NUTRITION ACROSS THE LIFESPAN
Infancy
 Refers to a person not more than 12 months of age
 A healthy full term infant weight 2.7 to 3.2 kg (6.7
lbs) and measures 48-50 cm (19-20 inches) in length
Nutrient Allowances
 Protein
o 3.5 gm/day for first 4 months
o 3.1 gm/ day for the next 8 months
o Amount of protein in human milk is adequate for
the first 6 months
 Fat
o Whole cow’s milk contains satisfactory levels of
the essential fatty acid: linoleic acid (skin
permeable to water) and arachidonic acid
o 3 function of arachidonic acid
 Blood clotting
 Immunity
 Anti-inflammatory
o Arachidonic acid - has anti-bacterial property and
protection for infant
 Carbohydrates
o Should supply 30-60 % of the energy intake
during infancy
 Water
o The daily fluid needs of the infant are
approximately 2.5 ounces per pound of body
weight.
Guidelines for the introduction of foods
 Introduce iron-fortified baby rice cereal at about 6
months of age
 Add pureed vegetables and fruits, one at a time, at
about 7 to 8 months
 Add pureed meats at about 8 to 9 months
 Add juice when the infant is old enough to drink
from cup, at about 9 to 10 months
 Add foods with more texture and finger foods at
about 9 to 10 months
o Vit B6 - Pyrodoxine - convulsion life syndrome
o For moor and gross development
o Food Feeding frequency:
 2.5-2.7 Kkg - Q3
 2.6 - 4 kg - Q4
 Also include breastfeeding or formula
Common Disorder
Diarhhea
 Is most frequently caused by bacteria and viruses
 Signs
o INFANT: paglubog ng posterior fontalle
o Late signs: skin turgor, capillary refill delay … etc.
 Management:
o Rehydrate, use “oresol”
o Food can be given as early 8 hours after
rehydration
o Breastfeeding should be maintained
 Vomiting
o Characteristic of vomit: projectile or not
 Allergy
o Contain allergens: beta lactoglubulin
 Constipation
o Associated with formula milk - difficult to digest
 Colic
o Due to formula milk - infant unable to burp
 Inborn errors of Metabolism
o PKU, G6PD, GAL, CH, CAH
 Maple Syrup Urine Disease
Childhood Nutritional Requirement
 Calories - determined by age, activity and BMR
 Protein - higher than adult
 Fluid - 4 to 6 glasses or 1 to 1.5 liter
Daily Nutritional Guide Pyramid for Filipino Children
(1-6 years old)
Daily Nutritional Guide Pyramid for Filipino Children
(7-12 years old)
 Boys energy needs may be especially high, they
typically grow faster than the girls & develop a
greater proportion of lean body mass
 Protein Requirement
o 13-15 yrs old - female & male : 59g
o 16-19 yrs old - 59 kg male: 65g
o 16-19 yrs old - 48 kg female: 59g
 Vitamin A (vision), Vitamin C (immunity), Calcium
(bone development)
o 13-15 yrs old - 700mg - Calcium
o 16-19 yrs old - 600mg - Calcium
Daily Nutritional Guide Pyramid for Filipino Children
(13-19 years old)
Childhood
Feeding Problems
 Food Jags
o Child accepts very limited number of foods &
rejects all others
 Dawdling
o When child linger or dilly dallies with his food
during mealtime
 Gagging
o Child’s feels like vomiting especially when fed
coarse foods
 Eating too much
o May be due to hereditary, temperament, appetite
or mothers insistence of a “clean plate”
Common Nutritional Problems
 PEM
 IDA
 Vit A. Deficiency
 Iodine Deficiency Disorder
 Dental Caries
 Obesity
Prevention & Treatment of Obesity
 Diet
 Physical Support
 Psychosocial Support
 Behavioral Support
Adolescence
 Energy needs of adolescents vary greatly depending
on their current rate of growth, gender, body
composition & physical activity
Feeding Problems
 Most adolescents drinks soft drink instead of juice or
milk
 Eating away from home
 Peer influence
Nutrition Related Problems
 Anorexia Nervosa
o State of emaciation that has been brought on by
volume starvation
 Bulimia Nervosa “Binge & Purge”
o Enormous consumption of foods & then
immediately purging or eliminating the food by
vomiting or taking laxatives
Nutritional in Later Life
Aging
 Stage in life that is accompanied by psychological,
socio economic & physiologic changes
Physiological Changes
o Body composition
o Immune system
o Tooth loss
Sensory losses & other physical problems
Daily Nutritional Guide Pyramid for Filipino Adults
(20-39 years old)
Rheumatoid Arthritis
 Disease of the immune system involving
inflammation of the joints
Alzheimer’s Disease
 Degenerative disease of the brain memory loss &
major structural changes in neuron “Senile
Dementia of Alzheimer’s Type” (SDAT)
NUTRITION IN PREGNANCY
Pregnancy
 Is period of great physiological stress for woman as
she is nurturing a growing fetus in her body
 The period from conception to birth.
