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NUTRITION THROUGHOUT THE LIFESPAN NUTRITION IN PREGNANCY AND LACTATION PREGNANCY Calorie Allowances Total Energy Cost = 80,000

kcal Total Energy Cost per day = 300 kcal Energy intake per day = 36 kcal/kg Weight Gain A gain of 1.5 - 3.0 lb during the first trimester and a gain of 0.8 lb per week during the remainder of the pregnancy is a guideline. An average gain in weight during pregnancy is 24 lbs. RECOMMENDED WEIGHT GAIN BMI < 18.5 = 28 40 lb BMI 18.5 24.9 = 25 35 lb BMI 25 29.9 = 15 25 lb BMI > 30 = 15 lb BMI of 20 26 = 25 35lb BMI <20 = 28 40lb BMI > 26 = 15 20 lb And 1 lb per week in the 2nd and 3rd trimester of pregnancy

Weight Gain Patterns Underweight

first trimester Thereafter first trimester Thereafter first trimester Thereafter

5lb 1lb per week 3 lb 1lb per week 2lb 2/3 lb per week

Normal

Overweight

Underweight a. high risk of having low birth weight infants, and b. higher rates of pre-term deaths and infant deaths Overweight and Obesity a. high risk of complications like hypertension, gestational diabetes, and postpartum infections b. complications of labor and delivery c. large newborns increase the likelihood of a difficult labor and delivery, birth trauma and caesarian section d. may double the risk of neural tube defects

NUTRITION IN PREGNANCY Protein Allowances - The protein need of a normal woman is 1.1gm/kg BW - Normal pregnant woman requires an additional 9.5gms per day - A total of 900-950 gms for the 9 months gestation period. Carbohydrate Intake - Generous amount is critical to spare protein and to supply energy needs for higher basal energy expenditure and for building tissues. - Women with gestational diabetes need to select foods rich in complex carbohydrates and should limit their consumption of concentrated sugars Vitamin D - is increased during pregnancy to make easier the utilization of greater amounts of calcium and phosphorus Calcium 1300mg/day ( 14 18 year old) 1000mg/day ( 19 50 year old) Phosphorous 1259 mg/day ( 14 18 years old) 700/day (19 30 years old) Fluoride 2.9mg/day (14 18 years old) 3.1 mg/day ( 19 50 years old) Magnesium 400 mg/day ( 14 18 years old) 350mg/day ( 19 30 years) 360 mg/ day ( 31 50 years) Folate 400 600 mcg/ day Vitamin B12 2.6 mcg/day Vitamin A is especially important in the epithelial cells during organogenesis and is needed to ensure good vision. Vitamin B6 or pyridoxine have much value in preventing severe nausea and vomiting associated with childbearing. Vitamin K to stabilize the prothrombin level of the infant iron 27 28 mg /day at least 700mg-1000mg must be utilized by the mother throughout her pregnancy about 240 mg are spared by the cessation of the menstrual flow. The remainder must be made available from the diet. Vitamin C 80 mg/ day Zinc 15 mg/ day Iodine iodized salt SUGGESTED DAILY PATTERN OF FOOD INTAKE 5 cups cooked rice 1 small piece root crop 6 tsp sugar 7 tsp fat 2 servings of fish/meat/poultry cup whole milk whole egg cup cooked dried beans or nuts cup cooked Vit A rich vegetables 2 servings Vit C rich foods

1 servings of other fruits cup cooked other vegetables 6 8 glasses of Water Complications of Pregnancy and Possible Dietary Modifications Nausea and vomiting Small frequent feedings instead of three large meals, and high carbohydratelow fat foods such as crackers and jelly to overcome complications. Liquids are better taken between meals rather than at mealtime. Constipation - pressure exerted by the developing fetus on the digestive tract, - lack of exercise - insufficient bulk in the diet Lots of fresh fruits, vegetables, fluid and regular exercise will correct this disorder. Anemia Daily supplement of 30 60 mg of FeSo4 Daily supplement of 400mcg folacin Absorption can be enhanced by the inclusion of ascorbic acidrich foods in the same meal containing rich sources of iron. Diabetes more prone to develop pre-eclampsia, pyelonephritis and polyhydramnios and her baby has a higher risk of dying in utero or at birth. Rigid control of maternal blood glucose concentration is considered vital for a good prognosis of the fetus. LACTATION The preparation for assuring an adequate supply of good quality breast milk must begin with the onset of pregnancy. Most of the dietary essentials are increased over and above the requirements during pregnancy to meet the demands of milk production, namely, calories, proteins, calcium, Vitamin A, Thiamin, Riboflavin, Niacin and Ascorbic Acid. Calorie Allowances Extra food calories should be about twice those secreted in the milk of approximately 700 to 1500 calories of food for 500 to 1000ml of the milk. The FNRI recommends an increase by 1000 calories above the normal requirement for an average production of 850 ml of milk, with an energy value of about 600 calories. Protein 16 grams for the first 6 months and 12 grams for 7 months onwards per day over the normal recommendations for age Fat should provide 20 30 % of total calories - sources of polyunsaturated fats and regular consumption of fatty fish rich in omega 3 is encouraged VITAMINS AND MINERALS Calcium 1gm daily

