Nutritional needs through life (Extension)

Learning objectives To recognise the different key stages in life. To understand why different amounts of energy and nutrients are required through life. To describe the needs of different life stages to maintain health.

Key stages in life The key stages in life include: pregnancy; infancy; childhood; adolescence; adulthood. Energy and nutrient requirements change through life and depend on many factors, such as: age; sex; body size; level of activity.

Pregnancy A varied diet, providing adequate amounts of energy and nutrients, is essential both before a woman becomes pregnant (conception) 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. Did you know? 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. 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, should 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 from the time they stop using contraception 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 Estimated Average Requirement (EAR) increases during the last 3 months of pregnancy by an average of 800kJ per day.

Weight gain during pregnancy On average, if a woman eats to satisfy her appetite, her weight will usually increase by about 3.5kg in the first 20 weeks, then 0.5kg a week until the end of pregnancy. The total weight gain will be about 10-14kg over the full term. 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 cheese and cheeses with a soft rind, such as Brie and Camembert, may be contaminated by Listeria, which can cause a miscarriage or infect the baby, so should not be consumed. Shark, swordfish and marlin. These types of fish 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. 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).

To watch the e-seminar Nutrition in Pregnancy click the link below.

Breastfeeding / lactation The process of producing breast milk and delivering it to the baby is called lactation. The extra EAR for energy during lactation is 1400kJ per day in the first six months. There are also increased demand for nutrients, such as calcium, phosphorous, vitamins A and C.

Breast milk On average, 100g of breast milk provides: 289kJ energy 1.3g protein 4.1g fat 7.2g carbohydrate 34mg calcium Breast milk provides special proteins, antibodies and white blood cells, which help to protect the baby against infection. It also provides growth factors and hormones, important for the healthy growth and development 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.

Weaning After 4 to 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 weaning. Weaning before this age is not recommended, as the intestines and kidneys may not be able to process the food. Solids must be semi-fluid and soft, since the baby has no teeth and cannot chew.

Weaning Infants under 6 months should not be given: wheat or other cereals that contain the protein gluten to avoid a possible allergic reaction to gluten, called coeliac disease; raw eggs and foods that contain raw or partially cooked eggs due to the risk of food poisoning from Salmonella (eggs should be cooked until both the white and yolk are solid); foods with added salt because their developing kidneys are unable to handle the salt; honey (risk of botulism poisoning), deep sea fish such as shark, marlin and swordfish (potential of high mercury levels) and whole nuts (risk of choking).  Did you know? Sugar-containing foods and drinks (e.g. biscuits, some rusks, fruit juices) between meals should be limited.

Weaning 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. For some, these are available free via the Healthy Start scheme. 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.

To watch the e-seminar Weaning click the link below.

Childhood Children should be encouraged to eat a variety of foods from each of The eatwell plate’s four main food groups: fruit and vegetables; bread, rice, potatoes, pasta and other starchy foods; milk and dairy foods; meat, fish, eggs, beans and other non-dairy sources of protein.

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.

Toddlers (up to 5 years) 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. For some, these are available free via the Healthy Start scheme. 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 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 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 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 with a fluoride-containing toothpaste. Sugar-containing foods and drinks should be limited to meal times.

Adolescence 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 A growth spurt begins around 10 years of age in girls and 12 years in boys. In both sexes, an average of 23 cm is added to height and 20 to 26kg in weight. Before adolescence, both girls and boys have an average of 18% body fat. During adolescence, this increases to around 28% in girls and decreases to around 15% in boys.

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 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.

Healthy weight for adults Adults should aim for a healthy body weight for their height and try to keep it at that level. 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 less than 18.5 Normal 18.5 - less than 25 Overweight 25 - less than 30 Obese 30 - 40 Very obese over 40

Can you work out the BMI? = 26.1 = 19.7 (overweight) (normal) William Height: 1.75m Weight: 80kg BMI = Jane Height: 1.56m Weight: 48kg weight (kg) height (m) x height (m)

To watch the e-seminar Energy – a balancing act click the link below.

Waist circumference measurement Waist circumference measurement is also an indicator of whether a person has a healthy body weight. Abdominal or visceral fat (i.e. fat carried around the waist) is known to be a greater risk to health than weight carried on other parts of the body. Waist measurements should be below: 80 cm (31.5 in) for all women 94 cm (37 in) for men (black and white) 90 cm (35 in) for Asian men

Older adults Requirements for energy gradually decrease after the age of 50 as activity level falls. Older adults is the term usually referring to people over the age of 65.

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 intakes. 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.

Question Which list of foods can be eaten during pregnancy? Pâté, Brie and raw shellfish Liver, homemade mayonnaise and Stilton Cod, herbal tea and hard boiled eggs Swordfish, unpasteurised milk and Parma ham

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Correct answer. Next question

Question Which type of milk is suitable as a main drink for babies and young children aged 1 to 2 years of age? 1% skimmed semi-skimmed whole

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Correct answer. Next question

Question True or false? Children have a relatively high energy requirement for their size because they are growing rapidly and are often very active. True False

True. Children have a relatively high energy requirement for their size because they are growing rapidly and are often very active. Next question

Question Which group of supplements is recommended in the form of drops for children aged 6 months to 5 years? Zinc and iron Vitamins A, C and D B vitamins Sodium and magnesium

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Correct answer. Next question

Question True or false? Compared with recommendations, on average UK adults consume lower levels of saturated fat, added sugars and salt, and higher than recommended amounts of fruit and vegetables and oily fish. True False

False. Compared with recommendations, on average UK adults consume higher levels of saturated fat, added sugars and salt, and lower than recommended amounts of fruit and vegetables and oily fish. Next question

Question Which of the following is likely to happen to older women after menopause? Decrease in blood cholesterol levels Decrease in blood pressure Increase in bone loss Increase in hair growth

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Correct answer. The end