPPER SAMPLE MENU
¾ slice Breaded Pork
Rice or Substitute ¾ cup Rice
SNACKS AM: ½ cup Taho
½ glass milk (4 tbsp powdered milk in ½
cup water)

powdered whole milk

Rice/Bread with Butter/Margarine or jam 1 pc. Fried Egg
Beverage ¾ cup Rice
LUNCH SAMPLE MENU
1 pc. Paksiw na Galunggong
SUPPER SAMPLE MENU
¾ slice Breaded Pork
PM: ½ pc Boiled Camote
cup water)
Estimating DBW of Children

Formula : DBW (kg) = (Age in years x 2) + 8
Example: 7 years old child

= (7 x 2) +8
= 14 + 8
= 22 kg (Add 2 kg every year)
Estimating Total Energy Requirement of Children

d. Using kcal/kg body weight based on PDRI 2015
Example: 7 years old boy with 22 kg body weight

TER (kcal) = 70 kcal/kg x 22 kg
= 1540 or 1500 kcal
Kcal/DBW
Age range (Years)
Boys Girls
1-2 83 80
3-5 77 72
6-9 70 65
10-12 62 55
13-15 56 47
16-18 51 44
e. Using Narins and Weil
Formula: TER/day = 1000 + (100 x age in years)
Example: 7 years old

TER = 1000 + (100 x 7)
= 1000 + 700
= 1700 kcal
f. Using Cooper, Barber, etc.
Age range (Years) CMBRG (Cooper, Barber, etc)

1-3 100
4-6 90
7-9 80
10-12 70
13-15 60
15 years and above 50
Example: 7 years old child with 22 kg DBW
TER/day = 22 kg x 80 kcal/kg
= 1760 or 1800 kcal
Signs of Good Nutrition in Middle Childhood

1. Well develop body with normal weight for height
2. Firm and well-developed muscles
3. Good posture
4. Healthy skin, no lesions and hyperpigmentation
5. Smooth and glossy hair
6. Clear eyes
7. Alert facial expression and good disposition
8. Sound sleep
9. Good digestion and elimination
10. Good appetite
Nutrition in Adolescence
Adolescence
- is a period of transition from childhood to adulthood characterized by rapid
growth in height and weight, alteration in body composition, sexual
maturation and psychological changes.
• Refers to the whole period of transition or may mean one of
the two phases i.e. pubescence and adolescence; in the
case of the latter, adolescence follows pubescence and
terminates with completion of physical growth and maturity.
• Second growth spurt in life
• Onset has enormous variability that chronological age is
poor indicator of physiological maturity and nutritional needs;
Tanner stages: sexual maturity ratings based on the
development of secondary sexual characteristics, used to
evaluate growth and development age during adolescence.
Puberty
- Period characterized by increase in hormones secretions rapid growth and
appearance of secondary sex characteristics; pubescence (attainment or
onset of puberty)
Growth spurt
- The most rapid phase of adolescent growth
Peak
- Highest point of adolescent growth
Menarche
- First menstrual period; when the menstrual periods commence and other
bodily changes occur.
Menstruation
- Periodic shedding of blood, secretions, and the functional layer of
endometrium from the uterus; occurs at approximately four weeks’
intervals; lasts three to five days.
Growth Hormone somatotropin

- Stimulates protein anabolism
Thyroid Hormones Triodithyronine (T3) and Thyroxine (T4)

- Influence overall body growth and skeletal maturation; metabolic effects
of these hormones includes increase in oxygen consumption, heat
production, nitrogen retention, protein synthesis, glucose absorption,
glycolysis and gluconeogenesis.
Adrenal cortical steroids

- The adrenal cortex upon ACTH stimulation secretes steroid hormones
that promotes growth and sexual development and function; adrenal
cortex major source of estrogen and androgens
Gonadotropins
- Hormones such as follicle stimulating hormones (FSH) leutinizing
hormone (LH) and prolactin are secreted by the pituitary and influences
the gonads
Gonadal hormones
- The ovary in the female and teste in the male secrete hormones which
have anabolic action and influence growth of the whole body and of
specific tissues
Adolescent growth spurt

