{ Life Cycle

Fetal Growth and Development Fetal Growth and Development Embryo Embryo Two to eight weeks Two to eight weeks Development of vital systems Development of vital systems Fetus Fetus Next seven months Next seven months Organs grow to maturity Organs grow to maturity From less than 1 ounce to 6 ½ to 9 pounds From less than 1 ounce to 6 ½ to 9 pounds Pregnancy

Critical periods are finite periods of intense development and rapid cell division. Critical periods are finite periods of intense development and rapid cell division. Neural Tube Defects Neural Tube Defects The critical period is days gestation. The critical period is days gestation. Anencephaly affects brain development. Anencephaly affects brain development. Spina bifida can lead to paralysis or meningitis. Spina bifida can lead to paralysis or meningitis. Pregnancy

Weight Gain during Pregnancy Weight Gain during Pregnancy Recommended Weight Gains Recommended Weight Gains Underweight <18.5 BMI: pounds Underweight <18.5 BMI: pounds Healthy weight BMI: pounds Healthy weight BMI: pounds Overweight BMI: pounds Overweight BMI: pounds A Obese ≥30 BMI: 15- pound minimum A Obese ≥30 BMI: 15- pound minimum pregnant with twins: pounds pregnant with twins: pounds Maternal Weight

Weight Gain during Pregnancy Weight Gain during Pregnancy Weight-Gain Patterns Weight-Gain Patterns 3 ½ pounds first trimester 3 ½ pounds first trimester 1 pound per week thereafter 1 pound per week thereafter Maternal Weight

Weight Gain during Pregnancy Weight Gain during Pregnancy Components of Weight Gain Components of Weight Gain Increase in breast size = 2 pounds Increase in breast size = 2 pounds Increase in mother’s fluid volume = 4 pounds Increase in mother’s fluid volume = 4 pounds Placenta = 1 ½ pounds Placenta = 1 ½ pounds Increased blood supply = 4 pounds Increased blood supply = 4 pounds Amniotic fluid = 2 pounds Amniotic fluid = 2 pounds Infant at birth = 7 ½ pounds Infant at birth = 7 ½ pounds Increase uterus and muscles = 2 pounds Increase uterus and muscles = 2 pounds Mother’s fat stores = 7 pounds Mother’s fat stores = 7 pounds Maternal Weight

Energy and Nutrient Needs during Pregnancy Energy and Nutrient Needs during Pregnancy Energy Energy Second trimester +340 kcal/day Second trimester +340 kcal/day Third trimester +450 kcal/day Third trimester +450 kcal/day Protein Protein + 25 grams/day + 25 grams/day Use food, not supplements Use food, not supplements Essential Fatty Acids—especially long-chain omega-3 and omega-6 fatty acids Essential Fatty Acids—especially long-chain omega-3 and omega-6 fatty acids

Folate Folate B 12 B 12 Iron Iron Zinc Zinc Ca and Vit D for bone development Ca and Vit D for bone development Other nutrients support growth, development and health of mother and fetus Other nutrients support growth, development and health of mother and fetus Nutrients for blood and cell growth

Adequate energy is important. Adequate energy is important. Should include milk and milk products Should include milk and milk products Should contain a variety of legumes, cereals, fruits, and vegetables Should contain a variety of legumes, cereals, fruits, and vegetables Plant-only diets may cause problems during pregnancy. Plant-only diets may cause problems during pregnancy. Supplements of iron, Supplements of iron, vitamin B 12, calcium, and vitamin D may be required. Vegetarian Diets during Pregnancy and Lactation

Common Nutrition-Related Concerns of Pregnancy Common Nutrition-Related Concerns of Pregnancy Nausea Nausea Morning (anytime) sickness Morning (anytime) sickness Ranges from mild queasiness to debilitating nausea and vomiting Ranges from mild queasiness to debilitating nausea and vomiting Hormonal changes Hormonal changes

Malnutrition and Pregnancy Malnutrition and Pregnancy Malnutrition and Fetal Development Malnutrition and Fetal Development Fetal growth retardation Fetal growth retardation Congenital malformations Congenital malformations Spontaneous abortion and stillbirth Spontaneous abortion and stillbirth Premature birth Premature birth Low infant birthweight Low infant birthweight High-Risk Pregnancies

Food Assistance Programs Food Assistance Programs Supplemental Nutrition Program for Women, Infants and Children (WIC) Supplemental Nutrition Program for Women, Infants and Children (WIC) Nutrition education Nutrition education Food vouchers for nutritious foods only Food vouchers for nutritious foods only High-Risk Pregnancies

Maternal Health Maternal Health Preexisting Diabetes Preexisting Diabetes Proper management is important. Proper management is important. Risks include infertility, hypoglycemia, hyperglycemia, Risks include infertility, hypoglycemia, hyperglycemia, spontaneous abortions, and pregnancy-related hypertension. Gestational Diabetes Gestational Diabetes Routine screening Routine screening with glucose tolerance test with glucose tolerance test High-Risk Pregnancies

