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DNT 200
NUTRITION FOR HEALTH
SCIENCES
NUTRITION THROUGH THE LIFE CYCLE
PART 1
1
NUTRITION THROUGH THE LIFE CYCLE
For all the advances in medicine,
there is still no cure for the
common birthday
John Herschel Glenn, Jr.. (b. 1921)
Senator, American astronaut, politician, oldest man to fly in space
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Pregnancy: the impact of
nutrition on the future
– Preparing for pregnancy
• Nutrition before conception is
important
• In early weeks before pregnancy,
significant developmental changes
occur that depend on a woman’s
nutrient intake and stores
• Supplementation may be warranted
if there are any deficiencies
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Preparing for pregnancy (con’t)
• Appropriate weight for height benefits
pregnancy outcome
– 10% or more below or 20% or more
above standard weight for height results
in a greater risk for impaired pregnancy
outcome
– Women are advised to achieve a desirable
body weight to maximize chances for a
healthy baby and maintain their own
good health
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Preparing for pregnancy (con’t)
• A strong correlation exists between
pre-pregnancy weight and infant birth
weight -- infant birth weight is the
most potent single indicator of the
baby’s future health status
– Low birth weight -- 5-1/2 pounds or less
– Low birth weight babies are nearly 40 times as
likely to die in first month of life as normal
weight babies
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Preparing for pregnancy (con’t)
• Importance of pre-pregnancy
nutrition
– Determines the growth of a healthy placenta in
the first month of gestation
– Only way nutrients can reach developing fetus
is through the placenta
– If mother’s stores are inadequate during
placental development, now matter how well
she eats later, fetus will not receive optimal
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nourishment
NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during pregnancy
• Each organ of fetus needs nutrients
most during its own intensive growth
period
– Deficiency during one stage of
development may effect the heart, during
another stage, the developing limbs
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND
LACTATION
Critical Periods of Gestation
Central Nervous System
Heart
Tissue
Ears
Eyes
Legs and Arms
Teeth
Critical development
Palate
Continued development
External Genitalia
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4
6
8
10
12
14
16
Term
Weeks of Gestation
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during
pregnancy (con’t)
• Woman’s nutrient needs
during pregnancy and
lactation are greater than
any other time in her adult
life
• Energy
– Increases about 15% (300
kcalories per day)
– Pregnant teenagers,
underweight women, and
physically active women
need more -- 18 kcalories
per pound
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during pregnancy (con’t)
• Protein
– Recommend an additional 10 grams per
day throughout pregnancy
• Carbohydrate
– Generous amount to spare protein
• Vitamins
– Folate -- DRI increases by half from 400
to 600 micrograms
– Vitamin B-12 -- needs increase about
10%
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during pregnancy (con’t)
• Minerals
– Calcium
» Intestinal absorption of calcium
doubles during pregnancy
» Mother’s bone stores are drawn upon
as fetal bones begin to calcify
– Phosphorus
» Needed for developing bones
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during pregnancy (con’t)
• Minerals
– Magnesium
» Needed for developing bones
– Fluoride
» Needed for mineralization of fetal
teeth
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Nutrient needs during pregnancy (con’t)
• Minerals
– Iron
» Developing fetus draws on mother’s
stores to create its own stores
» Iron losses also occur with blood
losses during birth
» One of the most difficult needs to
meet
– Zinc
» Required for DNA and RNA synthesis
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Weight gain and exercise
• The pregnant woman must gain weight
Pre-pregnancy Weight
Status
Recommended
Weight Gain
Underweight (BMI < 19.8) 28 to 40 lbs
Normal weight (BMI 19.8
to 26)
25 to 35 lbs
Overweight (BMI 26 to
29)
15 to 25 lbs
Obese (BMI > 29)
15 lb minimun
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Weight gain and exercise (con’t)
• Ideal pattern -- 2-4 pounds
during the first three months
and a pound per week thereafter
• Weight gain reflected in
– Infant’s weight
– Placenta
– Increase in mother’s blood
