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Nutrition for the Life Cycle

Nutrition for the Life Cycle

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Nutrition for the Life Cycle

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  1. Nutrition for the Life Cycle JodeneImeson R.D., R.N. August 2010

  2. Objectives • Describe guidelines for nutrient and energy needs during stages of the life cycle including: infancy, childhood, adolescence, adulthood and geriatric periods. • State nutrition related area’s of concern in each lifecycle stage.

  3. Objectives… Describe the following nutrition related concern in each life cycle stage: • Infancy • Breast vs. formula fed • Introducing solid foods • Food allergies and intolerance • Childhood • Establishing eating behaviors • Childhood obesity • Hyperactivity • Adolescence • Eating disorders • Substance abuse

  4. Objectives… Describe the following nutrition related concern in each life cycle stage: • Adulthood • Healthy habits • Metabolic syndrome • Geriatric • Drug - nutrient interactions • Pressure wounds

  5. Infancy

  6. Energy and Nutrient Needs • Energy Intake • Growth needs: • Doubles wgt by 5 months (14-16 #, 6-7 kg) • Triples wgt by 1 year (21 – 24#, 9.5-11 kg) • Average wgt of 20-25 lbs by 1 year of age • Kcals: 100/kg • Support rapid growth rate during 1st 6 months, then increased activity level in 2nd 6 months

  7. Energy and Nutrient Needs • Nutrient Sources • CHO: 60% of daily energy intake to feed the brain • 0 - 5 months - 60 gm/qd • 5 -12 months - 95 gm/qd • Fat: supports rapid growth • 0 - 5 months - 31 gm/qd • 5 -12 months - 30 gm/qd • Protein: basic building block of the body • 0 - 5 months - 1.52 gm/kg/qd (9.5 – 11 gm/qd) • 5 -12 months - 1.50 gm/kg/qd (14 – 17 gm/qd)

  8. Energy and Nutrient Needs • Vitamins/Minerals • Need greater amounts than an adult, based on body size • Fat Soluble: A4.5x, E2.5x, D10x • Water Soluble: C4.5x • Minerals: Calcium2x, Iodine7x • Water • Younger the infant the higher the % of water wgt • Infants do NOT need supplemental water • 0 – 5 months: 116 cc/kg (1.5 – 1.75 c/qd) • 5-12 months: 88 cc/kg (3.3 – 3 c/qd) • Most water is in extracellular compartment – dehydration occurs quickly (fever, vomiting, diarrhea) • Rehydrate with electrolyte solution designed for infants

  9. Breast is Best • American Academy of Pediatrics and American Dietetic Association advocate breast feeding over formula feeding • High bioavailability of nutrients • Best nutrient composition • Immuno-protective • Promotes physiologic and cognitive development • Non allergenic • Sterile • Cost effective • Environmentally friendly

  10. Breast Milk – Nature’s Perfect Food • Energy Nutrients • CHO: disaccharide lactose • Easily digested, enhances Ca2+ absorption • Protein: alpha-lactalbumin • Efficiently digested, absorbed • Lower protein content, less damage to kidneys • Fat: Essential fatty acids (EFA) • Linoleic, Linolenic, • Non EFA’s: Arachadonic, Docosahexaenoic (DHA) • Being added to formula’s

  11. Breast Milk – Nature’s Perfect Food • Vitamins/Minerals • Calcium content perfect for bone growth, well absorbed • Iron in small amounts but highly available • Supplements Needed • Vitamin K at birth – to prevent hemorrhaging • Sterile intestine. Takes 6 months for bacteria producing Vitamin K to grow • Vitamin D from birth to 12 mos: • Breast milk is low in Vit D content • Need 500 cc qd of Vit D fortified formula or a supplement

  12. Breast Milk – Nature’s Perfect Food • Vitamins/Minerals • Fluoride after 6 months • low content in breast milk and infants reserves are used up. If fluorinated water is used to prepare formula’s and food, no supplement is needed • Iron after 6 months • RDA jumps from 0.27 mg/qd to 11 mg/qd at 6 mos

  13. Breast Milk – Nature’s Perfect Food • Colostrum: antibodies, white blood cells • Protection from infections to which mom has developed immunity • Bifidus: promotes growth of Lactobacillus bifidus • Keeps harmful bacteria in check • Lactoferrin: iron binding protein • Helps prevent growth of harmful intestinal bacteria • Lactadherin: protein that fights diarrhea-causing viruses • Growth Factor • Aides in development of infants digestive tract • Lipase: helps fight infection

  14. Formula Feeding • Formula standards set by the AAP reflect human milk from the 1st or 2nd month of lactation • FDA mandates safety, nutritional quality • Select the appropriate formula • Ask your pediatrician • Enfamil, Similac, Carnation, Parent’s Choice

  15. Formula Feeding • Formula baselines • Cow’s milk: majority of available formula’s • Whey, caseinate protein • Iron fortified • Soy • Soy protein • Additives: cornstarch, sucrose • Elemental

