This handout highlights the importance of nutrition across the entire lifespan. It talks about nutrition during pregnancy, lactation, childhood, adolescence and adults. Its very imperative to know what to eat and when to eat especially as we continue to age. Growth only proceeds up to a certain point when we have to be critical of the food we eat as any excess may results in chronic complications, especially becoming Obese and suffering from Diabetes Meliitus. This handout is going to help mostly the students of nutrition, midwifery and dietetics, and public health.

1. NUTRITION IN LIFESPAN
Lecture Notes for Nutrition & Food Science students
East Africa University - Garowe
Prepared by; H.Wahab [Lect. Nutrition & Food Science]
habibwahab8@gmail.com @habibwahab3

2. INTRODUCTION
The body’s machinery to process food and turn it into
nutrients is very efficient. The action takes place in the
digestive tract into two stages of digestion and absorption.
• Digestion; refers to the process of transforming the food we
eat into small units for absorption.
• Absorption; this refers to the process of movement of
substances into or across tissues. In particular, this is the
movement of nutrients and other substances into the walls
of the gastrointestinal tract and then into the blood stream.

3. PHYSICAL AND CHEMICAL DIGESTION
To absorb nutrients from the foods we eat, the bonds that link the
nutrients together must first be broken down in the digestive tract.
The break-down of food into smaller units and finally into absorbable
nutrients involves both chemical and physical processes. First, there
is the physical breaking of food into smaller pieces, such as what
happens when we chew. In addition, the muscular contractions of the
GI tract continue to break food up and mix it with various secretions,
while at the same time moving the mixture (called chyme) along the
GI tract. Enzymes, along with other chemicals, help complete the
breakdown process and promote absorption of nutrients.

4. THE PHYSICAL MOVEMENT AND BREAKING UP
OF FOOD
Distinct muscular actions of the GI tract take the food on its journey. From
mouth to anus, wavelike muscular contractions called peristalsis transport
food and nutrients along the length of the GI tract. Peristaltic waves from
the stomach muscles occur about three times per minute. In the small
intestine, circular and longitudinal bands of muscle contract approximately
every four to five seconds. The large intestine uses slow peristalsis to move
the end products of digestion (feces) towards the anus.
Segmentation; a muscular movement that occurs in the small intestine,
divides and mixes the chyme by alternating forward and backward
movement of the GI tract contents. Segmentation also enhances absorption
by bringing chyme into contact with the intestinal wall.

5. THE CHEMICAL BREAKDOWN OF FOOD
Chemically, it is the action of enzymes that divide nutrients into
compounds small enough for absorption. Enzymes are proteins that
catalyze, or speed up, chemical reactions but are not altered in the
process. Most enzymes can catalyze only one or a few related reactions, a
property called enzyme specificity. Enzymes act in part by bringing the
reacting molecules close together. In digestion, these chemical reactions
divide substances into smaller compounds by a process called hydrolysis
(breaking apart by water). Most of the digestive enzymes can be identified
by name; they commonly end in -ase (amylase, lipase, and so on). For
example, the enzyme needed to digest sucrose is sucrase.

6. CONTINU…..
In addition to enzymes, other chemicals support the digestive
process. These include acid in the stomach, a neutralizing
base in the small intestine, bile that prepares fat for digestion,
and mucus secreted along the GI tract. This mucus does not
break down food but lubricates it and protects the cells that
line the GI tract from the strong digestive chemicals.

7. DIGESTION IN THE MOUTH
• As soon as you put food in your mouth the digestive process begins. As you
chew, you break down the food into smaller pieces, increasing the surface area
available to enzymes. Saliva contains the enzyme salivary amylase (ptyalin),
which breaks down starch into small sugar molecules. Food remains in the mouth
only for a short time, so only about 5 percent of the starch is completely broken
down.
• Salivary amylase continues to work until the strong acid content of the stomach
deactivates it.
• Saliva and other fluids, including mucus, blend with the food to form a bolus,
which moves rapidly through the esophagus to the stomach, where it is digested
further.

