NDT Lec Midterm Reviewer

09 LEC
Nutrition and Diet Therapy

O8
30
Marieta Hilario 21
PREGNANCY AND LACTATION
OUTLINE
I INTRODUCTION
II IMPLANTATION PERIOD
III ORGANOGENISI  If the mother does not get her monthly period
IV RAPID FETAL GROWTH within 2 weeks, there is a tendency that the
V HABITS TO ESTBALISH IN PREPARATION mother is pregnant
FOR A HEALTHY PREGNANCY  that is 38 to 42 weeks or 9 months pregnancy
A. ACHIEVE AND MAINTAIN A HEALTHY
 divided into 3 trimesters (first three months,
BODY WEIGHT
second three months, and third three
I Recommended Weight Gains
Based on Pregnancy Weight months)
B CHOOSE AND ADEQUATE AND  has 3 events or periods
BALANCED DIET
I Pinggang Pinoy > The 2 events are periods that happen during the
VI NUTRITIONAL REQUIREMENT two months of pregnancy (these are called the
A ENERGY implantation period)
B CARBOHYDRATES
C PROTEIN
D VITAMINS
E MINERALS
C BE PHYSICALLY ACTIVE IMPLANTATION PERIOD
D AVOID HARMFUL INFLUENCES
VII DIETARY MANAGEMENT FOR COMMON  fertilized ovum implants itself in the uterus
MATERNAL DISCOMFORTS and begins to develop
A NAUSEA AND VOMITING  occurs during the 1st 2 weeks of conception
B HEARTBURN
C CONSTIPATION Source of nourishment: - uterine substances (UTMP)
D EDEMA
E LEG CRAMPS - glands in the endometrium ( the lining of the
F RAPID WEIGHT GAIN OR LOSS uterus) will secrete UTMP ( Uterine Milk
G PREGNANCY INDUCED Protein )
HYPERTENSION (PIH) - progesterone will stimulate the glands to
H ANEMIA secrete UTMP
I GESTATIONAL DM - estrogen causes endometrium to thicken to
VIII ADOCLESCENT PREGNANCY
produce UTMP
IX LACTATION
X BREASTFEEDING CONTRAINDICATIONS  the food of the baby depends on what the
mother eats that is why the foods consumed
should be healthy (the uterine substances will
be full of protein)
INTRODUCTION Adverse Influences are:
Gestation - is the period from conception to birth - smoking, drug abuse and malnutrition these
will result to failure to implant (might lead to
 Other term for pregnancy miscarriage or abortion)
 Conception will start at 2 weeks (after the - If the pregnancy continues, the baby might
menstruation stops) have Neural Tube Defect (NTD )
BSN-2B TRANSCRIBED BY: GROUP 8 1

ORGANOGENSIS  Birth defects— heart defects and neural tube
defects (NTDs)
- period of organ formation
Heart defect, chant of heart (chanting)
- occurs from 2 to 8 weeks after conception or
 Problems with diagnostic tests— too much
next 6 weeks
body fat leads to inaccurate ultrasound
- critical period when organs are formed and
results.
most vulnerable to adverse influences
If the abdomen is thick, the mother might be
> This is where the eyes, nose, lips, and etc. are subjected to Vaginal Ultrasound .
formed  Macrosomia—In this condition, the fetus is
larger than normal. Baby has a greater chance
RAPID FETAL GROWTH
of being obese later in life.
- the last 7 months (enough to live outside the - THE FETUS IS LARGER THAN NORMAL,
womb) OVERWEIGHT
- Characterized primarily by growth in the - GREAT POSSIBILITY THAT THE BABY WILL BE
number of cells and size of the organs until it OBESE IN LATER AGE
can support extra uterine environment.  Preterm birth— obese pregnant may
 The features of the baby is completed developed preeclampsia, may lead to a
medically indicated preterm birth.
Source of nourishment: Placenta
ESPECIALLY IF HAD HIGH BLOOD PRESSURE,
Simple diffusion – passive process in w/c nutrients before the mother will experience seizure and
move from high concentration in the maternal blood convulsion, the doctor may prescribe
to lower concentration in the fetal capillaries until termination of pregnancy even if it’s not yet
equilibrium is reached. due
The placenta is responsible for the supply of the May be at risk for both mother and baby
following:  Stillbirth—The higher the woman’s BMI, the
greater the risk of stillbirth
- O2 ,CO2 , FA, Steroids , Nucleotides
,electrolytes and Fat soluble vitamins
Preventions: the mother should achieve and
 These substances will be transferred from the
maintain a healthy body weight
placenta to the fetus via simple diffusion
HABITS TO ESTBALISH IN PREPARATION FOR A

HEALTHY PREGNANCY RECOMMENDED WEIGHT GAINS BASED ON
PREGNANCY WEIGHT
1. Achieve and maintain a healthy body weight. PREGNANCY WEIGHT RECOMMENDED

2. Choose an adequate and balance diet. WEIGHT GAIN
3. Be physically active. Underweight (BMI 28 to 40 lb (12.5 to 18.0
4. Avoid harmful influences <18.5) kg)
Healthy weight (BMI 25 to 35 lb (11.5 to 16.0
1. Achieve and maintain a healthy body weight 18.5 to 24.9) kg)
Overweight (BMI 25.0 to 15 to 25 lb (7.0 to 11.5
Underweight Pregnant 29.9) kg)
Obese (BMI ≤30) 15 lb minimum (6.8 kg
- if the pregnant mother is underweight she is a
minimum)
high risk of giving birth to a low birth weight
(LBW) infant.
LBW – infants have impaired growth and development
- prone to infection and disease

- will have lower adult IQ
Overweight or Obese Pregnant

High fiber food – not only rich in nutrient but also
fiber, which can prevent heart disease and diabetes,
which pregnant mother are prone to have
GLOW FOODS
FACTORS THAT CONTRIBUTE TO WEIGHT GAIN IN
Give much fruits and vegetables, more on vitamins
PREGNANCY
and mineral content
PREGNANY WEIGHT GAIN BREAKDOWN GROW FOODS
Give high biological value protein (HBV) – highly

absorbable kind of proteins (high quality protein:
white meat (fish and chicken without skin, legumes,
nuts and beans)
Give milk or calcium rich foods, recommend anchovies

or bolinao (the smaller the fish, the higher the calcium
content)
Mother should expose herself in the heat of sun in the

morning to activate the vitamin D for teeth and bones
of the baby.
 at risk: if the mother will not show increase in
weight gain.
2. Choose an adequate and balanced diet

 For the first 2 months of pregnancy, the
source of nourishment of the fetus is from the
mother, the uterine substances
 Restriction of supply, if not adequate
 malnutrition reduces fertility and impairs the
early development of an infant.
 placental development, implantation, and
early critical periods of embryonic and fetal
development depend on maternal nutrition NUTRITIONAL REQUIREMENT
before and during pregnancy.
 Dietary Management: -
ENERGY
 Pinggang pinoy
 the basic food groups (needs to be  Normal TER + 340 kcal on the start of 2nd
present and correct measurement) semester (3-6 months)
 Normal TER + 450 KCAL on the 3rd trimester (7 -9
months)
 Choose nutrient – dense foods
RATIONALE
 To supply the increase fuel, demanded by the

enlarged metabolic workload.
 2 BMR DURING PREGNANCY; the mother and the
baby
 BMR (BASAL METABOLIC RATE)- THE ENERGY
NEEDED FOR THE INVOLUNTARY ACTIVITY IN THE
GO FOODS BODY (DIGESTION, METABOLISM, CIRCULATORY
Whole grains, whole wheat bread, brown rice, and SYSTEM –FOR BLOOD OXYGEN, RENAL SYSTEM –
oatmeal URINATION AND DEFECATION.

CARBOHYDRATES 1. AI or RDA -1.9 mg / day
2. Rationale
 60 % of TER/ day
 To prevent nausea and vomiting.
RATIONALE  To prevent convulsion.
3. Richest food source
 Necessary to fuel the fetal brain.  meats , fish , poultry , liver
 Fiber in CHO rich foods such as WG,V, F will help  potatoes , legumes , non-citrus fruits soy
alleviate constipation. (one of maternal products
discomfort, need whole grains, vegetable and  Part of the b complex
fruits)
 To spare CHON for the added tissue-building FOLIC ACID
requirement.
1. Together with Vitamin C and Vitamin B12, to
Not use protein as a source of energy, mother
activates folate to folic acid, production of
should not deprive herself of carbohydrates, we
RBC, erythropoiesis)
have to protect the protein from being coverted
2. AI or RDA - 600 mcg / day
into energy
3. RATIONALE
PROTEIN  For blood volume increase.
 Development of new cells
 + 25g to normal CHON requirement/day  To prevent Neural Tube Defect (NTD)
RATIONALE FACTORS AFFECTING NTD
 For baby’s rapid growth 1. Inadequate folate
 For the development of the placenta 2. NTD on previous pregnancy
 Due to the increase in maternal blood volume 3. GDM
 Needed in the synthesis of Hgb and plasma CHON 4. Use of anti-seizure medications
(thrombin). 5. Maternal obesity
 For the formation of amniotic fluid 6. Exposure to high temperature( fever , hot tub
 For tissue storage reserve use )
VITAMINS VITAMINS 7. Race/ Ethnicity – common among Hispanic
people
1. Vitamin C 8. Low economic socio status
(1) AI or RDA (adequate intake/ 2 KINDS OF NTD

recommended daily allowance) 1. ANENCEPHALY
(2) < 18 - 80mg/day 19-50 - 85mg/day  an uncommon and always fatal type of NTD
Rationale  characterized by the absence of a brain.
 To prevent pre-eclampsia
THIAMIN
1. AI or RDA ( according to age )

 < 18 - 1.4mg/day
 19-50 - 1.4mg/day
2. Rationale
 For loss of appetite.
 For increase in metabolic work load.
 Prevention of beri-beri.
 To prevent leg cramps.
3. Richest food source -Enriched or fortified
whole grains and products.
PYRIDOXINE 2. SPINA BIFIDA

 one of the most common types of NTD , 3. Skeletal formation
characterized by the incomplete closure of 4. Tooth formation and normal bone growth
the spinal cord and its bony encasement.
Food sources
1. Fruits per 100g

2. 1.Milon = 1285 mcg
3. 2. Tesa = 1235 mcg
4. Mango ripe = 1165 mcg
LIVER per100mg = 5,525 mcg
Vegetables per 100g
 Malungay = 7,945 mcg

 saluyot = 7,320 mcg
 Upo = 6439 mcg
 tanglad = 4,205 mcg
3. Highest Food sources of folate  Ampalaya
Natural Folate Sources  leaves = 4,105
 Kamote tops = 3,195 mcg
1. Liver (3 ounces ) = 221mcg
 Alugati = 2,735 mcg
2. Asparagus (1/2 cup ) = 131mcg
 Lettuce = 2,350 mcg
3. Spinach ( 1 cup raw ) = 131mcg
 Onion leaves = 2,065 mcg
4. Avocado (1/2 cup ) = 45mcg
5. Orange juice (1 cup ) = 74 mcg VITAMIN D
Fortified Folate sources - the mother should expose herself under the
1. Pasta cooked ( 1 cup ) 110mcg sun to activate the vitamin D
2. Rice cooked ( 1 cup ) 134mcg - precursor of calcium and phosphorus
3. white bread ( 1 slice ) 28mcg 1. Maintain normal calcium metabolism
2. Promotes normal bones and teeth formation.
COBALAMIN 3. Prevent Tetany during infancy
1. AI or RDA = 2.6 mcg/day TETANY – a syndrome characterized by abnormal

2. RATIONALE - for maturation of RBC muscle twitching, cramps, sharp spasms of joints in
3. Richest Food Sources wrists and ankles. (We have to supplement vitamin D
- meat , fish , poultry , shellfish, milk , cheese to avoid this from happening to the child.)
and eggs
1. AI or RDA
VITAMIN A OR RETINOL 5 mcg / day
Retinol form – most need by pregnant; placenta Food sources :
fucntions, epithelial cells, skeletal formation of the
1. fortified milk 4. eggs
baby, the bone growth formation
2. fortified margarine 5. liver
1. AI or RDA 3. fortified butter 6. salmon, sardines
18 Y.O and below = 750 mcg / day
19 to 50 Y.O = 770 mcg / day
FUNCTIONS
1. Important for the placenta functions

2. For the integrity of the epithelial cells

MINERALS 4. IRON – iron for the mother and the baby
1. CALCIUM AI/RDA = 27mg /day
1. conservation of iron during pregnancy

 AI/RDA
2. maintenance of erythropoiesis (production of
1,300mg /day ( 14 -18yr ) RBW)
3. to prevent anemia
1,000mg /day ( 19 – 50yr)
4. to have sufficient supply of Hgb
1. for fetal bone development
2. for dentetion FOOD SOURCES
1. clams ( steamed ) 3 oz = 23.8mg

FOOD SOURCES
- high biological value of proteins and contains
1. 3 cups of milk = 300mg haemoglobin)
1. 2.sardines with bones 3oz= 324mg 2. lean beef steak 3 oz = 2.6 mg
2. tofu ½ cup = 275mg 3. black beans ½ c = 1.8mg (non-heme)
3. cheddar cheese 1 ½ oz = 306mg 4. enriched cereal 1cup = 8.1 mg (non-heme)
4. broccoli 1 ½ cup = 93mg 5. spinach cooked ½ cup = 3.2 mg (non-heme)
6. beef liver 3 oz = 5.24mg (contains
2. PHOSPHORUS hemoglabin)
 AI/RDA
1,250mg/day ( 14-18yr )
5. IODIONE
700mg/day ( 19-50yr )
 The very known function is the metabolic rate
- Involved in fetal skeleton building w/ Ca in terms of the growth or the function of the
mammary gland to produce milk
FOOD SOURCES
1. All animal tissues AI/RDA = 220 mcg ( 18 – 50yr )
1. to increase milk flow

2. to compensate increase in BMR
3. MAGNESIUM 3. to prevent cretinism (deficiency of iodine)
 AI/RDA
FOOD SOURCES
400mg /day ( 14-18yr)
 iodized salt and seaweeds (seafoods)
350mg /day ( 19-30yr)
360mg /day ( 31-50yr)

6. ZINC
1. Involved in bone mineralization
 Prevents diarrhea and it helps in the synthesis
2. normal muscle contraction
of RNA and DNA
3. transmission of nerve impulses
4. maintenance of teeth AI/RDA
12mg /day (18yrs and below )

FOOD SOURCES 11 mg/day ( 19 -50 yrs )
1. spinach cooked ½ cup = 78mg 1. For CHON synthesis
2. black beans ½ cup =60mg of Mg 2. for DNA and RNA synthesis
3. soymilk 1 cup = 46 mg of Mg
4. yogurt 1 cup = 43mg of Mg FOOD SOURCES
5. oysters 3 oz = 81 mg of Mg
1. oysters –steamed 3 oz = 72 mg
6. bran cereal 1cup = 60mg of Mg
2. lean beef steak 3 oz = 4.9 mg

