Nutritional Requirements for healt4.pptx

It is ppt on nutritional requirements for health and nutrition

1. NUTRITIONALREQUIREMENTS 1 Sintayehu H

2. LEARNING OBJECTIVES Rationale of knowing nutritional requirements Describe the principle behind the estimation of nutritional requirement for healthy populations Know the different factors that affect nutritional requirement and the need for intervention Explain nutritional requirements for the different spans of life ( critical periods in the life cycle ) Sintayehu H 2

3. What is nutritional requirement? Defined as the lowest continuing intake level of a nutrient, for a specified indicator of adequacy, that will maintain a defined level of nutrition in an individual 3 Sintayehu H

4. Dietary reference intakes (values) values that are quantitative estimates of nutrient intake to be used for planning and assessing diets for healthy people Include: Estimated Average Requirement (EAR) Reference Nutrient intake ( RNI) or Recommended Dietary Allowance (RDA) Lower Reference Nutrient Intake ( LRNI) Adequate Intake (AI) Tolerable Upper Intake Level (UL) 4 Sintayehu H

5. D ietary reference intakes (values)… Estimated Average Requirement (EAR ): the average daily amount of a nutrient that will maintain a specific biochemical or physiological function in half the healthy people of a given age and gender group. Reference nutrient intake ( RNI) or Recommended dietary allowance: Is the daily intake, which meets the nutrient requirements of almost all (97.5 percent) apparently healthy individuals in an age and sex-specific population group 5 Sintayehu H

6. D ietary reference intakes (values)… Lower Reference Nutrient Intake (LRNI): Is the amount of a nutrient that is enough for only the small number of people who have low requirements . The majority of the population need more 6 Sintayehu H

7. The distribution of nutrient requirement within a population Sintayehu H 7

8. D ietary reference intakes (values)… Adequate intake ( Safe intake): the average daily amount of a nutrient that appears sufficient to maintain a specified criterion; a value used as a guide for nutrient intake when an RDA cannot be determined . These values are based on observed or experimentally determined estimates of nutrient intake by a group (s) of healthy individuals . For some nutrients, there is insufficient scientific evide nce to determine an Estimated Average Requirement (which is needed to set an RDA). 8 Sintayehu H

9. A dequate intake ( safe intake ): Upper tolerable nutrient intake level : Are the maximum intake from food that is unlikely to pose risk of adverse health effects from excess in almost all (97.5 percent) apparently healthy individuals in an age and sex-specific population group 9 Sintayehu H

10. Distribution of requirements to prevent deficiency and toxicity 10 Adequate intake UL RNI Sintayehu H

11. W hat is energy requirement “… the average dietary energy intake that maintains energy balance and good health in a person of a given age, gender, weight, height, and level of physical activity represents the average dietary energy intake ( kcalories per day) that will maintain energy balance in a person who has a healthy body weight and level of physical activity. • 11 ) Sintayehu H

12. What is energy requirement… and development of children, for the deposition of tissues during pregnancy, and for the secretion of milk during lactation consistent with the good health of mother and child.” WHO, FAO, UNU Sintayehu H 12

13. Components of energy requirement Basal metabolism Need to maintain vital functions Depends on age, sex, body composition , etc Metabolic response to food Needed for digestion , transport and metabolism of nutrients Physical activity 13 Sintayehu H

14. Components of energy requirement Most variable component of the energy requirement Growth For forming new tissues ,and energy deposited in those tissues Pregnancy :Production of foetal and maternal tissues Lactation :For milk production( secretion) and energy stored in the milk Sintayehu H 14

15. P rotein requirement The lowest level of dietary protein intake that will balance the losses of nitrogen from the body, and thus maintain the body protein mass, in persons at energy balance with modest levels of physical activity, plus, in children or in pregnant or lactating women, the needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health 15 Sintayehu H

