nutrition care for special groups; children, elderly and
TRANSCRIPT
Outline• Introduction
• Definition of terms
• Nutrition care for children
• Nutrition care for adolescents
• Nutrition care for pregnant women
• Nutrition care for the elderly
• Conclusion
Introduction
• Nutrition Care for special groups refers to the provision in the household and community of time, attention, support and skills to meet the nutritional needs of socio-economically deprived and nutritionally vulnerable groups
• Among these groups the growing child is the most vulnerable, but others include women, the elderly and the adolescents
• The nutrient requirements during the four main stages of the human lifecycle vary considerably (childhood, adolescence, reproductive period and geriatric)
• What infants and children require is different from what adults and the elderly need.
• In addition, there might be specific nutrients which a pregnant women and lactating mothers need in higher amounts than adult men.
Definition of Terms
• Nutrition is the process of nourishing the body with food to maintain life.
• It involves the regular consumption of the proper amount of calories, vitamins, minerals, fiber and many other nutrients found in food.
• The amount of nutrients necessary for healthy living differs among individuals based on age, gender, physical activity level and other factors.
• Adequate nutrition promotes the maintenance of a healthy weight to prevent obesity and related diseases such as heart disease, cancer, and stroke.
• Inadequate nutrition may result in nutrient deficiencies such as calcium, folic acid and fatty acids that are essential for maintaining good health.
Nutritional Requirements in the Special Groups
• Nutritional requirements in the different segments of the population can be classified into four groups.
• These correspond to different parts of the lifespan, namely;
(a) pregnancy and lactation
(b) infancy and childhood
(c) adolescence and adulthood, and
(d) old age (geriatric)
Nutrition during pregnancy and lactation
• An unborn child needs a healthy and well-nourished mother to grow properly
• Therefore, a mother needs to gain weight during pregnancy to help nourish her growing baby.
• Women who do not gain enough weight often have babies that weigh too little (low birth weight).
• A low birth weight baby weighs less than 2.5 kg.
• Such baby has an increased chance of both physical and mental health problems.
• It may also suffer more from infection and malnutrition compared with babies of normal weight.
Increased nutrients required during pregnancy
• Increased requirements: energy, protein, essential fatty acids, vitamin A, vitamin C, B vitamins (B1, B2, B3, B5, B6, B12, folate), calcium, phosphorus, iron, zinc, copper and iodine.
• Women should gain at least 11 kg during pregnancy
• If the mother gains less than this, the baby’s chances of survival and health declines.
• If a mother is overweight, she still needs to gain weight for her baby’s health, she should not try to lose weight while she is pregnant.
Increased nutrients required during pregnancy
• To maintain a healthy pregnancy, approximately 300 extra calories are needed each day, in addition to the daily recommended allowance of 2100kcal
• These calories should come from a balanced diet of protein (an extra amount of 30 gram is required in pregnancy), fruits, vegetables and whole grains.
• Iron requirement is also increased hence the need for iron supplementation in pregnancy
• Calcium intake is increased in pregnancy hence an extra 300-400mg is needed in addition to the daily allowance of 800mg.
• Sweets and fats should be kept to a minimum.
• A healthy, well-balanced diet can also help to reduce some pregnancy symptoms, such as nausea and constipation.
Pica in Pregnancy• Pica is a disorder that causes cravings for items that contain no nutritional
value
• Pregnant women with pica may want to eat clay, sand, cigarette ashes, starch, chalk, paper among other strange substances
• When a woman has pica during pregnancy, it may indicate a lack of a specific vitamin or mineral
• It’s important to notify your doctor if a woman craves non-food items or have eaten non-food items.
• Eating such items can be dangerous for the mother and baby.
Nutrition during lactation
• During the first six months after delivery, the baby is fed only on breast milk, and the baby depends on the mother for all nutrient requirements.
• Eating a healthy diet while breastfeeding is important because what is eaten determines the energy, protein, nutrient and vitamin content of the breast milk.
• Additionally, some minerals and vitamins are required for body processes such as healing wounds quickly (e.g. vitamin C and zinc).
• Nutritional demands during lactation are high and can have a negative impact on both mother and infant if they are not met.
• A breast feeding mother’s daily diet will be adequate provided that her food selection and preparation is appropriate.
Nutrient requirement by breast feeding mothers
• Nutritional needs during breastfeeding are increased in response to breast milk production.
• They must meet the requirements of both baby and mother.
Energy;
• An additional 500 kcal for the first six months, and 400 kcal during the next six months, are required for a lactating mother.
