Nutritional needs through life Key Stages in Life The key stages in life include: pregnancy; toddlers; Energy and nutrient requirements change through life and depend on many factors, such as: childhood; adolescence; Adulthood; Older adulthood. • • • • • age; sex; body size; level of activity; genes. Pregnancy A varied diet, providing adequate amounts of energy and nutrients, is essential before and during pregnancy. The mother’s diet can influence the health of the baby. Having a healthy body weight is important. Being underweight can make it more difficult to become pregnant and make it more likely for the baby to have a low birth weight, leading to a greater risk of ill health. Being overweight increases the risk of complications, such as high blood pressure and diabetes during pregnancy. Conception and early pregnancy – folate/folic acid Folic acid is the synthetic form of the B vitamin, folate (vitamin B9). It is needed for rapid cell division and growth in the foetus that takes place during pregnancy. Folate has been shown to reduce the chance of neural tube defects (NTD), such as spina bifida, in the unborn baby. Foods that are good sources of folate include green leafy vegetables, oranges, bananas, bread and fortified breakfast cereals. Conception and early pregnancy – folate/folic acid Women who are trying to become pregnant, or who are pregnant, are recommended to take a 400 microgram (μg) supplement of folic acid every day. Women who are at a higher risk of an NTD may need to take higher doses as prescribed by their doctors. They should start while they're trying to get pregnant until at least the 12th week of pregnancy. This is because it is difficult to achieve the extra folate needed through diet alone. During pregnancy During pregnancy, some extra nutrients are needed (mainly in the last three months) to: • • • help the development of the uterus, placenta and other tissues; meet the needs of the growing foetus; lay down stores of nutrients and energy (as fat) for the growth of the foetus and in the mother for lactation. During pregnancy During the first 6 months of pregnancy, most women do not need to eat more than normal. The body becomes more efficient at absorbing and using nutrients from food. The dietary reference value for energy intake during pregnancy in the UK is an extra 200 kcal/day during the third trimester only. Weight gain during pregnancy The total weight gain will be about 10-12.5kg over the full term putting on most of the weight after week 20. However, weight gain in pregnancy varies greatly and the appropriate amount of weight gain for a woman depends on her weight prior to pregnancy. Did you know? Gaining too much weight can raise the mother’s blood pressure and increase her risk of being overweight or having diabetes. Food to avoid during pregnancy • • • • Too much vitamin A during early pregnancy has been linked to birth defects. Vitamin A rich foods include liver and liver products, such as pâté, vitamin A supplements and fish liver oils. Unpasteurised and soft cheese, such as Brie and Camembert, may be contaminated by Listeria, which can cause a miscarriage or cause illness in the baby, so should not be consumed. Shark, swordfish and marlin may contain high levels of mercury, which can harm an unborn baby’s developing nervous system. Pregnant women, and those who are trying to conceive, are advised to stop drinking alcohol and to cut down on caffeine. Alcohol may damage the unborn child Food to avoid during pregnancy To lower the risk of getting a foodborne illness, pregnant women should avoid the following: • ready-meals that are undercooked, particularly if they contain poultry, or are not pre-heated before consumption, e.g. quiches and cold meat pies; • unwashed fruit and vegetables; • raw or partially cooked eggs and products containing raw eggs, e.g. homemade mayonnaise; • raw or undercooked meat (particularly poultry and minced meat), including cured meat such as parma ham and salami; • contact of raw meat with products that are consumed raw; • unpasteurised milk and milk products (particularly goat’s milk). Breastfeeding / lactation The process of producing breast milk and delivering it to the baby is called lactation. A healthy diet for breastfeeding mothers should include: • plenty of fruit and vegetables; • wholegrains (e.g. wholegrain breakfast cereals, wholewheat pasta, wholemeal bread); • good quality protein (e.g. pulses, lean meat, oily fish, eggs, nuts and seeds); • some dairy or calcium-fortified dairy alternatives (choosing lower fat and sugar varieties) and; • small amounts of unsaturated oils, such as rapeseed or olive oil, and spreads made from these. Breast milk On average, 100g of breast milk provides: •289kJ (70kcals) energy •1g protein •4g fat •7g carbohydrate •25-35mg calcium Breast milk provides all the energy and nutrients a baby needs for growth and maintenance during the first 6 months of life. Breast milk Breast milk also provides special proteins, antibodies and white blood cells which help to protect the baby against infection. In the first three days after birth, the mother produces a special form of breast milk called colostrum. It contains less fat, more protein and is rich in antibodies, proteins that play a key role in the baby’s immune system. Breast milk Two to three days after birth, colostrum changes to a milk that may look thin compared with colostrum and babies will then begin to take larger volumes of milk. As well as changing over time from colostrum to a thinner milk, breast milk also changes during a feed – the milk available at the start of a feed is more dilute, providing the baby with extra fluids, whereas that at the end of a feed is more energy-dense. Colostrum is the milk produced by the mammary glands in the final stages of pregnancy and a few days after the birth of the baby. Bottle feeding Some women