Nutrition Module 6

to have a healthy baby

• moms health
• social support mom has
• environmental factors
• nutrition
• medical care

mom should be aware that care should begin prior to conception

• make sure that mom is taking in adequate vitamin and minerals prior to conception and throughout preg
• mom should have a healthy body weight
• mom should control existing health conditions (diabetes, hypertention etc)
• avoid teratogens (compounds that can cause birth defects)
• look at special groups (teen moms at high risk and need additional education and support)

• one would expect a low mortality rate for both mom and baby.
• Unfortunately, despite the availability of health care, either through a private company or programs that are available for low income and needy moms, the rate of infant mortality is among the highest in the world
• teen moms even at more risk bc they are more likely not to seek care during their pregnancy

40 weeks, divided into 3 trimesters

• at conception when egg and sperm unite, zygote forms
• over the next 14 days, cells divide rapidly. this is the Blastogenic stage
• By day 14 an embryo is formed
• weeks 2-8 are the embryonic stage
• embryonic stage is where the organ system develops

14 days after conception, zygote cells are rapidly dividing

• weeks 2-8 of preg
• this is where organ system develops
• week 5: heart begins to beat
• week 8: the embryo is known as a Fetus

week 9- birth- different periods of growth occur

week 9- end of preg

• look at all of the things that happen just days to weeks after conception- zygote to embryo to fetus 
• many times, mom does not even know she is pregnant until 2nd month of pregnancy, so need to be prepared nutritionally

• "I'm eating for 2" doesn't mean quantity, esp during first part of pregnancy
• need to eat the quality for 2

• a developmental period
• hands, feet, arms and legs develop
• your baby begins to look like a baby

mom: breasts enlarge, more fat tissue (to help with breastfeeding) increased blood volume, increased absoroption of vitamins and minerals

• a period of growth
• fetus doubles in length and increases in weight to 7-9lbs at delivery

• provides oxygen and nutrients from the mothers blood to the fetus 
• transfers fetal waste to mom for excretion
• the amount of nutrients being transported will help determine the weight of the baby and length of gestation

an infant born after 37 weeks, which is the period of intrauterine growth, and weighs more than 5.5 pounds has a chance at more positive outcomes, less chance of medical issues, and greater quality of life

infants weighing less than 5.5lbs at birth

those born prior to 37 weeks

a baby who is born full term but less than 5.5 pounds

low birth weight, preterm, and small for gestational age infants are more likely to have increased medical conditions and delayed growth in early months of life

• an adequate diet
• education for mom
• proper prenatal care

• calories
• adequate weight gain
• increased protein and carb needs
• increased vitamin needs
• increased mineral needs
• fitness and avoiding teratogens

• during first trimester, increased calories are required to support growth and development of fetus
• eating for two: calorie needs don't double, but the need for certain nutrients increase ~50%
• during second and third trimester, calorie needs increase ~20%
• make sure youre gaining weight and eating a wide variety

• a healthy weight gain of 25-35lbs during pregnancy- good predictor of a healthy preg
• weight gain should be monitored over course of preg
• norm: 2-4lbs Tri1 followed by 1lb weekly during the rest of the preg
• the chance for complications increase when preg mom is overwieght or obese or if baby is larger than normal, so monitor calories
• weight gain for overweight/obese moms is usually less than 25lbs while a teen or someone underweight may gain more
• everyone has their own history and needs so consult a doc for diet advice and weight advice

• most women eat enough protein
• preg moms require 25g more than the recommended daily amount, but this is easily met without dietary changes
• adequate carbs and protein are required to meet energy needs and for growth
• if inadequate carbs, body will use fat for energy and ketones will be produced

• inhibit brain development of fetus
• so eat carbs to avoid fat breakdown and protein for muscle maitenance and repair

• vitamin needs increase, esp B vitamins
• b vitamin increased need easily met through a normal diet, EXCEPT folate
• plan your menu to ensure adequate intake esp of folate

• needed for cell development and DNA synthesis, and RBC development
• without adequate folate the preg mom may get anemia
• also inadequate folate prior to conception and early in preg is correlated to higher risk of neural tube defects
• in some instance, a supplement is needed, but plan meals carefullly. 