8. NUTRIENT DIGESTION IN THE STOMACH
• The stomach cells produce secretions that are collectively called gastric juice
• Included in this mixture are water, hydrochloric acid. mucus, pepsino-gen (the
inactive form of the enzyme pepsin)
• Hydrochloric acid makes the stomach contents extremely acidic, drop-ping the pH to
2.
• This acidic environment kills many pathogenic (disease-causing) bacteria that might
have been ingested and also aids in the digestion of protein.
• Pepsin breaks protein bonds to produce smaller units of proteins.
• Stomach cells also produce an enzyme called gastric lipase. It has a minor role in the
digestion of lipids.
• Gastrin, another component of gastric juice, is a hormone that stimulates gastric
secretion

9. NUTRIENT ABSORPTION IN THE STOMACH
• Although a substantial fraction of digestion has been
accomplished by the time chyme leaves the stomach, very
little absorption has occurred.
• Only some lipid-soluble compounds and weak acids, such as
alcohol and aspirin, are absorbed through the stomach.

10. SMALL INTESTINE
• The small intestine is where the digestion of protein. fat, and nearly all
carbohydrate is completed.
• The small intestine is a tube about 3 meters long divided into three parts;
• The duodenum,
• The jejunum, and
• The ileum.
The duodenum is mainly responsible for digesting food
jejunum and ileum primarily deal with the absorption of food

11. CONTINUATION…
• In the duodenum, the acidic chyme from the stomach is neutralized by a
base, bicarbonate, from the pancreas.
• This is important because the enzymes of the small intestine need a more
neutral environment to work effectively.
• Pancreatic juice contains a variety of digestive enzymes that help to digest
fats, carbohydrates, and proteins.
• Other nutrients, such as vitamins, minerals, and cholesterol, are not
digested and generally are absorbed unchanged,
• In most cases, more than 90 percent of ingested carbohydrate, fat, and
protein is absorbed.

12. THE LARGE INTESTINE
• The peristaltic movements of the large intestine are sluggish
compared with those of the small intestine.
• During that time, the colon's large population of bacteria
digests small amounts of fiber, providing a negligible
number of calories daily.
• Other than bacterial action, no further digestion occurs in
the large intestine.

13. NUTRIENT ABSORPTION IN THE LARGE
INTESTINE
• Minimal nutrient absorption takes place in the large intestine
• The colon dehydrates the watery chyme, removing and absorbing most
of the remaining fluid.
• The semisolid feces, consisting of roughly 60 percent solid matter (food
residues, which include dietary fiber, bacteria, and digestive secretions)
and 40 percent water, then passes into the rectum.
• In the rectum, strong muscles hold back the waste until it is time to
defecate. The rectal muscles then relax, and the anal sphincter opens to
allow passage of the stool out the anal canal.

14. NUTRITION DURING PREGNANCY AND
LACTATION
• Nutrition requirements increase tremendously
during pregnancy and lactation
• The Mother not only has to nourish herself but also
the growing fetus
• Nutrient is required during;
Pregnancy
Lactation (breast feeding)

15. NUTRITION DURING PREGNANCY
• Pregnancy is a period of great physical stress for a
woman as she is nurturing a growing fetus in her body.
• Some changes occur in the mother’s body which
influences the need for nutrients and the efficiency with
which the mother's body uses the nutrients.These
changes include;
• basal metabolic rate (BMR):
• Gastrointestinal changes:
• Changes in body fluid:

16. CHANGES THAT OCCUR IN THE MOTHERS
DURING PREGNANCY
• basal metabolic rate (BMR):
This refers to the rate at which the body uses energy while at rest. Fetal growth and
development increase the BMR by 5% during 1st trimester and 12% during 2nd and
3rd trimesters.This increases the total energy requirement.
• Gastrointestinal changes:
There are changes in GI functions which causes nausea, constipation, and vomiting. In
the later trimester of pregnancy absorption of nutrients like vitamin B12, iron, and
calcium increases in order to meet the increased needs of the mother and fetus.
• Changes in body fluid:
The mother’s blood volume increases so as to carry the appropriate amount of
nutrients to the fetus and metabolic waste away from the fetus.