16. R ecommendations regarding infant and young child feeding Infants should be fed breast-milk if at all possible . The fatty acid composition of infant formulas should correspond to the amount and proportion of fatty acids contained in breast-milk. During weaning and at least until two years of age, a child's diet should contain 30-40 percent of energy from fat and provide similar levels of essential fatty acids as are found in breast-milk. 16 Sintayehu H

17. R equirement for fat Intakes of saturated fatty acids should provide no more than 10 percent of energy . Desirable intakes of linoleic acid should provide between 4 and 10 percent of energy. Reasonable restriction of dietary cholesterol (less than 300 mg/day) is advised. Total fat should average and n ot exceed 33% of total dietary energy 17 Sintayehu H

18. F actors that may influence requirement estimates of nutrients 1 . Physiological state Life-stages: - Pregnancy; - lactation; - menopause - infancy - adolescence 2. Health status: - Sick vs healthy Sintayehu H 18

19. F actors that may influence requirement estimates of nutrients … 3. Lifestyle Sedentary vs active : energy and those involved in release of energy from source of energy (B-1, B-2, niacin ) Athletes: Fe requirements Smokers: vitamin C requirements increased: increased turnover Vegetarians: poor bioavailability of Fe & Zn 19 Sintayehu H

20. F actors that may influence requirement estimates of nutrients 4. Environment Levels of UV light higher altitude: decreased UV light & less vit D synthesized via skin. Instead need more from diet Extremes in ambient temperature affect nutrient losses via sweat Exposure to high altitude 5 . Biological & genetic factors Sintayehu H 20

21. N utritional requirements for the different spans of life Sintayehu H 21

22. N utrition during pregnancy Pregnancy is considered physiological if mothers: D eliver a healthy baby with appropriate weight at birth. I n healthy, well nourished communities the incidence of LBW is less than 6% Produce enough milk ( >750g in the first 6 months) of good quality 70 kcal and 1.2g protein per 100g which is sufficient for the growth of exclusively breast fed infants during the first 6 months Mothers’ nutritional status is not depleted . 22 Sintayehu H

23. N utrition during pregnancy… A well nourished woman before pregnancy gains about 20% of her pre-pregnancy weight during pregnancy Weight gain during pregnancy follows a different curve than fetal growth First two trimesters are anabolic ( growth of breasts, uterus/placenta, production of amniotic fluid, increased in blood volume and deposition of body fat). 23 Sintayehu H

24. Nutrition during pregnancy… This time the fetal growth is slow However, a tripling of weight between 28 and 40 weeks from about 1000g to 3200-3600 Mother subsidizes fetal growth ( uses fat stores) if her intake is not sufficient -she will loose weight The last trimester is the most vulnerable period for the fetus in terms of birth weight Sintayehu H 24

25. P hysiological changes during pregnancy Increase in blood volume increased need for those nutrients most important for generating blood : protein, iron, folic acid and vitamin B6. If a woman has a normal BMI , is not iron deficient at the time of conception and has sufficient dietary intake of essential nutrients during pregnancy, she will make this adjustment with little problem, otherwise anemia may result. Sintayehu H 25

26. P hysiological changes during pregnancy 2. Changes in the gastrointestinal tract Increased progesterone production leads to decreased tone and motility of the smooth muscle of the GIT. food moves more slowly which leads to constipation. In early pregnancy, women also experience nausea and vomiting. Excessive vomiting can become a serious problem leading to electrolyte imbalance and dehydration . 26 Sintayehu H

27. P hysiological changes during pregnacy … 3 . Changes in renal function Blood flow through the kidneys and the GFR are increased Normally, most of the glucose, amino acids and water soluble vitamins that are present in the glomerular filtrate are reabsorbed in the tubules. However, during Px , substantial quantities of these nutrients are excreted in the urine suggesting that the increased glomerular filtration rate is not compensated by an increase in tubular reabsorption. Hence the need to ensure adequate intakes of calories, protein and water soluble vitamins is inevitable . 27 Sintayehu H