all grain products now fortified with folate as a precautionary measure to lower risk of neural tube defects

• need increased minerals, esp iodide, zinc and iron
• if you eat animal products, iodized salt and fortified breakfast cereals youll meet the iodide and zinc requirements
• iron needed to make hemagloben
• women in general have a higher iron need bc of periods, but during pregnancy even more is needed bc increased blood volume and iron also needs to be provided to the fetus

• can lead to preterm delivery, low birth weight, increased risk of fetal death
• animal products and fortified breakfast cereals are good sources
• combine plant iron sources with vitamin C rich sources to increase iron absorption

• moderate levels of physical activity are encouraged daily
• avoid alcohol and other known teratogens

• caffeine
• drugs (overcounter, prescription and illegal)
• alcohol
• tobacco

increases risk of miscarriage, stillbirth, preterm delivery and low birth weight infants

linked to fetal alcohol syndrome, which can result in physical abnormalities, mental disabilities and growth retardation

increase risk of Low birth weight, preterm delivery, miscarriage, birth defects and infant addiction

• heartburn
• morning sickness
• constipation

• hormones produced by the placenta relax GI tract muscles. which can allow backflow of stomach contents into esophagus, which gives a burning sensation
• avoid foods that trigger the reflux (spicy, high fat)
• avoid lying down for 1hour after a meal 
• eat small frequent meals

• as the fetus grows intestinal muscles relax causing constipation
• increase fiber in diet
• increase fluid consumption
• regular moderate exercise with dr.s approval will help keep the gi tract functioning (its a muscle)

• pregnancy related nausea and vomitting
• may interfere with a woman's intake and can be triggered by the smell of food or hormone changes in pregnancy
• avoid greasy foods
• eat smaller meals
• have good ventilation when cooking
• avoid large amounts of liquid at one time
• can occur at any time of day
• more common during first trimester, symptoms can persist throughout preg
• while annoying, symptoms can be managed with dietary changes, and present little risk

• physiological anemia
• gestational diabetes
• pregnancy-induced hypertension (aka preeclampsia)
• pica

• occurs during pregnancy as the blood volume increases and the concentration of RBCs is diluted
• if iron intake is too low to meet increased needs of preg, anemia develops and can have negative consequences on mother and baby

• may occur sometime after week 20
• hormones made by the placenta may interfere with insulin production and blood glucose control
• as a result, blood glucose levels rise bc insulin levels are not sufficient to transport the glucose from blood into the cells
• women over 35, family history of diabetes, or overweight before preg are most at risk
• blood glucose levels often return to normal after delivery, but mom then has increased risk of type II diabetes later in life
• if not controlled during pregnancy, can lead to a large baby (13-14lbs) requiring a c section and increased risk of trauma at birth

• aka preeclampsia- the early form, where bp just begins to rise
• or eclampsia in the severe form
• can be dangerous to both mom and fetus
• edema of the tissues occurs and increased blood pressure, protein in urine and changes in blood clotting
• if untreated: kidney failure, convulsions and death may result
• women under 17 or over 35, family history of pregnancy induced hypertension or overweight/obese most at risk
• a good dietary intake with additional calcium and limited sodium appears to help prevent this

• an abnormal craving for both food and nonfood items
• should be discussed with doctor
• a nightly craving for ice cream and pickles is harmless, the desire to drink a floor cleaner or eat chalk is not
• cravings are usually caused by a nutrient deficiency which once corrected eliminates the cravings

• moms who were concerned about their diet during pregnancy and wish to ensure proper nutrition for baby after birth, this can be a great choice
• American Dietetic Association and American Academy of pediatrics reccommend breastfeeding for first year

although its the preffered nourishment for baby, # of women who breastfeed is lower than recommendation outlined by Healthy People 2020

• education concerning breastfeeding
• social concerns
• working outside the home
• physical inability to nurse

• #1factor
• misinformation about bfeeding can cause a women to choose formula
• obstetricians and nurses can help dispel the misinformation and guide the new mom through process
• short hospital stays after delivery has negative affect on number of women who choose bfeeding
• new moms need knowledge and support over the first week to ensure feeding is going well
• lactation consultants are a valuable resource for info and provide help and support as questions or concerns arise

