This document discusses nutritional requirements during pregnancy in three parts. It begins by defining nutritional requirements and outlining factors that influence nutrient needs. It then explains how nutrient requirements change during pregnancy to support the growth of the fetus and mother's tissues. Key nutrients that increase include protein, iron, folate and vitamins B6, C, and D. The document concludes by discussing breastfeeding and its benefits for both infant and mother.

2. At the end of this session students will be able to:
 Define nutritional requirement
 Identify factors influence nutritional/nutrients
requirements
 Understand nutritional requirements at
different span of life
2

3. Seven decades ago:
 "the problem of assessing the calorie and
nutrient requirements of human beings, with the
greatest possible degree of accuracy, is of basic
importance to FAO" (FAO, 1950).
 The first attempt to establish human energy
requirement at population level was carried out
by FAO in 1950

4.  Health is strongly affected by the food that peoples
eat.
 Proper diet can delay, prevent or treat certain diseases
and disorders
 Today, nutritionists have a wide knowledge of the
role of nutrients in health and disease

4

5.  is defined as the lowest continuing intake level of a
nutrient, for a specified indicator of adequacy, that
will maintain a defined level of nutriture in an
individual
 The amount of each nutrient needed is called nutritional
requirement
 Each nutrient has a particular series of functions in the
body
 Some nutrients are needed in larger quantity than others
5

6.  Individual requirements of each nutrient are
depends on :
 Person’s age, Gender
 Level of physical activity, growth
 Environment, temperature, body composition
and state of health
 Some peoples absorb nutrients less efficiently
than others so will have higher than average
nutritional requirement than others
6

7. DPFH 7 04/04/2023
1. Determining food and nutrition adequacy of
population food intakes
2. Setting of national food and nutrition guidelines
by countries worldwide
3. Determining nutrient needs, and evaluating and
ensuring the adequacy of ration quality and
quantity for vulnerable groups (refugees, in times
of conflict or famine )

8. DPFH 8 04/04/2023
4. Guidance to the Codex Alimentarius Commission
5. Providing information to manufacturers of infant
formula and processed complementary foods.
6. Mapping and monitoring (potential and actual) food
shortages and under nutrition in developing countries
and globally, including Early Warning Systems.

9. 1. Physiological state
Life-stages: - Pregnancy;
- lactation;
- menopause
- infancy
- adolescence
2. Health status:
- sick VS healthy
9

10. 3. Lifestyle
 Sedentary vs active: energy + those involved in
release of energy from fuels (B-1, B-2, niacin)
 Athletes: Fe requirements
 Smokers: vitamin C requirements increased:
 increased turnover
 Vegetarians: poor bioavailability of Fe & Zn
10

11. 4. Environment
 Levels of UV light
 higher altitude: decreased UV light & less vit D
synthesized via skin. Instead need more from diet
 Extremes in ambient temperature
 affect nutrient losses via sweat
 Exposure to high altitude
– cachexia induced by increase in BMR
5. Biological & genetic factors
11

12. 12

13.  Pregnancy is considered physiological if
mothers:
 deliver a healthy baby with appropriate weight
at birth (in healthy, well nourished communities
LBW is <6%)
 Produce enough milk ( >750ML in the first 6
months) of good quality sufficient for the growth
of exclusively breast fed infants
 Mothers’ nutritional status is not depleted
13

14.  In preparation for a healthy pregnancy, a
woman can establish the following
routines:-
 Achieve and maintain a healthy body wt
 Choose an adequate and balanced diet
 Be physically active
 Avoid harmful influences
 Receive regular medical care
 Manage chronic conditions.
14

15. 1. Increase in blood volume
 increased need for those nutrients most
important for generating blood: protein, iron,
folic acid and vitamin B6.
 If a woman has a normal BMI, is not iron
deficient at the time of conception and has sufficient
dietary intake of essential nutrients during
pregnancy, she will make this adjustment with
little problem, otherwise anemia may result.
15

16. 2. Changes in the gastrointestinal tract
 Increased progesterone production leads to
decreased tone and motility of the smooth muscle
of the GIT.
 food moves more slowly which leads to
constipation.
 In early pregnancy, women also experience nausea
and vomiting.
 Excessive vomiting can become a serious problem
leading to electrolyte imbalance and dehydration.
16