 For human beings, gestation lasts from 38 to 42
weeks
 Pregnancy is often divided into thirds, called
trimesters
 Ideal weight gain is 25-35 lbs for BMI of 20 to 26
 28-40 lbs for underweight, BMI > 20
 15-20 lbs for overweight, BMI < 26
Daily Nutritional Guide Pyramid For Filipino Pregnant
Women
Daily Nutritional Guide Pyramid for Filipino Adults
(60-69 years old)
Nutritional Related Problems
Cataracts
 Thickening in the lenses of the eyes that impair
vision
Arthritis
 Inflammation the joint, usually accompanied by pain,
swelling & structural changes
Osteoarthritis
 Painful chronic disease of the joints that occurs
when cushioning cartilage in a joint breaks down
Nutritional Requirements
 During pregnancy additional PROTEINS is required
for
o Growth of fetus
o Development of Placenta
o Enlargement of Maternal tissues
o Increase maternal blood volume
o Formation of amniotic fluid
o Protein reserves prepares the mother for labor,
delivery and lactation
 Protein Allowance
o Pregnant adolescents - 59g to 73 g
Normal woman - 900 to 950 for the 9 months
Sources
 Animal origin
 Meat
 Milk
 Eggs
 Cheese
 Poultry
 Fish
 Fat (Omega-3 Fatty Acid) Requirement
o Omega-3 fatty acid like DHA (Docosahexaenoic
Acid) supplementation during pregnancy is
essential for brain development and prevents
preterm births
o It is required for fetal visual development
o It educes the incidence of heart diseases & heart
disease related deaths in infants
o 30g/mg - requirement
 Calcium is needed (additional during pregnancy)
o Growth & development of bones as well as teeth
of the fetus
o Calcium intake decreases risk of hypertension,
pre-eclampsia in mothers and low birth weights
and chronic hypertension in newborns
o Maintaining bone strength
o Proper muscle contraction
o Blood clotting
o 1000-2000 mg - requirement
o Calcium Gluconate - recommended
 Iron
o Fetal growth
o Expansion of maternal tissues including the red
blood cell mass
o Maintaining additional iron content of placenta
o Building the iron stores in fetal liver
o Compensate blood loss during delivery
o 30-60 mg/d: range
o Minimum: 41 mg/d
o
o
Minerals Requirement
 Folic Acid (US-RDA - 600 uq/d):
o Max: 800-1000 ug/d
o During pregnancy maternal blood formation
increases thus folic acid requirement also
increases
o Folic acid supplementation during pregnancy
prevents fetal neural tube defect and improves
birth weight of the fetus
 Zinc (US-RDA-15 mg/d)
o It is required for synthesis of nucleic acids DNA &
RNA and it is having important role in
reproduction
Zinc deficiency during pregnancy can cause poor
pregnancy outcomes and abnormal deliveries
including congenital malformations
o Magnesium: 360-400 mg
o Iodine: 125 mg
 Iodine deficiency - result to cretinism
o Fluoride: 3 mg
Vitamin Requirement
 Vitamin A (475 uq/d):
o It is needed in small amounts to protect the fetus
from immune system problems, blindness,
infection and death
 Vitamin D (5 ug/d) :
o It is required for formation of fetal bones
 Vitamin C (80 mg/d):
o It increase iron absorption and also helps in fetal
growth. Deficiency of vitamin C increase the
chances of preterm delivery
 Vitamin B6 (1.0 mg/d):
o It is required for normal fetal development &
positive pregnancy outcomes
 Vitamin B1 (+0.3 mg/d), B2 (+0.6 mg/d), B3
(+3mg/d):
o As total energy requirement increases during
pregnancy so B vitamin requirement also
increases
o
Nutritional Problems
Nausea “morning sickness”
 severe and continued vomiting that may result to
acidosis, dehydration or excessive weight loss
 Intervention
o On walking, arise slowly
o Eat dry toast or candy
o Eat small frequent feeding
o Avoid foods w/ offensive odors
o When nauseated, do not drink citrus juice, water,
milk, coffee or tea
Constipation & Hemorrhoids
 Eat foods high in fiber & exercise regularly
 Drink at least 8 glasses of liquid everyday
 Response promptly to the urge to defecate
 Use laxatives only as prescribed by the physicians
o LAXATIVES: can cause premature uterine
contraction
o Decrease of peristalsis
Heartburns (common in 3rd Trimesters)
 The hormone of pregnancy relax the digestive
