NCM 105 LEC & LAB REVIEWER  Patient/client interview (across the lifespan)

 Community-based surveys and focus groups

WEEK 8. NUTRITION CARE PROCESS  Statistical reports; administrative data
Nutrition Care Process  Epidemiological studies

• A systematic method that dietetics and

nutrition professionals use to provide nutrition Types of Data Collected
care.  Nutritional Adequacy (dietary history/detailed
Four Steps in Nutrition Care Process nutrient intake)
 Health Status (anthropometric and biochemical
1. Nutrition Assessment measurements, physical & clinical conditions,
2. Nutrition Diagnosis physiological and disease status)
3. Nutrition Intervention  Functional and Behavioral Status (social and
4. Nutrition Monitoring and Evaluation cognitive function, psychological and emotional
factors, quality-of-life measures, change
readiness)
STEP 1. NUTRITION ASSESSMENT
Nutrition Assessment Components
Basic Definition & Purpose
 Review dietary intake for factors that affect
 “Nutrition Assessment” is the first step of the
health conditions and nutrition risk
Nutrition Care Process.
 Evaluate health and disease condition for
 Its purpose is to obtain adequate information in
nutrition-related consequences
order to identify nutrition-related problems.
 Evaluate psychosocial, functional, and
 It is initiated by referral and/or screening of
behavioral factors related to food access,
individuals or groups for nutritional risk factors.
selection, preparation, physical activity, and
 Nutrition assessment is a systematic process of understanding of health condition
obtaining, verifying, and interpreting data in
 Evaluate patient/client/group’s knowledge,
order to make decisions about the nature and
readiness to learn, and potential for changing
cause of nutrition-related problems.
behaviors
 Nutrition assessment requires making
 Identify standards by which data will be
comparisons between the information obtained
compared
and reliable standards (ideal goals).
 Identify possible problem areas for making
 Nutrition assessment is an on-going, dynamic
nutrition diagnoses
process that involves not only initial data
Critical Thinking
collection, but also continual reassessment and
analysis of patient/client/group needs. The following types of critical thinking skills are
 Assessment provides the foundation for the especially needed in the assessment step:
nutrition diagnosis at the next step of the
Nutrition Care Process.  Observing for nonverbal and verbal cues that
can guide and prompt effective interviewing
methods
The specific types of data gathered in the assessment  Determining appropriate data to collect
will vary depending on:  Selecting assessment tools and procedures
(matching the assessment method to the
a) practice settings situation)
b) individual/groups’ present health status  Applying assessment tools in valid and reliable
c) how data are related to outcomes to be measured ways
 Distinguishing relevant from irrelevant data
Data Sources/Tools for Assessment  Distinguishing important from unimportant data
 Referral information and/or interdisciplinary  Validating the data
records
  Organizing & categorizing the data in a  As with other areas of nutritional assessment,
meaningful framework that relates to nutrition biochemical data need to be viewed as part of
problems the whole.
 Determining when a problem requires  static biochemical tests: measure either a
consultation with or referral to another nutrient in biological fluids or tissues or the
provider. urinary excretion of the nutrient or its
metabolite; especially useful in identifying the
second and third stages in the development of a
Documentation of Assessment nutritional deficiency
 Documentation is an on-going process that  functional tests: not only used to detect later
supports all of the steps in the Nutrition Care stages in the development of a nutritional
Process. deficiency but also to measure nutrient status
 Quality documentation of the assessment step associated with optimal health and reduction of
should be relevant, accurate, and timely. the risk of chronic disease
 Inclusion of the following information would  hemoglobin estimation is the most important
further describe quality assessment test and useful index of the overall state of
documentation: nutrition. Aside from anemia, it also tells about
protein and trace element nutrition
> Date and time of assessment  stool examination for the presence of ova
> Pertinent data collected and comparison with and/or parasites
standards  urine dipstick & microscopy for the presence of
> Patient/client/groups’ perceptions, values, and albumin, sugar and blood measurement of
motivation related to presenting problems individual nutrient in body fluids (serum retinol,
> Changes in patient/client/group’s level of iron, urinary iodine, vitamin D)
understanding, food-related behaviors, and other  detection of abnormal amount of metabolites in
clinical outcomes for appropriate follow-up the urine (urinary creatinine/hydroproline ratio)
> Reason for discharge/discontinuation if appropriate.  analysis of hair, nails and skin for micronutrients

