Nutrition through the Life cycle

BY, Nigatu T.(PHO, MPH)

03/14/2024 By, Nigatu T. 1

 Life cycle nutrition
• Under nutrition often starts in utero and may extend
throughout the life cycle.
• Nutritional needs vary from one life stages to another.
• Intervening at critical points, not only with the aim of
improving outcome at that point but also for
facilitating desirable outcomes for the next life cycle
points

03/14/2024 By, Nigatu T. 2

 Life cycle nutrition …
 The life cycle approach assumes that:
 Interventions have cumulative effect

 Maximum benefit in one age group can be derived from

interventions in an earlier age group.
 Intervening at one points or a few points is not enough for
sustainable improvement of nutrition and health outcomes
 Interventions in one generation will bring benefits to the
successive generations.
03/14/2024 By, Nigatu T. 3
 Nutrition throughout the life cycle (SCN,UN, 2000)

03/14/2024 By, Nigatu T. 4

 Maternal and Child nutrition

03/14/2024 By, Nigatu T. 5

 Why worry on Maternal and Child
Nutrition?

03/14/2024 By, Nigatu T. 6

Women and children (vulnerable group)
Intergenerational Cycling occurrence

03/14/2024 By, Nigatu T. 7

 Nutrition in the first 1000 days

03/14/2024 By, Nigatu T. 8

 The first two years of life is a window of
opportunity for breaking the intergenerational
03/14/2024
life cycle.
By, Nigatu T. 9
 Why worry on Maternal Nutrition?

03/14/2024 By, Nigatu T. 10

 Pregnancy
 Increased requirements for energy & nutrients
Formation of tissue: placenta, fetus, amniotic fluid
Increase in tissue: uterus, blood volume, breast & fat
deposition
Other changes: increased BMR
 Adequate nutrition before & during pregnancy is
essential for its progress & outcome

03/14/2024 By, Nigatu T. 11

 Pregnancy…
 Negative outcomes are more common in poorly
nourished women:
Abortions, stillbirths & fetal malformations,
morbidity & mortality (perinatal, infant & maternal),
impaired growth & psycho-motor developments

03/14/2024 By, Nigatu T. 12

 Pregnancy…
 Weight gain-essential to the well being of the developing
fetus
 First 2 trimesters

– Anabolic (growth of breasts, uterus/placenta,

production of amniotic fluid, increased in blood

volume & deposition of body fat).
– The fetal growth is slow

03/14/2024 By, Nigatu T. 13

 Pregnancy…
Later trimester
– Fetal growth- tripling of weight b/n 28 & 40 wks (1000g
to 3200-3600g)
– Catabolic for mother -subsidizes fetal growth ( uses fat
stores)
– If her intake is not sufficient -she will loose weight
– The most vulnerable period for the fetus in terms of birth
weight

03/14/2024 By, Nigatu T. 14

 Rate of Pregnancy Weight Gain

~2-5 pounds
in first
trimester

Gradual &
consistent
gains
thereafter

03/14/2024 By, Nigatu T. 15

 Pregnancy…
 A well nourished woman before pregnancy gains ~20%
(11-16kg) of her pre-pregnant weight during pregnancy

 1st trimester-1 to 2 kg & then 0.5 kg/wk

– 60% attributable to maternal weight gain-fluid

volume, protein & fat deposition

– 40%-attributable to fetus, placenta, & amniotic fluid

 The required weight gain depends on pre-pregnancy

status
03/14/2024 16 T.
By, Nigatu
 Recommended weight gains based on pre-pregnancy weight
_______________________________________________________
Pre pregnancy weight Recommended weight gain
(kg)
First trimester Total wt gain
_______________________________________________________
Underweight (BMI <18.5) 2.3 kg 12.5-18.0 kg