muscles and the growing fetus puts increasing
pressure on the mothers stomach
 Interventions:
o Relax & eat slowly & eat food thoroughly
o Eat small, frequent meals
o
o
o
o
o
Drink liquid between meals
Avoid spicy or greasy foods
Sit up while eating, elevate the head while
sleeping
Wait an hour after eating before lying down
Wait two hours after eating before exercising
Maternal Health:
 Gestational Diabetes Mellitus (GDM)
o Develops during the second half of pregnancy w/
subsequent return to normal childbirth
o Type 2 DM may develop later in life specially if
overweight
o Complication of GDM:
 High infant weight
 Birth Defects
 Symptoms of diabetes
 Family hx of diabetes
o Interventions :
 Small frequent meals
 Limit excessive weight gain
 High fiber intake & other complex CHO &
low fat & sugar
 Exercise regularly
 Weight gain for overweight: 15-20
 OHA (Oral hypoglycemic agents)
 Transient HPN → vasoconstriction
 Carries high BP increases the risks of LBW infant
 Develops in second half of pregnancy & resolves
after child birth
o SGA - limited transport of essential nutrition
o IF seen for 1st trimester: organogenesis: small
head of infant
 Alcoholism - result: Fetal Alcoholism Syndrome
 PRE-ECLAMPSIA
o Condition characterized by BP, fluid retention &
protein in urine
 ECLAMPSIA
o Severe stage characterized by convulsion & coma
Lactation
 Production & secretion of breast milk for the
purpose of nourishing an infant
 Prolactin - hormone responsible for milk production
 Oxytocin - hormone responsible for milk ejection
 Let down reflex - the reflex that forces milk to the
front of the breast
Practice Incompatible with lactation
 Alcohol-decreases the amount & altered the flavor
of the breast milk
o Cause physical/ mental retardation
o Causes sleepiness among infants
o
Interfere lactation by inhibiting the hormone
oxytocin
Contraindications to Breastfeeding
 HIV/ AIDS
 Breast abscesses
 Chronic disease like thyroid disorder
 Postpartum amenorrhea
 Tuberculosis
 Underweight mothers
ENABLING NATIONAL LAW & ISSUANCES ON NUTRITION
 The imperative to invest in nutrition is enshrined in
the 1989 Philippine Constitution as it mandates the
states to defend the right of children to assistance,
including proper care and nutrition (Article XV,
Section 3) and to make available an integrated and
comprehensive approach to health development
and other social services (Article XIII, Section 11)
National Laws
 Landmark legislations enacted at the national level
provide the legal bases for the implementation of
nutrition programs across local government in the
country
LOCAL NURITION PROGRAM MANAGEMENT
Presidential Decree 491 of 1974 or the Nutrition Act if
the Philippines
 Created the National Nutrition Council (NNC) to
supervise,
coordinate
and
evaluate
the
implementation of the national nutrition program
Presidential Decree 1569
 Strengthens the Barangay Nutrition Program by
providing for a Barangay Nutrition Scholar (BNS) in
every Barangay
Letter of Instruction 441 or 1976
 Instruct various department of government to
address malnutrition
Local Government Code of 1991 (RA 7160)
 Mandates local government units to exercise their
powers and discharge their functions as are
necessary and appropriate for the effective
provisions if basic services including child welfare
and nutrition services
FOOD FORTIFICATION
Salt Iodization Law (RA 8172)
 Was enacted to contribute to the elimination of
micronutrient in the country, particularly iodine
deficiency disorders, through the cost-effective
preventive measures of salt Iodization
Food Fortification Law (RA 8976)
 Provides for the establishment of the Philippine
Food Fortification Programs and its implementating
rules, regulation and guidelines
INFANT & YOUNG CHILD FEEDING
Philippine Milk Code (EO 51)
 Regulates the marketing of infant milk formula,
other milk products, food and beverages, as well as
feeding bottles and teats
Rooming-in and Breastfeeding Act (RA 7600)
 Specifies rules and regulations which contain
standard procedures to be followed for rooming-in
and breastfeeding in all private and government
