Life Cycle Nutrition

Life Cycle Nutrition: Pregnancy & Lactation

Nutrition During PREGNANCY During pregnancy a woman’s body changes dramatically:  uterus & supporting muscles increase in size& strength  blood volume increased to carry the additional nutrient & other materials  joint become flexible ( preparation for childbirth)  Breast enlarge ( preparation for lactation)  High concentration of hormone influence her mood

Energy & Nutrient Needs During Pregnancy • From conception to birth : all parts of infant( bones, muscles, organs, blood cells, skin, other tissues), are made from nutrients in the food the mother’s eats • To meet the high demands of pregnancy, a woman will need to make careful foods choices, but the body will also help by maximizing absorption and minimizing losses

Maternal Weight( MW) • All pregnant woman must gain weight • Maternal weight gain during pregnancy, correlates closely with infant birth weight • MW is a strong predictor of the health and subsequent development of the infant

Recommended weight gains based on pregnancy weight Pregnancy Weight

Recommended W G

• • • •

12,5 to 18,0 kg 11,5 to 16.0 kg 7,0 to 11,5 kg 6,8 kg minimum)

Underweight Healthy weight Overweight Obese

Components of Weight Gain During Pregnancy • • • • • • • • •

Increase in breast size Incr in mother’s fluid volume Placenta Inc in blood supply to plc Amniotic fluid Infant at birth Incr in size of uterus Mother’s fat stores TOTAL

0,9 kg 1,8 kg 0,7 kg 1,8 kg 0,9 kg 3,4 kg 0,9 kg 3,0 kg 13,5 kg

Energy (1) 2nd

• > than non pregnant • An additional : 180 kcalories during 1st trimester , 300 kcalories during the 2nd & 3rd • Underweight & physically active, require more • For a 2000kcal daily intake added kcal represent about 15 -20 % more food energy than before pregnancy

Energy ( 2 ) • The increase in nutrient needs is often greater  nutrient –dense foods should supply the extra kcal: whole grain breads & cereals, legumes, dark green vegetables, citrus fruits, low-fat milk and milk products, and lean meats, poultry and eggs. • Ample CH ( 175gr or more, but no less than 135 gr) to fuel fetal brain and spare the protein needed for growth

Protein

• Protein RDA during pregnancy : + 17 g/day • Sources : selecting meat, milk products, protein-containing plants foods ( legumes, whole grains, nuts and seeds

Essential Fatty Acids • Essential long-chain polyunsaturated fatty acids are particularly important to the growth and development of fetus • The brain is largely made of lipid materials, and it depends heavily on the long-chain omega-3 and omega-6 fatty acids for its growth , functions and structure.

Nutrient for Blood Production and Cell growth (1) • New cells are laid down at a tremendous pace as the fetus grows and develops • At the same time , the mother’s red blood cell mass expands all nutrient are important in these processes, but the needs for folate, vitamin B12, iron, and zinc, are especially great ,due to their key roles in the synthesis of DNA and new cells

• The requirement for folate increases dramatically. Sources : combination of supplement, fortified foods and a diet that include fruits, juices, green vegetables and whole

Nutrient for Blood Production and Cell growth (2) • Folate RDA during pregnancy 600 µg/day (400 µg + 200 µg )  1st, 2nd & 3rd trimester • Source : fruits, juices, green vegetables, and whole grains • Vitamin B12 RDA during pregnancy 2,6 µg / day (2,4 µg +0,2 µg)  activate folate enzym • Source : meat , fish , eggs, milk products , body store • Iron RDA during pregnancy : 27 mg/day to support enlarged blood volume and to provide for placental and fetal needs. • The increased need for iron in pregnancy cannot be met by diet or existing stores . • Therefore, iron supplements are recommended during the 2nd and 3rd trimester.

Nutrient for Blood Production and Cell growth (3) • Zinc RDA during pregnancy : 12 mg/ day ( ≤ 18 yr) , 11,5 mg/day ( 19-50 yr)  (9,8mg + 1,7mg) • Zn required for DNA and RNA synthesis, and thus for protein synthesis and cell development. •

Woman taking iron supplements ( more than 30 mg /day), however, may needs zinc supplement because large doses of iron can interfere with the body’s absorption and use of Zn

Nutrients for bone development(1) • Vit D and the bone- building minerals ( Ca, Phosphor, Mg , Fluoride) : are great demand during pregnancy. Insufficiency abnormal fetal bones and teeths. • Vit D plays a vital role in Ca absorption & utilization. Deficiency rickets in fetus, osteomalacia in the mother • Sources ; sunlight , fortified milk. Routine supplementation: not recommended

Nutrients for bone development(2) • Ca absorption more than doubles early in pregnancy, helping the mother to meet the Ca needs. • During the last trimester, as the fetal bone begin to calcify, over 300 mg/day are transferred to the fetus • Pregnant women under 25 yr less than 600 mg of dietary Ca daily need to increase their intake of milk, cheese, yogurt and other calcium-rich foods • Ca RDA during pregnancy 1000mg (800mg + 150-200mg)

Other Nutrients • Nutrient supplement : multivitamin • Prenatal supplement typically contains greater amounts of folate, iron and calcium , only beneficial for woman who do not eat adequately and for those in high risk group : multiple fetus, cigarettes smokers, alcohol/drug abusers ( may reduce the risks of preterm delivery, LBW and birth defect

Common Nutrition-Related Concerns of Pregnancy To alleviate Nausea : • • • • • •

On walking, arise slowly Eat dry toast or crackers Chew gum or suck hard candies Eat small . Frequent meals Avoid food with offensive odor When nauseated, don’t drink citrus juice, water, milk, coffee or tea

To prevent or alleviate Constipation • Eat food high fiber ( fruit , vegetables ,whole grain cereal) • Exercise regularly • Drink at least 8 glasses of liquid a day • Respond promptly to the urge to defecate • Use of laxative only as prescribed by a physician. Don’t use mineral oil, it interfere with absorption of fat-soluble vitamins

To prevent or Relieve Heartburn • • • • • •

Relax and eat slowly Chew food thoroughly Eat small , frequent meals Drink liquid between meals Avoid spicy or greasy foods Sit up while eating , elevate the head while sleeping • Wait an hour after eating before lying down • Wait two hours after eating before exercising

Nutrition During Lactation • Before the end of her pregnancy, a woman will need to consider whether to feed her infant : breast milk , infant formula , or both • Breastfeeding offers many health benefits to both mother and infant, and every woman should seriously consider it !

Benefits of Breasfeeding(1) For Infant : • Provide appropriate composition and balance of nutrients with high bioavailability • Provide hormones that promote physiological development • Improve cognitive development • Protects against a variety of infectious • May protect against some chronic diseases ( diabetes type1 and hypertension, later in life • Protects against food allergies

Benefits of Breasfeeding (2) For Mothers : • Contract the uterus • Delays the return of regular ovulation, thus lengthening birth interval ( not contraception method ! ) • Conserves iron stores ( by promoting amenorrhea) • May protect against breast & ovarian Ca

Benefits of Breasfeeding (3) Other : • Cost saving from not needing medical treatment for childhood illness or time off work to care for them • Cost saving for not needing to purchase the formula ( even after adjusting foods in the diet of lactating mother) • Environmental savings to society from not needing to manufacture, package, and ship formula and dispose of packaging

Lactation : A Physiological process • Lactation : production and secretion of breast milk for the purpose of nourishing an infant • During pregnancy , hormones promote the growth and branching of a duct system in the breast and development of milkproducing cells.

Ten steps of successful Breastfeeding( 1 ) 1.Develop a written breastfeeding policy that routinely communicated to all health care staff 2. Train of health care staff in the skill necessary to implement the breastfeeding policy 3. Inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within ½ hour of birth 5. Show mothers how to breastfeed and how to maintain lactation, even if they need to be separated from their infants

Ten steps of successful Breastfeeding (2) 6. Give newborn infants no food or drink other than breast milk, unless medically indicated 7. Practice rooming-in, allowing mothers and infants to remain together a day 8. Encourage breastfeeding on demand 9. Give no artificial nipples or pacifiers to breastfeeding infants 10.Foster the establishment of breastfeeding support groups and refer mothers to them at discharge from the facility

The Mother’s Nutrient Needs (1) • An adequate diet is needed to support the stamina, patience, and self-confidence that nursing an infant demands A. ENERGY INTAKE AND EXERCISE To produce an adequate supply of milk, a woman need extra energy, almost 500kcal/day (>regular need) during first six months of lactation should eat an extra 330 kcal of food each day Most woman need at least 1800kcal/day to receive all the nutrition required for successful lactation

The Mother’s Nutrient Needs (2) • Intense physical activity can raise the lactic acid concentration of breast milk, which may influence the milk’s taste. Some infant may prefer milk produced prior to exercise  breastfeed before exercise ! B. ENERGY NUTRIENT • Recommendation for protein and fatty acid during lactation = during pregnancy, but increase for CH (to replace the glucose used to make the lactose of breast milk).

The Mother’s Nutrient Needs (3) C. VITAMIN AND MINERALS • In general, nutritional inadequacies reduce the quantity not the quality the breast milk (protein, CH, lipid, mineral)  maintained at the expense of maternal stores • Nutrient in breast milk most likely to decline in response to prolonged inadequated intakes are the vitamins-especially Vit B6, B12, A, and D

D. WATER • Drinking more fluid does not produce more breast milk, but inlactating woman needs to drink plenty of fluid

The Mother’s Nutrient Needs (4) Others : • A woman may need iron supplements during lactation (to refill their depleted iron stores!) • Foods with strong or spicy flavors (such as garlic) may alter the flavor of breast milk • Infant with a strong family of food allergies, benefit from breast milk • Infants who develop symptoms of food allergy, may be more comfortable if the mother’s diet excludes the most common offenders : cow’s milk, eggs, fish, peanuts, and tree nuts

Practices Incompatible with Lactation • • • • • •

Alcohol Medical drugs Illicit drugs Smoking Environmental contaminants Caffeine

Pemberian ASI : cara lama dan baru 1.Perawatan Ibu-bayi 2.Motivasi 3. Awal menyusui 4.Jadual

Cara Lama ( ditinggalkan) dipisah

kurang 6 jam set. lahir ketat dgn jam

Cara baru ( dianjurkan ) di gabung

lebih banyak ½ - 3 jam sth lhr on demand ( sekehendak)

Pemberian ASI : cara lama dan baru Cara lama - diberikan

Cara baru - di hindarkan

5. Makanan Pra Lakteal 6. Pemberian susu - indikasi kurang - indikasi ketat Formula ketat ( bila perlu skl.) 7.Pemberian mak. - sejak 1 ½ bln - tidak diberikan pelengkap sebel. 4-6 bln. 8. Menyapih - 10 –12 bln - dianjurkan 2th 9. Perawatan - menyusui stop- diusahakan bayi di RS terus menyusu

Life Cycle Nutrition : •Infancy •Childhood •Adolescence

Nutrition During Infancy(1) • Initially the infant drink breast milk/ formula  to eat some food • In first year birthweight may triple over the following several year, the rates of weight gain gradually diminished • Growth directly reflect nutrient intake it is important parameter in assessing the nutrition status of infant and children

Nutrition During Infancy(2) A.Energy and Nutrient Needs • Healthy infant : - 5 months : double birthweight - 12 months : triple birthweight - length changes more slowly than weight - basal metabolic rate is remarkably high - A newborn baby requires about 100lcal /day - Infant requires about 100kcalories/kg BW - After 6 months  metabolic needs decline as the growth rate slow - Some of energy saved by slower growth is spent in increased activity

Nutrition During Infancy(3 B. Energy Nutrient ( CH, Fat , Protein) Recommendation : - During the 1st 6 months: based on the average intakes of healthy, full term infant breast milk - During 2nd 6 months solid food & breast milk: - CH : provide energy to all the cells of the body ( esp. brain) - Fat :provide energy in breast milk and standard infant formula  support the rapid growth of early infancy - Protein : essential to growth

Nutrition During Infancy(4) Vitamins ,Minerals & Water C. Vitamins and Minerals • Based on the average amount of nutrient consumed by infant breastfed by wellnourished mother D. Water. The most essential nutrient .The younger the infant, the greater the percentage of body weight is water. Much of fluid in an infant’s body is located outside the cells rapid fluid losses lifethreatening

Breast Milk ( BM ) • A source of nutrient for infant • Unique nutrient composition and protective factors promote optimal infant health and development throughout the first year of life • The primary goal is to provide the infant nourishment in a relaxed and loving environment

Frequency and Duration of Breast feeding • During the first few weeks : 8-12 feedings/day, on demand , or whenever the infant cries with hunger • Infant get older stomach capacity enlarges, the mother’s milk production increases allowing for longer feedings interval • Infant’s sucking, the complete removal of milk from breast stimulate lactation

Energy- nutrient composition of breast milk ( BM) (1) • The CH in breast milk ( and infant formula) : disaccharide lactose/ Lactose enhance Calcium absorption being easily digested • Much of protein in the breast milk is alpha-lactalbumin, which is efficiently digested and absorbed .The amount of protein in breast milk less than in cow’s milk, but the quantity is beneficial ( les stress on infant’s immature kidney)

Energy- nutrient composition of breast milk (2) • Brest milk’s LIPID contain : essentia; fatty acid : linoleic and linolenic acid , arachidonic acid and DHA ( Decosa Hexaenoic Acid ) • Infant can produce arachidonic acid and DHA from linolenic and linoleic acid, but researcher are trying to determine whether some infant need more than they can make  Formula with Arachidonic acid and DNA added, is available in commercially

Energy- nutrient composition of breast milk (3) • Except vitamin D, the vitamin in breast are ample to support infant growth • The vit D in breastmilk is low. Deficiency vit D will impairs bone mineralization , especially occurred in infant who are exposed to sunlight daily. They have darkly pigmented skin

Energy- nutrient composition of breast milk (4) Minerals : • Calcium content in breast milk is deal for infant bone growth and the Ca is well absorbed • Breast milk contain relatively small amount of IRON, but the iron has high bioavailability • Zinc also high bioavailability, because the presence of zinc-binding protein • Sodium is low ( benefit for immature kidney) • Breast milk is not good source of

Immunological protections of breastmilk(1) • Sterile • Actively fight diseases & protects infant from illness • Such protein is most valuable during the first year ( the infant’s immune system is not fully prepare to mount a response against infections

Immunological protections of breastmilk(2) • 2-3 days after delivery , the breast produce COLOSTRUM, a premilk substance containing serum & ANTIBODI and Leucocyte protect from infection • The maternal Ab swallowed with the milk inacativate disease-causing bacteria within digestive tract before they can start infections • This explain, why breastfed infant have fewer intestinal infections than formulafed infant

Immunological protections of breastmilk(3) • The other role: 1. Bifidus factors favor the growth of “friendly” bacterium ( Lactobacillus bifidus)in digestive tract  harmful bacteria cannot gain a foodhold 2. Lactoferrin ( an iron-binding protein)  keep bacteria from getting the iron they need to grow , helps the absorbed iron into the infant’s bloodstream , and kill some bacteria directly

Immunological protections of breastmilk(4) 3.Lactadherin ( an protein )  fights off the virus that causes most infant diarrhea 4.Growth factor  stimulates the development and maintenance of the infant’s digestive tract and its protective factor 5.Lipase enzyme  to protect the infants against infection

Allergy and Disease Protection • Breastmilk against the development of allergy and diseases • Compare with the formula, breastfed infant have : a. lower incidence of allergy reaction,such as asthma, allergic rhinitis, eczema, b. protection against the development of cardiovascular diseases, c.lower bloog cholesterol as adult

III.Nutrition during Childhood Introduction • Growth charge provide valuable clues to a child’s health • Weight gains out of proportion to height gains , may reflect over eating and inactivity • Measure below the standard, suggest malnutrition

Energy and Nutrient Needs in Childhood a. Energy Intake and Activity Individual children’s energy needs vary widely , depend on their growth and physical activites: - 1 year 800Kcal/day -6 year ( active) 1600Kcal/day -10 year (active) 2000 Kcal/day TOTAL energy needs increase slightly with age, but energy needs/BW actually decline gradually

Energy and Nutrient Needs in Childhood(2) b. Carbo Hydrate and Fiber - CH recommendation based on glucose use by brain - After one year of age + adult - Fiber recommendation = adult , to reduce the risk of coronary heart disease and based on energy intake

Energy and Nutrient Needs in Childhood(3) c.Fat and Fatty Acids • As long as children’s energy intake are adequate, fat intake below 30% of total energy don’t impair growth • Children who eat low-fat diets  have a low intake of some vitamins and minerals • The energy of dietary fat is important for young children who eat less food than older children and adult

Energy and Nutrient Needs in Childhood(4) d.Protein • Total protein needs increase slightly with age, but when children’s body weight is considered, the protein requirement actually decline slightly • The estimation of protein needs considers the requirement for maintaining nitrogen balance, the quality of protein consumed, and the added needs of growth

Energy and Nutrient Needs in Childhood(5) e. Vitamins and Minerals • The vitamin and minerals needs of children increase with age • A balance diets of nutritious foods can meet children’s needs for these nutrient, with exception of iron • During 2nd years of life , toddlers progress from diet of iron-rich to a diet of adult foods and iron-poor milk • To prevent iron deficiency, children need 10 mg iron/day ( iron-rich foods)

IV.Nutrition During Adolescence-1 Introduction • Teenagers make many more choice for themselves than they did as children • They are not fed, but they eat ! • They choose to go • They are concerned with , how diet can improve their life , to meet extreme ideas of slimness or athletic power

Nutrition During Adolescence -2 a. Growth and Development • •

In general, the adolescence growth spurt, begins at age 10 0r 11 for female, and 12-13 for males Before puberty, male and female body composition differ only slightly , but during adolescence spurt  difference become apparent. Male: skeletal system, lean body mass, fat store; Female: a large percentage of fat

Nutrition During Adolescence -3 b. Energy and Nutrient Needs. • Energy and nutrient needs are greater during adolescent than at any other time of life ( except pregnancy and lactation) • The energy needs of adolescence vary greatly, depend on their current rate of growth, gender, body composition, and physical activity.

Nutrition During Adolescence -4 • Boy of 15 may need 3500Kcal or more/day to maintain his weight • Girls of 15 may need only 1170 Kcal/day if she is to avoid excessive weight gain  special attention to being physically active and selecting foods of high nutrient needs without exceeding their energy needs ( Obesity will discussed by another lecture!)

Nutrition During Adolescence -5 C. Vitamins • RDA for most vitamins increase during adolescent years • Several of the vitamins recommendation for adolescents are similar to those of adults, including Vit D

Nutrition During Adolescence -6 d. IRON • Iron RDA for males: 9-13 years : 8 mg/d 9-13 yr in growth spurt : 10,9 mg/d 14- 18 ys : 11 mg/d 14 -18 in growth spurt : 13,9 mg/d • Iron RDA for females: 9-13 ys : 8 mg/d,menarche : 10,5 mg/d 9-13 ys in menarche and grw spurt : 11,6 mg/d 14-18 yr : 15 mg/d; in growth spurt : 16,1 mg/d

Nutrition During Adolescence -7 e.Calcium • For bone development, sometime calcium intake below current recommendation • To meet their calcium needs, teenagers should consume 3 cups of fat-free or low-fat milk or equivalent in milk products each day.