Nutrition Across the Life Span

Nutrition Across the Life Span

Child Role of Nutrition Growth Development Prevent disease Promote health Prolong life Infant Adolescence Elderly Pregnancy Adult

Nutrition in Pregnancy

Stages of Pregnancy & Birth
Terms for Stages surrounding Pregnancy and Birth 2 8 20 40 38 42 44 Fertilization Birth GESTATION Term Preterm Postterm Prenatal or Antenatal Postnatal or postpartum 28 Perinatal Zygote Embryo Fetus Neonate Infant 37 Preconception = before pregnancy Periconception = 1→3 months before pregnancy to the first 6 weeks after delivery

Physiological Changes during Pregnancy
Endocrine Body composition Blood volume & composition Metabolism Cardiovascular Respiration Kidney Gastrointestinal during pregnancy, many anatomical & physiological changes occur ==> both foetus & mother changes apparent at very early stages (weeks)

Nutritional Requirements in Pregnancy
There is increased need for energy and nutrients to support growth of the fetus, placenta and maternal tissue. Physiologic changes that cause hemodilution causes changes in nutrient turnover and homeostasis that affects requirements. Fetal demands occurs primarily during the second half of pregnancy when more than 90% of growth occurs.

Energy Needs China RNI Energy (Nonpregnant) Light Moderate Heavy
Energy (Pregnant) Full activity Reduced Women 18-55 2100 2350 +285 +200 Women <55 2050 2150 1st trimester  additional energy requirement is small 2nd / 3rd trimester  kcal/day Pregnant teenagers, underweight women, physically active women need more Increased energy due to 25% increase in basal energy requirements (growth of fetus, accessory tissues, maternal supporting tissues) and increased requirement by mother due to her increased weight Vit B6 = Pyridoxine  for amino acid metabolism & protein synthesis Vit. B12 = cobalamine  for cell division. Deficiency  megaloblastic anaemia

Energy & Related Nutrient Needs
Singapore RDDA B1 thiamin, mg B2 riboflavin, mg B3 niacin, mg Women 18-30 0.84 1.26 13.9 Women 30-60 0.86 1.29 14.2 Pregnant –full activity +0.11 +0.17 +1.9 Pregnant –reduced +0.08 +0.12 +1.3 as energy requirement increases  the need for thiamin, niacin & riboflavin increase proportionally they are coenzymes in reactions that releases energy from CHO, protein and fat Thiamine: enriched and fortified grains, cereals, and baked products, pork, whole grains, legumes, nuts, and seeds Riboflavin: milk, liver, red meat, fish, poultry, enriched breads, cereals, veges (asparagus, broccoli, mushrooms, green leafy) Niacin: meat, fish, mushrooms, wheat bran, asparagus, peanuts, enriched flour and baked goods

Macronutrient Needs Singapore RDDA Protein, g CHO, g Fat, g
Women 18-30 58 275 56 Women 30-60 282 57 Pregnant –full activity +9 +39 +8 Pregnant –reduced +28 +6 Protein essential for: synthesis of fetal & placental protein increased maternal protein synthesis to support expansion of blood volume & growth of breasts & uterus Vitamin B6 (pyridoxine) required for protein synthesis, therefore increase requirement during pregnancy CHO & fats help make up calories, spare protein Include a protein rich food at each meal (increasing milk automatically increases protein intake) milk, cheese, eggs, meat - all these also increases calcium, iron, B. Vits. legumes and whole grains From W&W 92000): 925g protein in foetus & maternal accessory tissues Rate of tissue synthesis not constant Must consider efficiency of deitary protein utilisation Protein utilisation depends on kcal intake RDAs set much higher than calculated reqmts Protein defy tied to energy defy Excess protein as diet supplement may have negative effects on pregnancy (renal?)

