Lab: Nutrition & Diet Therapy

Marial J. Contiga BSN 2 - Barnard

Barnard
MIDTERM NOTES
Components of Energy Expenditure Rule of Thumb
Basal Metabolism • 1 kcal per kg per hour for adult male and 0.9
kcal per kg per hour for adult female.
• Is the measure of energy needed by the body
• So an individual whose IBW is 50 kg has a basal
at rest for all its internal chemical activities;
metabolic energy need of 1200 kcal per day (50
approximately 1 calorie per kilogram of body
x 1 kcal x 24 hours).
weight per hour for an adult.
• This value however may not be applicable for
• It is the minimum amount of energy needed by
obese or lean individuals
the body at rest in the fasting state.
• COMPUTATION:
• It indicates the amount of energy needed to
suction the life processes: respiration, cellular Ex. Male 75 kg Ex. Female 65 kg
metabolism, circulation, glandular activity and = 1 kcal x 75 x 24 = 0.9 kcal x 65 x 24
the maintenance of body temperature. =1800 kcal = 1,404 kcal
• It accounts for more than one- half of calorie
requirements for most people.
Harris Benedict Formula
• Developed in 1909, using information on weight,
Basal Metabolic Rate
height, age and sex.
• Is the rate of basal metabolism in a given • RESTING ENERGY EXPENDITURE (REE)
person at a given time and situation. • Represents the amount of calories required for a
• It constitutes one-half of the calorie 24 hour period by the body during the non-active
requirements of an individual. period.
• For males:
• REE= 66 + ( 13.7 x wt (kg) ) + (5 x ht (cm)) –
Conditions Necessary for a BMR Test: (6.8 x age (yr) )
• To ensure accuracy: • For females:
• The subject must be in a fasting or post • REE= 655 + (9.6 x wt (kg) ) + ( 1.8 x ht (cm) )-
absorptive state, at least 12 hours after the (4.7 x age (yr) )
meal. Test is usually take in the morning. • Basal Metabolic Rate
• The subject must be awake, lying quietly, free • Men: BMR = 88.362 + (13.4 x weight in kg) + (5
from physical fatigue, nervousness or tension x height in cm) – (5.7 x age in years)
as this causes an increase in heat production. • Women: BMR = 447.6 + (9.3 x weight in kg) +
• The environmental temperature should be (3 x height in cm) – (4.3 x age in years)
between 20-25oC so that the subject can
maintain his body temperature.
• Values obtained in this test which are within Factors that Affect the BMR
the plus or minus 10% are still considered
normal
 Lab: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
• SURFACE AREA • ENDOCRINE GLANDS
• The greater the body or skin area, the greater • The secretion of the endocrine glands are the
the amount of heat loss will be, and in turn, principal regulators of the Metabolic rate.
the greater the necessary heat produced by the • The male sex hormones increase the BMR
body. about 10-15% and the female sex hormones a
• Muscle tissue requires more oxygen than little less.
adipose tissue. • FEVER
• SEX • It increases the BMR about 7% for each
• Women, in general, have a metabolism of degree rise in the body temperature above
about 5 to 10% lower than men even when 98.6 degrees F.
they are of the same weight and height.
•
Desirable Body Weight (DBW)
Women have a little more fat and less
muscular development than men.
• AGE
• The metabolic rate is highest during the • Is maximally healthful for a person, based
periods of rapid growth, chiefly during the chiefly on height, but modified by factors
first and second years and reaches a lesser such as:
peak through the ages of puberty and ➢ Gender
adolescence in both sexes. The BMR ➢ Age
declines slowly with increasing age to lower ➢ Build
muscle tone from lessened activity.
• BODY COMPOSITION
• A large proportion inactive adipose tissue Ador Dionisio’s Method
lowers the BMR.
• Athletes with great muscular development • HEIGHT- For every 5 feet, allow 100 lbs for
show about 5% increase in basal metabolism female and 110 lbs for male
over non-athletic individuals. • For each additional inch, allow 2 lbs each,
• STATE OF NUTRITION • AGE - For every 5 years between 25-50 yrs,
• A decrease in mass of active tissue like in 2 lbs additional.
undernourishment of starvation causes a • Example:
lowered metabolism often as much as 50%
below normal. DBW of a 45 years old male, 5’4” tall
• SLEEP Height = 5 feet =110 lbs
• During sleep, the metabolic rate falls 4” inches x 2 = 8 lbs
approximately 10-15% below that of waking _______________
levels. 118 lbs
• This is due to muscular relaxation and Age = 45 years x 2/5 =18 lbs
decreased activity of the sympathetic nervous DBW = 118 lbs + 18 lbs = 136 lbs
system.
 Lab: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Tannhauser’s Method

• Height in cm- 100 cm

• Take 10% of the remainder and subtract
answer from the remainder.
Ex: DBW of 45 years old, 5’4” tall
Height = 5’ 4” = 64 inches = 162.56 cm
162.56 cm -100 cm = 62.56 cm
10% of 62.56 cm = 6.256
62.56 cm --6.256 = 56.304 cm.
56.304 cm.
Conversion factor:
1 kg = 2.20462 lbs
1 kg = 2.20462 lbs
1 ft = 12 inches
1 inch= 2.54 cm
 Lab: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
BMI/TEA

• Is the ratio of weight to height

• Is a value derived from the mass and height of a
person.
• It is defined as the body mass divided by the
square of the body height and is expressed in
units of kg/m2, resulting from mass in
kilograms and height in meters.

