MODULE 2: NUTRITION AT VARIOUS LIFE STAGES
Life Stages:
➢ Pregnancy
➢ Breast-feeding / Lactation
➢ Infancy / Toddlerhood (0-2 Years Old)
➢ Early Childhood / Middle Childhood (3-12 years Old)
➢ Teenage hood/Adolescence (13-18 years)
➢ Early Adulthood (18-30 Years)
➢ Middle Adulthood (30-60 Years)
➢ Late Adulthood / Elderly Hood (60 years - Death)
Pregnancy
Pregnancy is a special time in a woman’s life. Healthy eating can increase the chances of having a healthy baby. Gradual
weight gain is important, 0.9kg-1.8kg during the first three months. A total gain of 11kg-15 kg is recommended.
Recommendations include:
• No ‘crash dieting’, as this can have a negative impact on the baby.
• No ‘eating for 2’, as this will lead to unnecessary weight gain
• Concentrate on diet quality rather than quantity.
• Accommodate cravings, but do not let them replace more nutritious foods.
• Nutrients for which there are increased requirements during pregnancy include folate, iron, vitamin B12 and
iodine.
• Iron is required for oxygen transport in the body. Increasing vitamin C intake can help increase iron absorption
from foods.
• Folate is important 3 months before and in the first trimester of pregnancy.
• Iodine is important for normal growth and development of the baby.
• Being physically active has many benefits. If you are active and fit, and are experiencing a normal pregnancy, you
can remain physically active during your pregnancy.
• Drink plenty of fluids.
• Do not smoke – both direct and passive smoking is associated with growth retardation, increased risk of
spontaneous abortion, stillbirths, placental complications and low birth weight.
All the weight gained goes directly to the baby and the mother’s tissue stores. Since most of the weight gain goes to the
baby, a small weight gain can mean too small a baby. The following chart describes the location of the weight gain.
Weight gain in pregnancy
Time Where
First trimester blood volume and uterus
Second trimester tissue storage
Third trimester growing foetus and its brain development
A pregnant woman’s lifestyle and poor nutrition habits can lead to a low-birth-weight baby (less than 2.49kg)
Low birth weight babies are more likely to have medical complications including:
• trouble breathing because the lungs are poorly developed;
• brain damage due to insufficient nutrition;
• anaemia (fewer red blood cells) due to insufficient nutrition or lack of time to store the iron it needed;
• low body temperatures because they do not have fat stored to stay warm; and
• bleeding in the brain. This occurs to 40-45% of the babies that are born too small; it results in brain damage or
death.
Low birthweight babies are related to 70% of infant deaths. In particular, the following habits are associated with low
birthweight babies:
• poor nutrition,
• smoking cigarettes,
• drinking alcohol,
• using drugs, and
• lack of early and regular prenatal medical check-ups.
Substance abuse during pregnancy
Risks associated with substance use in pregnancy
Substance Unborn baby Infant/child
Alcohol • Stillbirth • Failure to thrive
• Prematurity • Mental retardation
• Low-birth weight • Learning disabilities (FAS related)
• Fetal Alcohol Syndrome
(FAS)
Caffeine • Low-birth weight • Neurobehavioral changes
Cocaine & Heroin • Stillbirth • Neurobehavioral changes
• Prematurity • Sudden Infant Death Syndrome (SIDS)
• Physical abnormalities • Withdrawal symptoms (seizures,
• Low-birth weight irritability, feeding difficulties, diarrhoea,
• Brain haemorrhages Vomiting, Sweating, tremors, etc.)
• Addiction
Marijuana • Prematurity • Neurobehavioral change
• Low-birth weight
• Facial abnormalities
• Labour and delivery effects
Tobacco • Stillbirth • Sudden Infant Death Syndrome (SIDS)
• Low-birth weight • Growth deficits
• Learning problems in school
• Respiratory illness
Food for breastfeeding
If you are breastfeeding you need a significant amount of extra energy to cope with the demands of breastfeeding. This extra
energy should come in the form of nutrient-dense foods to help meet the extra nutrient requirements that also occur when
breastfeeding. If you are vegan and breastfeeding (and during pregnancy) you should take a vitamin B12 supplement.
Recommendations include:
• Eat enough food – breastfeeding burns through extra kilojoules.
• Eat foods that are nutrient dense – especially those foods that are rich in folate, iodine, zinc and calcium.
• Eat and drink regularly – breastfeeding may increase the risk of dehydration and cause constipation. Fluid needs are
approximately 750–1000 ml a day above basic need.
• Women should continue to avoid drinking alcohol while breastfeeding.
Infancy
Food for the first year
Age Food
Birth to 12 months:
Babies usually double their Length & triple their weight • Begin and continue breastmilk up to 6 months
compulsory. No Cow’s Milk
between birth & 1 year of Age
4 to 6 months
Babies can hold up their heads and move them around. • Start with Cooked & Mashed vegetables.
