PREGNANCY AND LACTATION
PREGNANCY
 Most critical and unique
 The foundation of a new life
 The mother and child have an intimate and inseparable relationship
 The health of the mother before and during pregnancy has profound effects on the status of her infant on the womb
and at birth.
COMMON NUTRITION-RELATED CONCERNS DURING PREGNANCY
1. Nausea and vomiting - :morning sickness”
 If accompanied by lack of appetite, may lead to malnutrition and loss of weight
 Disappears after the 1st trimester
Nursing Intervention:
 Small frequent feedings of dry meals instead of 3 large meals
 Foods high in CHO and low fat --- crackers and jelly, rice and little brown sugar
 Liquids are better taken in b/n meals rather than at meal times
 Avoid excessive spices
 A piece of candy helps curb the nausea
 Keep room well ventilated to let out odors that make one feel nauseated, esp. during cooking
o In cases of severe, hospitalization may be required to adm. IVF and electrolyte replacements to
avoid dehydration
2. Heartburn
 During the latter part of pregnancy due to pressure of the enlarged uterus on the stomach
 Regurgitation of stomach contents into esophagus
NURSING INTERVENTION:
 Limit the amount of food consumed at one time
 Eat less spicy, less greasy foods
 Eat slowly
 Sit upright for at least 2 hours after eating
 Avoid lying down after meals --- walk around the house leisurely
 Loose clothing around the waist must be worn
3. Constipation
 Due to pressure exerted by the developing fetus on the digestive tract, lack of exercise and insufficient bulk
(dietary fiber) and fluid intakes.
NURSING INTERVENTION:
 high fiber diet
 Lots of fresh fruits, vegetables and fluids
 Regular exercise
 Do not use medication like laxatives w/o doctor’s advice
 A bulking stool softener may be recommended
4. Edema
 Mild, physiologic edema is usually present in the extremities in the 3rd trimester

Swelling of the lower extremities may be caused by the pressure of the enlarging uterus on the veins that
return fluid from the legs
NURSING INTERVENTION:
 Elevate legs when lying down
 Not required for sodium restriction or other dietary change
5. Leg Cramps
 Occur usually at night
 Manifested by sudden contractions of the gastrocnemius muscle
 Thought to be related to a decline in sodium calcium levels related to a calcium-phosphorus imbalance
 But double-blind studies are nor definite that there is correlation b/n leg cramps and either the intake of
dairy products or calcium supplementation
NURSING INTERVENTION:
 Calcium, phosphorus and magnesium needs according to RDA recommendations
6. Rapid Weight Gain or Loss
 An increase of 3kg or more per month in the 2nd and 3rd trimesters
 A sudden increase in weight after about 20th week of gestation is a cause for suspecting that water is being
retained at an inordinate rate and should be regarded as a warning sign of impending eclampsia
7. PIH – Pregnancy Induced Hypertension / Toxemia of Pregnancy
 Leading causes of maternal deaths, pre-natal deaths, and low birth-weight infants
 Related more to nutritional deficiencies than to any other environmental factors.
 Calcium and magnesium deficiency may play a role in the dev’t of pre-eclampsia
Clinical Manifestations:
 Rapid weight gain
 Edema
 High blood pressure
 Excretion of albumin in the urine
 Convulsions
Classifications:
1. Pre-eclampsia – HPN w/ proteinuria and / or edema
2. Eclampsia – convulsions or coma; usually both when associated w/ HPN, proteinuria, edema
Nursing Intervention:
 Emphasis on protein foods of high biologic value
 Sources of iron, calcium and other minerals
 Salt intake is restricted for edema
8. Anemia
 The classic macrocytic anemia of pregnancy represents a combined deficiency of iron and folic acid
 The newborn becomes anemic also and there is increased chance of premature birth
Preventive measure:
 Adequate supplementation under physician’s care – ( about 60 mcg iron/day and up to 400 mcg folic
acid/day is safe)
9. Gestational Diabetes Mellitus
 May occur as a temporary response to stress of pregnancy and it disappears after the baby is born
 As many as 10% of pregnant women may experience
 Should seek dietary advice and should be under physician’s care
 If blood glucose as not controlled, there is risk of perinatal death, prematurity and other complications during
delivery e.g. macrosomia of the infant
10. PICA

Psychobehavioral disorder characterized by the ingestion of non-food substances.
