applied dietitic

1. Diet Menu Planning

2. Diet during normal life cycle
• Life is a succession of birth, life and death. By making wise
nutrition and diet choices throughout the life cycle, the quality
and quantity of one’s life may improve
• Diet planning starts with life in utero and focuses on maternal
nutrition and continues with infant nutrition and goes up to old
age
• Developing nutritious, age-appropriate foods & beverages and
positioning them within healthy lifestyle stages are some of the
most important roles that food and nutrition professionals may
have
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3. PREGNANCY AND LACTATION
A normal human pregnancy consists of three trimesters of three
months each, for a total of nine months. The nutritional needs of
the mother and the fetus increase during each trimester
Calories
A pregnant woman needs about 150 to 200 additional calories
daily during the first trimester. During the second trimester, she
requires about 350 calories daily, and during the third trimester,
about 450 additional calories
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4. • Energy requirement during pregnancy is increased because
of the additional energy required for
1. Growth and activity of fetus
2. Growth of placenta and maternal tissues
3. Increase in maternal body size
4. Steady rise in BMR
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5. Protein
• The Dietary Reference Intake (DRI)
• Non-pregnant adult woman-46 g of protein daily
• Pregnant woman-71 g of protein daily
• Increase of about 20-25 g of protein daily for:
1) Growth of the fetus
2) Development of placenta
3) Enlargement of uterus, mammary glands
4) Increased maternal blood volume
5) Formation of amniotic fluid
6) Preparation for labour, delivery, postpartum period and lactation by
maternal tissues
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6. Carbohydrates
• Also based on the DRIs, a pregnant woman requires about 175 g of
carbohydrates daily
• This amounts to about 700 ‘calories’ worth of carbohydrates daily
(175 g of carbohydrates×4 carbohydrate calories per g = 700 daily
calories)
Lipids
• Recommended levels of lipids during pregnancy have not been
determined
• Role of essential fatty acids linolenic and alpha-linolenic acids has
been established i.e. 13 g/day of linolenic acid, and 1.3 g/day of
alpha-linolenic acid
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7. Vitamins
• By consuming a wide range of foods and beverages and the right
amount of calories, most vitamin requirements during pregnancy
should be met. The need for folate is exceptional
• Folate (folic acid, folacin) is a B vitamin
• Found in broccoli, citrus fruits and juices, green leafy vegetables,
and legumes
• Folic acid is the synthetic form of this B vitamin that is used in
supplements and in fortified foods
• The AI for folate for women of childbearing years is 400
micrograms daily, which increases to 600 micrograms daily
during pregnancy to help decrease the risk of birth defects
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9. Minerals
Calcium
• The calcium requirement for an adult woman is 400mg/day
• During pregnancy the need increases to 1000mg/day
• The additional calcium is needed for the growth and
development of bones as well as teeth of the fetus and also for
the protection of calcium resources of the mother to meet the
high demand of calcium during lactation
• Inadequate intake of calcium results in the mobilization of
calcium from mother bones resulting in demineralization of
maternal bones and osteoporosis
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10. Iron
The requirement of iron increases from 30mg/day to 38mg/day
during pregnancy.
The increased requirement of 8mg/day is due to
1. Expansion of maternal tissues including red cell mass, iron content of
placenta and blood loss during parturition.
2. To build the iron store in fetal liver to last for atleast 4-6 months after birth.
This is because the baby’s first food milk is deficient in iron. Generally
infants are born with a high level of iron, 18-22g/ 100ml.
Iodine
Due to increase in BMR, iodine needs are also enhanced during
pregnancy
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11. Zinc
• Deficiency of zinc adversely affects the outcome of pregnancy
• Apart from being a component of insulin and enzyme systems, it
also participates in the synthesis of DNA and RNA, playing a
significant role in reproduction
• Hence zinc deficiency leads to fetal mortality, fetal,
malformations and reduced intra uterine growth rate
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12. THE NUTRITIONAL NEEDS OF LACTATION
• A lactating mother requires not only large quantities of body
building and protective foods but also additional energy yielding
foods to facilitate copious formation and secretion of breast milk.
Besides adhering to the basic principles of meal planning the
following guidelines need to be considered
• Large amount of fluids are essential for milk production. Therefore
adequate fluids such as milk, fruit juice, milk based beverages and even
water must be encouraged
• The choice of food is wide during lactation. No food need to be restricted
except spicy and strong flavored foods which might impart flavour to
milk that may be repulsive to the baby and that may cause gastric distress
to the mother
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13. Cont…
• Almost all medicines taken during lactation are absorbed into
mothers blood and are secreted in the milk. Hence any medicine
during lactation must be avoided or taken under strict medical
supervision.