17. 3. Changes in renal function
– Blood flow through the kidneys and the GFR
are increased
– Normally, most of the glucose, amino acids
and water soluble vitamins that are present in
the glomerular filtrate are reabsorbed in the
tubules.
17

18.  However, during Px, substantial quantities of
these nutrients are excreted in the urine
suggesting that the increased glomerular
filtration rate is not compensated by an increase
in tubular reabsorption.
 Hence the need to ensure adequate intakes of
calories, protein and water soluble vitamins is
inevitable.
18

19. 4. Increase in breast tissue and fat stores
 mammary glands in the breast begin to enlarge
 Fat stores increase in preparation for breast
feeding.
19

20. 5. Changes in weight
• The woman gains wt as both her tissues and the
foetal tissues increase and develop.
- Additional nutrients are required to build tissues
and maintain them.
- Increased amounts of energy, protein, folate, vitamins
C, B6 and iron are required.
20

21.  Effects of underweight during pre-
pregnancy
 An underwt woman has a high risk of having a
LBW infant, especially if she is unable to gain
sufficient wt during Px.
 This is the most potent single predictor of
infant’s future health and survival.
 A LBW baby is 40 times more likely to die in
the first year of life.
21

22.  Problems in Px faced by obese women
are:-
 larger than normal, even if born prematurely,
may not be recognized and receive the
required special care.
 The infant may be twice as likely to be born
with a neural tube defect as infants born to
normal wt pregnant women more due to
poor glycemic control than folate deficiency
22

23.  Problems in Px faced by obese women…
 more likely to require drugs to induce labour or
require surgical intervention for birth
 They suffer from GDM, HTN and infections
after birth
 Both overweight and obese women have a
greater risk of giving birth to infants with
heart defects and other abnormalities
23

24.  Recommended wt gains based on pre Px weight
24
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) 0.9 kg 7.0-11.5 kg
Obese (BMI ≥ 30) 0.9 kg 6.8kg minimum

25. Underwt and normal wt woman should gain
0.5Kg/wk after the 1st trimester
Overwt and obese woman should gain 0.3Kg/wk
after the 1st trimester
Women should not diet during pregnancy.!!!!
25

26.  Weight gain for a pregnant adolescent must be
adequate enough to accommodate her own
growth and that of her foetus.
 Women who are carrying twins must gain
more weight.
 A sudden large weight gain is a danger signal,
because it may indicate the onset of
preeclampsia.
26

27. 1. Energy
 vary as the pregnancy progresses.
 no additional energy in the first trimester
 additional 340 kcal daily during the second
trimester and
 extra 450 kcal each day during the third
trimester.
27

28. TABLE: Physical activity equivalents and their PA factors
28
Type of
activity
Physical activities Girls 9-18 yrs
PA factor
Women
>19yrs
PA factor
Sedentary
Only those physical activities
required for typical daily living
1.0 1.0
Low active Daily living + 30-60mins moderate
activity
1.16 1.12
Active Daily living + ≥ 60mins moderate
activity
1.31 1.27
Very active Daily living + ≥ 60mins moderate
activity and ≥ 60mins vigorous
activity or ≥ 120mins moderate
activity
1.56 1.45

29.  Estimated Energy requirement (EER) calculation
 EER for girls 9-18 years
o 135.3 - (30.8 X age) + PA X [(10.0 X wt)+(934 X ht)]+25
 EER for adult woman ( >19 years)
o 354 - (6.91 X age) + PA X [(9.36 X wt)+(726 X ht)]
 Pregnancy
o 1st trimester: EER = non pregnant EER + 0
o 2nd trimester: EER = non pregnant EER + 340
o 3rd trimester: EER = non pregnant EER + 450
29

30. Work out
 Consider a low active 25 year-old pregnant on 2rd
trimester who was 1.8m tall and weighed 80Kg
before getting pregnant.
 What is the estimated energy requirement of this
particular pregnant women?
 Given:
 Age = 25
 PA = 1.12
 Weight = 80Kg
 Height = 1.8m
 Required = EER?
30

