Nutrition Throughout
Life Cycle
Dr. Etisa Adi Murbawani, M.Si, SpGK
Nutrition
in Childhood and Adolescence
Nutrition and Health
Childhood and adolescence = key periods for
growth and development
Ensure daily energy and nutrients requirements
for health, growth and development and health
in adulthood
Inadequate intake of nutrients
(esp. 0-2 years ) might cause irreversible
changes
Brain and cognition
Most intensive development of NS in prenatal
period and up to 3 years
Decreased intake of energy and essential
nutrients in first years – important impact on
structural and functional development of CNS
Characteristics of Infants
Digestion, absorption & metabolism is similar to
older children except:
– Pancreatic amylase deficient until around 4th month
– Fat absorption is inadequate
– Stomach acidity is low
Calories
Reasons for increased need:
Rapid growth rate
Great heat loss due to large body surface area
Activity of the infant
Protein
RDA: 6 mos = 2.2 g/kg
12 mos = 2.0 g/kg
Human milk = 1.2 gms/100 ml
Cow’s milk = 3x more CHON
Disadvantage:
– increase blood urea
– high renal solute load
– AA pattern different from human milk
Carbohydrate
Prevent hypoglycemia & ketosis
Lactose: sole source
Provides galactosides: brain & nerve cell formation
Human milk = 42% of total caloric value
Cow’s milk = 20%
Fat
Must constitute 35-55% of TER
Essential fatty acids: linoleic & alpha-linolenic acid
(omega 3 series)
EFA: retina & brain
Breastmilk = 30-40 mg/ml
Cow’s milk = 10-15 mg/ml
Nutrition during childhood
Energy requirements :
1 year : 800 kcal
6 year : 1600 Kcal
10 year : 2000 Kcal
Carbohydrate, Fat & Fiber
Carbohydrate = adults
Fiber :
- Age 1-3 : 19 grams
- Age 4-8 : 25 gram
Fat and Fatty acids
- Children 1-3 years should have 30-40% of energy
from fat
- Children 4-18 years should have 25-35% of energy
from fat
adolescence
It is the time between the onset of puberty and
adulthood.
Boys grow about 16 cm, gain about 20 kg and
increase their lean body mass.
Girls grow about 12 cm, gain about 17 kg and
increase their body fat.
Facts about Teen Nutrition:
• Teen nutrition affects athletics, academics
and attitudes
• Most teens are overfed, but undernourished
• Teens grow a lot, so they need to eat a lot of
the right kind of food
• Teens frequent fast food places, where high
fat and nutrient depleted foods are the norm
Eating Disorders in Adolescents
An estimated 20% of teens engage in some type
of abnormal eating.
5% of high schools girls have been diagnosed
with an eating disorder.
Adolescents are frequent users of OTC diet pills.
Multiple factors contribute: thin “ideal” , family
pressure, exhibiting body control.
Growth Spurts
Growth through adolescence is hormone driven.
Girls :
between ages 10.5 and 11 years
with a peak in the rate of growth at around age 12
Boys : between ages 12.5 and 13
and peak at around age 14
. This period of maximal growth lasts about 2 yr.