3. yogurt 1 c = 2.2 mg  Do eat enough to support the additional
4. shrimp 3 oz = 1.5 mg needs of pregnancy plus exercise.
5. enriched cereal 1 c = 3.8mg  Do rest adequately.
6. porkchop 3oz = 2mg
DONT’S
 Don’t exercise vigorously after long periods of

7. SODIUM inactivity.
 AI/RDA = 1,500 mg / day ( 18yr and below )  Don’t exercise in hot, humid weather.
 Don’t exercise when sick with fever.
1, 500mg / day ( 19 to 50 yr old )
 Don’t exercise while lying on your back after
1. keep minimal to prevent edema and PIH the first trimester of pregnancy or stand
motionless for prolonged periods.
FOOD SOURCES
 Don’t exercise if you experience any pain or
1. table salt, soy sauce, processed foods discomfort.
 Don’t participate in activities that may harm
HABITS TO ESTBALISH IN PREPARATION FOR A the abdomen or involve jerky, bouncy
HEALTHY PREGNANCY movements.
 Don’t scuba dive.
3. BE PHYSICALLY ACTIVE
- A woman who wants to be physically active Suitable activities during pregnancy include:
when she is pregnant, needs to become - brisk walking
physically active before hand. - swimming
 The ideal body weight should be achieved - indoor stationary cycling
before the woman gets pregnant for a healthy - prenatal yoga
pregnancy - low impact aerobics under the guidance of a
- Staying active during the course of a normal, certified aerobics instructor
healthy pregnancy will: - special exercises to prepare for labor and
delivery
1. improves the fitness of the mother-to-be
2. facilitates labor
3. helps to prevent or manage gestational
diabetes and gestational hypertension,
4. reduces psychological stress.
GUIDELINES FOR PHYSICAL ACTIVITY DURING

PREGNANCY
DO’s
 Do exercise regularly (most, if not all, days of

the week).
 Do warm up with 5 to 10 minutes of light
activity. 4. AVOID HARMFUL INFLUENCES
 Do 30 minutes or more of moderate physical - both maternal and paternal ingestion of
activity. harmful
 Do cool down with 5 to 10 minutes of slow - substances ( cigarettes, alcohol, drugs or
activity and gentle stretching. environmental contaminants) can alter genes
 Do drink water before, after, and during or their expression.
exercise. - it can also interfere fertility and will cause
abnormalities

PRACTICES TO AVOID IN PREGNANCY
DIETARY MANAGEMENT FOR COMMON
1. MEDICAL DRUGS AND HERBAL SUPPLEMENTS MATERNAL DISCOMFORT
ASPIRIN AND IBUPROFEN. (should not be
taken without the doctor’s prescription 1. NAUSEA AND VOMITING
because it might lead to excessive bleeding  Morning sickness
during delivery)  most popular theory is that morning
2. DRUG ABUSE sickness is the body's reaction to the
- AMPHITAMINES pregnancy hormone, human chorionic
- BARITURATES gonadotropin (hCG) and progesterone
- COCAINE and estrogen.
- OPIATES  Caused by the pregnancy hormone
- MARIJUANA  Chorionic gonadotropin is the maternal
 Affects the mental development of the baby pregnancy detection. If this is observed in the
3. ENVIRONMENTAL CONTAMINANTS woman’s urine, it indicates that the woman is
- LEAD pregnant.
- MERCURY (prone to mothers who are  Maternal pregnancy detection hormone, as
exposed to mining business) well as progesterone and estrogen (contribute
4. FOODBORNE ILLNESS to nausea and vomiting
LISTERIOSIS - caused by: BACTERIUM LISTERIA
DIETARY MANAGEMENT (DIET, FOOD AVOID AND
MONOCYTES
GIVEN AND HOW TO GIVE OR MODE OF FEEDING)
5. VITAMINS AND MINERALS MEGADOSES (if
taken excessively, it may result to physical 1. HICHO , LOW FAT DIET
defect) - eat dry toast or crackers, jellies, candies ,and
6. DIETARY – LOW CHO or FATS can cause gums.
Ketosis 2. CHEMICALLY BLAND DIET
 Low CHO or FATS means the body is deprived - avoid excessive spices and no offensive odors
to produce energy from CHO or FATS - Cold or frozen drinks can be better tolerated
 Ketosis is the breakdown of fats from adipose in morning sickness.
tissue by the protein and it may lead to the - do not drink juice , water , milk , coffee or tea
increase of the ketone bodies. Once the when nauseated.
ketone bodies increase, it may lead to too
much acid in the blood and aggravate MANAGEMENT
heartburn or acid reflux. 1. On waking , get up slowly
7. SUGAR SUBSTITUTE – allowed as long as with 2. Eat small frequent meals whenever hunger
FDA guidelines strike
- ASPARTAME not recommended with 3. Room should be in proper ventilation
PHENYLKETONUREA 4. Fluid between meals.
 It has sugar content that can aggravate the
expression of ketone bodies in the urine 2. HEARTBURN
8. CAFFEINE – coffee and cola beverages may - acid reflux
also result to fetal death - acidic stomach, causing burning sensation
9. ALCOHOL – fetus irreversible brain damage - a pain felt in the chest by a burning sensation
- growth retardation in esophagus which located close to where
- mental retardation the heart is.
- facial abnormalities - the growing fetus weakens the LES ( lower
- vision abnormalities esophageal sphincter) – the main barrier of
the acid reflux weakens
- which is the main barrier of gastric reflux from
the stomach to esophagus.

DIET  The fluid will be returned from the pelvic
bone to the legs that is why legs are the most
1. Chemically bland diet
affected
- avoid spicy and greasy foods
- foods that may help reduce the symptoms
DIET
are:
1. Moderate sodium ( 2000mg/day )
* vegetables , ginger, oatmeal, non-citrus fruits, lean
meats, seafoods, eggwhites, healthy fats - less consumption of salty foods such as ;
sauces, condiments and
- gravies canned goods ,processed foods with
MANAGEMENT
preservatives
1. Relax and eat slowly - consume natural sodium containing foods
2. Eat small frequent meals - because sodium contributes to water
3. Drink liquid between meals. retention cause it attracts water.
4. Sit up while eating.
5. Wait 1 hour after eating before lying down. MANAGEMENT
6. Wait 2 hours after eating before exercising. 1. Enough rest
2. Lying down position when sleeping to
mobilized extra vascular fluid and activation
3. CONSTIPATION of urination process.
- due to the pressure exerted by the developing
fetus on the digestive tract.
 Progesterone will decrease the motility of the
5. LEG CRAMPS
stomach and it will also weaken the muscle
including the muscle of the large intestine. 1. There is a sudden contraction of
 When the baby grows, there is a tendency gastrocnemius muscle.
that that it will pressure the small intestine 2. This is due to decline in serum Ca levels
and large intestine. This pressure may cause related to Ca – Mg imbalance or caused by
the muscle tone not top develop. calcium or magnesium deficiency.
- due to the increase of hormone progesterone
during pregnancy DIET
1. Give Ca rich foods

DIET
2. Give P rich foods
1. HIFIBER DIET – more fruits and 3. Give Mg rich foods
vegetables
2. INCREASE FLUID INTAKE – at least 8 MANAGEMENT
glasses of liquids per day. 1. Stretch your calf muscles, stretching before
bed
MANAGEMENT
2. Stay active. Regular physical activity
1. Exercise daily 3. Stay hydrated. – minerals mingle with water
2. Respond promptly to the urge to defecate 4. Choose proper footwear.
3. Use laxative only as prescribed by a physician
6. RAPID WEIGHT GAIN OR LOSS
4. EDEMA
DIETARY MANAGEMENT
– caused by the pressure of the enlarging
1. Obese
uterus on the veins that return fluid from the
- rapid weight gain may result from excess food
legs.
intake and lack of physical activity.
- No addition of calories and CHON

- Give more on nutrient density rather than  Vitamin A - carrots, egg, pumpkins, spinach,
energy density foods, give complex CHO. green leafy vegetables.
- make your cravings constructive (give them  Salt restricted diet - sodium in salt will stiffen
three basic foods groups) and hardens the blood vessels that aggravates
- eat balanced meals and refuel often congestion of blood pathways.
 normal diet should be given
8. ANEMIA
2. Underweight
 resulted from the deficiencies of iron and folic
- Additional calories and CHON must be
acid
followed.
 very fatal
- Give nutrient – energy density food
DIETARY MANAGEMENT
7. PREGNANCY-INDUCED HYPERTENSION (PIH)
- Iron Supplementation
- or the gestational hypertension in which rapid
- Folic acid Supplementation
weight gain is one of
- Vitamin C Supplementation
- the main causes.
- high blood pressure during pregnancy may 1. Eat foods rich in heme (coming from animals that
cause intrauterine growth restriction. contains haemoglobin so they are highly absorbable) –
Characterized into : liver and eggyolk
 Preeclampsia
 Eclampsia 2. More on dark green leafy vegetable (none heme,
rich in iron but not highly absorbable, can resist
SYMPTOMS: digestion)
 Mild preeclampsia high blood pressure water 9. GESTATIONAL DM

retention protein in the urine.
- may result as temporary response to stress of
SEVERE PREECLAMPSIA OR ECLAMPSIA (doctor will pregnancy and it disappears after the baby is
recommend termination of pregnancy because this born
will lead to death of both mother and baby - temporary if the mother can maintain ideal
body weight, adequate and balanced diet and
Will experience oliguria (stunted urine); dangerous for physical activity, if not the GDM will stay with
this stage the mother
 headaches - hormone made by the placenta such as
 blurred vision estrogen, cortisol, and human placental
 inability to tolerate bright light lactogen can have a blocking effect on insulin
 nausea/vomiting ( contra-insulin effect ) may result to glucose
 urinating small amounts build up in the blood instead of being use by
 pain in the upper right abdomen the cells.
 shortness of breath - fetus is at higher risk of glucose-mediated
 seizures macrosomia.
 Convulsion - Macrosomic child is larger than normal, the
glucose will transfer to the fetus through
DIETARY MANAGEMENT simple diffusion
1. Optimum nutrition
- DIETARY MANAGEMENT
2. CHON – HBV( High Biological Value Proteins )
 Give complex carbohydrates, more in
3. Supplementations
green leafy vegetables
 Fe - dark greeen leafy vegetables
 Avoid foods that are high in glycemic
 Ca - rich foods like dairy products like: milk,
index
curd, soya milk

 HIFIBER diet  in every 100ml of human milk there is a lost of 1.2
 Avoid products that uses added sugar and grams of CHON from the mother
trans fats.  next 6 months, there are complementary food of
the baby, gradually added with solid foods.
ADOLESCENT PREGNANCY 3. MINERAL AND VITAMINS SUPPLEMENTATTIONS
Nutrient deficiencies
 Ca (bones and teeth) , Zn (immunity) and I (milk
1. Vitamins A , D , Folate flow- metabolic purposes)
2. Minerals Fe , Zn , Ca  vitamins A , C (prevent infection and additional
immunity) and B complex (nerve activation)
RISK IN ADOLESCENT PREGNANCY
4. WATER AND OTHER FLUIDS (additional liquid of the
- giving birth to LBW babies, Preterm deliveries milk)
and Severe Neonatal conditions  8L/day ( 3.1 L from beverages and rest from other
- why? sources ).
- Because adolescent mother’s physical and
mental growth, and maturity of personality BREASTFEEDING CONTRAINDICATION
are not completed yet. 1. Breast cancer
- Because the uterus did not reach its full 2. HIV (target the fluid and breastmilk is
maturity and not capable to handle a fluid )
pregnancy. 3. Active TB
- Because adolescent needs to meet their own  Covid 19 will not affect breastmilk
nutrients requirement for their own growth
Problems in breastfeeding
and development.
 inverted nipple
LACTATION  baby has narrow mouth (practice the baby)
 sore nipples (engorgement of breast or not proper
- the period of milk production by the
positioning)
mammary gland.
 baby falls asleep during feeding
- hormones responsible for milk production
 clogged milk duct
 PROGESTERONE – important in production,
development of the mammary gland system TERMS ASSOCIATED WITH BREASTFEEDING
 PROLACTIN – synthesis of milk
1. .Engorgement – overfilling of the breast with
 OXYTOCIN – ejection of milk from the
milk
mammary gland
2. Letdown reflex – the reflex that forces milk to
NUTRITIONAL REQUIREMENT the front of the breast when the infant begins
to nurse.
1. ENERGY
3. Mastitis – infection of a breast
 add 330 kcal /day added to the normal
4. Sucking /rooting reflex – a reflex that causes
requirement
an infant to turn toward whichever cheek is
 if overweight/obese no need for the addition touched in search of a nipple
 NOTE: A healthy mother can produce 25 oz of
milk/day, 25 oz is = to 500 kcal lost/day that
will also have a weight lost of 1 to 2 lbs /
month for the 1st 6 months of lactation
2. CHON
 add 16 grams /day for the 1st 6 mos.

 add 12 grams/day for the next 6 mos.

REFERENCES
“PROF’S PPT ON QUIPPER AND LECTURE”

10 LEC
O9
07
Marieta Hilario 21
NUTRITION IN INFANCY
OUTLINE 3. LIPIDS
I Effects of Sound Nutrition in Infancy - will provide the main source of energy
II Methods of Feeding Infants - contain generous proportion of EFA
A. Breastfeeding
B. Infant Formula Milk 1. LINOLENIC ACID OR OMEGA 3
C. Mixed Feeding 2. LINOLEIC ACID OR OMEGA 6
III Nutrient Content of Breastmilk 3. DHA
IV Immunological Protection of Breastmilk
V Other Potential Benefits of Breastmilk 4. CHON
VI Importance of Complementary Foods at 6 ALPHA - LACTALBUMIN a CHON a human infant can
Months easily digest.
VII Premature Infants
A. Feeding Premature Baby LACTOFERRIN
B. Total Parenteral Nutrition 1. An iron gathering compound that helps absorb iron
C. Indications for TPN into the infant's bloodstream
2. It also acts as an antibacterial agent
Effects of Sound Nutrition in Infancy
5. VITAMINS
1.Promotes normal growth and development.
1. Vitamin D
concentration in breastmilk is low
2. Facilitates academic and physical performance
2. Vitamin C
3.Helps prevent obesity, HD, Cancer and
abundant in supply
degenerative disease in adulthood.
- Early nutrition affect later development.
6. MINERALS
- Early feeding sets the stage for eating habits
1. Calcium
that will influence nutritional status for a
ideal for infant’s bone growth and highly absorbable
lifetime.
Methods of Feeding Infants 2. Sodium

low in sodium
1. BREASTFEEDING
3. Iron
in limited amount but highly absorbable
- breastfeed infants exclusively from 0 to 6
months and add complementary feeding on the 4th or
4. Zinc
6th months while continuing breastfeeding up to 2
highly absorbable due to the presence of a zinc
years and beyond.
binding CHON
1. immature stomach and intestine can digest
milk sugar but not starch. Immunological Protection of Breastmilk
Nutrient Content of Breastmilk 1. Have unsurpassed protection against infection

it has protective factors that includes:
1. ENERGY
has a balance of energy and make the most nearly
a. antiviral agents
perfect food.
b. antibacterial agents
c. other infection inhibitors
2. CHO
2. Contains colostrum
lactose in breastmilk is easily digested and will
a thick yellowish breastmilk
enhance Ca absorption
3. present on the 1st two or 3 days of lactation

4. a pre milk substance containing antibodies 4. Offer protection against the development of
and white blood cells from the mother's CVD.
blood.
5. Have lower blood cholesterol in adult years.
5. Breastmilk also contain:
6. May also have + effects on intelligence later in
1. BIFIDUS FACTORS life.
Bacterium Lactobacillus Bifidus, this favors the

growth of friendly bacteria in the infant’s
intestinal tract. Methods of Feeding Infants
2. LACTADHERIN
A CHON in breastmilk that attacks diarrhea 2. INFANT MILK FORMULA
Causing viruses. 1. Cow’s milk protein-based formulas.
- Most infant formula is made with cow's milk that's
3. Immuno globulins (IgA) a certain kind of CHON that been altered to resemble breast milk.
allows a mother to pass immunity to her baby. -The formula has the right balance of nutrients and
makes the formula easier to digest.
Other Potential Benefits of Breastmilk 2.Soy based formulas.

