Nutritional Requirements in Different Age Groups

1. Nutritional
Requirements in
Different Age
Groups

2. These groups are to be affected to a much greater
extent than the general population with nutritional
deficiency due to their physiological status, include:
Feeding of infants
Feeding of children
Feeding of mothers [pregnant and lactating].
Feeding of adolescence
Feeding of the elderly.
Energy requirement =BMR+ physical activity +TEF

3. The total calorie content of food can be measured by a
device called (Bomb Calorimeter). It is design to burn food
& the amount of energy produced per gram of protein, fat
or CHO by Bomb calorimeter are;
1 gm of protein = 4 Kcal
1gm of fat = 9 Kcal.
1gm of CHO = 4 Kcal.
1 gm of alcohol =7 Kcal (not nutrient)
The percentage of various nutrients to the total calories
intake;
Protein10-20% , fat 20-30%, CHO 50-60% of total calories
(or according to the food guide pyramid). The intake more
than two third of the R.I. of nutrients are considered
adequate.

4. Pre& periconceptional
nutrition in womenThe fetus is most vulnerable to nutritional deficiencies in
1st
trimester of pregnancy , often before pregnancy.
Poor maternal nutrition has both immediate (LBW)& long
term consequences (CVD &type II D.M.)
Dietary changes can the mother made to giving birth to
a healthy infant; take folic acids supplements to protect
against neural tube defects, 400µg during preconception
until 12th
week of pregnancy, to prevent recurrence of
NTD 5000µg during preconception until 12th
week of
pregnancy.

5. Choose foods rich in folic acid; >100µg kale , spinach,
50-100µg fortified bread, cereals, broccoli, cauliflower , Chickpeas , lettus .

6. Maintain ideal wt. at preconception (3m. Before conception), obesity (BMI≥30) can
inhibit ovulation (associated changes in insulin activity,& its effect on hormone
activity), underwt. (BMI<18.5) at preconception can increase the risk of pre term
delivery &LBW.
Avoid excessive intake of retinol (β-carotene is not toxic), avoid vit.A supplements
(drugs or oint.), liver, sausage (8000-10000µg).
Giving up smoking& drinking alcohol.

7. Nutritional Requirements During Pregnancy &
Lactation:
The RDA suggest increase during
pregnancy of all nutrients except
Vit. A, D, Ph, florid, with separate dietary recommendations for pregnant adolescent.
CHO requirements:
not less than 50-200 gm / day, to prevent ketosis &excessive protein breakdown.

8. Fats & Essential fatty acids
requirements:
Maternal fat is accumulated primarily
during the 1st &2nd trimester & 3-5gm/ day of EFA required for lactation. Most of
the fat in fetal organs such as liver &brain contain a high proportion of
phospholipids that require long- chain Poly Unsaturated FA that are derived from
linolenic W6& linolenic acid W3 . 4.5% of caloric intake in form of EFA is
recommended during pregnancy.

9. Caffeine:
It can pass rapidly crosses the human placenta & enters the fetal circulation.
The fetus & neonate appear to lake the enzymes that necessary to
demethylate the caffeine. It is present in high concentration in coffee(45-
155mg/cup), in tea(9-50mg/cup), cola(30-65mg/cup). Soft beverages
not more than
300mg/day or 2 cups.

10. Vit. & mineral supplements:
Try to obtain nutrients from a balanced diet (Eatwell plate), &advice her
against taking high dose multivitamin & minerals supplements.
* folic acid 400µg/d.
*Iron supplementation.

11. FACTS:
Folic Acid supplementation is recommended even prior
to conception.
Adolescent pregnant more prevalent to an iron
deficiency
A woman who enters pregnancy malnourished, with
limited nutrient stores, is more likely to have a low-
birth-weight infant who may continue with retarded
growth during childhood.
Malnutrition during 1st
trimester this stage can cause
irreversible damage to brain and spinal cord, heart,
liver, kidneys, etc.

12. Sweet should consume in moderation to avoid excessive weight gain.
A woman who enters pregnancy weighing >20% of her ideal body weight for
her height is at a higher risk for gestational diabetes & hypertensive disorders.
Pregnancy is NOT the time to reduce extra wt.

