Hospital Diets

Hospital
Diets
Standard Diet Full diet focuses on
providing food for the patient. Doctors must
refrain from ordering “Diet as tolerated.”
Upbuilding diet aims to increase energy
intake for weight gain.In reducing diet,
about 500 calories is deducted from the
computed TCR. (MNT for Filipinos, 2011)
Diet Therapy
By: Kriselda Manzano- Saracho, RN,

MSN
Diet Therapy

MSN
Therapeutic
Diet
Modified in consistency
Modified in
composition
Modified in
composition
Modified in
composition
A. Hospital Diets
1. Standard Diet- Full diet focuses on providing food for the
patient. Doctors must refrain from ordering “Diet as tolerated.”
2. Therapeutic Diet
a. Modified in consistency
Clear Liquid
Description Leaves no residue in the GIT
Indication Given before and after surgery
Foods Allowed Vegetable soup, Gelatin, Candy,Coffee/ Tea
Foods Not Allowed Highly fibrous foods
General

Liquid
Description Readily become liquid at body temperature
Surgery of the mouth, neck and face,Transition
Indication from clear
liquid to full diet
Foods Allowed Cream soup, Custard, Soft-boiled egg
Foods Not Allowed Highly fibrous foods
Mechanical Soft
Description Modified in texture for ease of mastication
Indication Poor dentures, oral lesions or surgery, chewing difficulty
Soft-cooked rice, Ground meat, Chopped vegetables,

Foods Allowed
Fruit shake
Foods Not Allowed Tough meat and vegetables
Soft
Description Soft whole food, lightly seasoned, low in fiber
After surgery, fever, mild infection, GI disturbance

Indication Transition from liquid diet to full diet, or from TF to oral
diet
Foods Allowed Congee, Fish/ chicken fillet, Soft vegetable and fruit
Foods Not Allowed Tough meat, Vegetable salad
b. Modified in composition
Low Fat
Description Regulates the amount and kind of fat. Must be planned to

provide 15-20% of total calories
For patients with fatty liver, gall bladder, disease, irritable

Indication colon, GI disturbance, functional indigestion
Foods Allowed Boiled, steamed, roasted foods

Foods Not Allowed Fried foods
Low Salt
Description Sodium restriction may contain 1 to 4 grams of sodium/day
Indication Hypertension, heart disease, kidney disorder
Salt Choices: Each choice is 500 mg sodium

Salt- ¼ teaspoon
BBQ sauce- 4 Tablespoon
Catsup- 3 Tablespoon
Fish Sauce- 1 ½ teaspoon
Mustard- 8 teaspoon
Soy sauce - 1 ½ teaspoon
Worcestershire sauce- 2 tablespoon
Reflux
Precaution
Reflux laryngitis, Gastro-esophageal
Description
reflux disease
For patients with fatty liver, gall bladder

Indication disease, irritable colon, indigestion
Coffee, chocolates, milk and dairy,

carbonated drinks
Highly seasoned meats, poultry, fish
Foods Not Allowed and salad dressing
Mints, lemons, oranges, pineapple,
berries and citrus juices Tomato and
tomato products
Low Residue
Easily digested and absorbed, leaving

Description
minimum residue in the GI tract
Spastic constipation, diarrhea, ulceration

Indication and
post hemorrhoidectomy
Sample Meal Plan

Breakfast Lunch Dinner
1/2 C juice 4 ounces meat
5 ounces meat
1/2 C. Cereal 1/2 cup potato or substitute 1/2 cup potato or substitute
1 egg 1/2 cup vegetable juice
2 slices bacon 2 slices bread 1/2 cup vegetable juice
2 slices bread 4 tsp margarine 2 slices bread
4 tsp margarine
2 tsp. margarine 1/2 cup dessert 1/2 cup dessert
1 tsp jelly Beverage
1/2 C milk Beverage
1 Tbsp sugar
Beverage
1/2 Tbsp sugar

Low
Purine
High CHO and low fat, since CHO favor

Description uric acid excretion while fats favor
retention
Indication Gouty arthritis, elevated uric acid levels

or high tendency to form kidney stones
Foods Not Allowed Red meat, Organ meat, Fin fishes,

Alcoholic beverages
Low Oxalate
Description Oxalic acid occurs primarily in food of plant origin
Indication High tendency to form oxalic acid kidney stones
Chocolate milk, cocoa, tea, Baked beans canned in