  16. Formula Feeding • Risks of formula feeding • No protective antibodies • Formula’s become contaminated leading to infection • Sterilize bottles • Sterile water • Refrigeration • Expiration dates • Cost

  17. Advancing the Diet

  18. Developmental Skills Feeding Skill Food to Add Breast Milk, infant formula Iron fortified cereal Puree vegetable and fruit Textured vegetable, fruit Diluted fruit juice in cup • 0 – 4 mos • Swallows using back of tongue • Strong extrusion reflex to push food out • 4 – 6 mos • Extrusion reflex decreases • Begins chewing action • Brings hand to mouth • Grasps with palm of hand • 6 – 8 mos • Able to feed finger food • Begins to drink from cup • Develops finger to thumb grasp

  19. Developmental Skills Feeding Skill Food to Add Table cereals, bread Yogurt Soft cooked table vegetables and fruit Begin finely cut meat, fish, casseroles, cheese, eggs Progress to food pyramid suggested servings • 8 – 10 mos • Holds own bottle • Grabs spoon, fork • 10 -12 mos • Masters spoon with some spillage

  20. Advancing the Diet • Cow’s milk • Nutrient content • High protein, calcium • Low iron, Vitamin C • Wait until at least 1 yr of age before introducing • May cause GI bleed and loss of iron • Higher protein content stresses infants kidneys • Whole milk (5% fat content) for first 2 yrs • Transition to 2% fat content between 2 - 5 yrs.

  21. Introducing Solid Food • 4 – 6 months of age • Physically, metabolically able • Introduce foods with nutrients no longer available in breast milk, or reserve stores are depleted • Introduce one food at a time • Use small portions (2 - 3 tbs) • Wait 4 – 5 days before introducing another new food • Start with iron fortified cereals, then pureed vegetables and fruits • Avoid potential allergen’s • Wheat, cow’s milk

  22. Introducing Solid Food • Nutrient considerations • Do NOT restrict Fat content in a child less than 2 yrs of age • Toddler food labels can’t provide fat levels - prevents attempts to restrict fat intake • Iron needs from food increase: • Infant stores are depleted • Breast milk can’t supply adequate amounts • Iron fortified cereals - poor bioavailability add vitamin C source to aid Fe absorption

  23. Introducing Solid Food Nutrient considerations…. • Limit fruit juice to 4-6 oz a day thru age 6 yrs • Must be diluted for infants 6 – 8 months • Serve from a cup, not in a bottle • Omit baby desserts and sweets • Sugar is an innate taste • Provide only empty calories • Promote obesity • Avoid Honey, Corn syrup • botulism

  24. Introducing Solid Food • Choking Hazards • Hot dogs - Peanut Butter • Popcorn - Nuts • Grapes - Cherries • Hard or gel candies - Gum • Marshmallows • Raw celery, carrots

  25. Mealtime with Toddlers Provide nutritious foods and beverages in a safe, loving and secure environment

  26. Mealtime with Toddlers • Don’t allow unacceptable behavior. Be firm, not punitive • Throwing food, standing to eat • Use finger foods to allow exploring • Don’t force foods • Need repeated experience to accept them • Allow choices from variety of nutritious foods • Limit sweets • Don’t use food as a reward • Keep meal time pleasant

  27. Food Allergies • Food allergy: • 3 - 5% of children develop true allergy • occurs when large molecule proteins in the blood stimulate an immune response with creation of antibodies • Will be confirmed by antibody (Ab) testing • Symptoms may or may not occur • Immediate vs up to 24 hrs delayed reaction • Food intolerance:

  28. Food Allergies • Allergic reaction • Anaphylactic shock • Hives, rash, swelling • Difficulty breathing, asthma attack • Swelling of mouth, tongue, throat • Tingling sensation in mouth • Vomiting, GI cramps, diarrhea • Hypotension • Loss of consciousness • Death

  29. Food Allergies • Most Common Food Allergens • Peanuts*: #1 risk for life threatening reactions • Tree nuts • Milk* • Eggs* • Soy* • Wheat • Shellfish, fish *cause most reactions in children • Food labels must state if contain allergy producing food

  30. Food Intolerance • Symptoms occur but no antibodies are formed • Adverse Reactions • Hives • Wheezing, cough, bronchial irritation • Rapid heart rate • Stomachache, diarrhea, cramping • Headache • Other agents causing adverse reactions • Food chemicals: MSG, red/yellow dye • Pesticides • Lactose • Sulfur • Psychological aversion

  31. Childhood

  32. Energy and Nutrient Needs • Energy Needs • Growth • Gains 2 - 3 inches in height per year • Gains 5 - 6 pounds per year • Increase in muscle and bone mass and density • Total calories/Kg needed declines with age • “Growth Spurt” intermingled with periods of little to no growth • Meal patterns will coincide with growth patterns