1.Contain several enzymes and several hormones -Can be useful if you want to exclude animal proteins
from the baby's diet.
a. thyroid hormones -Also be an option for babies who are intolerant or
- Small amounts of triiodothyronine (T3) and allergic to cow's milk formula or to lactose, a
thyroid stimulating hormone (TSH) have been carbohydrate naturally found in cow's milk.
identified in breast milk. Believes to protect a
breastfed newborn from hypothyroidism. 3. Protein hydrolysate formulas.
-These types of formulas contain protein that's been
b. Prostaglandins broken down (hydrolyzed) partially or extensively into
- Hormone that are derived enzymatically smaller sizes than are those in cow's milk and soy
from the fatty acid (arachidonic acid). based formulas.
- immunoreactive prostaglandin were - These are meant for babies who don’t tolerate cow's
detected in all fresh human milk samples, but milk or soy based formulas.
not in cows' milk-based formulas. - Extensively hydrolyzed formulas are an option for
- protect and maintain intestinal epithelial cell babies who have a protein allergy.
integrity in developing babies.
4. Specialized formulas - Are available for premature
c. Enzymes infants and babies who have specific medical
since the pancreas of the baby is still immature the conditions.
following:
Example of Specialized Premature formulas
1. Lipase
LPL (Lipoprotein Lipase) from breastmilk will help milk
fat synthesis
2.Protease from BM will release peptides

-that provides important assistance to digesting milk
proteins.
3. Amylase
amylase from breastmilk is used to digest the CHO in
BM.
3. Protects common illnesses of infancy like:

a. Middle ear infection Three Forms of Infant Formulas
b. Respiratory illness

1. Powdered formula - is the least expensive. Each - might help some babies who need extra nutrition.
scoop of powdered formula must be mixed with - MF is given when mother is away part of the day.
water.
4. Introducing Solid Foods
2. Concentrated liquid formula - this type of formula
also must be mixed with water. 3. Ready to use A.) When to Give Solid Foods
formula. 1. The infant can sit with support.
- is the most convenient type of infant formula. 2. The infant is 4 or 6 months old.
- it doesn't need to be mixed with water.
- it's also the most expensive option. B.) Things to Consider in Giving Solid Foods
1. The infant’s nutrient needs.
3. Ready to use formula. 2. The infant’s physical readiness to handle different
-is the most convenient type of infant formula. kind of foods.
-it doesn't need to be mixed with water. 3. The need to detect and control allergic reaction
-it's also the most expensive option.
C.) Give Foods that will Provide Fe and Vitamin C
1. Cereal that are iron fortified.
INFANT FORMULA STANDARD 2. Meats and nuts alternatives such as legumes.
3. Fruits and vegetables that are rich in vitamin C to
- All infants formulas must meet the nutrient enhance iron absorption.
standards set by the PFDA.
- EO 51 is popularly known as the Philippine Milk Code D.) Dietary Guidelines
of 1986. ( Labeling and Marketing MF) Infants should not eat or drink unpasteurized milk,
- Although manufactures might vary in their formula milk products, raw or undercooked eggs, meat,
recipes, the PFDA requires that all formulas contain selfish, fish and raw bean sprout.
the minimum recommended amount of nutrients that
infants need through Fortification and Enrichment. E.) Feeding Guidelines
1. Feed with love. Will grow more both in height and
1. Fortification weight than babies fed with same food in an
- add extra vitamins and minerals that are not emotionally negative climate.
naturally found in milk in significant amounts. 2. Discourage an acceptable behavior.
- should be added with iron, linolenic acid, vitamins D 3. Let the baby explore and enjoy food.
and E, and taurine. 4. Do not force the food on babies.
5. Limit sweets strictly.
1. Enrichment add amounts of nutrients normally
present in the product or not normally present or that Importance of Complementary Foods at 6
have been removed or lost during processing. Months
- Some infant formulas are enhanced with
docosahexaenoic acid (DHA) and arachidonic acid Starting other foods in addition to breastmilk at 6
(ARA). completed months helps a child to grow well,
- DHA and ARA are for infant eyesight and brain However, giving complementary foods before 6
development. months may increase risk of illness because of less
- Enhanced also with Pre and Probiotic to mimic the consumption of the protective factors in breastmilk. It
immune benefits of BM. may also take the place of breastmilk, making it
- Infant formula is generally recommended until age 1. difficult to meet the nutritional needs of the child. On
- Followed by whole milk until age 2.
the other hand, delaying introduction of
- Reduced fat or skim milk generally isn’t appropriate
complementary food will affect growth and
before age 2 because it doesn’t have enough calories
development and may cause malnutrition since the
or fat to promote early brain development.
child does not receive the nutrients required to meet
Methods of Feeding Infants his growing needs.
3. MIXED FEEDING
- is when the mother supplement breastfeeding with
infant formula.
- milk formula (MF) is given to complement breastmilk WAYS TO INTRODUCE COMPLEMENTARY
if it is insufficient in supply. FOODS

1. Introduce one new food at a time.
Continue with the same food for 3 to 4 What are common food-related problems in infancy?
days.
2. Start with small amounts of any food Colic is the abdominal discomfort caused by
(teaspoonful or less). swallowing air. To prevent colic, the baby should
3. Use thin puree consistency when starting be burped after each feed. Hold the baby next to
solid foods _ Gradually shift to a thicker the shoulder or put the baby on his stomach over
consistency of food with higher nutrient the lap and pat his back until he burps.
density.
4. Never force an infant to eat. Regurgitation is the effortless expulsion of gastric
5. If baby objects to taking some food, mix it contents caused by gastrointestinal reflux. To
with other foods he likes until he becomes minimize regurgitation, position the infant at a 45
accustomed to the flavor- to 60-degree angle after a feed.
6. If after several trials, the baby refuses to eat a
particular food, omit it for a week or two, and Diarrhea is the frequent passage of loose, watery
try again. If the dislike persists, omit entirely and unformed stools. Breastfeeding should be
and substitute with another food of similar continued during the episode. Plenty of fluids, and
nutritional value- if necessary, an oral rehydration solution made
7. Foods may be seasoned slightly. Salt
with table salt and sugar in water or commercial
should not be added to the diet of the
infant before the age of I year, since the preparations such as those given by the health
baby's maturing kidneys cannot handle center, should be provided. Foods such as banana
sodium efficiently. hasten the development of formed stools and may
8. When baby is able to chew, gradually switch be included in the diet if the baby is old enough. A
to finely chopped vegetables, fruits, fish and physician should be consulted if diarrhea
meats. Do not continue soft smooth food for continues for more than a day.
too long.
9. A mother's dislike for a particular food must Food allergy is a hypersensitive state resulting
not reflect in the choice of foods for the baby. from the interaction of an allergen with an
antibody within the body. It may be manifested in
various ways such as diarrhea, skin rashes,
eczema, etc. The offending food should be
eliminated and acceptable substitutes should be
offered. It is best to consult a physician or a health
care-provider if food allergy is suspected.
Can the mother with HIV breastfeed her baby?

Research has shown that exclusive breastfeeding
during the first few months of life carries a lower
risk of HIV transmission than mixed feeding.
For HIV-positive mothers, WHO recommends

exclusive breastfeeding for the first six months
unless replacement feeding is:
1. Acceptable (socially welcome);
2. Feasible (facilities and help are available
to prepare formula);
3. Affordable (formula can be purchased for
six months);
4. Sustainable (feeding can be sustained for six
months); and
5. Safe (formula is prepared with safe water
and in hygienic conditions).

Premature Infants
-are babies who are born too early, before 37weeks of
pregnancy.
-may not be fully developed at birth.

TOTAL PARENTERAL NUTRITION
-infants born earlier (32 to 34 weeks) may have more
health problems and may need to stay in the neonatal - Given to pre terms less than 32 weeks or infants with
intensive care unit (NICU) longer than babies born limited enteral intake.
later. - This method is used when an infant cannot or should
not receive feedings or fluids by mouth and bypasses
-their digestive systems may not be fully developed so the GI.
they may experience feeding difficulties such as: - Used for extremely premature infants or very sick
newborn infants.
1. Problems establishing nipple feedings, at - Nutrients such as glucose, protein, fat solutions,
breast or with the bottle. - because the electrolyte, vitamins and minerals are given directly
sucking reflex is not developed yet, the infant into the baby's bloodstream intravenously.
can't suck and swallow properly.
2.Gastric residuals. INDICATIONS FOR TPN

- occurs when babies don't completely empty
1. Preterm infant < 30 weeks of gestation and
their stomachs from a previous feeding.
< 1000 mg birth weight.
2. Severe IUGR (Intrauterine Growth Restriction)
3. Gastroesophageal reflux
3.Necrotizing Enterocolitis (NEC)
- occurs when a small amount of stomach
4. Gastrointestinal tract anomalies
contents,
NEC a devastating disease that affects mostly the
including stomach acid, refluxes or regurgitates into
intestine of premature infants.
the esophagus.
- the wall of the colon is invaded by bacteria,
- this can be painful to the infant and, when severe,
(clostridium perfringens) which cause local infection
may cause signs of distress such as apnea (a condition
and inflammation that can ultimately destroy the wall
in which a baby temporarily stops breathing).
of the intestine.
- happens when there is low oxygen at birth.
4. Abdominal distension
-is an abnormal enlargement or swelling of
the stomach.
-distension may be a sign of more severe GI
problems.
FEEDING PREMATURE BABY
1. GAVAGE/ ENTERAL TUBE FEEDING

- Given to babies born before weeks 32 to 34 of
pregnancy.
- A feeding tube is used for infants who do not have
the strength or muscle coordination to breastfeed or
drink from a bottle.
- A tube placed through baby’s nose (Nasogastric tube STRATEGIC THRUST FIRST 1000 DAYS
/NGT) or mouth into their stomach.
Under RA 11148, a full slate of health and nutrition
- Breastmilk/ Milk formula is used to feed the baby.
services will be provided from the pre-natal period, to
FEEDING PREMATURE BABY
the immediate postpartum period, the newborn
period and up until children reach two years of age.

The bill also sets a strategy to prioritize mothers and
children in areas with a high prevalence of
undernutrition, as identified by the National
Household Targeting System.
REFERENCES

10 LEC
10
07
Marieta Hilario 21
NUTRITION IN CHILDREN
OUTLINE 1. Kwashiorkor
I Pinggang Pinoy Age Range 2. Marasmus
II Important Role of Nutrition to Preschool 3. Celiac Disease
and School Children 4. Phenylketonuria
III Special Nutritional Concerns During School
Age Years Daily Nutritional Guide Pyramid for Filipino Children
IV The Phsical Activity Pyramid (1-6 years old)
V Kwashiorkor
VI Marasmus
VII Celiac Disease
VIII Phenylketonuria
IX Traffic Light System for PKU food
sources:
Daily Nutritional Guide Pyramid for Filipino Children

(7-12 years old)
(3 to 5 years old)
(6 to 9 years old)
(10 to 12 years old)
Food Pyramid Age Range
(1 to 6 years old)
(7 to 12 years old)
Parents should encourage their child to eat varied diet
that includes:
ImportantPinggang Pinoy AgetoRange
Role of Nutrition Preschool and
School Children 4. A glass of milk daily to meet the need for
calcium, protein and B-vitamins
5. Foods fortified with vitamins (especially
1. Furnishing energy needed for the vigorous activity vitamin A or beta-carotene and vitamin C) and
of this age minerals (especially iron and iodine)
6. A good breakfast each day. The breakfast
2. Helping to maintain resistance to infection meal can be any combination of body-
3. Providing building materials for growth building, energy-giving and regulating foods.
Generally, a good breakfast provides 1/4 to
4. Providing adequate nutrient stores to assist in 1/3 of the RENI of the PDRI 2015
adolescent stage. 7. Nutritious snacks. Children are unable to take
enough food at main meals to meet their
TOPICS
nutrient needs because of the small capacity
1. “Pinggang Pinoy” of their stomachs. During periods of high
2. The physical activity pyramid nutrition needs such as growth spurts, snacks
3. Dietary management are essential. Snacks should be well timed and

given in small portion so as not to lessen the 3. Sweet tooth
appetite for the next meal. Well-planned 1. Although craving for sweets may
school lunch and snacks should provide 1/3 of somehow satisfy a growing body’s
the child’s daily food requirement need for extra calories, sweets may
create an environment favorable for
Special Nutritional Concerns During School Age the growth and development of
Years microorganisms that cause tooth
decay. Sweets should not be taken
For school-age children, common eating problems close to mealtime. In addition,
are: children should be taught to brush
1. Inadequate meals their teeth and wash their mouth
1. Breakfast ideally should provide 1/4 after eating sweet foods.
to 1/3 of the daily nutrient
allowances. Breakfast is often missed
or hurriedly taken.
2. Lunch can also become a dietary
problem when children have to take
their lunch away from home. The
“baon” may be nutritionally
inadequate, unappetizing, boring or
repetitive and “lunch swapping”
among youngsters at schools may be
to the disadvantage of the one who The Physical Activity Pyramid
swaps his well-prepared balanced Cut down on:
lunch for someone else’s meal which
is not nutritious. These problems may 4. Watching TV and videos
be avoided by preparing not only 5. Playing video and computer games
nutritious meals but one that is 6. Sitting for more than 30 minutes
appetizing and easy to eat, and
2-3 times a week:
ensuring a variety of food from day to
day 7. Miniature golf
3. With regard to the problem of hurried 8. Canoeing
meals, sufficient time for meals 9. Swinging
should be allowed by waking children 10. Tumbling
early enough for breakfast and 11. Pull-ups/push-ups
requiring a certain amount of time to 12. Rope climbing
be spent for meals at table 13. Ballet dance
2. Poor appetite 14. Karate
1. Demanding school work, tiring extra-
3-5 times a week:
curricular activities, excitement of
new experiences outside the home 15. Aerobic exercises and recreational activities at
coupled with poor eating practices, least 20 minutes
e.g. consumption of calorie-rich snack 16. Biking swimming
products proving little or no vitamins 17. In-line skating
and minerals, especially close to meal 18. Jump rope
times, are factors that take away a 19. Skateboard
child’s relish for food. Thus, a 20. Running around
balanced program of class work, play 21. Basketball
and rest should form the activities of 22. Soccer
a child. The child should be guided in 23. Relay races
the proper food selection at home 24. Kickball
and in school to encourage good food 25. Skiing
habits. 26. Volleyball

