Nutrition in The Lifecycle

Nutrition in the Lifecycle
By: Berhe Gebremichael (MPH, Assistant Professor)

Haramaya University, Ethiopia
July 2023
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Outline
• The human lifecycle and nutrition
• Nutrition during preconception
• Nutrition during pregnancy
• Nutrition during lactation
• Nutrition during infancy and childhood
• Nutrition during adolescence
• Nutrition during adulthood
• Nutrition during the elderly
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The human lifecycle and nutrition
The lifecycle
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The human lifecycle and nutrition…cont’d
Critical stages of the lifecycle for nutrition
• Before conception (pre-conception)
• During pregnancy
– Maternal nutrition
– Fetal nutrition
• Postnatal period
– Maternal nutrition during lactation
– Newborn and young infant nutrition
• Childhood
• Adolescence
• Adulthood
• Old age
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Why the lifecycle approach is important in nutrition?
• It is a powerful framework for understanding the critical stages for interventions

• Nutritional status at one stage of life influences the health or nutritional status of the
subsequent stage (intergenerational cycle)
• Individuals require the same nutrients throughout their life, but the amounts vary based
on the stage of life
• People have unique nutritional requirements at different stages of life (from conception
to the old age)
• Generally, this approach reduces the healthcare cost and the burden of NCDs, and
improves productivity/economic growth
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Intergenerational cycle of malnutrition
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Growth and development
• Growth—refers to an increase in mass or number of cells
• Development—refers to differentiation of cells into different types of tissues and their
maturation
• Types of growth and developments:
– Physical: body growth
– Mental: mind/brain development
– Emotional: feelings
– Social: interactions and relationships with others
• Phases of human growth
– Phase1 (Intrauterine period)
– Phase 2 (Infancy)
– Phase 3 (Childhood)
– Phase 4 (Adolescence)
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Growth velocity and growth curve by sex
The fastest growth occurs during intrauterine life followed by infancy period and
puberty
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Fetal programing
• It is the process through which variation in the quality or quantity of nutrients

consumed during pregnancy exerts permanent effects upon the developing fetus
• It is important risk factor for non-communicable diseases of adulthood, including;
– Coronary heart disease and
– Other disorders related to insulin resistance
• Early exposure determines later fate
• Thrifty phenotype hypothesis
– Maternal undernutrition fetal undernutrition fetal programing
NCDs in adulthood
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Low birth weight (birth weight < 2.5 kgs)
• Birth weight is governed by two major processes:

– Short gestation period (prematurity or preterm birth)
– Retarded intrauterine growth (small for gestational age)
• IUGR (developing countries )
– Caloric expenditure (maternal work), antenatal care, and certain vitamins and trace
elements
• Prematurity (developed countries)
– Genital tract infection, antenatal care, maternal employment and physical activity,
and stress and anxiety
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Nutrition during preconception
• Preconception is the period before pregnancy or between pregnancies and is one of
high risk stage
• Some deficiency related problems develop very early in pregnancy
– Folate deficiency prior to conception
– Neural tube defects
• Adequate folate (400 µg daily) before conception can reduce the risk of NTDs
• A low pre-pregnancy BMI chronic nutritional insufficiency
– Women may have delayed conception
– Risks of low birth-weight, small for gestational age or preterm
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Nutrition during preconception…cont’d
Neural tube defects (NTDs)
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WHO recommendation for the prevention of NTDs
• Advise women trying to conceive to take a dose of 400 μg folic acid daily, starting
two months before the planned pregnancy and to continue until they are 12 weeks (3
months) pregnant.
• Advise women to take 5 gram of folate daily if they:
– Had previous history of baby born with NTD,
– Have diabetes
– Are under anticonvulsant treatment
– Are at increased risk of a future food intake
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Important steps in period prior to pregnancy
1. Achieve and maintain a healthy body weight: both underweight and overweight are
associated with impaired fertility
2. Choose an adequate and healthy diet, and physical activity
3. Receive regular medical care: regular health care visits can help ensure a healthy
start to pregnancy (e.g. screening for health risks that could affect future pregnancy)
4. Avoid harmful influences: harmful substances such as alcohol and cigarettes can
cause abnormalities and interfere with fertility
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Nutrition during pregnancy
• A balanced and nourishing diet throughout pregnancy provides the nutrients needed
and:
 Supports fetal growth and development
 Provides the mother with the nutrients she needs
 Minimizes the risks of nutrient excess or deficiency
• Nutritional status is one major factor that determines how well the process of
pregnancy goes.
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Nutrition during pregnancy…cont’d
• Pregnancy is considered physiological if mothers:
 Produce a healthy baby with appropriate weight at birth
 Produce enough milk ( >750 g in the first 6 months) and of good quality for the
growth of exclusively breast feed infants during the first 6 months
 Mothers’ nutritional status is not depleted
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• There is increased requirement for nearly all nutrients during pregnancy
• The increased requirement of nutrients is for:
 Formation of tissues—placenta, fetus, amniotic fluid
 Increased in tissue size—uterus, blood volume, breast and fat deposition
 Other changes—increased BMR
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Energy requirement
• On average, 300 kcal/day extra amount of energy is required during pregnancy, which
is 14% more than the non-pregnant non-lactating state
• Energy requirements increase due to increased maternal body mass and fetal growth
 First trimester—no additional energy is required
 Second trimester—increases 340 kcal/day
 Third trimester—increases 450 kcal/day
• Maternal BMR does not measurably increase until the fourth month of pregnancy
• After 4th month, there is increase in growth of the uterus, mammary glands, placenta,
fetus, and blood volume, and the work of the heart and respiratory begin
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Protein and carbohydrate requirements
Carbohydrate:
• Approximately 50-65% of daily calories should come from CHO
• Should consume a minimum of 175 g/day to meet the fetal brain’s need for glucose
Protein:
• Increases from 46 g/day to 71 g/day
• 1.1 g/kg/day of protein (animal protein has high biological value)
• Increased need above non-pregnancy is greater for protein (54% increase) than any
other nutrient
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Additional protein required during pregnancy and lactation
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Fat requirement
• Fat helps newborn regulate body temperature
• Same percentage of calories as in non-pregnancy
 20-35% of women’s total daily energy requirement should be provided by dietary
fat
• No dietary requirement for monounsaturated, saturated, or trans fatty acids
• The recommended daily limit for saturated fatty acids does not change during pregnancy
and lactation and is less than 10% of total energy needs
• Trans fatty acid intakes, such as hydrogenated vegetable oils, should be as low as
possible
• The omega-3 polyunsaturated fatty acid, docosahexaenoic acid (DHA), is critical for
neurologic and eye development
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Vitamins requirements during pregnancy and lactation
• Recommended intake of most vitamins increase during pregnancy and lactation
• Recommended intake levels for some vitamins do not differ for pregnant and
lactating women
• Folate is the only vitamin with higher recommended intake for pregnant women than
lactating women
• Vitamin D
• Vitamin K equal amount
• Thiamine
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RDA of selected vitamins for pregnant and lactating women

(in comparison to the non-pregnant and non-lactating women)
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Recommended intake of certain vitamins during pregnancy and lactation
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Requirements of minerals during pregnancy and lactation
• The requirements of most minerals increases during pregnancy and lactation
• For most minerals, requirements are higher during lactation than during pregnancy
 Iron and magnesium are needed in greater amount during pregnancy
 Ca, F, P, Na, Cl and molybdenum are equally needed in pregnancy and lactation
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Comparison of mineral requirements during pregnancy and lactation
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Recommended mineral intake for pregnant and lactating women
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Micronutrients during pregnancy and their implications
Nutrient Requirement Implication Remarks
Vitamin A Well nourished Low maternal Vitamin A is Excessive
mother doesn’t need associated with Preterm labor & supplementation
supplement IUGR associated with
deleterious effect
Vitamin D 10 microgram Deficiency leads to neonatal
hypocalcaemia and tetany, infant
hypoplasia of tooth enamel, and
maternal osteomalacia
Folate 280, 660, and 470 Neural tube defect, low birth
microgram/d in the weight, abruprtio placentae
1st, 2nd and 3rd
trimesters
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Micronutrients during pregnancy and their implications…cont’d
Nutrient Requirement Implication Remarks
Calcium 1200mg Important for fetal bone Calcium absorption
development increased during
pregnancy.
Iron 15-30mg/d Used in the formation of Iron absorption increased
placenta, development of the during pregnancy.
fetus, increase in blood volume
& hemorrhagic loss during
delivery. Iron deficiency is
associated with LBW &
prematurity
Zinc more than 15 mg/d Deficiency can lead to

reproductive anomalies. This
occurs in women who smoke,
use drugs & who are carrying
multiple fetus
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Supplements during pregnancy
• Meeting all nutrient needs requires careful and complex dietary planning
• Prenatal multivitamin-mineral supplements are not strictly necessary
• Supplements good insurance for vegans and adolescents
• Supplements should be taken in addition to, not as substitutes for, a nutrient-rich diet
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Fluids during pregnancy
• Fluid requirement increases to 3 liters/day for:
 Increased blood volume of mother
 Body temperature regulation
 Amniotic fluid: protects and cushions fetus
 Combat fluid retention, constipation, and dehydration (due to morning
sickness/vomiting)
 Prevent urinary tract infections
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Weight gain during pregnancy
• Women should gain weight at least an average of 12.5 kg during pregnancy (20%
increment)
 Typically 25-35 lb (11-16 kg); NB: 1 kg = 2.205 lb
• If the mother gains less than the recommended weight,
 There will be IUGR (symmetric versus asymmetric)
 The baby will be low birth weight
 The baby’s chance of survival and health declines
• If a mother is overweight, she still needs to gain for her baby’s health
• She should not try to lose weight while she is pregnant
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Weight gain during pregnancy…cont’d
• Pattern of weight gain is important:
 First trimester: 3-5 lb (1-2 kg)
 Second and third trimesters: average 1 lb (0.5 kg) per week
• Of the weight gained during pregnancy,
 60% is attributable to maternal weight gain, fluid volume, protein & fat deposition
 40% is attributable to fetus, placenta, & amniotic fluid
• Weight loss during pregnancy may deprive the fetus of critical nutrients
• Birth weight of at least 5.5 lb (2.5 kg) is a marker of successful pregnancy
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Recommended weight gain during pregnancy
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Recommended weekly weight gain for 2nd and 3rd trimester
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Composition of weight gain
• Infant at birth = 3-4 kg
• Placenta/amniotic fluid = 1-2 kg
• Tissue fluid = 2-3 kg
• Maternal blood = 1-2 kg
• Enlargements of uterus = 1 kg
• Breasts = 1 kg
• Maternal stores = 2-4 kg
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Weight gain for multi-fetal pregnancy
• Recommended weight gain is 16 to 20 kg.
• Rate/pattern of weight gain in twin pregnancy:
 0.2 kg per week in 1st trimester
 0.7 kg per week in 2nd and 3rd trimesters
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Nutrition and pregnancy outcomes
• Malnutrition in women causes LBW, especially if it occurs in late pregnancy
• PEM early in pregnancy results in increased rate of fetal loss and malformations
• Maternal malnutrition affects breast feeding
• Lower volume of milk produced with energy and nutrients in the same concentration
 Quality stays the same but quantity diminished
• Nutrients such as calcium and iron are taken from the maternal stores
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Pregnant women who might need special help include:
 Women from poor families, or who are unemployed
 Women who are widows/separated, and have no support
 Mothers who have given birth to many babies over a short time
 Women who are ill from diseases like tuberculosis (TB)
 Women who look thin and depressed
 Mothers whose previous babies were small and malnourished
 Teenagers
 Women with a history of their baby or babies dying in their first year of life
 Mothers overburdened with work
 Mothers who are very worried, particularly first time pregnancies
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Nutrition during lactation (breastfeeding)
• Human milk is the best food for newborn infants for the first year of life or longer
• Maternal diet does not significantly alter the protein, carbohydrate, fat and major
mineral composition of breast milk, but it does affect the fatty acid profile and the
amounts of some vitamins and trace minerals.
• When maternal diet is inadequate, the quality of the milk is preserved over the
quantity for the majority of nutrients
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Nutrition during lactation…cont’d
Components of human breast milk and their functions
• Whey (protein): energy source
• Casein (protein): energy source and carrier for Ca, Fe, Zn, Cu and phosphate
• PUFAs: development of tissues
• Immunoglobulin (IgA, IgM, IgE, IgD): protection against microbial infections
• Bifidus factors: promote formation of healthy bacterial colonization in infants lower GI
• Lactoferin: iron binding protein that reduces the availability of iron to bacteria in the GIT
• Lactoperoxidase: destroys bacteria
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Components of human breast milk and their functions…cont’d
• Lysozyme: kills bacteria by destroying the cell wall
• Macrophages: destroy bacteria by phagocytosis, synthesizes lactoferin and lyzozyme
• Vitamin B12 binding protein: decrease vitamin B12 availability for bacterial growth
• Interferon: interferes with viral replication in host cells
• Lymphocytes: synthesize IgA
• Anti-staphylococcus factors: inhibits the growth of staphylococcal bacteria
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Nutrition during lactation (breastfeeding)
Human milk composition
• Breast milk contains all the nutrients that an infant needs in the first 6 months of life
• It nurtures and protects infants from infectious diseases augmenting the infant’s
immature immune system
• Human milk composition changes over a single feeding, over a day, based on age of
the infant and presence of infection in the breast
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Human milk composition…cont’d
• Water is the major component of human milk
• Human milk provides 0.65 kcal/mL energy, 3.5 g/ml fat and 0.9 g/100 ml protein
• Lactose is the major carbohydrate found in human milk
• Breast milk contains sufficient vitamins for an infant unless the mother herself is
severely deficient
• The exception is vitamin D, where infants need exposure to sunlight to generate
endogenous vitamin D or, if this is not possible, a supplement
• The minerals iron and zinc are present in relatively low concentration, but their
bioavailability and absorption is high
• Maternal undernutrition has little effect on the volume or composition of breast milk
unless malnutrition is severe
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Differences between human milk and cow’s milk
Nutrition content of human and cow’s milk (in g/100 ml)
Type of milk Carbohydrate Protein Fat Ca P Iron
Human milk 7.0 1.5 3.8 33 15 0.15
Cow’s milk 4.8 3.3 3.7 125 96 0.1
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Colostrum and mature breast milk
• Colostrum is the earliest form of breast milk—yellowish and relatively viscous (thick)
• It is produced during lactogenesis-II (from day 1 to 3 after infant birth)
• It is produced in small amounts, about 40-50 ml on the first day, but it is all that an
infant normally needs at this time
• Infants may drink only 2 to 10 mL (1.5–2 tsp) of colostrum per feeding in the first 2–3
days
• Colostrum consists a variety of dissolved or suspended substances—electrolytes and
immune factors
 The immune factors are protective against bacterial and viral infections
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Colostrum and mature breast milk…cont’d
• Caloric density of colostrum vs. mature BM = 670 vs. 740 kcal/l
• Colostrum provides about 580-700 kcal/L
• It is low in carbohydrate and fat, and higher in protein than mature BM
• Secretory immunoglobulin-A and lactoferrin are the primary proteins present in
colostrum, but other proteins present in mature milk are not present
• The concentration of mononuclear cells (a specific type of white blood cell from the
mother that provides immune protection) is highest in colostrum
• Vitamin A content in colostrum is double that of mature BM, and often makes the
colostrum yellowish in color
• Colostrum has higher concentrations of sodium, potassium, and chloride than mature
milk
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Energy requirement
• A lactating mother needs 1900 Kcal if physically inactive and 2,400 Kcal if active
• A lactating mother needs extra 500 kcal/day
• Usually, lactating mothers increase food intake and reduce physical activity to cope
with increased need
• In the first 6 months postpartum, well-nourished lactating women experience an average
weight loss of 0.8 kg/month, which is equivalent to 170 kcal/d (6,500 kcal/kg)
• Weight stability is assumed after 6 months postpartum
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Energy requirement…cont’d
• Energy need is much greater than that of pregnancy—attributable to rapid growth of

infants
• 23% increase in energy demand over a non-pregnant or non-lactating state
• Average breast milk production is 674 g/day, and producing this milk costs a woman
about 500 Kcal/day (production of 100 ml of milk requires expenditure of 85 Kcal)
 RDA for energy is 500 Kcal during the first and the second 6 months of pregnancy
• Obese and overweight may not need to add the entire calories they required
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• In the first six months of lactation:
 Milk production is 750 ml per day
 Total energy required for the daily milk production—750 x 85/100ml = 637.5 kcal
 Deposited fat during pregnancy—3000g of fat*9 = 27,000 kcal
 If stored fat is utilized for the first 6 months (180 days) of lactation, then the daily
energy extracted from these stores—27000 kcal/180 days = 150 kcal
 So, the additional daily energy needed from food in the first 6 months of lactation
is—637.5 kcal - 150 kcal ~ 500 kcal
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• In the second six months of lactation:
 Average milk production—600 ml per day
 Daily energy requirement for milk production—600*85/100 = 510 kcal
 The fat stored during pregnancy is utilized during the first 6months of lactation
 So, lactating mothers need an additional energy intake of at least 500 kcal per day
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Protein and carbohydrate requirement
• Protein = 0.8 g/kg/day
Average additional protein = 25 grams per day
• Carbohydrate = 210 g/day
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Fat requirement
• Fat constitutes 25-30% of total daily energy intake
• PUFAs are present in all cell membranes
• They are essential for the development of brain and retina of infants (half of PUFA are
Omega-3 and half are Omega-6)
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Benefits of breastfeeding for women
• Increased oxytocin stimulates uterus to return to pre-pregnancy status
• Minimizes postpartum blood loss
• Effective as a contraceptive method during the first 6 months, given that amenorrhea
persists, breastfeeding is frequent and exclusive
• Facilitates bonding with the baby
• Women who breastfeed at a younger age and for a longer duration have a lower risk of
developing ovarian and breast cancers
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Benefits of breastfeeding for women…cont’d
• Less risk of mastitis
• Lower risk of damage to nipple from breast pump
• Decreased incidence of type 2 diabetes
• Potential reduction in perceived stress and negative mood
• Less time in preparing and cleaning of supplies
• Breast milk at optimal temperature without preparation
• Cost savings in not renting or buying
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Benefits of breastfeeding for infants
• Superior nutritional content • Greater breathing efficiency
• Immunological benefits • Higher oxygen saturation
 Lower infant mortality • Increased body temperature
 Fewer acute illnesses • Increased breast milk volume
• Prevents childhood overweight • Lower risk of bacterial contamination
• Cognitive benefits • Optimal mandibular development
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Benefits for the family and community
• No expenses in buying formula, firewood or other fuel to boil water, milk or utensils
• The money saved can be used to meet the family’s other needs
• No medical expenses due to sickness that formula could cause
• The mothers and their children are healthier
• Healthy babies make a healthy community
• Protects the environment (trees are not used for firewood to boil water, milk and
utensils, thus protecting the environment)
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Nutrition recommendations during lactation in Ethiopia
• A lactating woman needs at least two extra meals (650 Kcal) of whatever is available
at home
• In addition, a dose of vitamin A (200,000 IU) should be given once between delivery
and six weeks after delivery
• Iodized salt in her diet
• At least one liter of water per day
• Vitamin A and iron rich foods
• Iron/folate supplementation
• Bed net and deworming
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Critical contacts for promotion of breast feeding
PREGNANCY: TT, antenatal DELIVERY: safe delivery, BF,
visits, BF, iron/folic acid, de- Vitamin A, iron/folic acid, diet,
worming, anti-malarial, diet, FP, STI prevention
risk signs, FP, STI prevention,
safe delivery, iodized salt
IMMUNIZATION:
POSTNATAL AND
vaccinations, vitamin A,
FAMILY
BF, de-worming, assess
PLANNING: , diet, BF,
and treat infant’s anemia,
iron/folic acid, diet, FP,
FP, and STI referral
STI prevention, child’s
vaccination SICK CHILD: monitor growth,
WELL CHILD AND GMP: assess and treat per IMCI,
monitor growth, assess and counsel on infant feeding, BF,
counsel on infant feeding, assess and treat for anemia,
iodized salt, check and check and complete vitamin A
complete vaccination /immunization/ de-worming
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Nutrition during infancy and childhood
• Infants—birth to one year of age
• Toddlers—1-3 years
• Preschool—4-5 years
• School age children—6-12 years
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Nutrition infancy and childhood…cont’d
• Rapid growth and development is the common denominator for the increased
nutritional requirement of these stages of life
• Small children and infants are more vulnerable to infection, nutrient store are not well
developed and have larger surface area to volume ratio
• These factors increase their basal metabolic rate (BMR) resulting in an increased
requirement for nutrients
• Therefore, they need a nutrient intake that is in commensurate with their rate of
growth.
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Birth to six months of age
• During the first four to six months of life, infants need only breast milk or formula to
meet all their nutritional needs
• Never give honey to an infant

 Clostridium toxicity
• Proper infant and young child feeding

 Start breastfeeding early
 Exclusive breast feeding the child till six months
 Avoid early initiation of other foods
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Infancy
• Is a period from birth to the completion of first year characterized by the fastest growth
in human life next to fetal growth
 Length increases by about 40% and weight is tripled
 Head circumference is also increased by about 30%
 BMR of infants is very high—about 2 times that of adults
• The rapid growth and high BMR needs an ample supply of all the nutrients
• Around 6 months, energy needs begin to decrease as the growth rate begins to slow
• But, some of the energy saved by slower growth is spent on increased activity
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Infancy…cont’d
Energy requirement
• The highest energy need per unit of body weight
• A new born infant may require 3-4 times the amount of energy per kg in
comparison to an adult
• A new born requires about 90-120 kcal/kg compared to an adult requirement of 30-
40 kcal/kg
• Most of the energy is required for BMR followed by for growth
Protein requirement
• The highest period of protein requirement in human life
• RDA—2.2 g/kg for the 1st 6months and 2.0 g/kg for the 2nd 6 months
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Infancy…cont’d
Carbohydrates
• Major energy contributor during infancy
• Lactose is the primary CHO at least in the first half of infancy
• 5g/kg of CHO is required to prevent ketosis
Fat & fatty acids
• > 50% of the energy in breast milk (BM) is derived from fat
• Essential fatty acids are required in larger amount during infancy (>30% of the total
energy) mainly for neurological development
• Milk is a better source of both omega-3 and -6 PUFAs
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Infancy…cont’d
Vitamins and minerals
• Consumption of 700-800 ml of BM provides 2 times the RDA of vitamin-A
• But, BM does not allow the RDA for Vitamin D and the infant should be exposed to
sunlight
• BM is not also a good source of vitamin K, it is recommended to be given routinely at
birth
• If the mother was taking enough Fe during pregnancy, the iron store in the infant is
enough for the first 6 months
• Iron supplementation is needed after 6 months of life
• Consumption of iron rich foods
• Adequate calcium should be consumed from foods
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Infancy…cont’d
Other nutrients
• Vitamin D
 Children aged 1–8 years consume 10 micrograms (400 IU) of vitamin D per day
• Young children need nutrient-dense beverages
• Fluid recommendations are based on body weight
• Drinking too much fluid may reduce fiber or iron intake
 Preferred beverages include water and milk
 100% fruit juice can be provided in moderation
 Soda and sugary drinks should be avoided
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Nutritional needs of toddlers
• The nutritional needs of toddlers vary from child to child
• They should consume 1,000 to 1,400 calories per day
• The energy requirement is high (90-108 kcal/kg of body weight)
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Older children (school children)
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Nutrition during adolescence
• Adolescence is the second decade of life (no longer childhood, not yet adulthood)
• It is the time between the onset of puberty and adulthood (10-19 years of life)
• It is the developmental stage between childhood and adulthood
• It is accompanied by physical, physiological, behavioral, and social changes leading to
increased demand for nutrients
• 90% of adolescents live in low- and middle-income countries (LMICs), where they
comprise 19% of the population
• Sub-Saharan Africa is expected to have more adolescents than any other region by
2050
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Nutrition during adolescence…cont’d
Why nutrition for adolescents needs special concerns?
• Rapid growth
 Attainment of 20%, 50% and 45% of final adult height, weight and bone mass,
respectively
• Body and behavioral changes influenced by hormones
• Nutritional problems progressing from childhood
• Nutritional concerns for reproductive functions
• New feeding habits and changes in lifestyle
• Risks to diet-related chronic diseases in adulthood
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Why nutrition for adolescents needs special concerns?...cont’d
• The period of rapid growth could be second window of opportunity to compensate

earlier growth failure (last opportunity to break intergenerational cycle of
malnutrition)
• More effort could be made to avoid further growth failure during this stage which
could pass to adulthood and the next generation
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Velocity curve for height by sex (from birth to 18 years of age)
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Possibility of catch-up growth during adolescence
• Some catch-up growth may be possible in adolescence, but there is little evidence to
support it
• Stunted children are more likely than non-stunted children to become stunted
adolescents and adults as long as they continue to reside in the same environment that
gave rise to the stunting
• Stunted women also are more likely to have obstructed labor due to pelvic
disproportion Stunted children lead to stunted adults, leading to LBW infants
• Stunting tends to be transmitted from one generation to the other
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Nutrition during adolescence should meet the following objectives
• Provide the necessary nutrients to meet the demands of physical and cognitive growth
and development
• Provide adequate stores for illness or pregnancy.
• Prevent adult onset of diseases related to nutrition—e.g. cardiovascular diseases,
diabetes, osteoporosis and cancer
• Encourage healthy eating habits and lifestyle
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RDA for selected nutrients during adolescence by age and sex
Nutrients Females Males

11-14 yrs 15-18 yrs 11-14 yrs 15-18 yrs
Energy (kcal) 2200 2200 2500 3000
Protein (g) 46 44 45 59
Iron (mg) 15 15 12 12
Calcium (mg) 1200 1200 1200 1200
Zinc (mg) 12 12 15 15
Vitamin A (µg) 800 1000 800 1000
Vitamin D (µg) 10 10 10 10
Vitamin C (mg) 50 60 50 60
Folic acid (µg) 150 180 150 200
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Energy needs
• Energy needs are influenced by:
 Activity level
 Basal metabolic rate (BMR)
 Pubertal growth and development
 Gender
• Since males have greater increases in height, weight and lean body mass (LBM) and
higher BMR, they have a higher caloric need than females
• Energy needs can range from 1800 kcal/day for an inactive female to 3500 kcal/day for
a highly active male
02/18/2024 82
Protein needs
• Protein requirements influenced by protein needed:
 To maintain existing lean body mass (LBM)
 For growth of new LBM
• RDA is 0.85 g/kg
• Low protein intakes is linked to:
 Reductions in linear growth and LBM
 Delays in sexual maturation
02/18/2024 83
Vitamins and minerals requirements
• Higher vitamins and minerals needs
• Vitamins
 Needs for all vitamins increase
 Vitamin D needs special attention because it allows for calcium absorption
• Minerals
 Iron, calcium, zinc
02/18/2024 84
Dietary iron requirements: throughout the life cycle
12 Required iron intake

10
(mg Fe/1000 kcal)
Men
Pregnancy Women
8
0
0 10 20 30 40 50 60 70
Age (years)
02/18/2024 85
Factors influencing nutritional needs of adolescents
• Onset of puberty—nutrient needs parallel the rate of growth, with the greatest needs
occurring at the time of peak growth
• Body composition and size—the increase in lean body mass associated with growth
results in an increased need for protein, iron, zinc, calcium and folate
• Menstruation—increases the need for iron (menstrual losses range from 15-28 mg iron
per cycle)
• Socioeconomic conditions:
 Adolescent childbearing is concentrated among teenagers who are poor and low
income
 Pregnant teenagers may enter pregnancy with reduced nutrient stores and increased
risk of nutritional inadequacy
02/18/2024 86
Overall strategy for nutrition intervention in adolescence
• Nutrition promotion: it involves the promotion of healthy eating, physical activity and
other components of healthy lifestyle
• Promotional activities are to be conducted through the media, and for interpersonal
communication, through schools, health facilities, communities and even work sites
(use of technology)
02/18/2024 87
Nutrition during adulthood
• With good luck, good genes and good habits, adulthood covers a life span of roughly
44 years
 Early adulthood (20-40 years)—adults generally stopped growing
 Midlife (40-64 years)—body composition and hormone shift, and activity
decreases
 Old age (> 64 years)—consequences of earlier lifestyle choices
02/18/2024 88
Nutrition during adulthood…cont’d
Physiological changes of adulthood
• Growth and maturation are complete by early adulthood
• After 40 years of age, body composition starts to change to more of fat mass
• Nutritional emphasis turns to maintaining physical status, continuing to build strength,

and avoiding excess weight gain
• Differences between:
 Males
 Females
02/18/2024 89
02/18/2024 90
The food guide pyramid
02/18/2024 91
Nutrition related health problems during adulthood
• The economic livelihood of populations depends to a large extent on the health and
nutrition of adults
• Adult malnutrition:
 Underweight
• Decrease in food intake, often along with disease
 Overweight
• Fewer calories out than in
 Micronutrient deficiencies
02/18/2024 92
Nutrition related health problems…cont’d
• Appears to be a continuous gradient in work capacity and productivity that is linked

to body weight
 Adults with low body weight allocate fewer days to heavy labor
 Are more likely to fail to appear for work because of illness or exhaustion
• Mortality rates go up when BMI<18.5
• High BMIs are also associated with increased mortality rates
 Growing data that shows burden of obesity is becoming greater among the poor
than others
02/18/2024 93
Main contributors of adult malnutrition
• Demographic transition
• Epidemiological transition
• Nutrition transition
02/18/2024 94
Recommendations on healthy life style for adults
1. Do aerobic physical exercise
• F: Frequency—3-6 times per week
• I: Intensity—moderate (brisk walk)
• T: Time—30-60 min/session (may be in split sessions as AM and PM)
• T: Type of exercise—aerobic
 Physical activity could be formal exercise such as jogging, swimming, or tennis or
routine activities, such as gardening, walking, and housecleaning
02/18/2024 95
Recommendations…cont’d
2. Reduce consuming the three whites
Sugar—9 TSP for men and 6 for women (AHA,

2009)
Salt—1500-2300 mg/day (use iodized salt)
Fat—eat red meat and liquid vegetable oil, and

avoid saturated fat and trans fat such as solidified
oils
02/18/2024 96
Hydrogenation solidifies vegetables oils and changes them into trans fats
Hydrogenation
Vegetable oil
02/18/2024 97
3. Stop smoking
• Smoking is widely accepted as a major risk factor

for cardiovascular disease.
• Smoking reduces insulin sensitivity, induces insulin
resistance, and enhances cardiovascular risk factors,
such as elevated plasma triglycerides, reduced high
density lipoprotein–cholesterol, and hyperglycemia
02/18/2024 98
4. Avoid drinking excessive alcohol
• Do not drink if you can

• If you drink, limit intake to < 2 drinks/day
02/18/2024 99
Alcohol consumption and blood pressure
02/18/2024 100
5. Eat diversified diet—at least 4 food groups/meal and 6 food groups/day
02/18/2024 101
6. Do not chew khat
• Khat chewing leads to 2 times high risk of

death from CHD
02/18/2024 102
7. Get adequate sleep (6-8 hours per day)
• < 7 hrs sleep is 1.23 times higher risk of

metabolic syndrome (p<0.001)
• < 5 hrs sleep is 1.51 times higher risk of
metabolic syndrome (p<0.001)
02/18/2024 103
8. Do not spend large amount of time sitting
• People with sedentarily life style were 1.66 times

higher risk of metabolic syndrome
• Older people may benefit from:
 Reducing total sedentary time and
 Avoiding prolonged periods of sedentary
time by increasing the breaks during
sedentary time
02/18/2024 104
9. Avoid eating foods fried in an oil
• Consumption of even small amounts of trans fatty

acids (2% of total energy intake) is consistently
associated with a markedly increased incidence of
coronary heart disease.
02/18/2024 105
10. Eat your meal as follows
• Do not share your breakfast with anyone
• Share your lunch with most your fiends
• Give your dinner to your enemy
02/18/2024 106
11. Drink adequate amount of water
• 1 ml water per calorie of food ingested
• 2000 calorie diet = 2000 ml of water
• We should drink 8-10 large glasses of clean water per day
02/18/2024 107
Nutrition during elderly
• It is generally the period > 65 years of age, and is classified as:
 Young old (65-74 years)
 Middle old (75-84 years)
 Oldest old (85 and older)
• Diseases and disabilities are not inevitable consequences of ageing
• Elderly is the most neglected stage in the lifecycle
02/18/2024 108
Nutrition during elderly…cont’d
Longevity
• The Center for Disease Control and Prevention (CDC) suggests that longevity depends
on:
 19% genetics
 10% access to health care
 20% environmental factors
 51% lifestyle factors
02/18/2024 109
Nutritional needs of the elderly
Energy
• Requirement decreases with age
• Body composition changes
• BMR and physical activity decrease
Protein: 1-1.5 g/kg is needed to help blunt loss of lean body mass
Carbohydrate: 50-65% or more total calories from carbohydrates
Fat: 25 to 35% of total calories
Minerals: 700 mg of calcium for adults over 50 years to slow bone loss
• Iron intake is recommended due to reduced absorption
• Slower uptake of vitamin-A by peripheral tissues—higher circulating levels
02/18/2024 110
Nutrition concerns of the elderly
• Nutritional problems of the elderly include:
 Problems of procuring and preparation of foods
 Psychosocial
 Digestion problems
 Nutrient absorption problems
 Renal Changes
 Memory losses (senile dementia)
 Sensory changes
 Physical problems like weakness, gouty arthritis and pain in the joints
02/18/2024 111
Nutrition concerns of the elderly…cont’d
• Nutritional status is related to functional ability
• Undernutrition (even after controlling for age, sex, and disease) is associated with
higher risk of impairments in:
 Psychomotor speed and coordination
 Mobility
 The ability to carry out activities of daily living independently
02/18/2024 112
• Sarcopenia (the gradual loss of muscle mass with age) is linked to:
 Age-related losses of strength
 Increased risks of morbidity
 Functional impairment
 Dependence
 Mortality
• Studies show that energy and protein intake can directly affect this condition
02/18/2024 113
• Malnutrition leads to decreased functional capacity and need for more help
 Can contribute less to the family
• Malnutrition is related with mental health problems
• Very little experience with nutrition interventions for older adults at the global level
• It is not really known if nutritional status can be improved or if it would lead to better
functional ability
• More research is needed on adequate nutrition for this age group
 Previous experience shows some possibilities
02/18/2024 114
Factors affecting nutritional needs of elderly
 Change of taste (loss of taste buds) and smell
 Inadequate diet
 Lack of dental hygiene, dental care and gum disease (cause tooth decay)
 Lose of sense of thirst (reduced fluid intake)
 Diminish secretion of saliva
 Lactose intolerance
 Diminished gastric secretion—Interference with the absorption of calcium, iron, zinc
and vitamin B-12
 Constipation
02/18/2024 115
Factors affecting nutritional needs of elderly…cont’d
 Reduced glomerular filtration and tubular reabsorption which affects the
excretion of waste and reabsorption
 Efficiency of immune system declines
– Adequate protein and zinc is helpful for immune system
 Hearing and vision decline with age which affects access to food and food
preparation
 Muscle cells shrinks and lost
 Water and lean body mass decline
 Decreased bone mass especially for women
 Exercise increases lean body mass and food intake by increasing energy
expenditure
02/18/2024 116
Some general nutritional interventions during old age
• Advice/counsel the elderly to practice small and frequent meals
• Improving fluid intake, including water
• Nutrient supplementation between meals (e.g. multivitamin, proteins and minerals)
• Fortification
• Exercise for at least 30 minutes per day in most days
• Prevention and treatment of health conditions
02/18/2024 117
Thank you!
02/18/2024 118

Nutrition in The Lifecycle

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Nutrition in The Lifecycle

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Nutrition in the Lifecycle

By: Berhe Gebremichael (MPH, Assistant Professor)

Why the lifecycle approach is important in nutrition?

• It is a powerful framework for understanding the critical stages for interventions

Intergenerational cycle of malnutrition

• It is the process through which variation in the quality or quantity of nutrients

• Birth weight is governed by two major processes:

Additional protein required during pregnancy and lactation

RDA of selected vitamins for pregnant and lactating women

Recommended intake of certain vitamins during pregnancy and lactation

Comparison of mineral requirements during pregnancy and lactation

Recommended mineral intake for pregnant and lactating women

Zinc more than 15 mg/d Deficiency can lead to

Recommended weekly weight gain for 2nd and 3rd trimester

Differences between human milk and cow’s milk

Nutrition content of human and cow’s milk (in g/100 ml)

Type of milk Carbohydrate Protein Fat Ca P Iron

Human milk 7.0 1.5 3.8 33 15 0.15

Cow’s milk 4.8 3.3 3.7 125 96 0.1

• Energy need is much greater than that of pregnancy—attributable to rapid growth of

• In the first six months of lactation:

 Milk production is 750 ml per day

 Deposited fat during pregnancy—3000g of fat*9 = 27,000 kcal

• Fat constitutes 25-30% of total daily energy intake

• PUFAs are present in all cell membranes

Birth to six months of age

• Never give honey to an infant

• Proper infant and young child feeding

Older children (school children)

• The period of rapid growth could be second window of opportunity to compensate

RDA for selected nutrients during adolescence by age and sex

Nutrients Females Males

Dietary iron requirements: throughout the life cycle

12 Required iron intake

• Growth and maturation are complete by early adulthood

• Nutritional emphasis turns to maintaining physical status, continuing to build strength,

• Appears to be a continuous gradient in work capacity and productivity that is linked

Sugar—9 TSP for men and 6 for women (AHA,

Salt—1500-2300 mg/day (use iodized salt)

Fat—eat red meat and liquid vegetable oil, and

• Smoking is widely accepted as a major risk factor

• Do not drink if you can

6. Do not chew khat

• Khat chewing leads to 2 times high risk of

• < 7 hrs sleep is 1.23 times higher risk of

8. Do not spend large amount of time sitting

• People with sedentarily life style were 1.66 times

• Consumption of even small amounts of trans fatty

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