5 to 6 months
Babies can sit up in a high chair with support. • Start plain Boiled & Smashed Foods and meats
which have more iron and protein combination.
6 to 9 months
Babies begin to use their thumb and forefinger in a pincer- • Start finger foods.
• Practice using a cup to drink milk, juice, or water
like movement. They pick up pieces of food and grab what
as an adult holds it
they want.
9 to 12 months
Babies can chew soft foods. Muscle control and hand-eye • well chopped or mashed. Avoid giving hard foods,
such as nuts, popcorn, or raw vegetables; babies
coordination is good.
easily choke on these items.
NOTE:
➢ Do not add excess salt or Sugar
➢ Avoid Dairy Milk in first 12 months
➢ Give Whole fruit, not fruit Juices
➢ Avoid Sugary Juices & Aerated Drinks
➢ Introduce Foods One at a time. Offer New Foods once in Every 4 Days to avoid Confusion
Early Childhood / Middle Childhood:
Young children like to feed themselves just like they like to do everything else for themselves. It's easy to spill milk and
make other messes as they learn how to eat. Parents and babysitters can help young children learn to eat and feed
themselves by providing:
• small utensils that are easy to hold.
• plates with edges so that food won't slip off the plate.
• small cups that will not tip over easily.
• foods that can be picked up and eaten with fingers.
• small servings of food on a plate because too much can be overwhelming.
• a high chair, booster seat, or cushions to reach the table.
Children who have positive experiences during family meals are more likely to develop healthy attitudes. This is an
opportunity to reinforce good eating habits and to introduce a wide variety of foods. However, food should not be used
to calm or cheer up children. That may result in children associating food with emotions and not hunger.
Children have small stomachs and cannot eat a lot of food at one time.
Nutrients in snack foods
Snack Major nutrient (s)supplied
peanut butter / Crushed or Boiled Peanuts • Protein
• Complex carbohydrates
Raw vegetables with a yogurt dip • Vitamin A
• Calcium
• Fibre
Rice Crackers/ Khakhra • B-vitamins
• Iron
Popcorn • Fibre
• B-vitamins
Rice cakes with fruits • Complex carbohydrates
Fresh fruit mixed into yogurt • Vitamins A and C
• Calcium
• Fibre
String cheese • Calcium
• Protein
Soaked Dry Fruits (Almonds, Dates, Raisins,) • Vitamin A and C
• Iron
• Use cookie cutters to make sandwiches in the shapes of animals or toys.
• Make sandwich ribbons, pinwheels (curled-up sandwich), or any other design.
• Shape foods in unusual way, such as roll-ups. For older children, toothpicks can hold cut vegetables in the shapes
of boats or buildings.
• Draw faces on fruits that are peeled, such as bananas, oranges. Or, cut a fruit in half, such as a peach, spread with
yogurt or low-fat cream cheese and add raisins or other pieces of dried fruit for a fruit face.
• Make a face on a sandwich. Peanut butter can be the “glue.” For the eyes, try raisins. For eyelashes and eyebrows,
try parsley. For yellow hair try carrot curls. For a nose, try a carrot tip. For a mouth, try a slice of red pepper. Add
arms and feet by attaching carrot or celery sticks.
Another factor that contributes to food selection is television/Media. Children are influenced by the foods advertised on
television. Before the age of seven or eight, few children can think critically about those advertised foods and may beg
parents to buy a frequently advertised food.
Teenage Years / Adolescence
A child’s body begins a period of rapid change in size and shape approximately around the age of 10 years in girls and
12 years in boys. This is called the “adolescent growth spurt.” During the next four years, an average girl may grow 10
inches taller and gain 18 to 22 kgs. An average boy may grow 12 inches taller and gain 22 to 28 kgs. At the same time,
their body shape begins to change, too.
The adolescent growth spurt requires many different nutrients. Calcium is especially important for bone growth and
health because 45% of the bone an adult has is built up during adolescence.
Alternative Sources of Nutrients in Milk
Nutrients in Milk Alternative sources
Calcium Yogurt, cheese, paneer, dark green leafy vegetables (especially broccoli),
kale, eggs, beans, tofu (soybean curd)
Vitamin A Deep yellow fruits and vegetables (such as carrots, squash, peaches, and
cantaloupe), dark green leafy vegetables, watermelon, cheese, eggs, and
liver.
Vitamin D Eggs, Fish, liver, salmon, Mushrooms (Sunlight).
Protein Chicken, beef, fish, beans or lentils, nuts, and seeds (peanut butter), eggs,
cheese, yogurt, and breads and cereals.