Determination for Continuation of Care CLINICAL ASSESSMENT

- If upon the completion of an initial or • It is an essential feature of all nutritional
reassessment, it is determined that the problem surveys.
cannot be modified by further nutrition care, • It is the simplest & most practical method of
discharge or discontinuation from this episode ascertaining the nutritional status of a group of
of nutrition care may be appropriate. individuals.
• It utilizes a number of physical signs (specific &
METHODS OF NUTRITIONAL ASSESSMENT nonspecific) that are known to be associated
• Anthropometric methods with malnutrition and deficiency of vitamins &
• Biochemical and laboratory methods micronutrients.
• Clinical methods • Good nutritional history should be obtained
• Dietary evaluation methods • General clinical examination with special
attention to organs like hair, angles of the
BIOCHEMICAL AND LABORATORY METHODS mouth, gums, nails, skin, eyes, tongue, muscles,
bones & thyroid gland
 Provide the most objective and quantitative • Detection of relevant signs helps in establishing
data on nutritional status the nutritional diagnosis
 Laboratory tests based on blood and urine can
be important indicators of nutritional status, DIETARY ASSESSMENT
but they are influenced by non-nutritional  24 hour food recall
factors as well.  Food frequency questionnaire
 Laboratory results can be altered by  Food dairy/dietary records
medications, hydration status, and disease  Diet history
states or metabolic processes, such as stress.  Food consumption record
24-HOUR DIETARY RECALL
• Record of all foods and beverages consumed • “Nutrition Diagnosis” is the second step of the
the previous day or over the past 24 hours prior Nutrition Care Process, and is the identification
to interview and labeling that describes an actual
• Interview conducted face-to-face, structured occurrence, risk of, or potential for developing a
without probing questions nutritional problem that dietetics professionals
• Estimates of portion size are made using are responsible for treating independently.
standardized cups and spoons • At the end of the assessment step, data are
• Record of food amounts converted into nutrient clustered, analyzed, and synthesized.
intakes using food composition tables • This will reveal a nutrition diagnostic category
from which to formulate a specific nutrition
FOOD DIARY/DIETARY RECORDS diagnostic statement.
• Self-reported account of all food and beverages • Nutrition diagnosis should not be confused with
consumed by a respondent over a specified medical diagnosis, which can be defined as a
period of time disease or pathology of specific organs or body
• Useful in assessing total dietary intake and/or systems that can be treated or prevented.
particular aspects of the diet • A nutrition diagnosis changes as the
• May be used to estimate current diet of patient/client/group’s response changes.
individuals and population groups, as well as to • A medical diagnosis does not change as long as
identify groups at risk of inadequacy the disease or condition exists.
• A patient/client/group may have the medical
FOOD FREQUENCY QUESTIONNAIRE diagnosis of “Type 2 diabetes mellitus”;
however, after performing a nutrition
 Report usual frequency of consumption of each assessment, dietetics professionals may
food item from a list of food items in reference diagnose, for example, “undesirable overweight
to a specified period (past week/month/year) status” or “excessive carbohydrate intake.”
 Face-to-face interview, telephone or by • Analyzing assessment data and naming the
administration nutrition diagnosis(es) provide a link to setting
 Describes dietary patterns or food habits not realistic and measurable expected outcomes,
nutrient intake selecting appropriate interventions, and
tracking progress in attaining those expected
DIET HISTORY outcomes.
 An accurate method for assessing nutritional
Data Sources/Tools for Diagnosis
status
• Organized and clustered assessment data
 Information should be collected by a trained
• List(s) of nutrition diagnostic categories and
interviewer.
nutrition diagnostic labels
 Detailed information about an individual’s usual
• Currently the profession does not have a
intake, types, amount, frequency & timing
standardized list of nutrition diagnoses.
 Cross-checking to verify data is important
Nutrition Diagnosis Components (3 distinct parts)
FOOD CONSUMPTION RECORD
1. Problem (Diagnostic Label)
• Direct observation of dietary intake and food
• The nutrition diagnostic statement describes
consumption behaviour by a trained personnel
alterations in the patient/client/group’s
• Provides an objective assessment of dietary
nutritional status.
intake and
• A diagnostic label (qualifier) is an adjective that
• accurate information on the social and physical
describes/qualifies the human response such
context of dietary intake
as:
• Most unused method in clinical practice but
> Altered, impaired, ineffective,
recommended for research purposes
increased/decreased, risk of, acute or chronic.
• Highly accurate but expensive and requires time
& effort
2. Etiology (Cause/Contributing Risk Factors)
STEP 2. NUTRITION DIAGNOSIS
 The related factors (etiologies) are those factors > The signs (objective data) are observable
contributing to the existence of, or maintenance of changes in the patient/client/group’s health
pathophysiological, psychosocial, situational, status.
developmental, cultural, and/or environmental
problems. Nutrition Diagnostic Statement (PES)
• Linked to the problem diagnostic label by words • Whenever possible, a nutrition diagnostic
“related to” (RT) statement is written in a PES format that states
• It is important not only to state the problem, the
but to also identify the cause of the problem. • Problem (P), the Etiology (E), and the Signs &
• This helps determine whether or not nutritional Symptoms (S).
intervention will improve the condition or • However, if the problem is either a risk
correct the problem. (potential) or wellness problem, the nutrition
• It will also identify who is responsible for diagnostic statement may have only two
addressing the problem. elements,
• Nutrition problems are either caused directly by • Problem (P), and the Etiology (E), since Signs &
inadequate intake (primary) or as a result of Symptoms (S) will not yet be exhibited in the
other medical, genetic, or environmental patient.
factors (secondary).
• It is also possible that a nutrition problem can A well-written Nutrition Diagnostic Statement should
be the cause of another problem. For be:
example,excessive caloric intake may result in 1. Clear and concise
unintended weight gain. 2. Specific: patient/client/group-centered
• Understanding the cascade of events helps to 3. Related to one client problem
determine how to prioritize the interventions. 4. Accurate: relate to one etiology
• It is desirable to target interventions at 5. Based on reliable and accurate assessment data
correcting the cause of the problem whenever
possible; however, in some cases treating the Examples of Nutrition Diagnosis Statements (PES or PE)
signs and symptoms (consequences) of the • Excessive caloric intake (problem) “related to”
problem may also be justified. frequent consumption of large portions of high
• The ranking of nutrition diagnoses permits fat meals (etiology) “as evidenced by” average
dietetics professionals to arrange the problems daily intake of calories exceeding recommended
in order of their importance and urgency for the amount by 500 kcal and 12-pound weight gain
patient/client/group. during the past 18 months (signs)
• Inappropriate infant feeding practice RT lack of
3. Signs/Symptoms (Defining Characteristics) knowledge AEB infant receiving bedtime juice in
• The defining characteristics are a cluster of a bottle
subjective and objective signs and symptoms • Unintended weight loss RT inadequate
established for each nutrition diagnostic provision of energy by enteral products AEB 6-
category. pound weight loss over past month
• The defining characteristics, gathered during • Risk of weight gain RT a recent decrease in daily
the assessment phase, provide evidence that a physical activity following sports injury
nutrition related problem exists and that the •
problem identified belongs in the selected Documentation of Diagnosis
diagnostic category.
• They also quantify the problem and describe its  Documentation is an on-going process that
severity: supports all of the steps in the Nutrition Care
> Linked to etiology by words “as evidenced by” Process.
(AEB)  Quality documentation of the diagnosis step
> The symptoms (subjective data) are changes should be relevant, accurate, and timely.
that the patient/client/group feels and  A nutrition diagnosis is the impression of
expresses verbally to dietetics professionals dietetics professionals at a given point in time.
  Therefore, as more assessment data become 3. Biochemical data, medical tests and procedures
available, the documentation of the diagnosis 4. Nutrition focused physical examination findings
may need to be revised and updated.
Critical Thinking during this step:
Inclusion of the following information would further 1. Selecting appropriate indicators/measures
describe quality documentation of this step: 2. Using appropriate reference standards for
comparison
 Date and time 3. Defining where patient/clients is in terms of expected
 Written statement of nutrition diagnosis outcomes
4. Explaining a variance from expected outcomes
Determination for Continuation of Care 5. Determining factors that help or hinder progress
• Since the diagnosis step primarily involves 6. Deciding between discharge and continuance of
naming and describing the problem, the nutrition care
determination for continuation of care seldom
occurs at this step. WEEK 9 - NUTRITION ACROSS THE LIFESPAN
• Determination of the continuation of care is
more appropriately made at an earlier or later NUTRITION IN INFANCY
point in the Nutrition Care Process.
NUTRITION EDUCATION
STEP 3. NUTRITION INTERVENTION - designed to encourage positive, appropriate
• is a purposely planned actions designed with feeding practices and, if necessary, recommend
the intent of changing a nutrition-related strategies to correct inappropriate practices.
behavior, risk factor, NUTRITION ASSESSMENT
• environmental condition, or aspect of health - provides the nutritionist or health counselor
status consists of planning and implementing with important feeding practices and other
• directed toward resolving nutrition diagnosis or information pertinent to an infant’s health.
the nutrition etiology ACCURATE ASSESSMENT OF THE INFANT’S
NUTRITIONAL STATUS
Four categories of Nutrition Intervention - used to determine infant’s nutritional needs
1. Food and/or Nutrient Delivery and develop a nutrition care plan.
2. Nutrition Education
3. Nutrition Counseling PARTS OF ASSESSMENT
4. Coordination of Nutrition Care 1. Medical and Health Information
2. Dietary Intake
Critical Thinking during this step: 3. Anthropometric Data
1. Setting goals and prioritizing 4. Biochemical Data
2. Defining the nutrition Prescription or basic plan
3. Making interdisciplinary connections Health and Medical Information
4. Initiating behavioral and other nutrition interventions • Information gathered through chart review,
5. Matching nutrition intervention strategies with caregiver interview, health care provider
patient/ client’s need, nutrition diagnosis, and values referral form(s), or other sources that may
6. Choosing from among alternatives to determine a include history of chronic or acute illnesses or
course of action medical conditions, birth history,
7. Specifying the time and frequency of care developmental disabilities, a clinical assessment
STEP 4. NUTRITION MONITORING & EVALUATION identifying signs of nutritional deficiencies, and
other pertinent information
• identifies the amount of progress made and Example: immunization record
whether goals/expected outcomes are being
met Dietary Intake Data
Feeding history – Eating behaviors, feeding techniques,
Four categories of outcomes measured: feeding problems, and environment.
1. Food and nutrition related history
2. Anthropometric measurements
Appetite and intake – Usual appetite, factors affecting
intake such as preferences, allergies, intolerances, Physiology
chewing/swallowing problems, feeding skills • The average weight at birth is 3.5 kg, with a
normal range of 2.7–4.6 kg.
Diet history – Breastfed and/or infant formula-fed; • The average length is 50 cm and the average
frequency and duration of breast feeding; frequency occipitofrontal head circumference is 35 cm.
and amount of infant formula complementary foods • The heart rate is between 110 and 160
fed; age at introduction of complementary foods; beats/minute.
variety of complementary foods provided; • The respiratory rate is 30–50 breaths/minute.
vitamin/mineral or other supplements given; and • Respiration is noiseless; respiratory ‘grunting’
problems such as vomiting, diarrhea, constipation, or must be investigated at once.
colic; • The average systolic blood pressure is 75–100
mg/Hg, and the circulating blood volume is 85–
Socioeconomic background 90 mL/kg.
1. Primary and other caregivers • The normal body temperature range is from
2. Food preparation 36.5 to 37.4°C (axillary).
3. Storage facilities
4. Use of supplemental feeding and financial Reflexes
assistance programs • Appropriate neurological development is
5. Access to health care indicated by the presence of primitive or
6. Ethnic and/or cultural influences on the diet. primary reflexes (sucking, rooting, and snout
Anthropometric Data reflexes)
• Anthropometric measurements, i.e., weight for • These reflexes can be elicited in the healthy
age, length for age, weight for length, and head term infant and should disappear with
circumference for age (Infantometer) increasing maturity.
Biochemical Data (Their absence in the neonate is suggestive of
• Data used to diagnose or confirm nutritional depression of the central nervous system) (slow brain
deficiencies or excesses, hemoglobin, activity)
hematocrit, or other hematological tests are (Persistence of primitive reflexes beyond infancy may
performed to screen for iron deficiency anemia. be a sign of central nervous system pathology)