are unable to or choose not to breastfeed their baby. Their midwife or health visitor will be able to give information on preparing and feeding the baby with infant formula. Infant formula (also known as ‘baby milk’) does not provide any of the factors that help prevent infections. It is important to note that once a mother has started to bottle feed her baby, it is difficult to change to breast feeding. Complementary feeding After 6 months of age, milk no longer fulfils all the baby’s needs for energy and nutrients. The baby must be given other foods in addition to breast milk or infant formula. This process is called complementary feeding. • Complementary feeding too soon (before 4 months) can increase the risk of infections and allergies, as your baby's digestive system and kidneys are still developing. • Leaving complementary feeding too late (longer than 6 months) may mean your baby doesn’t get enough of all the nutrients they need. This is because stores of essential nutrients, such as iron, decline from birth and by 6 months need to be replenished with food. • Solids must be semi-fluid and soft, since the baby has no teeth and cannot chew. • Foods to avoid Infants under 6 months should not be given: • • • • Sugar –as well as giving foods and drinks with added sugars, such as biscuits, cakes and fruit squash to your baby; Salt – babies under one year should have less than 1 g (less than ¼ tsp) of salt per day as their kidneys cannot cope with very much salt; Honey – honey should not be given to babies under one year because there is a risk it can contain bacteria that can cause a serious illness called 'infant botulism‘; Shark, marlin and swordfish – these types of fish should not be given because the levels of mercury they sometimes contain can affect the developing nervous system. Foods to avoid • • • Whole nuts - should not be given to children under 5 years of age because of the risk of choking. Raw shellfish – raw shellfish should not be given to babies as they are at an increased risk of food poisoning. Unpasteurised milk or products made from unpasteurised milk (e.g. some soft cheeses). There are also some foods that may trigger food allergies and it is important not to introduce these before 6 months, these include; milk (other than breastmilk and infant formula); egg; soya; wheat [and other cereals containing gluten (e.g. rye, barley and oats)]; nuts; seeds; fish and shellfish. Complementary feeding • • • • • Babies consuming less than 500 ml/day of infant formula should be given a daily supplement containing vitamins A, C and D. This is particularly important if they do not eat a varied diet. It is also recommended that from birth to one year of age, baby should be given a daily supplement containing 8.5-10 µg of vitamin D. Baby should given at least 500 ml of infant formula per day, do not need a vitamin supplement as vitamins A, C and D are already added to the formula. Cows’ milk is not suitable as a drink before 12 months of age because it is low in iron, but can be used in small amounts in cooking from 6 months. Low-fat varieties of milk, as a main drink, are not suitable for babies and young children until at least 2 years of age. Complementary feeding – key points • • • • • Exclusive breastfeeding is recommended for around the first 6 months; Introduce solid foods at around 6 months, ideally alongside continued breastfeeding for at least the first year; Start by offering small amounts of food and gradually increase the amount, so by 9-12 months your baby is eating 3 healthy meals a day plus some healthy snacks; Smooth purees and mashed foods are a good start but move to lumpier foods soon as your baby is ready. Soft finger foods can be given from the start of complementary feeding; Appropriate complementary foods to offer from 6 months include vegetables and fruit, starchy foods, protein foods and dairy products; Complementary feeding – key points • • • • • Sugar and salt should not be added to complementary foods, and foods with added salt and sugar should be avoided; Breastmilk (or formula) should be your baby’s main drink until 12 months of age; Babies consuming less than 500 ml/day of infant formula should be given a daily supplement containing vitamins A, C and D; Repeatedly offering baby a wide variety of foods that are part of a healthy, balanced diet, will help them accept and gradually learn to like these foods; To reduce the risk of choking, always stay with baby while they are eating and never offer small round foods. Nutritional needs through life task Pregnancy and pre-conception 1. Why is it advisable to take a folic acid supplement pre-conception and up until the 12th week of pregnancy? ______________________________________________________ ________________ 2. Why do some women become deficient in iron during pregnancy? ______________________________________________________ ________________ Nutritional needs through life task Infants 3. Why is breastfeeding the recommended method of infant feeding for the first 6 months of life? ______________________________________________________ ________________ 4. What are the guidelines for a healthy diet when breastfeeding? ______________________________________________________ ________________ Nutritional needs through life task Complementary feeding 5. What does the term ‘complementary feeding’ mean? ______________________________________________________ ________________ 6. What foods should be avoided when complementary feeding a baby? Why? ______________________________________________________ ________________ Toddlers (Early Childhood) Supplements of vitamins A, C and D in the form of drops are recommended for children aged from 6 months to 5 years. This is particularly important if they do not eat a varied diet. Semi-skimmed milk (as a main drink) can be gradually introduced when the child reaches 2 years if they