Healthy weight (BMI 18.5-24.9) 1.6 kg 11.5-16.0 kg

Overweight (BMI 25-29.9) 0.9kg 7.0-11.5 kg

Obese (BMI ≥ 30) 0.9kg 6.8kg minimum

______________________________________________________
03/14/2024 By, Nigatu T. 17
 Pregnancy…
• Nutrient needs during pregnancy increase more for
certain nutrients than for others-due to special needs
related with physiologic changes of pregnancy
• Body adapt by increased appetite & nutrient absorption
& minimizing losses
• But still need to increase intake

03/14/2024 By, Nigatu T. 18

 Pregnancy…
Energy requirement during pregnancy
 On average 300 kcal/day extra amount of energy is required
 14% more than non pregnant non lactating
 Energy needs of a pregnant woman vary as the pregnancy
progresses.
 In the first trimester: needs no additional energy
 2nd trimester: additional 340 kcalories daily
 3rd trimester: extra 450 kcal daily

03/14/2024 19 T.
By, Nigatu
 Pregnancy…
Protein
• Needed for the development of new tissue:
 Formation of placenta & fetal tissue
 Expansion of uterus, breasts & blood volume

• +10 g/d to the RDA (0.8g/kg/d)~ 1.1g/kg/day

• High biological value-animal protein

Fat
• PUFA-essential for tissue development (brain)
• More foods containing omega 3 & omega 6 fatty acids
03/14/2024 20 T.
By, Nigatu
 Vitamins & Minerals
Nutrient Requirement Implication Remarks
Vitamin A Well nourished Low maternal Vitamin A is Excessive
mother doesn’t need associated with Preterm labor & supplementation
supplement IUGR associated with
deleterious effect

Vitamin D 10 microgram Deficiency leads to neonatal

hypocalcemia & tetany, infant
hypoplasia of tooth enamel, &
maternal osteomalacia

Pyridoxal 2.3mg/d Supplemented for

phosphate women at risk for
inadequate intake

Folate 280,660,and 470 Neural tube defect, low birth

microgram/d in the weight, abruprtio placentae
1st ,2nd & 3rd
trimesters
03/14/2024 By, Nigatu T. 21
 Vitamins & Minerals
Nutrient Requirement Implication Remarks
Calcium 1200mg Important for fetal bone Calcium absorption
development increased during
pregnancy.

Iron Increased by 15- Used in the formation of placenta, Iron absorption

30mg/d development of the embryo/fetus, increased during
increase in blood volume & pregnancy.
hemorrhagic loss during delivery.
Iron deficiency is associated with
LBW & prematurity

Zinc Increased by more Deficiency can lead to

than 9mg/d reproductive anomalies. This
occurs in women who smoke, use
drugs & who are carrying multiple
fetus

03/14/2024 By, Nigatu T. 22

 Lactation
 Lactation costs much more energy and nutrient than
pregnancy

 BM production significantly affected only in

severe malnutrition
 But inadequate intake during lactation is on the
expense of the mother’s nutritional status

03/14/2024 By, Nigatu T. 23

 Lactation…
Colostrum
 Is the earliest form of BM
 It is yellowish & relatively viscous
 Consists a variety of dissolved or suspended substances:

• electrolytes & immune factors

 Immune factors: protective against bacterial & viral
factors

03/14/2024 By, Nigatu T. 24

 Lactation…
Colostrum---
 Caloric density of colostrum (670kcal/l) is slightly
less than that of matured BM (740kcal/l)

 Higher in protein & lower in fat than matured BM

 In 1st 2 wks of lactation BM becomes matured

03/14/2024 By, Nigatu T. 25

 Lactation…
Energy demands of Lactation

• Much greater than that of pregnancy: Attributable to

rapid growth of infants

• 23% increase in energy demand over a non-pregnant,

non lactating

• Some of the energy is derived from maternal stores

during pregnancy

03/14/2024 26 T.
By, Nigatu
 Lactation…
• Average BM (674 g/d): Producing this milk costs a
woman ~ 500 Kcal/day
• Extra 330 Kcal from food + 170 Kcal from fat stored
during pregnancy
• Provided that there is some storage of certain
micronutrients in infants, BM is adequate for the first 6
months-iron, vit D

03/14/2024 27 T.
By, Nigatu
 Lactation…
• Average BM intake (g/d):

 674 at 6-8

 616 at 9-11

 549 at 12-23 months

• The composition of BM doesn't vary enormously.