Characteristics of a healthy full term infant Reflexes that can be elicited in the neonatal period
include :
Appearance • Sucking reflex - involuntary movements that
• A term baby is one born between 37 and 42 happen either spontaneously or as responses to
weeks’ gestation. different actions. The sucking reflex, for
• The dermis is well formed and the skin is usually example, happens when the roof of a baby's
smooth, with adequate subcutaneous fat and mouth is touched. The baby will begin to suck
good muscle tone. when this area is stimulated, which helps with
• The skin is generally well perfused although nursing or bottle feeding
transient mild blueness of the feet and hands is • Rooting reflex - starts when the corner of the
normal at birth. baby's mouth is stroked or touched. The baby
• The skin should be free from blemishes. will turn his or her head and open his or her
• Injuries such as cuts, bruises, marks from mouth to follow and root in the direction of the
forceps blades or ventouse cups must be stroking. This helps the baby find the breast or
recorded. bottle to start feeding. This reflex lasts about 4
• Movements, including chest wall movement, months
are symmetrical. • Moro (startle) reflex - startle reflex. That's
• Asymmetrical limb movement may indicate because it usually occurs when a baby is
skeletal, muscle or nerve damage. startled by a loud sound or movement
• The infant will be vigorous and the cry lusty, not • Palmar grasp reflex (grasp reflex) - is a
weak, or high-pitched. primitive and involuntary reflex found in infants
of humans, most primates, and domesticated
 felines. When an object, such as an adult finger, • Experts say breast milk is the best source of
is placed in an infant's palm, the infant's fingers nutrition for babies during the first 6 months,
reflexively grasp the object. but formula can be a good alternative.

[ Persistence of the grasp reflex could be an indication First 6 Months

of brain lesions or cerebral palsy. Presence of the reflex • Calcium. Helps build strong bones and teeth.
in infants older than four months could be an indicator • Fat. Creates energy, helps the brain develop,
of damage to the central nervous system. This damage keeps skin and hair healthy, and protects
could be a result of neural degeneration, lack of oxygen against infections.
in the brain, or other genetic factors ] • Folate- Helps cells divide.
• Iron- Builds blood cells, and helps the brain
• Plantar grasp reflex - It can be tested by lightly develop. Breast-fed babies should receive iron
touching your baby's feet or toes. The palmar supplements.
reflex only lasts until your child is about 6 • Protein and carbohydrates- provide energy and
months old fuel growth.
• Zinc- Helps the cells grow and repair themselves

Your baby also needs vitamins such as:

• Vitamin A. Keeps skin, hair, vision, and the
immune system healthy.
• Vitamin B1 (thiamine). Helps the body turn food
into energy.
• Vitamin B2 (riboflavin). Helps the body turn
food into energy, and protects cells from
damage.
• Vitamin B3 (niacin). Helps the body turn food
into energy and use fats and protein
Feeding • Vitamin B6. Keeps the brain and immune
• optimal method of infant nutrition and provides system healthy.
all the fluid and nutrient requirements for the • Vitamin B12. Keeps nerve and blood cells
infant. healthy, and makes DNA -- the genetic material
• encourages proximity to the mother thus in every cell.
helping maintain body temperature and normal • Vitamin C. Protects against infections, builds
heart and respiratory rate. bones and muscles, and helps wounds heal.
• Some babies will not be breast fed, either from • Vitamin D. Helps the body absorb calcium from
maternal choice or from necessity. food, and keeps bones and teeth healthy.
Elimination Breast-fed babies may need a D supplement.
• The infant will usually pass urine and meconium • Vitamin E. Protects cells from damage, and
within 24 hours of birth. strengthens the immune system.
• Once milk feeding starts the stools change from • Vitamin K. Helps the blood to clot
dark green meconium to brownish (changing
stools) then to yellow, usually at around 5 days
of life. Nutrients in Formula (Most infant formulas today are
• Urinary output is usually approximately 100– made from cow's milk. They are fortified to make them
200 mL/kg/day by 7 days of life. as close to breast milk as possible, and to give babies all
Dietary Requirements the nutrients they need to grow and be healthy.)
• Your baby is about to go through an
amazing growth spurt. Expect your baby to Most cow's milk formulas contain:
double his or her birth weight by about age 5 -6
months and triple their birth weight by a year of - Carbohydrates, in the form of the milk sugar
age.. To grow that much, they need a lot of "lactose"
nutrients -- more than at any other time in their - Iron
life. - Protein
 - Minerals, such as calcium and zinc **You also don't want to give your baby soy milk or
- Vitamins, including A, C, D, E, and the B vitamins homemade formula. These substitutes may not have
the balance of nutrition baby needs right now
Some formulas add other nutrients to make them even
more like breast milk, such as: Important Nutrients for Infants
• Essential fatty acids. ARA and DHA are fatty  Energy
acids that are important for the baby's brain  Carbohydrates
and vision.  Protein
They're naturally found in breast milk when the mother  Fat
includes them in their own diet. Many formulas add
them. Yet there's not a lot of evidence that formulas Important Nutrients
supplemented with fatty acids offer kids any real Energy
advantages as they grow • for activity,growth, and normal development.
• Energy comes from foods containing
• Nucleotides. These building blocks of RNA and carbohydrate, protein, or fat.
DNA are also found in breast milk and added to Kilocalorie
some formulas • is a measure of how much energy a food
• Prebiotics and probiotics. supplies to the body and is technically defined
Probiotics are "good" bacteria that might help as the quantity of heat required to raise the
protect against the "bad" types of bacteria that temperature of 1 kilogram of water 1 degree
cause infection. Celsius.
Prebiotics promote the growth of these good
bacteria in the gut. Formula that's supplemented Factors Affecting Infant’s Energy or Caloric
with probiotics may prevent babies from getting the Requirement
skin condition eczema, but it doesn't seem to help • body size
with diarrhea or colic. • composition
• metabolic rate (the energy the body expends at
Babies Who Need Special Nutrition to Help them Catch rest)
Up on Growth. • physical activity, size at birth, age, sex, genetic
• Babies who were born early (before 37 weeks) factors, energy intake, medical conditions,
• Babies with low birth weight (less than 5 ambient temperature, and growth rate.
pounds, 8 ounces) ***Infants are capable of regulating their intake of food
Breast-fed babies may get a fortifier added to the milk, to consume the amount of kilocalories they need.
which contains:
• Extra calories Energy Intake and Growth Rate
• Extra fat • A general indicator of whether an infant is
• Protein consuming an adequate number of kilocalories
• Vitamins per day is the infant’s growth rate in length,
• Minerals weight, and head circumference.
Babies who can't breast-feed will need a special Physical growth
formula made for preterm babies. These formulas • is a complex process that can be influenced by
are higher in calories. They also contain extra size and gestational age at birth,environmental
protein, vitamins, and minerals and genetic factors, and medical conditions, in
addition to dietary intake.
What to Avoid During the First 12 Months
Whole cow's milk. An infant’s growth rate can be assessed by periodically
• It doesn't have enough iron, vitamin E, and plotting the:
essential fatty acids for your baby. • infant’s weight
• It contains too much protein, sodium, and • length,
potassium for your child's body to absorb and • head circumference for age and weight for
can cause harm. length
• Wait to introduce cow's milk until your baby is 1
year old.
 Healthy infants double their birth weight by Lactose-free infant formulas (soy-based infant formulas)
6 months of age and triple it by 12 months • provide carbohydrates in the form of
of age. sucrose,corn syrup, or corn syrup solids.
Keep in mind that there are normal • prescribed to infants who cannot metabolize
differences in growth between healthy lactose or galactose, a component of lactose.
breastfed and formula-fed infants during
the first year of life. In later infancy, infants derive carbohydrates
After 3 months of age, the rate of weight from additional sources including cereal and
gain in the breastfed infant may be lower other grain products, fruits, and vegetables.
than that of formula-fed infants, but Infants who consume sufficient breast milk or
differences are generally not reported infant formula and appropriate complementary
between these infants for length and head foods later in infancy will meet their dietary
circumference needs for carbohydrates.