Foods Not Allowed tomato sauce, Fruit cocktail, strawberry, Peanut, almond,
cashew, Beans, celery,cucumber, eggplant, mustards, okra,
parsley, pepper, spinach
Medical nutrition therapy (MNT) is an evidence-based,
individualized nutrition process meant to help treat certain medical
conditions. The term was introduced in 1994 by what is now the
Academy of Nutrition and Dietetics, the largest organization of
registered dietician nutritionists (RDNs) and other credentialed
food and nutrition professionals in the United States. MNT is
developed and implemented by an RDN with the approval of the
patient’s doctor. MNT may be conducted in a hospital, in an
outpatient clinic, or as part of a telehealth program.
Nutritional care is an integral part of patient care management. It is
interrelated with the individual’s basic needs such as the physical,
physiological, emotional, sociological and economic factors. The
application of competence in nutritional care is of prime importance for
the nurse to ensure the well-being and better health outcome for the
patient. The module will be started with a though- provoking activity on
nutrition ad life cycle process in the pre-task. The discussion of the
lessons will focus on stages of life cycle and its characteristics.
Corollary to its stages, is the management of the common nutrition
concerns. Every after the presentation of lessons, you will doing a
check-in activity that allows you to have a self-reflection/self-assessment
of your understanding on the concepts presented. In the post-task, you
will be asked to integrate the concepts presented in a given case
scenario.

Pregnancy is the most unique and critical among the periods in human life cycle
since the well-being of an individual depends so much on the well-being of
another.
The following are the definitions of pregnancy :
• The period from conception to birth and for human aging 38 to 42 weeks.
• It is divided into 3 trimester : 1st, 2nd, 3rd
•3 stages of Pregnancy
• Implantation- period in which the fertilized ovum implants itself to the uterus &
begins to develop
• Organogenesis- called the critical period since it the time during which cells of
a tissue or organ are genetically programmed to multiply
• If malnutrition occurs at this stage , it may affect organ development that may
not be reversed by subsequent refeeding
• Growth- the remaining 7 months in the last stage where the number of cell and
in the size of the organ to support extra-uterine life
Nutritional Requirements during Pregnancy
1) CALORIE ALLOWANCES
During the course of pregnancy, the total energy cost of storage plus maintenance (additional
work for maternal heart and uterus and a steady rise in basal metabolism) amounts to
approximately 80,000 kcal. The energy cost of pregnancy then is about 300 kcal per day. The
energy should be 36 kcal per kg of pregnant weight per day.
The following are the considerations for calorie requirements during pregnancy:
1.1 Weight gain
• A small weight gain observed during the first trimester. Rapid weight gain happens in the
2nd Slower weight gain is recorded during 3rd trimester
• An average weight gain during pregnancy is 24 lbs which is commensurate with a better-
than-average course and outcome of pregnancy
• A gain of 1.5-30 lbs. during the first trimester and a gain of 0.8lb per week during the
remainder of the pregnancy should be the guideline
• An average maternal weight gain:
The following are conditions are related to weight gain in pregnancy :
1.Underweight – may result to high risk of having a low-birth weight infants &
higher rates of pre-term deaths & infant deaths
2.Overweight and Obesity – may result to the following conditions :
1.High risk of complications like hypertension, gestational diabetes, & post-
partum infections
2.Complications of labor & delivery
3.Increased likelihood of difficult labor & delivery, birth trauma and
cesarian section (CS) for large babies
4.Double risk of neural tube defects
The total weight gain for a normal pregnant woman is kept ideally between 15-
20lbs, the gain is divided into 3lbs, 7lbs and 7lbs respectively in the three
trimesters.
2) PROTEIN ALLOWANCES
• Additional allowance of protein during pregnancy takes into account the increased
nitrogen content of the fetus and its membranes, maternal tissues and the added
protection of the mother against
• World Health Organization (WHO) recommends an additional 9 grams of protein
per day for the latter part of
• A normal pregnancy woman requires a total of 900-950 grams for the 9 months
gestation period.
The following are the reasons for additional protein intake during pregnancy :
• To provide for the storage of nitrogen
• To protect the mother against many of the complications of pregnancy
• For the growth of the woman’s uterus, placenta, and associate tissues
• To meet the needs for the fetal growth
• For the growth of mammary tissues
• For the hormonal preparation for lactation
3) CALCIUM ALLOWANCES
Some calcium and phosphorus deposition takes place
early in pregnancy, but the amounts are small.
It has been shown that the calcium and phosphorus
retained in the fetus during the last two months of
pregnancy are 65% and 64% respectively, of the total
body content of the full term fetus.
COMMON COMPLICATIONS IN PREGNANCY

