Nutrition Throughout

Life Cycle

Dr. Etisa Adi Murbawani, M.Si, SpGK

Nutrition
in Childhood and Adolescence
Nutrition and Health
 Childhood and adolescence = key periods for
growth and development
 Ensure daily energy and nutrients requirements

for health, growth and development and health

in adulthood
 Inadequate intake of nutrients

(esp. 0-2 years ) might cause irreversible

changes
Brain and cognition
 Most intensive development of NS in prenatal
period and up to 3 years
 Decreased intake of energy and essential
nutrients in first years – important impact on
structural and functional development of CNS
Characteristics of Infants
 Digestion, absorption & metabolism is similar to
older children except:

– Pancreatic amylase deficient until around 4th month

– Fat absorption is inadequate
– Stomach acidity is low
Calories
Reasons for increased need:
 Rapid growth rate

 Great heat loss due to large body surface area

 Activity of the infant

Protein
 RDA: 6 mos = 2.2 g/kg
12 mos = 2.0 g/kg
 Human milk = 1.2 gms/100 ml

 Cow’s milk = 3x more CHON

Disadvantage:
– increase blood urea
– high renal solute load
– AA pattern different from human milk
Carbohydrate
 Prevent hypoglycemia & ketosis
 Lactose: sole source
 Provides galactosides: brain & nerve cell formation
 Human milk = 42% of total caloric value
 Cow’s milk = 20%
Fat
 Must constitute 35-55% of TER
 Essential fatty acids: linoleic & alpha-linolenic acid
(omega 3 series)
 EFA: retina & brain
 Breastmilk = 30-40 mg/ml
 Cow’s milk = 10-15 mg/ml
Nutrition during childhood
Energy requirements :
 1 year : 800 kcal

 6 year : 1600 Kcal

 10 year : 2000 Kcal

Carbohydrate, Fat & Fiber
 Carbohydrate = adults
 Fiber :

- Age 1-3 : 19 grams

- Age 4-8 : 25 gram
 Fat and Fatty acids

- Children 1-3 years should have 30-40% of energy

from fat
- Children 4-18 years should have 25-35% of energy
from fat
adolescence
 It is the time between the onset of puberty and
adulthood.

 Boys grow about 16 cm, gain about 20 kg and

increase their lean body mass.

 Girls grow about 12 cm, gain about 17 kg and

increase their body fat.
Facts about Teen Nutrition:
• Teen nutrition affects athletics, academics
and attitudes
• Most teens are overfed, but undernourished
• Teens grow a lot, so they need to eat a lot of
the right kind of food
• Teens frequent fast food places, where high
fat and nutrient depleted foods are the norm
Eating Disorders in Adolescents

 An estimated 20% of teens engage in some type

of abnormal eating.
 5% of high schools girls have been diagnosed
with an eating disorder.
 Adolescents are frequent users of OTC diet pills.
 Multiple factors contribute: thin “ideal” , family
pressure, exhibiting body control.
 Growth Spurts
 Growth through adolescence is hormone driven.
 Girls :

between ages 10.5 and 11 years

 with a peak in the rate of growth at around age 12
 Boys : between ages 12.5 and 13

 and peak at around age 14

. This period of maximal growth lasts about 2 yr.
Adolescence:
The Vulnerable Life Stage
 Big changes: Biological
 Boys—get tall, lean, and dense (bones, that is)
 Attain15% of final adult ht during puberty
 Lean body mass doubles
 Large calorie needs