Summary of nutritional care during pregnancy
Energy intake must allow a weekly gain of about 0.4 kg for the last 30 weeks of pregnancy
Protein intake must be increased by an additional 10 gm.day, preferably from food sources with high
biologic value
Sodium intake is at least 2000 mg/day
Minerals, especially iron and folic acid requirements which are difficult to be provided by usual diets, need
supplementation under the physician’s care
Alcohol consumption is omitted due to adverse results to the fetus
Caffeine intake is limited or restricted to 200 mg/day (2 cups of coffee OR equivalent in other caffeinecontaining drinks)

LACTATION
Related to good diet are regular light exercises, adequate rest and sleep and avoiding stress/infections.


Period of milk production by the mammary glands
Preparation of lactation starts during adolescence when hormonal changes bring about the development and
increase of the breast, areola and nipple
Colostrum – 1st milk
 Thick, yellowish fluid that comes out on the 2nd to the 5th day after delivery
 Contains antibodies and immune cells
 Richer in CHON and lower in CHO and fat compared to breast milk in later days, w/c are more watery and
bluish
 Also a laxative w/c initially cleans out the baby’s digestive organs
Nutritional Requirements During Lactation
1. Energy
 An additional 500 Kcal during lactation
2. Water and other fluids
 Fluids as much as 3 quarts a day depending on the weather
 Inadequate fluid intake reduces the quantity of milk production
3. Protein
 Additional 16 gm protein/day for the 1st 6 mos. Of lactation and 12gm for the next 6 mos.
 1.2 gm protein is stored / 100 ml of human milk
4. Lipid

5. Minerals

6. Vitamins

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
4. It contains immune cells and antibodies that will give natural immunity for the body
5. It is the least allergenic of any infant food
6. It is inexpensive compared to commercial milks
7. Breast-feeding is convenient (e.g. travelling of night feedings)
8. It promotes closer mother-baby ties or contact
9. Babies are least likely to be overfed with breast-feeding
10. Breast-feeding promotes good tooth and jaw development
Ten steps to successful breast-feeding
1. Have a written breast-feeding policy that is routinely communicated to all health care staff in the hospital
2. Train all health care staff to acquire the skills necessary to implement this policy
3. Inform all pregnant women about the benefits and management of breast-feeding
4. Help the mother initiate breast-feeding within 30 minutes after birth
5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants
6. Give newborn infants no food or drink, other than breast milk, unless medically indicated
7. Practice rooming-in; allow mothers and infants to remain together 24 hours a day
8. Encourage breast-feeding on demand
9. Give no artificial teats or pacifiers to breast-fed infants
10. Foster the establishment of breast-feeding groups and refer mothers to them upon discharge
Additional BENEFITS OF BREAST-FEEDING
For the Mother:
o
o
o
o
o
Breast-feeding can mobilize fat stores to help lose weight, particularly lower body.
Early breast-feeding stimulates uterine contractions to help control blood loss and regain pre pregnant size.
Breast-feeding may decrease the risk of thromboembolism, especially after operative deliveries.
Childbirth and breastfeeding may be protective against breast cancer.
Although not reliable for birth control, breast-feeding does afford some contraceptive protection.
For the Infant:
1) “Breast is best” – breast milk is unique in its types and concentrations. It contains optimal amounts and forms
of nutrients the infant can easily tolerate & digest.
2) Breast milk is a “natural “ food that contains no artificial colorings, flavorings, preservatives or additives.
3) Breast milk is sterile, has the proper temperature and is readily available
4) Breast-feeding avoids nursing-bottle caries.
5) Breast-feeding is associated w/ decreased frequency of certain chronic diseases later in life, such as NIDDM,
lymphoma and Crohn’s disease.
