Nutrition and lifecycle Lecture 13 &14 March 9, 2015 Dr. Quadro.

Nutrition and lifecycle

Lecture 13 &14March 9, 2015

Dr. Quadro

Lecture 13 & 14 – March 9, 2015

Nutrition for the Life Cycle

Nutritional needs change at each stage of the life cycle.

• Pregnancy

• Infancy

• Early and middle childhood

• Adolescence

• Adulthood

• Senior adulthood

Lecture 13 & 14 – March 9, 2015

Pregnancy

Trimester: one-third of the normal duration of pregnancy. First trimester is 0 to 13

weeks Second trimester is 13 to 26

weeks Third trimester is 26 to 40

weeks

Prenatal – Before birth

Postnatal – After birth

Lecture 13 & 14 – March 9, 2015

Pregnancy

The only way nutrients can reach the developing fetus is through the placenta, the special organ that grows during pregnancy to support new life.

The close association between the fetus’s and mother’s circulatory systems permits the mother’s

bloodstream to deliver nutrients and oxygen and remove waste

products

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Zygote

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Copyright 2010, John Wiley & Sons, Inc.

Fetal Development

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Nutritional Needs of Pregnancy

Lecture 13 & 14 – March 9, 2015

Nutritional Needs During Pregnancy

• Nearly all nutrients are recommended in increased amounts during pregnancy and lactation

• Only small increase in metabolic demands (energy) of pregnancy and fetal development

2nd trimester - add 350 Calories per day

3rd trimester - add 450 Calories per day

Lecture 13 & 14 – March 9, 2015


Lecture 13 & 14 – March 9, 2015

Macronutrients recommendations

-RDA for protein increases. An additional 25 g/day in 2nd and 3rd trimester. For a women of 136 lbs = 75 grams /day

-RDA for carbs is increased by 45 g/day = 175 grams / day (typical intake is 300 grams)

-Total fat intake does not need to increase. Increase intake of essential fatty acids (linoleic and alpha-linolenic). Insufficient scientific evidence. Only AIs are given.

-Macronutrient distribution should be the same (Nutrient-dense foods).

Lecture 13 & 14 – March 9, 2015

WATER recommendations

- Need of water is increased due to increased blood volume, production of amniotic fluid and the needs of the fetus.

-From 2.7 l/day to 3 l/day

-Potassium, sodium and chloride needs do not change

Lecture 13 & 14 – March 9, 2015


Lecture 13 & 14 – March 9, 2015

• The DRI for calcium during pregnancy does not increase during pregnancy: 1,300 milligrams for teens 1,000 milligrams for adults over 18 years of age

• Intestinal absorption of calcium doubles early in pregnancy, and the mineral is stored in the mother’s bones

• During the last trimester of pregnancy when fetal skeletal growth is maximum and teeth are being formed. The fetus draws approximately 300 milligrams per day from the

maternal blood supply.

Nutritional Needs During Pregnancy - Calcium

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• No need to increase, if sufficient amount is obtained from the diet and if sufficient sun-light exposure is met.

• Some ethnicities can be at higher risk of developing vitamin D deficiency

Nutritional Needs During Pregnancy - vitamin D

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*RDA for iron during lactation is equal to half of the RDA for non-pregnant

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Nutritional Needs During Pregnancy - vitamin C

• It is needed for the synthesis of collagen (skin, tendons, and protein matrix of bone) Recommended intake increased by 10mg/d

This requirement can easily be met by including citrus fruits and juices in the diet, thus supplements are usually not necessary.

Lecture 13 & 14 – March 9, 2015

From Lohnes et al., 1994From Abu-Abed et al., 2001

Vitamin A-deficiency Vitamin A-excess

Nutritional Needs During Pregnancy - vitamin A

Lecture 13 & 14 – March 9, 2015

Nutritional Needs During Pregnancy - Folate

• A pregnant woman’s recommended intake for folate is 50% greater. - 400ug Folate supplements given around the time of

conception are known to reduce the recurrence of neural tube defects.

Women are advised to get recommended amounts of folate before becoming pregnant and during the first trimester.

As of 1999, all refined grains are fortified with folate (140 mg/ 100g of grain product).

Lecture 13 & 14 – March 9, 2015

Folic acid requirements

• Neural tube defects: include any of a number of birth defects in the orderly formation of the neural tube during early gestation.

• Both the brain and the spinal cord develop from the neural tube; defects result in various central nervous system disorders. The two main types are: Spina bifida: incomplete closure of

the bony casing around the spinal cord.

Anencephaly: a partially or completely missing brain.