Everyday: 5. Avoid fats or oils from animal sources. These are
associated with excessive amounts of fat in the diet
27. Play outside
leading to bowel and intestinal dysfunction
28. Ride your bike or walk to the store
29. Help around the house 6. Once energy demands are met, proteins are
30. Take the stairs instead of the elevator incorporated into the diet, along with essential
31. Take your dog or brother/sister for a walk vitamin and mineral supplements
32. Pick up your toys
7. Should consume foods containing proteins such as
Dietary Management meat, fish, poultry, eggs, soybeans and legumes. Milk
and milk products are also rich in protein
Causes of kwashiorkor
8. For children suffering from kwashiorkor with
33. Is caused by a diet low in protein lactose-intolerance may need lactase enzyme
34. It can also arise due to infections, parasites, or supplements to digest milk, yogurt and cheese.
other conditions that interfere with protein
absorption from the GI. 9. Give CHONs that are in high quality value such as
35. It is most common in children living in areas lean meats, eggs, white meats and substitutes.
hit by drought and famine
10. Give ready to use therapeutic foods (RUTF) these
36. It can be related to dietary changes due to
have been proven most efficient and effective for
milk allergies in infants, fad diets, poor
treatment of kwashiorkor
nutritional education, or a chaotic home life
1 packet RUTF:
Diets:
HICAL
What is Ready-to-use Therapeutic Food
HICHON
(RUTF)?
Management:
37. An inexpensive mixture of ground peanuts,
1. Calories need to be increased slowly because the powdered milk, sugar, oil, and vitamins and
patient’s diet lacked any significant nutrition for a long minerals.
period 38. Energy-dense and highly nutritious, filled with
micronutrients and antioxidants
2. The child’s diet must be introduced slowly but
39. It needs no cooking or refrigeration
should be fed ad libitum to limit potential problems
40. Best of all, toddlers can eat RUTF in their own
associated with the change in cellular and organ
homes, thus avoiding the need for an
function due to inadequate diet.
expensive stay at a distant hospital. A mother
3. A gradual introduction of carbohydrate foods such or sibling can feed the malnourished child
as fruits, starchy vegetables, breads and cereals to with RUTF as often as eight to ten times a day.
provide calories. 41. Because of all advantages. Leading
organizations – UNICEF, Doctors Without
4. Use soya oil and cotton-seed oil, oil-based Borders, and the World Health Organization –
substitutes as source of fats these will provide have declared RUTF an “essential medicine.”
nutrients and calories from fat that are essential for 42. They advocate that all the world’s
protein synthesis, cost efficient, and also allows for an malnourished children have access to this
increase in the intake of calories revolutionary treatment

43. Gives the child the chance for the normal 50. In children with marasmus, the following can
development of their brains and bodies – and also occur:
the hope for a healthy adulthood 1. Chronic diarrhea
2. Respiratory infections
Marasmus 3. Intellectual disability
4. Stunted growth
51. Seriously malnourished children may look
older and have little to no energy or
enthusiasm for anything
Dietary Management of Maramus

3 Phases of Management
Is a form of severe malnutrition. It can occur in 1. Initial Treatment

anyone who has severe malnutrition, but it usually
- Life threatening problems identified and
occurs in children. You can get marasmus if you have a
treated
severe deficiency of nutrients like calories, proteins,
carbohydrates, vitamins and minerals. - Specific deficiencies/ metabolic
abnormalities corrected
It is more common in developing countries, like in
some areas of Asia and Africa. People in these nations - Feeding begun
are prone to having poor access to food, making it
2. Rehabilitation
difficult to get enough nutrients. A risk of certain
infectious diseases can cause marasmus if left - Intensive feeding
untreated.
- Emotional and Physical stimulation
Causes of Marasmus
- Mother and caregiver training
44. Poor diet – a poor diet that lacks essential
nutrients, may also be at risk of developing 3. Follow – up
marasmus. - Prevention of relapse
45. Food shortages – more common in
developing countries that have high poverty - Assure continued development
and lack of food. These regions also have
frequent famines and natural disasters,
resulting in shortages. Intensive Feeding
46. Insufficient breastfeeding – If mothers are
1. Reintroduction to food should be gradual
malnourished, they are unable to feed their
infants enough milk during breastfeeding - to allow time to reverse adaptations to
47. Infections and diseases are – caused by starvation
viruses, bacteria, parasites, and other
pathogens can cause loss of appetite. This can - because pancreatic digestive enzymes are
lead to low intake of essential nutrients in low
infected children and adults. - because glucokinase levels are low
Symptoms of Marasmus - because hemoglobin levels are low
48. The main symptom of marasmus is being 2. Low CHO diet
underweight. Children with this condition
have lost a lot of muscle mass and - < 40% of TER
subcutaneous fat
- minimizes insulin surge and the resulting
49. Subcutaneous fat is the layer of fat just under
hypokalemia, hypophosphatemia and
the skin. Dry skin and brittle hair are also
hypoglycemia
symptoms of marasmus

3. RUTF 58. Bloating and gas
59. Discolored teeth
4. Follow – up management phase
60. Fatigue
61. Anemia
62. Headaches or migraine
Diet: 63. Itchy skin rash (dermatitis herpetiformis)
HICAL 64. Depression
65. Liver Disease
52. For infants: 66. Constipation
1. (24 to 30 kcal/oz) 67. Anxiety
2. Encourage nutritious, and fortified 68. Tingling numbness
fluids 69. Joint pain
3. To increase nutrient density 70. Infertility
53. For older children: 71. Diarrhea
1. Suggest fruit smoothies using whole
milk and ice cream. Recommended Diet:
2. Refeed the malnourished child with Gluten-Free
caution, monitoring electrolytes,
calcium, magnesium, and 72. Avoid all foods that contain gluten
phosphorous daily or more frequently
Management:
if abnormal.
3. Gradually increase nutrients, and use 73. Wheat, rye, and barley and their products are
small, frequent feedings with not allowed
adequate fluids to ensure hydration
So, as a basic rule, you would need to develop the
4. Monitor intake and output
habit of checking the back labels of items to make
5. Maintain high-nutrient diet until
sure gluten is not found anywhere in the ingredients
weight is appropriate for height
of the food you are buying.
6. Advise family that some nutritional
intervention will be continued until Watch out for stealth gluten, which are not as easy to
appropriate height for age is reached spot.
Celiac Disease Example:
54. Also known as celiac sprue, non-tropical sprue 1. Milo chocolate drink – a malt drink commonly made
or gluten-sensitive enteropathy) is a digestive from barley that has energy giving properties and will
multisystem disorder. enhance flavor and color.
55. A complex immune-mediated disorder, one in
2. Hydrolyzed vegetable protein or hydrolyzed wheat
which the immune system causes damage to
protein, that is used as a flavor enhances in processed
the small bowel when affected people eat
food like soups, gravies, and some meat products like
gluten (a protein in some grains such as
hotdogs.
wheat, barley, and rye)
Symptomatology:
Watch out for bakery products that are made of
wheat such as white bread and whole wheat bread.
Choose variety of alternatives which use other types

of flour, such as brown and white rice flour, and
cassava starch. Breads like these are safe and
available in gluten-free specialty shops.
Signs and Symptoms: Give food items that are naturally gluten free such as
eggs, unprocessed meats, fruits, vegetables, all-
56. Delayed growth in children natural cheeses and dairy, and other starches such as
57. Decreased appetite potato and rice.

Sample 1 day meal plan for Celiac Sprue in children 83. Hyperacidity
with 1,600 kcal/day 84. Intellectual disability
85. Delayed development
86. Behavioral, emotional and social problems
87. Psychiatric disorders
Management:
A.
1. Meat, fish, cheese, eggs and nuts are rich in protein

and therefore phenylalanine, so they are not allowed.
2. Other foods which contain some protein such as

potato, milk and cereals are given in small measured
quantities so that the blood phenylalanine, which is
measured regularly, is kept within safe limits. These
measured foods are spread out between the day’s
meals.
3. Most fruit, some vegetables and salads can be

taken in normal quantities but avoid excess use.
Sugar, jam, syrups, and fats such as butter, lard and
cooking oil can be used freely.
4. As high protein foods cannot be eaten these have

to be replaced by a special protein mixture from
which the phenylalanine has been removed. These
protein substitutes are all available on prescription
and will provide the essential ‘safe’ protein for growth
and development
5. Vitamins and minerals should also be supplemented

Phenylketonuria into the diet. Some protein substitutes include these,
but if they are not, then vitamin and mineral
74. Also known as PKU supplements are available on prescription
75. A disease in which an individual lacks the
6. Specially formulated low protein wheat-based
enzyme Phenylalanine hydroxylase
products are available, including bread, flour, biscuits
76. Without the enzyme necessary to process
phenylalanine (amino acid), a dangerous and pasta. Some of these are available on
buildup can develop prescription, others can be purchased through your
77. High levels of phenylalanine in the blood are pharmacy or at specialist stores.
toxic to brain tissue, and can result in mental
degradation and possible death Traffic Light System for PKU food sources:
Recommended diets:
Red – STOP! Do not eat these foods
LOW CHON
88. Meat – all kinds of round meat, poultry and
PHENYLALANINE-FREE/ RESTRICTED offal
Symptomatology: 89. Fish – all kinds including oily, white and
shellfish and fish products
78. Musty odor in breath, skin or urine 90. Eggs
79. Neurological problems 91. Cheese – all kinds including cheese spreads.
80. Skin rashes 92. Nuts and seeds – beans, peas, legumes
81. Fair skin and blue eyes 93. Wheat products – ordinary bread, flour,
82. Abnormally small head cakes, biscuits, pasta

94. Soya – and soya products 125. Strawberries
95. Aspartame- an artificial sweetener found in 126. Banana
some fizzy drinks, cordials, puddings and 127. Cantaloupe
chewing gums, as well as some tablet and 128. Honeydew
granulated sweeteners. 129. Jackfruit
130. Mango
131. Pear
Amber – Go cautiously! These foods can be eaten in 132. Plum
controlled amounts 133. Watermelon
Basic list of foods with 50mg PHE per exchange- these

items should be measured accurately or weigh food
Vegetables
after cooking unless otherwise stated.
134. Cabbage
96. Potatoes
135. Celery
1. Boiled and mashed 80g
136. Green beans
2. Roast 55g
137. Mushroom
3. Chips – frozen, fresh, oven, 45g
138. Onions
4. Instant mashed potato 10g
139. Pumpkin
97. Broccoli tops, fresh, boiled 30g
140. Tomatoes
98. Brussels sprouts, boiled 35g
141. Carrots
99. Peas – fresh, frozen and petit poise 25g
142. Cucumber
100. Spinach – boiled 25g
143. Leek
101. Sweet corn kernels and baby corn – canned
144. Okra
drained 35g
145. Parsley
102. Corn on the cob – raw 55g (4cm)
146. Radishes
103. Sweet potato – boiled 60g
147. Turnips
104. Avocado – flesh only 55g
148. Cauliflower
105. Cornflakes 15g
149. Eggplant
106. Bran flakes 10g
150. Lettuce
107. Oatmeal (raw) and rolled oats 10g
151. Olives
108. Rice (raw) – white or brown 15g
152. Peppers
109. Rice (boiled) – white or brown 45g
153. Spinach (raw only)
154. Yucca
Green- Go! These foods may be eaten in normal
Miscellaneous
quantities.
Sugar: white, brown, caster, icing; glucose. Jam,
Fruits honey, marmalade, syrup, treacle, boiled sweets,
110. Apple rock, candy, sherbet, barley sugar, candy floss.
111. Blackberries Food essences and colorings:
112. Cherries
113. Grapefruit e.g.
114. Jicama
155. Vanilla, peppermint, almond essence
115. Orange
156. Salt and pepper, herbs and spices, curry
116. Pineapple
powder, vinegar, mustard
117. Raspberries
157. Baking powder, bicarbonate of soda, cream of
118. Apricot
tartar
119. Blueberries
120. Cranberries Special formulated low protein products:
121. Grapes
122. Kiwi 158. low protein bread, flour, biscuits, pasta, etc.
123. Peach Beverages
124. Pumpkin

159. Water, soda water, mineral water, fizzy drinks
e.g.
160. Lemonade, coke, fruit cordial and squash,

instant tea, black coffee, pure fruit juices
Sample 1 day meal plan for PKU – patients
Breakfast
161. Fresh fruits

162. Oatmeal 10g, sugar
163. Protein substitute as prescribed
Mid-morning
164. Sweet potato, boiled 30g and butter

165. Pure fruit juice
Lunch
166. Rice (boiled) white or brown 45g

167. Vegetable soup (vegetable in go traffic list)
168. Fruits in honey
Mid-afternoon
170. Low protein biscuits

171. Marmalade
172. Pure fruit juice
Evening Meal
173. Rice (boiled) white 20g

174. Vegetable salad in olive oil (Go vegetable)
175. Fruits

●
10
Male has higher requirement in terms of basal
Nutrition and Diet Therapy metabolic rate and energy requirement,

compared to female 14
MARIETE HILARIO 21
NUTRITION IN ADOLOESCENCE
OUTLINE
I Nutritional Guidelines for Adolescence
II Adolescence
● Diet: in terms of how they will look, a good
III Nutritional Needs During Adolescence
A Daily Food Guide for Adolescents kind of food, they will look better. They
B Sample Meal Based in Pinggang started to get attraction with the opposite
PInoy for Teens sex, concerned with the outer appearance
IV Additional Reminders ● Are increased because the increased growth
V Nutritional Concerns During Adolescent rate and changes in body composition
VI Overweight and Obesity associated with puberty
A Factors responsible for Obesity ● Male and female adolescents have different
VII Underweight management needs during this crucial time of growth
VIII Anemia ● For teenagers, maintaining a healthy diet will
IX Pre menstrual Syndrome make the person look and feel better
X Adolescent Pregnancy
● Having a proper diet will make one’s skin and
XI Recommendations to improve nutrition
hair healthier and help achieve one’s ideal
among pregnant adolescent
weight.
*green print – prof’s additional input
● Eating right helps them look better, feel
better and stay healthier.
● Teens become stronger and think more
Nutritional Guidelines for Adolescence clearly, thus may even perform better in
sports and get better grades
● The 3 ways to achieve good health and ● They will also be less likely to get depressed or
wellness in Adolescents (nutritional stressed.
guidelines; prevention)
● And how to prevent this rated problems in DAILY FOOD GUIDE FOR ADOLESCENTS
adolescence (minimize the side effects) ● Per serving, not per exchange
● With FEL, 7 group list (Vegetables, fruits, rice,
ADOLESCENCE
milk, meat, fats and sugar), for the rice they 1
● The transitional phase of growth and serving.
development between the childhood and ● 1 serving/cup = 2 exchanges in the FEL
adulthood ● 6-8 serving for (13-15 years old = 6-8 cups
● Age of puberty in which there is growth spurt; meaning to stay there are 12-16 exchanges of
fast growth in terms of physical, mental and rice in adolescents.
psychological ● Not always one serving, one exchange
● Person between the ages of 10 – 19 ● Milk: not all of it are pure milk, it can be
● In our chart, we consider adolescents ages 13- diluted in water. Milk is equivalent to 4
19, but WHO consider age 10 because there tablespoon, not indicated if heaping or not,
are children who are pregnant at 10 years old. not sure of 1 exchange or not
NUTRITIONAL NEEDS DURING ADOLESCENCE ● Veg A and Veg B are combined
● Fruits, the same with 1 exchange
● Increase during growth spurt, growth and ● Fats, the same with 1 exchange
development and puberty ● Sugar, the same with 1 exchange