31. Work out.....
 354 - (6.91 X age + PA X [(9.36 X wt)+(726 X ht)]
=354 - (6.91 X 25 + 1.12 X [(9.36 X 80)+(726 X 1.8)]
=354 - (172.75+ 1.12 X [(748.8)+(1306.8)]
=354 - (172.75+ 1.12 X [2055.6]
=354-172.75+2302.272
=181.25+2302.272
=2483.522
EER = non pregnant EER + 340
EER = 2483.522 + 340
EER = 2823.522
31

32. TABLE: Energy needs of pregnant women who are
overweight / obese during preconception
32
Age
group
TEE Physical activity
(PA)
>19 Y 448 − 7.95 × age + PA × (11.4 × wt + 619 × ht) 1.00 Sedentary
1.16 Low active
1.27 Active
1.44 Very active
3 – 18 Y 389 − 41.2 × age + PA × (15.0 × wt + 701.6 × ht) 1.00 Sedentary
1.18 Low active
1.35 Active
1.60 Very active

33. Carbohydrate
 Ample carbohydrate, ideally, 135-175g per day
is necessary to fuel the foetal brain and spare the
protein needed for foetal growth.
33

34. 3. Protein
The protein Recommended Dietary Allowances(RDA)
for Px = non pregnant+25g per day
Hence protein rich food of high biological value from
animal foods should be included in the diet during Px.
Vegetarian pregnant women should include generous
servings of plant protein foods
Protein supplements can be harmful and their use is
discouraged.!!!
34

35. 4. Fat
 essential fatty acids are important to the
growth and development of the foetus.
 The brain contains a substantial amount of lipid
material and depends heavily on long chain
omega 3 and omega 6 fatty acids for its growth,
function and structure.
35

36.  Folate and vitamin B12
 needed in large amounts during Px due to their
significant role in cell reproduction.
 Folate plays an important role in preventing
neural tube defects in the early weeks of
pregnancy.
 folate rich sources:- liver, lentils, chickpeas,
asparagus, spinach, avocado, orange juice and
beets.
36

37. 37

38.  Folate and vitamin B12...
 women who are capable of becoming pregnant
should obtain 400ug of folic acid from
supplements, fortified foods or both in addition
to eating folate rich foods.
 2.6ug per day of vitamin B12 receive all the
vitamin B12 they need for pregnancy.
 Those who exclude all animal products from
the diet need vitamin B12 fortified foods or
supplements.
38

39.  Vitamin D and Calcium
 calcium, phosphorus and magnesium are in
great demand during pregnancy.
 Intestinal absorption of calcium doubles in
early in pregnancy, when the mother’s bones
store the mineral.
 Recommendations to ensure an adequate
calcium intake during pregnancy are aimed
at conserving the mother’s bone mass while
supplying foetal needs
39

40.  Vitamin D and Calcium...
 For women whose pre pregnancy calcium
intakes are below recommendations and for
women who are less than 25 years of age,
increased intakes of milk, cheese, yoghurt
and other calcium rich foods are required.
 Women who exclude milk products need
calcium and vitamin D fortified foods such as
soy milk.
40

41.  Vitamin D and Calcium...
 Three cups of milk per day will supply 900mg of
calcium.
 Calcium Adequate Intake(AI) during pregnancy
14-18yrs – 1300mg/day
19-50yrs - 1000mg/day
 Phosphorus RDA during pregnancy
14-18yrs – 1250mg/day
19-50yrs - 700mg/day
 Magnesium RDA during pregnancy
14-18yrs – 400mg/day
19-30yrs - 350mg/day
31-50yrs - 360mg/day
41

42.  Fluoride
 Fluoride is needed for mineralisation of the
foetus’s teeth and bone dev’t.
 Fluoride supplements are not recommended
for pregnant women who drink fluoridated
water.
 For women who live in communities without
fluoridated water, a fluoride supplement
may protect foetal teeth.
 AI = 3.0mg/day.
42

