This document provides an overview of nutrition in the life cycle, covering several life stages. It begins with an introduction to maternal and child nutrition, discussing the relationship between nutrition and pregnancy outcomes, low birth weight, lactation, and women's nutrition between births. It then covers nutrition and child development from infancy through childhood and adolescence. Key topics for adolescents include growth, nutrient requirements, weight issues, and dietary sources of vitamins and minerals. The document also discusses interventions to address nutritional problems for mothers and children, including supplementation and breastfeeding. It concludes with a chapter on the nutritional concerns of the elderly, such as changes in nutrient requirements and food pyramid recommendations with aging.

1. NUTRITION IN THE LIFE CYCLE
Credit Hours: 2
By : Kefyalew Taye (MPH Nutrition, Asst-prof,
PhD, Candidate)

2. COURSE CONTENTS
 Chapter I: Introduction to maternal and child nutrition
– the intricate relationship
 Nutrition and pregnancy outcomes
 Low birth weight , prevalence determinants, and consequences
 Nutrition during lactation
 Nutrition care for women between births
 Chapter II: Nutrition and child development
 Introduction
 Infant and young child feeding (IYCF) strategies
 Nutrition during Childhood (2-9 years),

3. CHAPTER III: ADOLESCENT NUTRITION (10-19 YEARS)
 Introduction
 Nutrient requirements
 Chapter IV: Direct interventions to address nutritional problems
of mothers and children
 Nutrient supplementation
 Breast feeding
 Chapter V: Nutritional concerns of elderly
 Aging and nutrition
 Nutrient requirements
 Nutrition related risk factors
 Nutrition related health problems
 Intervention strategies

4. Introduction to Nutrition in
the life cycle

5. WHY LIFE CYCLE APPROACH
 Special nutrient requirement
 Vulnerable to malnutrition
 Far reaching effects
 Lifecycle approach intervention have
 there is a cumulative effect in the next generation
 long term impacts on succeeding generations

6. NUTRITION THROUGHOUT THE LIFE CYCLE
6

7. ADOLESCENT NUTRITION

8. ADOLESCENT NUTRITION
Adolescence :
 period of transition between childhood and adulthood, ages 10-
19 (WHO) often referred to as puberty
 Period of exploration and learning
 Good time to establish proper health and nutrition practices and
behaviors
 Expanding relationship and friendships
 Influence lifestyles and behaviors
8

9. ….ADOLESCENT GROWTH…
 Second highest rate of growth attained, second to the first
year of life
 More than 20% of total growth in stature and up to 50% of
adult bone mass are achieved
 Nutrient requirements are significantly increased above
those in the childhood years
 Among girls, the "growth spurt" or peak growth velocity
occurs normally about 12-18 months before menarche at
some time between 10 to 14 years.

10.  Growth in stature continues, however, for up to 7 years
after menarche
 Maximal adult height in women may thus be attained as
early as 16 years or, particularly for populations with high
rates of under nutrition, as late as 23 years
 The development of the birth canal is not fully completed
until about 2-3 years after growth on height has ceased
;whereas peak bone mass is not achieved until the age of
25 years.
 The adult height finally attained may still differ as a result of
pre-existing childhood stunting

11. CAN ADOLESCENTS CATCH-UP INCOMPLETE
CHILDHOOD GROWTH?

12. FINDING FROM DIFFERENT STUDY
RESULTS
1. Children of poor families were adopted to a wealthy
families and from the studies it was shown that :
 Girls, who were stunted when adopted in infancy, were
also significantly shorter in adulthood than their peers
who were not stunted at the time of adoption
 The improved early childhood growth in these adopted
girls hastened menarche considerably and shortened
the period of rapid premenarcheal growth.

