NUTRISI PADA ANAK DAN

DEWASA
 Food Guide Pyramid

The Food Pyramid, developed by the US Department of

Agriculture (USDA), is an excellent tool to help you make
healthy food choices. The food pyramid can help you
choose from a variety of foods so you get the nutrients
you need, and the suggested serving sizes can help you
control the amount of calories, fat, saturated fat,
cholesterol, sugar or sodium in your diet.
 Grains, Bread, Cereal and Pasta form the Base
 Fruits and Vegetables
 Lean Meat and Fish, Beans, Eggs
 Dairy Products
 Fats and Sweets
 Food Guide Pyramid (2)

What counts as ONE serving

 Grain group: 1 slice of bread, ½ cup of cooked rice, ½ cup of
cooked cereals, 1 ounce of ready to eat cereal.
 Fruit/ Vegetable group: ½ cup of chopped raw or cooked
vegetables, ½ cup of raw leafy vegetable, 1
piece of fruit or one melon wedge, ¾ cup of juice, ½ cup of canned
fruit, ¼ cup of dried fruit
 Meat group: 2-3 ounce of cooked lean meat, poultry or fish, ½
cup of cooked dried beans or 1 egg (counts 1 ounce of lean meat), 2
tablespoon of peanut butter (counts 1 ounce of lean meat)
 Milk group: 1 cup of milk or yogurt, 2 ounces of cheese
 Fats & Sweets group: limit calories from these.

4-6 years old children can eat these serving sizes. For children below
4 years, a total of 2 servings from the milk group each day.
 Nutrient requirement

Children  growing & developing

need more nutritious food

May be at risk for malnutrition if :
- poor appetite for a long period
- eat a limited number of food
- dilute their diets significantly with
nutrient poor foods
 Daily dietary reference intakes for
energy for children
Age Males Females
(yr) (kcal) (kcal)

1–2 1046 992

3–8 1742 1642
9 – 13 2279 2071

IOM, Food and Nutrition Board, 2002

 Energy

Energy needs of healthy children determined on

:
- basis of basal metabolism
- rate of growth
- energy expenditure
Must be sufficient to ensure growth & spare
protein, but not so excessive
Suggested intake proportions :
50 – 60% carbohydrate, 25 – 35% fat,
10 – 15% protein
OVERWEIGHT >< UNDERWEIGHT
 Protein

Early childhood  1.1 g /kg BW

Late childhood  0.95 g/kg BW
At risk for inadequate protein intake :
- strict vegan diets
- with multiple food allergies
- who have limited food selection because
of fad diets
- behavioral problems
- inadequate access to food
Daily dietary reference intakes for protein for children

Age Grams Grams / kg

(yr)

1–3 13 1.1
4–8 19 0.95
9 – 13 34 0.95

IOM, Food and Nutrition Board, 2002

 Minerals and vitamins

Necessary for normal growth & development

Insufficient intake  impaired growth

deficiency disease
 Iron

Children 1 – 3 years  high risk for iron

deficiency anemia
Rapid growth period   Hb & total iron

diet may not be rich in iron-containing food

 Calcium

Needed for adequate mineralization & maintenance

of growing bone
DRI : 1300 mg/day  9 – 18 yrs
800 mg/day  4 – 8 yrs
500 mg/day  1 – 3 yrs
Primary sources : milk & dairy product  children
who consumed no or limited amount  at risk for
poor bone mineralization

SHORT STATURE
 Zinc

Essential for growth  if deficiency :

- growth failure
- poor appetite
- decreased taste acuity
- poor wound healing
RDA : 3 mg / day  1 – 3 yrs
5 mg / day  4 – 8 yrs
8 mg / day  9 – 13 yrs
Best sources : meats & seafood
Marginal zinc deficiency  reported in children
from middle & low-income families (Robert &
Heyman, 2000)
 Vitamin D

Needed for calcium absorption & deposition

calcium in the bones
The amount required from dietary sources is
depend on nondietary factors (geographic
location & time spent outside)
Primary sources : vitamin D-fortified milk
 Vitamin-Mineral supplement