28. P hysiological changes during pregnancy … 5 . Changes in weight The woman gains wt as both her tissues and the foetal tissues increase and develop. Additional nutrients are required to build tissues and maintain them. Increased amounts of energy , protein , folate , vitamins C , B6 and iron are required. Effects of underweight during pre-pregnanc y . 28 Sintayehu H

29. Physiological changes during pregnancy … This is the most potent single predictor of infant’s future health and survival. A LBW baby is 40 times more likely to die in the first year of life . An under wt woman has a high risk of having a LBW infant , especially if she is unable to gain sufficient wt during Px 29 Sintayehu H

30. W eight gain during pregnancy Recommended wt gains based on pre Px weight Sintayehu H 30 Pre pregnancy weight Recommended weight gain (kg) First trimester Total wt gain Underweight (BMI <18.5) 2.3 kg 12.5-18.0 kg Healthy weight (BMI 18.5-24.9) 1.6 kg 11.5-16.0 kg Overweight (BMI 25-29.9) 0.9 kg 7.0-11.5 kg Obese (BMI ≥ 30) 0.9 kg 6.8kg minimum

31. W eight gain during pregnancy… U nderwt and normal wt woman should gain 0.5kg/wk after the 1 st trimester O verwt and obese woman should gain 0.3kg/wk after the 1 st trimester. W eight gain for a pregnant adolescent must be adequate enough to accommodate her own growth and that of her foetus . W omen who are carrying twins must gain more weight. A sudden large weight gain is a danger signal, because it may indicate the onset of preeclampsia Sintayehu H 31

32. N utrient needs during pregnancy Energy vary as the pregnancy progresses. no additional energy in the first trimester additional 340 kcal daily during the second trimester and extra 450 kcal each day during the third trimester. 32 Sintayehu H

33. N utrient needs during pregnancy… There is a relationship between pre-pregnancy body weight and weight gain during pregnancy and mortality during pregnancy For underweight women, perinatal mortality rates decrease as the women experiences greater weight gains 33 Sintayehu H

34. N utrient needs during pregnancy ... Carbohydrate Ample carbohydrate, ideally, 135-175g per day is necessary to fuel the foetal brain and spare the protein needed for foetal growth . 34 Sintayehu H

35. N utrient needs during pregnancy... Protein The protein RDA for Px = non pregnant+25g per day Hence protein rich food of high biological value from animal foods should be included in the diet during Px. Vegetarian pregnant women should include generous servings of plant protein foods . 35 Sintayehu H

36. N utrient needs during pregnancy... 4,. Fat Essential fatty acids are important to the growth and development of the foetus. The brain contains a substantial amount of lipid material and depends heavily on long chain omega 3 and omega 6 fatty acids for its growth, function and structure. 36 Sintayehu H

37. N utrient needs during pregnancy... Folate and vitamin B 12 N eeded in large amounts during Px due to their significant role in cell reproduction . Folate plays an important role in preventing neural tube defects in the early weeks of pregnancy. folate rich sources:- liver, lentils, chickpeas, asparagus, spinach, avocado, orange juice and beets . 37 Sintayehu H

38. N utrient needs during pregnancy ... Sintayehu H 38

39. N utrient needs during pregnancy... Folate and vitamin B 12 ... women who are capable of becoming pregnant should obtain 400ug of folic acid from supplements, fortified foods or both in addition to eating folate rich foods . 2.6ug per day of vitamin B12 need for pregnancy . Those who exclude all animal products from the diet need vitamin B12 fortified foods or supplements. 39 Sintayehu H

40. N utrient needs during pregnancy ... Vitamin D and Calcium calcium, phosphorus and magnesium are in great demand during pregnancy. Intestinal absorption of calcium doubles in early in pregnancy, when the mother’s bones store the mineral. Recommendations to ensure an adequate calcium intake during pregnancy are aimed at conserving the mother’s bone mass while supplying foetal needs 40 Sintayehu H