HEALTH TEACHINGS:
Instruct the client and partner:
1. About the benefits of breast-feeding – point out that even a short period of breast-feeding is better than not
nursing at all.
2. On the mechanics of breast-feeding.
a) breast care, positioning of the infant, ways to stimulate the infant & how to end feeding
b) nurse for 5 minutes on each breast on the first day to achieve let-down reflex and milk ejection.
c) nurse at short interval – easily digested than formula milk.
3. How to pump milk for later use – refrigerate of frozen immediately
 24 hours if refrigerated
 3 months – freezer compartment of the ref.
 w/in 2 years if maintained at 0 F
4. About the importance of eating a varied and balanced diet that is adequate in calories, fluid and calcium
5. Not to aggressively diet while breast-feeding
6. Not to take drugs or medications unless approved by physician.
7. Where to find additional information
Contraindications of Breast-feeding
 Breast cancer detected during pregnancy
 HIV
 Active TB
Problems that may hinder successful breast-feeding
 Retracted or inverted nipples
 Sore nipples
 Plugged milk ducts
 Breast abscess in one side
 Baby has narrow mouth
 Baby falls asleep during feeding
 Engorged breast
 Poor milk production
 Poor let-down reflex
NUTRITION IN INFANCY
INFANCY
 Characterized by rapid growth and development
 Weight – doubles during 1st 4-6 mos, and triples --- 1st year
 Stomach capacity --- 20 – 30 ml at birth to 200 ml by 1 yr of age
 Breast milk is the best food for the infant
Reasons:
1. Its composition is designed to provide the necessary energy and nutrients in appropriate amounts
2. It contains factors that provide protection against certain bacteriologic infections, diarrhea and otitis media
3. Allergic reactions to human milk are relatively rare
4. The closeness b/n the mother and infant during breast-feeding facilitates attachment and bonding
The first 6 months
 Mother should nurse her infant immediately after birth
 Should be held or cuddled during the feeding whether beast of formula fed
 Feed ---- 2 -3 hours interval
 Human milk should be used as the only source of food for the 1st 4-6 months
 Solid food should not be introduced before 4 months of age ------- early addition of other foods promotes
a decrease in breast milk intake and early weaning
 6 months of age --- supplementary feeding
After 6 months
 Breast-feeding should be continued up to a yr of age
 b/n 4-5 months --- solids should be introduced
o cereals (lugaw, oatmeal or boiled rice) – fortified w/ iron
o fruits ( banana, papaya, mango and avocado) -- vit C
o vegetables (leafy green and yellow veg.)
 5 months

o Hard cooked eggs and cooked dried beans such as monggo and peanuts
6 months
o Fish, liver, meat and poultry
Directions for home Preparation of infant Foods
1. Choose fresh, high quality fruits, vegetables or meat
2. Be sure that all utensils, including cutting boards, grinder, knives, spoons, cups, pots, pans and other utensils
to be used are thoroughly clean
3. Wash your hands before preparing food
4. Clean, wash and trim the food in as little water as possible
5. Cook the foods until tender in as little water as possible. Avoid overcooking to preserve heat sensitive nutrients
6. Do not add salt. Use sugar sparingly. Do not add honey or corn syrup to food intended for infants younger than
1 year. Botulism spores have been found in these foods and infants do not have the immune capacity to resist
this infection
7. Add enough water to easily puree the food
8. Strain or puree the food using a food mill, baby food grinder, kitchen strainer or electric blender
9. When ready to serve, place in a serving container the amount of food that will be consumed in one feeding
10. For later use, pour puree into an ice cube tray and freeze. When the food is frozen, remove the cubes and store
in freezer bags. When ready to serve, defrost and heat in a serving the container the amount of food that will
be consumed by the infant.