17. IMPORTANCE OF GOOD NUTRITION DURING
PREGNANCY
• Mother has to nurture the fetus, health of the newborn depends on nutritional status of the
mother during and prior to conception.
• A well-nourished woman prior to conception enters pregnancy with a reserve of several
nutrients
• A well-nourished woman suffers fewer complications during pregnancy & there are few
chances of premature births.
• A well-nourished mother will give birth to a healthy child.
• Maternal diet during pregnancy has a direct influence on fetal growth, size, and health of the
newborn.
• Poor diet during pregnancy affects a mother’s health, a malnourished mother provides
nutrients to the fetus at the expense of her own tissues.
• Poor nutrition during pregnancy increases the risk of complications such as prolonged labor
and even death.
• Inadequate diet during pregnancy affects the health of the baby during early infancy.

18. ENERGY REQUIREMENT DURING
PREGNANCY
During pregnancy additional energy is required to support
• The growth of the fetus,
• Development of placenta and maternal tissues
• To meet the needs for increased basal metabolic rate
• To deposit fat which will be used during lactation.
• Additional 300 kcal of energy is required during 2nd and
3rd trimester of pregnancy.

19. PROTEIN REQUIREMENT DURING
PREGNANCY
During pregnancy additional protein is required for
• Growth of the fetus
• Development of placenta
• Enlargement of maternal tissues
• Increased maternal blood volume
• Formation of amniotic fluid
• Protein reserves prepare the mother for labor, delivery,
and lactation

20. FAT (OMEGA-3 FATTY ACID)
REQUIREMENT DURING PREGNANCY
Omega-3 fatty acid (DHA): 300mg/d
• Omega-3 fatty acid like DHA (Docosahexaenoic acid)
supplementation during pregnancy is essential for brain
development and prevents preterm births.
• It is required for fetal visual development
• It reduces the incidence of heart diseases & heart disease related
deaths in infants.

21. CALCIUM REQUIREMENT DURING
PREGNANCY
During pregnancy additional calcium is needed for;
• Growth and development of bones as well as teeth of the fetus.
• Calcium intake decreases the risk of hypertension
• Maintaining bone strength
• Proper muscle contraction
• Blood clotting

22. IRON REQUIREMENT DURING PREGNANCY
During pregnancy, iron is essential for
• Fetal growth
• Expansion of maternal tissues including the red blood cell
mass
• Maintaining additional iron content of placenta
• Building the iron stores in fetal liver
• Compensate blood loss during delivery

23. MINERAL REQUIREMENT DURING
PREGNANCY
Zinc (RDA-12mg/d) :
• It is required for the synthesis of nucleic acids DNA and
RNA and it is having an important role in reproduction.
• Zinc deficiency during pregnancy can cause poor
pregnancy outcomes and abnormal deliveries including
congenital malformations.
• Iodine: Lack of iodine causes still birth, birth defects &
decreased fetal brain development.

24. VITAMIN REQUIREMENT DURING PREGNANCY
• Vitamins A: It is needed in a small amount to protect the fetus from
immune system problems, blindness, infections, and death.
• Vitamin D: It is required for the formation of fetal bones.
• Vitamin K: Vitamin K is required for normal coagulation of blood
• Vit C: It increases iron absorption and also helps in fetal growth. The
deficiency of vitamin C increases the chances of preterm delivery.

25. OTHER CONSIDERATIONS DURING PREGNANCY
• Caffeine: Coffee should be avoided since it can enter the placenta and into fetal
circulation and increasing the risk of miscarriages, premature deliveries, and small or
date infants.
• Smoking During pregnancy smoking results in placental abnormalities and fetal
damage, including prematurely and low birth weights. Smoking impairs oxygen &
nutrient transport through the placenta due to reduced blood flow.
• Alcohol: During pregnancy alcohol consumption causes low birth weight infants &
growth retardation,
• Drugs: During pregnancy, drugs consumption leads to poor prenatal weight gain,
very short or prolonged labor, operative delivery, and other perinatal problems.