41. N utrient needs during pregnancy ... Vitamin D and Calcium... For women whose pre pregnancy calcium intakes are below recommendations and for women who are less than 25 years of age, increased intakes of milk, cheese, yoghurt and other calcium rich foods are required. Women who exclude milk products need calcium and vitamin D fortified foods such as soy milk. 41 Sintayehu H

42. N utrient needs during pregnancy.. Vitamin D and Calcium... Three cups of milk per day will supply 900mg of calcium. Calcium AI during pregnancy 14-18yrs – 1300mg/day 19-50yrs - 1000mg/day 42 Sintayehu H

43. Nutrient needs during pregnancy Phosphorus RDA during pregnancy 14-18yrs – 1250mg/day 19-50yrs - 700mg/day Magnesium RDA during pregnancy 14-18yrs – 400mg/day 19-30yrs - 350mg/day 31-50yrs - 360mg/day 43 Sintayehu H

44. N utrient needs during pregnancy... Fluoride Fluoride is needed for mineralisation of the foetus’s teeth and bone dev’t. Fluoride supplements are not recommended for pregnant women who drink fluoridated water. For women who live in communities without fluoridated water, a fluoride supplement may protect foetal teeth. AI = 3.0mg/day. 44 Sintayehu H

45. N utrient needs during pregnancy ... Iron During Px, menstruation ceases and absorption of iron increases up to threefold due to a rise in the blood’s iron absorbing and iron carrying protein transferrin . But still, iron needs are so high that stores decline . The developing foetus draws heavily on the mother’s Fe stores to last through the first four to six months of life after birth. 45 Sintayehu H

46. N utrient needs during pregnancy ... Iron... Women who enter Px with IDA have a greater risk of delivering LBW or preterm infants . For all pregnant women, an iron supplement of 30mg per day is recommended during the second and third trimesters of pregnancy. RDA = 27mg per day 46 Sintayehu H

47. N utrient needs during pregnancy ... Zinc required for DNA and RNA synthesis and thus for protein synthesis. zinc absorption increases when zinc intakes are low. . 47 Sintayehu H

48. N utrient needs during pregnancy... Zinc ... Women taking Fe supplements > 30mg per day may need Zn supplementation b/se large doses of iron can interfere with the body’s absorption and use of zinc . The RDA during pregnancy is as follows: ≤ 18 years – 12mg/day 19 – 50 years – 11mg/day 48 Sintayehu H

49. N utrient requirements of lactating mother... Water The nursing mother is advised to drink plenty of liquids each day (about 13 cups) to protect herself from dehydration. To help themselves remember to drink enough liquid, many women make a habit of drinking a glass of milk, juice or water each time the infant nurses as well as at mealtimes . Sintayehu H 49

50. C ontraindications to breastfeeding Alcohol E asily enters breast milk and can adversely affect the production, volume, composition and ejection of breast milk as well as overwhelm an infant’s immature alcohol degrading system. C oncentration in breast milk peaks within one hour after ingestion of even moderate amounts Sintayehu H 50

51. C ontraindications to breastfeeding... It may alter the taste of the milk to the disapproval of the nursing infant, who may in protest drink less milk than normal. Caffeine As during pregnancy, caffeine consumption should be moderate. Sintayehu H 51

52. C ontraindications to breastfeeding Cigarette smoke Research shows that lactating women who smoke produce less milk and milk with a lower fat content than mothers who do not smoke. → infant gains less weight Infants exposed to nicotine and chemicals via breast milk and to direct smoke, experience a wide range of problems such as poor growth , hearing impairment , vomiting , breathing difficulties and even unexplained death . Sintayehu H 52

53. Contra indications to breastfeeding Medications and Illicit drugs If a nursing mother must take medication that is secreted in breast milk and is known to affect the infant, then breastfeeding must be put off for the duration of treatment. Some drugs are not at all compatible with breast feeding, both because they are secreted into the milk and can harm the infant or because they suppress lactation. Sintayehu H 53

