Nutrition care for special groups; Children, elderly and

pregnant women

Dr. R.O. Akande

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

Spectrum of physical characteristics seen among adolescents with eating disorders.

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