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NUTRITION
Level 4, Academic Year (AY) 1435—1436 H
Ahmad Albalawi, MSN
Lecturer
Learning Objectives:
• Identify the nutritional needs of pregnant women,
lactating women, infants, children, adolescents and adults
and patients with health problems;
• Prepare a flyer/pamphlet or any health education material
and deliver actual health education on proper diet to a
certain client
• Do web search and present evidenced-based studies about
effects of diet and/or effective diet therapy.
• Demonstrate teamwork in meal planning, in making health
education material and in research presentation.
• Demonstrate the essential role of a nurse in health
promotion, disease prevention and complication
prevention through proper diet planning
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Topic Outline
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Nutrition during Pregnancy and Lactation
Nutrition during Infancy
Nutrition during Childhood
Nutrition during Adolescents
Nutrition During Adulthood
Energy and Nutrient Needs during
Pregnancy
• Nutrient needs during
pregnancy and
lactation are higher
than at any other time.
• To meet the high
nutrient demands of
pregnancy, a woman
will need to make
careful food choices
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Energy and Nutrient Needs during
Pregnancy
• Energy
– Second trimester- +340 cal
– 3rd trimester-+450 cal
• Represents about 15-20% in 2000-kcal daily
intake
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Energy and Nutrient Needs during
Pregnancy
• Suggested foods: whole-grain breads and
cereals, legumes, dark green vegetables,
citrus fruits, low-fat milk and milk products,
and lean meats, fish, poultry, and eggs.
• CHO- 135- 175 grams or more per day is
necessary to fuel the fetal brain.
• Sufficient carbohydrate ensures that the
protein needed for growth will not be broken
down and used to make glucose
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Energy and Nutrient Needs during
Pregnancy
Protein
• + 25 grams per day higher than for nonpregnant
women.
• Suggested food sources: meats, milk products,
and protein-containing plant foods such as
legumes, whole grains, nuts, and seeds.
• Use of high-protein supplements during
pregnancy may be harmful to the infant’s
development, it is discouraged.
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Energy and Nutrient Needs during
Pregnancy
Essential Fatty Acids
• essential long-chain polyunsaturated fatty
acids are particularly important to the growth
and development of the fetus
• brain is largely made of lipid material, and it
depends heavily on fatty acids for its growth,
function, and structure
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Energy and Nutrient Needs during
Pregnancy
Sources of Omega-3 and Omega-6 Fatty Acids
• Omega-6
• Vegetable oils (corn, sunflower, safflower, soybean,
cottonseed), poultry fat, nuts, seeds, Meats, poultry,
eggs (or can be made from linoleic acid)
• Omega-3
• Oils (flaxseed, canola, walnut, wheat germ, soybean)
Nuts and seeds (butternuts, flaxseeds, walnuts,
soybean kernels) Vegetables (soybeans), anchovy,
herring, lake trout, sardines, tuna) (or can be made
from linolenic acid Department of Nursing
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Energy and Nutrient Needs during
Pregnancy
Nutrients for Blood Production and Cell Growth
• folate, vitamin B12, iron, and zinc- important
in the synthesis of DNA and new cells.
• Folate RDA during pregnancy: 600 μg/day
• Vitamin B12 RDA during pregnancy: 2.6
μg/day
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Energy and Nutrient Needs during
Pregnancy
• Folate sources: from a combination of
supplements, fortified foods, and a diet that
includes fruits, juices, green vegetables, and
whole grains
• Vitamin B12 sources: meat, fish, eggs, or milk
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Energy and Nutrient Needs during
Pregnancy
• Iron RDA during pregnancy: 27 mg/day
• daily iron supplement - second and third
trimesters- 30 to 60 milligrams
• taken between meals or at bedtime and with
liquids other than milk, coffee, or tea, which
inhibit iron absorption
• Vitamin C or orange juice can enhance
absorption
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Energy and Nutrient Needs during
Pregnancy
• Zinc RDA during pregnancy:12 mg/day (18 yr);
11 mg/day (19–50 yr)
• required for DNA and RNA synthesis and thus
for protein synthesis and cell development.