54. C ontra indications to breastfeeding... Medications and Illicit drugs ... Breast feeding is also contraindicated if the mother uses illicit drugs. Regarding oral contraceptives, those which combine estrogens and progesterone suppress milk output, lower the nitrogen content of the milk and shorten the duration of breastfeeding. Hence the progesterone only pills which do not have an effect on breastfeeding are considered appropriate for lactating women. ) Sintayehu H 54

55. C ontraindications to breastfeeding ... Maternal Illness If a woman has an ordinary cold, she can go on nursing without worry. If a woman has active untreated tuberculosis or is receiving therapeutic radioactive isotopes, breastfeeding is contraindicated. Sintayehu H 55

56. 56 Sintayehu H

57. Nutrition during infancy 57 Sintayehu H

58. Nutrition during infancy... An infant grows faster during the first year of life than ever in the life cycle. Length increases by about 40% and weight is tripled Head circumference is also increased by about 30% birth wt doubles by about 4-6 months of age and triples by the age of one year. 58 Sintayehu H

59. NUTRITION DURING INFANCY... BMR of the infant is very high, ~2X that of an adult. The stomach capacity increases 10 to 20 ml at birth to 200 ml by 1 year, enabling infants to consume more food The rapid growth and metabolism of the infant demands an ample supply of all the nutrients. 59 Sintayehu H

60. NUTRITION DURING INFANCY... One of the most important nutrients for infants, as for everyone is water. Breast milk or infant formula normally provides enough water to replace fluid losses in a healthy infant. Even in hot, dry climates, neither breastfed nor formula fed infants need supplemental water . 60 Sintayehu H

61. BREAST MILK AND ITS ADVANTAGES Breast milk excels as a source of nutrients for the young infant. With the possible exception of vitamin D, breast milk provides all the nutrients a healthy infant needs for the first six months of life. It provides many other health benefits as well . 61 Sintayehu H

62. B reast milk and its advantages ... Energy nutrients 39% carbohydrate, 55% fat and 6% protein. This proportion is different from that recommended for adults (53%Carb, 26%Fat, 21%Prot). The carbohydrate in breast milk is lactose. In addition to being easily digested, lactose enhances calcium absorption. . Sintayehu H 62

63. B reast milk and its advantages... Energy nutrients ... Also the infants fed formulas fortified with DHA and arachidonic acid had better visual function at one year of age than those who were fed standard formulas. The protein in breast milk is largely alpha- lactalbumin, a protein the human infant can easily digest. 63 Sintayehu H

64. breast milk and its advantages... Energy nutrients ... Another BM protein, lactoferrin is an iron gathering compound that helps absorb iron into the infant’s blood stream. keeps intestinal bacteria from getting enough iron to grow out of control and also works directly to kill some bacteria . 64 Sintayehu H

65. Breast milk and its advantages... Vitamins and Minerals The concentration of vitamin D in breast milk is low and vitamin D deficiency impairs bone mineralization. Even vitamin C, for which cow’s milk is a poor source, is supplied generously. 65 Sintayehu H

66. Breast milk and its advantages... Vitamins and Minerals... With respect to minerals, the calcium content of breast milk is ideal for infant bone growth and the calcium is well absorbed. The limited amount of iron in breast milk is highly absorbable and zinc is also better absorbed than from cow’s milk due to the presence of a zinc binding protein. 66 Sintayehu H

67. B reast milk and its advantages... Immunological protection A gainst infection ( antiviral, antibacterial agents and other infection inhibitors ). During the first two or three days of lactation, the breasts produce colostrum Colostrum contains maternal immune factors that inactivate harmful bacteria within the digestive tract . 67 Sintayehu H