Critical Periods Vulnerable Periods of Foetal Development Critical periods = finite periods during development in which certain events may occur that will have irreversible effects on later developmental stages A critical period is usually a period of rapid cell division i.e. embryonic/fetal development SHOULD NOT have any exposure to tetratrogens/ malnutrition

Neural Tube Defects & Folate Supplements
The neural tube is the embryo's precursor to the CNS. About days after conception, the neural tube closes to form the brain and the spinal cord. If this tube fails to close, a NTD occurs Folic acid plays an essential role in cellular division. It is also needed for the proper closure of the neural tube NTDs occur between the th day after conception, before most women know that they are pregnant. Because about half of all pregnancies are unplanned, it is important to include at least 400 mcg of folic acid in every childbearing age woman's diet. (US RDA)

Critical Periods Critical periods occur early in development.
An adverse influence occuring early can have a much more severe & prolonged impact than one occurring later on. Ref: W&R (1999) pp. 471, Fig 15-3

Teratogen Teratogen = any substance, agent or process that induces the formation of developmental abnormalities in a fetus e.g. Thalidomide, alcohol, German measles, cytomegalovirus, irradiation with X-rays, ionising radiation Teratogenesis = process leading to developing mental abnormalities in the foetus 1957 to 1962 in UK, Canada, Germany, Japan - not FDA approved prevented morning sickness 12,000 babies who survived, with phocomelia (flipper-like arms or legs)

Assessing Nutritional Status In Pregnancy
Anthropometric measurements weight, height, BMI, fatfolds, waist circumference?? Biochemical parameters blood test, urine test – levels of vitamins, minerals, protein?? Clinical assessment skin, glands, muscle, bones & joints, cardiovascular, gastrointestinal, nervous system?? Dietary intake 24 hr recall, dietary history, food records, FFQ?? adequate weight gain for a mother is one of the best predictors of pregnancy outcome = birthweight is most reliable indicator of an infant’s health ==> higher BW presents lower risks for infants 1) the products of conception: foetus, amniotic fluid and the placenta. and 2) growth of maternal tissue: expansion of blood and extracellular fluid, enlargement of reproductive tissues(e.g. uterus and mammary glands) and maternal stores (adipose tissues)

Maternal Weight & Weight Gain
Optimal pregnancy outcome (appropriate infant birth weight and well being of both infant & mother) reflects an interaction between gestational weight gain and the pregravid weight status of the mother adequate weight gain for a mother is one of the best predictors of pregnancy outcome = birthweight is most reliable indicator of an infant’s health ==> higher BW presents lower risks for infants 1) the products of conception: foetus, amniotic fluid and the placenta. and 2) growth of maternal tissue: expansion of blood and extracellular fluid, enlargement of reproductive tissues(e.g. uterus and mammary glands) and maternal stores (adipose tissues)

Underweight mothers – inadequate nutrient reserves to support the critical period of organogenesis & continued fetal growth & development  high risk of birth defects, growth restriction (SGA), preterm, foetal & neonatal mortality, maternal complications like antepartum hemorrhage, premature rupture of the membranes & anemia  Solution: gain sufficient wt pre-conception & extra wt during pregnancy

Overweight mother  high risk of medical complications (pregnancy induced hypertension, diabetes mellitus, thromboembolic disease), complicated delivery, post-term birth, late foetal deaths, poor developments in infants  Solution: achieve healthy weight pre-pregnancy & avoid excessive weight gain during pregnancy. Postpone weight loss until after childbirth adequate weight gain for a mother is one of the best predictors of pregnancy outcome = birthweight is most reliable indicator of an infant’s health ==> higher BW presents lower risks for infants 1) the products of conception: foetus, amniotic fluid and the placenta. and 2) growth of maternal tissue: expansion of blood and extracellular fluid, enlargement of reproductive tissues(e.g. uterus and mammary glands) and maternal stores (adipose tissues)

Prepregnancy Weight Status BMI Recommended total weight gain ranges Low <19.8 kg Normal kg High kg Obese >29.0 > 6.0 kg Mitchell (2003). Nutrition Across the Lifespan. Saunders adequate weight gain for a mother is one of the best predictors of pregnancy outcome = birthweight is most reliable indicator of an infant’s health ==> higher BW presents lower risks for infants 1) the products of conception: foetus, amniotic fluid and the placenta. and 2) growth of maternal tissue: expansion of blood and extracellular fluid, enlargement of reproductive tissues(e.g. uterus and mammary glands) and maternal stores (adipose tissues) Mothers underweight before pregnancy had the lowest perinatal mortality when they gained at least 16 kg while obese women had the lowest perinatal mortality when they gained only 7 kg