Do not necessarily fulfill specific nutrient needs

Children who take supplement  do not
exceed the RDA
Should not take megadoses, particularly fat
soluble vitamins  toxicity
Children at risk who may benefit from
supplementation :
- from deprived families
- with anorexia, poor appetites, poor eating habits
- with chronic diseases (cystic fibrosis, liver dis)
- enrolled in dietary programs from weight
management
- vegetarian diets with inadeq intake of dairy product
or calcium containing foods
FEEDING PRESCHOOL CHILDREN
(1 – 6 yrs)
 Still gaining height & weight
 Start to walk & talk

Depend on brain development

Depend on genetic & environmental

influences  stimulation & nutrition
Marked by vast development and the acquisition
of skills
Decreased interest in food  a difficult time for
parents
Smaller stomach capacity & variable appetite 
small serving
Eat 4-6 x/day  snacks is important  should be
chosen carefully
Should not be given any food or drink within
1½ hours of meal
Excessive intake of fruit juices  chronic non
specific diarrhea
Excess juice intake  may replace the
consumption of higher energy foods  
child’s appetite   food intake & poor
growth
Children usually eat well in group setting 
ideal environment for nutrition education
program
 FEEDING SCHOOL-AGE
CHILDREN (6 - 12 yrs)
May participate in the school lunch program or
bring a lunch from home
 NUTRITIONAL CONCERNS
Obesity

Increased prevalence
Not a benign condition
The longer a child has been overweight  the more
likely the is to be overweight during adolescent &
adulthood
Factors contributing :
- food establishment
- eating tied to leisure activities
- larger portion size
- inactivity
 Underweight & Failure to Thrive

Etiology :
- chronic illness
- restricted diet
- poor appetite
- feeding problems
 Iron deficiency
One of the most common nutrient disorders of
childhood (9% of toddlers)
Possible factors associated : dietary intake,
parent’s educational level, access to medical care
1-yr old child who consume large quantities of
milk only  milk anemia
Do not like meat  iron consumed in the
nonheme form
Prevention :
- consuming good dietary sources of iron
-  the amount of ascorbic acid and MFP to
 absorption
 Dental Caries

Drink sweetened liquids from a bottle at bedtime

 susceptible to early childhood caries (Baby bottle
tooth decay)
Snacks  choose that are least cariogenic
Chewing sugarless gum   salivary pH 
beneficial
Toothbrush should be introduced
 Allergies

Usually develop during infancy & childhood and

more likely when family history (+)
Allergic responses most often include respiratory
or GI symptom & skin reaction
 Autism Spectrum Disorders

Affect the children’s nutrient intake & eating

behaviors
Typically eat only specific foods

restricted diet

at risk for inadequate nutrient intake

Usually refuse fruit & vegetables
Commonly very resistant to taking supplement
 Calcium & bone health

Osteoporosis prevention :
- begins in childhood  by maximizing
calcium retention & bone density
- most efficient during childhood &
adolescent
Education is needed to encourage young
people to consume an appropriate amount
 Fiber

Needed for health & normal laxation

Education is needed to help increase fiber intake
 PREGNANCY
 Time of tremendous changes, guided by changing levels of hormones.
Uterine, breast and adipose tissues grow, blood volume expands and
gastrointestinal motility slows. All these changes have nutritional and dietary
implications for pregnant women.
 Weight gained during pregnancy is a combination of fetal and maternal
tissues and fluids. Weight gain recommendations are based on BMI prior to
pregnancy. Women of normal weight (BMI=19.8-26) should gain 25-35
pounds over the course of pregnancy Most of this weight gain occurs during
the second & third trimester.