▪ Desserts are usually creamy and sweet, in
fine dining, last served is the desert
because they can alter the appetite.
▪ Do not eat plenty of high fat and high
sugar food because it can decrease the
appetite.
3. Remember to remain active and exercise or
join a sport.
▪ Exercise and be active, especially
nowadays, we are more in technology and
having virtual class, more on sedentary
activity
4. Get enough rest and sleep
5. Do not smoke and do not drink alcoholic
beverages
Note: Follow the Pinggang Pinoy for teens and these

tips will assure that they will have the adequate
SAMPLE MEAL BASED IN PINGGANG PINOY FOR energy and nutrients to grow to their full potential
TEENS height, be actie, healthy and strong.
- Adapt Pinggang Pinoy, Food Pyramid and

● Body energy giving, body regulating, body
Food guide
building should be present
- Pinggang pinoy: what are the right kinds of
food to eat; go, grow and glow
- Food Pyramid: what are the right amount to
eat; drink a lot, eat more, eat most, eat a
little, eat moderately
SPECIAL NUTRITIONAL CONCERNS DURING

PUBERTY AND ADOLESCENCE
NUTRITIONAL CONCERNS DURING ADOLESCENCE
1. UNDERWEIGHT, OVERWEIGHT, AND OBESITY

● Maybe due to eating disorders, inappropriate
food patterns like skipping meals, use of
Some additional reminders to ensure teen’s alcohol and drugs
overall health and well-being: ● May resort to the practice of food pads/fat
diets
1. Eat regular meals, especially breakfast. This ● Fad diets are alluring, especially for teenagers
keeps the body fueled and will give the energy who are having a hard time to maintain their
needed for the day. figure since they are starting to get attracted
▪ Do not skip meals, eat regular meals, to an opposite sex and they become more
especially breakfast. concert about their outer appearance
2. Cut down on high fat and high sugar foods. 2. ANEMIA
One doesn’t have to give up one’s favourite - Not only in our country but globally,
cookies or cheeseburger. Just eat them less especially in developing countries
and eat healthy snacks 3. PMS
▪ It does not mean you will omit, you can 4. ADOLESCENT PREGNANCY
still have it but you have to prioritize the
nutritious food

⮚ Hormonal imbalance will lead you to
obesity and obesity will also lead you
to hormonal imbalance
OVERWEIGHT AND OBESITY - Drugs
- Tobacco and alcohol
OVERWEIGHT: A person may be overweight from
extra muscle, bone, or water, as well as having too
much fat.
⮚ Overweight is usually due to drinking water ENERGY BALANCE

- This is the equilibrium between energy
OBESITY: This is a state in which there is a generalized intake and energy needs. To maintain a
accumulation of excessive fat in adipose tissue in the healthy body weight, it is important to
body leading to more than 20% of desirable weight maintain energy balance at a level
compatible with health and well-being.
⮚ The more fats you have, the more storage for
fats you have INDICATORS FOR UNDERWEIGHT/OVERWEIGHT/
⮚ Fat storage are accommodating OBESITY
⮚ Obesity has a lot of adverse effects, especially
chronic diseases that is why WHO considered For children: weight for age
is a “double burden” (the amount of obese For teenagers: calories for age (growth and
people are also increasing, unlike before that development)
people were much focused on the For adults: weight for height (desirable body weight
based on height)
overweight)
For elders: based on the physical activity
FACTORS RESPONSIBLE FOR OBESITY
1. Weight for Age
2. BMI
What you eat and drink is energy intake. What you
3. Waist to Hip Ration (WHR)
burn through physical activity is energy expenditure.
4. Weight Circumference
⮚ When you burn these foods for
physiological needs or processes like NNC GOVERNING BOARD
Resolution No. 4, Series of 2018
digestion that requires energy, it is
ADOPTING THE NNC POLICY STATEMENT ON FAD
basal metabolism or basal metabolic
DIETS
rate
- RESOLVED FURTHER and to ensure that
- Inactive lifestyle
this policy statement is disseminated as
- Gene and family history
widely as possible to the general public,
- Junk food and over eating
practitioners and health and nutrition
⮚ The more you eat fatty foods and
workers and those in the medical and
salty foods, it will stimulate your
allied professions; and its dissemination
appetite (fatty acids make our foods
monitored and reported to the Governing
palatable and palatable enhances
Board
one’s appetite that leads to
overeating)
1. Fad diets are not recommended for weight
- Psychological
loss as it may pose potential risk and dangers.
⮚ Stress is the root cause of all diseases
2. Instead, the NNC recommends the adherence
- Environmental causes
to a holistic, sustainable, adequate, and
- Diseases
nutritionally-balanced diet, complemented by
an active lifestyle and lifelong behavioral
modifications.

- Balance diet DEFINITION PREMISE
- Active lifestyle - Primarily developed as treatment for
- Self-discipline epileptic children
- A hight-fat, low-carb diet, in which dietary
and body fat is converted into energy
-
POSITIVE IMPACT/ADVANTAGE
SOME FAD DIETS
- May show promising results for weight
⮚ They are not really bad, they are
loss, blood glucose control, and decrease
designed as therapeutic diet for a
in lipid blood values
specific disease condition
- Increased satiety due to high-fat
VERY LOW ENERGY DIET (VLED) consumption
NEGATIVE IMPACT/DISADVANTAGE
DIET
- Multiple complications such: Metabolic
- Very Low Energy Diet (VLED)
acidosis, Diabetic ketoacidosis with SGLT2
⮚ “Crash diet” (intended for obese with
inhibitors, fatty liver, liver toxicity,
BMI more than 30)
gallstones, acute pancreatitis
Definition Premise
- Severely low blood sugar, blood
- A diet with extremely low daily food
potassium levels
energy consumption
- “Keto flue”, fatigue, headache, fever
- It allows 800 kcal/day or less
- Kidney stones (Nephrolithiasis,
- Also known as “Crash diet”
hypercalcurcia, hypocitraturia, renal
- Primarily intended for obese with BMI >
damage)
30 for those with risk factors
- Bone health impairment
POSTIVE IMPACT/ADVANTAGE
- Results to rapid weight loss (about 1.5-2.5 - Increased bad cholesterol (HDL
kl/wk) Cholesterol) levels
NEGATIVE IMPACT/DISADVANTAGE - Cardiac – heart rhythm problems, dilated
- Requires medical supervision cardiomyopathy arterial stiffnesss
- Often replaces food with low calories - Macronutrients deficiencies
shakes and other meal replacements - Brain impairment
- Can encourage binge- eating and - Nausea, vomiting, constipation
overeating due to restriction - Bad breath
- Difficulty transitioning to regular meals - Leg cramps
once weight loss is achieved ZONE DIET
KETOGENIC/ ATKIN’S DIET DIET
DIET - Zone Diet – moderate carbohydrates/high
- Ketogenic Diet/Atkin’s Diet Protein diet
⮚ This is not recommended without a ⮚ Sometimes abused since people who
prescription because this is merely don’t eat vegetables only rely on
designed for epileptic children meats and beverages
⮚ Very effective in losing weight but is ⮚ They indulge in drinking soda and
not intended for people who have no alcoholic beverages without protein
epilepsy foods
⮚ Food intake should be high in fat but ⮚ One should have cereal, boiled
it should come from MUFA, PUFA, or camote, boiled banana and etc. with
the healthy kind of fats (not from the meat because if carbohydrates
trans fats and saturated fats) are not included in the foods you

consume, there is a chance of alternative nutrients is adequate and a
developing ketosis small provision is reserved for additional
nutrients to endure the short length of
DEFINITION/PREMISE leanness.
- Specifies the consumption of calories
form carbohydrates and protein in a
specified ratio; recommending eating five
times a day to make a sense of satiety ▪ Intermittent fasting – no food after 6 pm.
that discourages overeating ▪ Mediterranean diet – ancestral diet, more on
whole grain cereal, fruits and vegetables.
POSITIVE IMPACT/ADVANTAGE (parang vegetarian diet)
- May have anti-inflammatory benefits
Overweight/ Obesity Management
NEGATIVE IMPACT/DISADVANTAGE Aim to lose 1 to 2 pounds (0.5 to 1 kilogram) a week
- Achieving macronutrient is challenging through a lower calorie diet and regular physical
- Costly activity.
- Frequent eating may not promote fat
1. Deduct 500 kcal for Obese and 250 for
burning
overweight kcal from the normal TER/day
WATER FASTING - To loss 500 to 1,000
DIET calories/day, through a
lower calorie diet
Water Fasting
2. Change diet gradually
● Definition/Premise consuming only water for 3. Buy less meat and fatty foods. Eat fish at least
an extended period of time. 1 or 2x a week
▪ In the morning – once ka lang kakain in a 4. Try to have more servings of fruits and
day ng whole meal. Usually tea, high fiber vegetables per meal
tea 5. Read the food labels, many foods have hidden
▪ Lunch – whole meal quantities of fats
6. Choose whole grains to get added nutrients as
POSITIVE IMPACT/ADVANTAGE vitamin B
▪ shown to preserve a greater portion of 7. If you crave sweets, try eating dry foods such
lean body mass during weight loss as raisins or fresh fruits
8. Take nuts for added potassium, fiber and zinc
NEGATIVE IMPACT/DISADVANTAGE 9. Cut down on high calorie foods and poor
● require drastic changes to eating patterns sources of nutrients
- May result in hyperphagia (marami na ang 10. Choose foods that have been baked or broiled
nakakain mo) 11. Eat slowly and chew your foods thoroughly
- Poor adherence
- Nutrient deficiencies
- psychologically it will affect you B.) Active Lifestyle – regular physical activity
NNC recommends the adherence to a holistic, ● is defined by WHO as the bodily

sustainable, adequate and nutritionally-balanced movement produced by skeletal muscles
diet, complemented by an active lifestyle and that requires energy expenditure.
lifelong behavioral modifications. ● the goal is to burn or expend more energy
from PA and exercise that what is being
A.) Nutritionally-balance diet taken from food. The greater the energy
deficit created by exercise, the greater the
▪ Is a diet that contains different kinds of fat loss.
foods in certain quantities and ● All children and adults should set a goal
proportions so that the requirement for according to WHO.
calories, proteins, minerals, vitamins and

- PHYSICAL ACTIVITY – is a key determinant of ● Example; 1. Get up to change the TV
energy expenditure and thus is fundamental to energy channel instead of using the remote
balance and weight control. control
● Example 2: Take the stairs instead of
the elevator or escalator.
TYPE OF PHYSICAL ACTIVITY
1. Aerobic Exercise – requires the use of lung

muscle or dependent on oxygen for air.
Example are:
● brisk walking, taking a bicycle ride outdoor or

using a stationary bicycle indoor, jumping
jack
For maintenance: 30 minutes/day, at least 5 times a

day (kung ang DBW mo ay nasa normal da, then e
maintain nalang 30 minutes every day.)
To lose weight: 60 minutes/day

*weight lifting (vigorous effort) = 440, 380
To start-up: 5 to 10 minute per day, then add more
minutes/week ● Kung 5’2 ka and then supposed to be you are
52 kg, your Desirable Body Weight is to be 70
kg, then you will do the activities here. You
2. Strength Training – include muscle and will lose the calores per hour.
bone strengthening activities such as; *Heavy yard work (chopping wood) = 440, 380
push-ups, sit-ups, lifting weights, climbing
stairs, digging in the garden, running and ● Mas lesser kung hindi masyado Malaki yung
jumping rope. pinagtaba. If overweight ka lang, ito ang ma
● Feet, legs or arms support your body’s loss mo.
weight and your muscles push against
your bones. This will make bones
stronger. (sa mga severely obese na C.) Behavioral Modification
mga teenager na may history of ● usually seeks to extinguish, or stop an
hypertension then this activity can be
unwanted behavior and replace that behavior
recommended) with a desired behavior.
3. Flexibility Exercise – also called stretching,
● Aims at reducing caloric intake, increasing
is a form of exercise that target muscle by
physical activity, and expanding your
elongating them to their fullest length. nutrition knowledge and food choices.
● Lowers stress and help bones flexible ● (kung tamad ka noon, wag na maging tamad
and reduce chances of injury during
ngayon. Purpose is just to brainwash your
exercise.
mind, na kailangan mo magbawas ng timbang
● Gentle stretching for 5 to 10 minutes for wellness.)
help the body warm up and get ready
for aerobics activities and to cool Motivation:
down after an activity. (usually
Positive reinforcement
ginagawa after waking up in the
morning) ● Example – if you will wake up at 6 am to do
4. Work or Lifestyle Activities – to add your 30minute exercise per day. I will buy the
formal exercise, doing this activity can shoes that you want.
keep you active throughout the day.
Negative reinforcement (based on the survey ito ang
● Being extra active can increase the
pinaka effective)
number of calories you burn.