Gestational Diabetes Gestational Diabetes Risk factors Risk factors Age 25 or older Age 25 or older BMI >25 or excessive weight gain BMI >25 or excessive weight gain Complications in previous pregnancies Complications in previous pregnancies Symptoms of diabetes Symptoms of diabetes Family history of diabetes Family history of diabetes Hispanic, African American, Native American, South or East Asian, Pacific Islander or indigenous Australian Hispanic, African American, Native American, South or East Asian, Pacific Islander or indigenous Australian Consequences Consequences Complications during labor and delivery Complications during labor and delivery High-birthweight infant High-birthweight infant High-Risk Pregnancies

Maternal Health Maternal Health Preexisting Hypertension Preexisting Hypertension Heart attack and stroke Heart attack and stroke Low-birthweight infant Low-birthweight infant Separation of placenta from wall of uterus resulting in a stillbirth Separation of placenta from wall of uterus resulting in a stillbirth Transient Hypertension of Pregnancy Transient Hypertension of Pregnancy Develops during second half of pregnancy Develops during second half of pregnancy Usually mild Usually mild Returns to normal after birth Returns to normal after birth High-Risk Pregnancies

Pre eclampsia Pre eclampsia High blood pressure High blood pressure Protein in the urine Protein in the urine Edema all over the body Edema all over the body Affects all organs Affects all organs Retards fetal growth Retards fetal growth Eclampsia Eclampsia Also known as Toxemia Also known as Toxemia Severe stage of pre eclampsia Severe stage of pre eclampsia Seizures and coma Seizures and coma Maternal death Maternal death

{ Infant Feeding First milk – Colostrum First milk – Colostrum 2-3 days 2-3 days High antibodies and white blood cells High antibodies and white blood cells Breast Milk Breast Milk Lactalbumin – easily digested Lactalbumin – easily digested Correct proportions of vitamins and minerals Correct proportions of vitamins and minerals Calcium is well absorbed Calcium is well absorbed High bioavailability of Iron and Zinc High bioavailability of Iron and Zinc

Benefits of Breastfeeding Benefits of Breastfeeding For infants For infants Appropriate composition and balance of nutrients with high bioavailability Appropriate composition and balance of nutrients with high bioavailability Hormones that provide physiological development Hormones that provide physiological development Improves cognitive development Improves cognitive development Protects against infections Protects against infections May protect against some chronic diseases May protect against some chronic diseases Protects against food allergies Protects against food allergies Nutrition during Lactation

For mothers For mothers Contracts the uterus Contracts the uterus Delays the return of ovulation, thus lengthening birth intervals Delays the return of ovulation, thus lengthening birth intervals Conserves iron stores Conserves iron stores May protect against breast and ovarian cancer May protect against breast and ovarian cancer Other benefits Other benefits Cost savings Cost savings Environmental savings Environmental savings Do not have to purchase Do not have to purchase or prepare formula Nutrition during Lactation

Prenatal and postnatal growth retardation Prenatal and postnatal growth retardation Impairment of brain and central nervous system. Impairment of brain and central nervous system. Abnormalities of face and skull and birth defects. Abnormalities of face and skull and birth defects. Fetal Alcohol Syndrome: Symptoms

Another rapid state of growth occurs during adolescence. Another rapid state of growth occurs during adolescence. Nutrient needs rise, and iron and calcium are especially important. Nutrient needs rise, and iron and calcium are especially important. Busy lifestyles make it challenging to meet nutrient needs and develop healthy habits. Busy lifestyles make it challenging to meet nutrient needs and develop healthy habits. Peer pressure is significant among adolescents. Peer pressure is significant among adolescents. Energy needs vary Energy needs vary Depends on activity Depends on activity Weight gain possible (esp. females) Weight gain possible (esp. females) Vitamin and mineral needs increase Vitamin and mineral needs increase Iron deficiency anemia Iron deficiency anemia Calcium and vitamin D Calcium and vitamin D Nutrition during Adolescence

Physiological Changes Physiological Changes Immune System Immune System Compromised immune systems can occur with age. Compromised immune systems can occur with age. Incidences of infectious disease increase Incidences of infectious disease increase GI Tract GI Tract Slower motility resulting in constipation Slower motility resulting in constipation The Aging Process

GI Tract GI Tract Atrophic gastritis impairs digestion and absorption of nutrients due to: Atrophic gastritis impairs digestion and absorption of nutrients due to: stomach inflammation, stomach inflammation, bacterial overgrowth, bacterial overgrowth, lack of hydrochloric acid and intrinsic factor. lack of hydrochloric acid and intrinsic factor. Dysphagia is defined as difficulties in swallowing and can result in nutritional deficiencies Dysphagia is defined as difficulties in swallowing and can result in nutritional deficiencies

Physiological Changes Physiological Changes Tooth Loss Tooth Loss Tooth loss and gum disease can interfere with food intake. Tooth loss and gum disease can interfere with food intake. Edentulous is lack of teeth. Edentulous is lack of teeth. Conditions that require dental care Conditions that require dental care Dry mouth Dry mouth Eating difficulty Eating difficulty No dental care in 2 years No dental care in 2 years Tooth or mouth pain Tooth or mouth pain Altered food selections Altered food selections Lesions, sores, or lumps in mouth Lesions, sores, or lumps in mouth Ill-fitting dentures Ill-fitting dentures

Physiological Changes Physiological Changes Sensory Losses and Other Physical Problems Sensory Losses and Other Physical Problems Vision problems can make driving and shopping difficult. Vision problems can make driving and shopping difficult. Taste and smell sensitivities may diminish. Taste and smell sensitivities may diminish.

