Asupan Gizi Tahap

Kehidupan Neonatus
Remaja
Special Nutritional Needs
Lifecycle Nutrition

Dr Brain Gantoro, M.Gz,

SpGK

Eating Through the Life

Cycle
Setiap

Individu
mempunyai
kebutuhan
nutrisi berbeda

Eating Through the Life

Cycle

Stages of the Life Cycle

Pregancy
Lactation
Infancy (0-12 months)
Toddler (1-3 years)
Preschool (3+ years)
School-aged
Adolescence/Teen-aged
Adulthood/Adults
Senior adulthood/Older Adults (50+ years)

Pregnancy

Choosing low-fat,
nutrient dense foods

Increase calories
based on Drs
recommendation

Extra helpings of dairy

items
Reduce Caffeine intake
Iron needs to double
Folic acid
Contaminants in foods
can cause problems

Fish (tuna, swordfish,

etc.)

Pregnancy
Poor eating habits baby at risk for
serious problems
Inadequate nutrition damage mothers
health.

Baby pulls nutrients from mothers supply

Teen pregnancy
Teens need added nutrients for their own
growth & development
Increase in low birth weight, physical &
learning problems

Pregnancy
Trimester: one-third of the normal duration of
pregnancy.
First trimester is 0 to 13 weeks
Second trimester is 13 to 26 weeks
Third trimester is 26 to 40 weeks

Prenatal Before birth

Postnatal After birth

Pregnancy

The only way nutrients

can reach the
developing fetus is
through the placenta,
the special organ that
grows during
pregnancy to support
new life.
The close association between the
fetuss and mothers circulatory
systems permits the mothers
bloodstream to deliver nutrients
and oxygen and remove waste
products

Fetal Development

Copyright 2010, John Wiley &

Sons, Inc.

Nutritional
Needs of
Pregnancy

Nutritional Needs
During Pregnancy

Nearly all nutrients are recommended in

increased amounts during pregnancy and
lactation

Only small increase in metabolic demands

(energy) of pregnancy and fetal development

2nd trimester - add 350 Calories per day

3rd trimester - add 450 Calories per day

Nutritional
Needs of
Pregnancy

Macronutrients
recommendations
RDA: protein . + 25 g/day in 2nd and 3rd
trimester. For a women of 136 lbs
(68kg) = 75 grams/day
RDA: carbohydrates 45 g/day = 175
grams/day (typical intake is 300 grams)
Total fat intake does not need to
increase. Increase intake of essential
fatty acids (linoleic and alpha-linolenic).
Insufficient scientific evidence. Only AIs
are given.
Macronutrient distribution should be the
same (Nutrient-dense foods).

WATER
recommendations

Need of water due to blood

volume, production of amniotic
fluid & the needs of the fetus.
(2.7 3) l/day
Potassium, sodium & chloride
needs do not change

Nutritional
Needs of
Pregnancy

Nutritional Needs During Pregnancy Calcium

The DRI for calcium during pregnancy

does not increase during pregnancy:

1,300 milligrams for teens

1,000 milligrams for adults over 18 years of age

Intestinal absorption of calcium doubles

early in pregnancy & the mineral is stored
in the mothers bones

During the last trimester of pregnancy

when fetal skeletal growth is maximum
and teeth are being formed.

The fetus draws approximately 300 milligrams per day from the
maternal blood supply.

Nutritional Needs During Pregnancy - vitamin D

No need to increase, if sufficient

amount is obtained from the diet
and if sufficient sun-light exposure
is met.

Some ethnicities can be at higher

risk of developing vitamin D
deficiency

Nutritional
Needs of
Pregnancy

Nutritional Needs During Pregnancy - vit C

It

is needed for the synthesis of

collagen (skin, tendons, and protein
matrix of bone)
Recommended intake + 10mg/d
This

requirement can easily be met

by including citrus fruits and juices
in the diet, thus supplements are
usually not necessary.

Nutritional Needs During Pregnancy - vitamin A

Vitamin A-deficiency

From Lohnes et al., 1994

Vitamin A-excess

From Abu-Abed et al., 2001

Nutritional Needs During Pregnancy Folate

A pregnant womans recommended intake
for folate is 50% greater. - 400ug
Folate supplements given around the
time of conception are known to reduce
the recurrence of neural tube defects.

Women are advised to get recommended

amounts of folate before becoming
pregnant and during the first trimester.

As of 1999, all refined grains are fortified

with folate (140 mg/ 100g of grain
product).