13. ..CONT..STUDY FINDING
 There remains little evidence that growth retardation
suffered in early childhood can be significantly caught up
in adolescence.
 Stunted children are more likely than no stunted children
to become stunted adults, while they remain in the same
environment which gave rise to the stunting

14. 2. RESULTS FROM STUDIES IN INDIA, COHORTS OF DUTCH
HUNGER TIME , AND GUATEMALA:
 Growth failure in early childhood manifested by stunting,
may be irreversible to a large extent
 Early childhood stunting and its functional correlates can be
addressed together only if the environment in which the
young child grows is improved at that time; i.e., within the
first two years of life
 Early childhood stunting among young girls was correlated
significantly with the birth weights and mortality risk of their
infants

15. ENERGY AND NUTRIENT NEEDS FOR MALE AND FEMALE
ADOLESCENTS
• After reaching the age of puberty male and
female slightly differ in their nutritional
needs
• The requirements of both could be increase if by
workloads as they start to work for their families
• Adolescent girls need special attention
– To ensure adequate nutrition for their own development
– Ensure adequate nutrient reserve for future pregnancy
and lactation.

16.  Energy and protein requirements peak at 11-14 for
girls (2,200 Cal/d) and 15-18 for boys (2,500+
Cal/d).
 Protein requirements of 0.8 –1.0 g/kg/d are met by
typical American teens (even vegetarians).
 Fat: adult levels of 30% of calories should be
encouraged.
 Calcium: 1,200-1,500 mg/d recommended (600-800
consumed)
 Iron: prevalence of Fe-deficiency anemia 2-10%
 Zinc: growth increases zinc requirements

17. MORE REASON TO PAY ATTENTION TO
ADOLESCENT NUTRITION
 This second period for rapid growth could be window
of opportunity to compensate earlier growth failure.
 More effort could be made to avoid further growth
failure during this stage which could pass to
adulthood which makes malnutrition to pass to next
generation.

18. WHAT CAN ADOLESCENTS GIRLS DO TO ENSURE THEIR
NUTRIENT NEEDS?
 Eating a diet rich in dairy foods and leafy green
vegetables help to ensure calcium
 Increase their consumption of iron-rich
foods, such as red meats, fish, poultry and
legumes, to meet iron needs
 Early pregnancy is better avoided
 Special care must be provided during adolescent
pregnancy

19. SPECIAL ADOLESCENT POPULATIONS
 Pregnant: add 300 Cal/d, increases protein and calcium
requirements, needs of the mother compete with the needs of the
fetus
 Athletes: may use protein powders unnecessarily. For females:
eating disorders, amenorrhea, & inadequate Ca intake all contribute
to osteoporosis risk.
 Obese: associated with development of cardiovascular risk,
exercise and avoidance of empty calories are important, caloric
restriction increases chances of deficiencies, ketogenic diets may
reduce hunger.
 Vegetarian: many teens decide to adopt alternative diets, focus on
what is eaten rather than what is avoided
 Poverty: low socioeconomic status is correlated with risk for poor
diets

20. DIETARY SOURCES OF VITAMINS NEEDED BY
ADOLESCENTS
 Vitamin A:
 Liver, tomatoes, winter squash, cantaloupe, carrots,
spinach, broccoli, sweet potato
 Vitamin B6:
 Liver, soybeans, bananas, meat, fish, beans, nuts, whole
grains
 Vitamin E:
 Oils (wheat germ, sunflower, safflower, corn), almonds,
peanuts
 Vitamin D:
 Sunlight, fortified milk
 Vitamin C:
 Peppers, broccoli, citrus fruits, melons, strawberries,
tomatoes, cabbage, green leafy vegetables, papaya,
winter squash
 Folic acid:
 Brewer’s yeast, liver, green leafy vegetables, beans,
asparagus, orange juice

21. DIETARY SOURCES OF MINERALS NEEDED
BY ADOLESCENTS
 Iron:
 Organ meats, fish, green vegetables, nuts, iron-fortified cereals,
raisins.
 Calcium:
 Dairy products, green leafy vegetables, sardines, salmon
 Zinc:
 red meat, organ meats, oysters, crabmeat, beans, whole grains
 Magnesium:
 Whole seeds, nuts, legumes, grains
 Fiber:
 Peas, beans, whole grains, sweet potato, green leafy
vegetables

22. ADOLESCENT NUTRITION
 Weight problems usually begin to occur in this period.
 Drug and alcohol decisions are being made
 Eating disorders increase in female teens
 Can be as high as 4000 calories in males related to lean
body mass and activity level.
 Much lower in females compared to males due to size
differences, higher body fat and decreased physical
activity.