Although some teenagers become concerned that they are not changing as rapidly as their friends or other classmates
in school, there is wide variation in the age at which the adolescent growth spurts starts. It is generally more dependent
on the hereditary characteristics than on being a certain age.
How an adolescent feels about their body is closely related to how they feel about themselves. It is important for
teenagers to:
• know that change is normal,
• take care of the body they have, and
• talk to supportive family members and friends.
It is important to emphasize that changes in body size and shape are part of normal adolescent development. Females
gain proportionally more body fat during this time, while males gain proportionally more muscle and bone mass.
One of the changes taking place during adolescence is the varying hormonal levels in the body. These hormones are
responsible for the changes seen in the physical development of the body and secondary characteristics such as facial
hair growth and deepening voices.
LATE ADULTHOOD:
Throughout a lifetime, three of the keys to good health have been to:
• eat a variety of nutritious foods;
• limit the amount of saturated fat, processed salt, and refined sugar in the diet; and
• regular exercise.
Although these keys cannot guarantee good health, they can help an individual stay healthy as they grow older or
perhaps improve health. However, older adults often have special nutritional needs because:
• they need fewer calories than younger people to stay at the same weight; and
• certain health problems become more common as people grow older.
After the teen years, the need for calories decreases approximately 5% every 10 years. Thus, a 60-year-old needs 20%
fewer calories than a 20-year-old of the same weight. The best way for older adults to stay at the same weight is to:
• eat less, and/or
• exercise more.
The vitamin and mineral needs of healthy older adults appear to be similar to those of younger adults, although few
studies on the nutrient requirements of the elderly have been conducted. Recent studies have shown that although
older adults need fewer calories, the requirements for protein and calcium were somewhat higher in older adults than
in younger adults. One explanation for these results could be that older adults absorb these nutrients less efficiently.
Thus, older adults should be encouraged to consume recommended amounts of protein foods including milk, especially
since a common problem among older adults is their rejection of meat and milk.
Many older adults have difficulty chewing and swallowing food. Resolving these problems is critical to the nutritional
status of the elderly. The following suggestions for easy to chew and swallow protein-rich foods may be helpful:
• vegetables served in a cream or cheese sauce;
• raw fruits and vegetables chopped or grated in a salad;
• eggs cooked any way;
• legumes, such as split peas, navy beans, lima beans, pinto beans, and kidney beans;
• fish; and
• ground meats or finely chopped meats.
Many people eat less as they get older – this can make it harder to make sure your diet has enough variety to include all
the nutrition you need.
Recommendations include:
• Be as active as possible to encourage your appetite and maintain muscle mass.
• Remain healthy with well-balanced eating and regular exercise.
• Eat foods that are nutrient dense rather than energy dense, including eggs, lean meats, fish, liver, low-fat dairy
foods, nuts and seeds, legumes, fruit and vegetables, wholegrain breads and cereals.
• If possible, try to spend some time outside each day to boost your vitamin D synthesis for healthy bones.
• Limit foods that are high in energy and low in nutrients such as cakes, sweet biscuits and soft drinks.
• Choose foods that are naturally high in fibre to encourage bowel health.
• Limit the use of table salt, especially during cooking.
• Choose from a wide variety of foods and drink adequate fluids.
• Share mealtimes with family and friends.
Life Stage Change in Nutrient Needs
Pregnancy Increased requirements: energy, protein, essential fatty acids, vitamin A, vitamin C, B-vitamins (B1,
B2, B3, B5, B6, B12, folate, choline) & calcium, phosphorus, magnesium, potassium, iron, zinc, copper,
chromium, selenium, iodine, manganese
Lactation Increased requirements: vitamins A, C, E, all B-vitamins, sodium, magnesium
Infancy, Increased requirements: energy, protein, essential fatty acids
childhood
Adolescence Increased requirements: energy, protein, calcium, phosphorus, magnesium, zinc, iron (females only)
adulthood (ages Increased requirements for males, compared with females: vitamins C, K; B1, B2, B3, and choline;
19-50) magnesium, zinc, chromium, manganese
Increased requirements for females, compared with males: iron
Middle age Increased requirements: vitamin B6, vitamin D, Calcium
(ages 51-70)
Elderly (age Increased requirements: vitamin D
70+) Decreased requirements: energy; iron (females only)
Changing Nutrient Needs Through the Life Cycle
Conclusion
Requirements for energy and micronutrients change throughout the life cycle. Although inadequate intake of certain
micronutrients is a concern, far greater problems come from the dietary excesses of energy, saturated fat, cholesterol,
and refined carbohydrate, which are fuelling the current epidemics of obesity and chronic disease. Nutritionists can
assist patients in choosing foods that keep energy intake within reasonable bounds, while maximizing intakes of
nutrient-rich foods, particularly vegetables, fruits, legumes, and whole grains.