Center for Human Nutrition

Medical Nutrition Syllabus

Guide to Healthy Diet and Lifestyle

Exercise Guidelines

Managing Obesity

Exercise Prescription

Medicine and Surgery Nutrition Assessment Checklist

Pediatric Nutrition Assessment Checklist

Adolescent Nutrition Assessment Checklist
Syllabus Menu: | Dietary Assessment | Weight Assessment | Dietary Recommendations | Nutritional Deficiencies | Nutrition During Lifecyle | Nutrition in Pathological Conditions | Vegetarianism | [Popular Diets | References |

 
Nutrition During the Lifecycle
INFANCY (0-12 months)
  • For the first four months only breast milk or formula should be given.
  • Iron fortified infant cereal should be the first solid food at 4-6 months of age.
  • If solid foods are introduced too early it may lead to development of food allergies &/or obesity.
  • Pureed/strained fruits and vegetables can be started at 5-7 months of age.
  • Recommended interval between introduction of new foods is 4 days.
  • Cottage cheese, plain yogurt given at 6-8 months of age; cow’s milk should be introduced at 9-12 months of age.
  • Variety of regular table foods such as fish, poultry, beans, meat etc., can be given at 9-12 months of age.
  • Certain foods are more allergenic than others (e.g. cow’s milk, citrus fruits, egg yolk, wheat) and their introduction should be postponed to later in the first year.

BENEFITS OF BREAST-FEEDING

  • Immunological Benefits - breast milk contains leukocytes, immunoglobulins, bifidus factor (supports GI Lactobacillus bifidus), lysozyme, interferon, and lactoferrin (inhibits growth of E.coli). Research suggests infants who are breast-fed during the first 4 months of life experience a decreased incidence of ear infections, gastroenteritis, and respiratory illnesses during the first year of life and a decreased risk of otitis media for the first 7 years of life.
  • Convenience- breast milk is a very economical food source that is adequate without supplementation until the infant is 4-6 months old. Breast milk is also convenient because it is ready to serve.
  • Allergy Avoidance - there is a decreased chance that a child will be allergic to cow’s milk after being breast-fed first.
  • Reduced Incidence of Overfeeding - breast-fed infants are less likely to be overfed than those fed with formula.
  • Physiological and Social Benefits - breast-feeding promotes good jaw and tooth development in the infant and also fosters mother-infant bonding.

CHILDHOOD

  • Growth rate slows down after the first year, which leads to decrease in energy requirements and appetite.
  • Children learn to feed themselves between 1-2 years of age.
  • Pre-school children can be very picky eaters with strong likes and dislikes.
  • Certain foods (hard to chew/small & round/sticky) may cause choking in children under 3-4 years of age and should be avoided e.g. nuts, grapes, raw carrots, corn, peas, chunks of meat, frankfurters, hard candy, peanut butter served in chunks.
  • Recommended daily intake for 1-3 years old ~ 1300 kcal/day; for 4-6 years old ~ 1700 kcal/day; for 7-10 years old ~2400 kcal/day.
  • School-age children usually eat 4-5 times a day.
  • There is a growing problem of obesity in childhood as children consume increasing amounts of high fat fast foods and snacks, leading to excess calories, coupled with decreasing amounts of exercise.

ADOLESCENCE

  • Vitamin B6 and folate deficiencies have been observed in American teenagers.
  • Low intake of iron, calcium and zinc is seen in adolescents’ diets.
  • Calcium intake is low among girls and this may compromise their peak bone density.
  • Very high protein intake can increase loss of calcium.
  • Obesity, anorexia and bulimia are prevalent in the adolescent population.