43.  Iron
 During Px, menstruation ceases and
absorption of iron increases up to threefold
due to a rise in the blood’s iron absorbing and
iron carrying protein transferrin.
 But still, iron needs are so high that stores
decline.
 The developing foetus draws heavily on the
mother’s Fe stores to last through the first four
to six months of life after birth.
43

44.  Iron...
 Women who enter Px with IDA have a
greater risk of delivering LBW or preterm
infants.
 For all pregnant women, an iron supplement
of 30mg per day is recommended during the
second and third trimesters of pregnancy.
 RDA = 27mg per day
44

45.  Zinc
 required for DNA and RNA synthesis and
thus for protein synthesis.
 zinc absorption increases when zinc intakes
are low.
 routine supplementation during Px is not
advised!!!.
45

46.  Zinc ...
 Women taking Fe supplements > 30mg per
day may need Zn supplementation b/se
large doses of iron can interfere with the
body’s absorption and use of zinc.
 The RDA during pregnancy is as follows:
≤ 18 years – 12mg/day
19 – 50 years – 11mg/day
46

47.  The American Dietetic Association (ADA)
advocates breastfeeding for
 the nutritional health it confers for the infant
 as well as for the physiological, social,
economic and other benefits it offers the
mother.
47

48. For Infants For Mothers
Provides the appropriate composition
and balance of nutrients with high
Bioavailability
Contracts the uterus
Provides hormones that promote
physiological development
Delays the return of regular ovulation,
thus lengthening birth intervals (is not,
however, a Dependable method of
contraception)
Improves cognitive development Conserves iron stores (by prolonging
amenorrhea)
Protects against a variety of infections May protect against breast and ovarian
cancer and reduce the risk of diabetes
type2
May protect against some chronic
diseases, such as diabetes (both types),
obesity, atherosclerosis, asthma, and
hypertension, later in life
Protects against food allergies
48

49.  Other
 Cost savings from not needing medical treatment
for childhood illnesses
 Cost savings from not needing to purchase
formula
 Environmental savings to society from not
needing to manufacture, package, and ship
formula and dispose of the packaging
 Convenience of not having to shop for and
prepare formula
49

50.  Energy
 A nursing woman produces about 25 ounces of
milk per day with considerable variation from
woman to woman and in the same woman
from time to time depending primarily on the
infant’s demand for milk.
 This costs a woman almost 500 kcal per day
above her regular need during the first six
months of lactation.
50

51.  Energy...
 the woman is advised to eat an extra 330 kilo
calorie of food each day.
 The other 170 kilo calories can be drawn from
the fat stores she accumulated during Px.
 Severe energy restriction hinders milk
production and can compromise the mother’s
health.
51

52.  Vitamins and Minerals
- A question often raised is whether a mother’s
milk may lack a nutrient if she fails to get
enough in her diet.
- Nutritional deprivation of the mother reduces
the quantity, not the quality of her milk.
- Women can produce milk with adequate protein,
carbohydrate, fat, folate and most minerals, even
when their own supplies are limited.
52

53.  Vitamins and Minerals...
 For these nutrients, milk quality is maintained at
the expense of maternal stores.
 This is most evident in the case of calcium.
 Dietary calcium has no effect on the calcium
concentration of breast milk, but maternal bones
lose some density during lactation when calcium
intakes are inadequate.
53

54.  Vitamins and Minerals...
 Such loses are generally made up quickly when lactation
ends and breastfeeding has no long term harmful effects
on women’s bones.
 Nutrients in breast milk most likely to decline in
response to prolonged inadequate intakes are the
vitamins – especially vitamins B6, B12, A and vitamin D.
 Vitamin supplementation of undernourished women
appears to help normalize the vitamin concentrations in
their milk.
54

55.  Water
 The nursing mother is advised to drink plenty of
liquids each day (about 13 cups) to protect
herself from dehydration.
 To help themselves remember to drink enough
liquid, many women make a habit of drinking a
glass of milk, juice or water each time the infant
nurses as well as at mealtimes.
55

56.  Particular foods
 infants may be sensitive to foods such as cow’s milk,
onions or garlic in the mother’s diet and become
uncomfortable when she eats them.
 Nursing mothers shouldn’t automatically avoid such
foods.
 Breast feeding mother is advised to eat whatever
nutritious foods she chooses.
 But, if a particular food seems to cause the infant
discomfort, she can try eliminating that food from her
diet for a few days and see if the problem goes away.
56