volume to supply placenta
– Increase in mother’s fluid volume
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Weight gain reflected in (con’t)
– Increase in size of mother’s uterus and
muscles to support it
– Increase in size of mother’s breasts
– Fluid to surround infant in amniotic sac
– Mother’s fat stores
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Practices to avoid
• Do not try to diet during pregnancy
• Cigarette smoking
– Restricts blood supply to growing
fetus
– Increases iron needs
– Decreases availability of:
» Vitamin B-12
» Vitamin C
» Folate
» Zinc
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Practices to avoid (con’t)
• Caffeine
– Crosses placenta
– May retard fetal growth
– Heavy consumption may increase risk of
spontaneous abortion
– Consumption should be minimal (one cup
coffee or two 12 ounce colas per day
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Practices to avoid (con’t)
• Drugs -- can cause serious
birth defects
• Alcohol consumption -Can cause
– Irreversible brain damage
– Physical and mental
retardation
Pregnant woman should
drink absolutely no
alcohol
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Medical complications and other
problems of pregnancy
• Gestational Diabetes
– Is the appearance of abnormal glucose
tolerance during pregnancy with
subsequent return to normal postpartum
– Risk factors
» Age 30 or older
» Obesity
» Complications in previous pregnancies
» Family history of diabetes
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Medical complications and other
problems of pregnancy (con’t)
• Gestational Diabetes
– Without proper management, can lead to
infant sickness and death
– Medical nutrition therapy
» Select foods rich in complex
carbohydrates
» Limit intakes of concentrated sweets
» Provide for optimal protein intake
» Three meals daily plus snacks
– May be controlled by diet alone however
insulin therapy can be required
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Medical complications and other
problems of pregnancy (con’t)
• Transient Hypertension of Pregnancy
– Is high blood pressure that develops in the
second half of pregnancy
– Most often is mild and does not affect
pregnancy outcome
– Along with preeclampsia and eclampsia
was formerly known as pregnancy-induced
hypertension and toxemia
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Medical complications and
other problems of pregnancy
(con’t)
• Pre-eclampsia -- a condition
characterized by
» High blood pressure
» Generalized fluid retention
» Protein in the urine
– Pre-eclampsia may lead to eclampsia,
a severe stage of eclampsia
characterized by convulsions
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
–Medical complications and other
problems of pregnancy (con’t)
– Pre-eclampsia can be fatal to the mother
– Greater risk is for the baby
» Only known cure is to give birth
prematurely
» Puts baby at risk for complications
(respiratory distress, mental
retardation)
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Medical complications and other
problems of pregnancy (con’t)
• Nausea of morning sickness
– Arises from normal hormonal changes
taking place early in pregnancy
– Helpful strategies
» On waking, arise slowly
» Eat dry toast or crackers
» Eat small frequent meals
» If some food odors are offensive, avoid
those foods
» When nauseated, drink no citrus juice,
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water, milk, coffee or tea
NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Medical complications and other
problems of pregnancy (con’t)
• Constipation
– Results from
» Hormones of pregnancy alter muscle tone
» Thriving infant crowds intestinal organs
» Painful hemorrhoids may develop
– Treatment
» Eat foods high in fiber (raw fruits and
vegetables, whole-grain cereals)
» Exercise daily
» Drink plenty of liquids (at least 8 glasses a
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day), including fruit juices
NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Medical complications and other problems
of pregnancy (con’t)
• Heartburn
– Is a burning sensation in the lower esophagus,
near the heart
– Growing infant may put pressure on the
woman’s stomach, causing acid to back up
– Treatment
» Eat small frequent meals
» Drink liquids between meals
» Avoid spicy or greasy foods
» Sit up while eating
» Wait an hour after eating before lying
down
» Wait two hours after eating before
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exercising
NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
Where do parents get their information?