If BMI is Weight Status (non-pregnant) Expected Total Weight Gain > 20 Underweight 12 to 18kg 20 ~ 25 Normal healthy weight 11 to 15kg 25 ~ 30 Overweight 6 to 11kg <30 Obese 6 to 9kg adequate weight gain for a mother is one of the best predictors of pregnancy outcome = birthweight is most reliable indicator of an infant’s health ==> higher BW presents lower risks for infants 1) the products of conception: foetus, amniotic fluid and the placenta. and 2) growth of maternal tissue: expansion of blood and extracellular fluid, enlargement of reproductive tissues(e.g. uterus and mammary glands) and maternal stores (adipose tissues) Taken from Eating for a Healthy Baby – Food & Nutrition Department, MOH, 1997

Components of weight gain during pregnancy
Quality of Weight Gain Components of weight gain during pregnancy 64%: maternal tissue & fluid accumulation 25%: foetus 5%: placenta 6%: amniotic fluid wt gain should be the result of a high-quality diet  gradual & consistent gains in weight throughout pregnancy foods consumed should be nutritious foods consumed should be nutritious (not contributing only “empty calories”) = nutrient-dense foods 30% fat (90% in maternal fat stores) - avg mother accumulates 2 kg of new fat during healthy pregnancy. Fat used for lactation needs and serve as energy reserves in late pregnancy

Special Nutritional Requirements Prior To Pregnancy
Good nutritional status before pregnancy is important for successful outcome. Severe undernutrition superimposed on previous marginal nutrition : low fertility rates & if conception occurs – birth defects, preterm births & neonatal deaths Undernutrition that occurs later part of pregnancy less likely to result in birth defects but causes fetal growth restriction & LBW Maternal malnutrition  reduce ability to conceive Underweight/ overweight  should achieve appropriate weight for height & age

Malnutrition & Foetal Growth & Development
After fertilisation: zygote stage (0 - 2 wks) embryonic stage (2 - 8 wks): Hyperplasia (↑in cell no) fetal stage (8 - 38/42 wks): Hyperplasia & hypertrophy (↑ in cell size) Effects of malnutrition depends on the stage of gestation & also duration Malnutrition early in gestation : teratogenic effects during organogenesis e.g. folate with NTDs Malnutrition in last trimester : not teratogenic but restrictions can have serious effects as the fetus gains 2/3 of its full term weight in 3rd trimester - accretion of fat, EFA, calcium, iron, vit E  LBW, poorly developed muscles, no subcutaneous fat Malnutrition throughout gestation : affects wt & ht, size of foetus reduced proportionally effects of malnutrition depends on stages of gestation malnutrition early in gestation ==> teratogenic effects (= cell synthesis & cell differentiation) ==> cause foetal malformations & death of embryo; retarded growth malnutrition after 3rd mth of gestation ==> no teratogenic effects ==> but affect foetal growth malnutrition in last trimester ==> small restrictions can have serious effects ==> cells increasing rapidly in both no & size ==> cell no and cell size reduced Teratogen =any substance, agent, or process that induces the formation of developmental abnormalities in a foetus e.g. thalidomide, alcohol, German measles, cytomegalovirus, irradiation with x-rays, ionising radiation

Risk Factors in Pregnancy
Risk factors present at onset of pregnancy: age frequent pregnancies poor obstetric history poverty faddist food habits abuse of nicotine, alcohol, or drugs therapeutic diet required for a chronic disorder inappropriate wt (BMI <19.8 or >28) Risk factors occurring during pregnancy: low haemoglobin inadequate/excessive weight gain, any weight loss medical complications age ==> 15 and younger ==> 35 and older frequent pregnancies ==> 3 or more during a 2 year period poor obstetric history or poor foetal performance therapeutic diet required for chronic disorder gastrointestinal problems HIV/AIDS diabetes Body weight: less than 85% of standard weight more than 120% of standard weight During pregnancy weight gain less than 1 kg per month after the first trimester excessive weight gain greater than 1 kg per week after 1st trimester

Planning Meals For A Pregnant Mother
Healthy Diet Pyramid Rice & Alt Meat & Alt Fruit Veg Adults 18-65 5-7 2-3 2 Pregnant 6 2 + 1 dairy green leafy if undereat ==> malnourished ==> iron defy anaemia ==> poor physical & mental growth dev ==> poor concentration in school ==> lack of body fat ==> delay in puberty in adolescent girls Courtesy of Health Promotion Board