57.  Alcohol
 easily enters breast milk and can adversely affect the
production, volume, composition and ejection of breast
milk as well as overwhelm an infant’s immature alcohol
degrading system.
 concentration in breast milk peaks within one hour after
ingestion of even moderate amounts
 It may alter the taste of the milk to the disapproval of the
nursing infant, who may in protest drink less milk than
normal.
57

58.  Caffeine
 make an infant jittery and wakeful.
 As during pregnancy, caffeine consumption
should be moderate.
58

59.  Cigarette smoke
 Research shows that lactating women who
smoke produce less milk and milk with a lower
fat content than mothers who do not smoke. →
infant gains less weight
 Infants exposed to nicotine and chemicals via
breast milk and to direct smoke, experience a
wide range of problems such as poor growth,
hearing impairment, vomiting, breathing difficulties
and even unexplained death.
59

60.  Medications and Illicit drugs
 If a nursing mother must take medication that is
secreted in breast milk and is known to affect the
infant, then breastfeeding must be put off for the
duration of treatment.
 Some drugs are not at all compatible with breast
feeding, because they are secreted into the milk
and can harm the infant or because they suppress
lactation.
60

61.  Medications and Illicit drugs...
 Breast feeding is also contraindicated if the mother
uses illicit drugs.
 Regarding oral contraceptives, those which combine
estrogens and progesterone suppress milk output,
lower the nitrogen content of the milk and shorten the
duration of breastfeeding.
 Hence the progesterone only pills which do not have
an effect on breastfeeding are considered appropriate
for lactating women.
61

62.  Maternal Illness
 If a woman has an ordinary cold, she can go on
nursing without worry.
 If a woman has active untreated tuberculosis or is
receiving therapeutic radioactive isotopes,
breastfeeding is contraindicated.
62

63. 63

64.  An infant grows faster during the first year of life
than ever in the life cycle.
 birth wt doubles by about 4-6 months of age and
triples by the age of one year.
 The infant’s length changes more slowly than
weight, increasing about 10 inches from birth to
one year (~50%).
 By the end of the first year, the growth rate slows
considerably.
64

65.  An infant typically gains less than < 4.5 kg during
the second year and grows about 5 inches in height.
 BMR of the infant is very high, ~2X that of an adult.
 The stomach capacity increases 10 to 20 ml at birth
to 200 ml by 1 year, enabling infants to consume
more food
 The rapid growth and metabolism of the infant
demands an ample supply of all the nutrients.
65

66.  One of the most important nutrients for infants, as
for everyone is water.
 Breast milk or infant formula normally provides
enough water to replace fluid losses in a healthy
infant.
 Even in hot, dry climates, neither breastfed nor
formula fed infants need supplemental water.
66

67.  Breast milk excels as a source of nutrients for the
young infant.
 With the possible exception of vitamin D, breast
milk provides all the nutrients a healthy infant
needs for the first six months of life.
 It provides many other health benefits as well.
67

68.  Energy nutrients
 39% carbohydrate, 55% fat and 6% protein.
 This proportion is different from that
recommended for adults (53%Carb, 26%Fat,
21%Prot).
The carbohydrate in breast milk is lactose.
 In addition to being easily digested, lactose
enhances calcium absorption.
68

69.  Energy nutrients ...
 Also the infants fed formulas fortified with
Docosahexaenoic acid (DHA) and arachidonic
acid had better visual function at one year of age
than those who were fed standard formulas.
 The protein in breast milk is largely alpha-
lactalbumin, a protein the human infant can
easily digest.
69

70.  Energy nutrients ...
 Another BM protein, lactoferrin is an iron
gathering compound that helps absorb iron into
the infant’s blood stream.
 keeps intestinal bacteria from getting enough
iron to grow out of control and also works
directly to kill some bacteria.
70

71.  Vitamins and Minerals
 The concentration of vitamin D in breast milk is
low and vitamin D deficiency impairs bone
mineralization.
 Even vitamin C, for which cow’s milk is a poor
source, is supplied generously.
71

