NUTRITION DIET LECTURE LABORATORY

1. DIET DURING PREGNANCY AND
LACTATION
Weight Gain during Pregnancy
- Average weight gain is 25–35
pounds for normal-weight women.
- Underweight women should gain
28–40 pounds.
- First trimester: 2–4 pound weight
gain
- Second and third trimester: 1
pound/week
- No one should lose weight during
pregnancy.
- No additional calories are usually
required during the first trimester.
- An additional 300 calories needed
during the second and third
trimesters.
- Folic acid supplementation prior to
conception decreases risk of brain
and spinal cord defects
Nutritional Needs during Pregnancy
- The protein requirement is increased
by 20% for pregnant women over
age 25 (25% for pregnant
adolescents).
- No need to increase vitamin A;
excess vitamin A can cause birth
defects.
- Vitamin D requirement is 10 g.
- Vitamin E requirement is 5 g.
- Vitamin K requirement is 75–90 g
depending upon age.
- Requirements for all the
water-soluble vitamins are
increased.
- Requirements for vitamins B and C
are increased.
- Requirements for calcium, iron, zinc,
iodine, and selenium are all
increased.
- Iron supplements are commonly
prescribed.
Fulfillment of Nutritional Needs during
Pregnancy
- Base diet on MyPyramid.
- Drink additional fat-free milk or
appropriate substitute.
- Prenatal vitamins and iron
supplement may be prescribed.
- Over-the-counter nutrient
supplements may be harmful to the
fetus
Concerns during Pregnancy
1. Nausea
- “Morning sickness” occurs most
commonly in the first trimester.
- Suggestions
- Eat dry crackers or dry toast before
rising
- Eat small, frequent meals
- Avoid food with offensive odors
- Avoid liquids at mealtime
2. Hyperemesis Gravidarum
- Occurs when the nausea becomes
so severe that it is life-threatening
- May require hospitalization and
parenteral nutrition
3. Constipation
- Caused by relaxed gastrointestinal
tract due to progesterone
- Eat a high-fiber diet.
- Participate in daily exercise.
- Drink eight glasses of water per day
4. Heartburn
- Caused by pressure on the stomach
by the growing fetus and relaxation
of the cardiac sphincter.
- Eat small, frequent meals.

2. - Avoid spicy or greasy foods.
- Avoid liquids with meals.
- Wait at least 1 hour after eating to lie
down and 2 hours before exercising.
5. Excessive Weight Gain
- Re-evaluate diet and eliminate foods
that do not fit within MyPyramid.
- Drink fat-free milk.
- Eat clean, crisp, raw vegetables as a
snack.
- Eat fruits and custards made with
fat-free milk as desserts.
- Broil, bake, or boil instead of frying
6. Pregnancy-Induced Hypertension
- Formerly called preeclampsia or
toxemia
- Characterized by high blood
pressure, presence of protein in the
urine, and edema in third trimester
- May progress into the eclamptic
stage with convulsions, coma, and
possible death of the mother and
infant
- Higher incidence during first
pregnancy, multifetal pregnancies,
morbidly obese mothers, or those
with inadequate diets, especially
protein deficient
7. Pica
- Pica is the craving for nonfood
substances such as starch, clay
(soil), or ice.
- Ingestion of soil should be
discouraged due to possible
contamination and nutrient
deficiencies.
- Multiple nutritional deficiencies can
result from pica.
8. Anemia
- Anemia is a condition caused by an
insufficiency of red blood cells,
hemoglobin, or blood volume.
- Causes weakness, fatigue, poor
appetite, and pallor
- Iron-deficiency anemia is the most
common form.
- Folate deficiency may lead to
megaloblastic anemia and is
prevented by folate
supplementation.
9. Alcohol, Caffeine, Drugs, and
Tobacco
- Fetal alcohol syndrome (FAS) is
characterized by a growth
deficiency, central nervous system
dysfunction, microcephaly (small
head), and other physical
characteristics.
- Fetal alcohol effect (FAE) causes
fewer physical defects, but many
behavioral and psychosocial
problems.
- Abstinence of alcohol is
recommended.
- Caffeine has been shown to cause
birth defects in rats, but no data exist
for humans. Limit caffeine intake to <
300 mg/day.
- Illegal drugs can cause the infant to
be born addicted.
- Drugs derived from vitamin A can
cause fetal malformations and
spontaneous abortions.
- Tobacco smoking is associated with
low birth weights, sudden infant
death syndrome (SIDS), fetal death,
spontaneous abortions, and
complications at birth.
Diet for the Pregnant Woman with
Diabetes

3. - The nutrient requirements of the
pregnant woman with diabetes are
the same as for the nondiabetic
pregnant woman.
- The dietitian should plan the diet
depending on the type and number
of insulin injections required.
- Gestational diabetes occurs during
pregnancy and disappears after the
infant is born.
- Routine screening for gestational
diabetes is part of prenatal care.
- Insulin is used during pregnancy to
control any type of diabetes.
- Oral hypoglycemic agents have not
been used during pregnancy.
- Artificial sweeteners have been
found to be safe during pregnancy.
Pregnancy during Adolescence
- The nutritional, physical,
psychological, social, and economic
demands on pregnant adolescents
are tremendous.
- Nutrition must meet the needs of her
growing body and the needs of the
fetus.
- High risk for pregnancy-induced
hypertension and premature delivery
- Inadequate nutrition of the mother is
related to both mental and physical
birth defects.
- Much counseling and emotional
support is needed.
Lactation
- The production and secretion of
breast milk for the purpose of
nourishing an infant
- Recommended that no supplemental
feedings be given until feeding
routine is established.
- Human milk is formulated to meet
the nutrient needs of infants for the
first 6 months of life.
Benefits of Breastfeeding for the Infant
- Breast milk has the perfect
composition for a baby’s needs.
- No babies are allergic to their
mother’s milk.
- Human milk contains at least 100
ingredients not found in formula
- Lower incidence of ear infections,
diarrhea, allergies, and hospital
admissions
- Breastfed babies receive antibodies
from breast milk.
- Promotes good jaw development
- Decreases risk of obesity later in life
- Facilitates bonding
- Helps lose the weight gained during
pregnancy
- Stimulates uterus to contract back to
its original size
- Breastfeeding is economical.
- Provides opportunity for resting
- Milk is always at the right
temperature and is readily available.
Nutrient Requirements during Lactation
- The Food and Nutrition Board
suggests an increase of 500 calories
a day.
- Most nutrient requirements are
increased, especially protein.
- Nutrition should be based on
MyPyramid.
- Fluid intake should replace fluids
used for milk production
- Most chemicals can pass into the
mother’s milk.
- Check with obstetrician before using
any medication or nutrient
supplement.