• offers classes in breastfeeding and provides support for bfeeding moms
• most communities have a local chapter

• social concerns about feeding in public places
• second major factor
• women should be assured that breastfeeding can be done modestly and successfully almost anywhere
• often times people dont even know breastfeeding is occuring

• in many families, mom has to work
• can make breastfeeding difficult
• 3rd biggest issue
• breast pumps can be used to collect milk that can then be stored in the fridge and freezer
• this milk can be used during th day and the baby can nurse in the evening
• if this becomes to difficult, you can do a combination of formula and breastfeeding

• for some women its impossible to nurse due to breast or nipple structure
• for others, the demand of the baby might be larger than the amount of milk they can make
• working with consultants and getting support/advise from other moms can help
• in other cases, formula may be the best option for baby and mom

• in underdeveloped countries, breastfeeding is almost always the healthiest choice and the most important
• lack of sanitary water and limited education about formula prep could cause illness if the infant is formula fed
• mom may also try to stretch out the formula as long as possible and dilute it to save money
• many times, mom will start breastfeeding, and if she becomes pregnant again afterward, and must wean the infant off too early which can lead to malnutrition and death

• in preg, the body readies the breast by increasing the amount of fat in the breast tissue and maturation of the structure
• hormones stimulate these changes and produce lobules

• sac like strucutres in the breast for milk
• formed by hormones during pregnancy

after birth, this hormone is secreted by the pituitary gland to produce milk

as the infant nurses, this reflex causes the release of milk from the milk ducts in the breasts

• a hormone important for breastfeeding success
• stimulates the lobules in the breast which in turn stimulates the letdown reflex

2-3 weeks for a feeding routine to be established and for milk supply to meet demand

• the first few days after delivery: a think yellowish substance called colostrum
• several days following delivery: the milk composition changes and has a thin watery bluish appearance (but still very high in nutritional quality)

• thick yellow substance released from the breast in the first few days
• rich in protein and immune factors that protect the intestinal health of the newborn
• so important, even if you can just get a mom to breastfeed for a few days to give this to baby

• a mother's breastmilk adapts to her infants individual requirements
• ie: the amount of fatty acids produced. we need fatty acids for the synthesis of brain tissue and CNS development. Moms milk for preterm infant had more fatty acids than moms milk for a full term infant

• formula is fine, but cows milk should NEVER be given to an infant under a year
• cows milk is too high in protein and minerals for the baby's GI tract
• they cant digest the protein
• if they do eat it before a year it can cause digestive disabilities and food allergies

• made to meet infant needs
• a variety of types are available to meet different needs
• still an accptable way to feed

• bfeeding mom needs to get plenty of rest
• find a relaxed atmosphere to nurse in
• eating eathy
• hydration- 13 cups fluid per day

• similar to what a woman needs during 2nd and 3rd trimesters of preg
• increased need for vitamins A, E, C, and riboflavin 
• increased need for many minerals
• calorie needs are higher in lactation than during pregnancy
• hydration very important- drink 13 cups fluid per day for adequate milk production
• a diet that provides the proper amount of calories (ask dr how much), moderate fat and a variety of fruits, veggies, whole grains and dairy will meet bfeeders needs

• helps mom recovery from the pregnancy faster and return to her pre-preg weight 
• convenient and economical
• while it provides advantages over bottle feeding with formula, formula meets an infants needs and promotes adequate growth
• a mother should be supported whether she chooses bmilk or formula

During the first year of life, an infant requires more nutrients and calories per pound of body weight than in any other time of life

• rapid growth occurs
• infant will double their weight during the first 4 to 6 months of life
• weight will triple in the first year
• after the first year, growth slows but adequate nutrients and calories are necessary to support brain and physical growth

• Children who do not receive adequate nutrients are at risk 
• causes kids to be short and underweight for their age
• more prevalent in developing countries where bfeeding ceases and the child relies on rice as their main staple in diet with minimal protein