• Only selectively affected by the diet & nutritional

status of the mother.

03/14/2024 By, Nigatu T. 28

 Lactation…
Group I nutrients

 B1, B2, B6 & B12, Vitamin A, I & Se

 During lactation, maternal intake & stores of these nutrients are

of most concern b/c

 Low maternal intake or stores reduces the amount of these
nutrients secreted in BM
 The concentration of BM can rapidly restored by increasing
maternal intake
 Infant store of most of these nutrients are low & readily
depleted,
03/14/2024 By, Nigatu T. 29
 Lactation…
Group II nutrients
• Folate, vitamin D, Ca, Zn, Fe, Cu
 Maternal intake & deficiency have relatively little effect on
their secretion in BM.
 BM concentration are not reduced when the mother is
deficient, therefore, she is vulnerable to further depletion
during lactation
 Maternal supplementation during lactation is more likely to
benefit the mother than her infant
03/14/2024 By, Nigatu T. 30
 Breastfeeding
Mother Health Benefits
• Less postpartum bleeding
• More rapid uterine involution
• Weight loss
• Decreased premenopausal breast cancer rates
• Decreased ovarian cancer rates
• Lactational amenorrhea

03/14/2024 By, Nigatu T. 31

 Benefits BF: Mother …
 Breast feeding reduces risk of Osteoporosis:

 BF has paradoxical association with osteoporosis

 Women loss calcium while lactating

 However current study shows after 6mos, BF mothers

bone density returns to pre-pregnancy or even higher
levels
 Women who didn’t breast feed have a higher risk of
OP
03/14/2024 By, Nigatu T. 32
 Breastfeeding
Parent Benefits
– Saves money
– Saves time
– Babies love it

03/14/2024 By, Nigatu T. 33

 Infancy
 Characterized by the most rapid growth in human life

• Length increases by about 40% & weight is tripled

• Head circumference is also increased by about
30%
 BMR of infants is very high, ~ 2X that of adults

03/14/2024 By, Nigatu T. 34

 Infancy
• The rapid growth & high BMR demands an ample supply of
all the nutrients

• Around 6mos, energy needs begin to increase less rapidly as

the growth rate begins to slow

• But some of the energy saved by slower growth is spent on

increased activity.
03/14/2024 By, Nigatu T. 35
 Infancy…
Energy
• The highest energy need per unit body weight
• A new born infant may require 3-4X Kcal/kg/d compared
to an adult (90-120 kcal/kg vs. 30-40kcal/kg)
• Most of the energy is required for BMR followed by
for growth
• The proportion of energy yielding nutrients in breast
milk is 39% carbohydrates, 55% fat & 6% protein.
03/14/2024 By, Nigatu T. 36
 Infancy…
Protein

 The highest period of protein requirement in human life

 RDA-2.2g/kg for 1st 6mos & 2.0g/kg for 2nd 6 mos

CHOs

 Major energy contributor during infancy

 Lactose is the primary CHO at least in the first half of

infancy

 5g/kg of CHO is required

03/14/2024 to T.prevent ketosis
By, Nigatu 37
 Infancy…
Fat & fatty acids
 >50% of the energy in BM is derived from fat
 Essential fatty acids are required in larger amount
during infancy (>30% of the total energy)
 Essential FA-mainly for neurological development

03/14/2024 By, Nigatu T. 38

 Infancy…
Vitamins & Minerals
 Consumption of 700-800 ml of BM provides 2X
RDA of Vitamin A but will not allow the acquisition
of RDA for Vitamin D