1994 NS Infant Feeding Survey Results
(NSDH, 1998)
– 34% mothers find MDs most helpful
source of info
– 25% identified a female family member
– Year One Food for Baby used by 46% of
mothers
• 90% who received it reported using it
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Breast feeding
– The mother’s nutrient needs
• Preparation
– Eat high quality foods
» Inadequate diet does not support the
stamina, patience, and self confidence
that a nursing infant demands
– Don’t restrict weight unduly
» Severe energy restriction will hinder
milk restriction
» Choosing nutrient-dense foods will
result in gradual weight loss, even
though energy intake may be greater
than normal
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– The mother’s nutrient needs (con’t)
– Enjoy ample foods and fluid at frequent
intervals throughout lactation
» Nursing mother produces an average of 25
ounces of milk per day (wide variations
possible)
» Breast milk contains 21 kcalories per
ounce
» An additional 525 kcalories per day are
required to produce breast milk
» Energy allowance during the first six
months of lactation amounts to 640
kcalories above mother’s ordinary need
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– The mother’s nutrient needs (con’t)
• Food choices for the mother -- should
– Provide energy
– Offer abundant nutrients, especially those
needed to make milk
» Calcium
» Protein
» Magnesium
» Zinc
» Fluid
– Foods with strong or spicy flavors may alter
the taste of breast milk -- may annoy some
infants
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– The mother’s nutrient needs (con’t)
• In general, nutritional deprivation of the
mother will affect the quantity, not the
quality of the mother’s milk
• Vitamin supplements for undernourished
mothers appears to raise the vitamin
concentrations of their milk and appears
beneficial
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Contraindications of breast feeding
• Alcohol easily enters breast milk
– Peaks within an hour after ingestion
– Leads to decreased consumption by the infant
• Excessive caffeine consumption may cause
infant irritability and wakefulness
• Smoking may reduce milk volume
• Communicable diseases (tuberculosis,
hepatitis) may require maternal-child
separation
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
– Contraindications of breast feeding
(con’t)
• Medication may be secreted in breast milk
• Oral contraceptives (containing estrogen)
may reduce milk volume and the protein
content of breast milk
• Environmental contaminants may be
present -- consult with physician or
dietitian familiar with local condition
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Nutrient needs
• Infant grows faster than ever
during the first year
• Birth weight doubles around
four months and triples by one
year
• By the end of the first year,
growth rate slows so that
between the first and second
birthdays, weight gain amounts
to less than 10 pounds
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
Weight Gain of Human Infants in Their
First Five Years of Life
Weight, (lb)
50
40
30
20
10
0
0
1
2
3
4
5
Ye ars
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Nutrient needs (con’t)
• Energy nutrients and vitamins and minerals
crucial to the growth process have special
importance
– Vitamin A
– Vitamin D
– Calcium
– Iron
• Need smaller amounts of nutrients than
adults, but compared to weight, need over
twice as much of most nutrients
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Nutrient needs (con’t)
• Most important nutrient of all -- water
– Normally breast milk provides enough water
to replace losses in a healthy infant
– Losses may result from
» Vomiting
» Diarrhea
» Sweating
» Urinary loss
– Life threatening dehydration can result from
losses without replacement
– Infants may need supplemental water -- they
cannot tell you why they’re crying
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Breast Milk
– With possible exception of Vitamin D
and fluoride, breast milk provides all the
nutrients needed for the first six months
– Advantages
» Tailor-made to meet the nutrient needs of
the human infant
» Ample vitamins except Vitamin D
» Minerals ideal for infants
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Breast Milk Advantages (con’t)
• Immunological protection -- breast milk
offers unsurpassed protection against
infection
– Colostrom
» A milk-like secretion from the breast
present during the first day or so after
delivery
» Contains antibodies and white cells from
the mother’s cells
» Helps protect the infant from infections
from which the mother has developed an
immunity
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Breast Milk Advantages (con’t)
– Bifidus Factors
» Factors in colostrum and breast milk that
factor the growth, in the infant’s intestinal
tract, of friendly bacteria so that less
desirable inhabitants will not flourish
– Lactoferrin
» A protein in breast milk that binds iron and
keeps it from supporting the growth of the