Sample Daily Menu for Mother-to-be
Sample meal plan No. of servings Rice & alt Fruit Vege Meat & alt Breakfast : 2 slices wholemeal bread with thin spread of margarine & jam 1 glass milk 1 Morning snack: 1 small raisin bun Lunch: 1 bowl rice 1 small square beancurd cooked with lean meat & mixed vegetables ¾ mug steamed broccoli 1 wedge papaya 2

Sample Daily Menu for Mother-to-be
Sample meal plan No. of servings Rice & alt Fruit Vege Meat & alt Dinner 1 bowl rice 1 piece grilled fish, palm sized ¾ mug stir-fried kangkog Carrot & potato soup 1 banana 2 1 Supper 2 wholemeal biscuits 1 glass milk Total servings 6 3 Adapted from “Eating for a healthy baby” - a healthy eating guide for mother-to-be. Food & Nutrition Department (1997). Ministry of Health, Singapore.

Nutrition during Lactation

Nutrient requirements by lactating women are greater in amounts when compared to the requirements of non-pregnant women as lactation is a high priority physiological process. Read article: on benefits of breastfeeding  psychological benefits; nutritional benefits Immunological benefits Maternal health benefits

Milk Component Biosynthesis
Primary substrates extracted from blood – glucose, amino acids, fatty acids vitamins & minerals. Some mobilized from body stores or synthesized de novo Quality of milk is maintained at expense of maternal stores (e.g. fat stores, skeletal calcium stores) Throughout lactation, breast milk changes in composition Lactation continues as long as adequate suckling stimulation is maintained

Roles of Hormones Infant suckling at the breast  message to hypothalamus hypothalamus stimulates anterior pituitary to release prolactin (promotes milk production by alveolar cells of mammary glands) Effect on reproductive organs: prolactin inhibit ovulation (Ref: W&W (2000) pp ) When the baby suckles, two things happen: milk production “let down reflex. Prolactin-- stimulated by suckling, the pituitary gland produces this milk-producing hormone. Oxytocin-- hormone produced by post pituitary gland to squeeze the milk from storage lobules into and through the ducts of the breast. sucking nipple promotes oxytocin secretion oxytocin casuses ejection of milk let-down inhibited by embarrassment or stress successful let-down: drippling milk before feeding feeding on demand maintains lactation

Nutritional Requirements during Lactation
Energy Singapore RDDA Women Energy (Nonpregnant) Light Moderate Heavy Energy (Pregnant) Full activity Reduced Energy (BF) 1st 6 After 6 mth mth 18-30 2000 2100 2350 +285 +200 +500 30-60 2050 2150 Milk = 67 – 70kcal / 100ml energy for producing milk (comes from diet and body stores) protein for milk production B vitamins (thiamin, riboflavin & niacin) because of increased energy utilization and secretion in milk fluids to prevent dehydration of mother (more fluids does not equal more milk)  2 – 3 litres/ day vit & mins (folic acid, Vit. C, E, magnesium, zinc) to replace losses in milk Maintain Ca intake  if reduce intake  reduce bone mineral mass  osteoporosis in later life. All these nutrients the baby needs can be attained by the mother eating a well-balanced diet, including nutrient dense foods. Nursing mother produces about 25 ounces of milk/day and this requires about 650 kcalories/day from fat stores, the rest from the diet

Macronutrients Singapore RDDA Protein, g CHO, g Fat, g Women 18-30 58
275 56 Women 30-60 282 57 Pregnant –full activity +9 +39 +8 Pregnant –reduced +28 +6 BF 1st 6 mth +25 +69 +14 BF After 6 mth +19 Milk = 67 – 70kcal / 100ml energy for producing milk (comes from diet and body stores) protein for milk production B vitamins (thiamin, riboflavin & niacin) because of increased energy utilization and secretion in milk fluids to prevent dehydration of mother (more fluids does not equal more milk)  2 – 3 litres/ day vit & mins (folic acid, Vit. C, E, magnesium, zinc) to replace losses in milk Maintain Ca intake  if reduce intake  reduce bone mineral mass  osteoporosis in later life. All these nutrients the baby needs can be attained by the mother eating a well-balanced diet, including nutrient dense foods. Nursing mother produces about 25 ounces of milk/day and this requires about 650 kcalories/day from fat stores, the rest from the diet Protein: Based on protein content of 11g/l of projected milk volumes. Protein intakes do not appear to significantly  volumes but severe restrictions may alter content of some nitrogen-containing compounds Lipids: dietary alterations do not appear to affect the amount of fat in the milk but women with low fat stores appear to secrete milk with lower fat content. Important – type of fatty acids (linoleic, α-linolenic) to support CNS & retina development