• Since the nutrient needs are enhanced, the meal pattern may be
changed to 5-7 meals a day by introducing snacks between the
meals
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14. Cont…
• The nutritional needs during lactation are very similar to the
nutritional needs of pregnancy. Milk production requires about
800 calories daily
• On average, mothers who breastfeed produce about 30 ounces of
milk daily, which is generally covered by a modest increase in
calories and fluids. One ounce of breast milk contains about 20
calories
A pregnant or lactating woman requires about:
• 3 to 4 daily servings of dairy products or equivalents
• 1 serving = about 1 cup of dairy milk or 1 ounce or 1 slice of cheese
• 2 to 3 daily servings of meats or vegetable proteins
• 1 serving = about 3 ounces of beef, fish or shellfish, poultry or vegetarian substitute
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15. • 3 to 4 daily servings of fruits
• 1 serving = about 1 small piece of fruit or ½ cup of canned fruit)
• 3 to 5 daily servings of vegetables
• 1 serving = about 1 cup of fresh vegetables or ½ cup of cooked
vegetables)
• 7 to 11 daily servings of breads, cereals and grains, with at least
half of these servings from whole grains
• 1 serving = about 1 slice of bread or ½ cup of cooked grains, such as
rice or pasta)
• 4 daily servings of fats and oils
• 1 serving = 1 teaspoon margarine or butter or 1 tablespoon salad
dressing)
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16. THE NUTRITIONAL NEEDS OF INFANCY
• Breast milk is considered by some to be nature’s almost perfect
food
• Dairy- or soy-based infant formulas may be nutritious options to
breast milk
• The production of human breast milk and the process of
breastfeeding are adaptable, antibacterial, connective,
convenient, economical, nutritional, protective and restorative
• Infant formula is an alternative to human breast milk for early
nourishment
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17. Comparison between average nutrients of 1 ounce of
breast milk, cow’s milk, soy-based formula
Nutrients Breast Milk Cow’s Milk Soy-Based Formula
Calories 20 17 20
Carbohydrates (grams) 2 1 2
Proteins (grams) 0.3 1 1
Total fat (grams) 1 1 1
Cholesterol
(milligrams)
5 11 7
Iron (milligrams) 0.01 0.36
Calcium (milligrams) 31.6 20.7
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18. Energy
• The infants require 108 kcal/kg and 98 kcal/kg during 0-6
months and 6-12 months of age respectively
• Of the energy supplied 50 percent is used for basal energy,
25 percent for activity and 25 percent for growth
• After six months 70 percent of energy requirement is met
by breast milk and for the rest supplementary foods have to
be given
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19. Protein
• The human milk provides all the amino acids essential for
proper growth
• Protein intake of healthy infants during first 6 months of age
is 2g/kg body weight
• Protein requirement decreases after 6 months as do the
energy requirement
• After six months the protein requirement is 1.65 g/kg body
weight, the contribution being equal from the mothers milk
and vegetable protein supplements
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20. Fat
• Adequately breast fed infants receive 30g of fat /day of which 10
percent is linoleic acid and 1 percent linolenic acid. Breast milk
also meets the essential fatty acid requirements
• Foods used as substitutes when breast milk is inadequate or not
available should provide this proportion of fat and also ensure
that 5-6 percent of energy is in the form of essential fatty acids
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21. Calcium
• Upto 6 months when the infant is solely breast fed 300 mg of
calcium daily is adequate
• Large per cent of calcium in breast milk is retained by infant
• As the baby grows, rapid calcification of bones take place which
is essential to support the weight of the body by the time the
baby walks
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22. Iron
• The infants require iron for growth, expansion of blood volume
and for improving iron stores in the body
• The infant is born with good iron stores sufficient to last for four
months
• The haemoglobin level which is about 17g / 100mL at birth falls to
11g/100 mL during second week
• The released iron from the haemoglobin breakdown is stored in the
infant to be used subsequently
• Though mothers milk contains negligible iron, the amount of bio
available iron is sufficient to meet the needs of exclusively breast
fed infants
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23. INTRODUCING SOLID FOODS TO INFANTS
• After 4 to 6 months, solid foods can be gradually introduced. Introducing
solid foods any sooner may cause allergies, digestive problems and
childhood obesity, among other issues
• Once an infant learns to eat and tolerate one food, another food can gradually
be offered. Generally meats and vegetables contain more nutrients per
serving than fruits, vegetables or cereals, unless they are enriched or fortified
• A good source of vitamin C like vitamin C fortified fruit juice may be
introduced at about 6 months of age. Only 4 to 6 ounces (about ½ to ⅔ cup)
of fortified juices per day are recommended. More may add extra calories
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24. NUTRITIONAL NEEDS OF TODDLERS AND CHILDREN
• A young child who is learning to walk or “toddle” is considered a toddler,
the second stage of human development after infancy. This stage occurs at
around 1 to 3 years old
Daily Nutrients for Children Ages 1 to 3 Years Old
• According to the DRIs, children in this age require about 130 g (1,200
calories) of carbohydrates daily,19 g of fiber and 13 g (54 calories) of
protein, depending on their BMI and activity level
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25. Daily Servings of Foods and Beverages for Children 4 to 8 years of Age
Based on the USDA recommendations, children 4 to 8 years of age
require a range of 1,200 calories daily (girls) to 1,400 calories
daily (boys)
• 5 ounces of breads, cereals, cooked grains or starchy vegetables with
one-half (2½ ounces) whole grains
• 1½ cups of vegetables
• 1 to 1½ cups of fruit
• 2½ cups of dairy milk and milk products or substitutes
• 4 ounces of meat or meat substitutes
• 4 teaspoons of additional fats or oils
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26. Daily Servings of Foods and Beverages for Children
9 to 13 years of Age
Based on the USDA recommendations, children 9 to 13 years of age
require a range of 1,400 to 2,200 calories daily for girls, and 1,600
to 2,600 calories daily for boys, depending on growth and activity
level
• 5 ounces of breads, cereals, cooked grains or starchy vegetables for girls,
and 6 ounces of breads, cereals, cooked grains or starchy vegetables for
boys with one-half (2½ to 3 ounces) whole grains
• 2 cups of vegetables for girls
• 2½ cups of vegetables for boys
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27. Cont..