NUTRITION PROBLEMS
1. Obesity
 Weight above 95th percentile in relation to height, sex and body build
 Secondary to excessive intake of food
 Poor infant feeding practices and misuse of solid foods such as introducing them too soon can contribute
to overfeeding
2. Baby Bottle Tooth Decay
Sugar-sweetened beverages or fruit juices in a bottle at bedtime is susceptible to a pattern of tooth decay

Intervention:
Infants should be fed, burped and put to bed w/o milk, juice or food
3. Colic
Severe abdominal pain in infants
 Healthy, well-fed infants cry for several hours each day, draw their legs onto their abdomens and pass large
amounts of gas
 Causes: food allergy or intolerance
 Resolved ---- change to hypoallergenic formula
 Breast-fed infants: eliminate milk, cruciferous vegetables, onions and chocolate in the mother’s diet may
prevent colic
LOW BIRTH WEIGHT INFANT
Term infant – b/n 37 – 42 week of gestation
Preterm or premature infant – less than 37 weeks of gestation
Post term infant – born after 42 weeks of gestation
Low birth weight (LBW) – weighs less than 2500g (5 ½ lbs.)
Very low birth weight infant (VLBW) – less than 1500g (3 1/2lb)
Extremely low birth weight infant (ELBW) – less than 1000g (2 ¼ lb)
Small for Gestational age (SGA) – birth wt. is less than 10 10th percentile of the standard wt. for that gestational age
Appropriate for gestational age (AGA) – wt is b/n 10th to 90th percentiles on the intrauterine growth chart
Large for gestational age (LGA) – birth wt. is above the 90th percentile on the intrauterine growth chart
FEEDING the LBW / preterm infant
 Enteral feeding as early as possible to stimulate GI enzymatic development and activity, promote bile flow and
increase villous growth in the small intestine
 If mother desires to breastfeed, nurse at the beast as soon as possible
 She should express her milk for tube feeding
Developmental Stages of Readiness to Progress in Feeding Behaviors During the First 2 Years of Life
Developmental Landmarks
Change Indicated
Example of appropriate Foods
Tongue laterally transfers food in Introduction of soft, mashed table Tuna fish; mashed potatoes; wellthe mouth
food
cooked, mashed vegetables;
Voluntary
and
independent
ground meats in gravy; soft, diced
movements of the tongue and lips
fruit such as banana, papaya
Sitting posture that can be
sustained
Beginning of chewing movements
(up and down movements of the
jaw)
Reaches for and grasps objects
with scissors 9palmar) grasp
Brings hand to mouth
Voluntary release (refined digital
pincer grasp)
Finger feeding 9large pieces of
food)
Rotary chewing pattern
Introduction of food of varied
texture from family menu
Approximates lips to rim of cup
Introduction of cup for sipping
liquids
Beginning of self feeding 9though
messiness should be expected)
Understands
relationship
container and its contents
of
Increased movements of the jaw
Development of ulnar deviation of
the wrists
Walks alone
Names
food,
expresses
preferences
Prefers unmixed foods
Appetite appears to decrease
More skilled at cup and spoon
feeding
May seek and
independently
obtain
food
Oven-dried toast, teething biscuit,
cheese sticks
(food should be soluble in the
mouth to prevent choking)
Bits of cottage cheese, dry cereal,
peas
and
other
bite-size
vegetables, small pieces of meat
Well-cooked, chopped meats,
cooked vegetables and canned
fruit
(not
mashed),
toast,
potatoes, macaroni, spaghetti,
peeled ripe fruit
Food that when scooped, adheres
to the spoon such as cooked
cereal, mashed potatoes
Chopped fibrous meats such as
roasts, steaks
Raw
vegetables
and
fruit
(introduce gradually)
Balanced food intake should be
offered, and the child permitted to
develop food preferences
Parents should not be concerned
that these preferences will last
forever
NUTRITION IN PRESCHOOL AGE
PRE-SCHOOLERS
 1 – 6 years of age.