Phosphorus Vit D 400 I U Iron There is an increased demand for Vitamin A, thiamine, Niacin, Riboflavin,Ascorbic Acid above the requirements of pregnacy during lactation SUGGESTED DAILY PATTERN OF FOOD INTAKE 5 2/3 cups cooked rice 1 small pc root crop 6 tsp sugar 7 tsp fat 2 2/3 servings of fish/mest/poultry cup whole milk 1 whole egg cup cooked dried beans or nuts 1 cup cooked vit A rich vegetables 2 servings Vit C rich foods 1 servings of other fruits cup cooked other vegetables 8 glasses of water or more Avoid alcohol, caffeine FACTORS AFFECTING MILK SECRETION 1. Diet 2. Nutritional state of mother 3. Emotional and physical state 4. Suckling 5. Uses of contraceptives and drugs INFANCY INFANT Refers to a person not more than 12 months of age. A healthy full term infant weighs 2.7 to 3.2 kg (6 to 7 lbs) and measures 48 to 50 cm (19 to 20 inches) in length. His head circumference averages 35 cm (14 inches). His skin is moist, elastic and not wrinkled. Energy requirement - A newborn requires only about 650 kcal per day and this is about 100 kcal / kg of DBW - 800-1200 calories in one year - Breastmilk provides the needed calorie needs during the first year Diet Breastfeeding Meets nutrient needs of early months Provides immunity factor and reduces chance for infection

Bottle feeding - Formula designed to match nutritional ratio of breastmilk composition - May meet needs of working mother - must be prepared under clean conditions and sterilized to prevent contamination Mixed feeding Combination of breastmilk and milk formula Water To prevent dehydration Feeding time A 2.5 to 2.7 kg baby usually feeds A 3.6 to 4 kg baby usually feeds At 2 months old, the baby sleeps through the night after the 10 pm feeding. Between 2 to 3 months old, the baby is on a 4 to 5 feeding schedule. FOOD FOR INFANTS Solid foods during the first year of life 4 5 months iron fortified infant cereals 5 6 months strained fruits and vegetables 6 8 months mashed or chopped fruits and vegetables juice from cup 9 12 months crackers, toast, plain meats, egg yolk and finger foods Infants vary and the program of additions depends on the individual babys development readiness 4 6 months iron fortified rice cereals, followed by other single grain cereals mixed with breastmilk, formula or water Suggested amount cup thin cereal or rice gruel 2 tbsp cooked dried beans, minced 1 tbsp cooked and flaked fish, meat or chicken egg yolk 3 tbsp ripe fruits 3 tbsp cooked and minced vegetables 6 - 8 months = infant bread and crackers, mashed vegetables and fruits and their juices Suggested amount 1 cup rice gruel or cereal pc potato or other root crops cup cooked and minced dried beans pc egg yolk 2 tbsp cooked and minced fish, meat or chicken cup ripe fruits cup cooked and minced vegetable 4 6 ounces daily of 100% juice

8 10 months a. Bread and cereals from the table b. Soft, cooked vegetables and fruits from the table c. Finely cut meat, fish, chicken, cheeses,yogurts, tofu, eggs and legumes Suggested amount 1 cup rice gruel or cereal pc potato or other root crop 2 tbsp margarine or oil for cooking cup minced and dried beans pc egg yolk 2 tbsp cooked and minced fish, meat or chicken cup ripe fruits cup cooked and minced vegetables 10 12 months Continue to introduce a variety of nutritious foods Offer only bland foods and never highly salty foods and too much sugar Never give leftover foods Handle foods properly Suggested amount 2 cups rice gruel or cereal 1 pc potato or other root crop 5 tbsp margarine or oil for cooking - cup cooked and minced dried beans to 1 pc eggyolk 2 tbsp cooked and minced fish, meat or chicken - cup ripe fruits - 1/3 cup cooked and minced vegetables OTHER IMPORTANT RECOMMENDATIONS 1. Offer foods by spoon and cups at around 6 months 2. Observe possible cause of food allergy 3. Avoid sweets, canned vegetables, raw carrots, peanut butter, hard candies, popcorn, whole grapes, hotdog slices, skim milk, cows milk and egg white 4. Do not force food 5. Position the infant at 45 60 degree angle if there is regurgitation 6. Burped baby afer each feeding to prevent colic 7. In case of diarrhea, continue breastfeeding, give plenty of fluids

Indication of good nutrition Weight Gain A steady weight gain of 150 to 240 gm/week that slows down toward the end of the first year to about 120 gm/week is considered as the proper weight gain (doubled birth weight at the end of 5 months and tripled at the end of 1 year). Length Baby length increases by about 25.4 cm or 50% more at the end of the first year.

Behavioral Development 0 - I month = suckles and smiles 2 - 3 months = vocalizes and controls head 4 - 5 months = controls hand and rolls over 6 - 7 months = sits briefly and crawls 8 - 9 months = grasps and pulls up 10 - 11 mos = walks with support and stands alone 12 months = starts to walk alone