  33. Energy and Nutrient Needs Age Kcal needs 85 kcals/kg 1000 kcal qd Females 82 kcal/kg Males 87 kcal/kg 85 kcals/kg 1650-1750 kcals/kg Females 82 kcal/kg Males 87 kcal/kg 60 kcals/kg 2000-2250 kcals/kg Females 56 kcal/kg Males 63 kcal/kg • 1 – 3 years • 4 – 8 years • 9 – 13 years

  34. Energy and Nutrient Needs • Nutrient Sources • CHO: brains need for CHO is constant with that of an adults brain after 1 year of age • 130 gms CHO qd • Fat: no RDA established • 1 – 3 years: 30 – 40% of total kcals • 4 – 13 years: 25 – 35% of total kcals • Protein: requirement decreases with age • 0 - 5 months: 1.52 gm/kg/qd • 5 -12 months: 1.50 gm/kg/qd

  35. Energy and Nutrient Needs • Vitamins and Minerals • Well balanced diet doesn’t require supplementation except for Vitamin D and fluoride • Vitamin D may be adequate with sunlight exposure • Fluorinated water supply meets the need • Iron deficiency • #1 nutrient deficiency in childhood • Offer iron fortified infant formula’s and cereals • Critical time for brain growth and development • used to make neurotransmitters that regulate attention span and learning ability • 7-10 mg Fe qd

  36. Developmental Skills Age Food Skill Uses short handled spoon. Feeds self Lifts and drinks from cup Spears food with fork Feeds independently Helps pour, mix, spread food Uses all utensils Helps mash, roll, peel foods Helps measure, cut soft foods • 1 – 2 years • 3 years • 4 years • 5 years

  37. Establishing Eating Behaviors • Children have increased influence on family food decisions. Parents have responsibility to teach good nutrition and consumer skills • Television commercials • Family eating out • Make choices with school lunches

  38. Establishing Eating Behaviors:Children’s Preferences • Raw vegs to cooked • Warm foods to hot • Mild flavors • Smooth textures • Familiar foods • Child sized table • Small portions • Geometric shapes • Silly names • Eating with friends

  39. Establishing Eating Behaviors • Allow children to help plan meals and prepare foods • Offer new foods one at a time, in small portions, at the beginning of the meal when the child is hungriest • Let the child decide for themselves what food they want to select from the healthy foods presented to them. Do NOT force unfamiliar foods • Power struggles over food sets up resistance and closes a child’s mind to eating

  40. Establishing Eating Behaviors • Let the child choose what, how much and when to eat. They need to learn to listen to their internal satiety cues • Provide nutritious snacks and let the child choose for themselves what to eat • Snacks may consist of mealtime foods eaten at a time the child is ready to eat them • Limit but don’t restrict access to high fat/sugar foods and favorite foods • If food is restricted the child will want it even more

  41. Establishing Eating Behaviors • Play first, then eat • Child is more relaxed and hungry • Will be racing thru meal to get down to play • Brush and floss • Establish good dental care early in life • Monitor for choking • Children typically have silent choking

  42. Childhood Obesity

  43. Childhood Obesity • 1 of 3 US children are considered overweight or obese • Overweight • Greater than 95th percentile • Number of overweight children has more than doubled in 20 years • 15% of US children are at risk of becoming overweight • Greater than 85th percentile

  44. Childhood Obesity • Body Mass Index (BMI) is used as a screening tool to plot percentile on standardized growth charts • BMI Formula lbs x 703 inches2 • Does not account for muscle vs fat content, larger than average body frame sizes, varying growth rates

  45. Childhood Obesity • Risk Factors • Diet: loading up on fast foods, high fat and sugar snacks • Lack of exercise: television, video games replace outdoor activities and burning of kcals • Family History: • Parental obesity doubles the chance a child will become an obese adult • Non-obese children with non-obese parents have <10% chance of becoming obese adults

  46. Childhood Obesity • Risk Factors • Psychological factors: coping mechanism for stress, emotions, boredom • Family Habits: types of foods purchased, how meals/snacks are served in the home • Socioeconomic: low income children are at greater risk of obesity • Medical: genetic syndromes, endocrine disease, medications

  47. Complications of Childhood Obesity • Physical Complications • Type II diabetes, insulin resistance • High cholesterol, abnormal lipid ratio’s • High blood pressure • Metabolic Syndrome • Asthma, shortness of breath • Sleep disorders • Early puberty and menstruation

  48. Complications of Childhood Obesity • Psycho-Social factors: • Low self esteem • Depression • Hopelessness • Flat affect • Socially withdrawn • Behavior and learning problems

  49. Prevention of Childhood Obesity

  50. Prevention of Childhood Obesity • Healthy Eating • Limit sweetened beverages • Regular soda, fruit juice • Provide healthy snacks • Fruits, raw vegetables, plain crackers and cookies • Do NOT limit all sweets and favorite snacks • Children will rebel and find ways to get these items • Limit the meals eaten outside the home • Avoid Fast Food. Use sit down restaurants with limited portions, heart healthy entrée’s • Eat together as a family • turn off the tv, video, computer, phones