Nutritional Requirements During Pregnancy: Nutritional Requirements During Pregnancy Related to: Perinatal Nutrition Maternal Developmental Stage Fetal Growth and Development Growth of Maternal Supporting Tissues Expansion of Maternal Blood Volume


Impact of Perinatal Nutrition on Fetal Development: Impact of Perinatal Nutrition on Fetal Development


Change in Requirements of Selected Nutrients During Pregnancy: Change in Requirements of Selected Nutrients During Pregnancy Most of increased need occurs in 2nd and 3rd trimesters Nutrient requirements are increased disproportionately to energy requirements Reserves are particularly important during 1st trimester or when intakes may not be consistent Larger increases in requirements may be needed for adolescents or undernourished women


Protein and Energy Requirements: Protein and Energy Requirements Energy Sustains metabolic activity Supports protein synthesis Reflects fat and carbohydrate intakes after increased protein requirement is included Total cost= 55,000 kcal = 28 wks x 7 d +300 kcal/day Protein Expansion of maternal blood volume Growth of breast and uterine tissues Growth of fetal tissues Increase from 0.8 g/kg body weight to 1.1 g/kg +10 g/day


Equivalents of 300 kcal Energy and 10 g Protein : Equivalents of 300 kcal Energy and 10 g Protein 48 g protein 360 kcal 2 g protein 245 kcal 7 g protein 90 kcal 30 g protein 310 kcal 1 oz meat = 8 g 1 svg dairy = 7 g 1 svg grain = 2 g


Roles for Increased Maternal Nutrient Requirements - 1 of 2: Roles for Increased Maternal Nutrient Requirements - 1 of 2 Cell replication DNA synthesis Zinc, Folate (& B12), iron Protein synthesis Protein & B6 Fetal skeletal development Mineral formation Calcium & phosphorus Calcium metabolism Vitamin D & magnesium Matrix formation iron, copper, vitamin C, vitamin A, vitamin K, protein


Roles for Increased Maternal Nutrient Requirements- 2 of 2: Roles for Increased Maternal Nutrient Requirements- 2 of 2 Energy metabolism Electron transport Iron, copper ATP synthesis & utilization Magnesium, thiamin, riboflavin, niacin Oxygen transport Hemoglobin synthesis Iron, copper, B6 Erythropoiesis Folate (& B12), iron Cell replication nutrients


Nutritional Requirements For Lactation: Nutritional Requirements For Lactation Related to: Biosynthesis of Human Milk Human Milk Nutrient Composition Infant Developmental Needs


Nutrient Requirements for Lactation: Nutrient Requirements for Lactation


Energy Cost of Lactation: Energy Cost of Lactation Milk Volume Produced = 750 mL/day = 600 mL/day (6-12 mos) Energy Content = 75 kcal/100 mL = 562 kcal/day = 450 kcal/day Energy Intake Equivalent = 562/85% = 661 kcal/day = 450/85% = 529 kcal/day Recommended allowance = + 500 kcal/day Energy Deficit of 150 kcal/day x 7 = 1050 kcal/week = 0.3 lb body fat (3500 kcal/lb fat )


Effect of Maternal Diet Composition on Nutrient Content of Human Milk : Effect of Maternal Diet Composition on Nutrient Content of Human Milk


Human Milk Fat Composition: Omega-6 Fatty Acids Types Linoleic acid (18:2) Arachidonic acid (20:4) Functional Roles Eicosanoid synthesis Satisfy essential fatty acid requirements Sources Vegetable seed oils (LA) Meat (AA) Human Milk Fat Composition Omega 3 Fatty Acids Types Linolenic acid (18:3) Eicosapentanoic acid (20:5) Docosahexanoic acid (22:6) Functional Roles Eicosanoid synthesis Nerve & retina activity Sources Flaxseed, nuts, soybean (LNA) Fish (EPA/DHA) Alga (DHA)


Infant Nutritional Requirements: Infant Nutritional Requirements Related to: High Growth Velocity Neurological Development Vulnerability to Dehydration Developmental Immaturity Digestive tract Renal function


Average Weight and HeightBirth to 36 months: Average Weight and Height Birth to 36 months


Energy Requirements By AgeLight to Moderate Activity: Energy Requirements By Age Light to Moderate Activity * Average for males and females


Protein Requirements by Age: Protein Requirements by Age * Average for males and females


Primary Roles of Nutrients During Infancy: 0-12 Months: Primary Roles of Nutrients During Infancy: 0-12 Months Growth Cell replication DNA & protein synthesis Skeletal development Mineral & matrix formation Calcium metabolism Maintenance of Fluid Balance High metabolic rate High surface area/volume ratio Brain/nervous system development Structural Components Long chain PUFA, B12, vitamin E, galactose Cognitive development Iron DHA* *Requirement not established


Relative Size of Body Water Compartments: Infants and Adults: Relative Size of Body Water Compartments: Infants and Adults Percentage of Body Weight


Developmental Factors Affecting Infant Nutrition: Developmental Factors Affecting Infant Nutrition Digestive Tract Low lipase levels and bile salt concentration Low disaccharidase activity except lactase Low saliva production Low pancreatic amylase activity Small stomach volume (10-20 mL) Low gastric acidity Renal System Low urine concentrating capacity (700 mOsm/L) Immune system Intestinal epithelium permeable to macromolecules