72.  Vitamins and Minerals...
 With respect to minerals, the calcium content of breast
milk is ideal for infant bone growth and the calcium is
well absorbed.
 The limited amount of iron in breast milk is highly
absorbable and its zinc is also better absorbed than from
cow’s milk due to the presence of a zinc binding protein.
72

73.  Immunological protection
 offers the infant unsurpassed protection against infection
(antiviral, antibacterial agents and other infection
inhibitors).
 During the first two or three days of lactation, the breasts
produce colostrum
 Colostrum contains maternal immune factors that
inactivate harmful bacteria within the digestive tract.
73

74.  Immunological protection...
 Later, breast milk also delivers immune factors, although
not as many as colostrum.
 bifidus factors and lactoferrin.
 The bifidus factor favours the growth of the
friendly bacterium Lactobacillus bifidus in the
intestinal tract.
 These bacteria prevent other less desirable
intestinal inhabitants from flourishing.
74

75.  Immunological protection...
 also contains several enzymes, hormones (including
thyroid hormone and prostaglandins) and lipids
 all of which protect stomach and intestinal
disorders during the first few months of life and so
experience less vomiting and diarrhoea than
formula fed infants.
75

76.  Immunological protection...
 protein lactadherin which binds to and inhibits
replication of the diarrhoea causing viruses.
 protects against other common illnesses of
infancy such as middle ear infection and
respiratory illness.
76

77.  The age at which whole cow’s milk can be
introduced to the infant’s diet has long been a
source of controversy.
 Children one to two years of age should not be
given reduced-fat, low fat or fat-free milk
routinely; they need the fat of whole milk.
 excessive fat restriction should be avoided.
77

78.  <6 months of age, whole cow’s milk causes intestinal
bleeding & is a poor source of iron.
 Consequently it causes iron loss and fails to replace
iron.
 Also the bioavailability of iron from infant cereal and
other foods is reduced when cow’s milk replaces breast
milk or iron fortified formulas during the first year.
78

79.  Compared to BM or iron fortified formulas, cow’s
milk is higher in calcium and lower in vit C,
characteristics which reduce Fe absorption.
 Furthermore, the higher protein concentration of
cow’s milk can stress the infant’s kidneys.
 In short, cow’s milk is a poor choice during the first
year of life.
79

80.  Changes in the body organs during the first year affect
the infant’s readiness to accept solid foods.
 Until the child is several months old, the immature
stomach and intestines can digest milk sugar (lactose),
but not starch.
 This is one of the many reasons why breast milk and
formulas are such good foods for an infant;
80

81.  The infant can sit with support and control head mov’ts
 The infant is six months old
 Addition of foods to an infant’s diet should be governed
by three considerations:-
The infant’s nutrient needs; the nutrient needed earliest is
iron, then vitamin C
The infant’s physical readiness to handle different forms of
foods
The need to detect and control allergic reactions
81

82.  Foods to provide iron and vitamin C
 Iron deficiency is common in young children throughout
the world, especially 6 mo – 3yrs
 when they are growing fast and milk which is a
poor source of iron, has a large place in their diets.
 The iron an infant has stored from birth typically runs out
after the birth weight doubles in six months.
82

83.  Foods to provide iron and vitamin C...
 Infants can derive adequate iron from
 breast milk or formulas with iron,
 iron-fortified cereals and from meat or meat alternates
 infants should be given fruits and vegetables
 Fruit juices can lead to diarrhoea, hence should be given
between 4 and 6 ounces per day.
83

84.  Physical readiness for solid foods
 The ability to swallow solid food develops at 4-6mo for
most infants and food offered by spoon helps to develop
swallowing ability.
 At 8 months to 1 year, an infant can sit up, handle finger
foods and begins to teethe.
 hard crackers and other hard finger foods may be
introduced to promote the dev’t and control of the jaw
muscles.
84

85.  Allergy causing foods
 New foods should be introduced singly and at intervals
spaced
 E.g. - rice is offered first for several days because it is
unlikely to cause an allergic response.
- Wheat cereal is offered last because it is the most
common offender
 If a cereal causes an allergic reaction its use should be
discontinued before introducing the next food.
85