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Energy and Nutrient Needs during
Pregnancy
Nutrients for Bone Development
• Vitamin D and the bone-building minerals calcium,
phosphorus, magnesium, and fluoride are in great demand
during pregnancy.
• The AI for vitamin D and calcium does not increase during
pregnancy
• Sources: Regular exposure to sunlight and consumption of
vitamin D–fortified milk, cheese, yogurt, and other
calcium-rich foods.
• Less preferably, they may need a daily supplement of 600
milligrams of calcium.
• Vitamin D plays a vital role in calcium absorption and
utilization
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Energy and Nutrient Needs during
Pregnancy
• The recommended intake of fiber for pregnant
women is 28 g/day
• No need to increase vitamin A.
• Vitamin E requirement increases for all ages
(from 8 to 10 g).
• Vitamin K requirement remains the same for
women 25 and older (65 g), but dramatically
increases for girls 11-14 (from 45 g to 65 g).
• Requirements for all the water-soluble vitamins
are increased.
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Maternal energy and Nutrient during
Lactation
• Energy
requirement during
lactation:
• 1st 6 mo: +330
kcal/day
• 2nd 6 mo: +400
kcal/day
Fiber- + 1 g
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Maternal energy and Nutrient during
Lactation
• See figure on Comparison of Nutrient
Recommendations for Nonpregnant, Pregnant,
and Lactating Women (Understanding Nutrition by Whitney and Rolfes)
• See figure on Dietary Reference Intake for
lactating women (Understanding Nutrition by Whitney and Rolfes)
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M
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Post-Lecture Evaluation
1. Energy needs during pregnancy increase by
about:
a. 100 kcalories/day.
b. 300 kcalories/day.
c. 500 kcalories/day.
d. 700 kcalories/day.
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Post-Lecture Evaluation
2. Pregnant women should not take
supplements of:
a. iron.
b. folate.
c. vitamin A.
d. vitamin C.
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Nutrition During Infancy
• During the first year, the normal child needs
about 100 kcal per kilogram of body weight
each day.
• Infants up to 6 months of age should have 2.2
g of protein per kg of weight each day; age 612 months should have 1.56 g of protein per
kg of weight each day.
• This is satisfactorily supplied by human milk or infant
formulas
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Nutrition During Infancy
• Iron-fortified cereal is usually started at about
6 months.
• A vitamin K supplement is routinely given
shortly after birth.
• Infants should not be given an excess of
vitamin A or D. Vit A can damage the liver and
cause bone deformities, Vit D can damage the
cardiovascular system and the kidneys
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Nutrition During Infancy
• minimum of 30g of fat per day
• Human milk contains generous amounts of
essential fatty acids
• water intake -1.5 ml/kcal/day
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Nutrition During Infancy
• Essential vitamins and minerals can be
supplied in breast milk, formula and food
except for Vitamin D |(it is necessary to
expose infants to sunlight on a regular basis).
• Vitamins: Vitamin C- human milk, fortified
formula; Vitamin K- given shortly after birth
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Nutrition During Infancy
• Guidelines in Feeding
– Breastfeeding
• Breast should be offered every 2 hours in the first few
weeks.
• The infant should nurse 10-15min on each breast.
• Growth spurts occur at about 10 days, 2
weeks, 6 weeks, and 3 months; infant may
nurse more frequently.
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Nutrition During Infancy
• Indications of adequate nutrition include:
– The infant has six or more wet diapers per day.
– The infant has normal growth.
– The infant has one or two mustard-colored bowel
movements per day.
– The breast becomes soft during nursing
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Nutrition During Infancy
• Bottle Feeding
– The infant should be cuddled and held in an
upright position.
– He should be burped to prevent regurgitation.
