1. Nutrition and lifecycle
Lecture 13 &14 March 9, Dr. Quadro

2. Nutrition for the Life Cycle
Nutritional needs change at each stage of the life cycle.
Pregnancy
Infancy
Early and middle childhood
Adolescence
Adulthood
Senior adulthood

3. Pregnancy Trimester: one-third of the normal duration of pregnancy.
First trimester is 0 to 13 weeks
Second trimester is 13 to 26 weeks
Third trimester is 26 to 40 weeks
Prenatal – Before birth
Postnatal – After birth

4. Pregnancy
The only way nutrients can reach the developing fetus is through the placenta, the special organ that grows during pregnancy to support new life.
The close association between the fetus’s and mother’s circulatory systems permits the mother’s bloodstream to deliver nutrients and oxygen and remove waste products

5. Zygote

6. Copyright 2010, John Wiley & Sons, Inc.
Fetal Development
Copyright 2010, John Wiley & Sons, Inc. 6

7. Nutritional Needs of Pregnancy7

8. Nutritional Needs During Pregnancy
Nearly all nutrients are recommended in increased amounts during pregnancy and lactation
Only small increase in metabolic demands (energy) of pregnancy and fetal development
2nd trimester - add 350 Calories per day
3rd trimester - add 450 Calories per day

9. Nutritional Needs of Pregnancy9

10. Macronutrients recommendations
-RDA for protein increases. An additional 25 g/day in 2nd and 3rd trimester. For a women of 136 lbs = 75 grams /day
RDA for carbs is increased by 45 g/day = 175 grams / day (typical intake is 300 grams)
Total fat intake does not need to increase. Increase intake of essential fatty acids (linoleic and alpha-linolenic). Insufficient scientific evidence. Only AIs are given.
Macronutrient distribution should be the same (Nutrient-dense foods).

11. WATER recommendations
- Need of water is increased due to increased blood volume, production of amniotic fluid and the needs of the fetus.
From 2.7 l/day to 3 l/day
Potassium, sodium and chloride needs do not change

12. Nutritional Needs of Pregnancy12

13. Nutritional Needs During Pregnancy - Calcium
The DRI for calcium during pregnancy does not increase during pregnancy:
1,300 milligrams for teens
1,000 milligrams for adults over 18 years of age
Intestinal absorption of calcium doubles early in pregnancy, and the mineral is stored in the mother’s bones
During the last trimester of pregnancy when fetal skeletal growth is maximum and teeth are being formed.
The fetus draws approximately 300 milligrams per day from the maternal blood supply.

14. Nutritional Needs During Pregnancy - vitamin D
No need to increase, if sufficient amount is obtained from the diet and if sufficient sun-light exposure is met.
Some ethnicities can be at higher risk of developing vitamin D deficiency

15. Nutritional Needs of Pregnancy
Nutritional Needs of Pregnancy *RDA for iron during lactation is equal to half of the RDA for non-pregnant 15

16. Nutritional Needs During Pregnancy - vitamin C
It is needed for the synthesis of collagen (skin, tendons, and protein matrix of bone)
Recommended intake increased by 10mg/d
This requirement can easily be met by including citrus fruits and juices in the diet, thus supplements are usually not necessary.

17. Nutritional Needs During Pregnancy - vitamin A
Vitamin A-deficiency
Vitamin A-excess
From Lohnes et al., 1994
From Abu-Abed et al., 2001 17

18. Nutritional Needs During Pregnancy - Folate
A pregnant woman’s recommended intake for folate is 50% greater ug
Folate supplements given around the time of conception are known to reduce the recurrence of neural tube defects.
Women are advised to get recommended amounts of folate before becoming pregnant and during the first trimester.
As of 1999, all refined grains are fortified with folate (140 mg/ 100g of grain product).

19. Folic acid requirements
Neural tube defects: include any of a number of birth defects in the orderly formation of the neural tube during early gestation.
Both the brain and the spinal cord develop from the neural tube; defects result in various central nervous system disorders. The two main types are:
Spina bifida: incomplete closure of the bony casing around the spinal cord.
Anencephaly: a partially or completely missing brain.

20. Nutritional Needs During Pregnancy - Zinc
It is involved in the synthesis of DNA, RNA and protein
Zinc absorption is inhibited by high iron intake, thus iron supplements may compromise zinc status if the diet is low in zinc
RDA is 11mg/d (lean ground beef)

21. Nutritional Needs During Pregnancy - Iron
Pregnant needs 50 % above non-pregnant needs (synthesis of hemoglobin and other iron-containing proteins)
Many women begin pregnancy with diminished iron stores
An iron supplement of 27 milligrams ferrous iron daily during the second and third trimesters is recommended
Red meats, leafy green vegetables, fortified cereals
Citrus fruits and red meat increase iron absorption

22. What is in a Prenatal Supplement?
Must be taken in conjunction with, not in place of a carefully planned diet 22

23. Consequences of Maternal Malnutrition in Pregnancy
Fetal growth retardation
Birth defects
Spontaneous abortion and stillbirth
Premature birth
Low infant birth weight
Maternal and fetal anemia

24. Malnutrition in the prenatal and postnatal periods also affects learning ability and behavior

25. Common nutrition-related problems of pregnancy
Pregnancy-induced hypertension (PIH): high blood pressure that develops during the second half of pregnancy
Preeclampsia: a condition characterized by hypertension, fluid retention, and protein in the urine
Eclampsia: a severe extension of preeclampsia characterized by convulsions
Gestational diabetes: the appearance of abnormal glucose tolerance during pregnancy, with a return to normal following pregnancy.