Carbohydrates
• 0–6 months 60 g/day of carbohydrate
• 7–12 months 95 g/day of carbohydrate
Carbohydrates fall into these major categories:
• simple sugars or monosaccharides (e.g.,
glucose, galactose, fructose, and mannose)
• double sugars or disaccharides (e.g., sucrose,
lactose, and maltose)
• complex carbohydrates or polysaccharides (e.g.,
starch, dextrins, glycogen,
• and indigestible complex carbohydrates such as
pectin, lignin, gums, and cellulose)

Dietary Fiber
• another name for indigestible complex
carbohydrates of plant origin (these are not
broken down by intestinal digestive enzymes).
• Sugar alcohols, including sorbitol and mannitol,
are also important to consider for infants.

Functions of Carbohydrates

Carbohydrates serve as primary sources of energy

to fuel bodily activities while protein and fat are Fiber found in:
needed for other essential functions in the body, • legumes
such as building and repairing tissues. • wholegrain foods
• fruits
• Supply food energy for growth, body functions, • vegetables
and activity;
• Allow protein in the diet to be used efficiently Note:
for building new tissue; • Breast milk contains no dietary fiber, and
• Allow for the normal use of fats in the body infants generally consume no fiber in the first 6
• Provide the building blocks for some essential months of life.
body compounds. • As complementary foods are introduced to the
diet, fiber intake increases
Lactose • It has been recommended that from 6 to 12
• the carbohydrate source in breast milk and months whole-grain cereals, green vegetables,
cow’s and legumes be gradually introduced to provide
milk-based infant formula. 5 grams of fiber per day by 1 year of age.
 • results from a deficiency of kilocalories
Protein For Infants MARASMUS-KWASHIORKOR
• 0–6 months 9.1 g/day of protein • resulting from a deficiency of kilocalories and
For older infants protein.
• 7–12 months 11 g/day of protein
Characteristics of Marasmus
ESSENTIAL/INDISPENSABLE AMINO ACID • Wasting of fat and muscle.
• there are 9 of these and cannot be • Emaciated
manufactured in the body, therefore must be • The loss of fat and muscle under the skin may
provided by the diet cause the skin to hang loose in folds
• histidine, isoleucine, leucine, lysine, methionine, • A state of infantile starvation, characterized by
phenylalanine, threonine, tryptophan, and marked under- weight, with atrophy of both
valine. muscles and subcutaneous fat.
****PVT TIMHaLL • The face is monkey-like, due to the absence of
fat pads in the cheeks.
CYSTINE & TYROSINE
• essential for the preterm and young term infant DIFFERENCE BETWEEN KWASHIORKOR & MARASMUS
because enzyme activities involved in their
synthesis are immature.

Functions
• Infants require high quality protein from breast
milk to:
▘ Build, maintain, and repair new tissues,
including tissues of the skin, eyes, muscles,
heart, lungs, brain, and other organs;
▘ Manufacture important enzymes, hormones,
Lipids/Fats
antibodies, and other components; and
• 0–6 months 31 g/day of fat
▘ Perform very specialized functions in
• 7–12 months 30 g/day of fat
regulating body processes.
ESSENTIAL FATTY ACIDS
Sources
• must be provided in the diet to maintain health
• Breast milk and infant formulas provide
Linoleic acid and α-linolenic acid
sufficient protein to meet a young infant’s
• both essential fatty acids.
needs if consumed in amounts necessary to
• small amounts of linoleic and α-linolenic acid
meet energy needs.
must be provided in the diet
• In later infancy, sources of protein in addition to
breast milk and infant formula include meat,
Two other fatty acids
poultry, fish, egg yolks, cheese, yogurt, legumes,
Arachidonic acid (ARA) and docosahexaenoic acid (DHA)
and cereals and other grain products.
• also known as long-chain polyunsaturated fatty
acids (LCPUFA)
When an infant starts receiving a substantial portion of
• are derived from linoleic acid and α-linolenic
energy from foods other than breast milk or infant
acid respectively.
formula, these complementary foods need to provide
• they are considered essential fatty acids only
adequate protein
when linoleic acid and α-linolenic acid are
lacking in the diet.
Protein Deficiency
Requirements for n-6 Polyunsaturated Fatty Acids
KWASHIORKOR
(Linoleic acid [LA], Arachidonic acid [ARA])
• Infants who are deprived of adequate types and
• 0–6 months 4.4 g/day of n-6 polyunsaturated
amounts of food for long periods of time,
fatty acids
resulting principally from a protein deficiency
• 7–12 months 4.6 g/day of n-6 polyunsaturated
MARASMUS
fatty acids
Requirements for n-3 Polyunsaturated Fatty Acids (α- • Cholesterol is not added to infant formulas
Linolenic acid [ALA], Docosahexaenoic acid [DHA]) whereas breast milk contains a significant
• 0–12 months 0.50 g/day of n-3 polyunsaturated amount of cholesterol.
fatty acids Notes:
• No restriction of fat and cholesterol is
Functions recommended for infants <2 years when rapid
▘ Supply a major source of energy – fat supplies growth and development require high energy
approximately 50 percent of the energy intakes.
consumed in breast milk and infant formula; • The fast growth of infants requires an energy-
▘ Promote the accumulation of stored fat in dense diet with a higher percentage of
the body which serves as insulation to reduce kilocalories from fat than is needed by older
body heat loss, and as padding to protect body children.
organs;
▘ Allow for the absorption of the fat-soluble Trans fats
vitamins A, D, E, and K; and
▘ Provide essential fatty acids that are required Where does trans fat come from?
for normal brain development, healthy skin Artificial trans fats (or trans fatty acids) are created in an
and hair, normal eye development, and industrial process that adds hydrogen to liquid
resistance to infection and disease. vegetable oils to make them more solid. The primary
dietary source for trans fats in processed food is
Sources “partially hydrogenated oils.
• Breast milk and infant formula are important
sources of lipids, including essential fatty acids, • Which are believed to be similar to saturated
during infancy. fats in their atherosclerotic affect,
• The lipid content of breast milk varies, but after • Are found in fat that has been modified to a
about the first 2 weeks postpartum, breast milk more solid form, such as polyunsaturated oils
provides approximately 50 percent of its • Used to make spreadable margarine
calories from lipids. • Not routinely used in the preparation of infant
• Infant formulas also provide approximately 50 formulas
percent of their calories as fat.
• Breast milk provides approximately 5.6 g/liter of WEEK 10. BASIC NUTRITION & DIET THERAPY
linoleic acid,16 while infant formulas currently
provide 3.3–8.6 g/liter. ADOLESCENCE
• In addition, breast milk provides approximately • Period of transition between childhood and
0.63 g/liter of n-3 polyunsaturated fatty acids adulthood.
(including α-linolenic acid and docosahexaenoic • Adolescence begins at puberty, which now
acid) while infant formulas provide 0 to 0.67 occurs earlier, on average, than in the past.
g/liter • The end of adolescence is tied to social and
• Manufacturers of infant formulas add blends of emotional factors and can be somewhat
vegetable oils, which are high in linoleic acid, to ambiguous
improve essential fatty acid content.
• Food sources of lipids in the older infant’s diet, Changes during Adolescence
other than breast milk and infant formula,  Physical
include meats, cheese and other dairy products,  Intellectual
egg yolks, and any fats or oils added to home-  Personality development
prepared foods.  Social Development