– Formulas are developed so that they are similar
to human milk in nutrient and kcal values.
Burping a Baby:
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Nutrition During Infancy
• Sterile water must be used to mix formula.
• Infants under one year should not be given
regular cow’s milk.
• Consistent temperature should be used.
• Infants should not be put to bed with bottle.
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Nutrition During Infancy
• Supplementary Foods
• Limit diet to breast milk until the age of 4 to 6 months.
• Cow’s milk should be avoided until after one year of
age.
• Solid foods should not be introduced before 4
to 6 months of age and should be done
gradually.
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Nutrition During Infancy
• The general guidelines for the introduction of solid foods
are as follows:
– Introduce iron-fortified rice cereal at six months and no
younger than 4 months
– Add pureed vegetables and fruits at about 7-8 months
– Add pureed meat at 8-9 months
– Add juice when the infant is old enough to drink from a cup, at
about 9-10 months
– Add foods with more texture and finger foods at 9-10 months
(chopped meats, crackers, etc)
– Add allergenic foods like egg whites, whole milk, wheat
products and orange juice after 1 year
– Honey should never be given to an infant because it could be
contaminated with Clostridium botulinum bacteria
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Nutrition During Infancy
• Indications for Readiness for Solid Foods
– Ability to pull food into the mouth rather than
pushing the tongue and food out of the mouth.
– Willingness to participate in the process.
– Ability to sit up without support.
– Having head and neck control.
– The need for additional nutrients.
– Drinking more than 32 ounces of formula or
nursing 8 to 10 times in 24 hours.
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Nutrition During Childhood
• Nutritional Requirements during childhood
– The suggested intake proportion of energy for children is:
– 50% - 60% carbohydrate
– 25% - 35% fat
– 10% - 15% protein
– Nutrient needs increase because of increase in body size.
– Need 2 to 3 cups of milk or equivalent in terms of calcium
per day.
– Minimize sweets.
– Limit sweetened fruit juices.
– Drink 1 ml of water for each kcal of food.
• Introduce fiber slowly.
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Nutrition During Childhood
• Protein
– The need for protein per kg body weight decreases from
approximately 1.1 g in early childhood to 0.95 g in late
childhood
– Minerals and vitamins
• Fe – children between 1 and 3 years of age are at high risk of
developing IDA
• Ca – 500 mg/day for children 1-3 years, 800 mg/day for children 48 years and 1300 mg/day for 9-13 years
• Zn – an allowance of 3 mg/day for children 1-3 years, 5 mg/day for
children 4-8 years and 8 mg/day for children 9-13 years. Because
thebestsources for Zn are meats and seafood, children usually
have low intake.
• Vit D – the best source of vit D is also from milk. Children living in
tropical areas do not need Vit D supplementation.
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Nutrition During Adolescents
• Except for Vitamin D, nutrient needs increase
dramatically at the onset of adolescence.
• Because of menstruation, girls have a greater
need for iron than do boys.
• Adolescents may prefer to imitate their peers.
• Calculation of caloric requirement:
• 80 kcal/kg of body weight for prepubescent children
• 45 kcal/kg of body weight for active adolescent males
• 38 kcal/kg of body weight for active adolescent females
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Nutrition During Adolescence
• Protein
– Protein intake must be increased to make up for the fast
growth and development of body organs
• Calcium
– The recommended dietary intake of calcium for
adolescents is 1200 to 1500 mg.
– Greater need for boys than girls
• Iron
– All adolescents have high requirement for iron. The buildup of muscle mass in boys is accompanied by greater
blood volume, and girls lose iron monthly with the onset
of menses
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Nutrition During Adolescence
• Zinc
– It is known to be essential for growth and sexual
maturation.
• Vitamins
– Because of tissue synthesis, the body has an
increased demand for vitamin B6, folic acid, and
vitamin B12. It also needs more vitamin D for
rapid skeletal growth and vitamins A, C, and E for
new cell growth.
