A public Health lecture on nutrition.

1. NUTRITION INTHE LIFE SPAN
MRS. SIAME

2. LEARNING OBJECTIVES:
• Discuss the need for public health nutrition services for
women, infants, children, adolescents and the elderly.
• Describe nutrient requirements for each group.

3. INTRODUCTION
• Adequate food and nutrition throughout the life cycle is important for optimal health.
• Numerous negative outcomes (small for age infants, gestational diabetes, nutrient
deficiencies, stunting, overweigh, etc.).
• Pregnancy, infancy, childhood and adolescence – require nutrients at the right time in
right amount for development of systems.
• Double burden of malnutrition (10% underweight; and 19% overweight in women of
reproductive age).

4. GENERAL NUTRITIONAL NEEDS:
Many Health Problems Are Linked To NUTRITION. ItWould BeWiseTo Know And Follow
The Guidelines Of FOOD PYRAMID And Dietary Guidelines.
Good nutrition:
1) Resists DISEASE
2) Helps decrease healing time
3) Supplies ENERGY!
EXERCISE is important throughout the life cycle.
Proper amounts of FIBER in the diet is directly linked to preventing many health problems

5. MATERNAL HEALTH
• Before conception – nutritional status of the mother establishes the
environment.
• Early stages – critical for fetal development - nutritional deficiencies alcohol
and illicit drugs lead to negatives outcomes.
• Extreme weight (under or obese) – higher risk for preterm or health
problems.
• Normal range weight is recommended
• Maintain health and monitor medical conditions.

6. GUIDETO NUTRIENT INTAKE
• Nutrition assessment and advice is critical
• Weight gain based on BMI categories
• Normal weight (BMI 19.8 – 26)
• Underweight (BMI < 19.8)
• Overweight (BMI > 26 – 29)
• Obese (BMI > 29)

7. NUTRITIONAL NEEDS DURING PREGNANCY
 The diet can affect both the MOTHER and FETUS
If the mother does not eat foods containing the
proper nutrients, nutrients may be taken from the
mother’s BODY
FOLATE is needed to prevent neural tube damage
(Brain and Spinal Cord) and should be taken by
women before they even become pregnant
The mother will need more PROTEIN to support
the growth of the fetus, yet most people already eat
enough to support the increased need

8. • CALCIUM is needed to form bones
• An IRON reserve needs to be built up before
birth, since breast milk is not a rich source of iron
• The mother should eat an extra glass of milk and
leafy green vegetables each day
• The mother should also take a PRENATAL
vitamin each day, but should consult their
physician first.

9. WEIGHT IN PREGNANCY
• Weight gain components – fetus, fat stores, extracellular fluid, blood
volume, uterus, amniotic fluid, placenta and breast tissue.
• Excessive weight gain is undesirable, but diet restrictions and weight loss -
not recommended.
• Underweight pregnant women (BMI less than 19) require additional food
to achieve an average monthly gain of 2kg in the second and third
trimester

10. NUTRIENT INTAKE DURING PREGNANCY
• Recommended intakes – nearly all nutrients are higher.
• Vitamins and mineral supplements should be evaluated on individual basis.
• Nutrients that may require supplementation include iron, folic acid and
calcium.
• Additional nutrients may be indicated in adolescents and women with multiple
fetuses.

11. KCAL AND PROTEIN INTAKE
• Nutrient intake vary by Trimester
• Estimated Energy Requirements (EER)
First Trimester – same as for the non-pregnant woman
SecondTrimester – and additional 340 Kcal/day
ThirdTrimester – 452 Kcal/day
• Protein for growth and development of fetus
First Trimester = additional 25 g/day
SecondTrimester = additional 25 g/day
ThirdTrimester = additional 25 g/day

12. CONCERNS FOR PREGNANT WOMEN
• Generally, during second and third trimesters, metabolic rate increase by
15%, peaking at 20%.
• Insulin efficiency decreases during the later part of pregnancy.
• Dangers:
 Mother may developType 2 diabetes later (esp. if obese)
 Mother has increased risk of preeclampsia
 Baby at risk of becoming too large (macrosomia), still born, hypoglycemic at birth and
may develop diabetes, hypertension, obese as an adult.


13. ANEAMIA IN PREGNANCY
• Nearly half pregnant women suffer from iron deficiency anaemia
• Anaemia is of particular concern during pregnancy.
• Routine Iron and Folic Acid is provided at antenatal
• Folic acid supplementation is recommended a month before conception
and in early pregnancy.