Adolescence:
The Vulnerable Life Stage
Big changes: Biological
Boys—get tall, lean, and dense (bones, that is)
Attain15% of final adult ht during puberty
Lean body mass doubles
Large calorie needs
increase from 2,000 at 10 yr to 3,000 at 15 yr
Adolescence:
The Vulnerable Life Stage
Girls—get taller and fatter
% body fat increases from the teens into the mid-
20s
Gain almost 50% of their adult ideal weight 6-9
mo before ht rate increases during puberty
Dieting
can have a negative impact on linear
growth during this time
Calorie needs increase by only 200 from 10 yr to
15 yr
Bone growth
0-2 years – very fast growth (esp.in length)
11-13 years (prepuberty) – intensive bone
mineralization - half the mass of calcium of the
adult is laid down
9-14 years – the period of peak bone growth –
adolescents acquire 25% of their final bone mass
Intense bone turnover in children, who replace
50 to 100% of their skeleton in a year, compared
to 10% in adults
Bone growth
Calcium requirement of children (3-8 years) per
unit bodyweight are 2 to 4 times greater than
that of adults
Bone growth
Calcium Vitamin D
Phosphorus Vitamin A
Fluoride Vitamin K
Protein Vitamin C
Nutritional Risk
Calcium
Builds bone and prevents osteoporosis
Teens need about 1300 mg a day
Osteoporosis prevention
Nutritional status of mother in last trimester of
pregnancy (highest accumulation of calcium)
Genetic factors (60-80 %)
Hormonal factors (puberty)
Nutritional factors (esp. consumption of dairy
products and other food rich in calcium – see
next slide)
Physical exercise (increases bone density)
Vitamins
Pubertal growth needs more vitamins.
Hence adolescents have a Recommended Dietary
Allowance (RDA) for vitamins higher than infants and
children and
almost equal to or even greater than adults.
Iron-deficiency anemia is the most common nutritional
disorder in adolescents,
particularly adolescent girls.
To ensure adequate intake of iron, diet should contain
plenty of green leafy vegetables,
meat, eggs and milk.
Weekly supplements of iron have been shown to be
effective in prevention of iron
deficiency anemia
Nutrition Issues in Adolescent
Health
Cardiovascular and cancer disease risk
Osteoporosis and bone mineralization
Overweight and obesity
Type 2 diabetes
Eating disorders
Cardiovascular Disease
and Cancer Risk
One-third of CVD and cancer-related morbidity
attributed to dietary patterns
Diets high in sat fat, total fat, and sodium and low in
fiber
Diets low in fruits and vegetables
Dietary fat
Recommended: <10% of calories from sat fat
and <30% total fat
Consumed: 1/3 of adolescents are in this range
Sodium
Recommended: <2.5 g/d
Consumed: 3-5 g/d
Fiber
Recommended: Age + 5
Consume: ½ this amount
NUTRITION IN
PREGNANCY
Pregnancy
Physiology of pregnancy
Maternal physiological changes
Growth of adipose, breast, uterine tissues
Increase blood volume
Slower GI motility
Increased risks during pregnancy
• The embryo and fetus are vulnerable to damage because
cells are dividing rapidly, differentiating, and moving to
form structures
• Developmental errors can be caused by deficiencies or
excesses in maternal diet and by harmful substances in
the environment, diet, medications, or recreational drugs
• Teratogen: agent that causes a birth defect during a
critical period in development
Critical periods of development
Increased risks during pregnancy
• Some women are at increased risk for complications during
pregnancy due to their:
• Nutritional status
• Age
• Pre-existing health problems
• Exposure to harmful substances
Maternal nutritional status
Before pregnancy:
Importance of proper nutrition for the maintenance of normal
body fat, hormone levels and fertility
During pregnancy, malnutrition can lead to:
growth retardation, low birth weight, birth defects, premature
birth, spontaneous abortion, stillbirth
increase child’s risk of developing chronic diseases such as
cardiovascular disease, high blood pressure, diabetes mellitus,
obesity and osteoporosis
future food preferences of an infant
Weight gain during pregnancy
• Blood volume increases by 50%
• Placenta develops to nourish the fetus an to produce
hormones
• Amount of body fat increases to provide energy needed
late in pregnancy
• Uterus enlarges and muscles and ligaments relax to
accommodate the growing fetus and allow for childbirth
• Breasts develop in preparation for lactation (milk production
and secretion)
Weight gain during pregnancy
• The weight of an infant at birth:
about 25% of total weight gain
during pregnancy
• The balance of weight gain:
• placenta, amniotic fluid, and
changes in maternal tissues,
including enlargement of the uterus
and breasts, expansion of the
volume of blood and other
extracellular fluids, and increased
fat stores.