4. - Caffeine may make an infant
irritable.
Considerations for the Health Care
Professional
- Articles in newspapers and
magazines may be inaccurate.
- Re-education may be necessary.
- Teaching pregnant teenagers
presents the biggest challenge
Conclusion
- A pregnant woman is most likely to
remain healthy and bear a healthy
infant if she follows a well-balanced
diet.
- Anemia and PIH are two conditions
that can be caused by inadequate
nutrition.
- Caloric and most nutrient
requirements increase
Diet during Infancy
Nutritional Requirements of the Infant
- Birth weight doubles by 6 months of
age and triples within the first year.
- During the first year the normal child
needs about 98–108 calories per
kilogram of body weight each day.
- Infants need 1.5 mL of water per
calorie.
- Nutritional needs depend on a
child’s growth rate.
Nutritional Requirements of the Infant
- A vitamin K supplement is routinely
given at birth.
- Basis of infants’ diet is breast milk or
formula.
- Excess vitamin A or D can be toxic
to infants.
- Fluoride may be supplemented as
needed.
Breastfeeding
- Provides infant with temporary
immunity to many infectious
diseases.
- It is economical, nutritionally perfect,
and sterile.
- Breast milk is easily digested.
- Breastfed infants have fewer
infections.
- Breastfeeding promotes oral motor
development.
- Breast should be offered every 2
hours in the first few weeks.
- The infant should nurse 10–15
minutes on each breast.
- Growth spurts occur at about 10
days, 2 weeks, 6 weeks, and 3
months during which infant may
nurse more frequently.
- Breastfeeding is also beneficial to
mothers (less risk of breast cancer
and osteoporosis).
- Indications of adequate nutrition
include: The infant has six or more
wet diapers per day. The infant has
normal growth. The infant has 1–2
bowel movements per day. The
breast becomes less full during
nursing.
Bottle Feeding
- The infant should be cuddled and
held in a semiupright position.
- Baby should be burped often.
- Formulas are made from modified
cow’s milk to resemble breast milk in
nutritional value.
- Synthetic formula made from
soybeans may be used for sensitive
or allergic infants.
- Formula must be prepared with the
correct amount of water to prevent
health complications.

5. - Cow’s milk can cause
gastrointestinal blood loss in infants
and should not be used.
- Use consistent temperature for
formula.
- Putting infants to bed with a bottle
may cause baby bottle mouth.
Share with a partner your own feelings
regarding breastfeeding versus
bottle-feeding. • Do you support a woman
who decides to breastfeed? • Do you
support a woman who decides to bottle
feed? • Could your beliefs affect the care
you give?
Supplementary Foods
- Solid foods should not be introduced
before 4 to 6 months of age and
should be done gradually.
- Solids should be started with
iron-fortified rice cereal, then other
infant cereals.
- Cooked and pureed vegetables
follow, then cooked and pureed
fruits, egg yolk, and finally, finely
ground meats.
- Between 6 and 12 months, toast,
Zwieback teething biscuits, and
Cheerios can be added.
- Honey should never be given to an
infant because it could be
contaminated with Clostridium
botulinum bacteria.
- When the infant learns to drink from
a cup, juice can be introduced.
- Juice should never be given from a
bottle because babies will fill up on it
and not get enough calories from
other sources.
- Use only 100% juice products and
limit to 4 ounces per day because
they are nutrient dense.
- Indications for Readiness for Solid
Foods
- Disappearance of extrusion reflex
(pushing food out with tongue)
- Willingness to participate in the
process
- Ability to sit up without support
- Having head and neck control
- Drinking more than 32 ounces of
formula or nursing 8 to 10 times in
24 hours
Developing Good Eating Habits
- By age one most babies can eat
foods from all food groups.
- Table foods can be used.
- Avoid excess sugar and salt.
- Avoid foods that can cause choking.
- Help children develop an active
lifestyle and healthy eating habits.
Special Nutritional Needs
- Premature infants
- Children with cystic fibrosis
- Failure to thrive
- Metabolic disorders
- Galactosemia
- Phenylketonuria
- Maple syrup urine disease
Premature Infants
- An infant born before 37 weeks’
gestation
- The sucking reflex is not developed
until 34 weeks’ gestation. Infants
born earlier will require total
parenteral nutrition, tube feedings, or
bolus feedings.
- Other concerns include: low birth
weight, underdeveloped lungs,
immature gastrointestinal tract,
inadequate bone mineralization, and
lack of fat reserves