● Example – if you will not wake up early and and nutrients necessary for weight gain and
will not do your 30minute exercise per day, I body repair.
will deduct your allowance by 15%. 6. Enjoy milk and fruit juices. This can subtly
increase your energy intake.
D.) Pharmacological Treatment 7. Observe an exercise routine. Strength training
primarily can foster muscle build-up.
● Sibutramine and Orlistat are the only 2
8. Do exercise before a meal to stimulate
medications currently approved for long term peristalsis and appetite. Remember to
treatment of obesity. One reduces food increase energy intake to support exercise.
intake; the other reduces nutrient absorption. 9. Always include a variety of foods from the 3
It is imperative to consult a physician before basic food groups.
taking any medication. 10. Seek a medical expert for underlying
● Doctor’s advice or prescription before taking conditions which may inhibit your body to
synthetic reducing pill. gain weight.
E.) Surgical Treatment
● Surgical procedures effectively limit food ANEMIA

intake by reducing the capacity of the ● Is currently one of the most common and
stomach and also suppress hunger by intractable nutritional problems globally. It is
reducing the production of the hormone a global public health problem that affects
Ghrelin. Ghrelin termed as “hunger hormone” both developing and developed countries
stimulates the appetite, increases food intake with major consequences for human health as
and promotes fats storage. well as social and economic development.
● only given to those have a very high risks of ● Many more adolescents are in fact suffering
cardiovascular disease, renal disease, or major from iron deficiency (ID) with its adverse
organs affected then the doctor will advice effects on health and physical stamina.
this, but at the moment kasi hindi na siya for
Adolescents are at a high risk of Anemia due to:
medical purposes, although its still healthy
purposes but its overuse because of aesthetic 1. Accelerated increase in requirements for iron
purposes. (especially for girls because of menarche, and
for men because of their activities and they
UNDERWEIGHT MANAGEMENT are more active than female teenagers)
2. Low dietary intake by adolescents and bio-
● mahirap especially sa mga taong may
availability of iron consumed against the
hypothyroidism kasi kapag meron nito the
significant increase in requirements. (iron is
metabolism is fast so there is a tendency that very sensitive with water and heat, especially
hindi sila tataba. Before they go into food- vitamin C which is the enhancer of the iron.
based resort, they have to go to the doctor to Vitamin C is so sensitive with heat kaya bawal
threat their hypothyroidism before they ang kalamansi juice sa mainit na tubig ilagay
consult for their diet. kasi mawawala ang vitamin C content)
3. Adolescent pregnancy
1. Add 500 kcal for severely underweight and 4. Frequent infectious diseases and parasitic
250 kcal for moderately underweight to the infections (parasites in the stomach, they
normal TER/day. have to be deworm first before they will given
2. Focus on energy-dense food. Select foods supplements with iron)
with MUFA and PUFA. Consequences of iron deficiency (ID)
3. Avoid sweets and fatty foods before the main
meals as these may lessen appetite for more ● Iron deficiency adversely affects
nutritious foods. ( because sweet and fatty attentiveness, memory and school
foods will stay long in the intestine kaya performance of adolescents, their school
matagal magutom) attendance and retention, physical growth
4. Increase serving portions gradually. This will and onset of menarche, immune status and
offer time to the person to adjust.
morbidity from infections, physical capacity
5. Take regular meals and snacks. This ill give
and work performance.
opportunity for the body to receive calories

● Specifically iron deficiency anemia during ● PMS symptoms go away within a few days
pregnancy increases fetal morbidity and after a woman’s period starts as hormone
mortality, increases perinatal risks for levels begin rising again.
mothers and neonates, incidence of low birth ● Some women get their periods without any
weight (LBW), increases overall infant signs of PMS or only very mild symptoms.
mortality. ● For others, PMS symptoms may be so severe
that it makes it hard to do everyday activities
Interventions to prevent and correct iron deficiency like go to work or school. Severe PMS
and IDA symptoms may be sign of premenstrual
dysphoric disorder (PMDD).
● Food-based approaches to increase iron ● PMS goes away when you no longer get a
intake through food fortification and dietary period, such as after menopause and after
diversification are important sustainable pregnancy. PMS might come back, but you
strategies for preventing iron deficiency and might have different symptoms. (according
IDA in the general population. daw to researchers, ang cause nang PMS is
the short production of estrogen and
Food-based approaches is the most difficult to progesterone because these two hormones
disseminate to the public because usually the mother are just available abundantly during
of filipino’s family kapag sinabihan na they have to pregnancy.)
give their teenagers this kind of food their usual Premenstrual Dysphoric Disorder (PMDD)
reason is poverty, walang budget for that)
● Is a health problem that is similar to (PMS) but
Choose iron-rich foods: is more serious.
● Causes severe irritability, depression, or
● Red meat, pork and poultry, seafoods
anxiety in the week or two before your period
● Beans, dark green leafy vegetables, such as
starts.
malunggay/saluyot
● Symptoms usually go away two to three days
● Dried fruit, such as raisins and apricots
after your period starts.
● Iron-fortified cereals, breads and pastas
● Peas PMS may happen more often in women who:
Iron supplementation ● Have high level of stress

● Have a family history of depression
Since it is difficult to influence dietary due to social
● Have a personal history of either postpartum
reasons and poverty, it is proposed jointly by
depression or depression.
UNICEF/WHO that in countries where anemia
prevalence exceeds 40% in pregnant women, Cause of PMS
provision of universal iron supplements for adolescent
● Researchers do not know exactly what causes
girls (at a minimum for those aged 12 to 16 years) and
PMS.
women of child bearing age is necessary.
● Changes in hormone levels during the
Iron-folic acid supplements are cost-effective and menstrual cycle may play a role.
positive results are evident in a short period of a few ● These changing hormone levels may affect
months. some women more than others.
PREMENSTRUAL SYNDROME PHYSICAL SYMPTOMS OF PMS
● (more on women)
● Is a combination of physical and emotional ⮚ Swollen or tender breasts
symptoms that many women get after ⮚ Constipation or diarrhea
ovulation and before the start of their ⮚ Bloating or a gassy feeling
menstrual period. (not all teenagers in women ⮚ Cramping
experience this) ⮚ Headache or backache
● Researchers think that PMS happens in the
days after ovulation because estrogen and
⮚ Clumsiness
progesterone levels begin falling dramatically ⮚ Lower tolerance for noise or light
if you are not pregnant.
EMOTIONAL OR MENTAL SYMPTOMS OF PMS

⮚ Irritability or hostile behavior - Helps with PMS symptoms including
⮚ Feeling tired moodiness, irritability, forgetfulness,
⮚ Sleep problems (too much or too little) bloating, and anxiety
⮚ Appetite changes or food cravings - Take it as a dietary supplement
⮚ Trouble with concentration or memory - sources: fish, poultry, potatoes,
⮚ Tension or anxiety fortified cereals, fruits (except for
⮚ Depression, feelings of sadness, or crying citrus fruits
spells MAGNESIUM
⮚ Mood swings
- May help relieve some PMS symptoms
PMS MANAGEMENT
including migraine
⮚ Get regular aerobic physical activity - sources: leafy vegetables, spinach,
throughout the month nuts, whole grain, fortified cereal
- Exercise can help with symptoms such
POLYUNSATURATED FATTY ACIDS (OMEGA-3
as depression, difficulty concentrating,
AND OMEGA-6)
and fatigue
⮚ Choose healthy foods most of the time
- Take a supplement with 1-2 grams of
- Avoiding foods and drinks with
PFA to reduce cramps and other PMS
caffeine, salt, and sugar in the two
symptoms
weeks before your period may lessen
- Sources: flaxseed, nuts, fish, green
many PMS symptoms
leafy vegetables
⮚ Get enough sleep
- For cramps
- Try to get about eight hours of sleep
each night ADOLESCENT PREGNANCY
- Lack of sleep is linked to depression
● adolescent pregnancies are more likely to
and anxiety and can make PMS
occur in marginalized communities,
symptoms such as moodiness worse
commonly driven by (according to WHO)
⮚ Find healthy ways to cope with stress
poverty, lack of education, and
- Talk to your friends or write in a
employment opportunities
journal
● motherhood is valued
- Yoga, massage, and meditation are
● marriage or union and childbearing may
also helpful
be the best of the limited options
⮚ Do not smoke
available ; and pregnant
- In one large study, women who
● additional cause of unintended pregnancy
smoked reported more and worse
is sexual violence (which is widespread
PMS symptoms than women who did
with more than a third of girls in some
not smoke
countries reporting that their first sexual
CALCIUM encounter was coerced)
- Helps reduce some PMS symptoms
SOCIAL AND ECONOMIC CONSEQUENCES
such as fatigue, cravings, and
depression - social consequences for unmarried
- Take calcium supplement pregnant adolescents may include
- sources: milk, cheese, yogurt, cereal, stigma, rejection, or violence (to save
bread, orange juice shame, they should be married to
have no disgrace) by partners,
parents, and peers
- girls who become pregnant before the
VITAMIN B6
age of 18 are more likely to experience

violence within a marriage or agencies are tasked to assist youth councils in
partnership implementing programs aimed at educating the
youth adolescent sexual and reproductive health,
providing youth-friendly and rights-based
WHO RESPONSES measures, formulating retention strategies, and
following-up on pregnant girls or young mothers
- the global programs can be achieved
with the application of good science
(reproductive health; contraceptive
pills or drugs or thing that will hinder
pregnancy, but not jeopardized (1) Focus on foods, not nutrients
reproductive system)(contraceptive or - focus on food sources, not the
pills) combined with strong leadership nutrient itself
(strong governance; supported with - focus on what food that you need to
rules and regulations of the country), eat
management, and perseverance (2) Individualize and work within the
pregnant adolescent’s current eating
STATISTICS BASED ON 2019 habits
The Philippines has recorded a total of 180,916 - Give them the right food
live births among adolescents aged 10 to 19 in (3) Consider the context of family and peer
2019, according to the data from the Civil groups
Registration and Vital Statistics System of the (4) Reward efforts
Philippine Statistics Authority. The figure is - Motivate the mother to eat nutritious
equivalent to 495 live births per day in the 10 to foods for the baby; “it is for your
19 age group baby”
(5) Make it easy
President Rodrigo Duterte
- Effort wise, time wise and money wise
- Has declared the prevention of - Be wise
teenage pregnancies as a “national (6) Focus on weight gain patterns for optimal
priority” birth outcomes
- He made the decision as he - The mother has to gain weight for the
acknowledged that childbearing in baby, the placenta, the amniotic fluid
adolescences carries increased risk of (7) Refer to a dietician, as needed
health problems for both mother and - Seek professional help if the situation
child such as anemia, sexually is not easy to handle anymore
transmitted infections, and
postpartum haemorrhage
REFERENCES
UNDER EXECUTIVE ORDER (EO) 141 ISSUED ON
JUNE 25
- stressed the need to implement

measures that will address the root
causes of the rising number of
adolescent pregnancies
The Human Development and Poverty Reduction

(HPDR) Cabinet Cluster and other relevant

10 L E C
Nutrition and Diet Therapy 28
Marieta Hilario 21 12
NUTRITION IN ELDERLY
OUTLINE
I Introduction
II Biological factors that have a big impact in their  Elders' appetites can change as they get
Nutrition older.
III Life expectancy and life longevity
IV Factors to Achieve Life Expectancy
 As they aged, their body digest slows down
V Factors Affecting Longevity
VI Healthy aging for Lolo and Lola
 Basal metabolic rate = slow
A NNC 3 steps
VII Daily Food Guide
 Low calorie requirement
VIII Nutritional Concerns in Elderly
1 Cataract
2 Macular Degeneration (MD)
 Senses and smell change as they age; make
3 Arthritis their eating less enjoyable for them
4 Senile Dementia
LIFE EXPECTANCY AND LIFE LONGEVITY
 Longevity - long duration of life (that why we
INTRODUCTION eat health/ do healthy lifestyle to live
according to what we expect)
 OLD AGE is the closing period in the life span,  Life expectancy - the average number of years
it is a period when people ”move away” from live by people in a given society. Filipinos' life
previous more desirable periods or times of expectancy is up to 71 years old.
“usefulness” o Based on the survey, filipinos life
expectancy is up to 71-75 years old
 During this time they should be given
recognition
 *early old age - 60 to 70 years FACTORS TO ACHIEVE LIFE EXPECTANCY
 *advanced old age - 70 to the end of life 1. Sleeping regularly and adequately
 Elders (a person of authority// we come to  At least 6-8 hours a day
them to ask for advice ) desire a life with good  As you grow older, short term and
health, dignity, economic independence and frequent sleep (wake up 2 hours then
finally a peaceful death sleep again)
 Understanding their needs and concerns, will 2. Eating a well-balanced meals, including eating
ensure their good health breakfast regularly
 Skipping breakfast contributes to
 Lending an emotional support to the elders
alzheimer's disease
keep them jovial (happy = can increase their
3. Maintaining a healthy body weight
lifespan), which is inevitably the ideal way to  Pregnancy up to elderly: maintain
live a healthy life healthy body weight
 Desirable body weight for your height
BIOLOGICAL FACTORS THAT HAVE A BIG IMPACT IN and age
THEIR NUTRITION 4. Engaging in regular physical activity
 To achieve number 3, you have to
1. Age engage with physical activity
2. Gender 5. No to smoking
3. Growth  No vices like smoking & alcohol
4. Disease states 6. No alcohol or use it moderately
5. Genetic makeup  2 drinks for men, 1 drink for women

FACTORS AFFECTING LONGEVITY HEALTHY AGING FOR LOLO AND LOLA
1. Heredity 3 NNC STEPS:
 Lifespan determined by the genes we
inherit from the parents 3 steps are the factors that will contribute life long
 Although you have longevity in your longevity
genes if you do not have a healthy 1. Follow the pinggang pinoy for elderly persons
lifestyle your genes will still not gonna  Go grow glow sources of food
cope.  Food pyramid
 Time of conception and until you’ll 2. Drink lots of water daily for adequate
aged hydration
 Indulge in proper diet and healthy 3. Be physically active at least 30 minutes daily
lifestyle
 NO VICES
2. Healthy lifestyle
a. Nutrition
 Mediterranean diet more on fruits and
vegetables, whole grains and nuts,
healthy fats
 Limitation in sugar, red meats and
processed foods
 i.e. in America geriatric patients
usually consume a Mediterranean DAILY FOOD GUIDE
diet
 foods are blended or pureed or
chopped up into small pieces to make
sure they do not choke
 Diet modified in consistency - foods
are modified not only in terms of
nutrient content, but also how solid,
soft, and loosen the consistency of
the food.
 Foods are reduce into smaller
portions to avoid choking: mashed etc
b. Physical activity
 Scheduled morning exercises
c. Emotional management
 Group sharing - should have
moderator as they tend to go beyond
the limit
3. Socio economic status (SES)