Weight gain during pregnancy
• Healthy, normal-weight woman should gain 11–16 kg
(25–35 lbs) during pregnancy
• Rate of weight gain is as important as amount
• Little gain is expected in the first 3 months (1st trimester), usually
about 1–2 kg (2–4 lbs)
• In the 2nd and 3rd trimesters, the recommended maternal weight
gain is about 0.5 kg (1 lb)/week
• Women who are underweight or overweight/obese at
conception should, respectively, have higher and lower weight
gain than normal-weight women
Weight gain during pregnancy
• Although a similar
pattern of weight
gain is
recommended for
women who, at the
start of pregnancy,
are normal weight,
underweight,
overweight, or
obese, their
recommendations
for total weight gain
differ
Gestational
Weight Gain Patterns
Only 30 to 40% of women actually gain weight
within the recommended ranges during pregnancy.1
Many women gain much more weight than is
necessary during pregnancy, which is related to
postpartum weight retention.2
Underweight during pregnancy
• Being underweight by 10% or more at the onset of
pregnancy or gaining too little weight during pregnancy
increases the risk of producing a low-birth-weight baby
The Intergenerational
Cycle of Malnutrition
Child growth failure
Low birth Early Low weight and
weight babies pregnancy height in teens
Small adult women
ACC/SCN, 1992
Overweight during pregnancy
• Excess weight before conception or gained during
pregnancy increases mother’s risks for high blood
pressure, diabetes, a difficult delivery, need for a cesarean
section, and having a large-for-gestational-age baby (>4 kg
(> 8 lb.)
• Excessive prenatal weight gain:
• increased mother’s long-term risk for obesity
• increased offspring’s risk for overweight/obesity
Overweight during pregnancy
• Dieting during pregnancy is not advised!!
• Excess weight should be lost before pregnancy begins or
after birth and weaning
Energy Needs
During Pregnancy
Extra Energy Needs for Normal Weight Women:1
First trimester ~ 0 kilocalories
Second trimester ~ 350 kilocalories
Third trimester ~ 500 kilocalories
There is great variability among pregnant women with regard
to energy costs during pregnancy related to differences in
body size and lifestyles.1
Appropriate weight gain and appetite are better indicators of
energy sufficiency than the amount of kilocalories consumed.2
Nutrition In The
Elderly
Osteoporsis Diabetes Celiac Disease Malabsorption Palliative Care
Syndromes
Pressure Congestive
Heart Superbugs
Ulcers GERD
Failure ALS
Obesity
Renal Disease
Nutrition Issues Falls
Malnutrition For Older Adults Anemia
Parkinson’s Constipation
Disease
Alcohol
Pneumonia Dementia Stroke Abuse
Multiple
COPD System Issues
Sclerosis
Dysphagia
Family Related
Mental Illness Cancer Osteoarthritis Issues
In most national and international dietary
recommendations,the elderly are age 65
and above.
CHANGES ASSOCIATED WITH
AGEING
The functional changes related to
ageing include:
a decline in quickness of response
a changed motor and visual coordination
a decreased interest
a lowered oxygen consumption
Changes associated with ageing
a decreased capability of adapting to altering
conditions
a decrease in basal metabolism
a decreased kidney function
a decreased immune response
a decrease in gastric juice production
a reduced feeling of thirst.
Changes associated with ageing
a reduced muscle mass
an increased fat content
a decline in extracellular fluid
hardening of soft tissues
atherosclerosis
osteoporosis.
GASTROINTESTINAL
SYSTEM
Reduced GI secretions
Reduced GI motility
Decreased weight of liver
Reduced regenerative
capacity of liver
Liver metabolizes less
efficiently
RENAL SYSTEM
After 40 renal function
decreases
By 90 lose 50% of function
Filtration and reabsorption
reduced
Size and number of nephrons
decrease
Bladder muscles weaken
Less able to clear drugs from
system
Smaller kidneys and bladder
Nutritional Needs Change with
Aging
Increased requirements:
calcium
vitamin D
vitamin B12
vitamin B6
(protein)
Decreased requirements:
calories
(vitamin A)