6. - Many special formulas are available
but breast milk is best because its
composition is perfect, even for
premature babies
Cystic Fibrosis
- An inherited disease in which the
body secretes abnormally thick
mucus
- Decreased production of digestive
enzymes and malabsorption of fat
- Recommendation: 35%–40% of diet
should be from fat.
- Digestive enzymes and fat-soluble
vitamin supplementation at meal
times
- Nighttime tube feedings may be
indicated
Failure to Thrive
- Determined by plotting the infant’s
growth on standardized charts
- May be caused by watering down
formula, congenital abnormalities,
acquired immunodeficiency
syndrome (AIDS), lack of bonding,
child abuse, or neglect
- The first 6 months are the most
crucial for brain development.
Galactosemia
- A condition in which there is a lack
of the liver enzyme transferase.
- Transferase normally converts
galactose to glucose.
- The amount of galactose in the
blood becomes toxic.
- Results in diarrhea, vomiting,
edema, and abnormal liver function.
- Cataracts may develop, galactosuria
occurs, and mental retardation
occurs.
- Diet therapy: exclusion of anything
containing milk from any mammal;
nutritional supplements of calcium,
vitamin D, and riboflavin
- Lifelong elimination of lactose in diet
Phenylketonuria (PKU)
- Infants lack the liver enzyme
phenylalanine hydroxylase, which is
necessary for the metabolism of the
amino acid phenylalanine.
- Infants are normal at birth, but if
untreated become hyperactive,
suffer seizures, and become
mentally retarded between 6 and 18
months old.
- Diet therapy: commercial formula
Lofenalac, regular blood tests,
synthetic milk for older children,
avoidance of phenylalanine
- Lifelong diet therapy
- Hospitals are required to screen
newborns for PKU before discharge.
Maple Syrup Urine Disease (MSUD)
- Congenital defect resulting in the
inability to metabolize three amino
acids: leucine, isoleucine, and
valine.

7. - Named for the odor of clients’ urine
- Hypoglycemia, apathy, and
convulsions occur and, if not treated
promptly, may result in death.
- Mild form of the disease may cause
mental retardation and bouts of
acidosis.
- Diet therapy: extremely restricted
amounts of the three amino acids; a
special formula and low-protein diet
is used; diet therapy necessary
throughout life.
Spotlight on the Life Cycle
● Women, Infants, and Children (WIC)
- A federally funded program that
provides monthly food packages of
infant formula or milk, cereal, eggs,
cheese, peanut butter, and juice to
new mother
Conclusion
- Babies must have adequate diets so
that their physical and mental
development are not impaired.
- Breastfeeding is nature’s way of
feeding an infant.
- Formula feeding is also acceptable.
- Some infants have special nutritional
need
Medication glass
1pc tuberculin
2pcs insulin,5cc, 10 cc
Spare needles
Sterile gloves (5)
Clean gloves (5)
Tongue depressor (5)
Cotton applicator (5)
4x4 gauze (5)
Betadine in small container
Hydrogen peroxide
Forceps
Plastic waste bag (9)
Diet during childhood and adolescence
Nutrition in Children
- Children’s nutrition affects their
physical, emotional, and
intellectual development.
- Once developed, poor eating
habits are difficult to change.
- Poor eating habits can exacerbate
emotional and physical problems
Children Ages 1–12
- Children’s appetites often vary
according to their rate of growth.
- Children’s likes and dislikes
change.
- New foods should be introduced
gradually.
- Children should be involved in food
selection and preparation.
- Fats should not be limited before
the age of 2 years.
- Fat intake should be 30%–35% of
calories for 1–3 year olds.
- Fat intake should be 25%–35% of
calories for 4–18 year olds.
- Whole milk is recommended until
the age of 2, but low-fat or fat-free
milk should be served from age 2
on
- Calorie needs will depend on rate
of growth, activity level, body size,
metabolism, and health.
- Nutrient-dense snacks are needed
every 2 to 3 hours.
- Forcing a child to eat can cause
eating disorders.
- Choking is prevalent in young
children.
Calorie and Nutrient Needs of Young
Children

8. - Nutrient needs increase because
of increased body size.
- Use MyPyramid for meal planning
for kids.
- No more than 2 to 3 cups of milk or
equivalent in terms of calcium per
day
- Limit sweets and sweetened fruit
juices.
- Need 1 mL of water per calorie and
introduce fiber slowly
Childhood Obesity
- Childhood obesity has become an
epidemic.
- A child is overweight if he or she is
above the 95th percentile for body
mass index (BMI) by sex and age.
- 85% of obese children over the
age of 10 will become obese
adults.
- Leads to many health and social
problems
- Increased severity of asthma
- Increased blood pressure and
heart rate
- Type 2 diabetes
- Sleep apnea
- Hyperlipidemia
- Hip and knee problems
- Social stigma
- Treatment
- Exercise
- Portion and snacking control
- Parents can help by modeling
healthy food choices and an active
lifestyle.
What Parents Can Do
- Provide only healthy, nourishing
foods.
- Limit TV and computer time.
- Never tell a child that he or she is
too fat.
- Learn correct portions.
- It is more important how often and
how much is eaten rather than
what
- Never provide food as comfort or
reward.
- Eat only at the table and at
designated times.
- Give water rather than juice, soda,
or sweetened drinks.
- Eat slowly.
- Determine reasons for eating
Adolescence
- Period of rapid growth and physical
changes causing increased calorie
needs.
- Adolescents typically have
enormous appetites.
- Often substitute popular low
nutrient density foods.
- Food choices are affected by peer
pressure and busy schedules.
- Except for vitamin D, all nutrient
needs increase.
- Menstruation in girls creates a
greater need for iron.
- The DRIs for many nutrients are
higher for boys than for girls.
Adolescent Problems Related to Nutrition
- Anorexia nervosa
- Bulimia
- Overweight
Anorexia Nervosa
- A psychological disorder that
causes a client to drastically
reduce calories consumed,
causing altered metabolism.