1. Morning sickness
•This is commonly called the nausea and vomiting of pregnancy (NVP). It
occurs at any time and often lasts all It has no cure but symptoms can be
reduced
•Management :
-Eat small, frequent meals and snacks
-Consume fluids between meals
-Well-tolerated: frozen ice pops, gelatin desserts, watermelon, and mild broths
2.Gastroesophageal Reflux/Heartburn
•This is due to pregnancy hormones relax lower esophageal smooth muscle and
enlarge uterus pushes on the stomach
•Management :
-Avoid excessive weight gain
-Eat small, frequent meals; chew food slowly
-Wait 1 hour after eating before lying down
-Sleep with your head elevated
3.Constipation
•This is due to pregnancy hormones cause smooth muscle to relax ad slow
colonic movement of food residue
•Management :
-Eat 25−35 g/day of fiber
-Drink plenty of fluids
-Keep physically active
4.Gestational Diabetes
•This is due to insufficient insulin production or insulin resistance increases blood glucose levels
•It predispose to the risk of delivering a large baby, risk of having type 2 diabetes even after the delivery
of the baby and overweight later in life
•Management:
•Requires strict diet, physical activity, and/or medication on uncontrolled blood sugar
5.Hypertensive Disorders
•Gestational hypertension: no symptoms
•Preeclampsia: sudden increase in maternal blood pressure
•Can be fatal if left untreated
•Deficiencies in vitamins C and E, calcium, magnesium increase the
risk
6.Alcohol, Caffeine and Nicotine
•Smoking during pregnancy lowers the mean birth weight and increases the
risk of perinatal mortality
•Nicotine causes a decrease in the oxygenation of the fetus
•Excessive maternal alcohol ingestion is linked to fetal alcohol syndrome
(FAS). Its major features are CNS disorders, mental retardation, growth
deficiencies and facial deformities
•Caffeine crosses the placenta to the fetus very The fetus can metabolize
alcohol to a limited extent but not caffeine.
•Alcohol, caffeine and nicotine dramatically increase the circulating levels
of catecholamine
7.Adolescent Pregnancy
•The full physical stature of the woman is not yet
•There is a higher needs for calories and bone-related nutrients (calcium,
phosphorus, magnesium)
•Inadequate maternal weight gain
•Poor prenatal care; higher rates of prenatal alcohol and drug use
•It causes a higher rates of preterm births, low-birth-weight babies, and other
complications
8.Pregnancy in Older Women
•The following condition may develop :
•Hypertension and diabetes
•Higher rates of premature birth and low birth weight
•Birth defects
•Fetal death
9.Repeated Pregnancies
•As parity increases, the tendency toward lower
nutrient intake increases
•Gestation in close interval depletes the
maternal reserves of nutrients. Cases of
replenishment of nutrients does not take place,
the mother’s nutritional status, and
consequently that of the infant are greatly
affected
LACTATION
During your community exposure home visit in level 2, you had encountered lactating
mothers. As a review, this is defined as the preparation for assuring an adequate supply
of good quality breast milk must begin at the onset of pregnancy. It is important that
you are aware of their nutritional needs.
Nutritional Requirements in this stage of the women’s life:
1) CALORIE ALLOWANCE
It is generally suggested that the extra food calorie should be about twice
those secreted in the milk of approximately 700 to 1,000 ml of the milk.
An increase by 1,000 calories above the normal requirement for an average
production of 850ml of milk, with an energy value of about 600 calories
2) PROTEIN ALLOWANCES
•Lactation makes large demands on the human stores.
•The food intake of a nursing mother must contain sufficient proteins to supply both the
maternal needs and the essential amino acids to be transferred through her breast for the
baby’s growth.
•Additional protein in the diet tends to increase the yield of breast milk while a decrease of
protein lowers the amount of milk secreted.
3) CALCIUM, PHOPHORUS and VITAMIN D ALLOWANCES
•Calcium allowance is 1.0g daily for good milk production.
•If the protein requirement and other essentials of the diet are fulfilled, the increased need
for phosphorus will be met.
•The vitamin D requirement of 400 IU remains the same as during pregnancy.
4) IRON ALLOWANCES
•Baby is born with a relatively large reserve of iron.
•Since milk is not a good source of iron, a good allowance of
iron in the mother’s diet during lactation does not convey
additional iron to the infant.
•Iron-rich foods are essential for the mother’s own health while
supplements are included early in the infant’s diet.
5) VITAMIN ALLOWANCES
•There is an increased demand for Vitamin A, niacin, riboflavin,
thiamine and ascorbic acid above the requirements of pregnancy
during lactation.
The nutritional requirements in lactation are greater than in pregnancy to ensure enough supply of milk for
the baby. Specifically:
1.Calories - most women who are breastfeeding need about 500 calories more than moms who aren't – that's a
total of 2,000 to 2,500 calories per Energy giving foods are good sources of calories.
2.Protein - nursing mothers need two to three servings, or at least 65 grams, of protein per Breast-feeding
moms can meet their protein needs by making sure they have, at a minimum, a healthy source of protein at each
meal.
3.Calcium and phosphorus = an increase of 0.5 mg to the normal allowance is needed to prevent severe depletion
of maternal calcium reserve since this is used for milk production
4.Iron – an additional intake is recommended for blood lost in parturition, for milk iron and basal
5.Vitamin A – an additional 2,000 IU to the normal allowance is needed to provide the amount of Vitamin A
secreted in
6.Vitamin B1 – an additional allowance is needed for thiamine secreted in milk. A mother whose diet is low in
thiamine may secrete a toxic substance called “gloxaline” which accumulates in thiamine
7.Riboflavin, vitamin C.- an additional allowance is needed for milk secretion.
8.Fluids = an intake of 8 glasses or more is recommended to increase milk production.
NUTRITION in INFANCY
During your previous exposure in the OB ward, you have handled infant as your client. As a review, Infancy is
described as the first year of life. It is characterized by rapid physical growth , development and maturation of
oral, fine and motor skills. Adequate nutrition is of prime important to support this growth.
The requirements of protein, energy and other essential nutrients are higher per unit of body weight than nay other time
in childhood.
Breast milk is still the best food for the infant.
Lesson 2: : Nutrition in
Infancy
NUTRITIONAL ASSESSMENT
1. Anthropometry
reflects nutritional well-being & major indicator of nutritional status
Wasting/ thinness- low eight for height
Stunting- low height for age
Measurement recommended :
a. WEIGHT – should be measured to the nearest 10g (1/2 oz) for infants
b. LENGTH- measured in the recumbent position on a measuring board w/ fixed
headboard & movable footboard
- recorded as the distance between the headboard & frontboard when the
drjasonhall.com
infant is positioned properly
c. HEAD CIRCUMFERENCE – confirms that growth is proceeding normally
- detect protein-energy malnutrition & evaluate impact on
brain size
CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