• use a growth chart
• from birth to 36months you can look at length for age and weight for age and measure head circumference to make sure kid is growing the way they should
• the growth pattern can be tracked and compared to other infants of the same age based on percentiles
• these percentiles represent the rank of the infant among 100 peers of the same age and gender
• the pediatrician will weigh and measure length and circumference of infant and use growth charts
• an infant at the 60% percentile for weight would have 40% peers weighing more and 59% who weigh less
• there are additional growth charts for people age 2-20 based on gender, weight and height for age
• BMI can also be used to assess growth

• when poor growth occurs in children younger than 2
• can be caused by inadequate intake related to disease (constant diarrhea, intestinal problem or some other physical or health problem)
• usually occurs due to inadequate feeding practices
• parents may lack information on feeding, be inexperienced and need education to care for the kid, or have lack of resources for food procurement

• dr will be alerted to the delayed growth by tracking growth pattern and can intervene
• if not addressed, failure to thrive can lead to poor growth, impaired mental development, and behavioral issues

• can indicate a risk for overweight and obesity in children and adults
• in children a BMI of 85 percentile or higher can indicate risk for obesity

• human milk or infant formula should make up the total diet for the first 4-6 months
• parents should follow what the dr. says
• even after solid food is introduced, human milk or formula should be given for the first year

• infants require 2-4 times more calories per kg of body weight than what an adult requires
• both breast milk and infant formulas are rich in fat to provide a concentrated source of calories as well as the fat needed for brain and nervous system development

• requires the fatty acids arachidonic acid (AA) and docosahexaenoic acid (DHA) 
• they are long chain fatty acids
• human milk provides both of these, esp if mom eats fish
• recently, infant formula has been supplemented with them as well

can be met with a varied diet with typical intake of human milk/formula and solid foods

• excess protein should be aboided to prevent putting stress on infants kidneys as they try to clear the waste products from protein metabolisms
• excess consumption or early introduction of proteins can lead to food allergy as the infants immune system reacts to the protein

• vitamin K
• iron
• fluoride

vitamin D in breastfed

• formulas provide all vitamins needed except vitamin K
• breastfed kids need a vitamin D supplement
• if the nursing mom is vegan, the infant will need b-12 supplementation
• all infants given a vitamin K shot at birth to hel with clotting

• iron is crucial for mental development. lack of it leads to anemia
• most infant formulas are iron fortified
• breast fed infans should have adequate amounts provided in the milk until ~6months when solids are introduced
• if mom was iron deficient in preg, or while nursing, infant may require a liquid iron supplement

if untreated, the infant may experience long term effects of impaired mental development, motor development and behavioral issues later in life

recommended in infants over 5 months who are nursing and those on formula prepared with non-fluoridated water

In most cases both human milk and formulas provide enough water to meet the needs

• could occur due to diarrhea, vomiting, fever, or excess sun exposure
• supplemental water should be given if this occurs
• extreme dehydration requires medical attention to prevent loss of kidney function

• dark yellow or strong smelling urine
• lack of wet diapers
• dry mouth and lips
• lethargy 
• absence of tears when crying

• parents for watch for them around 6months
• between 4-6 months infant will gain head and neck control and be able to sit up with support- they can almost sit up on their own
• the extrusion reflex will dissappear
• child can digest protein and starch

• thrusting of the tongue that pushes food out of the month
• occurs in infants not ready for solid food

• digestive tract and kidneys have matured and kid can digest starch and excrete waste products from the protein
• whole proteins better absorbed and risk for developing allergies is decreased (even though at this point, chances of allergies start to decrease)

• rice cereal- its less likely to cause allergies
• begin with a teaspoon of cereal and gradually increase the amount over the next seven days
• after a week the next food can be introduced

• introduce new foods one at a time 1 week apart, and monitor for allergies
• order to introduce: cereals, vegetables, fruits, meats, and egg yolks gradually
• By 1 year your baby should be eating a variety of foods
• you can do commercial baby foods or make your own by pureeing or grinding food at home with very little seasoning or spice
• parents should stay calm and expect new foods to not be recieved well. may need to introduce several times

• fruits are sweeter in taste than veggies
• if you start with fruits you may have a hart time getting them to eat veggies