• 1½ cups of fruit for girls and boys
• 3 cups of dairy milk and milk products or substitutes for
girls and boys
• 5 ounces of meat or meat substitutes for girls and boys
• 5 teaspoons of additional fats or oils for girls and boys
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28. Adolescence
The teenage years between ages 13 and 19, is a period of rapid growth and
development with demanding nutritional needs. The changes in body images
are unparalleled because adolescents transform from childlike physiques into
young men and women
• Puberty is a period of rapid physical growth and sexual maturation that
signals the start of adolescence.
• Prepubescence marks the start of secondary sexual characteristics—
features that distinguish between boys and girls but are not directly part of
the reproductive system
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29. During the teenage years caloric needs parallel growth and
development. The daily nutrient recommendations according to the
2010 USDA Dietary Guidelines for girls aged 14 to 18 years are shown
in following table
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900 mg/d vitamin A 1.2 mg/d vitamin B6
75 mg/d vitamin C 400 mcg/d folate
5 mcg/d vitamin D 2.4mcg/d vitamin B12
L5 mg/d vitamin E 5 mg/d pantothenic acid
75 mcg/d vitamin K 25 mcg/d biotin
1.2 mg/d thiamin 550 mg/d choline
1.3 mg/d riboflavin 1,300 mg/d calcium
L4 mg/d niacin 35 mcg/d chromium

30. • According to the DRIs, the Recommended Dietary Allowance (RDA) for
carbohydrates for 14 to 18-year-old girls and boys is similar: 130 grams of
carbohydrates daily, or 520 calories
• Some teenagers barely eat this amount of calories if they are dieting. The
DRI Acceptable Macronutrient Distribution Range for carbohydrates is 45 to
65 percent of total calories for children through teenagers, 14 to 18 years of
age
• Based on an average intake of 2,000 calories daily for teenagers, this
amounts to about 900 to 1,300 calories, or 225 to 325 g of carbohydrates
daily. Once again, some teenagers do not come close to consuming this
amount
• Teenagers have a special need of: Calcium, Iron, Folate and Calcium
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31. THE MIDDLE YEARS
MOVING INTO ADULTHOOD: AGES 20 TO 65
The consensus among health professionals for “normal” adults in this age
group is to consume more of the following:
• Beverages, especially water, antioxidant-rich teas, 100 percent fruit juice and
calcium-rich dairy milk or milk substitutes for fluids, nutrients and
protective substances
• Broccoli and other members of the cruciferous family, such as Brussels
sprouts, cabbage and cauliflower, with phytonutrients for immunity
• Dairy milk and milk substitutes, calcium-fortified 100 percent fruit juice and
green leafy vegetables
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32. • Dairy milk and milk substitutes, calcium-fortified 100 percent fruit
juice, green leafy vegetables, and canned salmon and sardines,
with calcium for healthy bones and teeth
• Deep leafy green vegetables, such as chard, kale and spinach, with
calcium, folate and iron for heart health and cancer protection
• Fatty cold water fish, such as salmon and mackerel, with omega-3
fatty acids for brain and heart defense
• Fruits and vegetables with edible seeds and skin, such as dried or
fresh apricots, berries, grapes and plums, for healthy digestion
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33. • Healthy oils, such as canola and olive, with monounsaturated fatty
acids for heart protection
• Lean protein, such as some cuts of beef, fish and shellfish and
skinless poultry, for muscle mass and blood sugar stabilization
• Oatmeal, barley and apples, with soluble fiber for healthy digestion
• Whole grains, such as brown rice, quinoa with B vitamins and
fiber for healthy digestion
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34. The consensus among health professionals for average adults
in this age group is to consume less of the following:
• Animal protein over bodily needs
• Extra sugars
• Fried foods
• Highly processed foods
• Extra fats and oils
• Sodium
• Sweetened beverages
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35. Balanced diet for Adults
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