Reconciling Developmental Barriers to Infant Feeding: Reconciling Developmental Barriers to Infant Feeding


Comparison of Human Milk to Cow’s Milk and Soy Formulas : Comparison of Human Milk to Cow’s Milk and Soy Formulas *Unique to human milk


Weights of Bottle-Fed vs Breast-Fed Infants: Birth to 9 Months: Weights of Bottle-Fed vs Breast-Fed Infants: Birth to 9 Months


Preterm and SGA* Infants: High Nutritional Risk : Preterm and SGA* Infants: High Nutritional Risk Physiologically immature Metabolic abnormalities Fluid and electrolyte imbalances, acidosis hypo- or hyperglycemia Illness present Respiratory distress, sepsis, pneumonia, meningitis Poor nutrient stores Fat, glycogen, micronutrients High nutrient requirements Intravenous (parenteral) feeding often necessary *Small for gestational age


Solid Food Introduction: Solid Food Introduction Nutritional Indicators Insufficient nutrient density of milk to meet increasing needs Physiological Indicators Intestinal epithelial cell closure prevents entry of whole proteins Digestive enzyme maturation Functioning at adult levels Presence of disaccharidases Saliva, gastric acid levels increase Bile concentration increases Urine concentrating ability increased Deciduous teeth erupt Extrusion reflex disappears Milk ~ 1 kcal/g Cereals ~ 2 kcal/g Meat ~ 2-3 kcal/g


Childhood Nutritional Requirements: Childhood Nutritional Requirements Related to: Linear growth and weight gain Cognitive development Exposure to childhood diseases


Childhood Nutrient Requirements: Childhood Nutrient Requirements Linear growth Cell replication Skeletal formation and development Brain development C20 and C22 fatty acids, B12, vitamin E Cognitive development Iron Immune function Iron, vitamin A, vitamin C, protein, zinc, B6 Cell replication


Average Weight Gain Girls and Boys 1-11 years: Average Weight Gain Girls and Boys 1-11 years


Nutrition and Brain Development: Nutrition and Brain Development Brain growth EFA are limiting nutrients LA=3% kcal and LNA = 0.5% kcal Brain and nerve structure Vitamin B12 in myelinization 60% lipid composition Neural membrane function C22 in synaptic membranes (signal transduction) C20 in Ca++ transport (signal activation & reception) C20 & C22 incorporated selectively


Nutritional Risks in Childhood : Nutritional Risks in Childhood


Change in Percentage of Overweight Children* Ages 6-11 (1963-1995): Change in Percentage of Overweight Children* Ages 6-11 (1963-1995) *Above the 95th percentile using 1960 norms- Source: CDCP


Adolescent Nutrition (11-18 yrs): Adolescent Nutrition (11-18 yrs) Related to: Rapid linear growth Addition of 45% of adult skeletal mass 20% of adult height and 50% adult weight Sexual maturation Changes in body composition


Energy Requirements During Adolescence: Energy Requirements During Adolescence


Protein Requirements by Age: Protein Requirements by Age


Average Weight Gain Girls and Boys 11-17 years: Average Weight Gain Girls and Boys 11-17 years


Adolescent Nutrient Requirements: Adolescent Nutrient Requirements Linear Growth Cell replication Skeletal mass and density Sexual maturation Gender differences in body composition Gender differences in reproductive development


Body Composition Changesin Girls and Boys Ages 8 to 18 : Body Composition Changes in Girls and Boys Ages 8 to 18


Nutritional Risks of Adolescents: Nutritional Risks of Adolescents


Change in Percentage of Overweight Adolescents* Age 11-17 (1963-1995): Change in Percentage of Overweight Adolescents* Age 11-17 (1963-1995) *Above the 95th percentile using 1960 norms- Source: CDCP


Adult Nutritional Requirements18-51 years: Adult Nutritional Requirements 18-51 years Related to: Cessation of linear growth Increasing sedentary lifestyle Establishment of chronic disease risk factors Adjustment to chronic stress


Nutrition Risks of Adults: Nutrition Risks of Adults Macronutrient excesses and micronutrient deficiencies Diminished activity and high fat intake Stress-related effects on immune function


Relationship of Disease Risk Factors to Nutrient Intakes: Relationship of Disease Risk Factors to Nutrient Intakes


Mean Change in Weight by Age U.S. Adults (1971-75 to 1984): Mean Change in Weight by Age U.S. Adults (1971-75 to 1984)


Adult Nutritional Requirements51 yrs and older: Adult Nutritional Requirements 51 yrs and older Related to: Physical, emotional, and physiological changes affecting appetite and ability to eat Medications that may interact with nutrients Diseases with specific nutritional requirements


Percentage of Malnutrition in Long-term Health Facilities: Percentage of Malnutrition in Long-term Health Facilities Contributing Factors Sensory losses Sarcopenia Decline in digestive/absorptive efficiency Stress Disease Medications


Age-Related Changes in Nutrient Requirements: Age-Related Changes in Nutrient Requirements


Comparison of AdultNutrient Requirements: Comparison of Adult Nutrient Requirements