- Growth in height and weight accelerates
- Timing, duration and intensity of growth vary from one individual to
another
- Females start earlier at 10-13 yrs. And peak at about 12-13 while male
start 12-16 and peak at 15-16
- Intensity growth is greater in males; thus they have larger growth
increment.
- Full stature for females at age 19, males at about 21 but bones mass
continues to increases until 25 years old.
- Most weight increases are due to muscle growth and bone ossification
- In females, fat is redistributed throughout the body.
Body proportions and configuration

- Body elongates to adult proportions
- Males are taller, lave longer limbs and broader shoulder
- Females have wider and rounder hips
Other changes
- Size and strength of heart increase
- Lung capacity increases
- Internal organs reach mature sizes
- Brain and sensory system are of adult size and capacity
Sexual maturation
- Primary sex characteristics developed
- Secondary sex characteristics appear
- Sexual reproduction become possible
Physiological maturation
- Reached at different times
- Body water; electrolytes levels, respiratory rate blood pressure, metabolic
rate, blood components and other physiological functions are generally
higher in males
Nutritional Requirements in Adolescence (refer to the PDRI 2015)

Fruits 3 3 servings; one should be vitamin C rich.
Milk 1 serving: ½ cup evap milk or 4 tbsp
powdered whole milk

Rice/Bread with Butter/Margarine or jam 1 pc. Fried Egg and ½ daing na bangus
Beverage 2 cups Rice
LUNCH SAMPLE MENU
1 ¼ pc. Paksiw na Galunggong
SUPPER SAMPLE MENU
1 ¼ slice Breaded Pork
cup water)

2 NUTRITION-ACROSS-THE-LIFESPAN-pregnancy

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NUTRITION ACROSS THE LIFESPAN

Diet for Pregnancy

Characteristics of the Diet

Weight gain in Pregnancy

Rates of Weight Gain*

To identify the weight gain,

 Calculate the pre-pregnancy Body Mass Index (BMI)

Example : 21 years old at 39 weeks gestation, 5’2” tall, actual weight is

 Estimating the Calorie or Total Energy Requirement (TER)/day for

 First Trimester = no change

TER/day = Normal requirement + 300 kcal (2nd and 3rd trimester)

Food Plan for 1800kcal (First Trimester of Pregnancy)

Food group Exchange Amount

Meal Pattern and Sample Menu for 1st Trimester

BREAKFAST SAMPLE MENU

Food group Exchange Amount

BREAKFAST SAMPLE MENU

Recommended Energy Nutrient Intakes Per day

Tolerable Upper Intake Levels or Upper Limits Per day

 Effects of Good Nutrition

Lactation – period of production of milk by the mother’s mammary glands to feed

Diet for Lactating Women

Characteristics of the Diet

TER/day = Normal requirement + 500 kcal

Food Plan for 1800kcal + 500 kcal (Lactating Women)

Food group Exchange Amount

Meal Pattern and Sample Menu for Lactating Women

BREAKFAST SAMPLE MENU

 Nutritional Requirements for Pregnancy

Recommended Energy Nutrient Intakes Per day

Diet for Infants (One to Six months)

Description and Characteristics of the Diet

Diet for Infants (After Six Months to Twelve Months)

Description and Characteristics of the Diet

Indication for Use

Food Selection Guide

Food Plan for 720 kcal (Infants > 6 months to 1 year)

Meal Pattern and Sample Menu

BREAKFAST SAMPLE MENU

Complementary Feeding of Infants 7 months onwards

Ideally, a multi-mix complementary food has four basic ingredients:

The Food Square

 Estimating the Desirable Body Weight for Infants

Example: 4 months old infant =

Example: 8 months old infant =

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

Example: 8 month old infant =

HEIGHT FOR LENGTH: increase by 24, 12 and 8 cm during the

 Estimating the Calorie or Total Energy Requirement (TER)/day for

Infants: TER/day = 90 – 95 kcal / kg DBW

Example: 4 month old =

C. Nutrition in Pre-School Age

Growth in Weight and Height

Internal system and tissues

Brain growth is rapid in the first 3-4 years after birth

Sign of Good Nutrition in Young Children

Example: 7 years old child

Estimating Total Energy Requirement of Children

Example: 7 years old boy with 22 kg body weight

b. Using Narins and Weil

Formula: TER/day = 1000 + (100 x age in years)

Example: 7 years old

c. Using Cooper, Barber, etc.

Age range (Years) CMBRG (Cooper, Barber, etc)