Cholesterol and Fatty Acids in Infant Diets PHYSICAL CHANGES

• Cholesterol performs a variety of functions in • The growth spurt (an early sign of maturation)
the body but is not an essential nutrient • Primary sex characteristics (changes in the
because it is manufactured by the liver. organs directly related to reproduction)
 • Secondary sex characteristics (bodily signs of • It can also include the ability to consider many
sexual maturity that do not directly involve points of view and compare or debate ideas or
reproductive organs) opinions.
• It can also include the ability to consider the
Growth Spurt process of thinking
• short periods of time when your child
experiences quick physical growth in height and Cognitive Changes during Adolescence
weight. Between 12 and 18 years of age
Primary Sex Characteristics • The developing teenager gains the ability to
• Present at birth and comprise the external and think systematically about all logical
internal genitalia (male genitalia and female relationships within a problem
genitalia) • The transition from concrete thinking to formal
Secondary Sex Characteristics logical operations happens over time
• Those that emerge during the prepubescent
through postpubescent phases (e.g., breasts in Three stages of adolescence
females and pigmented facial hair in males)  Early adolescence (10 to 13 years)
PREPUBESCENCE  Middle adolescence (14 to 17 years
• Begins with the first indication of sexual  Late adolescence/young adulthood (18 to 21
maturation. years and beyond)
• It ends with the initial appearance of pubic hair.
Males EARLY ADOLESCENCE/PRE-TEENS (10-13 years old)
• there is a continuing enlargement of the • Have concrete, black-and-white, all-or-nothing
testicles thinking and a limited capacity for abstract
• an enlargement and reddening of the scrotal thought
sac • Thinking may be egocentric
• an increase in the length and circumference of • May be self-conscious about their appearance
the penis and apprehensive about being judged by their
Females peers
Primary Characteristics • Intellectual interests expand, and early
• Prepubescent changes typically begin an adolescents develop deeper moral thinking
average of two years earlier than in males. • Also feel an increased need for privacy
• The first phenomena of female development in • They explore how to be independent from their
this period are the enlargement of the ovaries family and may push boundaries and react
and the ripening of the ova. strongly when limits are enforced
Secondary Characteristics • Complex thinking is focused on personal
• Rounding of the hips decision making in school and home
• First phase of breast development environments. This can include:
• Latter phase of breast development begins with *Begins to demonstrate use of formal logical operations
an elevation of the areola surrounding the in schoolwork.
nipple, which produces a small conelike growth *Begins to question authority and society standards.
called the breast bud
• Begins to form and verbalize their own thoughts
INTELLECTUAL CHANGES/COGNITIVE DEVELOPMENT and views on a variety of topics. These are
development of the ability to think and reason usually more related to their own life, such as:
***Features indicating growth from more simple to *Which sports are better to play
more complex cognitive development depends on each *Which groups are better to be included in
stage of Adolescence *What personal looks are desirable or attractive
*What parental rules should be changed
Adolescence Complex Thinking Processes
• Also called formal logical operations. MIDDLE ADOLESCENCE (14-17 years old)
• Include abstract thinking the ability to form • Interest in romantic and sexual relationships
their own new ideas or questions. may start and teens may question and explore
their sexual identity
 • Masturbation may be a part of this sexual *Develops idealistic views on specific topics or
exploration and getting to know their body concerns
• Arguments with parents may increase as teens *Debates and develops intolerance of opposing
strive for more independence views
• Less time is spent with family and more time is *Begins to focus thinking on making career
spent with friends decisions
• Teens become more self-involved, appearances *Begins to focus thinking on emerging role in adult
are important, and peer pressure can peak at society
this stage
• The brain continues to mature and there is a Fostering Healthy Adolescent Cognitive Development
growing capacity for abstract thought To help encourage positive and healthy cognitive
• Emotions often drive decision-making and they development in the adolescent:
may act on impulse without thinking things • Help adolescents in getting adequate sleep,
through hydration, and nutrition.
• During this stage, children may start to set long- • Include adolescents in discussions about a
term goals and become interested in the variety of topics, issues, and current events.
meaning of life and moral reasoning • Encourage adolescents to share ideas and
• Focus of middle adolescence often includes thoughts with adults.
more philosophical and futuristic concerns. • Encourage adolescents to think independently
Examples may include: and develop their own ideas.
*Often questions and analyzes more extensively • Help adolescents in setting their own goals.
*Thinks about and begins to form their own code of • Encourage adolescents to think about
ethics (such as, What do I think is right?) possibilities of the future.
*Thinks about different possibilities and begins to • Compliment and praise adolescents for well-
develop own identity (such as, Who am I?) thought-out decisions.
*Thinks about and begins to consider possible • Help adolescents in reviewing any poorly made
future goals (such as, What do I want?) decisions
*Thinks about and begins to make their own plans
*Begins to think long term PERSONALITY DEVELOPMENT
*Begins to consider how to influence relationships starts to develop from birth; the personality of a person
with others can be traced back from birth