PREGNANCY

  • Recommended daily caloric intake is an additional 200-500 kcal/day.
  • Dairy product consumption should be increased to 4 servings/day (e.g., 4 cups of fortified milk). The recommendation for non-pregnant adult women is at least 2 servings/day.
  • Women who are lactose intolerant should have more servings of calcium rich vegetables and fish; should take calcium supplements; should increase intake of meat/poultry/fish/legumes to get the additional proteins (see below).
  • Recommended daily allowance for protein is an additional 30 g/day-- Anywhere from half or all of that can come from the two additional servings of dairy products (2 servings of low-fat milk ~ 16 g of protein; 2 servings of plain nonfat yogurt ~ 26 g of protein) and the remaining protein can come from an additional serving of meat/poultry/fish/legumes.
  • Calorie and protein needs are the highest during the third trimester.
  • Recommended weight gain for women entering pregnancy at normal weight: 20-30 lb.
  • Weight gain pattern: ~1 lb./mo. during the 1st trimester & ~1 lb./wk during 2nd & 3rd.
  • Severe weight restriction/loss is NOT recommended even for obese pregnant women.
  • Plasma volume expands about 50% and GFR increases during pregnancy, which leads to dilution of many vitamins and their carrier proteins.
  • Prenatal vitamins contain the recommended amounts of folate (400-800 m g/day to prevent neural tube defects), iron (30-60 mg/day), zinc (3-5 mg) and almost other vitamins and minerals except calcium and vitamin B6 (see below).
  • Vitamin B6 supplementation of ~100 mg/day may help alleviate morning sickness and depression.
  • Calcium intake should be 1200 mg/day which is 400 mg more than the adult RDA.

LACTATING WOMEN

  • An additional 200-500 kcal/day are recommended (i.e. similar caloric intake as in pregnancy).
  • Gradual weight loss occurs in women who breast-feed as energy from 2-4 kg of body fat stored during pregnancy is used for milk production. Weight loss should not exceed 4.5lbs per month for the baby’s continued adequate growth.
  • Recommended daily allowance for protein is an additional 20 g/day.
  • Calcium intake should be 1200 mg/day.
  • Vitamins C and E and folate requirements are also increased.
  • Lactating women should consume one good source of vitamin A (carrots, sweet potato) and vitamin C (orange juice, tomato) per day.
  • Prenatal vitamins are often prescribed to lactating women to ensure adequate intake, but they should get their nutrients from a well-balanced diet.
  • To prevent dehydration, they should drink 2-3 quarts of fluid per day.

OLDER ADULTS

  • Decrease in caloric intake is recommended to match age associated decrease in physical activity -- for active women: ~2200 kcal (21-50 y); ~1900 kcal (>50 y) and for active men: ~2900 kcal (21-50 y); ~2300 kcal (>50 y).
  • Many Americans over 65 years of age have low dietary intake of thiamin, riboflavin, vitamin C, vitamin B6, folate, calcium and zinc.
  • RDA for most nutrients for adults aged 21-50 years and over 50 years are the same except for iron, thiamin and riboflavin, which are lower for the older age group.
  • Loss of bone mass because of osteoporosis and osteomalacia is major health concerns.
  • Some older people may need increased amount of vitamin D due to decreased exposure to sun and age-related changes in vitamin D synthesis.
  • Higher intake of vitamin B12 may be needed as less is absorbed due to atrophic gastritis.

There are several risk factors that may increase the chance that an elderly patient will develop malnutrition. The following checklist is a good way to identify these risk factors. It follows the mnemonic "DETERMINE":

  • Disease - Is there a disease that may cause the patient to change the way they eat, makes it hard for them to eat, or puts their nutritional health at risk?
  • Eating poorly - Is the patient eating too much or too little? Eating they eating from all the food groups? Is there enough calcium in their diet?
  • Tooth loss/ mouth pain -Does the patient exhibit missing, loose or rotten teeth or dentures which may make it difficult to eat? Are there sores in the patient’s mouth?
  • Economic hardship - Can the patient afford the foods needed to stay healthy?
  • Reduced social contact - One-third of all older people live alone. Being with people daily has a positive effect on well being and eating habits.
  • Multiple Medicines - The more drugs being taking, the greater the chance for side affects such as increased or decreased appetite, change in taste, constipation, weakness, drowsiness, diarrhea, nausea, etc. Vitamins and minerals taken in large amounts can be toxic.
  • Involuntary weight gain/loss - A radical loss or gain in weight may be a warning sign to a problem. Also being overweight or underweight is not healthy.
  • Needs assistance in self care - Some elderly people have problems walking, shopping and preparing their own foods.
  • Elder years above age 80 - Over the age of 80 the risk of frailty and health problems increase. It is important to check their nutritional health often.