Vitamins & Minerals Singapore RDDA Ca, mg Phos, mg Vit D, mcg B12, mcg
Folate, mcg Iron, mg Women 18-30 800 1200 2.5 2.0 200 19 Women 30-60 Pregnant –full activity 1000 10.0 3.0 400 Pregnant –reduced BF 1st 6 mth 300 BF After 6 mth Milk = 67 – 70kcal / 100ml energy for producing milk (comes from diet and body stores) protein for milk production B vitamins (thiamin, riboflavin & niacin) because of increased energy utilization and secretion in milk fluids to prevent dehydration of mother (more fluids does not equal more milk)  2 – 3 litres/ day vit & mins (folic acid, Vit. C, E, magnesium, zinc) to replace losses in milk Maintain Ca intake  if reduce intake  reduce bone mineral mass  osteoporosis in later life. All these nutrients the baby needs can be attained by the mother eating a well-balanced diet, including nutrient dense foods. Nursing mother produces about 25 ounces of milk/day and this requires about 650 kcalories/day from fat stores, the rest from the diet

Planning Meals For A Lactating Mother
Healthy Diet Pyramid Rice & Alt Meat & Alt Fruit Veg Adults 18-65 5-7 2-3 2 Pregnant 6 2 + 1 dairy green leafy Lactating 6-7 3 Milk = 67 – 70kcal / 100ml energy for producing milk (comes from diet and body stores) protein for milk production B vitamins (thiamin, riboflavin & niacin) because of increased energy utilization and secretion in milk fluids to prevent dehydration of mother (more fluids does not equal more milk)  2 – 3 litres/ day vit & mins (folic acid, Vit. C, E, magnesium, zinc) to replace losses in milk Maintain Ca intake  if reduce intake  reduce bone mineral mass  osteoporosis in later life. All these nutrients the baby needs can be attained by the mother eating a well-balanced diet, including nutrient dense foods. Nursing mother produces about 25 ounces of milk/day and this requires about 650 kcalories/day from fat stores, the rest from the diet

Importance of Preparatory Support to Promote Breastfeeding

Breastfeeding Support Groups
Breastfeeding Mothers' Support Group (Singapore) 96 Waterloo Street #02-04 SCWO Centre, Singapore Breastfeeding Information

The Growing Years (Infant, Toddler, Pre-schooler, School-aged Children, Adolescent)
Age ranges: Infant = birth to 1 yr Toddler = 1 to 2 years Preschooler = 2 to 6 years School-age girls = years School-age boys = years Great diversity in size, age, growth rates & developmental skills C_____________ = a period between infancy & adolescence Dramatic changes in 1st yr Period of most rapid growth Changes in food & feeding abilities timing and pattern of growth & development influenced by heredity, hormones and environmental factors (include nutritional factors) esp 6-10 yrs range growth rates highly individual, erratic at times with spurts (signs of increased appetite) in ht and wt followed by periods of little or no growth in healthy children, these patterns usually correspond to similar changes in appetite and food intake NH00 / Infant / GW 5