 Problems of filipino elders
 More dependent especially financial
 Stay at home and family will take
good care of them  Rice: 1 serving = 1 cup: 2 exchanges per
serving
4. Spiritual well being o 60-69 years: 4-5 ½
 Spiritual belief are not JOKE o 70 years and over: 3 ½ - 4 ½
 Helped in many ways o Decrease BMR as they grow old
 People with strong religious belief because of decrease digestion process
recovery immediately in surgery  Fish: 1 serving: 2 exchanges or 1 serving: 1 ex
 Less anxious and depressed depending on the type
 Low bp
o 60-69 years: 4 ½ - 5
 Cope better with chronic illnesses
o 70 and older: 5 -6
 Milk for calcium purposes (bones & teeth)

o 1 cup 3. Aerobic activity and strength training
 Vegetables - constipation because of slow  for the improvement in physical
BMR and peristaltic movement activity and help reduce weight.
 avoid fried foods, processed foods
 Refer to the table above and sugary snacks and soft drinks, all
of which appear to be associated with
NUTRITIONAL CONCERNS IN ELDERLY an increased risk of cataracts, as well
as obesity and other health problems.
 Physical activity will reduce weight
CATARACT
 To prevent obesity and cataract to
 AMD happen
 Senile Cataract  Sugar should be occasional
 Looks like cloudy covering
MACULAR DEGENERATION
 High in sugars especially mannitol in the eyes
 Characterized by gradual progressive clouding  Aged macular degeneration
and thickening of the lens of the eye  is an eye disease that occurs with aging.
 Facts:  Is when the macula (center part) of the retina
o Cause by oxidative stress (an (back part) declines or becomes damaged
imbalance between free radicals and  The macula helps you see images in sharp
antioxidants in your body) detail
o Can also be acquired from: exposure  When the macula becomes damaged, it
to UVL, toxic substances, injury, viral causes blurring or loss of vision in the center
infection, genetic disorder, other
of your eyesight
trauma
o Long term obesity can also cause
cataract CAUSES OF MD
 obesity ‘s longer term 1. The exact cause of MD is unknown
complication is diabetes  They conclude that one of the causes
 Diabetes long term is the deficiency of nutrients or
complication: retinopathy substances needed for growth and
related to cataract vision
2. MD may occur when the retina does not get
enough nutrients (substances needed for
growth)
 Decreased nutrients cause the
supporting tissues of the retina to
breakdown and waste material to
collect
 The damaged tissues and waste
material cause drusen (accumulation
of debri in the retina ) to form under
the retina
 The light-sensitive cells of the eyes
DIETARY MANAGEMENT (CATARACT) are then injured causing blurring the
center part of your sight
1. Consistently follow a healthy diet, that is rich 3. AMD (aged related - macular degeneration)
in antioxidants and phytochemicals in colorful  Wear and tear disease of retina
fruits, vegetables and whole grains - this will
minimize the damage and decreased risk of 2 TYPES OF MD
cataracts.
2. Give foods rich in carotenoids, vitamin C and  DRY MD
vitamin E o the most common and slowly causes
 this will prevent early onset of mild vision loss
cataract o Can sometimes turn into the wet form
 Vit A: eye sight/ vision of MD
 Vit C and E: protection against free  WET MD
radicals

o More severe and can quickly damage  Usually involves inflammation or
your vision degeneration (breakdown) of the joints. These
o Occurs when new, abnormal blood changes can cause pain when the joint is use
vessels grow in your retina  Arthritis is most common in the ff areas of the
o The blood vessels may break open, body: feet, hands, hips, knees, lower back
causing blood to leak out  Cause: degenerate of articular cartilage and
o Small scars may also form synovial membrane
o Volume of blood in the retina
IMPORTANT FACTORS OF THE JOINTS

DIETARY MANAGEMENT (MD)  Joints get cushioned and supported by soft
tissues that prevent the bones from rubbing
 Eat fish and a variety of dark, leafy
against each other
vegetables
 A connective tissue called articular cartilage,
o These foods support healthy eyes and
may help slow the progression of the helps joints move smoothly without friction or
symptoms. pain
o Diet rich in anti-inflammatory and  Serves as cushion
anti-oxidant rich foods such as fruits,  Some joints have a synovial membrane, a
vegetables, whole grains, nuts, seeds, padded socket of fluid that lubricates the
fatty fish, and oils, is associated with joints
decreasing risk and progression.  If mawala na yung mga cartilage and synovial
o Darker vegetable, higher vit A membrane, bone to bone will rub to each
 Vitamins A(vision), C, and E (anti other causing arthritis
inflammatory)
o Most effective vitamins for reducing
the risk of macular degeneration
o Only vitamin A plays an essential role
in the human retinal pigment
epithelial cells, whereas vitamins C
and E are known to act as
antioxidants
o Vit A - prevention and reducing the
progress of cataract or MD MOST COMMON TYPES IN THE ELDERLY
o C & E - anti inflammatory
 Do not smoke  Osteoarthritis
o Nicotine and other chemicals in o Wear and tear arthritis
cigarettes and cigars can make MD o Do not smoke Develops when joint
worse cartilage breaks down from repeated
 Improve the lighting in your home stress
o Increase the amount of light in your o Most common form
home to help you see objects better
 Protect your eyes from the sun  Ankylosing spondylitis
o Always wear sunglasses with o Arthritis of the spine usually your
ultraviolet (UV) protection lenses to lower back
protect your eyes when outdoors to o Use up of pelvic bones
avoid direct sunlight o Common in women
 Get regular eye exams o Workers lifting heavy items everyday
o Adults age 40 to 64 should have an o In lifting, bend your knees before
eye exam every 2 to 4 years carrying heavy items and one foot at
o Adults age 65 and older should get an the front and one foot for the back to
eye exam every 1 to 2 years support the weight
ARTHRITIS
 Gout
o A disease that causes hard crystals of
 A disease that affects the joints (areas where uric acid to form in your joints
the bones meet and move)

o Deterioration of synovial membrane o Advise the caregivers to read food
and cartilage labels and nutrition facts
o From the diet o Can trigger or worsen inflammation
o Aggravated by purine rich foods - will and are very bad for the
break off uric acid cardiovascular health
o Avoid processed foods such as
 Psoriatic arthritis cookies, crackers, doughnuts and fast
o Joint inflammation that develops in food
people with psoriasis (autoimmune o On labels, they are referred to as
disorder that causes skin irritation) “partially hydrogenated vegetable
oils”
 Rheumatoid arthritis  Gluten
o Disease that causes the immune o Protein found in many grains,
system to attack synovial membranes including wheat, barley, and rye
in your joints  Proteins are gliadin and
glutenin
CAUSE OF ARTHRITIS  Celiac disease do not have an
enzyme that can digest these
 The exact cause is unknown
types
 Have certain autoimmune diseases or viral
o Common in foods such as bread,
infections
pasta, pizza and cereal
 Age
o Doesn’t provide essential nutrients
o The risk of arthritis increases as you
o Some research suggests that people
get older
with rheumatoid arthritis are more
o As you get older, the more worn out
likely to have celiac disease
your synovial membrane and
 In people with celiac disease,
cartilage
eating gluten can cause
 Lifestyle
inflammation and arthritis-
o Smoking or a lack of exercise can
like symptoms
increase your risk of arthritis
 For these people, eliminating
o Have a job or play a sport that puts
gluten from their diet can
repeated stress on the joints
reduce overall inflammation
 Sex
and improve their symptoms
o More common in women
 Refined carbs and white sugar
o Especially yung maraming anak and
o These exacerbate inflammation, and
used up of pelvic bone
the food products that contain they
 Weight
tend to come with trans fats
o Obesity puts extra strain on your
o Contributory to obesity and contains
joints, which can lead to arthritis
trans fat
 Processed and Fried foods
ARTHRITIS CAN BE PREVENTED BY:
o Elders should have food cooked
 Avoiding tobacco products through boiling and not frying
o Less absorption of proper nutrients o Should not eat foods cooked in used
body oils
o Nicotine decrease appetite o Overcooked and have had all or most
o Depletion of nutrients (vit A, C, E) of their nutrients destroyed
 Doing low-impact, non-weight bearing o Also contain many known
exercise carcinogens
 Maintaining a healthy body weight o Many food that come fried contain a
 Reducing your risk of joint injuries number of heavily processed
ingredients
o All of these will cause inflammation
DIETARY MANAGEMENT OF ARTHRITIS by triggering the body’s defense
mechanisms, which will set of an
Foods to avoid
arthritic flare-up
 Trans fats
o Result of processed dehydrogenation
Foods allowed

 Nuts o Purines are a natural substance found
o Great source of protein for in some foods like shellfish, sweet
vegetarians breads, red meat and gravies, these
o Contain magnesium, zinc, vit E as well will give off uric acid when
as the immune booster alpha- breakdown
linolenic acid o Uric acid may contribute to gout in
o Easy way to get the protein you need elderly
to keep your digestive tract healthy,
and they are very filling Foods low in purine (not free food but give
 Garlic and onions according to the dietary requirements)
o Good for Gout - garlic and onions  Eggs, nuts and peanut butter
chopped and powdered with virgin  Low-fat and fat free cheese and ice
coconut oil then heat it for a while cream
 Place this on the affected area  Skim or 1% milk
for 1 day  Soup made without meat extract or
 Pacify inflammation of gout broth
 Good for ingestion and  Vegetables that are not on the
superficial treatment medium-purine list below
o Loaded with immune-boosting  All fruit and fruit juices
properties  Bread, pasta, rice, cake, cornbread,
o The superhero duo of the produce and popcorn
section  Water, soda, tea, coffee and cocoa
o Those who eat foods in the allium  Sugar, sweets, and gelatin
family (garlic and onions) exhibit  Fat and oil
fewer signs of osteoarthritis and joint
pain Medium-purine foods:
 Beans  Measure it first
o Great source of protein and fiber  Meats: limit the ff to 4 to 6 ounces
o Excellent way to replace many filer each day
foods that worsen joint pain and the o Meat and poultry
conditions associated with it o Crab, lobster, oysters and
o Rich in folic acid, zinc, iron and shrimp
potassium - important immune-  Vegetables: limit the ff vegetables to
boosting properties ½ cup each day
 Citrus fruits o Asparagus
o High in fiber and Vitamin C o Cauliflower
o Sweet, refreshing and delicious, o Spinach
oranges, grapefruits, lemons and lims o Mushrooms
are also valuable allies in the fight o Green peas
against joint pain  Beans, peas, and lentils (1c each day)
o rich in life-saving vit C (antioxidant)  Oats and oatmeal (2/3c uncooked
o also an ideal substitute for those who each day)
love sweets  Wheat germ and bran (1/4c each day)
 Green tea
o Known for its many health-promoting High-purine foods (ABSOLUTELY SHOULD NOT BE
benefits GIVEN): limit or avoid foods high in purine
o Help turn the tide against arthritic  Anchovies, sardines, scallops, and mussels
conditions  Tuna, codfish, herring, and haddock
o Loaded with powerful antioxidants  Wild game meats, like goose and duck
and polyphenols, green tea reduces  Organ meats, such as brain, heart, kidney,
inflammation and slows the process liver, and sweetbreads
of cartilage deterioration  Gravies and sauces made with meat
o Oolong tea  Yeast extracts taken in the form of a
 Give low purine diet supplement
o An eating plan that limits foods with
high purine Popular:
Glucosamine and conjointine

 Dietary supplement for arthritis  Limit foods with high saturated fats
 Materials: shells, shellfish like shrimps and and cholesterol
lobsters  Cut down refined sugars
 Taken PO orally  Limit foods with high sodium and use
 Riches part inside the bones, rich in less salt
conjointine o Especially in vascular
dementia because of the TIAs
SENILE DEMENTIA  Staying hydrated
 Mental deterioration (loss of intellectual POSSIBLE CAUSES OF POOR APPETITE:

ability) that is associated with or the
characteristics of old age 1. Not recognizing food.
 Senility is an older term used to describe a 2. Poor fitting dentures.
decline in an older adult physical and  As they aged, there is diminishing sense of
cognitive health taste and smell and also teeth
3. Medications.
 Hypertension
THREE MOST COMMON TYPES OF DEMENTIA ARE:  Diabetes
4. Not enough exercise.
1. Alzheimer’s Disease  They feel fuller because lesser digestion and
 One type of dementia less exercise
 Progressive degenerative disease that 5. Decreased sense of smell and taste.
attacks the brain and impairs thinking
behavior and memory MAKE MEAL TIMES EASIER:
 Terminal illness, no cure is currently
available 1. Limit distractions.
2. Keep the table setting simple.
2. Vascular Dementia 3. Distinguish food from the plate.
 Decline in thinking skills  Simple kind of plate
 Causes: 4. Check the food temperature
o The flow of the blood is block  Not too hot and not too cold
or reduce to various regions 5. Serve only one or two foods at a time.
of the brain, depriving them  In catching attention
of oxygen and nutrients  Elders are already messy
o Narrowing and blockage of 6. Be flexible to food preferences
the small blood vessels  Consider the other aspects lke sense
o Transient ischemic attacks or of taste
TIAs  To catch attention
 Not permanent 7. Give the person plenty of time to eat.
 By attacks  Wag madaliin
 So they is enough time to absorb and
3. Lewy Body Dementia ingest the food
 A type of progressive dementia that leads to a 8. Eat together.
decline in thinking, reasoning and  Will make their appetite to stimulate
independent function because of abnormal 9. Encourage independence
microscopic deposits that damage brain cells  Do not treat them as kids
over time  If they can still do it let them
10. Make the most of the person’s abilities
11. Serve finger foods
RARE TYPE AND MOST SEVERE TYPE OF DEMENTIA:  To practice reflexes
12. Use a watch me technique
1. Creutzfeldt-Jakob disease (CJD)  Demonstrate how to chew food
 Is a rapidly progressive, invariably appropriately
fatal neurodegenerative disorder 13. Don’t worry about neatness
believed to be caused by an abnormal  They are like children already
isoform of a cellular glycoprotein
known as the prion protein.

MINIMIZE EATING AND NUTRITION PROBLEMS
 Prepare foods so they aren't hard to chew or

swallow.
 Be alert for signs of choking.
 Address a decreased appetite.
 Provide a balanced diet with a variety of foods
 Limit foods with high saturated fats and
cholesterol
 Cut down on refined sugars
 Stay hydrated
 Limit foods with high sugar and use less salt
REFERENCES

10 L E C
Nutrition and Diet Therapy 28
Marieta Hillario 21 13
NUTRITION FOR SPECIAL GROUP OF PEOPLE
OUTLINE
I Nicotine & Alcohol Abuse NUTRIENT NEEDS FOR THE MOST AFFECTED
A Nutrient needs
I Vegetarian Diets ● For smokers, the RDA for Vitamin C is
A 4 Basic Types
B Benefits increased by 35 mg/day to help counteract
C Risk and Considerations the oxidative damage from nicotine.
III Feeding Athletes
A Types of Physical Activities ● Smoking and excessive intake of alcoholic
B Muscle Action & Fuel drinks interfere with bone health because
C General Training and Diet
they block calcium absorption
○ depletion of thiamine (Vitamin B1)
IMPORTANT NOTES
■ Being used excessively for the
● Nicotine & Alcohol Abuse (acetaldehyde - excess amounts of alcohol to
toxic byproduct of alcohol metabolism) metabolize it into energy
○ Liver cirrhosis ■ In alcoholism, there is
● Vegetarian Diets frequent urination, thus
● Feeding Athletes vitamin B is excreted in urine
○ Carbohydrates and proteins needs ● Excessive smoking and drinking increases fat
○ Water balance carried to the stomach which may increase
NICOLINE & ALCOHOL ABUSE risk for weight related health problems
○ Alcohol & smoking increase fat
● Going cold turkey
deposition in the stomach
○ term comes from the goosebumps
○ Women: abdomen
people sometimes get in the days
○ Male: tummy talaga
after they quit, which look like the
● For those who won't quit smoking, eat more
skin of a "cold turkey" in the fridge.
fruit and vegetables. Many studies show that
Some people go cold turkey because
lung cancer nsk decreases with increased
they think it will be easier to stop
consumption of fruits and vegetables
taking the substance right away than
➔ REMEMBER: No dietary supplement can fix an
to taper off or gradual retreat.
ongoing pattern of poor food choices.
○ Cold turkey refers to the abrupt
➔ Dietary supplements won't protect you from
cessation of substance dependence
the harmful effects of smoking or alcohol
and the resulting unpleasant
abuse.
experience, as opposed to gradually
◆ However, it will not give you instant
easing the process.
result
○ Cold turkey according to sydney
➔ Supplements won't give you instant results.
medical school’s professor simon
For benefits from other dietary supplements,
chapman. It’s certainly the method
you likely need to take them for longer
most successful quitters use. But cold
turkey - either stopping dead or
cutting down smoking and then
stopping - might be the most common
way to success.
- If gradual ang pag stop, along the way
you are tempted to use it again