are having a healthy, varied diet; but 1% or skimmed milk should not be given as a main drink until the child reaches 5 years. Young children should not be given whole nuts (risk of choking) and deep sea fish such as shark, marlin and swordfish (potential for high mercury levels). Childhood (Middle Childhood) Children have a higher energy requirement for their body size compared to adults because they are growing rapidly and are often very active. A nutrient-dense diet providing adequate energy and nutrients, which includes healthy snacks, is essential for growth and development. It is also important for children to have sufficient to drink. Young children also have small stomachs so they need to eat small and frequent meals. Childhood (Middle Childhood) Children’s diets from the age of 5 should be based on the principles of the Eatwell Guide and include plenty of starchy carbohydrates, fruit and vegetables, and some protein and dairy foods. Children should be encouraged to remain a healthy weight with respect to their height. A healthy family lifestyle can help to maintain a healthy weight, such as being active together or sharing meals. Childhood (Middle Childhood) Childhood is an important time for growth and development. Children need a good supply of protein, and other nutrients including calcium, iron and vitamins A and D. Children begin to take responsibility for their own food choices around this time. It is therefore important to encourage them to eat a healthy, varied diet which is rich in fruit, vegetables and starchy foods. Childhood (Middle Childhood) Dental hygiene is very important. Children should pay attention to dental hygiene and ways to prevent dental caries. Teeth should be brushed twice a day, for at least 2 minutes at a time, with a fluoride-containing toothpaste. Sugar-containing foods and drinks should be limited to meal times. Adolescence (Teenage years) Adolescence is a period of rapid growth and development and is when puberty occurs. The demand for energy and most nutrients are relatively high. Boys need more protein and energy than girls for growth. Girls need more iron than boys to replace menstrual losses. It is important to encourage an active lifestyle with a healthy, balanced diet during this time. This is because good habits practised now are likely to benefit their health for the rest of their lives. Adolescence – iron Teenage girls and women require 14.8mg of iron each day. Teenage boys need 11.3mg of iron daily and this reduces to 8.7mg for men aged 19 or over. Iron from meat sources, is readily absorbed by the human body. Did you know? Vitamin C helps to absorb iron from non-meat sources, such as green leafy vegetables, nuts, pulses, dried fruits, wheat flour and breakfast cereals. Adulthood Nutritional requirements do not change much between the ages of 19 to 50, except during pregnancy and lactation. On average, UK adults are eating too much saturated fat, sugar and salt from food, and not enough fruit and vegetables. A poor diet can lead to diseases such as obesity, cardiovascular diseases, cancer and diabetes. Adulthood To reduce the risk of developing these diseases, it is important to: •eat a balanced diet with plenty of fruit and vegetables; •opt for healthier fats; •get enough dietary fibre; •keep well hydrated; •stay active; •drink alcohol in moderation; •not smoke. Body Mass Index (BMI) The Body Mass Index (BMI) is an indicator of whether a person is underweight, overweight or a healthy weight. To calculate BMI (kg/m2), divide weight (kg) by height (m) x height (m). BMI = weight (kg) height (m) x height (m) Recommended BMI range Underweight Normal Overweight Obese Very obese less than 18.5 18.5 - less than 25 25 - less than 30 30 - 40 over 40 Can you work out the BMI? William Jane Height: 1.75m Height: 1.56m Weight: 80kg Weight: 48kg Recommended BMI range weight (kg) BMI = height (m) x height (m) = 26.1 (overweight) = 19.7 (normal) Underweight Normal Overweight Obese Very obese less than 18.5 18.5 - less than 25 25 - less than 30 30 - 40 over 40 Older adults (Senior years) Older adults is the term usually referring to people over the age of 65. Requirements for energy gradually decrease after the age of 65 as activity level falls. Older adults Older people may eat less for different reasons, for example: • • • • difficulty in chewing and swallowing; dental problems; changes in sense of smell and taste; difficulty in shopping, preparing and cooking food; • living alone; • financial problems; • illness. Older adults To maintain good health, it is important that older adults: •enjoy their food; •keep active; •have adequate nutrient ntakes. Older adults should adopt a healthy, balanced diet to maintain health. It is also important they keep hydrated by drinking plenty of fluid. Even minor dehydration may lead to health problems. Older adults After menopause (when menstruation stops), women lose bone strength at an increased rate. Having a great peak bone mass (PBM) in early adulthood helps adults to start from a higher point from which bones will be lost during the ageing process. Older adults should have plenty of calcium intake from the diet, but also remain active and have adequate vitamin D from foods, or through the action of sunlight on the skin. Adults over 65 years who are housebound should take a daily supplement of vitamin D as skin synthesis of this vitamin requires sunshine. Summary There are various key stages in life of importance nutritionally: pregnancy, infancy, childhood, adolescence, adulthood and older adulthood. Differing amounts of energy and nutrients are required at different life stages. It is important to maintain a healthy weight throughout life by eating a healthy diet and taking regular physical activity. Quiz- Kahoot https://create.kahoot.it/share/nutritionalneeds-throughout-life-extension/6239e0c99407-4893-b13c-5c0c857ef147