26. DIET AND FEEDING PATTERN DURING
PREGNANCY
• To meet the increased nutrients needed during pregnancy mother
should increase her feeding.
• Pregnant women should consume 5-6 meals a day and snacks in
between the main meals.
• To meet the increased protein demand good quality protein-rich
foods like milk, meat, eggs, fish should be included,
• Nutrient rich foods specially iron, calcium, folic acid, calcium and
DHA foods should be included in the diet during pregnancy.

27. IMPORTANCE OF NUTRITION DURING
LACTATION
• During lactation adequate nutrition is required as an infant derives all its
nutrition from the mother's milk
• Mother needs extra nutrition as she has to nourish a fully developed &
rapidly growing infant. She needs extra nutrients to meet the baby's needs in
addition to her own requirements.
• Any inadequacy in the mother’s diet influences both the quality & quantity of
mother's milk secreted.
• If the mother's diet is inadequate, then she will draw her own body reserves
to meet the needs of lactation at the cost of her own health.
• Nutrient deficiency can lead to lower levels of nutrients in the mother's milk.

28. NUTRITION REQUIREMENT DURING LACTATION
Energy requirement:
• Lactating mothers need additional energy for the production of milk.
• During pregnancy approximately 600-850 ml of milk is secreted daily.
• Energy content of mother's milk and efficacy of conversion of food energy
into milk energy determines the energy requirement of a lactating woman.
• During the first 6 months of lactation - additional 550 kcal/ d energy is
required
• During 6-12 months of lactation- additional 400 kcal/ d energy is required

29. PROTEIN REQUIREMENT:
• During lactation protein needs also increase as mother’s milk
contains 1.15g of protein/ 100ml.
• For proper milk production, adequate amounts of good quality
protein or good quality protein should be included in the
mother's diet,
• During first 6 months of lactation- 75g of protein is required
every day
• During 6-12 months of lactation - 68g of protein is required
everyday

30. CALCIUM
• Additional calcium is required for breast milk secretion. 30-40mg
of calcium is secreted per 100ml or 300mg of calcium per 850 ml
of milk.
• Additional intake of calcium is essential to enable the retention of
calcium in breast milk.
• Adequate dietary calcium intake during lactation meets the
calcium needs and extra calcium requirement for breast milk
production.

31. IRON:
• Iron requirement during lactation is the addition of the
requirement of the mother and required to make up the iron
secreted in breast milk
• Most lactating women have lactation amenorrhea, resulting in
saving of 1mg of iron per day which would otherwise lost in
the menstrual blood.
• The requirement of iron is same as the non-pregnant woman

32. VITAMIN REQUIREMENTS DURING
LACTATION
Vitamin A:
• Breast milk is rich in vitamin A so lactating mother needs adequate amount of
vitamin A in their diet.
• Average amount of vitamin A secreted in mother's milk is 350ug/d retinol.
Vitamin B6: its requirement increases during lactation.
Vitamin B12: Additional Vitamin B12 is required to meet the needs of the
lactation.
Folic acid: Additional folic acid intake will meet the needs of the lactation.
Vitamin C: Appreciable amount of vitamin C is secreted in breast milk.
Additional intake will meet the need for lactation.

33. DIET AND FEEDING PATTERNS DURING
LACTATION
• Lactating mother requires larger quantities of bodybuilding and protective
foods and additional energy-yielding foods to facilitate the formation and
secretion of breast milk.
• Fluid intake should be increased as fluids are essential for adequate quantity
of milk production.
• No food should be restricted except highly spiced & strongly flavored food, as
they impart flavor to milk which may be repulsive to the baby.
• Nutrient needs of lactating mother are greatly enhanced during lactation
hence she should have snacks in between the meals. Lactating mother should
have 5-6 meals in a day.