23. ADOLESCENT NUTRITION
 Important to emphasize physical activity especially to females
because they grow earlier, and fat cells grow in size (*and
number) at this age.
 Both males and females teens in America are more
overweight and obese than in past generations. (Increase of
diabetes type II also.)
 Body image issues and cultural pressures to be thin and sexy
are major contributing factors to food and behavior choices!

24. CHAPTER-FOUR
Direct interventions to address nutritional
problems of mothers and children

25. SCIENTIFIC EVIDENCES ON
INTERVENTIONS FOR MATERNAL AND
CHILD MALNUTRITION

26. MATERNAL MICRONUTRIENT AND DISEASE LINKSCHRISTIAN AND
STEWART 2011

27. INTERVENTIONS FOR MATERNAL AND BIRTH
OUTCOMES
• Protein-energy supplementation to pregnant women
– Reduces risk of LBW, mostly among the undernourshed
women
• Iron/folic acid supplementations to pregnant women
– Help for prevention of IDA, increases hemoglobin
– Help prevent neural tube defects among fetuses
• Multiple micronutrient (MMN) versus iron/folic acid
– MMN is more beneficial for increasing birthweight
• Nutrition education and Iron/folic acid supplements
to adolescents before pregnancy
– Increase hemoglobin and reduces anemia

28. INTERVENTIONS FOR NEW-BORN BABIES,
INFANTS AND CHILDREN
 Breast feeding support and promotion
 Reduce morbidity and mortality
 Increase in early initiation of breastfeeding
 Adequate and timely introduction of complementary
feeding
 No best package to apply
 Have beneficial effects in trials than in large
scale

29. INTERVENTIONS FOR NEW-BORN BABIES,
INFANTS AND CHILDREN
 Hygiene practices and interventions
 Decrease diarrhea and dysentery
 Hand-washing counseling reduce 30% diarrhea
 Lack of evidence on impact of hygiene practices
on stunting or underweight
 Deworming
 Small evidence base, but probably improve
growth of children

30. INTERVENTIONS FOR NEW-BORN BABIES,
INFANTS AND CHILDREN
 Micronutrient supplementation interventions
 Vitamin A supplementation (6-59 months) reduce
mortality by 24%
 Zinc supplementation reduces duration of acute
diarrhoea
 Poor evidence regarding effect of zinc on
stunting
 Fortifications of staple food by some
micronutrients are effective in reducing
deficiencies
 Treatment of severe acute malnutrition (SAM)
 Found to be effective in reducing mortalities

31. INDIRECT INTERVENTIONS
• Efforts that might influence underlying causes
• These are development efforts made to be more
“nutrition-sensitive”
– social protection to reduce household poverty
agricultural development to improve rural incomes and
household food security
– women’s empowerment
– wider health systems strengthening and
– water and sanitation measures

32. SOCIAL PROTECTION
• Policy instruments to address poverty and vulnerability
• Includes the following programs
– social assistance,
– social insurance and efforts at social inclusion
– subsidies and others
• Social protection programs of food security have different
sources for “entitlements” to
– Food
– Labor (public work)
– Trade (subsidies on food price, grain reserve managements)
– Transfers (supplementary feeding, school feeding programs, cash
transfers )

33. CASH TRANSFERS
• Main aim is to alleviate poverty
• Also contributes to wider range of development outcomes
• The benefits include
– Improved food consumption
– Improved child weight and height
– Reduction of risk of stunting by 7%
• However ,
– No evidence sustainability of the initial benefits
– Evidences are not conclusive about impact on malnutrition (wasting)
• cash transfer programs have positive impact on child
nutritional status
– More effective on stunting than on wasting
– More effective if targeted at younger children