Lecture 13 & 14 – March 9, 2015

• It is involved in the synthesis of DNA, RNA and protein

• Zinc absorption is inhibited by high iron intake, thus iron supplements may compromise zinc status if the diet is low in zinc

• RDA is 11mg/d (lean ground beef)

Nutritional Needs During Pregnancy - Zinc

Lecture 13 & 14 – March 9, 2015

• Pregnant needs 50 % above non-pregnant needs (synthesis of hemoglobin and other iron-containing proteins)

• Many women begin pregnancy with diminished iron storesAn iron supplement of 27 milligrams ferrous iron daily during the second and third trimesters is recommended

Red meats, leafy green vegetables, fortified cerealsCitrus fruits and red meat increase iron absorption

Nutritional Needs During Pregnancy - Iron

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What is in a Prenatal Supplement?

Must be taken in conjunction with, not in place of a carefully planned diet

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Consequences of Maternal Malnutrition in Pregnancy

• Fetal growth retardation

• Birth defects

• Spontaneous abortion and stillbirth

• Premature birth

• Low infant birth weight

• Maternal and fetal anemia

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Malnutrition in the prenatal and postnatal periods also affects learning ability and behavior

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Common nutrition-related problems of pregnancy

• Pregnancy-induced hypertension (PIH): high blood pressure that develops during the second half of pregnancy

• Preeclampsia: a condition characterized by hypertension, fluid retention, and protein in the urine

• Eclampsia: a severe extension of preeclampsia characterized by convulsions

• Gestational diabetes: the appearance of abnormal glucose tolerance during pregnancy, with a return to normal following pregnancy.

Lecture 13 & 14 – March 9, 2015

Fetal Alcohol Syndrome

Defined by four criteria:

1. Maternal drinking during pregnancy

2. Characteristic pattern of facial abnormalities

3. Growth retardation

4. Brain damage often manifested by intellectual difficulties or behavioral problems

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• These facial traits… low nasal bridge short eyelid opening small head circumference undeveloped groove in center

of upper lip …are typical of fetal alcohol

syndrome, caused by drinking alcohol during pregnancy.

• Irreversible abnormalities of the brain and other organs accompany these facial features.

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safe alcohol intake has not been established for pregnant women at any time during gestation, including the first few

weeks

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The developmental origin of adult diseases

Lactation and Nutrition

Mom and Baby

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Maternal Nutrient Needs during Lactation

• The need for nutrients is even greater during lactation than during pregnancy.

• Mothers provide energy and nutrients to the infant, who is growing faster and is more active than the fetus

• Human milk contains about 160 kcalories per cup (240 ml). About 330-400 additional Kcal/d

• Lactating women require approximately an additional liter of fluid a day.

• Most lactating women can meet all their need without supplements.

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Energy needs in infants - comparison

Infant Adult

Weight 15 lbs. 150 lbs.

Kcal / day 650 Kcal 2000 Kcal

• 1 year old = 1000 kcal/day



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Potential micronutrients infant deficiencies• IRON: babies are born with stores and iron in human milk, although not

abundant, is very well absorbed. After 6 months, stores are depleted, hence iron-fortified rice cereal or iron-fortified formula

• VITAMIN D: very low in breast-milk, so sunlight exposure is important. Infant formula is fortified. Brest-fed infants are often supplemented.

• VITAMIN K: it doesn’t cross the placenta efficiently and the gut of the newborn is sterile (no microbial synthesis). Breast-milk is low in vitamin K. Therefore, single intramuscular injection to the infant (0.5-1mg of vitK).

• VITAMIN B12: breast-milk of vegans mothers can be deficient in B12

• FLUORIDE: breast-milk is low in fluoride

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Benefits of Breast Feeding for Infant

• ‘Ideal’ sterile food

• Provides protective factors antibodies bifidus factors lactoferrin growth factor lipase enzyme

• Promotes better tooth and jaw alignment

• Favors bonding between mother and child

• Decreased incidence of obesity

Lecture 13 & 14 – March 9, 2015

Benefits of Breast Feeding for Mother

• Economical and convenient

• Helps return uterus to normal size faster

• Helps return to pre-pregnancy weight faster

• Delays onset of menstruation (not birth control)

• Improves bone re-mineralization

• Reduces risk for ovarian and pre-menopausal breast cancer

Lecture 13 & 14 – March 9, 2015

When Not to Breast Feed

• Infants with galactosemia

hereditary disease that is caused by the lack of a liver enzyme required to digest galactose

• Mothers taking certain medications

• Mothers with communicable diseases such as HIV or active tuberculosis

• Mothers who use illegal drugs

Lecture 13 & 14 – March 9, 2015

Healthy Infants with Formula

• Infant formulas are manufactured with the approximate nutrient composition of breast milk

• The parents can see that the baby is getting enough milk during feedings

• The mother can offer similar closeness, warmth, and stimulation during feedings as the breastfeeding mother does

• Other family members can get close to the baby and develop a warm relationship in feeding sessions

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Comparing Breast Milk and Formula

Elderly and Nutrition

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AGING

Inevitable, natural process! It is the result of cumulative effects of allbiochemical and physiological changesthat occur in a living organism and itsconstituents (cells, organs, systems)over time.Changes occur also in response to the interaction between genetic and environmental events.