13. Changes in the daily Food Guide pyramid during pregnancy & lactation:
Non pregnant pregnant or adolescent preg.
lactating & lactating
*Milk group 2-3 servings 3-4 servings 5 servings
*Meat group 2-3 servings 3-4 servings 4 =
*Fruits 2-4 servings 2-4 servings (1-2 citrus)
*vegetables 3-5 servings 3-5 servings (1-2 green leafy
vegetables)
*Bread group 6-11 servings 7-11 servings

14. RDA during pregnancy & lactation:
Adult women Pregnant Lactating
Energy (kcal) 2200 2500 2700
Protein (gm) 50 60 65
Vit.A (IU) 800 800 800
Vit. D (IU) 5 5 5
Vit.E (mg) 8 10 12
Vit.C (mg) 60 70 95
Folate (µg) 180 600-800 600-800
Ca (mg) 800-1000 1200 1200
Ph (mg) 700 700 700
Fe (mg) 15 30 30
Zn (mg) 12 15 19
I (mg) 150 175 200
Se (mg) 55 65 65
Moderate fat intake.

15. Problems During Pregnancy
Hyperemesis Gravidarum:
Severe & unrelenting vomiting in the 2nd trimester &may
severely interferes with mother’s life.
A serious condition usually requires i.v. replacement of fluids
& nutrients.
*There are no specific foods to avoid, but there may be some
benefit to eat small ,frequent meals
*Drink fluids between rather than with the meals.
*Avoid fried & greasy foods.
*Reduce coffee intake.
*Dry toast or crackers eaten before getting out of bed may
reduce nausea.
*Prepare meals near the windows to avoid cooking odors.

16. Constipation &hemorrhoids:
–advice to eat whole bran bread & cereals, eat
high fiber foods.
– drink at least 8 glasses of water/day.
– exercise regularly.
Heartburn
– relax and eat slowly
– eat small, frequent meals
– drink liquids between meals (in order to avoid increasing stomach pouch size & pressu
on lower esophageal sphincter).

17. Preeclampsia= Pregnancy Induced Hypertension PIH:
Sudden rise in arterial B.P. accompanied by rapid
weight gain & marked edema during pregnancy,
after 28 weeks of gestation.
PIT may occur in 5-15% of all pregnancies & is one of
the leading causes of prematurity & maternal & fetal
death.
Nutrition support during PIH includes provision of
a well-balanced diet;
protein replacement
adequate vitamins &minerals
sufficient energy intake

18. moderate sodium intake <2000mg/day (1 tea spoon)
Ca supplements
Linolenic acid = omega-3 f.a. (fish oil) suggested as preventive.

19. Nutrition during lactation:
To produce sufficient milk the mother has to eat a well
balanced diet with special emphasis on critical nutrients;
Ca, Fe, water sol. Vit., with a very Little alteration in the
normal diet.
The milk volume produced /day 550-850ml/d
More water& fluids intake8-10cups/d(additional700ml).
Avoid caffeine leads to infant hyperactivity &sleeplessness.
Avoid spicy foods.

20. Impact of nutrition status of lactating mother on
composition of milk:
Adequately nourished mother: composition is more or
less unchanged[ hind milk, however, is of more fat and
protein content than fore milk]
Inadequate nutrition is mild/ moderate: quantity of milk
may be somewhat affected while composition is not,
due to physiological adaptation, with depletion of
mother.
Sever malnutrition: both quantity and quality of
secreted milk are affected.

21. Lactation Effects:
It may be a good time for over weight mother to lose weight. By moderate
dietary restriction &ensuring
the availability of adequate amounts
of essential nutrient. Lactation minimizes
postpartum blood loss &helps to restore the uterus to its pre pregnancy
state sooner..

22. II] Advantages to BF to mother:
•Post partum value: suckling stimulates secretion of oxytocin that causes
contraction of the uterus and enhances involution of uterus.
•Lower risk of breast cancer.
•Psychological/ emotional value.
•Fertility regulation: exclusive breast feeding suppresses ovarian activity and
post partum ovulation, and is thus associated with lactation amenorrhea.