14. CONCERNS RELATEDTO ANEMIA
• Deficiency has negative repercussions of fetal growth and maternal
outcomes
• Positive maternal outcomes associated with early folic acid supplementation
- reducing the risk of neural defects such as spinal bifida, neural tube defects,
urinary track anomalies, oral facial defects (cleft lip and cleft palate).
http://womenshealth.gov/publications/our-publications/fact-sheet/folic-
acid.html#c

15. CONCERNS DURING PREGNANCY
• Alcohol – Fetal Alcohol Syndrome (FAS)
• Adolescent pregnancy – physiological risks both to the mother and baby.
• Smoking has profound impact on growth – less oxygen availability resulting in
small for gestational age baby (SGA), higher risk of complications at birth and
problems in the first year of life.
• Eating disorders (cravings, e.g. pica)

16. CONCERNS RELATEDTO POST PREGNANCY
• Post partum depression
• Lactation
• Breastfeeding
• postnatal

17. RECOMMENDATIONS
• Maintain healthy weight gain in relation to BMI
• Increase Kcal and protein intake in the second and third trimester
• Consume health diet that includes fruits, vegetables whole grains dairy products; and
adequate water etc.
• Maintain adequate intake of iron, folic acid, calcium, vitamin C,Vitamin D, proteins and
supplements as recommended.
• Maintain physical activity
• Abstain from alcohol and smoking
• Assess health and monitor medical conditions

18. CHILD NUTRITION
• Breast feeding (galactocemia/lactose interlance, drug abuse)
• Exclusive breastfeeding
• Feeding skills
• Development of food preference
• Food Allergies
• Eating disorders

19. INITIATIVES/POLICIES PROTECTING INFANT
NUTRITION
• Code of Marketing of Brest Milk Substitutes (WHO)
• Scaling Up Nutrition
• Immunizations

20. COMPLEMENTARY FEEDING
• Low birth weight
• Rapid growth and development (double by 6th Month and triple by 12th month
• Breast milk vs Formula: Breastfed tend to gain weigtht more rapidly in 2-3months but less
rapidly from 3 to 12 months (Differences disappear in the 2nd year)
• Complementary foods
• Key nutrients (Iron,Vitamin D, Fluoride)
• Juices such as apple and pear cause (10% absorbed – bloating or diarrhea, pain)

21. BREASTFEEDING
• The mother will need to make sure she gets enough nutrients to replace
those in the breast milk and she eats enough to cover the ENERGY needed
to produce the milk
• They will need to drink 2-3 quarts of liquid a day to provide water for the
breast milk and meet their own fluid needs
• Don’t drink ALCOHOL or drugs, for they can be passed to the baby
through the milk

22. INFANTS
• They will use their IRON reserve, because breast milk is low in iron.
• They will need all Fat soluble vitamins, and various water soluble vitamins
including riboflavin, niacin, B-5 and vitamin C.
• If formulas contain iron, the iron is often difficult to ABOSRB
• By the end of the first year a baby’s weight willTRIPLE, so it is important to
give them the nutrients they need.
• Newborns need to fed at least 7 or 8 times a day, by 2 months only 5 times a
day.
• Breast milk is recognized as the best food to foster BRAIN development

23. • Children can start eating solid foods around 6 months with
Rice baby Cereal, due to allergies.
• They should be introduced toVEGTABLES next, followed by
FRUIT. Fruit is sweet, so they may like vegetables less after being
introduced to them
• Lastly they can be given strained meat and poultry
• They should only be introduced to ONE new food at a time to
prevent food allergies
• Parents can add chopped food by one year, if babies’ TEETH
appear.

24. SCHOOL AGE CHILDREN
• Serving sizes/portions for children are SMALLER than adults.
Generally, offer children 1 TABLESPOON of a variety of foods per
year of age.
• Children need aVARIETY of nutrient-dense foods in small
amounts, FREQUENTLY
• Be sure they eat Breakfast, lunch, and dinner.
• SNACKS can provide added nutrients if they have trouble eating
enough at meals.

25. • Children’s taste buds are SENSITIVE.
• Avoid SWEET foods as snacks.
• Schedule snacks 1 ½ to 2 hours before meals.
• Make foods interesting and inviting for children: COLOR, texture, shape, size,
and temperature.
• Note: The eating habits and attitudes of children usually do not change in
ADULTHOOD.
• Encourage eating a variety of foods from the five food groups daily.
• Encourage the consumption of nutrient-dense foods such as milk, meat, whole
grains, fruits and vegetables.
• Do not restrict NUTRIENT- DENSE foods just because they contain some fat.