• these foods can cause allergies or be choking hazards
• Honey: contains spores of botulinum which could lead to botulism. spores are harmless to older children and adults but can be fatal for those under a year. its a neurotoxin serotype A (botox)
• Egg whites, chocolate and nuts: commonly cause allergic reactions (nuts are choking hazard too)
• choking hazards: small round foods like grapes or hotdogs, sticky foods (peanut butter), hard foods like candy and popcorn. These extend through age 5
• Excess apple or pear juice: excess juice may replaceing human milk or formula and infant may not be getting enough calcium for bone development. can also lead to failure to thrive if consumed instead of solids. linked to poor oral health and obesity. contain fructose and sorbitol which can cause diarrhea
• cow, goat and unpasteurized milk: due to inability to digest the proteins in this milk before 1year

• 6-7 months
• this is when coordination develops and the infant is eager to explore and experiment with food

• between ages 2-5 toddler growth slows and appetite declines
• trying to meet nutrient needs can be more difficult but can be accomplished with some careful meal planning and adding snacks

• offer nutrient dense foods with limited sugar, fat and sodium to help establish ahealthy eating pattern that can be followed for the rest of the kids life
• your job as a parent is to be a good role model- offer the food and provide positive role modeling by eating behaviors and eating a variety of foods
• offer foods in a variety of ways- steamed veggies with cheese sauce, cooked veggies or raw veggies with dip to help improve acceptance
• allow them to help with the meal, let them choose fruits/veggies at the store or letting them mix the salad making mealtime pleasant

• encourages the child to try one bite of food
• can be helpful in trying a variety of foods

• over time they develop their own preferences
• these kids develop food jags

• the desire to eat the same food or only a certain color food at every meal
• if caregivers continue to offer a variety of foods for meal and snacks the child will begin to try them and the jag will dissappear

• they have more taste buds than adults
• more sensitive to taste
• crisp textures, colorful food, milk flavors and finger foods are well accepted

• my child is a picky eater
• my child always wants a snack
• my child wont eat vegetables

• preschoolers have small stomachs and adults often overestimate how much they need to eat
• a good measuring tool- 1 tbsp or each food item per year of life- if you have roast beef, potatoes, peaches and they are 3 they should eat 3 tbsp roast beef, 3 tbsp of pots and 3 tbsp of peaches. may not look like a lot but its enough
• children should be allowed to pick the amount of grains and milk to eat based on their appetite
• if excess milk consumed, parents may need to limit intake to allow them to have room for other food groups
• within reason, children should be allowed to express their independence and food prefereence
• kids preference may be based on temp, taste, appearance and texture- parents can encourage this by offering a variety of healthy foods
• eating habits over the course of a week are more important than choices at one meal

• bc kids have small stomachs, snacks are important
• offering 6 small meals a day, focusing on nutrient dense choices will enable your child to meet their nutrient needs
• however- avoid juice, diet soda or even milk in large quantities as this will decrease the amount of solid foods eaten
• whole fruits and veggies are a better choice than juice and water with some of these snacks can be beneficial
• if juice offered give no more than 4-6 oz per day for kids 1-6
• for 7-18year olds no more juice than 8-12 oz/day

• fruits are often better accepted than veggies bc the natural sugar makes the sweet
• encourage your child to eat the rainbow
• look through magazines together or examine the different fruits and veggies at the grocery store and their many colors
• the more color on the plate, regardless of whether its a fruit or veggie= more nutrients
• have the child help prepare the vegetable and offer it in many ways to improve acceptance

• a toddler or preschooler who eats a variety of foods from many food groups is likely meeting their nutrient needs
• in most cases a multivitamin not reccommended for children
• exceptions: child who is ill and unable to eat a healthy diet or a child with very erratic eating habits
• in the exceptions case, the american academy of pediatrics says a child may benefit from a children's multivitamin that does not exceed 100% of the daily value
• still, focus should be on healthy food rather than supplement

• iron deficiency anemia
• constipation
• dental caries

• usually manifests between 6 and 24 months
• oxygen supply to cells declines and can lead to decreased energy an dlearning ability as well as decreased immunity and increased risk of disease
• iron fortified breakfast cereal and a small amount of meat will provide enough iron to meet a child's needs