Infant Weight Gain - First 5 Years
1 2 3 4 5 15 10 NH00 / Infant / GW 13

Indicators Of Nutritional Status
Developmental problems Head circumference-for-age Stunting/shortness Stature/height-for-age Underweight BMI-for-age Weight-for-length/stature Overweight Risk of overweight <5th percentile >95th percentile <5th percentile <5th percentile Most measures for monitoring a child’s growth: head circumference, length or height, and body weight. Evaluate a child’s growth pattern over time is more important than a single measurement But single measurements are used to screen children at nutritional risk and need additional assessment. Head circumference closely related to brain size to screen for potential developmental or neurological disabilities among infants at birth - 24 mth old <5th percentile or >95th percentile = health /developmental risks needing further medical assessment. length- or height-for-age <5th percentile may be short because their parents are short or may be stunted due to long-term malnutrition, delayed maturation, chronic illness/ genetic disorder. Underweight If weight-for-length or BMI-for-age <5th percentile = recent malnutrition, dehydration / genetic disorder. If <5th percentile and >95th percentile = only to screen potential health / nutrition problems and identify those to receive further medical assessment Overweight > 95th percentile of weight-for-length / BMI-for-age. 85th percentile included on the BMI-for-age and the weight-for-stature charts. children and adolescents aged 2 to 20 years between the 85th and 95th percentiles are at risk of being overweight. Evaluating a child’s pattern of growth over time is more important than a single measure of size. The pattern of growth is based on periodic measurements which are tracked on a percentile line as a child grows. >95th percentile >85th to <95th percentile

Sequence of Development of Feeding Behavior
Age Reflexes Motor Dev Feeding Bhv Food 1 - 3 mths Rooting, suck & swallow reflexes present at birth Poor head control →→head stable Hands fisted →→holds toys Secures milk with suckling pattern →→opens mouth/ anticipates feeding Breast milk or infant formula 4 - 6 mths Rooting reflex fades. Tongue thrust present if spoon feeding attempted →→reduced Palmar grasp – to bring objects to mouth Supported sitting Suckling strength increases Chewing motion begins (gumming food) Mouth open for spoon, bring hands to bottle, holds, sucks & bites cookies Strained, pureed or blenderised food from spoon →→ mashed food without lumps Palmar grasp: clasping an object in the palm and wrapping whole hand around it.

Sequence of Development of Feeding Behavior
Age Reflexes Motor Dev Feeding Bhv Food 7 - 9 mths Gag reflex weaker Bears weight on legs when held Sits briefly alone Holds one object in each hand Develop inferior pincer grasp Tries to finger feed soft food Use tongue to move lumps of food Holds bottle alone, cup drinking Munching/chewing movements when solid foods eaten, rotary chewing begins Mashed lumpy foods by spoon, large pieces of easily chewed finger foods mths Tooth eruption continues, chewing matures Bites nipples/teats, spoons & crunchy foods Finger feeds with refined pincer grasp Continue addition of new food with easy-to-chew texture Palmar grasp: clasping an object in the palm and wrapping whole hand around it.

Nutrient Needs high energy & nutrient demands
Rapid growth & major changes in body composition: high energy & nutrient demands most nutrient needs of infants, in proportion to body weight, is > double that of adults example: Infant Adult Energy (kcal/kg/day) 90 – > 30 – 40 Protein (g/kg/day) – > – 1 impossible to establish a single standard for all infants recommendations expressed as ranges e.g. for birth - 6 mths & 6 mths - 1 year If maternal diet is adequate, breast milk will meet the major nutrient needs of the baby best method to determine adequacy of infants’ energy intakes is to monitor gain in height and weight on growth charts = ht and wt should proceed at approx same percentile not honey / corn syrup ==> can contract botulism as infant has no immunity to this NH00 / Infant / GW 32

Infant Feeding Patterns
3 overlapping stages: Nursing period Breast milk/ formula provides complete nutrition for the infant (4 - 6 mths after birth) As physical & developmental capabilities mature, Transitional period Specially prepared semi-solid foods are introduced, composition & consistency progressively Breast milk/ formula continues Modified adult period Eating a variety of foods from a mixed diet (1/3 – ½ of dietary intake) Breast milk/formula still main source of energy & nutrients (by 12 mths)

Recommended Supplementary Food Introductions During The 1st Year
4-6 mths 6-8 mths Breast milk/ iron fortified infant* formula 4-6 feeds 3-4 feeds * follow up formula Rice/Cereals Iron fortified rice cereals, potato Infant cereals – mixed, teething biscuits Fruit Pureed, strained fruits; juices (diluted) Mashed/scraped lumpy fruits Vegetables Pureed, strained vegetables Mashed/scraped lumpy vegetables Meats Scraped/mashed/finely minced meats; scraped /mashed egg yolk, tofu