23. Nutritional Requirements During infancy:
For the 1st 6ms of life; exclusive breast feeding,
as often the child wants day &night, at least 8x/d.
Energy requirement: up to 120Kcal/kg/day,
(both breast milk & formula provide 67Kcal/100ml)
Protein requirement: 2-2.5gm/kg /day
(35% of total caloric intake).
CHO : 50% of total calories.
Amylase enzyme which digest starch is low during
1st
4-6m of life, (starchy foods should be avoided).
Major CHO source is lactose which incr. absorption of dietary
Ca &Mg (decr. PH of intestinal content).

24. Lipids: play a role in absorption of
fat sol. Vit.& as a source of E.F.A.,
milk provides E.F.A. &long chain
PUFA. Infant formula containing
Only 2% of total EFA. Growth monitoring is important.
Vitamins& minerals:
*Vitamin K is routinely administered 0.5-1mg i.m. or oral to
protect them against hemorrhagic diseases .
*Vit. D; in exclusive B.F. infant, & adequate exposure to
sunlight there is no need for vit D supplementation during 1st
6m. If no sunlight exposure 10µg/day vit.D
supplementation = 400IU.

25. *Iron store can last up to the age of 6m to start
complementary feeding.
Oral dose of 1mg/kg/d as prophylactic.
*V.A 50 000IU-100 000IU with measles vaccine.
*Fluoride for teeth growth (from diet or fortified water
=fluoridated).
Water: 1.5ml/ Kcal, under ordinary circumstances breast milk
supply sufficient water &
no need for extra water.
Can only give other foods if:
-The infant not gaining wt.
-Appear hungry after breast feeding.
Given 1-2x/d after B.F.( one or more of food listed under 6-
12m.)

26. Breast milk contains all of the vitamins and minerals
that an infant needs (but is low in vit D, so may need
to supplement).
– carbohydrates, proteins, fats are
already predigested for absorption.
– breast milk is very high in omega-3 fats.
– the iron, zinc, and magnesium in breast milk is
highly absorbable.
– breast milk is low in sodium.
– the Calcium to Phosphorus ratio is 2:1, so calcium
absorption is enhanced.

27. If breastfeeding is not possible, an iron fortified infant
formula should be used to prevent iron deficiency
anemia.
Cow’s milk is not recommended because:
– Protein is poorly digested in newborns and can
cause GI upset.
– Too high in sodium.
– Very low in iron and vit C.
– Can cause failure to thrive because
of the overall lack of nutrients
in cow’s milk.

29. Complementary feeding:
For the past few decades there has
been a trend towards earlier
introduction of solid foods, often after
4-6wks of life. While the current recommendation
is to delay until 6ms of age.
Addition of semisolid foods is desirable, which provide
iron & other nutrients esp. vit. C. Start with iron
fortified cereals. Each type should be given separately
for about week to avoid allergy or intolerance. Rice is
the best cereals to begin with (less likely cause allergy).
Fruits & vegetables are added next. No need to add
sugar or salt at the beginning.

30. 6-12m.:
•Breastfeed as the child wants.
•Give adequate servings of:
*Thick porridge made of rice, potato, milk with starch
can add sugar & oil or sesame oil after 8th month.
*Mixture of mashed foods; rice or potato with green
vegetables, beans, chicken, red meat, & finally fish.
•Give 3 meals /d if breastfed.
•Give 5 meals/d if not breastfed.
•Give nutritious snacks between meals like egg, banana or
bread after 8th
m.
•Allergy Foods: peanuts , seafood, cow milk, egg.

31. Regular monitoring of wt. &ht./1 m. during 1st
y. of life,
&/ 2m. During 2nd
y. of life.
Adverse reactions to food:
* Milk allergy: incidence of cow’s milk protein allergy1-
3% in bottle-fed babies. Breast milk is ideal, also soy
protein milk appear to be tolerated by most of infants.
* Wheat allergy = celiac disease: sensitivity to gluten (in
wheat , barley , rye & oats) asymptomatic until 6m. of
age.

32. *Lactose intolerance=Lactase enz. Def.
disaccharide lactose hydrolyzed to glucose & galactose
by lactase enz., either;
Genetic (inborn error) or acquired condition( following diarrhea of any
cause). It is temporary state & reversible, temporary elimination of all
lactose containing
foods.