• may be related to a medical condition
• usually though its caused by other factors
• increase fiber through fresh fruits and veggies, whole grains, cereals and bean to help
• consume 4-5 cups fluid a day with the additional fiber
• encourage the child go to the bathroom when they feel the urge

• occur when sugar from food and drink is allowed to ie on the teeth or gums for a period of time
• to prevent them from developing never put a baby to bed with a bottle of milk, formula or juice
• wipe your infants gum and teeth after drinking and eating
• for toddlers and preschoolers avoid sticky high sugar snacks and encourage brushing with a small amount of fluoridated toothpaste

• children who follow total vegetarian diets: emphasis should be placed on adequate intake of plant sources of protein, vitamin D, vitamin B12, calcium, iron and zinc (all of these are abundant in animal products, but require careful meal planning for vegetarians)
• autistic children: nutritional intervention for these is in early research stages. gluten free, casein free diets and supplements of vitamin B6, magnesium, probiotics and essential fatty acids can be beneficial

• these years bring additional loss of control from parents and increased pressure from peers, the media and the childs own exertion of their independence when making food choices.
• studies show that few school aged children meet their daily requirements from all 5 food groups and their diets lack esp in calcium, iron and zinc and are high in sugar and fat

• lack of regular meal times
• excess consumption of saturated fat
• increasing incidence of overweight and obesity
• early onset of cardiovascular disease and diabetes

• particularly breakfast
• consumption of reg meals is important but breakfast often sacrificed so the child can sleep 10 extra minutes
• in other cases, kids dont like breakfast foods or arent hungry in the morning

• you are breaking the fast
• your body requires fuel for physical activity and to fuel your brain
• kids need to eat breakfast to meet their vitamin and mineral daily requirements

• a good source of iron, vitamin A and folic acid
• but no limits on what to eat for breakfast- leftovers from dinner, yogurt with granola, pizza, cheese sticks, dried fruit, a sandwich. you just want to combine a good source of protein with a carb to jump start your day and provide energy to get you to lunchtime

• All foods can be eaten in moderation and that includes an occasional treat that is high in fat or sugar
• but many kids eating excess fat in daily diet
• small changes can make a big deal- switch to lower fat milk, and part skim cheese, sub lean ground turkey for ground beef, take skin off chiken, baking and broiling instead of frying. these significantly decrease fat in food
• dont overrestrict fat- often results in the good food bad food attitude and is linked to eating disorders later on

• Childhood obesity is a serious health risk because approximately 40% of obese children become obese adults
• it is tough to be an overweight child- health risks and social ridicule and embarassment and isolation at school

• super-sized portions
• fast food
• convenience foods
• increased soft drink consumption
• easy access to sugar laden snack foods
• lack of physical activity- due to decreased gym time at school, lack of safe play areas and increased TV time

• most adults do a diet- this is not the best approach with kids
• first step: addressing the problem and look at how much physical activity the child gets in a day
• getting kids interested in physical activity for fun and enjoyment can help them reach a healthy weight and will set up exercise patterns for the rest of their life
• appropriate calorie intake is important- limit high calorie foods and focus on nutrient dense choices to help a child grow into their weight
• understand portion sizes and make small changes in food prep to allow the kid to continue to enjoy the foods they like in moderation and not feel deprived

health professionals reommend 60min of moderate phys. act. per day

• Families can play together by taking a walk, riding bikes, or trying a new sport such as rollerblading
• Enrolling kids in community leagues or classes that focus on fun rather than competition can provide them with a variety of activities from which they have the opportunity to discover what they enjoy

• Not many years ago heart disease and Type 2 Diabetes were usually found in overweight middle age individuals
• today a high number of children have high cholesterol and type II dabetes
• early screening advised
• treatment- a balanced diet and physical activity to help the child achieve a healthy weight
• Once a healthy weight is achieved, the symptoms of diabetes and high blood pressure generally resolve.