26. Fetal Alcohol Syndrome
Defined by four criteria:
Maternal drinking during pregnancy
Characteristic pattern of facial abnormalities
Growth retardation
Brain damage often manifested by intellectual difficulties or behavioral problems

27. Fetal Alcohol Syndrome
These facial traits…
low nasal bridge
short eyelid opening
small head circumference
undeveloped groove in center of upper lip
…are typical of fetal alcohol syndrome, caused by drinking alcohol during pregnancy.
Irreversible abnormalities of the brain and other organs accompany these facial features.

28. Fetal Alcohol Syndrome
safe alcohol intake has not been established for pregnant women at any time during gestation, including the first few weeks

29. The developmental origin of adult diseases

30. Lactation and Nutrition
Mom and Baby

31. Maternal Nutrient Needs during Lactation
The need for nutrients is even greater during lactation than during pregnancy.
Mothers provide energy and nutrients to the infant, who is growing faster and is more active than the fetus
Human milk contains about 160 kcalories per cup (240 ml). About additional Kcal/d
Lactating women require approximately an additional liter of fluid a day.
Most lactating women can meet all their need without supplements.
Copyright 2010, John Wiley & Sons, Inc. 31

32. Energy needs in infants - comparison
Infant Adult
Weight 15 lbs lbs.
Kcal / day 650 Kcal 2000 Kcal
1 year old = 1000 kcal/day
3 year old = 1300 kcal/day
10 year old = 2000 kcal/day

33. Potential micronutrients infant deficiencies
IRON: babies are born with stores and iron in human milk, although not abundant, is very well absorbed. After 6 months, stores are depleted, hence iron-fortified rice cereal or iron-fortified formula
VITAMIN D: very low in breast-milk, so sunlight exposure is important. Infant formula is fortified. Brest-fed infants are often supplemented.
VITAMIN K: it doesn’t cross the placenta efficiently and the gut of the newborn is sterile (no microbial synthesis). Breast-milk is low in vitamin K. Therefore, single intramuscular injection to the infant (0.5-1mg of vitK).
VITAMIN B12: breast-milk of vegans mothers can be deficient in B12
FLUORIDE: breast-milk is low in fluoride

34. Benefits of Breast Feeding for Infant
‘Ideal’ sterile food
Provides protective factors
antibodies
bifidus factors
lactoferrin
growth factor
lipase enzyme
Promotes better tooth and jaw alignment
Favors bonding between mother and child
Decreased incidence of obesity

35. Benefits of Breast Feeding for Mother
Economical and convenient
Helps return uterus to normal size faster
Helps return to pre-pregnancy weight faster
Delays onset of menstruation (not birth control)
Improves bone re-mineralization
Reduces risk for ovarian and pre-menopausal breast cancer

36. When Not to Breast Feed Infants with galactosemia
hereditary disease that is caused by the lack of a liver enzyme required to digest galactose
Mothers taking certain medications
Mothers with communicable diseases such as HIV or active tuberculosis
Mothers who use illegal drugs

37. Healthy Infants with Formula
Infant formulas are manufactured with the approximate nutrient composition of breast milk
The parents can see that the baby is getting enough milk during feedings
The mother can offer similar closeness, warmth, and stimulation during feedings as the breastfeeding mother does
Other family members can get close to the baby and develop a warm relationship in feeding sessions

38. Comparing Breast Milk and Formula
Copyright 2010, John Wiley & Sons, Inc. 38

39. Elderly and Nutrition

40. AGING Inevitable, natural process!
It is the result of cumulative effects of all
biochemical and physiological changes
that occur in a living organism and its
constituents (cells, organs, systems)
over time.
Changes occur also in response to the interaction between genetic and environmental events.

41. Demographic Trends and Aging
Number of elderly (65+) in the US will double by 2030 to more than 70 million people.
Improved life expectancy as a result of better prenatal and postnatal care and improved means of combating diseases in older adults.
Life expectancy in the U.S.

42. …More statistics
In the US, life expectancy is 73 years for men and 75 years for women.
Maximum life span (maximum age at which people die) is years.
Healthy life style (good diet, exercising, healthy environment) can slow the process of aging.