9. - Distorted body image and a fear of
being fat
- Clients often exercise excessively
- May result in hair loss, low blood
pressure, weakness, amenorrhea,
brain damage, and even death
Treatment for Anorexia Nervosa
- Individual and family counseling
- Self-acceptance
- Nutrition therapy
- Close supervision
- Time and patience
Bulimia
- A syndrome in which the client
alternately binges and purges by
inducing vomiting and using
laxatives and diuretics to get rid of
ingested food.
- Fear of being overweight
- Clients often binge on high-calorie
foods
- Usually not life-threatening, but
can irritate the esophagus and
cause electrolyte imbalances,
malnutrition, dehydration, and
dental caries
Treatment for Bulimia
- Limit eating to mealtime
- Portion control
- Close supervision after eating
- Psychological counseling
Overweight
- Contributing factors include
heredity, overfeeding as an infant
or child, and psychological factors
Treatment
- Evaluation by health care provider
- Change unhealthy eating habits
- Exercise
Being overweight is particularly difficult
during the adolescent period.
What makes being overweight during
adolescence especially difficult?
Being overweight during adolescence is
apt to diminish the individual’s self-esteem
and can exclude him or her from the
normal social life of the teen years, further
diminishing self esteem.
It also makes the adolescent prone to
being overweight as an adult
Fast Foods
- Nutrient charts are often available
at restaurants.
- Fast foods are excessively high in
fat, sodium, and calories, and
limited in minerals, vitamins, and
fibers.
- Fast foods are often used as
snacks by teens, adding extra
calories.
- Should be used with discretion in a
balanced diet
Alcohol and the Adolescent
- Alcohol contains 7 calories per
gram but few nutrients.
- Alcohol is a depressant with
serious side effects.
- Affects absorption and normal
metabolism of glucose, fats,
proteins, and vitamins.
- Alcohol causes excess water and
mineral loss.
- Abuse (overuse) of alcohol is
called alcoholism.

10. - Excessive, long-term drinking can
lead to liver cirrhosis, high blood
pressure, and damage to heart
muscle.
- Teenagers often ignore the
dangers of alcohol.
- Drinking teens are prone to
accidents and random acts of
violence.
Marijuana
- Use continues to increase among
teens.
- Increases appetite, especially for
sweets
- Marijuana cigarettes are more
harmful to the lungs than tobacco
cigarettes.
- May lead to the use of other drugs
Cocaine
- Highly addictive and extremely
harmful
- Weight loss is very common due to
decreased appetite.
- Form that can be smoked is called
crack.
- Half of crimes against property in
the United States are related to the
use of crack cocaine.
Tobacco
- Is addictive
- Can influence appetite, nutritional
status, and weight
- Smokers need more vitamin C
because smoking alters its
metabolism.
- Increases risk for lung cancer and
heart disease
Other Addictive Drugs
- Amphetamines cause heart,
breathing, and blood pressure
rates to increase.
- Methamphetamine is the most
potent form of amphetamines.
- Symptoms include dry mouth,
difficulty swallowing, dilated pupils,
and depressed appetite; as the
drug wears off fatigue and
depression are common.
- Inhalants are physically and
psychologically addictive.
- Risks include depression, apathy,
nosebleeds, headaches, eye pain,
chronic fatigue, heart failure, loss
of muscle control, and death
Nutrition for the Athlete
- The athlete needs additional water,
calories, thiamin, riboflavin, niacin,
sodium, potassium, iron, and
protein.
- The increase in calories depends
on the activity and its length.
- Plain water is the recommended
liquid for rehydration.
- Electrolyte drinks are useful after
an athletic event, but not during
one.
Glycogen Loading
- Carboloading: sometimes used for
long activities
- Begins 6 days before an event and
involves a regimen of diet and
exercise to maximize the amount
of glycogen in the muscles
- May result in an abnormal heart
rate and some weight gain
- Athletes should maintain good
eating and health habits.

11. Considerations for the Health Care
Professional
- Young children may have poor
appetites and parents may have
related anxiety.
- The health care professional can
be most helpful by exhibiting
patience and understanding and by
listening to the client and the
parents
- Working with adolescent clients
with disordered eating can be
challenging.
- Health care professionals working
with these clients should consult
with the client’s psychological
counselor.
- Parents of clients with disordered
eating must be included in
counseling.
Conclusion
- Nutritional needs vary as children
grow and develop.
- Nutrient needs gradually increase.
- Anorexia nervosa, bulimia, and
obesity are problems of weight
control that can occur during
adolescence.
- Alcohol and drug abuse can be
serious problems in adolescence
Diet during Young and Middle
Adulthood
Adulthood
- Broadly divided into three periods:
young, middle, and late adulthood
- Young adulthood age range is from
18–40 years.
- Middle period ranges from about
40–65 years of age.
- Late adulthood is over 65 years of
age
Nutrient Requirements
- Growth is usually complete by age
25.
- Nutrient requirements of healthy
adults during these years change
very little.
- The iron requirement for women is
higher than men until after
menopause.
- Protein requirement for adults is
0.8 g per kilogram of body weight.
- Current requirement for calcium for
adults from age 19–50 is 1,000
mg.
- Vitamin D requirement is 5 g per
day.
- Both calcium and vitamin D are
essential for strong bones, and
both are found in milk.
- Three glasses of milk per day
nearly fulfill the calcium and
vitamin D requirements.
- Bone loss begins slowly, at about
the age of 35 to 40
You are teaching a class about
rheumatoid arthritis to a group of
middle-aged adults.
A participant asks the following question:
“What diet changes can I make to prevent
rheumatoid arthritis?”
How do you respond?
- Researchers have determined that
diet changes have no effect on
rheumatoid arthritis.