34. NUTRITION
REQUIREMENTS CHANGE
ACROSS THE LIFESPAN
LECTURE SLIDE NOTES PREPARED FOR 4TH YEAR STUDENTS
OF EAU – GAROWE
HABIB WAHAB [Lect. Nutrition & Food Science]

35. INTRO.
• Nutritional status is determined by the balance between the supply of
nutrients and the demand for those nutrients in physiological and
metabolic processes.
• Both sides of the supply–demand balance equation can be affected by
a variety of different factors.
• Intake, for example, can be reduced in circumstances of poverty.
• Demand is elevated by physiological trauma.
• The main determinants of demand are, however, shaped by other
factors such as the level of physical activity (which will increase
energy requirements), by gender, by body size, and by age.

36. FETAL STAGE
• The demand for nutrients to sustain function begins from the moment
of conception.
• The embryonic and fetal stages of life are the life stages that are most
vulnerable in the face of any nutrient imbalance.
• Demands for nutrients are high in order to sustain the rapid growth
and the process of development from a single-celled zygote to a fully
formed human infant.
• The consequences of undernutrition at this stage can be catastrophic,
leading to miscarriage, failure of growth, premature birth, low weight
at birth, or birth defects

37. AT BIRTH
• After birth the newborn infant has incredibly high nutrient demands that, in
proportion to body weight, may be two to three times greater than those of an adult.
• These demands are related to growth and the maturation of organ systems as in fetal
life.
• Growth rates in the first year of life are more rapid than at any other time, and the
maturation of organs such as the brain and lung continues for the first 3–8 years of
life.
• Initially, the demands for nutrients are met by a single food source, milk.
• In later infancy, there is the challenge of the transition to a mixed diet of solids
(weaning), which is a key stage of physiological and metabolic development.
• The consequences of imbalances in nutrition can be severe at this stage.
• Infants are very vulnerable to protein– energy malnutrition and to micronutrient
deficiencies.

38. BEYOND INFANCY
• Beyond infancy, nutrient demands begin to fall relative to body weight, but
still remain higher than seen in adulthood.
• The demands are however at their greatest at the time of puberty when the
adolescents increase in height and weight.
• There is increase in body fat in female as a result of fat deposition altered in
response to the metabolic influences of the sex hormones.
• Proportions of muscle increase and the skeleton increases in size and degree
of mineralization in men.
• Nutrient supply must be of high quality to drive these processes.
• However, adolescents normally have extensive nutrient stores and are
therefore more tolerant of periods of undernutrition than preschool children
(1–5 years).

39. ADULT YEARS
• The adult years have the lowest nutrient demands of any stage of life.
• Here growth is complete, nutrients are required solely for the maintenance of
physiological functions.
• The supply is well buffered through stores that protect those functions against
adverse effects of undernutrition in the short term to medium term.
• In developed countries, and increasingly so in developing countries, the main
nutritional threat is overweight and obesity.
• It is difficult for adults to adjust energy intakes against declining physiological
requirements and the usual fall in levels of physical activity that accompany aging.
• Reducing energy intake, while maintaining adequate intakes of micronutrients is a
major challenge in elderly individuals.
• Chronic illnesses associated with aging can promote undernutrition through
increased nutrient demands, while limiting appetite and nutrient bioavailability.

40. FOR WOMEN (ADULT)
• For women, pregnancy and lactation represent special circumstances that
may interrupt the adult years and which increase demands for energy and
nutrients.
• Nutrition is in itself an important determinant of fertility and the ability to
reproduce.
• In pregnancy, provision of nutrients must be increased for the growth and
development of the fetus and to drive the deposition of maternal tissues.
For example, there are requirements for an increase in size of the uterus, for
preparation of the breasts for lactation and for formation of the placenta.
• Lactation is incredibly demanding in terms of the energy, protein, and
micronutrient provision to the infant via the milk.