 Food habits, likes and dislikes begin to establish, some are temporary but many form the basis for a lifetime of food
intake
 Rates of growth decrease and as a result appetite decreases
 Growth slows down ---- less food and appetite decrease -- a condition often mistaken as poor appetite
COMMON NUTRITION PROBLEMS
1. Protein-Energy Malnutrition (PEM)
 Due to lack of energy and protein in the diet
 1-3 y/o are vulnerable to PEM
 Most common and widespread form of malnutrition
 Major health problem causing a high rate of morbidity among pre-schoolers
2. Iron deficiency anemia (IDA)
 Defines as either low hgb or a low hct or both compared w/ normal concentrations
 Most common form of anemia among children -- occurs b/n 3mos. To 3y/o
 S/S
o Paleness of the eyes. Lips, fingernails, palms and skin
o SOB, easy fatigability, reduced ability to learn and irritability
 Causes:
o Ignorance of parents on the importance and food sources of iron
o Poverty
3. Vitamin A deficiency – due to low intake of vitamin A
 Night blindness – inability to see in dim light
 Xeropthalmia – dryness of the eyes
 Rough dry skin and membranes of nose and thro
 Increased susceptibility to infections
 Poor growth and blindness in severe cases
4. Iodine-deficiency Disorder
 Group of clinical entities caused by inadequacy of dietary iodine that includes:
o Goiter – enlargement of the thyroid gland on the front or sides of the neck
o Hot or cold intolerance
o Mental retardation
o Deaf-mutism
o Difficulty standing or walking normally
o Stunting of the limbs of children of goitrous mothers
5. Obesity
 Most widespread nutrition disorders of children
 Causes:
o Genetic or familial
o Metabolic hormonal abnormality
o Environmental
o Inactivity or sedentary lifestyle
o Poor eating habits (too much fat, sweets and sugars)
o Too much TV viewing
6. Dental Caries
 Major problem affecting 98% of children
 Diet and nutrition have an important role in preventing dental caries
 Preventive dietary practices include:
o Restricting sugary foods to mealtimes
o Brushing teeth immediately after eating sugary foods
o Decrease the practice of allowing children to go to sleep w/ a bottle containing juice, milk or other sugarcontaining fluid
o Fluoridation of water supply
o Use of fluoride toothpastes and mouthwashes
FACTORS INFLUENCING FOOD INTAKE
1. Family Environment
 Family – role model -- time of eating, foods liked or dislikes, location of eating, watching television
 Provide nourishing food – clean, safe and developmentally appropriate
2. Societal Trends
 More mothers – employed -- do not have much time to prepare meals nor teach children about good eating
habits
o Rely on others to cook or buy at fastfoods
3. Media
4. Illness or disease
 Ill children have decreased appetite and limited food intake
 Acute illness – require more fluids, CHON and other nutrients
 Chronic – more difficult to obtain nutrients for optimal growth
DEVELOPMENT OF FEEDING PATTERNS
A. The goals for the development of food patterns
1. Children should be able to eat in sufficient quantities the foods given to them, just as they take care of their
other daily needs
2. Children should be able to manage the feeding process independently and with dispatch, without either
necessary dawdling or hurried eating
3. Children should try to eat new foods in small portions the first time they are served to them and try them again
and again until they like or at least willingly accept them
B. Some techniques to help parents develop desirable eating patterns in children
1. The parents as the “gatekeepers” must recognize that the kinds of foods available to preschool children in the
home are what they buy and provide
2. Parents must decide which of their own food patterns they want to pass on to their children. Some parents need
to know that they can change their own food patterns and may even need help to do this
3. Parents must understand why children eat as they usually do to set up an environment that promotes a healthy
appetite. They should understand what causes a certain behavior in children
C. Recommendations to assist children in developing desirable food patterns
1. All foods should be well prepared and attractive in color, flavor and texture so that the child will approach the
meal and eat it happily. Children appreciate an attractive plate and they eat with great enthusiasm when there
are variety of textures and flavors in the meal.