33. 1-2y.:
*Breastfeed as often as the child wants.
*Give adequate servings of; Family foods,
mixture of mashed foods of rice,
potato, cereals, with meat----, beans,
+green vegetables, carrots+ add
sugar &oil mixed with milk.
*Give 3 meals/d +2 snacks.
*Encourage to eat.
2y. & older:
*Family foods 3 meals/d +2 nutritious snacks.
*Encourage to eat.

35. Nutrition during childhood:
The growth during 1st year (especially 1st
4m)
of life is very rapid( 3x BW &50% incr. B. Ht.),
but after 12m the speed growth is decrease.
Prior to adolescence there is little difference in yearly height
increment betw. both sexes, but boys wt. more than girls until
about 11-13y when girls wt. is more.
Energy & protein:
The needs vary according to the age, body size (Ht.& wt.) &
physiological activities (about 15-20% of school age children are
overweight).
Age total Cal. Cal/kg total protein protein/kg
1-3y 1300 102 16gm 1.2gm
4-6y 1800 90 24gm 1.1gm
7-10y 2000 70 28gm 1gm

36. Minerals & vitamins:
Preschool children are at risk for development of IDA. Attention to good sources of
iron foods.
Calcium should be adequate for bone mineralization & growth maintenance
(adequate milk & dairy products intake).
Child should learn good food pattern during this period.
Careful assessment of growth is important for early diagnosis of malnutrition.

37. Common Nutrition Related
Problems Among Children:
Obesity; 1 in 4 children and 1 in 4
adolescents are now classified as obese.
Prevalence has increased 50% in children in last 10years.
Deal with weight gain through growth, do not put child on a
weight loss diet; have child maintain current weight while he
grows taller.
Dental caries
Iron deficiency anemia
Hyperactivity due to lack of regular
meals & caffeinated beverages.

38. Nutrition During adolescence:
Adolescent is a period between the onset
of puberty & adulthood(10-20y).
Puberty is anabolic period with incr. in Ht.
&wt., a growth spurt is experienced by
every organ system in the body with the exception
of lymphoid system& CNS which remain stable.
Rapid growth for girls betw. 10-13y & for boys 12-
15y (last for 3y.).
Nutrient needs are greatest during the pubescent
growth spurt & gradually decrease as individual
achieve physical maturity.

39. The nutritional needs of males and females of the same age differ little in
childhood but diverge after the onset of the pubertal growth spurt.
After puberty, the differences in nutrient needs persist.

40. Energy & protein:
Age total Cal Cal/kg total protein
Boys 11-14y 2500 55 45gm
15-18y 3000 45 59gm
19-24y 2900 40 56gm
Girls 11-14y 2200 47 46gm
15-18y 2200 40 44gm
19-24y 2200 38 46gm

41. Vitamins & minerals:
All are needed in increased amount in proportion to
energy requirements.
Calcium, iron, zinc, are needed during growth spurt ;
Ca RDA 1200mg/d (from dairy foods =4 cups/d).
Fe RDA 12mg/d for male &15mg/d for female.
Zn RDA 15mg/d for male &12mg/d for female is
necessary for growth & sexual maturity (from meat, sea
foods, eggs,& milk).

42. Nutritional Needs During Adolescence:
Energy requirements begin to differ between males
and females beginning in adolescence, males have
higher kcal requirements due to increased muscle
mass.
• Body composition of females differ from males higher
body fat composition at onset of menstruation.
• Kcal needs are based on body composition (height
and weight), age, and physical activity.

43. Follow the Adult Food Guide Pyramid
• Snacks should be nutrient-dense
• Balance fast foods with fruits &vegetables high in fiber
• Do not skip breakfast
• Consume plenty of lean meats to increase iron and protein consumption
Consume at least 4 cups of low-fat milk to meet calcium requirements

44. • Encourage healthy eating habits and lifestyle,
to prevent adult onset of diseases related to nutrition e.g
.,cardiovascular diseases, diabetes, osteoporosis and
cancer.
Common Nutrition Related Problems During
Adolescence:
• Obesity 1 in 5.
• Eating Disorders.
• Dental Caries.
• Iron deficiency anemia seen
in adolescent girls.
• Calcium deficiency decrease in bone size.