68. B reast milk and its advantages... Immunological protection... Later, breast milk also delivers immune factors, although not as many as colostrum. bifidus factors and lactoferrin . The bifidus factor favours the growth of the friendly bacterium Lactobacillus bifidus in the intestinal tract. These bacteria prevent other less desirable intestinal inhabitants from flourishing. 68 Sintayehu H

69. NUTRITION DURING PRESCHOOL, SCHOOL GOING AGE & ADOLESCENTS 69 Sintayehu H

70. Learning objectives By the end of this session the students will be able to Describe the nutritional needs of preschool, school goin children & adolescents Explain hunger & school performance Distinguish about children food choice 70 Sintayehu H

71. NUTRIENT NEEDS ... Energy... those adhering to a vegan diet, may have difficulty in meeting their energy needs. Grains, vegetables and fruits provide plenty of fibre, adding bulk, but may provide too few kilocalories to support growth. Soy products, other legumes and nut or seed butters offer more concentrated sources of energy to support optimal growth and development. Sintayehu H 71

72. NUTRIENT NEEDS ... Nutrients Ideally, children accumulate stores of nutrients before adolescence. Then when they take off on the adolescent growth spurt and their nutrient intakes cannot keep pace with the demands of rapid growth, they can draw on the nutrient stores accumulated earlier. This is especially true of calcium 72 Sintayehu H

73. MALNUTRITION IN CHILDREN ... Hunger and school performance Children who eat nutritious breakfasts function better than their peers who do not. A nutritious breakfast is a central feature of a diet that meets the needs of children and supports their healthy growth and development. Sintayehu H 73

74. MALNUTRITION IN CHILDREN ... When a child consistently skips breakfast or is allowed to choose sugary foods in place of nourishing ones, the child will fail to get enough of several nutrients . 74 Sintayehu H

75. MALNUTRITION IN CHILDREN ... Hunger and school performance... Nutrients missed from a skipped breakfast will not be made up at lunch and dinner but will be left out completely that day. Children who do not eat breakfast are more likely to perform poorly in tasks requiring concentration, have shorter attention spans, score lower on tests and . 75 Sintayehu H

76. MALNUTRITION IN CHILDREN ... Iron deficiency and behaviour Iron deficiency has well known and widespread effects on children’s behaviour and intellectual performance. Iron works as part of large molecules to release energy within cells and plays key roles in many molecules of the brain and nervous system. A lack of iron not only causes an energy crisis, but also directly affects behaviour, mood, attention span and learning ability. Sintayehu H

77. MALNUTRITION IN CHILDREN ... Iron deficiency and behaviour... Furthermore, children who had IDA as infants continue to perform poorly as they grow older, even if their iron status improves. The long term damaging effects on mental development make prevention of iron deficiency during infancy and early childhood a high priority. 77 Sintayehu H

78. MALNUTRITION IN CHILDREN ... Preventing Iron deficiency To avert iron deficiency, children’s foods must deliver 7 to 10 mg of iron per day To achieve this goal, milk intakes must be limited after infancy because milk is a poor source of iron. iron rich foods such as lean meats, fish, poultry, and legumes. 78 Sintayehu H

79. NUTRITION DURING ADOLESCENCE Sintayehu H 79

80. NUTRIENT NEEDS OF ADOLESCENTS Iron The need for iron increases for both females and males for different reasons. Iron needs increase for females as they start to menstruate and for males as their lean body mass develops. Hence the RDA increases at age fourteen for both males and females . Sintayehu H 80

81. NUTRIENT NEEDS OF ADOLESCENTS ... Iron... the RDA for iron remains high into late adulthood for females. For males, the RDA returns to preadolescent values in early adulthood. Sintayehu H 81

82. NUTRIENT NEEDS OF ADOLESCENTS... Calcium the requirement of calcium reaches its peak during these years. increasing milk products in the diet to meet calcium recommendations greatly increases bone density. In addition to dietary calcium, bones grow stronger with physical activity. Sintayehu H 82

83. Intergenerational Effect of Malnutrition Sintayehu H 83

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