12. - Maintain a healthy diet that
includes adequate calcium and
protein
- A multiple vitamin containinG
vitamin D and a calcium
supplement should be taken daily.
- Omega-3 fatty acids have been
helpful in reducing inflammation.
Discuss with a physician.
Calorie Requirements
- Begin to diminish after the age of
25 when basal metabolic rate
decreases.
- Determined primarily by activity
and amount of lean muscle mass.
- Weight gain occurs if calories
exceed one’s need.
Special Considerations for the Adult
- Concerns about weight, cost of
food, or time may lead to nutrient
deficiencies.
- Selection of food is often based on
convenience and flavor rather than
nutritional content of food.
- Fast foods and prepared meals
lead to excess consumption of fat,
sugar, salt, and calories.
- Weight control is one of the top
concerns of adults in the United
States today.
- Most people are interested in
controlling their weight.
- Excess weight can lead to diabetes
mellitus and hypertension.
- Overweight people are poor risks
for surgery, live shorter lives, and
are prone to social and emotional
problems.
- Most common cause of being
overweight is energy imbalance
(more calories have been taken in
than were needed for energy).
- Other causes are genetics and a
hypothyroid condition.
- An excess of 3,500 calories will
result in a weight gain of 1 pound.
- The best solution is increased
exercise combined with reduced
caloric intake.
- A healthy eating plan should follow
MyPyramid guidelines.
Considerations for the Health Care
Professional
- The young and middle years of life
are busy and have many
responsibilities.
- Most people feel they have too
many things to do and too little
time to accomplish them.
- Health problems occurring during
these years can be psychologically
devastating.
Conclusion
- Although calorie requirements
diminish after age 25, most nutrient
requirements do not.
- Food must be selected with
increasing care as one ages to
ensure that nutrient requirements
are met without exceeding the
calorie requirement.
- Overweight can cause health
problems and a weight loss
program should be undertaken
Diet during Late Adulthood
- Physiological Changes

13. - Body’s functions slow with age,
and its ability to replace worn cells
is reduced.
- The metabolic rate slows.
- Bones become less dense.
- Lean muscle mass is reduced.
- Eyes lose focus on nearby objects
and some people develop
cataracts.
- Poor dentition is common.
- Heart and kidneys become less
efficient.
- Hearing, taste, and smell are less
acute.
- Immune system may be
compromised if poor nutrition has
been chronic.
- Arthritis can be debilitating for the
elderly.
- Excess weight and some vitamin
deficiencies may affect some forms
of arthritis.
- Healthy nutrition and exercise can
be beneficial for those with
arthritis.
- Digestion is affected by decreased
secretion of hydrochloric acid and
enzymes.
- Decrease in the synthesis of
intrinsic factor leads to a deficiency
of vitamin B12.
- Reduced intestinal tone causes
constipation or, in some cases,
diarrhea.
- Psychosocial problems can
increase as one grows older.
- Feeling of uselessness
- Loss of self-esteem
- Loss, grief, and loneliness
- Economic changes affecting food
choices
Sidestepping Potential Problems
- A healthy lifestyle and an active
social life throughout life can
prevent or delay physical
deterioration and psychological
depression during the senior years.
- Food-drug and drug-drug
interactions can affect nutritional
status and must be monitored
closely in the elderly.
Nutritional Requirements
- Protein requirement remains at 0.8
g per kilogram of body weight.
- After age 65, it may be advisable
to increase one’s daily protein
intake to 1.0 g per kilogram of body
weight.
- Vitamin requirements do not
change after the age of 51, except
for a slight decrease in the RDAs
for thiamin, riboflavin, and niacin.
- The need for iron is decreased
after age 51 in women because of
menopause.
- The calorie requirement decreases
approximately 2%–3% a decade.
- The Nutrition Screening Initiative
checklist was developed to identify
those at “no nutritional risk,”
“moderate nutritional risk,” and
“high nutritional risk.”
Food Habits of Senior Citizens
- Established food habits may be
especially difficult to change.
- The following may cause difficulties
in food selection and preparation:
Decreased income during
retirement Physical disability
Inadequate cooking facilities

14. - Grief, loneliness, boredom, or
difficulty in chewing can cause
anorexia.
- Many senior citizens consume
diets deficient in protein; vitamins
C, D, B6 , B12, and folate; and the
minerals calcium, zinc, iron, and
sometimes calories.
- Variety and nutrient-dense foods
should be encouraged.
- Water is important to help prevent
constipation, to maintain urinary
volume, and to prevent
dehydration and urinary tract
infections.
- Senior citizens may spend money
on unnecessary vitamins, minerals,
and foods in search of eternal life
or youth.
What makes this segment of the
population susceptible to food
faddists?
- Some older people are consciously
or unconsciously searching for
eternal life, if not youth.
- Food faddists may pick this
segment of the population to profit
from their ignorance.
- Some older people with chronic
disease may hope that such
products will bring them relief.
Special Considerations for the
Chronically Ill Older Adult
- Osteoporosis
- Arthritis
- Cancer
- Diabetes mellitus
- Hypertension
Osteoporosis
- Condition in which the amount of
calcium in bones is reduced,
making them porous.
- Bone density scan can be done
with a special X-ray to determine if
one has osteoporosis.
Osteoporosis
- A sedentary life and a diet low in
calcium, vitamin D, and fluoride,
and estrogen loss contribute to the
condition.
- Excessive phosphorus in the diet,
from sodas and processed foods,
may also be a contributing factor.
- Estrogen replacement therapy
(ERT), 1,500 mg of calcium, and
exercise are possible preventive
measures.
Arthritis
- Disease that causes the joints to
become painful and stiff
- Regular use of aspirin or
antiinflammatory drugs may help
relieve the pain, but have side
effects such as bleeding in the
stomach lining.
- There is no cure for arthritiS
Cancer
- Diets consistently high in fat, or low
in fiber and vitamin A may
contribute to cancer.
- Research about the role of nutrition
in the development of cancer
continues.
Diabetes Mellitus
- Chronic disease that develops
when the body does not produce
sufficient amounts of insulin or