• This can be met by eating, for example, an extra 6-8 slices of bread per day therefore, a lactating woman needs at least two extra meals (550 Kcal) of whatever is available at home.
• Simply eating more of the usual balanced diet should allow you to meet the higher energy demand while you breastfeed.
Nutrient requirement by breast feeding mothers
Protein
• The increase in protein requirements during lactation are minimal compared to that of energy.
• However, if the energy intake is low, protein will be used for energy production.
• The additional protein requirements during lactation can be met by consuming protein rich foods (e.g. one egg or 25 g of cheese or 175 g of milk).
• If the protein intake is not high enough, then the proportion of casein in the milk may be reduced.
• Casein protein is an important component of milk, and helps to provide the baby with calcium and phosphate
Nutrient requirement by breast feeding mothers Cont’d
• The intake of some nutrients (e.g. vitamins C, A, thiamine, riboflavin, B6, B12, iodine and selenium) is reflected in breast milk composition
• Newborn babies have very little amounts of these particular nutrients, and so they rely on breast milk for an adequate supply
• Good sources of iodine are seafood and iodised salt. • On the other hand, nutrients in breast milk such as zinc, iron, folic acid, vitamin D,
calcium, and copper are not affected by what the mother eats. • The levels of these nutrients in human milk are constant, despite variations in the
mother’s diet or body stores. • Dietary and supplemental intake of these nutrients during lactation will benefit the
mother more than the baby.• Calcium is essential during lactation because it is required for milk production. • An intake of 1000 mg calcium per day is required during the first six months after
delivery. • 500 ml of milk or milk products per day must be taken in addition to eating calcium
rich foods, such as green leafy vegetables and fish.
Unhealthy diets/practices to avoid during breastfeeding
• Minimize caffeine intake
• Be careful with drugs.
• Alcohol and smoking should be avoided, because they can make the baby feel sleepy, nervous and irritable.
• Resist the temptation of losing weight through diet or medication.
Nutritional requirements in infancy, childhood and adolescence
• The common feature of infancy, childhood and adolescence is that all these age groups are undergoing rapid growth and development.
• This in turn poses a heavy demand on their nutritional requirements
• Small children and infants do not have a well developed body nutrient store, and therefore are more vulnerable to infection
• In addition they have a larger surface area compared to their body size
• All these factors increase their basal metabolic rate (BMR), resulting in an increased requirement for nutrients.
Nutritional requirement in Infancy
• Babies under 6 months old-Baby should be given colostrum at birth (first breast milk secretion; very
nutritious)- Needs only breast milk at least eight to ten times each day.
• Babies above 6 months- Needs breast milk eight to ten times or more each day. - They need small meals, which are not bulky, three to five times a day.
As an energy source, breast milk offers significant advantages over manufactured formula milk.
• A 4 kg infant requires more than 100 kilocalories per kg (430 calories/day)• Infants of four to six months who weigh 6 kg require roughly 82 kilocalories per kg
(490 calories/day).
Nutrient requirement in children
• Energy needs remain high through the early formative years.
• Children of one to three years require approximately 83 kilocalories per kg (990 calories/day)
• Energy requirements decline thereafter and are based on weight, height, and physical activity.
Nutritional requirements among adolescents
• According to WHO, adolescence is a transition period between childhood and adulthood (10-19 years)
• Adolescents also undergo a very rapid growth during their puberty (called the pubertal growth spurt).
• During the pubertal growth spurt, they increase rapidly both in weight and height.
• Therefore, they need a nutrient intake that is proportional with their rate of growth.
• The growth rate is very high right after birth (infancy), then the growth rate slows down until the age of 12–14 years.
• At about 15–16 years (the pubertal period) there is a sharp rise in growth rate/velocity. After that, the growth rate slows down again.