Importance
.Ana is 45 kilograms, and 1.7 meters
tall. Solve for the BMI
• A way to figure out your approximate level of
SI: BMI = 45kgs/ (1.7m)2
body fat in an easy, inexpensive way. = 45 kgs/ 2.89 m2
• Can help you tell if you are at a healthy weight = 15.570 or 15. 571 or 16
for your height. = 16 ( Underweight)
•
• The higher the number, the more body fat a 2.Imperial :
person has. Shiela is 100 lbs, 66 inches in height:
BM I= 100 x 703
Formula: BMI ( 66) 2
= 70300/ 4356
= 16.13 (Underweight)
SI units: (International System of Units)/Metric
system

BMI= WEIGHT IN KILOGRAMS Conversion

( HEIGHT IN METERS ) 2
120 Inches to foot
IMPERIAL UNITS Solution:
120 in x 2.54 cm = 304.8 cm
BMI = MASS (lb) x 703 1 inch
(height (in) )2
304.8 cm x 1 ft = 10 ft
30.48 cm
BMI= MASS (lb) x 4.88 So therefore 120 inches is = to 10 ft.
(height (ft))2
 Lab: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES

Result of BMI 55 kg doing light activity

55 kg x 35 = 1925
• BMI LESS THAN 18.5 = Underweight PERCENTAGE DISTRIBUTION OF CHO,
• BMI 18.5 TO 24.9 = Normal weight CHON AND FAT
• BMI 25 TO 29.9 = Overweight CHO= 55-70% OF TEA
• BMI 30 AND HIGHER = Obese CHON= 10-15% OF TEA
FAT = 20—30% OF TEA

Sample computation: Sample Computation:

A individual who weighs 92 kg and is 175 cm tall CHO= 1925 X 65% OF TEA=1251.25Kcal
CHON=1925 X 10% OF TEA =192.5 Kcal
Conversion factor: FAT= 1925 X 20% OF TEA = 385 Kcal
1 cm = .01 meter
175 cm x .01 m = 1.75 No. of grams of CHO, CHON, and Fat
1 cm CHO= Kcal / 4
92 kg / (1.75 m)2 = 30 CHON = Kcal/4
FATS = Kcal/9

Total Energy Allowance Sample Computation:

CHO =1251.25 / 4 =313 grams
• Desired body weight x activity factor CHON =192.5 / 4 = 48 grams
• Is also known as Total energy requirement, FATS = 385 / 9 =43 grams
or Total Caloric requirement
• It is the unit of energy that your body uses
to function and perform daily life sustaining
activities.
• TEA = DBW x Activity Factor
• Activity Factor

Sample Computation:
• Use Ex.
• CHO = 65
• CHON = 10
• FAT = 20
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Nutrition during Pregnancy & Lactation
• The mother’s food habits and nutritional status
before conception, as well as during pregnancy,
influence the outcome of the pregnancy.
• Through the food a pregnant woman eats, she
gives her unborn child the nourishment required
to begin and sustain fetal growth and
development.
• The mother’s food habits and nutritional status
before conception, as well as during pregnancy,
influence the outcome of the pregnancy.
• Through the food a pregnant woman eats, she
gives her unborn child the nourishment required
to begin and sustain fetal growth and
development.
Protein Needs
• Protein serves as the building blocks for
growth of body tissues during pregnancy.
• Rapid growth of the fetus
• Development of the placenta
• Growth of maternal tissues
• Increased maternal blood volume
• Amniotic fluid
• Storage reserves
• Protein intake should increase 25 g per day
• Complete protein foods
• Milk, eggs, cheese, soy products, meat
• Incomplete proteins
• Legumes, grains
• Protein-rich foods contribute calcium, iron,
B vitamins
Key Minerals & Vitamins Needs
• Calcium
➢ Essential for fetal development of
bones and teeth
➢ Supplements might be needed in
cases of poor maternal stores or
pregnancies involving more than
one fetus
➢ Iron and iodine
➢ Iron essential for increased
hemoglobin synthesis
➢ Iodine essential to produce more
thyroxine
• Folate
➢ Builds mature red blood cells
during pregnancy
➢ Needed during early
periconceptional period
➢ Recommend daily folate intake of
600 mcg during pregnancy, 400
mcg per day for non-pregnant
women during childbearing years
• Vitamin
➢ Ensures absorption and utilization
of calcium and phosphorus for fetal
bone growth
➢ Daily intake of three to four cups
fortified milk
➢ Exposure to sunlight increases
endogenous synthesis of vitamin D
Weight Gain During Pregnancy
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
• Set weight goals according to
mother’s pregnancy nutritional status and body
mass index
➢ Underweight women: 28 to 40 lbs.
➢ Normal-weight women: 25 to 35 lbs.
➢ Overweight women: 15 to 24 lbs.
➢ Obese women: approximately 15 lbs.
➢ Teenage girls: 35 to 40 lbs.
➢ Women carrying twins: 35 to 45 lbs.
• Quality of foods consumed to increase weight is
important.
• Weight reduction should never be
undertaken during pregnancy.
•
Average amount of weight gain during
first trimester: 2 to 4 lbs.
• 1 lb. per week weight gain during remainder of
pregnancy
• Two to three g per day sodium needed.
Daily Food Plan
• Core food plan is designed to meet
increased nutritional needs.
• Ethnic backgrounds, belief systems,
lifestyles may require alternative food
plans.
• Pregnant women should avoid
alcohol, caffeine, tobacco, drugs.
• Includes sufficient quantity and regular meals.
• Pregnancy is a prime example of
physiologic synergism in which the mother,
fetus, and placenta collaborate to sustain and
nurture new life.
• Through her diet, a breastfeeding
mother continues to provide all of her nursing
baby’s nutritional needs.
Functional Gastrointestinal
Problems
1. Nausea and Vomiting
• Associated with increased levels of HCG
• Peaks at 12 weeks gestation
• Strategies for managing morning sickness:
➢ Eat small, low-fat meals and snacks
➢ Drink fluids between meals, avoid caffeine
➢ Reduce citrus, spearmint, peppermint
➢ Limit spicy and high-fat foods
➢ Avoid lying down after eating or drinking
➢ Take a walk after meals
➢ Wear loose-fitting clothes
• Effects of iron supplements:
➢ Constipation
➢ Hemorrhoids
➢ Heartburn
• Identifying risk factors and addressing
them early are critical.
• Identifying poor food patterns can
prevent nutritional problems.
•
• Insufficient food intake
• Poor food selection
• Poor food distribution throughout day
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES

• Teenage pregnancy • Acceptable activities:

• Planning personal care ➢ Walking, dancing, biking
➢ Work with mother in sensitive and ➢ Swimming, Yoga
supportive manner.
➢ Dangerous practices should be avoided. • Exercises to avoid:
➢ Craving for and consumption of nonfood ➢ Downhill Skiing, Scuba Diving, Trampoline
items sometimes seen ➢ Contact Sports (Ice Hockey, Basketball,
• Special counseling needs Amusement Slides)
➢ Age (adolescents, women 35+) ➢ Hot tubs
➢ Parity (several pregnancies within a
certain number of years) • Warning Signs to stop exercise:
➢ Alcohol abuse leading to fetal ➢ Vaginal bleeding, uterine contractions,
alcohol syndrome (FAS) decreased fetal movement, fluid leaking
➢ Smoking causing placental abnormalities from the vagina
and fetal damage ➢ Dizziness or feeling faint, increased
➢ Drug use: medicinal or recreational shortness of breath
➢ Vitamin abuse by megadosing also may ➢ Chest pain, headache, muscle weakness, calf
cause fetal damage. pain or
➢ Caffeine used in extreme excess may result
in fetal injury.
➢ Poverty puts pregnant women in danger due
to need for resources for financial assistance Exercise during Pregnancy
and food supplements
➢ Anemia • Breastfeeding has many known health
➢ Neural tube defect benefits for infants, children, and mothers and is
➢ Intrauterine growth failure a key strategy to improve public health.
• Breastfeeding on rise since 1960
➢ Pregnancy-induced hypertension
• In general, exclusive breastfeeding
➢ Gestational diabetes practices across the countries are expected to
➢ Preexisting disease increase from 39% in 2018 to 43% by 2025.
➢ More mothers are informed on benefits.
➢ Practitioners recognize human milk can
Exercise during Pregnancy meet unique infant needs.
➢ Maternity wards and birth centers modified
• Benefits of exercise during pregnancy: to support lactation.
➢ Helps reduce backaches, constipation,
bloating, and swelling 1 Croatia 98.13 2008
➢ May help prevent or treat gestational diabetes 2 Rwanda 86.93 2015
➢ Increases energy, improves mood and sleep 3 Chile 84.50 2006
➢ Improves your posture, promotes muscle 4 Burundi 82.33 2017
tone, strength, and endurance 5 Sri Lanka 82.00 2016
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Data for those countries were based on breastfeeding
rate estimates from 2010 or more recently.
1. Uruguay ranked highest - 98.7%
2. Sweden and Oman - 98%.
3. US - 74.4%
4. France - 63%
5. Ireland - 55%

• Breastfeeding is recommended for at least first

12 postpartum months.
• Proper instruction can overcome
common difficulties.
• Well-nourished mothers who
breastfeed exclusively provide
adequate nutrition
• Solid foods are added to baby’s diet at four
to six months of age.
• Throughout pregnancy mammary glands prepare
for lactation.
• Mammary glands extract nutrients from maternal
blood and synthesize other compounds.
• Stimulation of nipple from infant suckling
stimulates milk production.
• Stimulates prolactin: produces milk
• Oxytocin: Responsible for let-down reflex
• The more mother breastfeeds, the more milk is
produced.
Nutritional Needs for Lactation
• Milk production requires 800 kcals per day.
• Need for protein during lactation is 25 g per day
more than woman’s average need.
• About 3 L per day of water, juices, milk,
soup contribute to necessary fluids.
• Rest, moderate exercise, relaxation
are necessary
Advantages of Breastfeeding
• Fewer infections
• Fewer allergies and intolerances
• Ease of digestion
• Convenience and economy
• Improved cognitive development
• Higher lactose than cow’s milk
• Bottle feeding may cause malformation
of dental arch
• Cow’s milk protein causes allergy
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Breastfeed Misconception Nutrition during Infancy

1. A mother sick with TB cannot breastfeed • Infancy: The first year of life
2. Breast milk is not good if mother has stayed long • Extends from birth to age 12 months;
under the sun.
• Neonatal specifically refers to the first 28 days
3. Mother cannot breastfeed during pregnancy
of life.
4. Mother cannot breastfeed with only one breast if
the other breast is painful • A healthy full term has moist skin, elastic and
5. Mother cannot breastfeed if she has cold, flu, not wrinkled
or diarrhea
6. Breast milk is not good if mother has been caught
in a sudden shower Normal Newborn Appearance
➢ Less incidence of breast cancer
➢ Less incidence of blood clot formation
➢ Fast return of uterus to its original size 1. Acrocyanosis – body pink, extremities blue
2. Pallor – white discoloration of the skin
3. Harlequin sign – immaturity of circulation
[side of the body lying down will appear pink]
Breastfeed Misconception 4. Mongolian spot – slate gray patches at
the buttocks
1. Diet 5. Lanugo – fine downy hair that covers
the shoulders.
2. Nutritional state of mother
6. Desquamation – drying of the newborns skin
3. Emotional and physical state 7. Petechiae on face and neck – due to
intravascular pressure during delivery
4. Suckling/sucking 8. Milia – unopened sebaceous gland found in the
nose chin and cheeks; disappears in 2-4
5. Use of contraceptives and drugs
weeks.
9. Vernix caseosa

• PRIMITIVE REFLEXES
First observable reflex. Essential to NB survival.
Not learned; involuntary and necessary for
survival.

• LOCOMOTOR REFELEXES
Present at birth or shortly thereafter. Relates to
body movement or locomotion.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Nutritional Requirements
• ENERGY [Calories]
Caloric requirements: caloric intakes of 110 to
150 kcal/kg/day
• PROTEIN
Protein requirements are highest during the first 6
months of life. Requirements are adjusted to
infant’s size and growth.
• LIPIDS
Fats should comprise 30% - 50% of an infant’s
total daily caloric intake. It is a form of Linoleic
acid
Human milk and cow’s milk provide 48%-54%
calories while commercial infant formulas 36%-
38%
• WATER INTAKE
Infants have greater need than adults; obtains it
from breast milk and commercial
• Newborns tend to eat 2 to 3 ounces of breast
milk or formula at a time every two to three
hours a day
• 1-month-olds may be eating about 3 to
4 ounces every two to four hours a day,
• 2-month-olds may consume 4 to 5 ounces of
breast milk or formula every three to
four hours a day,
• 3-month-olds may consume about 4 to
5 ounces of breast milk or formula every
three to four hours.
Breastfeeding
• Most preferred form of nutrition in full term
infants.
• Three types of breast milk
➢ Colostrum - First milk with high level
immunoglobulin.
➢ Transitional Milk – Replaces colostrums
contain high level of fat, lactose, water-
soluble vitamins.
➢ Mature Milk - The final milk produced
contains high percentage of water and
provides 20kcal per oz.
Bottlefeeding
• Contains mostly saturated fatty acids,
differing amounts of amino acids and higher
protein, calcium, sodium and chloride levels
than breast milk.
• Formula designed to match the ratio of
breast milk composition
• May meet the needs of working mother
• Must be prepared under clean conditions and
sterilized to prevent contamination
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Advantages of Bottle Feeding
• Provides a suitable alternative to breast
feeding
• Less restrictive to the woman than BF
• Allows more accurate assessment of infants
intake
• May be indicated for infant with congenital
anomaly
• Necessary if infants require a special formula
Disadvantages of Bottle Feeding
• More difficult for infant to digest than Breast
milk.
• More expensive and more time consuming to
prepar
Mixed Feeding
• Mixed feeding is a combination of breast and
bottle feeding.
• Two Methods of formula preparation:
1. Aseptic Method: Sterilized separately for
at least min.
2. Terminal Method: Formula are poured into
clean bottles and sterilized together.
• Disadvantage:
• Scum formation can clog nipple holes.
Do’s of Bottle Feeding
• Do throw out any unused formula within
1 hour after feeding
• Do toss out mixed formula that has been
at room temperature for more than 1
hour
• Do: Stock up.
• Do: Try different varieties.
• Do: Invest in good bottles.
• Do: Invest in time-saving gadgets.
Don’ts of Bottle Feeding
• Don’t leave the bottle in baby’s mouth
while sleeping
• Don’t give cows milk to baby
before 12 months
• Don’t put cereal in bottle
• Don’t microwave baby formula
• Don’t: Leave formula out or prepare too
much ahead of time.
• Don’t: Stress about buying name brand.
• Don’t: Stress about getting formula to
the perfect temperature.
Why can’t infants drink cow’s milk?
• Your baby’s digestive system doesn’t
contain the enzyme to digest cow’s milk
• It can cause intestinal bleeding
• It contains incomplete nutrition
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Nursing Implication
• Teach mother of a bottle-feeding infant to:
• Investigate various types of formulas available
and their preparation.
• Make sure the hole of the nipple is large
enough for milk to drip out.
• Hold infant position similar to that used
for breast-feeding
• Hold infant during feeding do not prop
the bottle
• Point nipple directly to the infants mouth
• Feed infant usually every 4 hours
• Make sure infant retains 3-4 oz. Of milk
each feeding
• Hold infant upright against the shoulder
for burping
• Burp infant at regular intervals
• Discourage overfeeding
• Discourage unscheduled feeding.
Nursing Implication
• May be added in the diet 4-6 month
• Should not be delayed beyond ages 7-9 month
• Should be strained, pureed or mashed
• Each meal should progress ¼ to ½ cup as
infant grows
• Can start eating “finger foods” at 6-7 month
• Can start eating chopped table foods at 9-
12 month
Feeding Infant 4-6 months
• Breast milk and formula provide main
source of nutrition
• 4-month-olds usually consume 4 to 6
ounces of breast milk or formula every four to
five hours a day
• 5-month-olds may be eating 6 to 7 ounces
of breast milk or formula every four to five
hours a day.
• 6-month-olds can eat 7 to 8 ounces of breast
milk or formula every four to five hours a day,
as well as 1 to 9 tablespoons of solids such as
cereals, fruits and vegetables.
• Cereal (rice) can be eaten in bowl with baby
spoon
• No honey until baby is 12 months old. Why?
• Infant Botulism: a food borne illness causing
symptoms such as constipation, weakness and
decreased ability to move which can lead to
death.
• How do you know your baby is ready for
cereal?
• Baby sits up with some support
• Holds up his head by himself
• Does not push food out of his mouth with his
tongue
• Reaches out to grab your food and other things
Feeding Infants 7-9 Months
• Breast milk and formula
• Cooked or soft vegetables
• Cooked or soft fruit
• Well-cooked, strained or finely mashed meats
• Egg yolk
• Finger foods
• 7- and 8-month-olds may be eating about 24 to
36 ounces of breast milk or formula each
day (four to six nursing sessions, if
you're breastfeeding), plus 4 to 9 tablespoons of
cereal, fruit and vegetables daily as well as 1 to
6 tablespoons of meat/proteins.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
• 9- to 10-month-olds may be eating about 24
to 30 ounces of breast milk and/or formula a
day (three to five nursing sessions, if
you're breastfeeding), along with 1/4 to 1/2 cup
each of grains, fruit, vegetables, dairy products
and meat/protein foods.
• How do I know when my baby is ready to
use a sippy cup?
• When the baby is able to sit up and hold objects
on his own.
Finger Foods
• Dry cereal
• Pancakes or French toast cut into strips
• Cooked rice and chopped noodles
• Banana cut into small pieces
• Cooked fruit or chopped canned fruit or
vegetables
• To prevent choking, give your baby foods
that soften in the mouth and cannot be
swallowed in chunks.
Finger Infants 10-12 Months
• Breast milk and/or Formula given in sippy cup
• Water, 100% fruit juice in sippy cup
• Don’t give high sugar drinks
• Chopped or soft table foods
• 11-month-olds may be taking 16 to 24 ounces
a day of breast milk or formula a day (three to
five nursing sessions, if you're breastfeeding),
though their diet will include more solids: 1/4 to
1/2 cup each of grains, fruit, vegetables, dairy
products and meat/protein foods.
• 12-month-olds may be taking up to 24 ounces
a day of breast milk or formula (three to
five nursing sessions, if you're breastfeeding),
though many will start weaning from the bottle
or breast around now and start drinking cow’s
milk. In addition, they'll eat 1/4 to 1/2 cup each
of grains, fruit, vegetables, dairy products
and meat/protein foods.
Nursing Implication
• Teach mother to:
• Mix cereal with breast milk, formula or water
• Offer new foods one at a time
• Start with generally tolerated fruits
• Offer fruit juice on cup not on feeding bottle
• Prepare foods by baking, broiling, steaming
or poaching
• Include organ meats
• Introduced egg in small quantities
• Supervised all meals
• Be aware that candy, nuts grapes, and popcorn
are associated with choking.
• Cook foods until tender, make it easy to chew,
and must be serve in small pieces.
Nursing Implication
• For common nutrition related problems:
• Regurgitation or Vomitting - Forcible
ejection of gastric contents
• Assess for possible GI abnormalities
• Encourage mother to feed infant slowly and to
pause several times during feeding
• Burp infant often
• Hold infant upright position during feeding
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
• Place infant in his stomach of right side lying
position to prevent aspiration
• Notify the physician if condition persists
• Constipation - Infrequent bowel movement.
• Assess the amount & frequency of milk and
water feedings
• With physicians approval; encourage mother
to increase feeding and to add high fiber
foods in the diet.
• Provide a quite, relaxed atmosphere
during feeding
• Notify physician if constipation persist.
• Diarrhea – Frequent loose stools
• Assess amount and character of stools
• Assess infant’s skin turgor as indication of his
hydration status
• Evaluate feeding patterns and suggest
changes as necessary
• Notify physician if diarrhea persist .
• HICCUPS
• Encourage mother to offer water in between
feedings
• Burp infant often during feedings
• Quite and relaxed atmosphere
• COLIC – Acute paroxysm of pain
• Quite and relaxed atmosphere
• Feed infant slowly and pause several times
during
• Burp infant often during feeding
• Teach mother measures to promote infant
comfort such, as stroking caressing and
rocking
• FOOD ALLERGY
• Should introduce singly and with intervals
[3days] to allow detection.
• Food that causes allergy should be
discontinued before introducing another food.
• Foods that often cause allergies: eggs, fish,
milk, peanuts, shellfish, soybeans and wheat.
• FOODS TO BE AVOIDED
• Too much sweets [has high calories but little
essential nutrients]
• Canned vegetables [often high in salt]
• Raw carrots; honey [risk of botulism]
Nutrition in Children
TODDLER
• Refers to a child between infancy and pre-
school ages 1-3 years.
• The best time to introduce good food habits.
PRE-SCHOOL
• Refers to a child between 3-6 years old.
• High activity levels but slowed growth
rate.
Nutritional Requirement
Energy
• 12-18 months of life is 55 kcal/kg and after that
it declines to an adult level of 23-30 kcal/kg.
• Deficiencies: lack of calorie intake that leads to
CHON utilization = PEM and; adequate calorie
intake but low CHON in the diet = kwashiorkor.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Protein
• Increase from age 1-6; recommends
some 10%-15% CHON/kg; 2/3 should be of
high biological value
• For increase skeletal and muscle tissue
and protector against infection.
Vitamins
• Requirements for toddlers and pre-schools are
slightly greater than those of infants.
• Vitamin D for proper skeletal growth
and calcium metabolism.
Fluids
• Approximately 115ml/kg of fluids daily.
• Exact requirements depend on activity level,
climate and health status.
Functions of Diet for Child
• Provide fuel for muscular activity
• Supply necessary chemical elements and
compounds that the child’s body requires for
building materials and repairing worn out
tissues
• Gives pleasure and satisfaction to the child
Common Nutrition Problems
• Protein Energy Malnutrition [PEM]
• Iron Deficiency Anemia [IDA]
decrease hemoglobin and decrease hematocrit.
➢ Sometimes due to parasitism
➢ Lack of Iron S/S : paleness of eyes,
lips, fingernails, palms, skin, reduce ability
to learn, fatigability, irritability.
• Anemic children do poorly in
vocabulary, reading, mathematics, problem
solving and psychological test.
• Vitamin A Deficiency Xerophthalmia
= dryness of the eyes; Vit. A deficiency.
Night blindness, rough dry skin and
dry membrane of the nose and throat;
increase susceptibility to infection.
• Iodine Deficiency Disorder S/S
mental retardation, deaf mutes, difficulty
in standing and running.
• Obesity
• Dental Caries 98% of children has
tooth decay; caused by sticky sugar-
containing foods that cling to teeth.
Factors Affecting Pre-School NS
• Family Environment - Can provide
appropriate role models and
reinforcements. Set-up at home environment
that fosters development of desirable eating
patterns in young children.
• Social Trends - Some mother’s are
employed outside the home and do not have
much time to prepare meals or teach children
• Media T.V - Affects children request for and
attitude toward food. Parents should not be
persuaded to buy the non-nutritious foods
seen on T.V.
• Illness & Disease - Ill children have decrease
appetite and limited food intake. They
require increase fluid intake, CHON and
other nutrients.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Factors Affecting Pre-School NS
• Eating Too Little - As long as the child eats
the right foods, go slow in adding new foods
on the diet start meals with food that they like
best.
• Eating Too Much - Due to
heredity, temperament, appetite or mother’s
insistence on a “clean plate”. The only danger
is overweight and indigestion.
• Dawdling - Child who lingers or dillydallies
with their food is maybe trying to get
attention or may not feel well or are given
portion, which are too large.
• Gagging - A child who feels like
vomiting especially when being fed by coarse
foods. Sometimes this is due to negligence
in training the infant to eat chopped foods.
• Aversion Toward Some Foods - Milk
and vegetable are just two foods being
refused by some children. Fruits are good
substitutes for vegetables and for milk they
can be given in forms of leche flan,
cream soup, cheese and cereals.
• Allergy = Food allergy is common
especially seafoods and eggs decrease the
intake of protein rich foods. Chemicals in
the air, food preservatives and dyes are found
to worsen the allergy condition. So nutrient
intake must be monitored and
substitutions must be made when necessary.
Indication of Good Nutrition
• A healthy pre-school child exudes a feeling
of well being, of interest in all activities usual
for their age.
• Posture is erect, arms & legs straight, abdmen
pulled in and chest out.
• Head is normal size and shape, skeleton with
no malformation.
• Teeth are straight without crowding in the well-
shaped jaw. [6 years old 24 sets of teeth]
• Skin is smooth, slightly moist with health glow.
• Eyes are clean, bright with no signs of fatigue.
• Hair is shiny, muscles firm; gums light
pink, lips moist and tongue without lesions.
• Has good attention span for their age, not easily
irritated and restless
• Appetite, digestion and elimination are regular.
• Able to communicate and handle
abstract materials in thinking.
• Social and outgoing, loving and affectionate.
School Age
Is generally considered to be 6-12 years
old. Consistent in maturity but slow in growth
rate, maturation of fine and gross motor skills,
gains cognitive and social – emotional growth.
Your school-age child is full of contradictions. She
wants to master all things – including eating, but
she is still a child, and is entitled to be free from
worry about eating, moving, and weight. She
seems independent, but she depends on you to
keep control of the family menu and continues to
need the structure and support of regular family
meals and structured snacks.
Nutritional Allowance
Children need more nutritious foods in proportion
to their weight than adults do because they are
growing and developing bones, teeth, muscles
and blood.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
ENERGY Food Equivalent
• 80-90 kcal/kg 7-9 years old
• 70-80 kcal/kg 10-12 years old • 1 cup cooked rice [160 gms] = 5
pcs. Pandesal, 4 slices of bread 1-1/3 cup
corn meal, 1 cup cooked camote.
Common Nutritional Concerns • 1 serving meat [60 gms] = 1/3 cup raw
dried beans, 2 medium sized fish 55-60 gms,
2 medium sized egg 50 gms each.
1. Malnutrition and Learning • 1 serving of fruit = 1 medium sized fruit or
2. Iron Deficiency Anemia 1 slice of big fruit.
3. Obesity
4. Dental Caries
5. Constipation

Adolescentss
Feeding Problems
Is a transition of human development that occurs
1. Inadequate meals between childhood and adulthood.
2. Poor appetite
ex. Tired, demanding school work
3. Sweet tooth Nutrient Allowance
4. Prolonged mealtimes
5. Food refusal
Calories are the measurement used to express the
6. Disruptive and stressful mealtimes
energy delivered by food. The body demands
7. Lack of appropriate independent feeding
more calories during early adolescence than at any
other time.
Factors Affecting Food Intake
• Boys require an average of 2,800 calories
• Family per day.
• Peers • Girls require an average of 2,200 calories
• Schools per day.
• Societal Trends
Adultood
Proper Feeding for Schoolers:
A period of life when one attained full growth and
• Furnishing energy needed for vigorous maturity
activity;
• Helping maintain resistance to infection;
• Providing building materials for growth
• Providing adequate nutrient stores to assist
in adolescent growth.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Nutritonal Management 1. SENESCENCE
• The process of growing old or the period of
old age, a person belongs to this period is
Daily reference intakes for adults are: referred to as an elderly or a senior citizen.
• Energy: 8,400kJ/2,000kcal • A period characterized by disturbed
• Total fat: less than 70g regulatory and functional mechanism in the
• Saturates: less than 20g body.
• Carbohydrate: 260g
• Total sugars: 90g 2. GERIATRICS
• Protein: 50g • A study of the phenomena of old age and the
• Salt: less than 6g treatment of its accompanying diseases.

Feeding the Adult 3. SENILE

• Often clinically associated with an old man
with mental and physical weaknesses, a
To stay healthy, these must be observed meaning which should not be attached to a
and followed: normal aged person.
1. Eat variety of foods.
2. Maintain ideal weight.
Taste Changes:
3. Avoid too much fat, saturated fat
and cholesterol Our sense of taste and smell naturally weaken
4. Eat foods with adequate starch and fiber with age. This often leads to diminished appetite
5. Avoid too much sugar or adding more salt to foods to try and recover
6. Avoid too much sodium. the flavor we once remembered. Similarly, our
7. If you drink alcohol, do so in moderation sense for sweet tastes linger, leading many elderly
to overindulge.
The Elderly or Older Adult
Loss of Appetite:
Many factors contribute to loss of appetite in
Good nutrition is important, no matter what your
the elderly population. While its true that
age. It gives you energy and can help you control
metabolism slows as we age, a significant change
your weight. It may also help prevent some
in weight in a short period of time can be
diseases, such as osteoporosis, high blood
dangerous and should be avoided.
pressure, heart disease, type 2 diabetes, and
certain cancers.
But as we age, our body and life change, and so Oral Health & Dental Problems
does what we need to stay healthy. We may need
fewer calories, but we still need to get enough
nutrients.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
1. Dry Mouth: As we age, many people
experience dry mouth as a side effect of
medications or reduced saliva production.
2. Ill-Fitting Dentures: If you wear dentures,
over time they may become ill-fitting. When
dentures are not properly fitted, one may
experience pain with eating or chewing.
3. Dysphagia: This condition is where it becomes
more difficult to move food or liquid from your
mouth to your stomach. Dysphagia can occur at
any age, but is most common in older adults.
People who experience dysphagia will most likely
need a texture modified diet
4. Compromised Mobility: If you cannot cook or
shop for yourself, eating a balanced healthy diet
can seem impossible at times. There are many
options available to you, so don’t get discouraged.
5. Reduced Social Activity: Eating with other
people is almost as important as eating a variety
of foods, as it creates a more enjoyable
atmosphere around eating. We tend to eat better if
we enjoy meal times.
Osteoporosis
5 Nutrients for Healthy Strong Bones:
1. Calcium
Calcium is not only important for bone strength, but
also for heart, nerves, and muscles. If you don’t eat
enough calcium, your body will start to take
calcium that is stored in your bones to be use in
other places in your body, leaving you with
weak brittle bones
2. Vitamin D
Vitamin D has many important jobs in the body,
and is needed to help you absorb calcium from the
food you eat. The best way to get vitamin D
naturally is from sunlight, but some foods also
provide vitamin D.
3. Magnesium
In order for vitamin D to help the body metabolize
calcium, it must first be converted to the active
form. Magnesium is the mineral that is necessary
to convert vitamin D to the active form. Magnesium
is also important for bone mineralization that
prevents gout and arthritis
4. Potassium
Potassium helps to maintain fluid balances in the
body and protects bones by counterbalancing bone
damaging acids.
5. Vitamin K
In addition to improving cardiovascular health,
having adequate vitamin K in your diet reduces the
risk of bone fractures in osteoporotic patients by
playing a role in improving bone mineralization.
Alzheimer’s and Dementia
7 Nutrition Tips for Maintaining Brain Health
Dementia is an overall term that is defined as the
loss of memory, cognitive reasoning, awareness
of environment, judgment, and/or abstract
thinking as well as loss of the ability to perform
usual tasks associated with self-care and day-to-
day function
1. Limit Intake of Saturated and Trans Fats
Saturated and trans fats have been associated with
dementia. Saturated fat is found in animal products
like meat, eggs, and dairy while trans fats are
found in many packaged foods. Avoid words like
“partially hydrogenated oil” on food labels
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
2. Increase your intake of Plant Based Foods
Vegetables, fruits, legumes (beans, peas, and lentils)
and whole grains should become primary staples of
the diet. Increasing plant based foods in the diet will
help you eat less saturated fats from meat and dairy
as well as provide an abundance of phytochemicals.
3. Consume 15 milligrams of Vitamin E
From foods every day Vitamin E is an antioxidant
which scavenges toxic free radicals, which may
contribute to cognitive impairment. Eat more seeds,
nuts, leafy green vegetables, and whole grains to
increase vita- 4 min E in your diet
4. Take a B12 supplement Vitamin B12
Is important for healthy nerves and red blood cells.
Some dementia's are caused by a deficiency in
vitamin B12 and are reversible when treated.
Choose a reliable source of B12 such as fortified
foods or a supplement that provides at least the
recommended daily dose (2.4 micrograms for
adults)
5. Avoid vitamins with Iron and Copper
We now know there is a confirmed link between
high levels of iron and copper and increased risk of
Alzheimer’s . If you are using a multivitamin,
choose one without iron and copper and only take
an iron supplement if advised by your physician.
6. Choose Aluminum-free products
While the details as to how aluminum contributes to
Alzheimer’s is under continuous investigation, it
is recommended to reduce exposure to aluminum.
Minimize aluminum cookware, antacids, baking
powder, and other aluminum containing products
7. Exercise at least 120 minutes each week
Aerobic exercise is associated with a reduced risk of
cognitive impairment and dementia.
Walking, swimming, raking the yard, or any other
activity that increases you heart rate and breathing
counts!
Pressure Ulcers & Skin Conditions
Pressure ulcers form when an area of skin is
subjected to constant pressure or friction.
However, what many people don’t know is that you
can arm yourself from getting pressure ulcers and
heal faster if you are receiving adequate nutrition.
1. Eat enough calories: If you are losing weight or
are eating less than 75% of your daily needs or less
than 75% of you normal intake, consult your
physician or dietitian
2. Eat protein at every meal: Your body needs
protein to grow new cells and heal your wounds,
or prevent wounds from occurring. Including one
protein source at each meal will help to make
sure you are getting enough protein
3. Drink fluids throughout the day to stay
hydrated: The body is made up of 50-60% water.
Water also moves nutrients where they are needed
to help heal wounds. Aim for 6-8 cups of water each
day
4. Take a multivitamin with minerals: Unless
there is a known deficiency, there is no need to
mega dose on any particular vitamin or mineral but
taking a daily multivitamin will help you to receive
all the essential vitamins that you need each day.
Nutrition in Elderly/Aged
Eating right and staying fit are important no matter
what your age. As we get older our bodies have
different needs, so certain nutrients
become especially important for good health.
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Calcium and Vitamin D
Older adults need more calcium and vitamin D to
help maintain bone health. To meet these needs,
select calcium-rich foods and beverages and aim
for three servings of low-fat or fat-free dairy
products each day. Other sources of calcium include
fortified cereals and fruit juices, dark green
leafy vegetables, canned fish with soft bones, and
fortified plant-based beverages. Good sources of
vitamin D include fatty fish, such as salmon, eggs
and fortified foods and beverages. If you take a
calcium supplement or multivitamin, choose one
that contains vitamin D.
Vitamin B12
Some adults older than 50 may not be able to
absorb enough vitamin B12. Fortified cereal, lean
meat and some fish and seafood are sources
of vitamin B12. Ask your doctor or a registered
dietitian nutritionist if you need a vitamin B12
supplement.
Dietary Fiber
Eat fiber-rich foods to stay regular. Dietary fiber
also may help lower your risk for heart disease and
reduce your risk for Type 2 diabetes. Eat whole-
grain breads and cereals, and more beans and peas
— along with fruits and vegetables which also
provide dietary fiber.
Potassium
Consuming adequate potassium, along with limiting
sodium (salt) intake, may lower your risk of high
blood pressure. Fruits, vegetables, beans and low-
fat or fat-free dairy products are good sources of
potassium. Also, select and prepare foods with little
or no added salt. Add flavor to food with herbs
and spices.
Know Your Fats
Most of the fats you eat should be polyunsaturated
and monounsaturated fats, which are primarily
found in nuts, seeds, avocados, vegetable oils
and fish. Choose foods that are low in saturated fat
and trans fat to help reduce your risk of heart
disease.
Chronic Degenerative Disease
Arthritis Is the inflammation of one or more
joints, which results in pain swelling and stiffness
with limited movements.
Rheumatism Is a non-specific term for
medical problems affecting the joints and connective
tissues.
Gout Is a kind of arthritis that occurs when uric acid
builds up in the joints.
Coronary heart disease is the narrowing of
the small blood vessel that supply blood and oxygen
to the heart.
Diabetes Is a chronic [lifelong] disease marked
by high levels of sugar in the blood.
Nutrient Allowance
1. Energy
2. Carbohydrate
3. Fats
4. Protein
Vitamins and Minerals
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
Impaired GI bioavailability can cause lack of the Common Problems among Elderly
following:
1. Difficulty in chewing due to loss of teeth and
Vit.B12 Zinc Calcium Vitamin A
not getting used to dentures.
Iron Vitamin C 2. Lack of appetiteUnwanted weight and due to
lack of physical activity or to over eating
Due to low intake of meat, green leafy vegetables 3. Anxiety, confusion, insecurity, loneliness
and fruits 4. Poor digestion leading to constipation, gas
pains or diarrhea.
CALCIUM IRON VITAMIN B6 5. Poor absorption leading to anemia and other
VITAMIN E VITAMIN B12 and FOLACIN vit. deficiencies.
VITAMIN C COPPER ZINC WATER 6. Difficulty in sleeping
VITAMIN D THIAMIN
How to Live Longer
Factors Affecting NS
1. Avoid red meat
2. Eat veggies rich in beta carotine, eat
Psychological Factors more frequently
• Emotional stress can impair their ability 3. Adhere to low fat, low calorie diet
to utilized the ingested nutrients properly: 4. Avoid preserved foods
➢ Anxiety 5. Cut on smoked meats
➢ Depression 6. Take vitamin supplement daily
➢ Suspicion 7. Don’t smoke
➢ Confusion 8. Avoid fats and oils
➢ Loss of memory 9. Avoid all sugars
• Cultural Factors 10. Severely limit salt
• Physical Factors 11. Severely limit cholesterol
➢ Socio-economic Factors 12. Avoid to much alcohol, black tea, caffeinated
➢ Health Factors (e.g: Chronic drink
diseases + economic & psychological 13. Freely use whole grains products
factors = Poor Nutritional Status 14. Freely tubers and legumes
15. Drink plenty of water
Food that Helps Slow Down Aging 16. Eat good breakfast daily

Nuts
Wheat germ
Sardines
Red Salmon
Meal Planning
Whole bran Peas
Meal planning is the process of thinking and
Oatmeal Lima Beans
Chicken legs White Beans deciding the series of activities in meal
Spinach management. Activities including:
Pinto Beans
 Lecture: Nutrition & Diet Therapy
Marial J. Contiga BSN 2 - Barnard
Barnard
MIDTERM NOTES
1. Planning,
2. Purchasing,
3. Food supply storage,
4. Food preparation and cooking,
5. Food service and dining area preparation

Meal planning is essential to ensure that the food

served is:
1. Nutritionally adequate
2. Economical in terms of food cost, time and
energy spent in preparation
3. Aesthetically pleasing and
4. Sanitary

When plans and decisions have been made write

them down.

Meal Planning
Resource availability
• Socioeconomic status, family customs and
tradition, likes & dislikes
Family goals
• Gen. goals are use of resources, varied
& interesting, nutritious & sanitary, minimum
time and energy in preparation.
Family values with respect to goals
• Value health more regardless the cost
Changing lifestyle
• Working mothers less time in preparing
meals, sometimes eating outside.