• female: ages 10-13
• ---> grow in height and begin to accumulate both lean and fat tissue
• --->sexual development and menstration begin
• male:12-15
• --->much of the body weight is from lean tissue and males experience a growth in height of ~a food

• appetites increase substantially
• thoughts of eating healthy are not formonest in teens minds, satisfying hunger is
• temptation everywhere

• satisfying hunger
• temptation everywhere
• ads for snacks and drinks aimed at teens
• soft drink machines at school
• increased intake of fast food, sugary beverages, sugar laden snaks replece nutrient dense food choices

• peer pressure, concern over appearance, and exertion of their independence all affect food choice
• the result- most teen diets are low in calcium, iron, zinc, fat soluble vitamins and folate

• they have lost a lot of control- peers decide
• gently guide teens toward healthier choices by modeling good food habits at home
• discussing the role that nutrition plays in their development both now and in the future
• tell them health risks from poor dietary habits that occur later in life
• encouraging wise food choices when eating at restaurants.

• diseases that commonly manifest themselves in middle age
• hypertension
• diabetes
• cardiovascular disease
• osteoporosis
• obesity

can be controlled or prevented

• those 85 years and up
• aging is inevitable, not a disease
• however, a decline in health is not a given with increasing age
• advances in health care, food safety, and sanitation have allowed many to add years to their life

• each stage has their own unique needs
• 19-30: Young adulthood. Transition stage where adults are exploring their independence. They are establishing a career, and beginning a family
• 31-70: Middle adulthood. Individuals are adjusting. Maybe they have empty nest syndrome, juggling a home and kid's schedules and/or dealing with elderly parents
• 71+: Older adulthood. This is the period of downsizing, retirement, loss of a spouse and dealing with ones own mortality

• unlike other stages of lifecycle (except preg) there is no growth occuring
• adulthood is a period of body function maitenance until age 30
• after 30 we experience physical and physiological changes

• physical and physiological changes in body structure in function that occur after 30
• normal changes
• although aging occurs throughout adulthood, until we reach 30, the rates of cell synthesis and breakdown are in balance
• but after 30, breakdown occurs faster than synthesis which can cause a decline in body function
• aging is inevitable

• graying hair
• reduction in cell numbers
• reduced lung capacity

• No! 
• Degenerative or chronic diseases dont have to be accepted as part of it
• a healthy lifestyle with nutritious diet, exercise, adequate sleep and avoiding poor chioces (smoking and alcohol) can prevent or reverse age related changes

usual aging or successful aging

• the expected progression of cell death with age and the physical changes that occur related to unhealthy lifestyle choices
• ie: loss of bone mass, weight gain, high blood pressure and decreased lean body mass

• physical and physiological changes taht occur related to growing older but not related to poor lifestyle choices
• these ppl age at a slower rate and experience age related diseases later than usual agers
• delay of disabilities

• delay of disabilities caused by age related disease
• common in successful agers

• heredity
• lifestyle
• environment

• our genes play a role in how long we will live
• a family history of longevity can provide the potential for a long life
• females live longer than males
• metabolism can impact lifepsan- thrifty metabolism= more fat storage, once beneficial, but now detrimental as we have low activity and plenty of food
• your genes can impact your longevity but nurture plays a role too

• includes eating and exercise habits, and lifestyle choices such as tobacco or alcohol use
• Nations that follow the mediterranean diet- a diet high in seasonally fresh, locally grown foods, fish, limited red meat and dairy and focuses on olive oil as a main fait are also known to have longer lives with the least incidence of disease
• For those of legal age, moderate wine consumption with meals also has heart health benefits

• Okinawa
• a typical diet here is plant based with rice and fish as staples

• environment is our ability to make decisions
• many of our decisions are based on the environment and current circumstances
• education and available resources are important in decisions we make related to meal choices and health care
• adequate shelter provides safe living conditions and protects us from the elements of physical danger
• sufficient income is necessary for purchasing food and shelter
• if any of these are missing or inadequate there can be negative health impacted and faster aging

• delays the onset of some diseases
• increases physical, mental and social well-being
• improves immune system
• aids in recovery from illness

• diet low in saturated and trans fat, cholesterol, simple sugars and sodium
• diet focused on plant based foods with minimal processing, fish, whole grains, lowfat dairy and small amounts of meat