Nutritional requirements among adolescents
• Adolescence period is the fastest growth period in life second only to that in infancy
• It is a time of rapid physical changes – effect on body’s nutritional needs
• It is characterized by changes in body size and shape
• Menarche in girls – well nourished girls have higher pre-menarcheal growth velocities & reach menarche earlier
• Changes in lifestyle – effects from eating habits and food choices
Eating/ Dietary pattern among Adolescence
• Tend to eat differently than in childhood
• Hardly ever sit down to have 3 meals/day
• Tend to skip meals & eat away from home
• Fast food consumption is prevalent – high in fat and sugar; low nutritional value
• Snacking is very common
Eating Disorders Among Adolescents• At high risk of eating disorders e.g anorexa nervosa, bulimia nervosa
(characterized by self-induced vomiting) and developmental obesity
• Very conscious of their appearance – shape and size; self esteem
• Food choices often influenced by social pressure to achieve cultural ideals, gain peer acceptance
• Assert independence from parents
• Weight manipulation – influenced by models, dancers, gymnasts, musicians etcleading to deviation in body weight
• Use of laxatives
• Dieting/over eating
• Rigorous physical exercise
• Psychosocial disturbance
Nutrient requirements for Adolescents
• Eat 3 meals a day
• Eating breakfast affects both cognitive and physical performance
• Reduce consumption of junk foods
• Eat nutritious snacks
• Additional energy giving foods consumption for growth and activity
• Calcium – enhances strong bones; prevent osteoporosis in adulthood
• Iron – particularly in adolescent girls (menstruation)
• Fruits and vegetables - fibre
Nutrition among the elderly
• Elderly are persons aged ≥65 years of age
• Older persons are particularly vulnerable to malnutrition
• Moreover, attempts to provide them with adequate nutrition encounter many practical problems.
• First, their nutritional requirements are not well defined
• Since both lean body mass and basal metabolic rate decline with age, an older person’s energy requirement per kilogram of body weight is also reduced
• The process of ageing also affects other nutrient needs.
• For example, while requirements for some nutrients may be reduced, some data suggest that requirements for other essential nutrients may in fact rise in later life.
Nutrition among the elderly
• As we get older our bodies have different needs, so certain nutrients become especially important for good health.
• Older adults need more calcium and vitamin D to help maintain bone health. ...
• Vitamin B12. ...
• Dietary Fibers...
• Potassium….
Causes for Malnutrition among the Elderly
• Changes in the digestive system occur in older persons, these include Xerostomia (dryness of the mouth), decrease in saliva production
• Sedentary lifestyle, such as suddenly living alone or having trouble getting around, social isolation, loneliness and neglect
• Financial burden or low income/poverty
• Some medications used by the elderly can change how food tastes, make the mouth dry, or reduce appetite and also cause poor utilization of certain nutrients
• Problems chewing or swallowing your food due to loss of dentition
• Lack of interest and difficulties in preparing and eating food.
Malnutrition among the elderly and its effect
• Dietary fat seems to be associated with cancer of the colon, pancreas and prostate.
• Degenerative diseases such as cardiovascular and cerebrovascular disease, diabetes, osteoporosis and cancer, which are among the most common diseases affecting older persons, are all diet-affected.
• Micronutrient deficiencies are often common in elderly people due to a number of factors such as their reduced food intake and a lack of variety in the foods they eat.
• Another factor is the price of foods rich in micronutrients, which further discourages their consumption.
• Compounding this situation is the fact that the older people often suffer from decreased immune function, which contributes to this group’s increased
Nutrition Requirement for the Elderly
• Some daily requirements for elderly people differ from those of younger adults
• For example, in order to reduce the risk for age related bone loss and fracture, the requirement for vitamin D is increased from 200 IU/day to 400IU/day in individuals of 51–70 years of age and to 600 IU/day for those over 70 years of age
• Suggested iron intakes reduce however from 18 mg per day in women aged 19–50 to 8 mg/day after age 50, due to better iron conservation and decreased losses in postmenopausal women compared with younger women.
• Some elderly people demonstrate selenium deficiency, a mineral important for immune function
• Impaired immune function affects susceptibility to infections and tumours(malignancies)
• Vitamin B6 helps to boost selenium levels, so a higher intake for people aged 51–70 is recommended.
Nutrition Requirement for the Elderly Cont’dElderly people should eat the following foods that gives lots of nutrients without a lot of extra
calories such as
• Fruits and vegetables (choose different types with bright colors)
• Whole grains, like oatmeal, whole-wheat bread, and brown rice
• Fat-free or low-fat milk and cheese, or soy or rice milk that has added vitamin D and calcium
• Seafood, lean meats, poultry, and eggs
• Beans, nuts, and seeds
Elderly should;
• Avoid empty calories. These are foods with lots of calories but few nutrients, such as chips, candy, baked goods, soda, and alcohol.
• Pick foods that are low in cholesterol and fat
• Drinking enough water to prevent dehydration. Some people lose their sense of thirst as they age. And certain medicines might make it even more important to have plenty of fluids.
• Regular exercises or physical activity.
References
• Principles and practices of Nutrition for Public Health Practitioners; Prof Ojofeitimi E.O.; Non Such house, Ibadan, 2014, page 129-151
• Nutritional Issues In Adolescence; Prof D.A. Adelekan; Institute of Public Health, Obafemi Awolowo University, Ile - Ife
• http://www.fao.org/ag/agn/nutrition/ICN/icncare.htm