Folic acid requirements

Neural tube defects:

include any of a number of
birth defects in the orderly
formation of the neural
tube during early gestation.
Both the brain and the
spinal cord develop from
the neural tube; defects
result in various central
nervous system disorders.
The two main types are:

Spina bifida: incomplete

closure of the bony casing
around the spinal cord.
Anencephaly: a partially or
completely missing brain.

Nutritional Needs During Pregnancy - Zinc

It

is involved in the synthesis of

DNA, RNA and protein

Zinc

absorption is inhibited by high

iron intake, thus iron supplements
may compromise zinc status if the
diet is low in zinc

RDA

is 11mg/d (lean ground beef)

Nutritional Needs During Pregnancy - Iron

Pregnant = 50 % above non-pregnant

needs (synthesis of hemoglobin and other
iron-containing proteins)
Many women begin pregnancy with
diminished iron stores
An iron supplement of 27 milligrams
ferrous iron daily during the second and
third trimesters is recommended
Red meats, leafy green vegetables,
fortified cereals
Citrus fruits and red meat increase iron
absorption

What is in a Prenatal
Supplement?

Must be taken in conjunction with, not in place of a carefully planned diet

Consequences of
Maternal Malnutrition in
Pregnancy

Fetal growth retardation

Birth defects

Spontaneous abortion and stillbirth

Premature birth

Low infant birth weight

Maternal and fetal anemia

Malnutrition in the
prenatal and
postnatal periods also
affects learning ability
and behavior

Common nutrition-related problems of

pregnancy

Pregnancy-induced hypertension (PIH):

high blood pressure that develops
during the second half of pregnancy

Preeclampsia: a condition
characterized by hypertension, fluid
retention, and protein in the urine

Eclampsia: a severe extension of

preeclampsia characterized by
convulsions

Gestational diabetes: the appearance

of abnormal glucose tolerance during
pregnancy, with a return to normal
following pregnancy.

Fetal Alcohol Syndrome

Defined by four criteria:
1. Maternal drinking during pregnancy
2. Characteristic pattern of facial
abnormalities
3. Growth retardation
4. Brain damage often manifested by
intellectual difficulties or behavioral
problems

Fetal Alcohol Syndrome

These facial traits

low nasal bridge
short eyelid opening
small head circumference
undeveloped groove in
center of upper lip
are typical of fetal alcohol
syndrome, caused by drinking
alcohol during pregnancy.

Irreversible abnormalities of
the brain and other organs
accompany these facial
features.

Fetal Alcohol Syndrome

safe alcohol intake has not been
established for pregnant women at
any time during gestation, including
the first few weeks

The developmental origin of adult diseases

LactationFeeding Your
Child

Nutritional Needs

Increase water,
calcium, protein, folic
acid.
Increase calories
based upon body
weight.

Foods to Avoid

Eat no more than two

meals per week of fish
high in mercury.

Maternal Nutrient Needs during

Lactation

The need for nutrients is even greater during

lactation than during pregnancy.

Mothers provide energy and nutrients to the infant, who

is growing faster and is more active than the fetus

Human milk contains about 160 kcalories per cup (240

ml). About 330-400 additional Kcal/d

Lactating women require approximately an additional

liter of fluid a day.

Most lactating women can meet all their need without

supplements.

Eating Through the Life

Cycle

Infancy

(0-12 months)

The infant body

grows more at this
period of time than
any other in life.
Good nutrition is
critical for keeping
the infant healthy.

Energy needs in infants comparison

Infant
Adult
Weight
Kcal / day

15 lbs.
650 Kcal

1 year old
3 year old
10 year old

150 lbs.
2000 Kcal

=
=
=

1000 kcal/day
1300 kcal/day
2000 kcal/day

Potential micronutrients
infant deficiencies

IRON: babies are born with stores and iron in human milk, although
not abundant, is very well absorbed. After 6 months, stores are
depleted, hence iron-fortified rice cereal or iron-fortified formula

VITAMIN D: very low in breast-milk, so sunlight exposure is

important. Infant formula is fortified. Brest-fed infants are often
supplemented.

VITAMIN K: it doesnt cross the placenta efficiently and the gut of

the newborn is sterile (no microbial synthesis). Breast-milk is low in
vitamin K. Therefore, single intramuscular injection to the infant
(0.5-1mg of vitK).