 BM is not also a good source of Vitamin K , it is

recommended to be given routinely at birth

03/14/2024 By, Nigatu T. 39

 Infancy…
Complementary feeding to breast milk---
• Assuming an average intake of BM, CF need to provide:
– 5-30% of vitamin A,
– 20-45% of protein,
– 50-80% of B1,
– 50-65% of B2,
– 60% of Ca,
– 85% of Zn, &
– almost 100% of Fe.
• The lower the concentration of the nutrient in BM the more will
be needed from CF

03/14/2024 By, Nigatu T. 40

 Adolescent
Introduction
• Transitional stage of development between childhood and
adulthood.
- Early adolescent-10-13 years
- Middle adolescent-14-17 years
- Late adolescent-18-21 years
• Associated with marked:
- Physical growth
- Reproductive maturation
- Cognitive transformation
03/14/2024 By, Nigatu T. 41
 Adolescent…
• Second fastest growth stage of life after
infancy.
- 50% of the ideal body weight is gained
- 90% of skeletal mass is formed by the age of 18 years

03/14/2024 By, Nigatu T. 42

 Why Adolescent nutrition is important?

• Adolescent growth spurt creates an increased

need for many nutrients because :-
- Growth and development are rapid
- Considerable gain in muscle and bone mass
- Changes in body composition
- Biological changes
• Nutrition needs should be determined by the degree
of sexual maturation and biological maturity.
03/14/2024 By, Nigatu T. 43
 Why Adolescent……

• Optimal nutrition is required to:

- Prevent adult diet related chronic diseases
- CVDs - Obesity
- Cancers - Type II DM
- Osteoporosis

- Timely sexual maturity

- Compensate energy loss when physical activity is
high
03/14/2024 By, Nigatu T. 44
 Why Adolescent……

• The growth spurt of adolescent is modest

window of opportunity for catch up growth
deficit of childhood age.
• Further eating a balanced and healthy diet is
important to
-concentration and academic performance
-Promote psychological wellbeing by reducing
anxiety and stress and improving self esteem

03/14/2024 By, Nigatu T. 45

 Why Adolescent……
• Unhealthy eating behaviors are common during Adolescence
such as:
- Frequent Dieting
- Meal Skipping
- Consumption of junk foods (foods high in fat and sugar,
such as fast foods, soft drinks)
• They are more likely to develop new dietary behaviors because
of:
- peer influences,
- food availability,
- food preferences,
- cost,
- personal and cultural beliefs,
03/14/2024 By, Nigatu T. 46
- mass media
 Adolescent nutrient Requirements
Energy and protein intake

03/14/2024 By, Nigatu T. 47

 Calcium
 Adequate calcium intake is important for the
development of dense bone mass and the
reduction of the lifetime risk of fracture and
osteoporosis.
 The DRI for calcium for 9 to 18 yrs old is
1300 mg/day

03/14/2024 By, Nigatu T. 48

 Iron
• The onset of menstruation imposes additional
iron need for girls.
• RDA:
- 8 mg/day for 9-13 years old
- 11 mg/day for males ages 14-18,
- 15 mg/day for females ages 14-18.

03/14/2024 By, Nigatu T. 49

 zinc
• Adolescents who are zinc deficient experience
growth failure
• RDA:
- 8 mg/day for 9-13 ages
- 11 mg/day for males ages 14-18,
- 9 mg/day for females ages 14-18

03/14/2024 By, Nigatu T. 50

 Vitamin A
 I t is important for normal vision, reproduction, growth,
and immune system
 RDA:
- 600 μg/day for 9-13 ages
- 700 μg/day for males ages 14-18,
-900 μg/day for females ages 14-18.

03/14/2024 By, Nigatu T. 51

 Other micronutrients
• Other micronutrients highly important during
adolescents are Vit C, folate and Vit E.

03/14/2024 By, Nigatu T. 52

 THANK YOU!!!

03/14/2024 By, Nigatu T. 53