Lecture 13 & 14 – March 9, 2015

Demographic Trends and Aging

• Number of elderly (65+) in the US will double by 2030 to more than 70 million people.

• Improved life expectancy as a result of better prenatal and postnatal care and improved means of combating diseases in older adults.

Life expectancy in the U.S.

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• In the US, life expectancy is 73 years for men and 75 years for women.

• Maximum life span (maximum age at which people die) is 100-120 years.

…More statistics

• Healthy life style (good diet, exercising, healthy environment) can slow the process of aging.

Lecture 13 & 14 – March 9, 2015

Aging at the cellular level

• Impairment of DNA replication• Impairment of cellular proliferation• Loss of viability of the cell• Reduced rate of DNA repair• Free radical damage• Reduced rate of protein synthesis and catabolism

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15-90% reduction

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Aging and Nutritional Needs

Older adults do need to pay attention to quality and quantity of food.

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• Energy needs are reduced (reduced basal metabolism due to loss of lean tissues and decreased physical activity)

»Select nutrient-dense food»Plan regular exercise

Calories

• Caloric needs decrease about 5% per decade after age of 50

Lecture 13 & 14 – March 9, 2015

CALORIE RESTRICTION - animal models

30-40% fewer Calories but containing all the necessary nutrients

Moderate dietary restriction extends lifespan of the animals studied compared to control animals fed “ad libitum”

-complete dietary restriction-selective removal of individual macronutrients (fat, protein, carbohydrate)-selective removal of individual micronutrients (vitamins, etc)

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Calorie Imbalance

• Weight Gain Risk For Many Health Problems

• Weight Loss Risk For Malnutrition Don’t go below 1200 calories

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FatFat: Source of energy, biologicalmembranes, carrier for vitamins, hormones

and intracellular messenger• Fat digestion and absorption is not

impaired• Too much fat increases diseases’ risk.

Thus, limit fat to 30% or less of total calories

• Limit fat intake by choosing reduced fat (lean meat), and limiting added and hidden sources of fat

Lecture 13 & 14 – March 9, 2015

Water• Elderly have increased risk of

dehydration Body water decreases with age Medications increase water loss Thirst mechanism not as effective Decreased mobility to reach fluids

- 6-8 cups of water daily (30ml/kg)

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Vitamins and Minerals• Elderly tend to have low dietary intakes

of some vitamins and minerals Vitamin B6, B12, D Folate Magnesium Zinc Iron Calcium

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• Increase of specific nutrients

Reduced stomach acidity (calcium, iron, vitamin B12)

Decline in vision (antioxidant such as -carotene, lutein, vitamin E)

Reduced exposure to sunlight (vitamin D)

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• Reduce specific nutrients

Decline in hepatic functions (vitamin A)

Risk of cardiovascular diseases (fat)

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Jean Mayer USDA Human Nutrition Research Center onAging (USDA HNRCA) at Tufts University (2011)

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Nutrition-Related Problems of Older Adult

Functional decline in almost every organ (intake, absorption, storage, utilization and excretion of nutrients)

Chronic diseases (heart diseases, cancer, diverticulosis, vascular diseases, osteoporosis, diabetes, oral cavity diseases, neurological diseases, depression)

Lecture 13 & 14 – March 9, 2015

Aging and Nutrition Status

• Older people vary in their social, economic, functional capacities and physical condition.

• Most older people live at home, are fully independent, and have a good quality of life.

• Some others have problems with the Activity of Daily Living (ADL) and are at risk of malnutrition

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Factors Influencing the Nutritional Status of Older Adults

Socioeconomic

• Cultural Beliefs• Poverty• Level of education• Access to health care• Institutionalization

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Physiological

• Dietary intake• Lack of appetite• Inactivity/Immobility• Poor taste or smell• Alcohol or drug abuse• Chronic diseases

• Polypharmacy• Disability• Oral health problems

Factors Influencing the Nutritional Status of Older Adults (cont.)

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Psychological

• Loneliness• Cognitive impairment• Dementia• Depression• Loss of spouse• Social isolation


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Environmental

• Inadequate housing• Inadequate cooking facilities• Lack of transportation• Lack of access to health services


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Federal Elderly Nutrition Program(ENP)

Specific goals:Low cost nutritional mealOpportunity for social interactionNutrition education and shopping assistanceCounseling and referral to other social and rehabilitation servicesTransportation services

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Warning Signs of Malnutrition in Older Adults

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AGING WELL

“Life advantages”:

Genetic potentialContinue desire for new knowledge and experiencesSocialization, intimacy and family integrityPrudent dietAvoidance of substance abuseAcceptable living arrangementsAccess to health care

Nutrition and lifecycle Lecture 13 &14 March 9, 2015 Dr. Quadro.

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