Refers to the process by which the organized thought

LATE ADOLESCENCE/YOUNG ADULTHOOD(18 to 21 and behavior patterns make up a person's unique
years and beyond) personality emerge over time.
• Encompasses less physical development and
more cognitive developments Factors Influence Personality
• Most have grown to their full adult height  genetics
• Young people become able to think about ideas  environment
rationally, have impulse control and can delay  how we were parented
gratification, and plan for the future  societal variables
• They have a stronger sense of identity and
individuality and can identify their own values Temperament
• They also experience increased independence, • is a key part of personality that is determined by
emotional stability, stability in friendships and inherited traits.
romantic relationships, and may also establish Character
an “adult relationship” with parents, looking to • is an aspect of personality influenced by
them less as authority figures and more as peer experience that continues to grow and change
• Focus on less self-centered concepts and throughout life
personal decision making. Examples may
include:
*Increased thoughts about more global concepts
such as justice, history and politics
Freud (1905) anus, and the child derives great pleasure from
• Proposed that personality development in defecating.
childhood takes place during five psychosexual • The child is now fully aware that they are a
stages. person in their own right and that their wishes
• Believed that life was built around tension and can bring them into conflict with the demands
pleasure. of the outside world (i.e., their ego has
Also believed that all tension was due to the build-up of developed).
libido (sexual energy) and that all pleasure came from • Early or harsh potty training can lead to the
its discharge child becoming an anal-retentive personality
who hates mess, is obsessively tidy, punctual
Five Psychosexual Stages of Development and respectful of authority. They can be
 Oral stubborn and tight-fisted with their cash and
 Anal possessions.
 Phallic • In adulthood, the anal expulsive is the person
 Latency who wants to share things with you. They like
 Latency giving things away. In essence, they are 'sharing
their s**t'!' An anal-expulsive personality is
The Oral also messy, disorganized and rebellious.
• sucking
• swallowing PHALLIC STAGE (3 to 6 years)
• EGO develops • The phallic stage is the third stage of
The Anus psychosexual development, spanning the ages
• witholding or expelling feces of three to six years, wherein the infant's libido
Phallic - penis or clitoris (desire) centers upon their genitalia as the
• Masturbation erogenous zone.
• Superego develops • The child becomes aware of anatomical sex
Latency differences, which sets in motion the conflict
• Little or no sexual motivation between erotic attraction, resentment, rivalry,
Genital Stage jealousy and fear which Freud called the
• Penis Oedipus complex (in boys) and the Electra
• Vagina complex (in girls).
• Sexual Intercourse
This is resolved through the process of identification,
THE ORAL (birth to 1 year) which involves the child adopting the characteristics of
• 1st stage of psychosexual development the same sex parent
• the libido is centered in baby’s mouth
• the baby gets much satisfaction from putting all LATENCY STAGE (6 years to puberty)
sorts of things in its mouth to satisfy the libido • The latency stage is the forth stage of
• which at this stage in life are oral, or mouth psychosexual development, spanning the period
orientated, such as sucking, biting, and of six years to puberty. During this stage the
breastfeeding. libido is dormant and no further psychosexual
• Freud said oral stimulation could lead to an oral development takes place (latent means hidden).
fixation in later life. • Freud thought that most sexual impulses are
• We see oral personalities all around us such as repressed during the latent stage, and sexual
smokers, nail-biters, finger-chewers, and thumb energy can be sublimated towards school work,
suckers. hobbies, and friendships.
• Oral personalities engage in such oral behaviors, • Much of the child's energy is channeled into
particularly when under stress. developing new skills and acquiring new
knowledge, and play becomes largely confined
ANAL STAGE (1 to 3 years) to other children of the same gender
• During the anal stage of psychosexual
development the libido becomes focused on the
GENITAL STAGE (puberty to adult) NUTRITION AND ADOLESCENTS
• The genital stage is the last stage of Freud's • Adolescence is the second-fastest growth stage
psychosexual theory of personality in life after infancy.
development, and begins in puberty. It is a time • The adolescent’s growth spurt during this
of adolescent sexual experimentation, the period creates an increased need for many
successful resolution of which is settling down nutrients.
in a loving one-to-one relationship with another • Eating right assures an adequate amount of key
person in our 20's. nutrients: calcium, iron and vitamins A, C and D.
• Sexual instinct is directed to heterosexual • Some teens have a need for even more
pleasure, rather than self-pleasure like during nutrients if they are active in sports, following a
the phallic stage. special diet, have an eating disorder or are
• For Freud, the proper outlet of the sexual pregnant.
instinct in adults was through heterosexual
intercourse. Fixation and conflict may prevent Healthy Eating During Adolescence
this with the consequence that sexual • Parents / caregivers should set a good example
perversions may develop. in food/beverage choices and exercise.
• For example, fixation at the oral stage may • Make healthy foods, snacks and fluids available:
result in a person gaining sexual pleasure fruits, vegetables, low-fat dairy products, lean
primarily from kissing and oral sex, rather than proteins, water and sugar-free drinks.
sexual intercourse • Make time for family meals.
• Avoid more than two hours a day of TV,
SOCIAL DEVELOPMENT computer and video games.
The process of social development moves adolescents • Encourage your teen to participate in meal
from the limited roles of childhood to the broader roles planning, grocery shopping and cooking
of adulthood.
TRANSITIONS from limited roles of childhood to the Dieting
broader roles of adulthood. • Dieting is a common concern during adolescent
Expanding social circles years.
Expanding social roles • Diet trends can lead to unhealthy behaviors
such as restricting intake, skipping meals, taking
Expanding their social circles. diet pills or purging after a meal.
• Their social circle expands slightly as they enter
school. OVERWEIGHT & OBESITY
• By the time they reach adolescence, their • Overweight and obesity are defined as
networks also can include people from team abnormal or excessive fat accumulation that
sports, student organizations, jobs, and other presents a risk to health.
activities. • A body mass index (BMI) over 25 is considered
• As their social circles expand, adolescents spend overweight, and over 30 is obese.
less time with their families and may focus
more on their peers Causes of Obesity in Adolescents
• Young people also develop a greater capacity to • Hormonal disorders, such as an underactive
form stronger relationships with adults outside thyroid gland (hypothyroidism) or overactive
of their families who may function as mentors adrenal glands.
• The changes adolescents experience in their • Adolescents with weight gain caused by
brain, emotions, and bodies prime them to take hormonal disorders are usually short and most
on more complex social roles often have other signs of the underlying
• Physical development signals that adolescents disorder.
are becoming adults and that they may become • Genetics play a role, which means that some
entrusted with greater responsibility. people are at greater risk of obesity than
• Adolescents may assume new roles, such as others, and obesity may be more common
taking on a leadership position in school, on a among members of the same family.
team, or at church; serving as a confidante; or
being a romantic partner.
***Any adolescent with obesity who is short and has SOCIAL AND EMOTIONAL COMPLICATIONS
high blood pressure should be tested for the hormonal • Children who have obesity may experience
disorder Cushing syndrome. teasing or bullying by their peers.
***Because of society’s stigma against obesity, many • This can result in a loss of self-esteem and an
adolescents with obesity have a poor self-image and increased risk of depression and anxiety
may become socially isolated
NUTRITIONAL ANEMIA
Treatment of Obesity in Adolescents Anemia
Healthy eating and exercise habits • Anemia is when the number of red blood cells
• The treatment of adolescent obesity is focused in the body gets too low.
on developing healthy eating and exercise • Without enough of Red Blood Cells (a protein
habits rather than on losing a specific amount of that carries oxygen throughout the body),
weight. oxygen doesn't get to the body's organs.
• Reducing calorie intake and burning calories are • Without enough oxygen, the organs can't work
two ways to meet these goals. normally
• Adolescence is a time of increased iron needs
Calorie intake is reduced by: because of the expansion of blood volume and
• Establishing a well-balanced diet of ordinary increase in muscle mass.
foods • Young women are at particular risk for the
• Making permanent changes in eating habits development of iron deficiency due to
Calorie burning is increased by: menstrual blood loss.
• Increasing physical activity • Adolescent athletes and adolescents who limit
• Counseling to help adolescents cope with social their intake of meat products are at risk for iron
problems, including poor self-esteem, may be imbalance, specifically low iron
helpful.
Different Kinds of Anemia
PHYSICAL COMPLICATIONS Hemolytic Anemia (Anemias when red blood cells get
Type 2 diabetes broken down too fast)
• This chronic condition affects the way your • autoimmune hemolytic anemia: when the
child's body uses sugar (glucose). body's immune system destroys its own red
• Obesity and a sedentary lifestyle increase the blood cells
risk of type 2 diabetes. • inherited hemolytic anemias: these include
High cholesterol and high blood pressure sickle cell disease, thalassemia, G6PD
• A poor diet can cause your child to develop one deficiency, and hereditary spherocytosis
or both of these conditions. Anemia from bleeding
• These factors can contribute to the buildup of • This can happen due to bleeding from an injury,
plaques in the arteries, which can cause arteries heavy menstrual periods, the gastrointestinal
to narrow and harden, possibly leading to a tract, or another medical problem.
heart attack or stroke later in life. Anemia from red blood cells being made too slowly
Breathing problems • aplastic anemia: when the body stops making
• Asthma is more common in children who are red blood cells from an infection, illness, or
overweight. other cause
• These children are also more likely to develop • iron-deficiency anemia: when someone doesn't
obstructive sleep apnea, a potentially serious have enough iron in their diet
disorder in which a child's breathing repeatedly • anemia B12 deficiency: when someone doesn't
stops and starts during sleep get enough B12 in the diet or the body can't
Nonalcoholic fatty liver disease (NAFLD) absorb the B12
• This disorder, which usually causes no What Are the Signs & Symptoms of Anemia?
symptoms, causes fatty deposits to build up in • look pale
the liver. • seem moody
• NAFLD can lead to scarring and liver damage • very tired
• feel dizzy or lightheaded
• have a fast heartbeat
 • have jaundice (yellow skin and eyes), an • A critical period is an interval of time during
enlarged spleen, and dark tea-colored pee (in which cells of a tissue or organ are genetically
hemolytic anemias) programmed to multiply.
• At this stage, organs being formed are most
vulnerable to adverse influences.
WEEK 11- NUTRITION IN PREGNANCY • If cell division and the final cell number
achieved in an organ are limited during this
• Of all the periods in the human life cycle, the critical period, it will have irreversible effects on
period of PREGNANCY is the most critical and later developmental stage.
unique.
• It is critical because during pregnancy, the For example:
foundations of a new life is being laid. • Malnutrition that occurs at this stage may affect
• Pregnancy has social and psychological organ development that may not be reversed
importance affecting not only individuals but by subsequent refeeding.
also their families and society as a whole.
Growth
Examples are adjustments of the family budget, • The remaining seven months is the last stage
activities of daily living, depression caused by an characterized by growth in the number of cells
unwanted pregnancy, and on the other hand, happiness and size of the organs until it can support extra-
of the couple who waited many years to have a baby. uterine life.
Pregnancy is unique in that no other time in life does
well being of an individual depends so much on the well NUTRIENT REQUIREMENTS
being of another. • Nutrient needs during pregnancy and lactation
During pregnancy, the mother and child have an are higher than at any other time for most
intimate and inseparable relationship. women
The health of the mother before and during pregnancy • Adjustments have been made for the various
has profound effects on the status of her infant in the nutrients to account for the increased
womb and at birth. Therefore, efforts are directed to physiological activity of the mother and the
the mother to ensure a safe and successful delivery and growth and development of the fetus.
that her infant will be born well.
ENERGY
Physiological Basis of Nutritional Needs in Pregnancy  The two factors that determine energy
requirements are the (1.) mother’s usual physical
• Pregnancy or gestation is the period from activity and (2.) the increase in metabolic rate to
conception to birth and for human beings last support the work required for growth of the fetus
from 38-42 weeks and the other accessory tissues
• It is divided into thirds or trimesters  The cumulative cost of this extra work is 80,000
• Pregnancy has three stages namely, calories. This translates into about 300 extra kcal
implantation, organogenesis, and growth per day.
 This energy demand is distributed equally
Implantation throughout the three quarters of pregnancy
• the period in which the fertilized ovum implants  During the 2nd and 3rd quarters, deposition of 3.5kg
itself in the uterus and begins to develop. of fat in the maternal compartments accounts for
• This usually occurs during the first 2 weeks of 2/3 of the total energy needs.
conception.  During the 4th quarter, fetal needs are the greatest.
 During pregnancy, energy needs differ among
Organogenesis women.
• The embryo undergoes differentiation or rapid  Variations are due to (1) pre-pregnancy weight and
cell division that occurs from two to eight weeks composition, (2) amount and composition of weight
after conception. gain, (3) stage of pregnancy and (4) activity level
• This is called critical period.  It is assumed that if the rate of weight gain is
appropriate for the stage of pregnancy, energy
intake is adequate
 Every culture has had myths about diet in
pregnancy.
 According to one or more common pregnancy
myths, the fetus is a parasite, capable of drawing
whatever nutrients it needs from the mother at the
expense of her health.
 If this were true, there would be no such thing as a
small baby or poorly nourished newborn.
 It is concluded that the fetus is not a parasite
because, with few exceptions, it receives an
adequate supply of nutrients only if the mother’s
intake is sufficient to maintain her own health.