15. does not use it effectively for
normal carbohydrate metabolism.
- Diet is very important in the
treatment of diabetes mellitus.
Hypertension
- High blood pressure can lead to
strokes.
- Associated with diets high in salt or
possibly low in calcium
- Most Americans ingest from two to
six times the amount of salt
needed each day.
Heart Disease
- Heart attack and stroke are the
major causes of death in the
United States.
- Arteries become blocked
(occluded), thereby preventing the
normal passage of blood.
- Atherosclerosis: plaque, a fatty
substance containing cholesterol,
accumulates in the walls of the
artery
Effects of Nutrition
- Cumulative over many years
- Effects of a lifetime of poor eating
habits cannot be cured overnight.
- Prevention should begin in
childhood.
- Nutrition can be used to help
stabilize the condition of a client
who has a chronic disease.
Diets for Senior Citizens
- Plan around MyPyramid.
- When special health problems
exist, the normal diet should be
adapted to meet the individual’s
needs.
- The federal government provides
the states with funds to serve
senior citizens hot meals at noon in
senior centers.
- The federal government also
provides transportation for those
who are otherwise unable to reach
the senior center for the meal.
- Meals-on-Wheels project provides
food for homebound individuals.
- Participating people pay according
to ability.
Considerations for the Health Care
Professional
- Each client is an individual with
individual needs.
- It is important to remember that
older clients have feelings worth
addressing.
- The incapacitation that can
accompany old age is a terrible
indignity, and these clients deserve
special care.
Conclusion
- The elderly segment of the
population continues to increase.
- The nutritional needs of this group
are a growing concern.
- Many of the chronic diseases of
the elderly could be delayed or
avoided by maintaining good
nutrition throughout life
Diet and Diabetes Mellitus
Diabetes Mellitus
- A group of serious and chronic
disorders affecting the metabolism
of carbohydrates.

16. - Glucose is the primary source of
energy for the body.
- Glucose is transported by the
blood, and its entry into the cells is
controlled by insulin.
Insulin
- Secreted by the beta cells of the
islets of Langerhans in the
pancreas gland
- When there is inadequate
production of insulin, or the body is
unable to use the insulin it
produces, glucose cannot enter the
cells and it accumulates in the
blood, creating hyperglycemia.
Symptoms
- Glycosuria: glucose in the urine
- Polyuria: excessive urination
- Polydipsia: excessive thirst
- Polyphagia: excessive appetite
- Loss of weight, weakness, and
fatigue
Complications
- Ketones: substances into which
fatty acids are broken down in the
liver
- Ketoacidosis: condition in which
acids from ketones accumulate.
May lead to diabetic coma, which
can result in death if the client is
not treated quickly with fluids and
insulin.
- Atherosclerosis is a major cause of
death in individuals with diabetes.
- Retinopathy is the leading cause of
blindness in the United States.
- Kidney disease resulting in dialysis
- Nerve damage (neuropathy) is not
uncommon.
- Infections, especially of the urinary
tract are frequent problems
Etiology
- The cause of diabetes is unclear,
but it is believed to be hereditary.
- Environmental factors may also
play a role in the development of
diabetes.
- Viruses or obesity may precipitate
the disease.
Classification
- Prediabetes: precursor to type 2
- Type 1: insulin-dependent diabetes
mellitus
- Type 2: non-insulin-dependent
diabetes mellitus
- Gestational diabetes: diabetes in
pregnancy
Prediabetes
- Improper use of insulin by the cells
of the body
- Fasting blood glucose > 110 mg/dL
but < 126 mg/dL
- May advance to type 2 diabetes
Type 1 Diabetes
- Formerly juvenile-onset diabetes
mellitus
- 5%–10% of all new diabetes cases
- Little, if any, insulin is secreted.
Clients become insulin dependent,
requiring both insulin injections and
a carefully controlled diet.
- Risk factors: genetics, autoimmune
status, and environment
Type 2 Diabetes
- Previously called adult-onset
diabetes

17. - Used to occur after age 40, but
now found in teens and young
adults because of obesity
- Risk factors: family history, older
age, history of gestational
diabetes, physical inactivity, and
race or ethnicity
- Treatment: diet, exercise, oral
diabetes medication (may or may
not need insulin)
- Goals of medical nutrition therapy
include maintaining healthy
glucose, blood pressure, and lipid
levels, as well as weight reduction
Gestational Diabetes
- Occurs between 16th and 28th
week of pregnancy
- Insulin required if not responsive to
diet and exercise.
- Usually disappears after the infant
is born.
- Diabetes can develop 5 to 10
years after the pregnancy,
Treatment
- Goals Control blood glucose
levels Provide optimal
nourishment for the client Prevent
symptoms and thus delay
complications
- Normal blood glucose levels are 70
to 110 mg/dL
Treatment Regimes
- Diet alone
- Diet combined with
glucose-lowering medication
- Diet combined with insulin
- Exercise combined with any of the
above
- Regularly monitor blood glucose
levels in addition to any of the
above.
Nutritional Management
- Client’s calorie needs will depend
on age, activities, lean muscle
mass, size and resting energy
expenditure (REE).
- Recommended 50% to 60% of the
calories from carbohydrates 40%
to 50% from complex
carbohydrates 10% to 20% from
simple sugars (continues)
- The total amount of carbohydrates
eaten, rather than the type, affects
blood sugar levels.
- Fats should be limited to 30% of
total calories.
- Proteins provide from 15% to 20%
of total calories.
Carbohydrate Counting
- Newest method for teaching a
diabetic client how to control blood
sugar with food
- The starches and breads, milk, and
fruits have all been put under the
heading of carbohydrates.
- Exchange lists are used in
carbohydrate counting as well as in
traditional meal planning
Diets Based on Exchange Lists
- Foods within each list contain
approximately equal amounts of
calories, carbohydrates, protein,
and fats.
- One food on a particular list can be
substituted for any other food on
that particular list and still provides
the client with the prescribed types