Nutrition related components of preconception care

 Risk assessment: Age, Diet, Substance use, existing medical condition,
Barriers to prenatal care.
 Health Promotion: Healthful diet and refraining from substance use.
Compliance with prenatal care.
 Interventions: Referral to hospitals with highly equipped and trained staff.
Nutrition counseling, supplementation or referral to improve diet as needed.
Nutrient needs of Pregnancy
 A pregnant woman requires added calories to grow
and maintain not just her developing fetus but also
the placenta, increased breast tissue and fat stores.
 Growth & development of the fetus also requires
nutrients—carbohydrates, and fat as a source of
energy while proteins, vitamins and minerals to
support growth and cell differentiation.
 Nutritional Recommendations for Pregnancy
Non-pregnant Pregnant % Increase
Energy (Kcal) 2200 2500 14
Proteins 46 60 30
Vit A (ug) 700 770 10
Vit D (ug) 5 5 0
Vit E (mg) 15 15 0
Vit (K (ug) 90 90 0
Thiamine (mg) 1.1 1.4 27
Riboflavin (mg) 1.1 1.4 27
Niacin (mg) 14 18 29
Vit B6 1.3 1.9 46
Folate (ug) 400 600 50
Vit B12 (ug) 2.4 2.6 8
Choline (mg)425 450 6
Vit C (mg) 75 85 13
Calcium (mg) 1000 1000 0
Phosphorus (mg) 700 700 0
Magnesium (mg) 310 350 13
Iron (mg) 18 27 50
Zinc (mg) 8 11 38
Iodine (ug) 150 220 47
Copper (ug) 900 1000 11
 Folic acid supplementation before pregnancy reduces the
risk of neural tube defects such as spina bifida.
 Excessive intake of some vitamins (A) and use of drugs
increase the risk of poor pregnancy outcome.
 The energy RDA increases by 300 Kcal/day for the 2nd & 3rd
trimesters.
 Protein needs increases by about 10 gm/day while CHO &
fats as for non pregnant women.
 The diet should contain CHO & fats in the same proportion
as recommended for non pregnant women.
 Using the FGP pregnant women who consume enough
energy should be able to meet all their nutrients needs
except iron & folate. They should get extra calories mainly
from grains, fruits and vegetables.
 LACTATION
 Breast feeding mother must choose a varied, healthful and nutrient dense
diet.
 Need for energy and many nutrients is higher during lactation than during
pregnancy.
 RDA values suggest an additional 500 Kcal and 12-15 grams of proteins each
day.
 RI levels for minerals are generally higher during lactation than during
pregnancy.
 Fluids are also important for adequate milk production.
 Food choices during lactation should follow the USDA Food Guide Pyramid
and emphasize nutrient dense foods.
 With good choices and adequate intake a lactating mother may not need
vitamin or mineral supplementations.
 The main CHO in breast milk is lactose while triglycerides are the main
source of energy in breast milk.
Benefits of Breastfeeding
 For infants
 For mothers
 For country
Advantages of human milk over cows milk
Proteins: more whey less casein, less phenylalanine,
more peptidases
Lipids: more lipase enzymes, more Linoleic acid, higher
polyunsaturated to saturated fatty acid ratio, more
cholesterol.
Minerals: Less calcium, less sodium, higher calcium to
phosphorus ratio, iron and zinc in more available form
 Unless the lactating mother reduce their physical activity, breastfeeding
women need about 500 more Kcal/day than they did when they were not
pregnant. Obtaining adequate energy and using the Food Guide Pyramid
to balance choices most lactating women can obtain all the nutrients
they need from their diet. Alcohol, cigarettes and drugs should not be
used while breast feeding.
 Nursing mothers should eat plenty of vegetables (source of many
micronutrients)
 Vegetables of cabbage family causes colic symptoms in breastfed
children. Other foods with bad reputation include peanut butter,
chocolate, egg whites and nuts. But removal of these foods from the diet
should be done only under the supervision of a registered dietitian.
 Vegan women and who do not follow diet guidelines, should take
vitamin B12 supplement.
 Those women who do not get regular sun exposure or do not drink milk
or other fortified foods should get vitamin D supplementation.
 For most nursing mothers dietary counseling is the preferred way to
address nutrient imbalances.
THANK YOU