87.  Energy
 energy needs vary widely, depending on their
growth and physical activity.
 A 1yr old=800 kcal/d; an active 6yr old needs 2X
 By age ten, an active child needs about 2000 kcal/d.
 Total energy needs increase gradually with age, but
energy needs per kg of body weight actually decline.
88

88.  Energy...
 those adhering to a vegan diet, may have difficulty in
meeting their energy needs.
 Grains, vegetables and fruits provide plenty of fibre,
adding bulk, but may provide too few kilocalories to
support growth.
 Soy products, other legumes and nut or seed butters
offer more concentrated sources of energy to support
optimal growth and development.
89

89.  Nutrients
 Ideally, children accumulate stores of nutrients
before adolescence.
 Then when they take off on the adolescent
growth spurt and their nutrient intakes cannot
keep pace with the demands of rapid growth,
they can draw on the nutrient stores accumulated
earlier.
 This is especially true of calcium
90

90.  Children’s food choices
 intake of fruits and vegetables by toddlers are very
low
 Greater variety of nutrient dense vegetables and
fruits need to be given.
 Also inadequate intakes of calcium and fibre and
excess intakes of saturated fat, candy, cola and
other concentrated sweets are issues of concern in
preschool and school children.
91

91.  Overweight and obesity
 Obesity poses hazards to the health of children both
now and in the future.
 Strategies to prevent obesity in children must focus
on balancing energy intake and energy expenditure.
 Children who learn to enjoy physical play and
exercise, both at home and at school, are best
prepared to maintain active lifestyles as adults.
92

92.  Hunger and Malnutrition
 Hungry children are irritable, apathetic and
uninterested in their environment.
 Both short term and long term hunger exerts negative
effects on behaviour and health.
 Short term hunger, such as when a child misses a
meal, impairs the child’s ability to pay attention and to
be productive.
 Long term hunger impairs growth and immune
defences.
93

93.  Hunger and school performance
 Children who eat nutritious breakfasts function
better than their peers who do not.
 A nutritious breakfast is a central feature of a diet
that meets the needs of children and supports their
healthy growth and development.
 When a child consistently skips breakfast or is
allowed to choose sugary foods in place of
nourishing ones, the child will fail to get enough of
several nutrients.
94

94.  Hunger and school performance...
 Nutrients missed from a skipped breakfast will not
be made up at lunch and dinner but will be left out
completely that day.
 Children who do not eat breakfast are more likely to
perform poorly in tasks requiring concentration,
have shorter attention spans,
score lower on tests and
be tardy or absent more often than their well fed
peers.
95

95.  Iron deficiency and behaviour
 Iron deficiency has well known and widespread
effects on children’s behaviour and intellectual
performance.
 Iron works as part of large molecules to release energy
within cells and plays key roles in many molecules of
the brain and nervous system.
 A lack of iron not only causes an energy crisis, but
also directly affects behaviour, mood, attention
span and learning ability.
96

96.  Iron deficiency and behaviour...
 Furthermore, children who had IDA as infants
continue to perform poorly as they grow older,
even if their iron status improves.
The long term damaging effects on mental
development make prevention of iron deficiency
during infancy and early childhood a high priority.
97

97.  Preventing Iron deficiency
 To avert iron deficiency, children’s foods must deliver 7
to 10 mg of iron per day
 To achieve this goal, milk intakes must be limited after
infancy because milk is a poor source of iron.
 iron rich foods such as lean meats, fish, poultry, and
legumes.
98

98. 99

99.  the steady growth of childhood speeds up abruptly
 In general, a female adolescent’s growth spurt
begins at age 10 or 11 and in males at 12 or 13.
 On average, males grow 20.32 cm taller and females
grow 15.24 cm taller.
100

100.  Energy
 Girls enter their growth spurts earlier and grow
less than boys, their energy needs peak sooner and
decline earlier than boys.
An active teenage body of fifteen may need 3500 k/cal or
more per day just to maintain his weight.
An inactive girl of 15yr whose growth is nearly at a
standstill may need fewer < 1800 kcal per day if she is to
avoid excessive weight gain.
101