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Nutrition During Adulthood
• Nutritional Requirements for adults
– focuses on maintaining health by using food,
particularly plant-based foods and their
constituents, to optimize the function of the
digestive and liver detoxification systems and
other organs in the body including the immune
system.
• The iron requirement for women is higher
than men until after menopause
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Nutrition During Adulthood
• Protein requirement for adults is 0.8 g per
kilogram of body weight.
• Current requirement for calcium for adults
from 19-50 is 1,000 mg.
• Vitamin D requirement is 5 g per day.
• Both calcium and vitamin D are essential for
strong bones, and both are found in milk.
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Nutrition During Adulthood
• Three glasses of milk per day fulfill the calcium
and vitamin D requirements.
• Bone loss begins slowly, at about the age of 35 to
40.
• Kcal requirements begins to diminish after the
age of 25.
• Basal metabolic rates are reduced by 2 to 3% a
decade.
• Determined primarily by activity and amount of
lean muscle mass.
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Nutrition During Adulthood
• Nutritional Requirements for old adults
– Follow a modified food guide pyramid for
individuals 70 and older.
– Protein requirement remains at the average 50 g
per day for women and 63 g for men.
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Nutrition During Adulthood
• This is based on 0.8 g per kg of body weight.
• After age 65, it may be advisable to increase one’s
daily protein intake to 1.0g per kg of body weight.
• Vitamin requirements do not change after the age of
51, except for a slight decrease in the RDAs for
thiamin, riboflavin, and niacin because of decreased
kcal intake.
• The need for iron is decreased after age 51 in women
because of menopause.
• The kcal requirement decreases approximately 2 to 3%
a decade because metabolism slows and activity is
reduced.
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Nutrition During Adulthood
Nutrition Related concerns
• Osteoporosis
– Condition in which the amount of calcium in
bones is reduced, making them porous.
– Bone density scan can be done with a special Xray to determine if one has osteoporosis.
– Sedentary life coupled with a diet deficient in
calcium, vitamin D, and fluoride and estrogen loss
contribute to the condition.
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Nutrition During Adulthood
• Osteoporosis
– Estrogen replacement therapy (ERT), 1,500 mg of
calcium, and exercise are possible preventative
measures.
– Another possible cause of osteoporosis may be a
diet (Sodas, coffee, tea and processed foods)
containing excessive amounts of phosphorus,
which can speed bone loss.
– Good sources of calcium: milk products
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Post-lecture Evaluation
An infant should begin eating solid foods
between:
a. 2 and 4 weeks.
b. 1 and 3 months.
c. 4 and 6 months.
d. 8 and 10 months
Post-lecture Evaluation
To balance the day’s intake, an adolescent who
eats a hamburger, fries, and cola at lunch might
benefit most from a dinner of:
a. fried chicken, rice, and banana.
b. steak, baked potato, and salad.
c. pork chop, mashed potatoes, and apple juice.
d. spaghetti with meat sauce, broccoli, and
milk.
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Post-lecture Evaluation
During adolescence, energy and nutrient needs:
a. reach a peak.
b. fall dramatically.
c. rise, but do not peak until adulthood.
d. fluctuate so much that generalizations can’t
be made.
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Post-lecture Evaluation
On average, adult energy needs:
a. increases
b. Declines gradually
c. remain stable throughout life.
d. rise gradually throughout life.
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References
Whitney, W & Rolfes, SR (2008) Understanding Nutrition (11th
ed), Thomson Higher Education, Belmont, CA, USA.
Caudal, ML . (2008) Basic nutrition and diet therapy textbook
for nursing students /. Rev. ed. Quezon City : C & E Pub.
Grodner, M. et al. (2009). Foundations and Clinical Application
of Nutrition: A Nursing Approach. 4th Edition.
Topic for the Next Session
Unit V. Diet Therapy
• Definition of Diet Therapy
• Diet Therapy Determination (Indications)
and Identification