VITAMIN B12: breast-milk of vegans mothers can be deficient in

B12

FLUORIDE: breast-milk is low in fluoride

Benefits of Breast
Feeding
for
Infant
Ideal sterile
food
Provides

protective factors

antibodies
bifidus factors
lactoferrin
growth factor
lipase enzyme

Promotes

better tooth and jaw alignment

Favors bonding between mother and child
Decreased incidence of obesity

Benefits of Breast
Feeding
for
Infant
Ideal sterile
food
Provides

protective factors

antibodies
bifidus factors
lactoferrin
growth factor
lipase enzyme

Promotes

better tooth and jaw alignment

Favors bonding between mother and child
Decreased incidence of obesity

Benefits of Breast
Feeding for Mother

Economical and convenient

Helps return uterus to normal size faster

Helps return to pre-pregnancy weight faster

Delays onset of menstruation (not birth control)

Improves bone re-mineralization

Reduces risk for ovarian and pre-menopausal

breast cancer

When Not to Breast Feed

Infants

with galactosemia

hereditary disease that is caused by the lack of a liver enzyme

required to digest galactose

Mothers

taking certain medications

Mothers

with communicable diseases

such as HIV or active tuberculosis

Mothers

who use illegal drugs

Healthy Infants with

Formula

Infant formulas are manufactured with the

approximate nutrient composition of breast milk

The parents can see that the baby is getting enough

milk during feedings

The mother can offer similar closeness, warmth, and

stimulation during feedings as the breastfeeding
mother does

Other family members can get close to the baby and

develop a warm relationship in feeding sessions

Eating Through the Life

Cycle

Infancy
Breast-feeding vs. Bottle-feeding

Both provide all the nutrients needed

Yet, breast milk is recommended

Why?
This milk has the right balance of fat, carbs, and protein for the
baby.
Lowers the rate of infections
Mother passes immunities to baby through colostrum

Lactation

Mother is burning calories while producing milk therefore she

still needs to eat nutritiously.
Watch out for spicy foods, acidic foods, etc.
No alcohol or drugs!!!

Comparing Breast Milk and

Formula

Copyright 2010, John Wiley &

Sons, Inc.

Eating Through the Life

Cycle

Infancy

4-6 months--Add
solid foodsmash,
iron-fortified cereal
Introduce one food
at a timeWhy?
9 monthsself
feeding
Example of
finger foods.
Watch for food
allergies these
could be deadly

Eating Through the Life

Cycle
Foods

to Avoid

Avoid honey or corn syrup.

Beware of choking risks.
Eat no more than two meals per week
of fish high in mercury.
Withhold juice until 6 months of age.
Need whole milk for infants up to two
years of age

Eating Through the Life

Cycle

Toddler

(1-3 years)
Nutritional Needs
Increase iron.
Introduce new flavors
and textures in order to
increase the variety of
foods.
Increase self-feeding.
This becomes an
important
developmental
milestone.

Foods to Avoid

Eat no more than two

meals per week of fish
high in mercury.
No hot dogs, nuts, seeds,
chunks of meat or
cheese, whole grapes,
hard, gooey, or sticky
candy, popcorn, chunks
or peanut butter, raw
vegetables, raisins, or
chewing gum.
No more than 16-24
ounces of milk or 4-6
ounces of juice/day.
Servings should be
size of adults.

Eating Through the Life

Cycle

Preschool
(3+ years)
Nutritional Needs
Need same variety of foods
as adults but in smaller
proportions.
Serve about 2/3 of a serving.
Entice them with foods that
are bright in color, to make it
more appealing.

Encourage children to try

new foods.

Eating Through the Life

Cycle
Pre-school

Children have small stomachs and

short attention spans

Try small meals and regular snacks

throughout the day

Appetite varies depending on growth

During growth spurts they may eat more

Eating Through the Life

Cycle

School-aged

2nd most rapid growth

period of life
Need for calcium and
iron for bone growth is
of most importance
Like toddlers, teens
have growth spurts
increase in caloric
needs
Continue healthy
eating habits
Dieting, losing weight,
etc can be harmful

Eating Through the Life

Cycle
School

Age

Girls need 2200 kcal per day

Boys need 2800 kcal per day

Foods to Avoid

High-sugar snacks
Fatty foods

Eating Through the Life

Cycle

Teens
Nutritional Needs
Eat more
carbohydrates.
Females need more
calcium and iron.

Foods to Avoid
Avoid fried and
saturated fats,
excessive salt and
sugars.