18. and amounts of nutrients and
calories.
- The amounts of nutrients and
calories on one list are not the
same as those on any other list.
- The diet is given in terms of
exchanges rather than as
particular foods.
Fiber
- High-fiber intake appears to reduce
the amount of insulin needed
because it lowers blood glucose.
- It also appears to lower blood
cholesterol and triglyceride levels.
- High fiber may mean 25–35 g of
dietary fiber a day.
- Increase water when increasing
fiber.
Alternative Sweeteners
- Saccharin has been shown to
produce bladder cancer in rats
when used in large quantities.
- Approved by the FDA Aspartame:
made from amino acids; does not
require insulin for metabolism
Sucralose: sweetener made from
sugar molecules
Dietetic Foods
- Use of dietetic foods is
unnecessary and often misleading
to the client.
- Dietetic foods often contain the
same ingredients as foods
prepared for the general public, but
at a higher cost.
- Consumers need to read the food
labels.
Alcohol
- Not recommended for diabetic
clients
- Limited use sometimes allowed if
approved by a physician
- Some diabetic clients who use
hypoglycemic agents cannot
tolerate alcohol.
- Include in diet plan if used
Exercise
- Type 1: exercise can complicate
glucose control. If done, should be
on a regular basis, and considered
carefully as meals are planned to
avoid hypoglycemia.
- Type 2: exercise helps improve
weight control, glucose levels, and
the cardiovascular system
Insulin Therapy
- Clients with type 1 diabetes must
have injections of insulin every day
to control blood glucose levels.
- Insulin must be injected because it
is a protein and would be digested
if swallowed.
- Human insulin is the most common
and the preferred insulin; it is made
synthetically.
- Classified by action: very rapid-,
rapid-, intermediate-, and
long-acting
- Intermediate types work within 2 to
8 hours and are effective 24 to 28
hours.
- Shorter- and longer-acting insulin
may be given together and more
than one injection a day may be
required.
- Insulin pumps are now available
and can deliver short-acting

19. continuous dose and premeal
boluses.
Insulin Reactions
- An insulin reaction, or
hypoglycemic episode, can result
from too much insulin.
- Symptoms include headache,
blurred vision, tremors, confusion,
poor coordination, and eventually
unconsciousness.
- Brain damage, coma, or death can
result.
Treatment for Insulin Reactions
- Conscious clients may be treated
by giving them a glucose tablet, a
sugar cube, or a beverage
containing sugar followed by a
complex carbohydrate.
- Unconscious clients require
intravenous treatment with
dextrose and water.
- Diabetic clients should carry
identification.
Considerations for the Health Care
Professional
- If diet is followed, medication is
taken, and time is allowed for
sufficient exercise and rest, one
can live a near-normal life.
- Emphasize the importance of
eating all of the prescribed food.
- Meals should be eaten at regular
times, and clients should read
labels.
Conclusion
- The diabetic diet is used in treating
diabetes mellitus, a metabolic
disease caused by the improper
functioning of the pancreas.
- Serious complications, including
death, can occur if the condition is
left untreated.
- Treatment includes diet,
medication, and exercise
CHAPTER 18 IS NOT INCLUDED CHAR
Diet and Cardiovascular Disease
Cardiovascular Disease
- Affects heart and blood vessels
- Leading cause of death and
permanent disability in the United
States
- Cardiovascular disease can be
acute (sudden) or chronic.
- Metabolic syndrome puts one at
risk for coronary heart disease,
stroke, peripheral vascular
disease, and type 2 diabetes.
Metabolic Syndrome
- Risk factors in adults and children
Abdominal obesity Hyperlipidemia
High blood pressure Insulin
resistance Elevated highly
sensitive C-reactive protein (CRP)
in blood
Cardiovascular Disease
- Acute: myocardial infarction (MI);
also known as heart attack
- Chronic: develops over time; loss
of heart function
- Heart may beat faster and enlarge
to maintain circulation in
compensated heart disease
- Inability to compensate leads to
congested heart failure (CHF)

20. Arteriosclerosis and Atherosclerosis
- Arteriosclerosis: arteries harden,
making the passage of blood
difficult and sometimes impossible
- Atherosclerosis: thickening and
weakening of artery walls by
cholesterol and fatty deposits
called plaque
Atherosclerosis
- Plaque may cause a reduced
blood flow beyond the obstruction
and ischemia.
- Ischemia may cause pain.
- Angina pectoris: chest pain; may
radiate down left arm
- If the lumen narrows completely in
a coronary artery, a heart attack
occurs.
Atherosclerosis
- Coronary artery bypass graft
(CABG): procedure to bypass
circulation around a clogged artery
- Cerebrovascular accident (CVA):
blood flow to the brain is blocked
or a blood vessel bursts (stroke)
- Peripheral vascular disease:
vessels in the extremities are
affected
Risk Factors
- Major Hyperlipidemia (elevated
total cholesterol; high LDL, low
HDL)
- Hypertension
- Smoking
- Contributory factors
- Obesity
- Diabetes mellitus
- Male sex
- Heredity
- Personality type
- Age
- Sedentary lifestyle
Hyperlipidemia: Medical Nutrition Therapy
- Involves reducing the quantity and
types of fats, and often calories, in
the diet
- American Heart Association
guidelines
- Blood cholesterol of 200 mg/dL or
less is desirable. 200 to 239
mg/dL is borderline high
- 240 mg/dL and greater is high
- American Heart Association
recommendations for prevention:
- Adult diets less than 200 mg of
cholesterol per day
- No more than 30% of calories from
fat; maximum of 7% from saturated
fats and trans fats, 8% from
polyunsaturated fats, 15%–20%
from monounsaturated fats
- Proteins 12%–20% of calories, and
carbohydrates 50%–55% of
calories
Your client has been given a very low fat
diet to follow. The client expresses to you
that it is almost impossible to follow this
diet.
What recommendations would you
suggest?
- Thomson Delmar Learning, a
division of Thomson Learning Inc.
All rights reserved.
- A diet very low in fat will seem
unusual and highly unpalatable.
- It takes 2 to 3 months to adjust to a
low-fat diet.