34. AGRICULTURE
• Evidences on direct effect on nutrition is poor
• Interventions include
– Homestead gardening
– Promotion of crops for nutritional values
– Bio-fortification
• Review of evidences on impact of such intervention show
mixed results
– Child anthropometry
– Diet
– Iron and
– Vitamin A absorption
• Agricultural growth contributes
– Increased food production improves health and nutrition
– increased the income of the poor
– Reduces the risk of stunting , but not in India

35. WHAT IS NEXT
Make continuous effort to update yourself with new
evidences as scientific information in human
nutrition is very dynamic over time

36. Chapter Five
Nutrition concern of old age

37. WHAT IS AGING AND AGING PROCESS
• How Old is Older? People of older than sixty years are
older people
• Aging is not a disease: _If we live long enough change
in body composition, physical function, and
performance will occur in all of us
• Many of the change as well as health problem which
become more common in old age have long been
attributed to the normal aging process

38. AGING…
 Life expectancy: the average number of year lived
by people in a given society
 Longevity: long duration of life
 Life span: the maximum number of years of life
attainable by a member of a species (for humans is
130 yrs)

39. CHRONOLOGICAL AGE AND BIOLOGICAL AGE
• Chronological age: the age of a persons in years
since birth
• Biological age: a decline in functions that occur in every
human being with time
• Some people look and function as so they were older and others
as they were younger at the same chronological age
• The difference can go up to 10 years and some of the reason
could be due to improved life long nutrition

40. THE EFFECT OF AGING ON NUTRITIONAL STATUS
 Decrease in lean body weight
 Loss of taste and smell
 Oral Cavity Changes
 Decrease in gastrointestinal function
 Loss in visual and auditory function
 Loss of bone mineral mass
 Mental impairment
 Decrease in heart and lung fitness
 Decreased ability to metabolize drugs
 High prevalence of chronic disease
 Neuromuscular changes
 Decrease in liver and kidney function
11/24/2023

41. NUTRIENT REQUIREMENT FOR OLDER AGE
1. Water Needs
– Total body water decreases with age
– Can dehydrate rapidly
– Many older people do not feel thirsty or notice mouth dryness
– It may be difficult to get a drink or get to the bathroom
– Those who have lost bladder control may be afraid to drink
too much water

42. Dehydration Can lead to:
urinary tract infection
 pneumonia
 pressure ulcers
Confusion
 disorientation

43. REQUIREMENT…
2.Calories Needed
 Less calorie needed
 Physical activity decreases
 Basal metabolic rate decreases
 Due to decrease in lean body mass

44. 3. Protein requirement
 High-quality protein needed because of reduced calorie diet
 Important for supporting immune System
 Helps prevent muscle wasting Problem of expense

45. 4.Vitamin D
• Need more to prevent bone loss
• Less vitamin D made by body
– Limited exposure to sunlight
– Reduced capacity of skin to make it and
– liver to activate it
• Older adults drink less milk
– Increased incidence of lactose
intolerance

46. 5.Calcium
 Needed to prevent bone loss
 Problem of low dairy intake
 Solutions:
 Calcium-fortified juices,
 adding milk powder to foods
 supplements

47. 6.Iron
• Need in women decreases after menopause
• Low food intake can lead to deficit
• Loss of iron through chronic blood loss due to disease or
medicines
• Reduced iron absorption to due low stomach acid and
antacid use

48. 48
A food pyramid for the elderly
Calcium, vitamin D, vitamin B12,
Wholemeal
Fruit 2 portions
Cereals and tubers
6 portions
Wholemeal
is better
Vegetables
3 portions
Milk, yogurt, cheese
3 portions
Sweets and fats in moderation
Fish meat legumes
2 portions
Water and liquids 8 glasses

49. Thank you!