PROTEIN  B-vitamins
 This nutrient is essential as it forms the structural
basis for all new cells and tissues in the mother and
fetus
 Protein requirements are based on the needs of the
non-pregnant woman used as a reference plus the
extra amounts needed for growth.
 An average of 3.3 g of protein should be added to
the daily requirements
 The FAO/WHO recommended an additional 9g of
protein per day for the latter part of pregnancy
 But more recent body-composition measurements
do not show any maternal storage in early
pregnancy, thus increasing amounts are
recommended for each trimester
 The additional protein should be taken by
consuming more of a normal diet, rather than as Common Nutrition-related Concerns during Pregnancy
supplements. and Dietary Intervention
 The Philippine RENI is given at additional 8g
protein/day throughout pregnancy 1. Nausea and Vomiting
• Small frequent feedings of dry meals
FATS • Foods that are high in carbohydrate and low fat
 Linoleic and alpha linolenic acids (ALA) are the (crackers, jelly, rice, little brown sugar) can
essential fatty acids (EFA) overcome nausea and vomiting
 They are the nutrients that the body then further • Avoid excessive greasy foods, hot spices and gas
processes to gamma-linolenic acid, dihimo-gamma- formers (cabbage family and beans)
linolenic acid, eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) to form the structural 2. Heartburn
components of the central nervous system. • Due to pressure of the enlarges uterus and
 During pregnancy, the additional demand for stomach
uterine, placental and fetal growth, together with • This can usually be relieved by limiting the
the increased maternal blood volume and amount of food consumed at one time
mammary gland development, raises the EFA • Eat less spicy and less greasy foods
requirement by 1.5% energy in the maternal diet • Drink fluids between meals rather than with
meals
VITAMINS • Eat slowly and sit upright at least 2 hours after
The vitamins are important during pregnancy; the eating. Avoid lying down
most importantly cited are:
 folic acid
 ascorbic acid
 probability that restriction of calories result in
3. Constipation deficiency of some essential nutrients, the
• Due in part to the pressure exerted by the susceptibility to starvation ketosis during
developing fetus to the digestive tract, lack of pregnancy endangers fetal and maternal health.
exercise, and insufficient bulk (dietary fiber) and • It is advised that overweight and obese women
fluid intakes should avoid severe calorie restriction as well as
• With chronic or habitual constipation, one prevent excessive weight gain
experiences headaches and much discomfort. • On the other hand, a gain less than 500g per
• Fresh fruits that are not rich in pectins and month (1st trimester) and 250g during the
vegetables high in dietary fiber but are not gas- second trimester is considered a maternal “at
formers , generous fluids, and regular exercise risk factor”
will correct this disorder • Recommendation for weight gain of 13-18 kg
• Drink 8-12 glasses every day • Pregnant carrying twins can gain 16-20 kg
• Do not use medication like laxatives without
doctor’s advice
Other Nutrition-related Concerns during Pregnancy
4. Edema
• Mild, physiologic edema – usually present in 1. Pregnancy-Induced Hypertension (PIH)
extremities in the third trimester and should • Rapid weight gain
not be confused with the pathologic, • Edema
generalized edema associated with pregnancy- • High blood pressure
induced hypertension (PIH) • Excretion of albumin in the urine
• The swelling of the lower extremities may be • Convulsion
caused by the pressure of the enlarging uterus
on the veins that return the fluid from the legs Classification:
• This normal or physiologic edema does not 1. Pre-eclampsia – hypertension w/ proteinuria
require sodium restriction or other dietary and/or edema developing after the 20 th week of
change gestation
2. Eclampsia – convulsions or coma; usually both
5. Leg Cramps when associated with hypertension,
• Usually occur at night proteinuria, edema; occurs after 20th week of
• Pregnant mothers are advised to provide their gestation
calcium, phosphorus and magnesium need
• Proper exercises with supervision from a 2. Anemia
clinician help relieve leg crazy • The classic macrocytic anemia of pregnancy
represents a combined deficiency of iron and
6. Rapid Weight Gain or Loss folic acid
• The popular concept of “eating for two” is not • The newborn becomes anemic also and there is
valid among well nourished mother. It may lead increased chance of premature birth
to overweight with consequent toxemias or PIH, • Preventive measures include adequate
difficulties of labor and birth of large, sickly supplementation under a physician’s care (60
babies mcg iron/day) and up to 400 mcg folic acid/day
• Excessive weight gain during pregnancy is is safe
defined as an increase of 3 kg or more per • Choose foods rich in iron and B-vitamins
month in the second and third trimesters.
• Proper management of obese pregnant is a 3. Gestational Diabetes Mellitus (GDM)
matter of controversy
• Some obstetrician advocate moderate calorie • For some pregnant women, diabetes may occur
restriction with limited weight gain so that the as a temporary response to stress of pregnancy
patient will conclude pregnancy with a net and it disappears after the baby is born.
weight loss • If the blood glucose is not controlled, there is
• Nutrition experts generally oppose severe risk of perinatal death, prematurity, and other
calorie restriction because aside from the
 complications during delivery, e.g., macrosomia • The first milk is thick, yellowish fluid that comes
of the infant out on the second to the fifth day after the
• Dietary measures for GDM: delivery.
 Lower caloric intake by 30% but not • This is called the colostrum
lower than 1600 kcal Colostrum
 Limit carbohydrate intake to 40-45% of • it is very important that the baby is fed this first
total daily kcal milk because it contains antibodies and immune
 Space carbohydrates evenly throughout cells.
the day, but less for breakfast meal • it is richer in protein and lower in carbohydrate
 Plan 3 smaller meals and add snacks and fat, compared to the breast milk in later
days, which is more watery and bluish.
4. Other Pre-existing Medical Problems • It is also a laxative, which initially cleans out the
baby’s digestive organs
• A pregnant woman’s medical history and health
problems like cancer, type 1 diabetes mellitus, NUTRITIONAL REQUIREMENTS DURING LACTATION
pulmonary and heart disorders, infectious
diseases (HIV/AIDS), epilepsy, food allergies, ENERGY
history of depression will need more attention • Recommended an additional 500 kcal during
by the physicians and medical specialists and lactation
other interdisciplinary team members • The production of 100ml or 100 cc of milk
requires about 85 kcal expenditure
WEEK 11. NUTRITION IN LACTATING • An infant who is breast-fed more often tends to
stimulate more milk production
• Lactation is the period of milk production by the • Regardless of maternal diet, the composition
mammary glands and nutrient contents of breast milk remains
• The preparation for lactation starts during constant, with the exception of fatty acids,
adolescence when hormonal changes bring which could vary with the mother’s fat intake
about the development and increase in size of • Women who were obese prior to pregnancy or
the breast, areola, and nipple had gained excess fat during pregnancy may not
require the full 500 kcal/day during lactation
• Maternal stores of fat can be withdrawn
providing 100-150 kcal/day during the first 3
months of breastfeeding
• On the other hand, mothers who are already
lean should not reduce energy intake, because
her milk production will be less