2. The environment for eating should be suitable for the ability and comfort of the child
 E.g. appropriate tables and chairs and suitable dishes and implements
3. Feeding should occur in a relaxed and pleasant environment that fosters healthy digestion and pro-social
behavior
4. A child is expected to have a good appetite and to hungry when in good physical and emotional health
5. Appetite is fostered if the child is hungry and happily excited over the fact that it is mealtime
6. Pleasant associations with the food are fostered if the meal can be eaten successfully with reasonable effort.
They should come to the meal rested and the eating process should not be tiring. Fatigue often defeats
children’s desire for food.
FEEDING THE PRESCHOOL CHILD
1. Energy foods –
 rice, corn, bread, yellow camote or gabi
 fats and oils that also give heat and energy
2. body building foods
 milk for growth, strong bones and teeth and increased resistance to infection
 fish, meat, poultry, eggs and dried beans for growth, building form and strong muscles, giving energy and
helping keep the blood healthy
3. regulating foods
 green leafy and yellow vegetables
o malunggay, kangkong, kamote tops, petsay, carrot and squash for vitamins and minerals
 vitamin C rich foods
o papaya, mango, suha and dlanghita
 other fruits and vegetables
o banana, chico, avocado, sitaw, eggplant
snacks make a very important contribution to the total nutrient intake
snacks should be those dense in nutrients and should not promote dental caries
avoid serving extreme temperatures of food
children prefer lukewarm food
some foods are rejected because of strong odor
do not give food or drink w/in w ½ hours b4 meals ---- leads to decrease appetite
 children are at risk for choking
o hotdogs, candy, nuts, grapes
o foods that are hard, slippery or just right size to plug up the throat such as hard candy, grapes and popcorn
o thick sticky foods such as peanut butter
o some cookies
PREVENTIVE MEASURES:
1. children should eat sitting down so they can concentrate on chewing and swallowing
2. an adult should supervise children while they eat
3. foods on which preschoolers (age less than 3 years) often choke as listed above should be avoided
4. well-cooked foods, modified so the child can chew and swallow without difficulty, should be offered
5. eating in the car should be avoided for if the child chokes it would be difficult to get to the side of the road safely
6. Rub-on teething medications can cause problems with chewing and swallowing because the muscles in the throat
may also become numb.
NUTRITION IN SCHOOL AGE
SCHOOL AGE
 Food habits are influenced by peer group
COMMON NUTRITION CONCERNS
1. Malnutrition and Learning
2. Iron deficiency anemia
3. Obesity
4. Dental Caries
5. Lactose intolerance
 The onset of reduced levels rarely happens b4 3 years of age but occurs in childhood and adolescence
 Symptoms:
o Bloating, flatulence, abdominal cramping and diarrhea
 Intervention:
o Do not limit milk intake unless they have symptoms
o many children can consume up to one cup of milk at a time when consumed w/ meals
o if w/ symptoms, consume dairy products in w/c lactose has been fermented such as yogurt or
aged cheese
o provide other substitutes to supplement nutrients lacking in the diet
6. Allergies
 Allergic responses:
o SOB or wheezing
o Stomach pain and vomiting
o Skin reactions: swelling of lips, tongue and face
o Fatigue, lethargy, behavior changes, shock
o Death if not treated
7. Sports and fitness
 Increased interest in sports
 Some, overweight and obesity due to declining physical activity/sedentary lifestyle
FACTORS INFLUENCING FOOD INTAKE
1. Family
2. Peers
3. Schools
4. Societal trends
5. Media
FEEDING THE SCHOOL AGE CHILD
 Growth during the school age period is paralleled by a constant increase in food intake
 Nutrition plays an important role in:
1. Furnishing energy needed for the vigorous activity of this age
2. Helping to maintain resistance to infection
3. Providing building materials for growth
4. Providing adequate nutrient stores to assist in adolescent growth


Breakfast is an important meal and provides ¼ to 1/3 of the daily nutrient allowances
Often missed or eaten hurriedly due to:
o Late bed riser
o Nothing to eat
o Arrival of school bus
o Fear of being late for school
o Rush in preparing oneself for school




A child’s diet should provide adequate energy for optimal growth and development w/o excessive fatness
Use low fat dairy foods, lean animal protein and fewer high fat foods
Restrict the intake of fermentable CHO will prevent dental caries and improve nutrient density
Increase intake of vegetables, fruits, whole grains and legumes --- benefits:
o Increasing the fiber content
o Reducing dietary fat
o Increasing the amount of beta carotene and other dietary factors for cancer prevention
o Providing a diet that is nutrient dense