Other Changes Other Changes Psychological Changes Psychological Changes Depression and loss of appetite commonly occur together. Depression and loss of appetite commonly occur together. Support and companionship of family and friends are helpful. Support and companionship of family and friends are helpful. Economic Changes Economic Changes Older adults have lower incomes and are at risk for poverty. Older adults have lower incomes and are at risk for poverty. Only 1/3 receive aid from federal assistance programs. Only 1/3 receive aid from federal assistance programs. Social Changes Social Changes Loneliness is directly related to low energy intakes. Loneliness is directly related to low energy intakes. Malnutrition is common. Malnutrition is common.

Water Water Dehydration increases risks for: Dehydration increases risks for: urinary tract infections, urinary tract infections, pneumonia, pneumonia, pressure ulcers, pressure ulcers, confusion and disorientation. confusion and disorientation. Fluid needs are not recognized. Fluid needs are not recognized. Mobility and bladder problems Mobility and bladder problems Energy and Nutrient Needs

Energy and Energy Nutrients Energy and Energy Nutrients Energy needs decrease. Energy needs decrease. Protein to protect muscle mass, boost the immune system, and optimize bone mass Protein to protect muscle mass, boost the immune system, and optimize bone mass Carbohydrate for energy Carbohydrate for energy Fiber and water to reduce constipation Fiber and water to reduce constipation Fat to enhance flavors of foods and provide valuable nutrients Fat to enhance flavors of foods and provide valuable nutrients Vitamin and minerals to meet needs Vitamin and minerals to meet needs Energy and Nutrient Needs

Food Assistance Programs Food Assistance Programs Congregate meals are group settings at community centers. Congregate meals are group settings at community centers. Meals on Wheels is a home- delivered meal program. Meals on Wheels is a home- delivered meal program. The Senior Farmers Market Nutrition Program allows low-income older adults to exchange coupons for fruits, vegetables, and herbs. The Senior Farmers Market Nutrition Program allows low-income older adults to exchange coupons for fruits, vegetables, and herbs. Food Choices and Eating Habits of Older Adults

Nutrient Needs Nutrient Needs Energy – decreased BMR Energy – decreased BMR Protein – needs to not decline Protein – needs to not decline Fats – 20 – 35% energy needs Fats – 20 – 35% energy needs Fiber Fiber Water – monitor intake and output Water – monitor intake and output Vitamins B6 and B12, Vitamin D, Vitamins B6 and B12, Vitamin D, Calcium Calcium Antioxidants – Vitamin E, C, β-carotene Antioxidants – Vitamin E, C, β-carotene Nutrition and Aging

Preventing food insecurity Preventing food insecurity Economic Limitations Economic Limitations Programs provide nutrition education Programs provide nutrition education Social Limitations Social Limitations loneliness loneliness Physical Limitations Physical Limitations Limited mobility Limited mobility Medical Limitations Medical Limitations Dental problems Dental problems Difficulty chewing, dental caries, gum disease Difficulty chewing, dental caries, gum disease Changes in sense of taste and smell Changes in sense of taste and smell Intolerance of food Intolerance of food Medical conditions Medical conditions Medical nutrition therapy education Medical nutrition therapy education Prescriptions and over-the-counter drugs Prescriptions and over-the-counter drugs Drug nutrient interaction Drug nutrient interaction Nutrition and Aging

Federal Older American Act (OAA) Federal Older American Act (OAA) Title III Title III Serves at least one meal five days a week to persons 60 years and older Serves at least one meal five days a week to persons 60 years and older Congregate meals, faith based organizations Congregate meals, faith based organizations Nutrition Screening Initiative Nutrition Screening Initiative National program that promotes nutritional screening and more attention to nutrition in all health-care and social-service settings that provide for older adults National program that promotes nutritional screening and more attention to nutrition in all health-care and social-service settings that provide for older adults Nutrition and Aging

D – Determine D – Determine E – Eating poorly E – Eating poorly T – Tooth loss or mouth pain T – Tooth loss or mouth pain E – Economic Hardship E – Economic Hardship R – Reduced social support R – Reduced social support M – Multiple medicines M – Multiple medicines I – Involuntary weight loss (or gain) I – Involuntary weight loss (or gain) N – Needs assistance in self care N – Needs assistance in self care E – Elder above age 80 E – Elder above age 80 Nutrition and Aging