41. DIET IN RELATION TO
PREGNANCY OUTCOMES
Prepared by Dr. H.Wahab [Lect.Nutrition & Food Science]

42. • Human gestation is long to ensure growth and development
of an infant especially the brain.
• The long gestation means that the developing infant is
vulnerable to adverse factors (genetic, nutritional
deficiencies, incompatibility) that impact upon the mother.
• Many of these adverse factors can compromise the
pregnancy by imposing physiological and metabolic
stressors on the mother.
• Nutrition-related factors play an important role in
determining the outcomes of pregnancy.

43. MISCARRIAGE AND STILLBIRTH
• This is defined as the natural end of pregnancy at a stage of
fetal development.
• Miscarriage happens prior to the fetus being capable of
survival, which is before the 23-24 weeks gestation.
• Later in pregnancy, the fetus may die either prior to delivery or
during the delivery.
• The former case is termed Late Fetal Death, while the latter is
referred to as Stillbirth.
• There are a number of indicators that nutrition related factors
are predictive of miscarriage or later loss of the fetus.

44. RISK FACTORS FOR MISCARRIAGE IN THE
FIRST TRIMESTER
• A previous history of miscarriage
• Assisted conception
• Being an older woman,
• Alcohol consumption or use of drugs,
• Having a low BMI prior to pregnancy (Women with a pre-
pregnancy BMI below 18.5 kg/m2 (i.e., underweight) have been
reported to have between 24% and 72% greater risk of
miscarriage than women with a BMI of 18.5–24.9 kg/m2 going
into pregnancy.

45. PREMATURE LABOR
• Babies who are born prior to 37 weeks gestation are termed
premature, or preterm.
• Preterm delivery is the main cause of perinatal death (before
birth) and neonatal death (after birth).
• It is also associated with significant levels of disability among
children.
• As such, premature birth is associated with a major human cost,
and also has a significant economic impact upon health
services, due to the expense of neonatal intensive care.

46. RISK FACTORS FOR PREMATURE LABOR
• Maternal infection,
• psychological trauma of the mother,
• Maternal smoking,
• Lifestyle including nutrition-related factors
• Excessive physical activity.

47. HYPERTENSIVE DISORDERS OF PREGNANCY
• Rising blood pressure is a common feature of pregnancy.
• This is as a result of the changing renal function, requirement to maintain
placental perfusion (blood flow), and alterations in fluid balance.
• When hypertension has onset in the latter part of pregnancy, this is
termed gestational hypertension.
• If hypertension has an onset in the first 6 weeks of pregnancy and
persists throughout gestation, it is termed chronic hypertension of
pregnancy.
• Neither of these conditions is of major significance in terms of maternal
or fetal health.

48. NUTRITION OF THE INFANT
• Early nutrition affects later development, and early feeding sets
the stage for eating habits that will influence nutrition status for
a lifetime.
• The infant initially drinks only breast milk or formula but later
begins to eat some foods, as appropriate.
• An infant grows faster during the first year than ever again,
• The growth of infants and children directly reflects their
nutritional well-being and is an important parameter in
assessing their nutrition status.

50. IMPORTANCE OF GOOD NUTRITION DURING
INFANCY
• An infant’s birthweight doubles by about five months of age and triples
by the age of one year, typically reaching 9kg to 11kg.
• Imagine if it was an adult, starting at 54kg, were to do this, the person’s
weight would increase to 163kg in a single year.
• The infant’s length changes more slowly than weight, increasing about
10 inches from birth to one year.
• By the end of the first year, the growth rate slows considerably.
• Not only do infants grow rapidly, but, in proportion to body weight, their
basal metabolic rate is remarkably high

51. • The rapid growth and metabolism of the infant demand an ample
supply of all the nutrients.
• Infants need energy nutrients and the vitamins and minerals critical to
the growth process, such as vitamin A, vitamin D, and calcium.
• Because they are small, infants need smaller total amounts of these
nutrients than adults do, but as a percentage of body weight, infants
need more than twice as much of most nutrients.
• Infants require about 100 kcalories per kilogram of body weight per
day; most adults require fewer than 40 kcalories.