NUTRITION IN ADOLESCENCE
ADOLESCENCE
 The transition period between childhood and adulthood
 Marked by the beginning of secondary sex characteristics
 A challenge to the health professional because this period is characterized by:
1. Accelerated growth and development
2. Changes in lifestyle, including food habits
3. Involvement in social and physical activities
4. Emotional problems associated with increased personal and academic responsibilities and psychological
concerns
5. Problems with some teenagers that demand special nutritional needs, such as smoking, drug and alcohol
abuse, pregnancy and eating disorders
Nutrient Requirements
 Adolescents should consume diets with:
o Less than 30% of calories from fats
o Less than 10% calories from saturated fat
o 300mg cholesterol
o 55% of calories should be from carbohydrates
o Emphasis should be on foods rich in complex carbohydrates and fiber
o Animal products (meat, eggs, etc.) are excellent sources of iron and zinc
 Typical diet of adolescents:
o 36% of calories from fat
o 13% is from saturated fat







o complex carbohydrate and dietary fiber intake are low
o simple sugars are high
o Some adolescents limit their fat intakes resulting in dietary inadequacies or nutritional dwarfing
The need for vitamins and minerals rises during adolescence
A greater energy demand means the following will be necessary for the release of energy from carbohydrates:
o More thiamine
o More riboflavin
o More niacin
Increased tissue synthesis means a greater demand for the substances that are needed for DNA and RNA
metabolism:
o Folacin
o Vitamin B12
Rapid rate of skeletal growth means a need for:
o Vitamin D
An increase in the following substances are needed to maintain structural and functional properties of the new cells
attained during growth:
o Vitamin A
o Vitamin C
o Vitamin E
The need for minerals increases substantially during the growth spurt of adolescence
o Calcium for increased skeletal mass
o Iron for expansion of blood volume
o Zinc for the generation of skeletal and muscle tissue
Most likely to be inadequate during adolescence are:
o Iron
o Calcium
o Vitamin A
FEEDING PROBLEMS DURING ADOLESCENCE
1. Irregular meals and snacking
 They tend to omit breakfast
Interventions:
o Guide them w/ time management
o If the problem is waking up early, teach them to prepare the night before
o Teach them proper food choices -- nutritious foods their canteen may prepare, pack fresh fruits / juice
instead of soft drinks
o Let them help w/ planning balanced diets for the whole family
2. Establishing Body image
 They become too conscious especially females with their body shape and figure
 May lead to eating disorders (anorexia nervosa / bulimia)
Intervention:
o Educate the children about proper nutrition
o Familiarize them w/ hazards of fads and the harmful consequences of eating disorders
o Explain or correct their wrong beliefs about fallacies
3. Food Dislikes and Food Idiosyncrasies
Intervention:
o Establishing proper food habits should start in later infancy
Conditioning Factors of Inadequate Dietary Intake
1. Poverty
2. Parasitism – interferes w/ nutrient utilization
Intervention:
a. Practice personal hygiene
b. Observe safe food handling
c. Education
Adolescents with Special Nutritional Needs
1. The Pregnant Adolescent
o Demands increased nutrient needs from both the pregnancy state as well as her growth and development
o A young female who conceives soon after her first menstruation is at greatest physiologic risk -- herself
and to the fetus
o Undernourished and anemic --- greater risk
o Intervention
 Educate and encourage to gain recommended amount of weight -- 20 pounds for the entire
gestation period
 If underweight, 35 – 40 pounds
2. The Adolescent Athlete
o Energy and water needs are the most critical
o Dehydration or heat illness ranks 2nd to head injury as a cause of death
3. Substance abuse
o The effects of these substances to the nutritional status of an individual depend on the kind, dose or
concentration, frequency of use, duration and habitual use and the addicted person’s general state of health
o Causes loss of appetite
4. Acne
o
o
o
Part of normal development during adolescent
Diet is not a big causative factor
Hormonal --- medical treatment is needed for serious cases
 Antibiotic and topical ointments
ADDITIONAL TIPS FOR TEENAGERS
Premenstrual Syndrome (PMS)
 Manifested by depression, swollen breasts, water retention, feeling tired and being moody the week before the
period
 While large doses of vitamins and hormones have been prescribed for PMS, these treatments are not always safe
and effective. For safe way to feel better, begin with a nutritionally adequate diet
 Try the following:
o Eat less salt and salty foods to help reduce water retention
o Cut down on coffee, tea, colas and chocolates. Reducing caffeine intake may help reduce swollen and
tender breasts.