43. Aging at the cellular level
Impairment of DNA replication
Impairment of cellular proliferation
Loss of viability of the cell
Reduced rate of DNA repair
Free radical damage
Reduced rate of protein synthesis and catabolism

44. 15-90% reduction

45. Aging and Nutritional Needs
Older adults do need to pay attention to quality and quantity of food.
…not just growing children!

46. Calories
Energy needs are reduced (reduced basal metabolism due to loss of lean tissues and decreased physical activity)
Caloric needs decrease about 5% per decade after age of 50
Select nutrient-dense food
Plan regular exercise

47. CALORIE RESTRICTION - animal models
30-40% fewer Calories but containing all the necessary nutrients
Moderate dietary restriction extends lifespan of the animals studied compared to control animals fed “ad libitum”
-complete dietary restriction
-selective removal of individual macronutrients (fat, protein, carbohydrate)
-selective removal of individual micronutrients (vitamins, etc)

48. Calorie Imbalance Weight Gain Risk For Many Health Problems
Weight Loss
Risk For Malnutrition
Don’t go below 1200 calories

49. Fat Fat: Source of energy, biological
membranes, carrier for vitamins, hormones and intracellular messenger
Fat digestion and absorption is not impaired
Too much fat increases diseases’ risk. Thus, limit fat to 30% or less of total calories
Limit fat intake by choosing reduced fat (lean meat), and limiting added and hidden sources of fat
Functions of FAT (FA): building blocks of phospholipids and glycolipids (biological membranes); fuel molecules (Triglycerides); Hormones and intracellular messengers; carrier of fat-soluble vitamins
FAT digestion and absorption is not impaired
No RDA. Reduce intake to prevent chronic diseases
Unsaturated fat=double bonds
Saturated fat=single bonds

50. Water Elderly have increased risk of dehydration
Body water decreases with age
Medications increase water loss
Thirst mechanism not as effective
Decreased mobility to reach fluids
- 6-8 cups of water daily (30ml/kg)

51. Vitamins and Minerals
Elderly tend to have low dietary intakes of some vitamins and minerals
Vitamin B6, B12, D
Folate
Magnesium
Zinc
Iron
Calcium
Aging gut may increase or decrease vitamins absorption, thereby influencing total dietary vitamin requirements.

52. Aging and Nutritional Needs
Increase of specific nutrients
Reduced stomach acidity (calcium, iron, vitamin B12)
Decline in vision (antioxidant such as b-carotene, lutein, vitamin E)
Reduced exposure to sunlight (vitamin D)

53. Aging and Nutritional Needs
Reduce specific nutrients
Decline in hepatic functions (vitamin A)
Risk of cardiovascular diseases (fat)

54. Jean Mayer USDA Human Nutrition Research Center on
Aging (USDA HNRCA) at Tufts University (2011)

55. Nutrition-Related Problems of Older Adult
Functional decline in almost every organ (intake, absorption, storage, utilization and excretion of nutrients)
Chronic diseases (heart diseases, cancer, diverticulosis, vascular diseases, osteoporosis, diabetes, oral cavity diseases, neurological diseases, depression)

56. Aging and Nutrition Status
Older people vary in their social, economic, functional capacities and physical condition.
Most older people live at home, are fully independent, and have a good quality of life.
Some others have problems with the Activity of Daily Living (ADL) and are at risk of malnutrition

57. Factors Influencing the Nutritional Status of Older Adults
Socioeconomic
Cultural Beliefs
Poverty
Level of education
Access to health care
Institutionalization

58. Factors Influencing the Nutritional Status of Older Adults (cont.)
Physiological
Dietary intake
Lack of appetite
Inactivity/Immobility
Poor taste or smell
Alcohol or drug abuse
Chronic diseases
Polypharmacy
Disability
Oral health problems

59. Factors Influencing the Nutritional Status of Older Adults (cont.)
Psychological
Loneliness
Cognitive impairment
Dementia
Depression
Loss of spouse
Social isolation

60. Factors Influencing the Nutritional Status of Older Adults (cont.)
Environmental
Inadequate housing
Inadequate cooking facilities
Lack of transportation
Lack of access to health services

61. Federal Elderly Nutrition Program (ENP)
Specific goals:
Low cost nutritional meal
Opportunity for social interaction
Nutrition education and shopping assistance
Counseling and referral to other social and rehabilitation services
Transportation services
Federal, State and local agencies have nutrition programs for elderly.
Food Stamp: “credit card” to buy food for people who qualify. Also buy good food for less money (Food bankor food preparing site buys industry “irregulars” and makes it available at a reduced price.
FENP: congregate meals or home-delivered meals. Also social benefits and activities associated (diet counseling, exercise, etc.)

62. Warning Signs of Malnutrition in Older Adults

63. AGING WELL “Life advantages”: Genetic potential
Continue desire for new knowledge and experiences
Socialization, intimacy and family integrity
Prudent diet
Avoidance of substance abuse
Acceptable living arrangements
Access to health care