21. - Change should be made gradually
if the physician allows.
- Provide client with information
about the fat content of foods and
methods to prepare the food.
- Encourage client to select whole,
fresh foods and to prepare them
without the addition of fat.
- Lean meat should be selected and
all visible fat removed.
- Use fat-free milk and fat-free skim
cheeses.
- Gradually introduce 25–35 grams
of fiber.
- Discuss challenges with a dietitian
and the physician.
Cholesterol-Lowering Agents
- If blood lipid levels are not
corrected after 3–6 months of a
fat-restricted diet alone, a
cholesterol-lowering drug may be
prescribed.
- Food and/or drug interactions are
common with cholesterol-lowering
agents.
Myocardial Infarction
- Caused by blockage of a coronary
artery supplying blood to the heart
- Heart tissue beyond the blockage
dies.
- Causes: atherosclerosis,
hypertension, abnormal blood
clotting, infection such as that
caused by rheumatic fever
(damages heart valves)
- After the heart attack, the client is
in shock.
- Fluid shift occurs, and client may
be thirsty.
- Client should be NPO (nothing by
mouth).
- IV fluids may be given.
- After several hours, client may
begin to eat.
- Liquid diet usually recommended
for the first 24 hours.
- Then, a low-cholesterol,
low-sodium diet
- Foods should not be extremely hot
or cold.
- Food that is easy to chew and
digest is prescribed.
- Percentage of energy nutrients will
be based on particular needs of
the client.
- Sodium limited to prevent fluid
overload.
- Restriction on caffeine the first few
days after an MI.
Congestive Heart Failure
- From decompensation or severe
injury to the heart muscle
- Decreased circulation causes
decreased oxygenation of the
body.
- Shortness of breath, chest pain on
exertion, and edema are common.
- The heart beats faster and
enlarges.
- Death can occur in severe cases.
- Decreased nutrients to body
tissues
- Edema may mask the problems of
malnutrition and underweight.
- Fluid restriction may be ordered.
- Diuretics and a sodium-restricted
diet are typically prescribed.
- Diuretics can cause excessive loss
of potassium and blood levels
should be Monitored.

22. - Hypokalemia can upset the
heartbeat.
- Fruits, especially oranges,
bananas, and prunes, are excellent
sources of potassium, but
supplements may be given.
Hypertension
- Chronically high blood pressure
- Essential, or primary hypertension:
90% of cases; cause is unknown
- Secondary hypertension: 10% of
cases; caused by another
condition
- Causes of secondary hypertension
include kidney disease, problems
of the adrenal glands, and the use
of oral contraceptives
- Sphygmomanometer is used to
measure hypertension.
- Systolic pressure: top number
taken as the heart contracts
- Diastolic pressure: taken when the
heart is resting
- Measured in millimeters of mercury
(mm Hg)
- Normal: < 120/80
- Prehypertension: 120–139/80–88
- Stage 1: 140–159/90–99
- Stage 2: 160/100
- Contributes to heart attack, stroke,
heart failure, and kidney failure
“Silent disease” because sufferers
can be asymptomatic
- Heredity, age, obesity and
AfricanAmerican race are
predisposing factors.
- Smoking and stress also contribute
to hypertension
Dietary Treatment
- Weight loss usually lowers blood
pressure and, consequently, clients
are often placed on
weight-reduction diets.
- Sodium-restricted diet and/or
diuretics can be prescribed to
alleviate edema.
- Increasing fruits and vegetables to
6–10 servings per day helps to
lower blood pressure.
Sodium-Restricted Diets
- Regular diet with limited sodium
- Food and Nutrition Board
recommends daily intake of no
more than 2,300 mg.
- Board sets a safe minimum at 500
mg/day for adults.
- African Americans and people with
hypertension should limit sodium
intake to 1,500 mg/day.
- Sodium-free diet is impossible.
- Most foods naturally contain
sodium.
- Water contains varying amounts of
sodium.
- Processed foods often contain high
amounts of sodium.
- Some over-the-counter medicines
contain sodium.
- Transition to sodium-restricted diet
may be difficult.
- Gradual reduction in sodium is
easier.
- Remind the client of the numerous
herbs, spices, and flavorings
allowed.
Considerations for the Health Care
Professional
- Most cardiac clients will be told to
reduce fat, sodium, and

23. sometimes, the amount of calories
in their diets.
- Help the cardiac client want to
learn how to help himself or herself
via nutrition.
Conclusion
- Cardiovascular disease is the
leading cause of death in the
United States.
- May be acute, as in myocardial
infarction, or chronic, as in
hypertension and atherosclerosis.
- Hypertension may be a symptom
of another disease.
- Cholesterol is associated with
atherosclerosis and a
low-cholesterol diet or a
fat-restricted diet might be
prescribed.
- The health care professional can
encourage the client to maintain a
healthy weight, exercise, limit salt
and fat intake, and avoid smoking
to reduce the risk of heart disease.