Food 8-10 mths 10-12 mths Breast milk/ iron fortified follow up formula 3-4 feeds Cereals Other cereals, plain crackers, thin porridge Breads, soft rice, pasta, thick porridge Fruit Soft peeled fruits (mashed/chopped) Small pc soft, fresh, canned fruits (unsweetened) Vegetables Mashed/chopped vegetables Small pc tender-cooked veges; raw – finger foods Meats Plain baby yogurt; mashed/finely minced meats, cooked legumes - mashed Mashed/finely minced /chop/tender-cooked meats; mild cheeses

Planning Meals For Older Infants
Healthy Diet Pyramid Guide Rice & Alt Meat & Alt Fruit Veg 7-12 months 1-2 servings ½ serving To include additional 750 ml milk

Nutrition in Adolescence

Stages of the life cycle an adolescent has gone through…
Preschool Years Infancy Foetus Stages of the life cycle an adolescent has gone through… School Years Adolescence

Assessment of Nutritional Status
Three important features of the adolescent growth spurt that must be considered are time of onset, duration & magnitude Anthropometry – monitoring of growth /growth velocity is one of the most sensitive means for evaluation Assessment may be complicated by the fact that ratio of LBM and fat to height changes Crossing from one growth channel to another occurs frequently during this period of rapid growth – when two or more channels are crossed, further evaluation is necessary

Assessment of Nutritional Status
Knowing the stage of sexual maturity ratings helps in evaluation of nutritional significance of growth deviation – e.g. 85th percentile weight & skinfold for a girl at stage 1 indicates weight & fat accumulation preceeding pubertal growth spurt for a girl at stage 4 indicates excess body fat that may continue into adulthood Clinical – because of their rapid growth, adolescents’ nutrition deficiencies become apparent more quickly than do adults’. Physical signs reflect advanced stages of undernutrition

Nutritional Requirements in Adolescence

High Nutrient Needs Except for the first 2 years of life, there is no time when growth & development are as rapid Onset of puberty & adolescent growth spurt demands for energy, macronutrients, vitamins & minerals increase markedly Adolescence may serve as a window of opportunity for compensating for early childhood growth failure – nutrient intake must be favourable. However the potential for significant catch-up growth is limited

Planning Meals For Adolescents
Factors to consider: stage of growth/development gender & nutritional requirements Ensure that all nutrients are provided with a variety of foods balanced among the food groups in the Healthy Diet Pyramid Appropriate snacks – nutrient dense choices (low fat/skim milk & dairy products, fresh fruits /vegetables & juices, sandwiches with wholegrain breads & lean meats/low fat cuts) should be provided Calcium & iron-rich sources should be emphasized

Planning Meals For Adolescents
Healthy Diet Pyramid Age Rice & Alt Meat & Alt Fruit Veg 7-12 yrs 5-6 (this includes 1 serving of whole grains) 2 (include ml in addition to the 2 svgs above) 13-18 yrs 6-7 18-65 yrs 5-7 2-3

The Early Years The Middle Years The Older Years Stages of Adulthood
55

Dietary Recommendations For The Healthy Adult
Carbohydrate % of calories Protein % of calories Fat % of calories Refer to the following: “Dietary Guidelines 2003 for Adult Singaporeans (18-65 years)” HPB MOH Topic 2: Dietary Practices & Meal Planning for Healthy Diet Pyramid Guide 56 56

Planning Meals For Adults
Rice & Alt Meat & Alt Fruit Vege Men (Light Activities) 7 3 2 Women (Light Activities) 5 - 6 Young adults should choose heart-healthy diets to protect themselves against CVD in later years For adults on vegetarian or macrobiotic diets, refer to Topic 2 notes 57

Planning Meals With Less Fat
Mr Lim usually has … If he orders … He saves … Breakfast 2 pc roti prata w dhall curry 2 pc toast w jam 7.6 – = 5.6 g Lunch Chicken rice Plain rice Chicken roasted (skinless) Stir-fried mix vege 26.0 g – 8 = 18 g Afternoon Tea 2 pc currypuff, potato 2 pc popiah, 43.9 – 22.4 = 21.5 g Dinner Pork chop, 2 pc Cream of mushroom soup Black forest cake Broiled pork tenderloin, 6 oz, lean only Broth Fat-free ice cream 66.7 g -10 = 56.7 g Supper ½ c mixed nuts 2 pc fresh fruits 27.7 g - 0 = 27.7 g Saves 129.5 g fat !! 58

Nutrition Across the Life Span

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