 increase from 2,000 at 10 yr to 3,000 at 15 yr

Adolescence:
The Vulnerable Life Stage
 Girls—get taller and fatter
 % body fat increases from the teens into the mid-
20s
 Gain almost 50% of their adult ideal weight 6-9
mo before ht rate increases during puberty
 Dieting
can have a negative impact on linear
growth during this time
 Calorie needs increase by only 200 from 10 yr to
15 yr
Bone growth
 0-2 years – very fast growth (esp.in length)
 11-13 years (prepuberty) – intensive bone
mineralization - half the mass of calcium of the
adult is laid down
 9-14 years – the period of peak bone growth –
adolescents acquire 25% of their final bone mass
 Intense bone turnover in children, who replace
50 to 100% of their skeleton in a year, compared
to 10% in adults
Bone growth
 Calcium requirement of children (3-8 years) per
unit bodyweight are 2 to 4 times greater than
that of adults
Bone growth
 Calcium  Vitamin D
 Phosphorus  Vitamin A
 Fluoride  Vitamin K
 Protein  Vitamin C
Nutritional Risk
 Calcium
 Builds bone and prevents osteoporosis
 Teens need about 1300 mg a day
Osteoporosis prevention
 Nutritional status of mother in last trimester of
pregnancy (highest accumulation of calcium)
 Genetic factors (60-80 %)
 Hormonal factors (puberty)
 Nutritional factors (esp. consumption of dairy
products and other food rich in calcium – see
next slide)
 Physical exercise (increases bone density)
 Vitamins
 Pubertal growth needs more vitamins.
 Hence adolescents have a Recommended Dietary
Allowance (RDA) for vitamins higher than infants and
children and
 almost equal to or even greater than adults.
 Iron-deficiency anemia is the most common nutritional
disorder in adolescents,
 particularly adolescent girls.

 To ensure adequate intake of iron, diet should contain

plenty of green leafy vegetables,

meat, eggs and milk.
 Weekly supplements of iron have been shown to be

effective in prevention of iron

deficiency anemia
Nutrition Issues in Adolescent
Health
 Cardiovascular and cancer disease risk
 Osteoporosis and bone mineralization
 Overweight and obesity
 Type 2 diabetes
 Eating disorders
 Cardiovascular Disease
and Cancer Risk

 One-third of CVD and cancer-related morbidity

attributed to dietary patterns
 Diets high in sat fat, total fat, and sodium and low in
fiber
 Diets low in fruits and vegetables
 Dietary fat
 Recommended: <10% of calories from sat fat
and <30% total fat
 Consumed: 1/3 of adolescents are in this range
 Sodium
 Recommended: <2.5 g/d
 Consumed: 3-5 g/d
 Fiber
 Recommended: Age + 5
 Consume: ½ this amount
NUTRITION IN
PREGNANCY
 Pregnancy
 Physiology of pregnancy
 Maternal physiological changes
 Growth of adipose, breast, uterine tissues
 Increase blood volume
 Slower GI motility
Increased risks during pregnancy
• The embryo and fetus are vulnerable to damage because
cells are dividing rapidly, differentiating, and moving to
form structures
• Developmental errors can be caused by deficiencies or
excesses in maternal diet and by harmful substances in
the environment, diet, medications, or recreational drugs
• Teratogen: agent that causes a birth defect during a
critical period in development
Critical periods of development
Increased risks during pregnancy

• Some women are at increased risk for complications during

pregnancy due to their:
• Nutritional status
• Age
• Pre-existing health problems
• Exposure to harmful substances
 Maternal nutritional status

 Before pregnancy:
 Importance of proper nutrition for the maintenance of normal
body fat, hormone levels and fertility
 During pregnancy, malnutrition can lead to:
 growth retardation, low birth weight, birth defects, premature
birth, spontaneous abortion, stillbirth
 increase child’s risk of developing chronic diseases such as
cardiovascular disease, high blood pressure, diabetes mellitus,
obesity and osteoporosis
 future food preferences of an infant
 Weight gain during pregnancy

• Blood volume increases by 50%

• Placenta develops to nourish the fetus an to produce
hormones
• Amount of body fat increases to provide energy needed
late in pregnancy
• Uterus enlarges and muscles and ligaments relax to
accommodate the growing fetus and allow for childbirth
• Breasts develop in preparation for lactation (milk production
and secretion)
 Weight gain during pregnancy
• The weight of an infant at birth:
about 25% of total weight gain
during pregnancy

• The balance of weight gain:

• placenta, amniotic fluid, and
changes in maternal tissues,
including enlargement of the uterus
and breasts, expansion of the
volume of blood and other
extracellular fluids, and increased
fat stores.
 Weight gain during pregnancy
• Healthy, normal-weight woman should gain 11–16 kg
(25–35 lbs) during pregnancy
• Rate of weight gain is as important as amount
• Little gain is expected in the first 3 months (1st trimester), usually
about 1–2 kg (2–4 lbs)
• In the 2nd and 3rd trimesters, the recommended maternal weight
gain is about 0.5 kg (1 lb)/week
• Women who are underweight or overweight/obese at
conception should, respectively, have higher and lower weight
gain than normal-weight women
Weight gain during pregnancy
• Although a similar
pattern of weight
gain is
recommended for
women who, at the
start of pregnancy,
are normal weight,
underweight,
overweight, or
obese, their
recommendations
for total weight gain
differ
Gestational
Weight Gain Patterns
 Only 30 to 40% of women actually gain weight
within the recommended ranges during pregnancy.1
 Many women gain much more weight than is
necessary during pregnancy, which is related to
postpartum weight retention.2
 Underweight during pregnancy
• Being underweight by 10% or more at the onset of
pregnancy or gaining too little weight during pregnancy
increases the risk of producing a low-birth-weight baby
The Intergenerational
Cycle of Malnutrition

Child growth failure

Low birth Early Low weight and

weight babies pregnancy height in teens

Small adult women

ACC/SCN, 1992
 Overweight during pregnancy

• Excess weight before conception or gained during

pregnancy increases mother’s risks for high blood
pressure, diabetes, a difficult delivery, need for a cesarean
section, and having a large-for-gestational-age baby (>4 kg
(> 8 lb.)
• Excessive prenatal weight gain:
• increased mother’s long-term risk for obesity
• increased offspring’s risk for overweight/obesity
 Overweight during pregnancy

• Dieting during pregnancy is not advised!!

• Excess weight should be lost before pregnancy begins or

after birth and weaning
Energy Needs
During Pregnancy
 Extra Energy Needs for Normal Weight Women:1
 First trimester ~ 0 kilocalories
 Second trimester ~ 350 kilocalories
 Third trimester ~ 500 kilocalories

 There is great variability among pregnant women with regard

to energy costs during pregnancy related to differences in
body size and lifestyles.1

 Appropriate weight gain and appetite are better indicators of

energy sufficiency than the amount of kilocalories consumed.2
Nutrition In The
Elderly
Osteoporsis Diabetes Celiac Disease Malabsorption Palliative Care
Syndromes
Pressure Congestive
Heart Superbugs
Ulcers GERD
Failure ALS
Obesity
Renal Disease
Nutrition Issues Falls
Malnutrition For Older Adults Anemia
Parkinson’s Constipation
Disease
Alcohol
Pneumonia Dementia Stroke Abuse
Multiple
COPD System Issues
Sclerosis
Dysphagia
Family Related
Mental Illness Cancer Osteoarthritis Issues
In most national and international dietary
recommendations,the elderly are age 65
and above.
CHANGES ASSOCIATED WITH
AGEING
The functional changes related to
ageing include:
 a decline in quickness of response

 a changed motor and visual coordination

 a decreased interest

 a lowered oxygen consumption

Changes associated with ageing

 a decreased capability of adapting to altering

conditions
 a decrease in basal metabolism
 a decreased kidney function
 a decreased immune response
 a decrease in gastric juice production
 a reduced feeling of thirst.
 Changes associated with ageing

 a reduced muscle mass

 an increased fat content
 a decline in extracellular fluid
 hardening of soft tissues
 atherosclerosis
 osteoporosis.
GASTROINTESTINAL
SYSTEM
 Reduced GI secretions
 Reduced GI motility
 Decreased weight of liver
 Reduced regenerative
capacity of liver
 Liver metabolizes less
efficiently
RENAL SYSTEM

 After 40 renal function

decreases
 By 90 lose 50% of function
 Filtration and reabsorption
reduced
 Size and number of nephrons
decrease
 Bladder muscles weaken
 Less able to clear drugs from
system
 Smaller kidneys and bladder
Nutritional Needs Change with
Aging
Increased requirements:
calcium
vitamin D
vitamin B12
vitamin B6
(protein)

Decreased requirements:
calories
(vitamin A)