53. WATER
• One of the most important nutrients for infants, as for everyone, is
water.
• The younger a child is, the more of the child’s body weight is
water.
• Breast milk or infant formula normally provides enough water to
replace fluid losses in a healthy infant.
• If the environmental temperature is extremely high, however,
infants need supplemental water.
• Infants can easily loss water due to vomiting or diarrhea.

54. BREAST MILK
• Breast milk tops as a source of nutrients for the young
infant.
• With the exception of vitamin D, breast milk meets all of
a healthy infant’s needs for the first six months of life.
• It provides many other health benefits as well.

55. FREQUENCY AND DURATION OF
BREASTFEEDING
• Breast milk is more easily and completely digested than formula, so
breastfed infants usually need to eat more frequently than formula-
fed infants do.
• During the first few weeks, approximately 8 to 12 feedings a day on
demand, as soon as the infant shows early signs of hunger.
• An infant who nurses every two to three hours and sleeps
contentedly between feedings is adequately nourished.
• As the infant gets older, stomach capacity enlarges and the mother’s
milk production increases, allowing for longer intervals between
feedings.

56. ENERGY NUTRIENTS IN BREAST MILK
• The distribution of energy nutrients in breast milk differs dramatically from the
balance recommended for adults.
• The carbohydrate in breast milk (and standard infant formula) is lactose.
• In addition to being easily digested, lactose enhances calcium absorption.
• The carbohydrate component of breast milk also contains abundant
oligosaccharides(has smaller number of monosaccharide units), which are present
only in trace amounts in cow’s milk and infant formula made from cow’s milk.
• Human milk oligosaccharides help protect the infant from infection by preventing
the binding of pathogens to the infant’s intestinal cells.
• Human breast milk contains less protein which places less stress on the infant’s
immature kidneys. The protein alpha-lactalbumin, is efficiently digested and
absorbed.

57. VITAMINS AND MINERALS IN BREAST
MILK
• With the exception of vitamin D, the vitamin content of the breast milk of a
well-nourished mother is ample.
• The concentration of vitamin D in breast milk is low, however, and vitamin
D deficiency impairs bone mineralization.
• Vitamin D deficiency is most likely in infants who are not exposed to
sunlight daily.
• Its recommended to give infants a vitamin D supplement for all infants
who are breastfed exclusively.
• As for minerals, the calcium content of breast milk is ideal for infant bone
growth, and the calcium is well absorbed.
• Breast milk is also appropriately low in sodium. The limited amount of

58. ENERGY REQUIREMENTS DURING
CHILDHOOD
Carbohydrate and Fiber
• Carbohydrate recommendations are based on glucose use by the brain.
• After one year of age, brain glucose use remains fairly constant and is within the adult
range. Carbohydrate recommendations for children after one year are therefore the
same as for adults
• Fiber helps to reduce the risk of coronary heart disease and are based on energy
intakes.
• fiber recommendations are lower for younger children with low energy intakes than
for older ones with high energy intakes.

59. Fat and Fatty Acids
• fat intake of 30 to 40 percent of energy for children 1 to 3 years
of age and 25 to 35 percent for children 4 to 18 years of age.
• As long as children’s energy intakes are adequate, fat intakes
below 30 percent of total energy do not impair growth.
• Children who eat low-fat diets tend to have low intakes of some
vitamins and minerals.

60. Protein
• Like energy needs, total protein needs increase slightly
with age but decline slightly per unit of body weight.
• Protein recommendations must address the requirements
for maintaining nitrogen balance, the quality of protein
consumed, and the added needs of growth.

61. Vitamins and Minerals
• The vitamin and mineral needs of children increase with age.
• A balanced diet of nutritious foods can meet children’s needs for
these nutrients, except iron and vitamin D.
• Iron-deficiency anemia is common among children, especially
toddlers one to three years of age.
• During the second year of life, toddlers can be fed with iron-
fortified formula, and iron-fortified infant cereals.