(animals)
VEGETARIAN DIETS
Pescatarian All vegan Meat and
- general term used to describe eating patterns
diet foods and poultry
that includes plant-based foods and
fish, dairy
eliminates sore or all animal derived foods and eggs
FOUR BASIC TYPES OF VEGETARIAN DIETS Lacto (Milk) Dairy Poultry, meat
● Lacto-vegetarian vegetarian products and and fish
- accepts only dairy products from diet vegan food
animal sources to complement their
basic diet of plant foods Lacto-ovo Vegan food, Poultry, meat
● Ovo vegetarian vegetarian eggs, dairy and fish
- the only and folds included in this diet diet products
are eggs
● Lacto-ovo-vegetarian
- follows a food pattern that allows for
SOME NOTABLE BENEFITS
the consumption of both dairy
● Lower levels of dietary saturated fat and
products and eggs
cholesterol consumption
● Vegan
○ Fiber will bind cholesterol for
- also known as strict vegetarian diet
excretion
- abstains from the consumption of all
● Lower prevalence of obesity
animal products
○ No large content of cholesterol and
fats that will be deposited in adipose
tissue
Some of the types of vegetarian diets are ○ Eating high fat foods and atherogenic
listed below: food
● Better lipid profiles and lower rates of death
Type of diet Food Food from cardiovascular disease, including
included in excluded in ischemic heart disease and hypertension
the diet the diet ● Lowered risk of renal disease from high
glomerular filtration rates as compared with
long-term high animal protein intake
○ Renal disease can also be prevented
Vegan Fruits, All animal
○ Renal disease: hypertension and
vegetables, sources of
diabetes mellitus (due to eating
pulses, seeds food like
and nuts flesh of atherogenic foods)
animals and ● Effective management of type 2 diabetes and
dairy lowering of the risk for developing type 2
Only use products, diabetes and some forms of cancer (e.g.,
cane sugar honey prostate, gastrointestinal tract, female
coming from specific cancer) .
plants ● Overall, better quality diet for macronutrient
Honey and micronutrient intake as indicated by the
coming from Healthy Eating Index
bees ● Other possible benefits include a lowered risk
of dementia, diverticulitis, and gallstones

○ Dementia - less progress if we have ○ Prob: Oxalates reduce the absorption
more fruits and vegetables of calcium found in spinach, beet
RISK AND CONSIDERATION greens, and swiss chard
○ Sol: Regularly consume plant foods
(usual deficiency of vegetarian)
that are high in calcium and low in
● Protein oxalates, such as chinese cabbage,
○ Problem: plant protein quality varies; broccoli, napa cabbage, collards, kale,
lower bioavailability than animal okra and turnip greens. In addition to
protein calcium-fortified foods such as orange
○ Solution: consume a variety of plant juice
foods throughout the day, including ● Vitamin D
the soy products ○ Prob: other than endogenously
○ Vegetarians are not allowed to eat produced vitamin D from sunlight
animals; tendency that they are exposure, the primary source of this
deficient in protein vitamin is fortified cow’s milk
● Iron ○ Sol: sun exposure for 5 to 15 mins per
○ Prob: Plant foods contain non-heme day provides enough sunlight to
iron, which is less bioavailable than produce adequate amounts of vitamin
the heme iron found in animal foods D; dark-skinned people require more
and which is sensitive to inhibitors sun exposure; otherwise choose foods
such as phytate, calcium, tea, coffee, or dietary supplements that are
and fiber fortified with Vit D, such as soy milk,
○ Sol: iron intake recommendations are rice milk, orange juice, and breakfast
1.8 times higher than for omnivores; cereal
consume high-iron plant foods with ○ Vitamin D - highest food sources are
dietary sources of vit C, which is an coming from milk
enhance of iron absorption ○ From animals
○ Vegetarians are more likely to have ○ Strict vegans are not consuming milk
iron deficiency because they don't eat and dairy products
meats (have a lot of iron contents); ○ It is needed for the absorption of
although vegetables have iron, it is calcium
not highly absorbable because it is ○ Vegetarians should expose
fiber themselves at the heat of the sun
● Zinc ● Vitamin B12
○ Prob: plant foods high in phytates ○ Prob: no plant food contains active vit
bind zinc B12
○ Regularly consume foods such as ○ Sol: choose foods that are fortified
nuts, soy products, zinc-fortified with B12, such as soy milk, breakfast
cereals, and soaked and sprouted cereal, nutritional yeast: or use
beans, grains and seeds dietary supplements
○ Fruits and veges high in phytates and ○ There are plants that contain it. It not
oxalates in slimy vegetables like okra, just active so it needs a precursor
saluyot from high quality protein which is
■ These substances will bind animals
zinc and calcium which will ● Omega-3 fatty acid (alpha linolenic)
cause disadvantage in the ○ Prob: few plant foods are good
absorption of nutrients sources of alpha-linolenic acid
● Calcium ○ Sol: regularly include sources of
alpha-linolenic acid in the diet, such

as flaxseeds, walnuts, canola oil, soy ● e.g. brisk walking, dancing (Zumba),
products, and breakfast bars fortified roping
with DHA, or take DHA supplements
that are derived from microalgae
4. Activities of Daily Living (ADLs)
○ Coming from animals except for those
● a collection of fundamental tasks of
olive oils, sesame oils (not alpha
daily life
linolenic)
● e.g. grooming, eating, toileting
If you're pregnant and eat a vegan diet, you should MUSCLE ACTION AND FUEL
talk to your doctor about taking supplements. Vitamin
B12, vitamin D, and iron can be hard to get from a STRUCTURE & ACTION
vegan diet alone. ● finely coordinated series of small bundles
within the muscle fibers produce a smooth
- Synthetic type with the doctors prescription
symphony of action through simultaneous
and alternating contraction and relaxation
Vitamin B12 is found naturally only in foods that come
from animals, although some fortified breakfast
cereals contain B12 also. Vitamin D is most easily OXYGEN
found in milk and many fortified foods. Spending 10 ● the most profound limit to exercise is the
to 15 minutes in the sun three times a week may also ability to deliver oxygen to the tissues and to
be enough to make vitamin D. (just to activate the then use that oxygen for energy production
vitamin D available) ● depends on the fitness of the pulmonary and
cardiovascular systems
● fitness level (including oxygen and foet use) is
Iron can be found in beans, soy foods, spinach, influenced by two major factors:
seaweed, and more. As a vegan, you need twice as (1) the fitness of the lungs, heart, and blood
much iron in your diet as meat eaters. Doctors vessels, and
recommend taking an iron supplement to ensure you (2) body composition
get enough during pregnancy.
CARDIOVASCULAR FITNESS
FEEDING ATHLETES ● defined in terms of aerobic capacity, which
depends on the body's ability to deliver and
use oxygen in sufficient quantities to meet the
TYPES OF PHYSICAL ACTIVITIES
demands of increasing levels of exercise.
1. Resistance Training
● also called strength training
BODY COMPOSITION
● strengthens muscles by working
● a reflection of the four body compartments
against weight or force
that make up the total body weight: lean
● e.g. free weights (barbells, dumbbells,
body mass, fat, water, and bone
kettle balls), weight machines
2. Aerobic Exercise
● also called cardio FUEL SOURCES
● moving large muscles of arms, legs ● carbohydrate (glucose and glycogen) and
and hips to improve blood circulation some fat
and cardiovascular conditioning ● fluid and energy needs
● e.g. swimming, cycling, walking ○ Fluid
3. Weight-bearing Exercise ○ energy and nutrient stores
● exercises that forces the body to work
against gravity to strengthen the
bones and muscles and to improve
posture and balance

GENERAL TRAINING AND DIET - Theory: Your weight is also the
capacity you can lift
● Not percentage distribution
- Achieve more than body’s capacity:
● Special requirement for athletes
tend to have carbohydrate loading to
○ non calories ang c,p, f because they
achieve the capacity to go to higher
are using the kilogram DBW.
level or division
○ according to the kg of the athlete
- In weightlifting: kaya palang is 100 lbs
appropriate not the c,p,f or TER
and gusto umabot ng more than 120
lbs, do carbohydrate loading to
● Carbohydrates achieve the weight na kaya buhatin
- General training needs are usually met yung capacity na 120lbs
with 5 to 7 g/kg body weight per day
- If 50kgang athlete, it should be 5
● PREGAME
to 7kg
- ideal pregame meal depends on the
- So 250 kg carbohydrates
tolerance of the athlete
- Endurance athletes have higher needs of
- usually is a light to moderate meal
7 to 10 g/kg body weight per day
eaten 3 to 4 hours before the event
- Ultra-endurance athletes require up to
- high in carbohydrates (approximately
12 g/kg body weight per day.
1-4 grams of carbohydrate per
- weightlifting
kilogram of body weight), low in fat
- 50kg DBW X 12 = 600
and fiber, and moderate in protein:
carbohydrates per day
- Moderate protein enough to
● Fat
be digested
- Needed to meet energy needs, to
- High protein foods are not
supply essential fatty acids, and to
allowed because when
maintain weight.
digested, it will stimulate
- Energy use
urination and disturb the
- Essential fatty acid to have
game
the right source of energy and
- it should also provide sufficient fluid
to maintain of weight; no
and be familiar to the athlete
breakdown of glycogen
● Protein
HYDRATION
- For highly trained endurance and
● Before exercise
strength trained athletes,
- Establish euhydration (water balance)
requirement may increase to 1.2 to
at least 4 hours before exercise by
1.7 g/kg/day
drinking 5 to 7 mL/kg body weight of
- For repair worn out muscle and
water or a sports beverage.
energy breakdown during vigorous
- Void excess fluid before competition,
exercise
and do not attempt hyperhydration.
- To repair and mend
- Enough for their weight
- It will make the athlete feel
DIET BEFORE EXERCISE/COMPETITION heavy if there is no voiding of
excess fluid
● CARBOHYDRATE LOADING
- the protocol includes a moderate and
gradual tapering of exercise while
increasing total carbohydrate intake
in the diet
- Only done if they have a goal weight
like weightlifting

- Also create stomach REFERENCES
disturbances; Hydrochloric
acid production “PROF’S PPT ON QUIPPER AND LECTURE”
● During exercise
- Drink during exercise to avoid
excessive water loss (a loss of more
than 2% of body weight).
- If there is more than 2% loss
we need to hydrate
● After exercise
- Replace fluid loss after the completion
of exercise by drinking 16 to 24 oz of
fluid for every pound of body weight
that is lost.
- To replenish lahat ng worn
out muscles, joints, cartilage,
and burned calories,
rehydrate again
DIET AFTER EXERCISE: RECOVERY
● fluid- and carbohydrate replacement

beverages consumed immediately after a
glycogen-depleting endurance event result in
higher glycogen synthesis and muscle
recovery than if replacement beverages are
delayed for 2 hours or more
○ Right after rehabilitation or
replacement
○ Delayed for 2 hours or more will slow
down the glycogen synthesis
○ If dried up na ang sweat, very weak
● beverages with added sodium help minimize
insensible fluid losses
○ Mineral water
○ Instead of plain water, we can give
fruit juices that are high in
electrolytes
○
● for athletes taking only a short break between
events (e.g., triathletes), foods and beverages
that are ingested should primarily contain
simple carbohydrates
● athletes with at least 24 hours to recover
should consume at least 1.2 g of carbohydrate
per kilogram of body weight (taken over
several hours) from foods or fluids to optimize
the rate of muscle glycogen recovery

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09 LEC

Nutrition and Diet Therapy

INTRODUCTION Adverse Influences are:

BSN-2B TRANSCRIBED BY: GROUP 8 1

HABITS TO ESTBALISH IN PREPARATION FOR A

1. Achieve and maintain a healthy body weight. PREGNANCY WEIGHT RECOMMENDED

LBW – infants have impaired growth and development

- prone to infection and disease

Overweight or Obese Pregnant

BSN-2B TRANSCRIBED BY: GROUP 8 2

PREGNANY WEIGHT GAIN BREAKDOWN GROW FOODS

Give high biological value protein (HBV) – highly

Give milk or calcium rich foods, recommend anchovies

Mother should expose herself in the heat of sun in the

2. Choose an adequate and balanced diet

 To supply the increase fuel, demanded by the

BSN-2B TRANSCRIBED BY: GROUP 8 3

(1) AI or RDA (adequate intake/ 2 KINDS OF NTD

1. AI or RDA ( according to age )

PYRIDOXINE 2. SPINA BIFIDA

BSN-2B TRANSCRIBED BY: GROUP 8 4

1. Fruits per 100g

LIVER per100mg = 5,525 mcg

Vegetables per 100g

 Malungay = 7,945 mcg

1. AI or RDA = 2.6 mcg/day TETANY – a syndrome characterized by abnormal

18 Y.O and below = 750 mcg / day

19 to 50 Y.O = 770 mcg / day

1. Important for the placenta functions

BSN-2B TRANSCRIBED BY: GROUP 8 5

1. CALCIUM AI/RDA = 27mg /day

1. conservation of iron during pregnancy

1. clams ( steamed ) 3 oz = 23.8mg

1. All animal tissues AI/RDA = 220 mcg ( 18 – 50yr )

1. to increase milk flow

360mg /day ( 31-50yr)

12mg /day (18yrs and below )

BSN-2B TRANSCRIBED BY: GROUP 8 6

 Don’t exercise vigorously after long periods of

GUIDELINES FOR PHYSICAL ACTIVITY DURING

 Do exercise regularly (most, if not all, days of

BSN-2B TRANSCRIBED BY: GROUP 8 7

BSN-2B TRANSCRIBED BY: GROUP 8 8

1. Give Ca rich foods

BSN-2B TRANSCRIBED BY: GROUP 8 9

 Mild preeclampsia high blood pressure water 9. GESTATIONAL DM

BSN-2B TRANSCRIBED BY: GROUP 8 10

 add 16 grams /day for the 1st 6 mos.

BSN-2B TRANSCRIBED BY: GROUP 8 11

“PROF’S PPT ON QUIPPER AND LECTURE”

BSN-2B TRANSCRIBED BY: GROUP 8 12

Methods of Feeding Infants 2. Sodium

Nutrient Content of Breastmilk 1. Have unsurpassed protection against infection

BSN-2B TRANSCRIBED BY: GROUP 8 13

Bacterium Lactobacillus Bifidus, this favors the

Other Potential Benefits of Breastmilk 2.Soy based formulas.

2.Protease from BM will release peptides

3. Protects common illnesses of infancy like: