NCMA 215

NUTRITION

Yosuico, Angela Nicole Collante 1

NUTRITION
•Is the sum of all the interaction between ➢ Chiefly found in plants and
an organism and the food it consumes produced by the process of
•Is what the person eats and how the photosynthesis from - H2O, CO2
body uses it and sun.
Function:
•To MAINTAIN LIFE by allowing one to CLASSIFICATION OF
grow and be in state of optimum health CARBOHYDRATES
● Food
● Nutrients 1. MONOSACCHARIDES -Simplest form
● Calorie of sugar
● Carbohydrates- 4 calories per
gram A. Glucose
● Protein- 4 calories per gram ➢ ”physiologic sugar” or “blood
● Fat- 9 calories per gram sugar”, “dextrose”, “grape sugar”
•Are organic or inorganic substances ➢ principal form used by the body
found in foods that are required for body ➢ moderately sweet sugar works for
functioning. the body’s brain, nerve cells, RBC
•Nutritive value – the nutrient content of a ➢ stores last for only hours
specified amount of food. ➢ Gluconeogenesis – process where
•NO FOOD provides all essential protein is converted to glucose
nutrients. ➢ Ketosis – less available CHO for
energy
6 Essential Nutrients ➢ more fats to be broken down form
ORGANIC ketone bodies
● CHO ➢ sources: abundant in fruits, sweet
● CHON corn, corn syrup
● Vitamins
● Fats Lycopene-red
INORGANIC Carotene-orange, yellow
H2O Anthocyanin-blue, violet
● Minerals Cruciferae– green, white

Considered as the PRIMARY source of B. Fructose

fuel for the brain and the rest of the body.
➢ 50% - 70% of total energy
requirement
➢ 1 gram CHO= 4 calories upon
complete hydrolysis
Has SUGARS (Composed mainly of
SUGARS)
Organic compounds composed of carbon,
hydrogen and oxygen
➢ Derived from the Greek word
“saccharide” meaning starches and
sugars
➢ ‘“fruit sugar”, sweetest of all sugar,
“levulose’’
➢ sources: ripe fruits and honey
C. Galactose
➢ not found in nature, not found in
free foods
➢ produced from lactose (milk sugar)
by digestion and is converted to
glucose

Yosuico, Angela Nicole Collante 2

 ➢ Galactosemia – Infants born with
an inability to metabolize galactose
➢ Republic Act 9288 – Newborn
Screening Test
2. DISACCHARIDES- two sugar
molecules
A. Sucrose
➢ ”cane sugar”, “table sugar”, “beet
sugar”
➢ Sucrose = glucose + fructose
B. Maltose
➢ ”malt sugar”
➢ Derived from the digestion of
starch
➢ Maltose = glucose + glucose
C. Lactose
➢ ”milk sugar”
➢ Least sweet among sugars
➢ Lactose = glucose + galactose
➢ Source: milk and milk products
3. Complex Carbohydrates or
Polysaccharide - contains many
monosaccharides linked together
A. Starch
➢ storage form of carbohydrates in
plants
➢ supply energy for a long period of
time
➢ Source: cereal grains, rice, wheat
➢ Derived from dextrose (glucose),
dextrin is a low-molecular
➢ weight carbohydrate produced
from the hydrolysis of starches
➢ An intermediate product of starch
digestion plus acid with application
of heat of 150-200 C.
➢ Starchà(dextrin) =maltose + 2
glucose units
B. Dextrin is used in many glue
products due to its adhesive
qualities and safety. The
indigestible form of dextrin is often
used as a fiber supplement.
C. Glycogen
➢ “animal starch”, storage form of
CHO in the body found in the liver
and muscle
➢ Muscle glycogen supplies energy
directly to surrounding tissues
during work and exercise
➢ Liver glycogen is converted to
glucose to be used in the body
through the process called
“glycogenesis”
➢ Source: liver, oysters, muscle meat
➢ A glycogen storage disease (GSD,
also glycogenosis and dextrinosis)
is a metabolic disorder caused by
enzyme deficiencies affecting
either glycogen synthesis,
glycogen breakdown or glycolysis
(glucose breakdown), typically
within muscles and/or liver cells.
GSD has two classes of cause:
genetic and acquired.
➢ Glycogen storage disease type I
(GSD I) or von Gierke disease, is
the most common of the glycogen
storage diseases. This genetic
disease results from deficiency of
the enzyme
glucose-6-phosphatase, and has
an incidence in the American
population of approximately 1 in
50,000 to 100,000 births.
➢ Liver Biopsy – confirmatory test
D. Fibers
➢ ”roughage”because they form bulk
of the diet
➢ act as broom in our digestive tract
➢ indigestible part of food and
primary constituent of plant cell
wall
➢ not digested by human due to lack
of enzyme that will split or break it
➢ Requirement: 20-35 g/day
Yosuico, Angela Nicole Collante 3
FUNCTIONS OF CARBOHYDRATES
➢ Chief source of energy, protein
sparing
➢ Supplies energy to the body
➢ Takes part in building body tissues
to some limited extent
➢ Regulator of intestinal peristalsis
and provider of bulk
LACK OF CARBOHYDRATE RESULTS
TO:
● Underweight and/or rapid weight
loss
● General weakness
● Poor physical performance
● Fainting or collapse in severe
deficiency
● Hypoglycemia in acute
carbohydrate deficiency
EXCESSIVE CARBOHYDRATE MAY
RESULTS IN:
● Dental caries
● Obesity/overweight
● Diabetes mellitus
● Gas formation
⬆️ Hypoglycemia
⬆️ Hyperglycemia
Weight loss
Obesity, DM
Health Effects of Starch and Fibers
1. Promote weight loss/ weight
control – increase fibers, low fats
and added sugar
2. Protect against heart disease
and stroke – high in
carbohydrates
3. Protect against cancer – high in
carbohydrates
4. Fight against diabetes – high in
carbohydrates and low fats control
weight
5. Promote gastrointestinal health
– increase fibers enhances healthy
large intestine  ●
PROTEINS
● Complete and Incomplete Proteins
● Has amino acids which serve as
the building units of the body
tissues
● Organic compounds composed of
carbon, hydrogen, oxygen and
nitrogen
● Normal osmotic relations in body
fluids (albumin)
➢ 10%-15% of total energy
needs is supplied by CHON
➢ 1 gram CHON= 4 calories
upon complete hydrolysis
➢ Simple proteins
➢ albumins – soluble in water,
coagulated by heat
➢ globulins – insoluble in
water, soluble in salt
solution, coagulated by
heat
ACCORDING TO ESSENTIALITY
A. ESSENTIAL AMINO ACID (EAA)
OR INDISPENSABLE
➢ AMINO ACID-is one that cannot
be synthesized by the body
● Histidine 
● Phenylalanine
● Isoleucine 
● Threonine
● Leucine 
● Tryptophan
● Lysine  Valine
●   Methionine
B. SEMI-ESSENTIAL AMINO ACID
OR SEMI-INDISPENSABLE
AMINO ACID-  reduce a need for a
particular EAA and partially spares
it.
  Arginine 
Yosuico, Angela Nicole Collante 4
 ● Tyrosine ➢ Anabolism – repairing worn out
●   Cysteine  body tissue
● Glycine ➢ Catabolism – continued wear and
● Serine tear going on in the body
➢ Builds resistance to infection by
C. NON-ESSENTIAL AMINO ACID helping form antibodies
(NEAA)- is not dietary essential because ➢ Supplies additional energy
the body can synthesize it. ➢ Contributes to numerous body
secretions and fluids
●  Glutamic acid 
● Aspartic acid SOURCES OF PROTEIN
● Alanine 
● Proline ● ANIMAL SOURCE- egg, milk, milk
● Norleucine  products, meat, fish, poultry and
● Citrulline seafoods
● Hydroxyglycine 
● Hydroxyproline ● PLANT SOURCE- cereals (wheat,
rice, corn), legumes (munggo
beans, peas, peanuts, soybeans),
processed vegetable protein
(vegemeat, tofu)

LACK OF PROTEIN RESULTS IN:

Retarded growth in children

Low resistance to infection at any age
Slow recovery from illness
Low birth weight
Marasmus vs Kwashiorkor
Protein energy malnutrition- Marasmus
and Kwashiorkor
Loss of weight
Edema, skin lesions, mental sluggishness

EFFECTS OF EXCESSIVE PROTEIN

INTAKE

● Kidney function – high CHON diet -

increase work of kidneys
● Mineral losses – increase CHON
diet - calcium excretion rises
● Obesity – high CHON diet –
increase intake rich fat foods
● Heart disease – foods rich in
FUNCTIONS OF PROTEINS
animal protein – rich n saturated
fats
➢ Builds and repairs body tissue for
● Cancer – increase in CHON diet –
growth and maintenance
increases rich saturated fats foods
intake

Yosuico, Angela Nicole Collante 5

Fats
Facilitates absorption of the fat soluble
vitamins (A, D, E, K)
As insulator and protector
Two Fatty Acids – basic structural unit of
fat. They are the key refined fuel forms of
fat that the cell burns for energy
Serve as the continuing supply of energy
each and every hour
➢ Organic nutrient containing C,H,O
attached in a glycerol base.
➢ 1 gram fat=9 calories
➢ 20%-30% of TER is from fat.
➢ Remains in the stomach for the
longest period of time
Classification of FATS
Simple Lipids - neutral fats
1. chemical name is triglycerides
2. glycerol is derived from a water
soluble form of CHO
Compound lipids - combination of fats
with other components important in human
nutrition
A. Phospholipids - fatty acids,phosphoric
acids and nitrogenous base
1. Lecithin
➢ most widely distributed
➢ traces placed in liver, egg yolk and
vegetable oil; added to food
products such as cheese and
margarine to aid emulsification
2. Cephalin
➢ needed to form thromboplastin for
blood clotting
3. Sphingomyelin - found in brain
and other nerve tissue; serves as
insulation around nerve fibers
 B. Glycolipids - fatty acids combined
with CHO and nitrogen
C. Lipoprotein - lipids combination of
protein
1. Chylomicrons transport
diet-derived lipids -mostly
triglycerides
2. Pre-beta lipoprotein - VLDL (very
low density lipoprotein)
- fat circulating in the blood during
fasting state
3. Beta lipoprotein - LDL (low density
lipoprotein)- transport in the artery
wall
4.  Alpha lipoprotein – scavengers;
GOOD CHOLESTEROL
Derived lipids – fat substances produced
from fats and fat compounds
A. fatty Acids – basic structural unit of fat
1. Saturated fatty acids – palmitic and
stearic acid bacon  butter grated
coconut  coconut cream coconut
oil margarine   mayonnaise  cream
cheese sandwich spread  whipping
cream  chicharon  cholesterol rich
foods
What are Trans Fats?
Trans fats are extremely dangerous?
Fat you should avoid at all costs.
They are generally found in processed
food such as burgers, fries, margarine.
The health risks of consuming trans fats
include; increased heart disease risk, poor
blood cholesterol level.
Yosuico, Angela Nicole Collante 6
What are Good Fats?
Good Fat (monounsaturated fats &
omega 3's)
e.g., avocado, salmon, almonds, walnuts,
flax seeds, olive oil, etc., can help lower
triglycerides levels and decrease
Inflammation.
Not as Good Fat (saturated fats)
saturated fats like full-fat dairy products,
and animal proteins, might increase the
risk of heart disease, high cholesterol and
some cancers, including colon.
Really Bad Fats (trans fats)
Fried food, packaged chips, candy, etc.
decrease good cholesterol and
Inflammation, and increase risk of heart
disease and cancer.
2. Monounsaturated – oleic acid
(omega 9) avocado    peanut
butter peanut oil  pili nut olive
oil shortening
3. Polyunsaturated fatty acids –
linolenic acid- Vitamin F, Omega
4. 3, linoleic acid – Omega 6,
vegetable, oil corn, soybean      activities.
rapeseed, canola, sunflower
sesame
B. Glycerol
➢  water soluble component of
triglycerides
➢ available for the formation of
glucose in the diet
C. Steroids
➢ fat related substances that contain
sterols
➢ The main member is cholesterol –
an important constituent of body
cells and tissues.
FUNCTIONS OF FATS
● Supplies food energy in
concentrated form for body
● Protects vital body tissue and
insulates body
● Supplies essential fatty acids.
● Serves as a carrier of the
fat-soluble vitamins (A,D,E,K)
● Adds palatability and satiety value
(sense of fullness) to your meals.
LACK OF FAT IN THE DIET RESULTS
IN:
● Underweight
● Sluggishness
● Skin irritation similar to eczema in
infants
● Signs and symptoms of fat-soluble
vitamin deficiency
Yosuico, Angela Nicole Collante 7
EXCESS INTAKE OF FAT RESULTS IN:

● obesity/overweight
● cardiovascular diseases

Yosuico, Angela Nicole Collante 8

Nutrition Tools, Standards
and Guidelines Nutrient
Recommendation (lecture)
The Philippines is one of the countries in
the world where a significant number of
children remain malnourished despite the
economic growth and development in the
country over the past decades.
Data from the 2013 National Nutrition
Survey (2013 NNS) in the Philippines
reported that among children under 5
years old, the prevalence of malnutrition
measured by underweight and stunting
was 20% and 30%, respectively, and the
prevalence starts to increase at 6–11
months.
Dietary Reference Intakes (DRIs)
Dietary Reference Intakes (DRIs) is a
generic term for a set of nutrient reference
values that includes the Recommended
Dietary Allowance (RDA), Adequate Intake
(AI), Tolerable Upper Intake Level (UL),
and Estimated Average Requirement
(EAR).
This is for planning and assessing diets of
healthy groups and individuals. PDRI is
the collective term comprising reference
value for energy and nutrient levels of
intakes
Estimated Average Requirement (EAR)
is a daily nutrient intake level that meets
the median or average requirement of
healthy individuals in particular life stage
and sex group, corrected for incomplete
utilization or dietary nutrient bioavailability.
The estimated average requirement (EAR)
is the amount of a nutrient that is
estimated to meet the requirement for a
specific criterion of adequacy of half of the
healthy individuals of a specific age, sex,
and life-stage.
The amount of the nutrient necessary to
meet the appropriate criterion of adequacy
varies from one individual to the next, but
the data are usually distributed normally or
can be transformed to achieve a normal
distribution. A recommended dietary
allowance (RDA) for a nutrient is derived
from an estimated average requirement
(EAR), which is an estimate of the intake
at which the risk of inadequacy to an
individual is 50%.
Recommended Energy/Nutrient Intake
(RENI) also known as Recommended
Daily Allowances is a level of intake of
energy or nutrient which is considered
adequate for the maintenance of health
and well-being of healthy persons in the
population.
The Recommended Dietary Allowance
(RDA) is the average daily dietary intake
level that is sufficient to meet the nutrient
requirement of nearly all (97 to 98 percent)
healthy individuals in a particular gender
and life stage group (life stage considers
age and, when applicable, pregnancy or
lactation).
The 2015 Philippine Dietary
Recommended Intake (PDRI) shall be
used for planning and assessing diets for
individuals and groups, developing
food-based dietary guidelines, formulating
standards and regulations on food
fortification, nutrition labeling and claims,
and food safety, designing and evaluating
food and nutrition assistance programs,
determining food bundles, setting food
production targets, and other related uses
that require consideration of nutrient and
dietary intakes.
Yosuico, Angela Nicole Collante 9

Adequate Intake (AI) is a daily nutrient
intake level that is based on observed or
experimentally-determined approximation
of the average nutrient intake by a group
(groups) of apparently healthy people that
are assumed to sustain a defined
nutritional state.
Adequate Diet is composed of various
nutrients which body needs for
maintenance, repair, and for growth and
development.
The AI is based on observed or
experimentally determined estimates of
nutrient intake by a group (or groups) of
healthy people. For example, the AI for
young infants, for whom human milk is the
recommended sole source of food for the
first 4 to 6 months, is based on the daily
mean nutrient intake supplied by human
milk for healthy, full-term infants who are
exclusively breastfed.
The main intended use of the AI is as a
goal for the nutrient intake of individuals.
For example: if an individual has a total
calorie in a day of 1,500, that individual
can take at least 75% of the total calorie
for a day which is 1,125 calories is
allowable.
Tolerable Upper Intake Level or Upper
Limit (UL) is a highest average daily
nutrient intake level likely to pose no
adverse health effects to almost all
individuals in the general population.
As intake increases above the UL, the risk
of adverse effects increases. The term
tolerable intake was chosen to avoid
implying a possible beneficial effect.
Instead, the term is intended to connote a
level of intake that can, with high
probability, be tolerated biologically.
COMPONENTS OF ENERGY
EXPENDITURE
BASAL METABOLISM
measure of energy needed by the body at
rest for its internal chemical activities like
respiration, cellular metabolism,
circulation, glandular activity and
maintenance of body temperature
•approximately 1 calorie per kg of body
weight per hour
BASAL METABOLISM RATE (BMR)
•rate of basal metabolism in a given
person at a given time and situation
Factors affecting BMR or Individuals
Caloric Need
•Surface Area - the greater the body
surface area or skin area, the greater the
amount of heat loss will be, increases heat
- increases BMR. WHY? Muscle tissue
requires more O2 than adipose tissue.
•Sex/Gender - Men is higher BMR than
women. WHY? Women have a little more
fat and less muscular development than
men. So, men requires more calories
•Age - BMR is highest the periods of rapid
growth; first 2 years of life, adolescence,
pregnancy requires more calories, BMR
declines slowly with increasing age,
decrease age, increase BMR – increase
age, decrease BMR. WHY? Lowering
muscle tone from lessened activity.
•Body composition - a large proportion
of inactive adipose tissue lowers the BMR.
Athletes with greater muscular
development increases BMR than
non-athletic individuals
Yosuico, Angela Nicole Collante 10
•Activity - increased muscular activity •DM: more than 140 mg/dl for 2
increase BMR. Greater energy consecutive readings
expenditure requires more calories. •Appetite – triggered by sight, smell and
thought of food
•State of nutrition - a decrease in mass •Satiety – triggered by gastric distention.
of active tissue like in malnutrition,
undernourished or starvation causes
decrease BMR. Illness increases energy
requirements because of increased
metabolic rate.
•Sleep - Less energy required during
sleep, metabolic rate drops due to
Nutrition Tools, Standards
muscular relaxation and decreased activity and Guidelines Nutrient
of the sympathetic nervous system.
Therefore, dinner is ideally the lightest Recommendation (laboratory)
meal.

•Endocrine glands - the secretion of the Dietary Formulations:

endocrine glands are the principal
regulators of the metabolic rate. Body Mass Index (BMI)
Therefore, male sex hormones increase
about 10-15% the BMR and the female 1. BMI = kg/m2
sex hormone a little less.
Classification of Body Mass Index
•Fever - increases the BMR about 7% for BODY MASS INDEX INTERPRETATION
each degree rise in the body temperature < 18.5 Underweight
above 98.6F. 18.5 – 24.9 Healthy / Normal BMI
25.0 – 29.9 Overweight
• Climate - cold climate causes higher 30.0 – 34.9 Obese 1
BMR so people need more calories due to 35.0 – 39.9 Obese 2
increased thyroxine level in people who >40.0 Extremely Obese
live in cold climate
Desirable Body Weight (DBW)
PHYSICAL ACTIVITY (PA) – calorie
requirements depend upon the type and 2. Infants = 0 – 6 months
amount of exercise or work engaged into. DBW = Birth weight (kg) + (age in mos. X
The more vigorous the physical work, the 600)
greater the calorie cost.
3. Infants = 7 – 12 months
Food and Fluid Intake Regulating DBW = Birth weight (kg) + (age in mos. X
Mechanisms 500)
(Hypothalamus) * If the birth weight is unknown used 3000
•Thirst – triggered by loss of body fluid of grams.
more than 2%
•Hunger – triggered by low blood glucose 4. Children
level DBW = age in years x 2 + 8
•normal blood glucose level (70-110 mg/dl)
5. Adults (Tanhausser’s Method)

Yosuico, Angela Nicole Collante 11

DBW = ht. in cm – 100 – (10%) Basal Metabolic Rate - rate of basal
metabolism in a given person at a given
Total Energy Requirement (TER)/day time and situation

6. Infants = 0 – 6 months BMR Calculation:

TER = DBW x 120 Kcal/ day KDBW
Rule of thumb
7. Infants = 7 – 12 months. (Male) 1 kcal per kg per hour
TER = DBW x 110 Kcal/ day KDBW (Female) - 0.9 kcal per kg per hour

8. Children (2-12 years old) Example:

TER = 1000 + (100 x no. Of years) 11. BMR (Male)
Male 75 kg = 1 kcal X 75 X 24 = 1,800
9. Adolescent (13-17) kcal
TER = DBW x 45 Kcal
12. BMR (Female)
10. Adults (Krause Method) Female 65 kg = 0.9 kcal X 65 X 24 =
TER = DBW x PA value 1,404 kcal

Physical Activity (PA) – calorie CPF computation in grams

requirements depend upon the type and
amount of exercise or
work engaged in. The more vigorous the
physical work, the greater the calorie cost.
SAMPLE PHYSICAL ACTIVITY
Bed Rest: 27.5 – Comatose, Bed-ridden
Sedentary: 30 – Secretary, Clerk, Typist,
Administrator, Cashier, Bank teller
Light: 35 - Teacher, Nurse, Student, Lab
Tech, Housewife with maid
Moderate: 40 – Vendor, mechanic, public
utility vehicle and car driver
Heavy: 45 – Farmer, laborer, coal miner,
fisherman, heavy equipment operator,
wrestler,
sports player
13. Computation of CPF in grams
Example:
TER X methods 1-5 (depending on the
case of the client – DM can use method 5)
TER = 2,000 X .50 = 1,000 / 4 = 250
grams of carbohydrates/day
2,000 X .20 = 400 / 4 = 100 grams of
protein/day
2,000 X .30 = 600 / 9 = 67 grams of
fat/day
TER of 2,000 kcal/day with diet
prescription of C = 250 grams; P = 100
grams; and F = 67
grams

Basal Metabolism – measure of energy METHODS Carbohydrate Protein

needed by the body at rest for its internal Fats
chemical method 1 60 15 25
activities like respiration, cellular method 2 70 10 20
metabolism, circulation, glandular activity method 3 65 15 20
and maintenance of method 4 60 10 30
body temperature; approximately 1 calorie method 5 50 20 30
per kg of body weight per hour

Yosuico, Angela Nicole Collante 12


Dietary Guidelines and Food
Guides (lecture)
The Food Pyramid is designed to make
healthy eating easier. Healthy eating is
about getting the correct amount of
nutrients – protein, fat, carbohydrates,
vitamins and minerals you need to
maintain good health. Grains should be
taken as the major dietary source. Eat
more fruit and vegetables. Have a
moderate amount of meat, fish, egg, milk
and their alternatives
The Philippines uses the daily nutritional
guide pyramid and has developed
pyramids for different population groups.
The healthy food plate for Filipino adults
(Pinggang Pinoy) completes the
messages of the pyramid by showing
adequate distribution of nutritious foods in
a meal.
Ping gang Pinoy (Filipino Plate) is a new,
easy to understand food guide that uses a
familiar food plate model to convey the
right food group proportions on a per-meal
basis, to meet the body’s energy and
nutrient needs of Filipino adults. Pinggang
Pinoy serves as visual tool to help
Filipinos adopt healthy eating habits at
meal times by delivering effective dietary
and healthy lifestyle messages.
As its name suggests, Pinggang Pinoy is
specially designed for Filipinos which
features the three (3) food groups GO,
GROW and GLOW foods represented by
food items commonly consumed by the
population. Go food represents
carbohydrates, Grow food represents
protein and Glow food represents vitamins
and minerals. Go or energy-giving foods,
such as rice, grains and other starches,
provide energy to keep one going
throughout the day.
Grow or body-building foods, such as
meat, fish, dairy and eggs, provide the
protein and minerals necessary for the
growth and repair of tissues, muscles and
bones. Recognizing the different nutrient
requirements of the different age groups,
the FNRI has developed the Pinggang
Pinoy plates for children, adolescents,
pregnant women and lactating mothers
and the elderly.
Yosuico, Angela Nicole Collante 13

Food Exchange List
The Food Exchange Lists (FEL) for Meal
Planning is one of the basic tools in
nutrition and dietetics. It is a tool for quick
estimation of the energy and
macronutrients for use in planning meals
of individual clients. Exchange lists
provide a way of grouping foods together
to help people on special diets stay on
track. Each group lists foods in a certain
serving size.
In the food exchange list, commonly use
foods are divided into seven groups or list.
Each list or group contains approximately
the same amount of carbohydrates,
proteins, fats and calories per exchange.
A food in any one group can thus be
substituted for or exchange with another
food in the same list or sub-group. This
food list can be use in meal plan but
substituting each group in the same
group. Nurse can use this list to give more
choices in planning a meal for a client.
Food Labels
Food labels provide more than just
nutrition facts, though. They also tell the
public what's in a packaged food (i.e., the
ingredients). Food manufacturers are
required to list all ingredients in the food
on the label. But some ingredients can be
listed collectively as "flavors," "spices,"
"artificial flavoring," or in the case of color
additives exempt from certification,
"artificial colors", without naming each
one.
Nutrient Guidelines for Filipino
The Nutritional Guidelines for Filipinos
(NGF) is a set of dietary guidelines based
on the eating pattern, lifestyle, and health
status of Filipinos. The NGF contains all
the nutrition messages to healthy living for
all age groups from infants to adults,
pregnant and lactating women, and the
elderly.
The first NGF released in 1990 was
composed of five messages called
“Dietary Guidelines for Filipinos.” In 2000,
a revised nutritional guidelines composed
of ten messages was released and it was
called the Nutritional Guidelines for
Filipinos.
The 2012 NGF now includes the basis
and justification for each of the ten
Yosuico, Angela Nicole Collante 14
nutritional and health message. The
following 2012 NGF:
(1)Eat a variety of foods everyday to get
the nutrients needed by the body.
(2) Breastfeed infants exclusively from
birth up to six months and then give
appropriate complementary foods while
continuing breastfeeding for two years and
beyond for optimum growth and
development.
(3) Eat more vegetables and fruits to get
the essential vitamins, minerals, and fiber
for regulation of body processes.
(4) Consume fish, lean meat, poultry, egg,
dried beans or nuts daily for growth and
repair of body tissues.
(5) Consume milk, milk products, and
other calcium-rich food such as small fish
and shellfish, everyday for healthy bones
and teeth.
(6)Consume safe foods and water to
prevent diarrhea and other food-and
water-borne diseases.
(7) Use iodized salt to prevent Iodine
Deficiency Disorders.
(8) Limit intake of salty, fried, fatty, and
sugar-rich foods to prevent cardiovascular
diseases
(9) Attain normal body weight through
proper diet and moderate physical activity
to maintain good health and help prevent
obesity.
(10) Be physically active, make healthy
food choices, manage stress, avoid
alcoholic beverage, and do not smoke to
help prevent lifestyle-related
non-communicable disease
USDA Food Guide
The Dietary Guidelines for Americans
(Dietary Guidelines) is the cornerstone for
Federal nutrition programs and a go-to
resource for health professionals
nationwide. The Dietary Guidelines
provides food-based recommendations to
promote health, help prevent diet-related
chronic diseases, and meet nutrient
needs.
Serving Up MyPlate is a collection of
classroom materials that helps elementary
school teachers integrate nutrition
education into Math, Science, English
Language Arts, and Health. This yummy
curriculum introduces the importance of
eating from all five food groups using the
MyPlate icon and a variety of hands–on
activities. Students also learn the
importance of physical activity to staying
healthy.
Nutrition Care Process
(ADIME)
Nutritional Assessment
Adequate Diet – is composed of various
nutrients which the body needs for
maintenance, repair, and for growth and
development.
Essential of an Adequate Diet
•Milk Group - provide most of the calcium
requirements
•Meat Group - provides generous
amounts of protein in high quality
•Bread and Cereal Group – furnishes
carbohydrates, minerals and vitamins at a
relatively at low costs.
•Vegetable-Fruit Group - important
supplier of fiber, vitamins and minerals
particularly Vitamin A and C.
Assessment of Nutritional Status
Nutritional Status or Nutriture
Yosuico, Angela Nicole Collante 15

- is the degree to which the individual’s
psychological need for nutrients is being
met by food she or he eats.
- is the state of balance in the individual
between the nutrient intake and the
nutrient expenditure or needs
•Dietary History and Intake Data
A. 24 Hour Recall – patient or individual
completes a questionnaire or maybe an
interview asking to recall everything that
he or she ate within the last 24 hours.
B. Food Frequency Questionnaire –
patient answers the questionnaire for
frequency of food use as accurately as
possible
C. Dietary History
contains additional information about the
patient’s income, physical activity, ethnic
and cultural background, influence s on
eating habits and religion, home life and
meal patterns, factors that affect appetite,
allergies, intolerances, food avoidance,
dental and oral problems in eating,
gastrointestinal problems, chronic
diseases, dietary modifications and
medication.
Ethnic and Religion
1. Christianity – holy week observances
may restrict meat (Good Friday)
2. Seventh Day Adventist – no pork and
shellfish, alcohol, encourages veges diet
3. Judaism – no pork, shellfish, blood
products, mixing of milk or dairy products
with meat in one meal, Kosher diet, no
cooking during Sabbath day (Saturday)
4. Mormon – no alcohol, tobacco and
caffeine
5. Islam – no pork (Haalal diet), no
alcohol, caffeine, practices Ramadam
(fasting from sunrise to sunset of the
month)
6. Hinduism – all meats are prohibited
Food Avoidance
1. Phenylalanine (EAA) – low protein diet
to avoid imbalance of brain amino acids in
Phenylketonuria
2. Purine – reduce uric acid producing
foods in gouty arthritis and hyperurecemia
3. Tyramine – high protein foods that
underwent protein breakdown by aging,
fermentation and smoking
4. Gluten – a protein found in wheat, rye,
barley, and other starchy foods, except
rice and corn like in Celiac Disease
Medications
1.Monoamine Oxidase Inhibitors (MAOI)
– antidepressants, AVOID tyramine
containing foods like alcoholic beverages,
dairy products, avocado, banana, meats,
chocolates and
Condiments cause HYPERTENSIVE
CRISIS.
2. Warfarin Sodium (Coumadin) –
anticoagulant, AVOID or instruct the
patient to decrease intake of green leafy
vegetables
3. Methimazole (Tapazole) – antithyroid,
uses for Hyperthyroidism, inhibits
synthesis of thyroid hormone by interfering
with iodine. Teach the client to AVOID
seafood and iodine products.
4. Estrogen Replacement Therapy
(HRT) – management of menopausal
symptoms in women. Estrogens increase
risk of cardiovascular disease and cancer
so instruct the patient to AVOID or reduce
alcohol, caffeine and smoking.
D. Food Diary or Record – this method
involves time, understanding and
motivation on the part of the patient as
she or he writes down everything he or
she eats or drinks for a certain period of
time.
Yosuico, Angela Nicole Collante 16

E. Observation of Food Intake – most
and accurate method of dietary intake
assessment, because it requires knowing
the amount and kind of food presented to
the patient and record the amount actually
eaten.
General Rules for Menu Planning
•Use the whole day as a unit rather than
the individual meal.
•Use some food from each of the food
groups daily (energy giving foods, body
building foods and body regulating foods)
•Use some raw fruits or vegetables at
least once a day
•Plan to have for each meal at least one
food with staying power or high in satiety
value.
•Combine or alternate bland form with
those of a more pronounced flavor.
•Combine and alternate soft and crisp
foods.
•Have a variety of color, food and food
arrangement.
•When more foods are served at one
meal, decease the size of portions and
use fewer rich foods.
•Meal or menu patterns are helpful in
planning menu but consider the family’s
habits and needs. The traditional
recommended patterns for breakfast like
fruit, egg or substitute, bread or rice, hot
beverage and for lunch and dinner- meat,
fish and poultry, rice, vegetable and fruit or
dessert
•It is best to have a weekly menu plan.
Nutritional Survey – is an
epidemiological investigation of the
nutritional status of the population.
Methods of Nutritional Assessment
•DIRECT information
A.Clinical Examination
- advantages as more coverage in a short
time, inexpensive, no sophisticated
equipments
-disadvantages as non-specificity of signs,
overlapping of deficiency states and bias
of the observer
-system of collecting data starts from the
head to toe (cephalocaudal)
-establishing data base
Methods of Collecting Data
•Interview
•Observation - IPPA
Sources of Data
•Primary: Patient
•Secondary: Family Members, Significant
Others, Health team members and Chart
A.Biochemical Examination
- estimation of time desaturation, enzyme
activity or blood composition
- tests samples are blood and urine and
results generally compared to
standards
- advantages as objectivity and can detect
easily states of nutritional deficiency
- disadvantages as costly and time
consuming
-factors affecting accuracy of results like
standards of collection and method of
transport and storage of samples
A. Anthropometric Measurement –
measurement of the variations of the
physical dimensions and gross
composition of the human body at different
age levels and degrees of nutrition.
•Weight for age – uses weighing scale,
assess body mass
• Height for age – uses stadiometer,
anthropometric steel rods fixed accurately
and vertically to the wall
•Weight for height/length – most
accurate indicator of present state of
nutrition, an expression of leanness or
wasting
•Skin fold thickness – uses reliable
caliper
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• Body circumferences
• Birth weight
• What is the healthy waistline?
Women - <31 inches Men - <35 inches
•Methods that provide INDIRECT
information
A.Food Consumption Studies
B.Studies on Health Condition and Vital
Statistics
C.Studies on food supply situation
D.Studies on socio-economic conditions
E.Studies on cultural and anthropological
influence
MALNUTRITION
• it is a global problem.
• a condition caused by sustained,
deficient, excessive, or imbalanced supply
of calories, and nutrients.
Forms of Malnutrition
Under nutrition - a pathological state
resulting from the consumption of an
inadequate quantity of food, over an
extended period of time.
Specific deficiency - a pathological state
resulting from a relative or absolute lack of
an individual nutrient. (VAD, IDA,IDD)
Over nutrition - a pathological state
resulting from the consumption of an
excessive quantity of food, a calorie
excess over an extended period of time.
Types of Malnutrition
Acute malnutrition – related to the
present state of nutrition like weight loss,
low weight for height and normal height for
age
Chronic malnutrition – related to the
past state of nutrition like nutritional
dwarfism, low weight for height and low
height for age
Effects of Malnutrition
•Increases susceptibility of infections
•Inhibits mental development
•Imposes heavy social and economic
burdens
Causes of Malnutrition in the
Philippines
•Poverty
•Poor distribution of food supply
•Large family size
•Low level of education among household
member
Indicators for children below 10 years
old
Body Mass Index
Indicator for 18 – 65 years old
Weight in KILOGRAMS
2
(Height in METERS)
BODY MASS INDEX INTERPRETATION
< 18.5 Underweight
18.5 – 24.9 Healthy / Normal BMI
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25.0 – 29.9 Overweight •human pregnancy lasted for a period of
30.0 – 34.9 Obese 1
266 to 280 days (37-40 weeks)
35.0 – 39.9 Obese 2
>40.0 Extremely Obese •consists of three trimesters

WAIST CIRCUMFERENCE •has three main phases – implantation,

organogenesis, growth
This alone is accurate measure of the amount of

visceral fat (CENTRAL OBESITY) Nutrition in Pregnancy:

Normal Findings •Always start with diet history when it

Men - < 90 cm / 35 inches comes to giving nutritional instruction to the

Women - < 80 cm / 31.5 inches mother.

WAIST HIP RATIO •PICA – persistent ingestion of inedible

Waist Circumference (cm) – narrowest point substances of little nutritional value

Hip Circumference (cm) – widest point •Vegetarians – lack essential protein and
Normal Findings Men - < 1 Women - < 0.85
minerals, need Vitamin B12 supplement

• Calorie Allowances Non-pregnant

WEIGHT FOR AGE
requirements – 1,800 to 2,200 Kcal/day
Sensitive indicator of CURRENT nutritional status
Additional caloric requirement per day

HEIGHT FOR AGE –300 Kcal/day

Less sensitive and generally an indicator of PAST
Usual daily caloric need in pregnancy –
nutritional status (CHRONIC MALNUTRITION)
2,100 to 2,500; never less than 1,800

WEIGHT FOR HEIGHT Kcal/day

Most accurate indicator of present or current state •Maternal weight gain – 25 to 35 lbs
of nutrition
•Maternal under weight causes having

high risk of low birth weight, preterm and

Nutrition in Pregnancy infant deaths

•Maternal over weight causes having risk

Pregnancy and Lactation
of complications in labor and delivery,
It ensures optimum nutrition before, during
hypertension, gestational DM, post
and after pregnancy and during lactation
partum infections.
Characteristics of Pregnancy:

•fertilized ovum implants itself to the uterus

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•Protein allowances - body-building food - - supplementary in pregnancy is 30-

additional 30 g/day to ensure 74 to 76g/day 60mg per day

- rich food sources includes milk, meat, - needed to increase maternal RBC and

fish, poultry and eggs for fetal liver storage in the third trimester

- provide for the storage of nitrogen •Calcium - needed for maternal calcium

- protect the mother from any complications and phosphorus metabolism and fetal bone

- growth for maternal uterus, mammary and skeletal growth

tissues and placenta - 1,200 mg/day, equivalent to 1 quart of

- needs for fetal growth and repair milk a day (4 glasses)

- hormonal preparation for lactation •Sodium - most abundant cation in

•Carbohydrates - sufficient intake is extracellular flui

necessary for added energy - needed for tissue growth and

- Avoid “empty” calories like soft drinks development

•Fats - high energy foods for absorption of - should not be restricted without serious

vitamins ADEK indications

- AVOID too much fats to prevent •Iodine – needs for fetal development and

vomiting and heartburn avoid cretinism

•Iron - most important mineral that must be •Vitamins – water and fat soluble vitamins

taken in supplementary amount Weight Gain= 11. 2 – 16 kg (25 – 35 lb)

- supplementary in pregnancy is 30-60mg • recommended as an average weight gain

per day in pregnancy

- needed to increase maternal RBC and 11. 2 – 16 kg (25 – 35 lb)

for fetal liver storage in the third trimester 1 lb per month during FIRST trimester
1 lb per week during 2nd and 3rd
•Fats - high energy foods for absorption of
trimester
vitamins ADEK
3-12-12
- AVOID too much fats to prevent vomiting
CALORIE NEEDS
and heartburn
2,200 women in childbearing age + 300 in
•Iron - most important mineral that must be
pregnancy = 2,500 calorie
taken in supplementary amount
low= CHO high=CHON breakdown

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Mother – Ketoacidosis
Fetus – deprivation of essential
CHON – Neurologic defects, Death
Even an OBESE pregnant should never
consume LESS than 1,500 calories per
day.
Weight is the most accurate indicator if
the woman has adequate caloric intake Mineral Needs

PROTEIN NEEDS

44g – 46g women in childbearing age 60g

in pregnancy

low= Iron, B complex especially B12.

Calcium, Phosphorus

high= Cholesterol

Vitamin A Needs
Discomfort
Nausea and Vomiting

- Eat dry crackers before rising in bed

- High CHO, Low FAT diet

- Small frequent feedings

- NEVER self medicate esp. antacids

Vitamin B9 needs
Heartburn (Pyrosis)

- Small frequent meals

- Don’t lie down immediately after eating

- Amphojel (Aluminum hydroxide) or Maalox

may be prescribed

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Maalox = Aluminum hydroxide +

Magnesium hydroxide Breastfeeding benefits to the mother

•Promotes maternal-infant bonding

Complication of Pregnancy and Dietary •Promotes uterine contraction and provided

Modifications less incidence of thrombophlebitis

1. Morning Sickness •Reduces rate of ovarian cancer and

2. Rapid weight gain or loss premenopausal breast cancer

3. Toxemia of Pregnancy •Decreases maternal morbidity and mortality

4. Anemia •Save time, money, effort and economical

5. Gestational DM •Delays fertility

6. Constipation •Provide social and economic

7. Socio-economic and cultural factors benefitsBreastfeeding benefits to the mother

8. Alcohol, caffeine and nicotine •Promotes maternal-infant bonding

•Promotes uterine contraction and provided

Nutritional Requirements for Lactating less incidence of thrombophlebitis

Mothers •Reduces rate of ovarian cancer and

•the nutritional requirements in lactation are premenopausal breast cancer

greater than in pregnancy to ensure enough •Decreases maternal morbidity and mortality

supply of milk for the baby. •Save time, money, effort and economical

•Mother’s milk is the best food for baby •Delays fertility

(Executive Order 51) •Provide social and economic benefits

If vaginal delivery – breastfeeding may done Breastfeeding benefits for the baby

as early as 30 minutes after birth •Promote attachment

If CS delivery – 4 hours after delivery •Provide perfect food that contains all

•Demand feeding – best rule to observe when necessary nutrients

feeding the baby •Easily digested, has the right temperature

•Provide a relaxed, warm and supportive and free from harmful bacteria

environment as the letdown reflex is affected •Provides passive antibody transfer to the

by negative emotions of the mother. Provide newborn

reinforcement for •It has colostrums, high protein content

positive behavior or successful actions. contains antibodies which help resist infection

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•Causes fewer incidences of allergies, •Breast milk is higher in lactose than cow’s

vomiting, diarrhea, constipation and milk.

aspiration. Breastfeeding Misconceptions:

•Enhances brain development because of •A mother sick with PTB cannot breastfeed.

taurine content •Breast milk is not good if the mother has

•Decreases infant morbidity and stayed long under the sun

mortalityBreastfeeding benefits for the baby •A mother cannot breastfeed during

•Promote attachment pregnancy

•Provide perfect food that contains all •A mother cannot breastfeed with only one

necessary nutrients breast if the other breast is painful

•Easily digested, has the right temperature •A mother cannot breastfeed if she has a

and free from harmful bacteria cold, flu or diarrhea

•Provides passive antibody transfer to the •Breast milk is not good if the mother has

newborn been caught in a sudden shower

•It has colostrums, high protein content

contains antibodies which help resist infection Breastfeeding Misconceptions:

•Causes fewer incidences of allergies, •A mother sick with PTB cannot breastfeed.

vomiting, diarrhea, constipation and •Breast milk is not good if the mother has

aspiration. stayed long under the sun

•Enhances brain development because of •A mother cannot breastfeed during

taurine content pregnancy

•Decreases infant morbidity and mortality •A mother cannot breastfeed with only one

breast if the other breast is painful

Advantages of Breast milk than Cow’s •A mother cannot breastfeed if she has a

milk cold, flu or diarrhea

•Breast milk is higher in CHO, fat and water •Breast milk is not good if the mother has

content but lower in protein, vitamins and been caught in a sudden shower

minerals.

•It has lactalbumin – human milk protein – Breastfeeding Contraindications:

easy to digest and hypoallergenic and cow’s •Breastfeeding may not be advisable when

milk protein called casein causes allergy

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mother has syphilis, AIDS, DM or any severe • Dental Health

infections. • Early Child Development

•Breastfeeding is not encouraged when the • Child Health Injuries

mother is under emotional and mental stress. INFANT AND YOUNG CHILD FEEDING

•Mother who smokes. • Initiate breastfeeding WITHIN 1 HOUR after

•Mother who takes contraceptive pills or birth

drugs • EXCLUSIVE BREASTFEEDING for the first

•Other contraindication includes metabolic 6 months

abnormalities or severe prematurity of the • COMPLEMENTARY FEEDING for age 6

newborn which require the use of special months up to 2 years or beyond.

therapeutic formulas. – TIMELY

Factors affecting milk secretion – ADEQUATE

•Diet – SAFE

•Nutritional State of mothers – PROPERLY FED

•Emotional and Physical State

•Suckling Public Health Nursing in the Phils.

•Use of contraceptives and drugsFactors Diet - breastfeeding / breast milk is best be

affecting milk secretion given until 18 months to 2 years of age

•Diet •bottle feeding – artificial feeding with cow’s

•Nutritional State of mothers milk, costly, associated with infantile obesity

•Emotional and Physical State or “protein-calorie malnutrition plus”

•Suckling •mixed feeding -complemented - insufficient

•Use of contraceptives and dru supply of breast milk

-supplemented - mother is away from home

Child Health Programs for feeding

(newborn, infant, children)

Infant and Young Child Feeding Two methods of formula preparation:

• Newborn Screening •Aseptic method – equipments and

• EPI ingredient are sterilized separately

• IMCI •Terminal method – formulas are poured into

• Micronutrient Supplementation clean but unsterilized bottles and are

Yosuico, Angela Nicole Collante 24

sterilized together ● 9-12 months – whole tender foods or

Weaning: 6 months: breast to bottle foods chopped coarsely are given,

12 months: bottle to cup finger foods like cottage

Feeding Time: cheese, crackers, plain meats and

2.5 to 2.7 kg baby usually feeds every 3 egg yolks

hours (8 feedings)

•3.6 to 4 kg baby usually feeds every 4 Sequence of introducing solids

hours (6 feedings) cereal, fruit, vegetable, meat, fish 7-8 months

•2 to 3 months old, the baby is on 4 to 5 – foods are mashed or chopped finely, not

feedings, the baby sleeps through the night strained to teach mastication, soft cooked egg

after 10 pm feeding with rice porridge, boiled fish, banana and

camote mash and the like.

Supplementary foods:

● 2 months – liquids like rice water, ● 9-12 months – whole tender foods or

calamansi juice may be introduced foods chopped coarsely are given,

depending upon infant’s tolerance finger foods like cottage cheese,

and acceptance crackers, plain meats and egg yolks

● 4 months – first solid foods (rice

cereals) Sequence of introducing solids

● 5-6 months – teething foods; full diet cereal, fruit, vegetable, meat, fish

consisting of pureed meat, egg, Foods to avoid in the first year of life

strained fruits and vegetables and Infantile poisoning – honey (clostridium

chewy foods be given not only to botulinum)

soothe the sensitive gums but also to

teach the baby the art of self-feeding Choking hazards

● 7-8 months – foods are mashed or •hotdogs, grapes, hard candies, raw carrots,

chopped finely, not strained to teach pop corns, nuts, peanut butter

mastication, soft cooked egg with rice Insufficient calories - skim milk

porridge, boiled fish, banana and

camote mash and the like. Potential allergen – cow’s milk, egg whites

Yosuico, Angela Nicole Collante 25

Cues to readiness to solids: •Never start two new foods at the same time

•Sucking reflexes is intact •Allow an interval of 4-7 days between new

•Ability to sit with support foods

•Avoid feeding an infant lying supine to •Feed baby only with freshly-cooked foods or

prevent aspiration fruits freshly peeled. Avoid giving left-over

•Present salivary glands and intestinal foods to babies.

enzymes that aids in digestion •Do not bribe, plead, threaten or force the

•Fetal iron reserve in the liver usually infant

consumed by 4-6 monthsCues to readiness

to solids: Common Disorders:

•Sucking reflexes is intact •Diarrhea – most frequently caused by

•Ability to sit with support bacteria and viruses

•Avoid feeding an infant lying supine to •Vomiting

prevent aspiration •Allergy – milk intolerance

•Present salivary glands and intestinal •Constipation

enzymes that aids in digestion •Colic – most common

•Fetal iron reserve in the liver usually Health Problems with Infancy:

consumed by 4-6 months •Galactosemia

•Phenylketonuria (PKU)

Rules to follow when introducing •Maple Syrup Urine Disease (MSUD)

supplemental foods: Fluid needs of the YOUNG CHILD

•Introduce one food at a time • WATER is good for thirst.

•Show pleasure when giving new food at the • Too much FRUIT JUICE may cause

same time, make gesture. diarrhea and may

•Give a small amount (1 tsp) at a time reduce child’s appetite for foods

•Offer bland foods to the baby (not too salty, • SODAS are not suitable

not too sweets) • TEAS and COFFEE reduce iron absorption.

•Do not mix with formula • A SMALL DRINK will satisfy a child’s thirst

•Feed when newborn is hungry after a few during meals

sucks of milk to increase his patience for a

new food

Yosuico, Angela Nicole Collante 26

• A non breastfed child (6-24 mons) needs (glucogenic amino acids) carbohydrates

2-3 cups of water in a temperate day or 4-6 release cortisol, the so-called "stress"

cups in a hot climate hormone.

Glycogenesis – formation of glycogen to

Feeding the CHILD WHO IS ILL glucose

• Encourage to eat and drink with lots of Glycogenolysis – breakdown of glycogen to

patience glucose; The process is caused by the

• Feed small amounts frequently hormones glucagon and epinephrine which

• Give food that the child likes stimulate glycogenolysis and which are

• Give a variety of nutrient rich foods produced in

• Continue to breastfeed response to low blood glucose levels. It takes

place in the muscle and liver tissue which is

NUTRITION PROGRAM where glycogen is stored.

Common nutritional deficiencies

❶ Vitamin A ❷ Iron ❸ Iodine Total Energy Requirement

Micronutrient supplementation Carbohydrates (CHO) – 50 to 70 %

• Araw ng Sangkap Pinoy / Garantisadong Protein (CHON) – 10 to15 %

Pambata / Child Health Week – twice a year Fats (CHO with glycerol base) – 20 to 30%

distribution of Vitamin A capsule.

Food Fortification (RA 8976) Nutritional Growth and Development

• mandatory fortification of staples: (flour, INFANTS

cooking oil, refined sugar, rice and processed •refers to a person not more than 12 months

foods) through SANGKAP PINOY Seal •remove small objects that the infant can

choke on

•burp the baby after each feeding to prevent

colic

•daily caloric requirements: 1200 Kcal/day

Nutrition through breast milk

Finger foods at 10-12 months

Gluconeogenesis – converting protein
Alone in playing (solitary)

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Note for weight 2x at 6, 3x at 12 months •daily caloric requirement: 1,300 to 1,400

Teething begins at 6 months kcal/day or 100 cal/kg/day

Sucking gives gratification •physiologic anorexia (decrease in appetite)

because toddler is busy at play

Length X 50% at 1 year •weight quadruple at 2 years old

Only mother as significant others Temper tantrum

Estranger Anxiety around 6-8 months Offer choices

Stands alone at 12 months Diet preference unpredictable, able to feed

Trust vs Mistrust self

Pincer grasp at 10th month Dental examination at 2-3 years (2y/o -16

Lower incisors erupt before upper incisors 3y/o -30)

Allow cruising at 12 months Safety is priority

Yells (cries) without parents (parent No Attitude

preference) Ensures increase Ca, P and Fe

TODDLERS Elimination training (bowel training)

•a period of life from 1-3 years old Drinks 16-24 oz milk/day

•daily caloric requirement: 1,300 to 1,400 Separation anxiety

kcal/day or 100 cal/kg/day Autonomy vs shame and doubt

•physiologic anorexia (decrease in appetite) Parallel play

because toddler is busy at play Rituals, routines and dawdling

•weight quadruple at 2 years old Accident – prone

Involve parents in child care

Temper tantrum Sibling rivalry

Offer choices Explain procedure

Diet preference unpredictable, able to feed

self PRESCHOOLERS

Dental examination at 2-3 years (2y/o -16 • 3-6 years old

3y/o -30) •larger requirements for growth so there is a

Safety is priorityTODDLERS greater need for protein, vitamins and

•a period of life from 1-3 years old minerals

Yosuico, Angela Nicole Collante 28

•period of food habits and preferences, school years, needs adequate food for growth

selective, making him more vulnerable to and builds his body, gives plenty of energy for

nutritional deficiencies play, helps him to fight common infections,

•won’t eat era - appears thinner than a toddler helps keep the child healthy, happy and

decrease in weight, desire for food is erratic physically fit as well as mentally alert.

parents must be careful not to foster poor

eating habits by urging, forcing, or even Feeding Problems (Causes and

bribing the child to eat Remedies):

Fear of punishment, family as significant •Child is eating too little.

others •Child is eating too much.

Obesity is a risk •Child is dawdling during mealtime.

Kcal of 85/kg/day or daily calorie of 1,700 – •Child is gagging especially when fed course

1,800 foods.

Eating junk food is a problem •Child has aversion towards some foods.

Imaginative thinking; imaginary playmates •Child has allergies.Feeding Problems

Mutilation, abandonment and dark, fear of •Child is eating too little.

Associative play •Child is eating too much.

Grow rate slows and erratic •Child is dawdling during mealtime.

Initiative vs guilt •Child is gagging especially when fed course

No new teeth develops foods.

Appetite is not large •Child has aversion towards some foods.

Oedipus and electra complex •Child has allergies

Needs explanation Mucus produced by the exocrine glands is

Seen pleasures on touching of genitals abnormally THICK causing obstruction to

Good nutrition – is important during pre- small passageways of affected organs

school years, needs adequate food for growth • Common Problems

and builds his body, gives plenty of energy for – Pancreatic enzyme deficiency

play, helps him to fight common infections, – Chronic lung diseases

helps keep the child healthy, happy and – High Na and Cl SWEAT concentration

physically fit as well as mentally alert. – Infant tastes SALTY when kissed

Good nutrition – is important during pre-

Yosuico, Angela Nicole Collante 29

Cystic Fibrosis • Breastmilk contains LOW phenylalanine

• Administer pancreatic enzyme with meals to levels

enhance palatability

• High CHON, High Calorie diet Dietary Management

• Vitamins A, D, E, K supplementation • An inborn error of CARBOHYDRATE

• Salt supplements during hot weather or metabolism

fever • Galactose 1-phosphate uridine transferase

Dietary Management is absent– Enzyme necessary for conversion

• Intolerance to GLUTEN, the protein of GALACTOSE to

component of Barley, Rye, Oat, Wheat GLUCOSE

• Common Problems– Accumulation of amino

acid GLUTAMINE is toxic to Galactosemia

intestinal mucosal cells • Eliminate ALL milk and lactose containing

foods including BREASTMILK

Celiac Disease • Avoid PENICILLIN because it contains

• Gluten FREE Diet Foods allowed: lactose as filler

RICE, CORN, Meat, Dairy products Dietary Management

Not Allowed: BROW • Eliminate ALL milk and lactose containing

Pudding, Breads, Cookies, Cakes, Crackers, foods including BREASTMILK

Cereals, Noodles, Beer and Ale • Avoid P

Dietary Management

• Genetic disorder that results in CNS

damage from

toxic levels of phenylalanine in the blood

Phenylketonuria

• LOFENALAC

• Avoid high CHON – meats and dairy

products

Yosuico, Angela Nicole Collante 30