health institution
Expanded Breastfeeding Promotion Act (RA 10028)
 Requires private enterprises as well as government
agencies, including government-owned
and
controlled corporations, to put up lactations stations
care goods and services, and protected against
financial risk through a framework that fosters a
whole-of-system-government-society approach in
the development, implementation, monitoring and
evaluation of health policies programs and plans
PHILIPPINE PLAN OF ACTION FOR NUTRITION 20172022)
Programs of PPAN
 Infant and Young Child Feeding (IYCF)
 Philippine Integrated Management of Acute
Malnutrition (PIMAM)
 National Dietary Supplementation Program (NDSP)
 Micronutrient Supplementation
 Mandatory Food Fortification
 Nutrition in Emergencies
 Overweight and obesity Management and
Prevention Program
 Mobilization of Local Government Units for
Nutritional Outcomes
 Policy Development for Food and Nutrition
 Management Strengthening Support to PPAN
Effectiveness
Expanded Maternity Leave Law (RA 11210)
 Is an act increasing the maternity leave period to
one hundred and five (105) days for female workers
with pay and an option to extend for and additional
thirty (30) days without pay
 This grants extension of fifteen (15) days for solo
mothers, and for other purposes such as protection
of women on maternity leave from discrimination,
including demotion and layoff
NATIONAL STRATEGIES FOR NUTRITION
Kalusugan at Nutrisyon ng Mag-Nanay Act - Fist 1000
Days Law (RA 11148)
 Mandates the national agencies, LGUs, civil societies
and other stakeholders to develop and implement a
comprehensive and sustainable strategy for the first
1000 days of life to address the health, nutrition,
and developmental problems affecting infants,
young children, adolescent females, and pregnant
and lactating women
Universal Health Care (RA 11223)
 Emphasized the integrated and comprehensive
approach to ensure that all Filipinos are health
literate, protected from hazards, guaranteed
equitable access to quality and affordable health
NATIONAL GOVERNMENT AGENCY ISSUANCES
DILG Memorandum CIrcular 2015-16
 Directs the LGUs to accomplish and submit a
checklist on the determination of the functionality of
the local nutrition committee of all LGUs
 A list of core indicators, representing key activities
on capacity development, programs planning,
service-delivery, and monitoring and evaluation
conducted by the local nutrition committees serve
as the basis for determining functionality
DILG Memorandum CIrcular (2018-42)
 Provides guidelines on the roles and responsibilities
of LGUs in the implementation of the PPAN 20172022 including the formulation and/ or updating of
the local action plan, integration of application PPAN
programs in the respective local development plans
and annual investment programs, and passage of
local policies to support implementation of PPAN
DILG-DOH-NNC JOINT MEMORANDUM CIRCULAR NO.
2019-0001
 Enjoins all LGUs and barangay to prepare their
budget for FY 2020 and onwards for improved
nutrition outcomes, and anchored on the list of
suggested projects or actions from the PPAN 20172022 for implementation at barangay, municipal/city
and provincial level
Local Budget Memorandum No. 77a
 Enjoins all barangay to prioritize in all allocation of
local funs for FY 2019 the PPAs included in their
respective local nutrition action plans, which should
have been formulated in accordance with the PPAN
2017-2022
Local Budget Memorandum No. 78
 States that for FY 2020, the Local Expenditure
Program shall contain the Annual Investment
Program supported by a set of local plans including
the Local Nutrition Action Plan
Local Budget Memorandum No. 80
 Enjoins all LGUs to prioritize in the allocation of local
funds the PPAs included in their respective Local
Nutrition Action Plan (LNAP), which shall be
formulated in accordance with the Philippine Plan of
Action for Nutrition (PPAN) 2017-2022
 LBM No. 81 also includes a new provision requiring
the submission of the Barangay Nutrition Action
Plan (BNAP), together with the Barangay
Expenditure Program