o Have 5-6 meals a day composed of nutritious foods
o Frequent small feedings help reduce hunger pangs and also reduce cravings for sweets
o Walk, jog or bike; exercise helps one feel less depressed.
 These techniques help some women but they don’t work for everyone.
Weight Concerns
 Girls have a greater tendency to be over fat than boys; lack of exercise may be one factor in the weight gain.
 Another factor in weight gain may be that the teenager is misinformed and therefore think that some foods like milk,
potato, bread, rice and even water are fattening.
 There are hundreds of diets that one now follows, however, many of these are not safe and may not lead to
permanent weight loss.
 If overweight is a problem, do the following:
o Cut down on soft drinks, cakes, pies, candy, chips, mayonnaise, salad dressings, and gravies. These foods
are often high in calories. They are also poor sources of nutrients.
o Choose foods that have been baked or broiled rather than fried; frying adds calories
o Get more exercise. If you have not been active, start slowly. Work up at least 20 minutes of walking, jogging,
swimming or bicycling 3 to 4 times a week.
NUTRITION FOR ADULTS AND ELDERLY
ADULTHOOD
 Period of life when one has attained full growth and maturity
 b/n ages 21 – 50 y/o
 proper nutrition needs emphasis in adulthood, since it is the longest period of the life cycle and possibly the peak
of productive years
 nutritional management of the adult should include maintenance of the DBW
 Women often have special nutritional needs due to pregnancy, pre-menopause, menopause.
o Calcium, Iron, Vitamin D are particularly important
 Important to consider weight control as well as getting enough nutrients
SENESCENCE
 the process of growing old or the period of old age
 characterized by disturbed regulatory and functional mechanisms in the body
 energy needs decrease (fewer calories)
 they are at risk for nutritional deficiencies because of aging, medications affecting appetite, illness, social and
emotional health
Common Problems among the Elderly:
 Difficulty in chewing due to loss of teeth and not getting used to dentures – chop meat or fish; slice or chop
vegetables into small bite sized pieces for easy chewing.

NUTRIENT ALLOWANCES
 Concerned mainly with the conservation of good health and the prevention of chronic degenerative diseases to
which an elderly is prone to
o Arthritis, rheumatism, gout, coronary heart disease and diabetes
 A reduction of calories is recommended because of reduced basal metabolism and physical activity.
o Around 50% to 60% of total calories should come from CHO and 25-30% from fats in the form of
polyunsaturated fatty acids. Refined sugar and saturated fats are known to increase triglyceride and cholesterol
levels in the blood.
 A protein allowance of 1.1g/kg body weight is required to prevent muscle wasting and susceptibility to disease
 Calcium requirements are increased due to decreased bone density and absorption of dietary calcium
 Increased need for Vitamin B6 and the need for Vitamin B12 as a supplement or from fortified foods (this is due to
lower levels of gastric juice and the increased need to reduce homocysteine levels and optimize immune function)
 Vitamin D requirements are increased due to decreased bone density and decreased ability to synthesize vitamin
D in the skin.
 About 6 to 8 glasses of water should be consumed daily.