101.  Vitamins
 RDA for most vitamins increase during the teen years
 RDA of the vitamins is similar to those for adults,
including the recommendation for vitamin D.
 both the activation of vitamin D and the absorption of
calcium are enhanced
102

102.  Iron
 The need for iron increases for both females and
males for different reasons.
 Iron needs increase for females as they start to
menstruate and for males as their lean body mass
develops.
 Hence the RDA increases at age fourteen for both
males and females.
103

103.  Iron...
 the RDA for iron remains high into late
adulthood for females.
 For males, the RDA returns to preadolescent
values in early adulthood.
104

104.  Calcium
 the requirement of calcium reaches its peak
during these years.
 increasing milk products in the diet to meet
calcium recommendations greatly increases bone
density.
 In addition to dietary calcium, bones grow
stronger with physical activity.
105

105. 106

106. Old age is the most neglected stage in the life cycle
For older people, as with younger adults,, the diet should
follow the principles of a healthy balanced diet ( food guide)
 Bread and other cereals and potatoes
 Fruit and vegetables
 Milk and dairy products
 Meat, fish, and alternatives
 Foods containing fat and sugar
107

107.  Factors affect nutritional needs of elders
The senses of taste and smell
 Inadequate diet
 Zinc deficiency
 Loss of taste buds
Dental health
 Lack of dental hygiene and dental care
 Gum disease cause tooth decay
108

108. 109
Gastrointestinal Function
Lose of sense of thirst ( reduced fluid intake)
Diminish secretion of saliva
Lactose intolerance
Hiatus hernia leads to heart burn and intolerance to
food
Diminished gastric secretion-interference with the
absorption of calcium, iron, zinc and vitamin B-12
 Constipation

109. 110
Liver, Gall Bladder and Pancreas
 Decreased efficiency of liver function
 Decreased functioning of gall bladder
 Renal function
Reduced glomerular filtration and tubular reabsorption
Affect the excretion of waste and reabsorption
 Immune function
 Efficiency of immune system declines
 Adequate protein and zinc is helpful
 Over nutrition is also harmful to the immune system

110.  Hearing and Vision
 Decline with age
 Affects to access food
 Affects food preparation
 Intake of “nutritious” foods
 Lung function
 Lung efficiency declines with age
 Aggravated in smokers and tobacco user
 Leads to limited physical activity and endurance and
discourage eating
111

111. 112
 Change in body composition
 Muscle cells shrinks and lost
 Water and lean body mass decline
 Percentage of body mass increase
 Collagen increases and it becomes more rigid
:Exercise increases lean body mass and food intake by
increasing energy expenditure
 Decreased bone mass especially for women

112. 113
 Nutritional Needs of elders
 Energy
 Requirement decreases with age
 Body composition changes
 BMR decreases
 Physical activity decreases
 Protein
 1-1.5 gm/ kg body weight
 Help blunt loss of lean body mass
 Lower efficiency of dietary protein utilization

113.  Carbohydrate
 Abundant carbohydrates
 Increase intake complex carbohydrates
 65 % or more total calories from carbohydrates
 Fat
 25 to 35 % of total calories
Vitamins
 Vitamin A
 Slower uptake by peripheral tissues - higher circulating
levels
 Increased absorption because of changes in lining of small
intestine
114

114.  Vitamin D
 10 -20 microgram
 Limited exposure to direct sunlight
 Reduced dermal synthesis
 Reduced conversation to active hormone
 Vitamin B-6
 Increase requirement
 Falling blood concentration due to age
 Utilization diminished
115

115.  Vitamin B-12
 3 microgram
 Reduced absorption caused by fall in gastric acid
 Vitamin B 12 injection recommended if intrinsic synthesis
is inadequate
 Folate
 Folate deficiency is linked to elevated plasma homocystein
( risk factor for heart disease and stroke, Alzheimer’s disease)
 Good source of folate is needed
116

116. Minerals
 Calcium
 700 mg for adults over 50 years
 Slows bone loss
 Iron
 Increase intake is recommended
 Reduced absorption in elderly
 Sodium
 Needs to be restricted
 2-4 mg/day
117

117. 118