WATER AND OTHER FLUIDS

• Nursing mothers must be reminded to drink
liberal water and other fluids as much as 3
quarts a day, depending on the weather.
• A very hot weather may need more than 3
quarts/day
• Inadequate fluid intake definitely reduces the
• During pregnancy, these anatomical parts quantity of milk production
markedly increased, especially in the latter
stage of pregnancy, when the lobules of the PROTEIN
alveolar system reach maximum size. • Additional 23g protein/day for the first 6
months of lactation; and 18g protein/day for
• The 2 main hormones responsible for milk the second 6 months.
production are prolactin and oxytocin • The extra protein requirement is based on the
fact that about 1.2 g protein is stored per 100
ml human milk
 4. It contains immune cells and antibodies that will
LIPIDS give natural immunity for the baby
• Maternal energy intake and the relative 5. It is the least allergenic of any infant food
amounts of carbohydrates and fat in the diet 6. It is inexpensive compared to commercial milks
influence the fatty acid composition of the 7. Breast-feeding is convenient, (e.g., traveling, or
breast milk, but not the total amount of fat. night feedings)
• Restricting energy to a level of negative energy 8. It promotes closer mother-baby ties or contact
balance or below energy needs of the mother 9. Babies are least likely to be overfed with breast-
will result in mobilization of body fat and the feeding
milk produced will reflect the composition of 10. Breast-feeding promotes good tooth and jaw
the stored body fat. development
• Human milk has about 10-20mg/ml of
cholesterol and is not influenced by the
mother’s dietary intake of cholesterol
• It is also richer in omega fatty acids than cow’s
milk
• Breast milk from malnourished mothers has
lower lipid content and the fatty acids are
usually short-chained, suggesting lack of lipid
synthesis from carbohydrates

MINERALS
• During the first six months of lactation, a
decrease of 1-2 percent of bone density has
been observed
• However, as lactation continues, this
observation is reversed.
• Hence, the calcium requirement for lactation is
750mg/day compared to the 800 mg/day needs
of the pregnant state
• Iron needs remain the same (27 mg/day) when
menstruation cycle is resumed.
• Iodine requirement for lactation is the same as
in pregnancy at 200 mcg/day

VITAMINS
• Vitamin A - requirements increased to 900mcg
from 800 mcg during pregnancy to be able to
supply the needs of infants
• Vitamin C – 80mg for pregnant and 100-105 mg
for lactation
• Folic acid – additional 100 mcg/day for lactation
• In general, breast milk from poorly nourished
mothers has lower water-soluble vitamins than
those who are well-nourished.

Advantages of Breast-feeding

1. Human milk is nutritionally superior to other

kinds of milk
2. Breast milk is bacteriologically safe
3. Breast milk is always fresh and at the right
temperature for the baby