26. • Parents should urge kids to eat a good breakfast. Include low fat milk or
yogurt, high fiber bread or cereal, protein from peanut butter, cheese, lean
meat, fruit or 100% fruit juice.
• Be careful with soft drinks. CAFFENIE can dull appetite and may lead to
excluding more nutritious food.
• Children who drink too much JUICE risk gaining weight and losing their
appetite for milk which provides protein, calcium, and other vital nutrients.
• Children under 2 should drink whole milk; children over 2 should drink 1%.
• Recommended dietary fiber is 8 grams per day for 3 year old children to 23
grams per day by 18. Get this by eating lots of fruits & vegetables and high
fiber cereals and breads.
• Diets for healthy children should foremost provide ENERGY and
NUTRIENTS to support optimal growth and development.

27. OBESITY
• Obesity is common among CHILDREN.
• Parents should:
• Encourage their child to be ACTIVE
• Provide healthy snacks
• provide moderate PORTIONS
• Allow the child to stop eating when they are FULL

28. ADOLESCENTS
•Physical growth and development
•Changes in body composition
•Changes in emotional maturity

29. ADOLESCENTS (TEENS)
• This is a time of great activity and rapid GROWTH
• Teenagers need aVARIETY of nutritious foods throughout the
day. Follow the recommended number of servings from the
Food PYRAMID
• Girls will need approximately 2,200 calories and boys need
2,800 calories per day
• Teens should include foods that contain calcium (bones), iron(
support increase of blood volume and muscle mass), Zinc,
vitamin A ( reproductive maturity),vitamin E and C ( healthy
tissue and immune system).
• Nutritious snacks are especially important.

30. • Nutritional HABITS originating in adolescence often persist into adulthood.
• Obese adolescents often become OBESE adults.
• Remember that fast food meals usually contain more FAT and SODIUM than home-
cooked meals.
• Most common pitfalls in the teen diet:
• Too much fats and oils, salt and caffeine.
• Too many SWEETS.
• Too few fruits and vegetables.
• Too little fiber.
• Not enough IRON.
• Skipping breakfast and/or lunch.
• Eating the WRONG breakfast foods.
• YOU CAN’T LEAD A HIGH-ENERGY LIFE ON A LOW-ENERGY DIET!!!

31. TEEN ATHLETES
• Carbohydrates, fats, and proteins all contributes to stored nutrients that help
produce ENERGY
• Muscles are built by EXERCISE and NOT by extra protein.
• High energy output requires more NUTRIENT - DENSE foods.
• Meals should be eaten 3 - 5 hours before an athletic event.
• WATER is essential! This nutrient should be replaced quickly after participating in
athletic activities. 2 cups of water for every POUND lost is recommended.
• POTASSIUM replacement is recommended by eating
(1) dried fruit;
(2) low-fat milk;
(3) most fruits and vegetables rather than by taking tablets.

32. CONCERNS FORTHE PREGNANT
ADOLESCENT
• Adolescent’s growth and development is of concern
• Adolescent at particular risk of overweight and obesity, hypertension,
cardiovascular disease and non-insulin-dependent diabetes.
• Fetal growth restriction – disruption of fetal-placental flow – transmission of
nutrients to the fetus as a result of physiologic associated with maternal
growth.

33. KEY CONSIDERATIONS
• Maintain optimal growth and maturation by provision of energy based for desirable activity
• Protein to relate to growth pattern than age
• Vitamins and minerals are increased due to growth demands
• Calcium for skeletal development
• Iron increase due to increased (blood volume & hemoglobin concentration)
• Nutrition education must be provided
• Physical Activity must be encouraged.

34. ADULTS
• Metabolism SLOWS DOWN. Generally total food intake needs to
be REDUCED
• Due to busy SCHEDULES, nutritious meals are replaced with fast
food and snacks.
• It is important to get fruits, vegetables, whole grains, lean meats, and
low-fat dairy, while avoiding foods high in sugar and fat
• Inactive lifestyle creates a greater need for daily EXERCISE
• EXERCISING is the key to balancing food intake and output.

35. ELDERLY
 Aging adults have less sensitiveTASTE BUDS. Also, they are less sensitive
to SMELLS
 Adults overs the age of 50 need to increase their intake of vitamin D,
calcium, Folate,B6 and B12
 Because they are less active they need: (1) less fat, sodium, and calories in
their diet, and (2) more nutrient-dense foods. Some form of daily exercise
is still important.
 Elderly who live alone have a harder time eating a variety of nutritious
food. MALNUTRITION is a concern.
 Many health concerns and diseases incident to aging affects eating habits and
food choices.

36. GERIATRIC NUTRITION
• Chronic Diseases (Cardiovascular –CVD; kidney, diabetes, HIV infection)
• Under and over weight
• Malnutrition - Impaired appetite, physiological, cognitive and psychological
changes
• Osteoporosis
• Other considerations (poor sight, poor dentures, reduced activity)

37. THANKYOU