infant’s intestinal bacteria
» Helps absorb iron into the infant’s
bloodstream
» Works directly to kill some bacteria
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Infant formula
• Breast feeding should be encouraged
wherever possible
• May be valid reasons for choosing formula
• Does not differ significantly from breast
milk in nutrient content
• Concerns to be addressed
– Formulas do not contain antibodies
– Safety and sanitation
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Infant formula (con’t)
• Bonding can still take place and
include other members of the family
• Many mothers choose to breast feed
but wean children within one to six
months -- must be weaned on to
infant formula, not plain milk of any
kind
• American Academy of Pediatrics
recommends iron fortified formula
for all formula fed infants
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Infant formula (con’t)
• Standard formulas may be
inappropriate for some infants
– Lactose intolerant
– Milk hypersensitivity
• Mother should be trained in formula
preparation
– Proper preparation techniques
– Sanitation
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing cow’s milk
• Ordinary milk inappropriate during first
four to six months -- inadequate in
– Iron
– Vitamin C
• Many pediatricians recommend continued
use of breast milk or infant formula during
first year because of the iron it provides
• Before six months of age, infant’s digestive
tract may be sensitive to the protein content
of cow’s milk and may bleed
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods
• Changes in body organs
during first year affect the
baby’s readiness to accept
solid foods
• Ability to digest starch not
present until infant is several
months old
• Foods may be started
gradually beginning sometime
between four and six months
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
• Indications for readiness -- when
infant
– Has doubled birth weight
– Can consume 8 oz of formula and is still
hungry in less than 4 hours
– Can sit up
– Is consuming 32 oz formula per day and
wants more
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– Is 6 months old
NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
• Schedule
Age (months)
0-4
Feeding Skill
Appropriate
foods
Turns head
Breast milk or
toward any
infant formula
object that
brushes cheek.
Initially
swallows using
back of tongue;
gradually begins
to swallow using
front of tongue
also.
Strong reflex to
push food out
during first 2-3
months
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
Age (months) Feeding Skill
4-6
Ability to swallow
non-liquid food
develops.
Indicates desire
for food by
opening mouth
and leaning
forward.
Indicates satiety
or disinterest by
turning away and
leaning back.
Begins chewing
action.
Appropriate
foods
Begin ironfortified cereal
mixed with breast
milk, formula, or
water.
Begin pureed
vegetables and
fruits.
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
Age (months) Feeding Skill
6-8
Ability to feed
self finger foods.
Develops fingerto-thumb grasp.
Begins to drink
from cup
*****
Appropriate
foods
Begin breads and
other cereals.
Begin textured
vegetables and
fruits.
Begin plain,
unsweetened
fruit juices from
cup.
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
Age (months) Feeding Skill
8-10
Begins to hold
own bottle.
Reaches for and
grabs food and
spoon.
Sits unsupported.
****
Appropriate
foods
Begin breads and
cereal from table.
Begin yogurt.
Begin pieces of
soft, cooked
vegetables and
fruit from table.
Gradually begin
finely cut meats,
fish, casseroles,
cheese, eggs, and
legumes
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
Age (months) Feeding Skill
10-12
Appropriate
foods
Begins to master Include at least 4
spoon but still
servings of
spills some.
breads and
cereals from
table in addition
to infant cereal.
Include at least 2
servings of fruits
and 3 servings of
vegetables.
Include 2
servings of meat,
fish, poultry,
***
eggs, or legumes.
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– Introducing first foods (con’t)
• New foods should be introduced singly and
slowly so that allergies can be detected
• Choices can be commercially prepared
baby food or blenderized table food
(without salt)
• Poor choices -- choking risk
– Popcorn
– Whole grapes
– Hot dog slices
– Nuts
**
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant
– First year of life lays the foundation for
future health -- nutrition concerns are
obesity and dental health
– Avoid teaching infants to seek food as a
reward
– Firmly discourage unacceptable
behavior (standing up, throwing food)
*
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NUTRITION THROUGH THE LIFE CYCLE
NUTRITION DURING PREGNANCY AND LACTATION
• Nutrition of the infant (con’t)
– Let child explore and enjoy food
– Don’t force food on children -gradually they will acquire a taste for
different foods
– Limit sweets strictly
– Parents choose the foods but the child
should choose how much
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