45. Nutrition & Aging:
Aging is a complex biological process,
normal, progressive& irreversible
phenomenon throughout adult life & is
associated with incr. prevalence of chronic
diseases or degenerative conditions
eg. CVD, H.T., D.M., cancer, obesity, & osteoporosis. Elderly
form 10-12% of population.

46. The process of aging begins with the cessation of growth & development & the
changes that occur in body composition, organ function & physical
performance.
There is a general variability from person to person& even within individuals
when various organs may age at different rates.

47. Epidemiological & social aspects of
ageing:
There are an estimated 605 million older persons, i.e.
age 60 and over, in the world today, nearly 400 million
of whom live in low-income countries.
Older persons currently represent around 20% of the
total population and the proportion is expected to
increase to 29% by 2025.
Women today have lower mortality than men do in
every age group& for most causes of death.

48. Older persons are vulnerable to protein-energy
malnutrition (PEM), which is one of the main public
health problems in most low-income tropical and
subtropical countries with predominantly rural
populations.

49. Factors affecting nutrition status:
Physiologic changes:
Decline in total body K & N as age advances which is
indicative of a decr. In total body cell mass & skeletal
muscle.
Decline in lean body mass with concomitant incr. in total
body fat with same body wt., & centralized shift of s.c.
fat from the limbs to the trunk.
Total body water is decr. Which is significant for
detoxified metabolites &thermal regulation.
Reduction of organs function& wt.; kidneys, lungs, liver,
bone 12% in male & 25% in women.

50. Mal absorption &GI disorders:
The efficiency of digestion &absorption of nutrients is
affected due to reduced level of some enzymes.
Metabolism:
Decr. In BMR about 20% between 30-90y. decr. of
vit. D precursor with decr. Ca. absorption. Also a
progressive impairment of CHO intolerance.
Diseases: CVD, DM, HT& Cancer all may modify nutrient
requirements.
Other factors: Disability, inadequate or
improperly fitted dentures, poverty, social
& personal problems all affect nutritional status.

51. Nutrient Requirements:
Energy:
A progressive decline in lean body mass, along with
depressed physical activity, causes a reduction of
energy needs in aged compared to younger
individuals.
For ages 51-75y, energy allowances decrease to
about 90% of the amount for young
adult( reduction of 300Cal/d for men & 200Cal/d
for women.
For person over 75y, there is a further reduction to
about 75-80% of energy consumed by young adult (
progressive decrease of voluntary intake of
energy).

52. Protein:
It is necessary to maintain nitrogen balance in elderly because of possible
decrease in the efficiency of digestion, absorption, & utilization of dietary
protein

53. some feel that the need for protein is more in aged
population; however because of the decreased
skeletal muscle mass the loss of daily total body
protein is less so the need for protein may be less
than younger adult 12-14% of total energy intake.
Other macronutrients:
*Daily consumption of 15-25gm fat( to ensure a
source of EFA & carrier of fat sol. Vit.).
.

54. *There is no RDA for CHO but not < 50-100gm /d of total
caloric intake with the inclusion of more complex CHO
&less refined sugar.
*Dietary fiber serves an important function in
intestinal tract by promoting the elimination of waste
products moderate intake of dietary fiber (20-35g/d)
from fruits, veg., & whole grains, & not rely on laxatives

55. Micronutrients:
For most of nutrients, the needs for elderly are the same
except for thiamine& riboflavin which are expressed in term of
total caloric intake.
The need for vit. D higher because of the reduction capacity
of their skin to produce 7-dehydro cholesterol ( precursor to
convert inactive form to active one)+ their limited exposure to
sunlight.
Efficiency of calcium absorption is decr. With age
osteoporosis advisable to take 1200mg
cal./d +daily use of multivitamin
mineral supplements.

56. • Encourage to eat several (5–6) small non-fatty
meals. This pattern appears to be associated with
greater food variety and lower body fat & lower
blood glucose and lipid levels, especially if larger
meals are eaten early in the day.
• Be physically active on a regular basis and include
exercises that strengthen muscles and improve
balance.

57. • Avoid dehydration by regularly consuming, especially in warm climates, fluids
and foods with a high water content. 30 ml/kg of water/d
at least 1500 ml of fluid per day.