• healthy diet as previously described
• maitenance of healthy weight through daily exercise and safe food handling practices to avoid food bourne illness

• no
• many adults continue to consume excess calories, fats, sodium and alcohol

exchanging complex carbs for simple ones can lower the risk of colon cancer and heart disease, prevent constipation and lower blood cholesterol levels

• adequate water needed as we age
• many adults confuse thirst with hunber which results in a mild stage of dehydration
• as we age we lose our thirst sensation and by the time we realize we are thirsty were dehydrated
• if inadequate fluids overtime dehydration symptoms will occur- disorientation, mental confusion, constipation, bowl impaction, death

• physical disabilities: may limit our ability to cook or shop for food
• dental issues: ie lack of teeth or ill fitting dentures can negatively affect intake of meats
• taste: declines and our desire to eat may decrease
• social isolation: may limit food choices or number of meals
• lack of income: may limit our food choices or number of meals also

because of issues related to aging can negatively affect food choices, a multivitamin and mineral supplementation being added to their intake is beneficial for many older adults

• calcium
• vitamin d
• iron
• zinc
• magnesium
• b vitamins
• carotenoids

• physiological factors
• psychosocial factors

each of these have multiple components that can impact our nutrition status and affect how we age

• Body composition changes
• Skeletal system changes
• Digestive system changes
• Chronic Disease
• Medications

• sarcopenia: a loss of lean muscle, which leads to a decreased BMR. With this change there is an increase in fat stores and we are not burning calories efficiently
• increase of fat stores is sarcopenic obesity
• Aging typically leads to a more sedentary lifestyle that can cause decreased mobility, joint issues related to increased weight and decreased physical activity as well as decresed flexibility

• skeletal changes occur as bone loss related to osteoporosis and decreased bone progresses in both males and females
• adequate vitamin D and calcium as well as a review of medications should be addressed to maintain bone mass

• common in older adults related to lactose malabsorption and decreased stomach acid
• constipation is a common complaint among the elderly due to lack of fluids, fiber and exercise as well as decreased GI motility
• gallbladder, liver and pancreas functions also decline with age

• related to malnutrition, altered nutrient utilization and altered nutrient needs
• affect many elderly
• those 65+ who are in an institutional setting are at extra risk

• can negatively impact nutritional status
• medications can lead to loss of taste or smell, induce anorexia or interact and inhibit the absorption of nutrients
• antibiotics can disrupt natural GI flora and delpete vitaminK
• diuretics can lead to loss of potassium and a

• Social isolation: related to a lack of support from family and friends can lead to poor intake (they dont wanna cook for themselves they dont go out anymore)
• Depression: can lead to social withdrawal, poor appetite, weight loss and malnutrition
• Alzheimers Or Dementia: causes loss of memory, confusion and decreased social contact
• Economic factors: can lead to inability to purchase food or nutrient dense food choices affecting both the quality and quantity of diet

• a nutrition screening initiative tool that can be used to evaluate an elderly persons risk for malnutrition related to both physiological and psychosocial factors
• a nutrient checklist that can be performed by medical personnel, family, and the oder person themselves to evaluate individual needs

• D: Disease- Alzheimers, cancer, heart disease, etc
• E: Eating poorly
• T: Tooth loss
• E: Economic Hardship
• R: Reduced social contact
• M: Medications
• I: Involuntary weight loss
• N: Needs assistance
• E: Elderly- over 80years

• the medical community can provide education and resources to the family to help the person obtain the help they need
• Nutrition programs for individuals over 60: congregate meal programs, meals on wheels, SNAP, food coops, and religious and social organizations
• The US Federal govt. subsidizes meals for seniros served in a community setting through the congregate meal programs
• home health care and adult daycares are other options to help meet the needs of older pop

• a govt subsidized program 
• a home delivery program
• one or two meals can be delivered 5 days per week

• 1. Increased nutrient density
• 2. Adequate fluid and fiber intake
• 3. Lean meats to provide iron, zinc, vitamin B6 and B12 which are frequently inadequate
• 4. Use of multivitamin and mineral supplement
• 5. Modified physical activity to maintain lean body tissue and prevent unwanted weight gain from fatty tissue