BIOCHEMICAL ASSESSMENT
• Assess iron status using Hb or hematocrit determination
• Anemia in infants 6-24 months of age – Hb cocentration
of less than 11g/dl or hematocrit of less than 33 %
DIETARY ASSESSMENT
• Provide information on adequacy of infant’s diet lovingtouch.com
• Use to develop plan to resolve problems on food &

nutrients patterns

NUTRIENT ALLOWANCES for INFANTS
1 . ENERGY
• Requirement for Infants- 3-6 months – breastmilk
• Infants- 6 -12 months – breastmilk & supplementary foods
Upward or downward changes in weight percentile occur w/out changes in
length- suspected of over nutrition or over nutrition
2. PROTEIN
• In early childhood – protein supplies amino acid for the synthesis of new
tissues & nitrogen for maturation of existing tissues
• Human milk or formula – major protein source littlestart.ca
• Requirements : First 4 months – average 3.5 g/day

• 4-8 moths – 3.1 g/day
• Increases requirement to 11-14.6 % in the first year
3 FATS or LIPID
.
• Requirement for Infants: fatty acids, linoleic acid, arachidonic acid

• Linoleic – essential for growth & dermal health, provide 4-5% of total kilocalories
* 4% total energy in human milk
* 10% total energy infant formulas
* 1% total energy cow’s milk
4. CARBOHYDRATES
• Requirement for Infants: 30-60% of energy intake
• Can be synthesize from amino acid & glycerol : no specific dietary recommendation littlestart.ca
• 37% in human milk

• 40-50% of energy from commercial milk
• SourcesCENTRO
: Sugar & complex carbohydrates
ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019
5. WATER
• Essential component of body structure
• Transport nutrients & waste products from cell
• Regulate body temperature
• Requirement for Infant: determined by amount loss from the skin, lungs, feces & urine
• Source for the 1st 6 months : Breastmilk or infant formula
• Boiled milk /formulas are not appropriate : water evaporates & solutes become
concentrated
• Rationale WHY infant can dehydrate very rapidly :
* Higher % of infant’s body weight is water
* Infant’s fluid exchange rate 7X greater than adult littlestart.ca
* Metabolic rate 2X greater relative to body weight

5 . VITAMINS
• Milk form healthy lactating mother supplies all vitamins needed except vit. D
• Breast-fed infants needs vit. D supplement : exposure to sun at least 30
mins./week for those wearing only diaper. 2 hours/week for fully clothed
w/out hats
• Rickets : common in breast-fed infants w/ dark skin & w/ little exposure to
sunlight
Commercially prepared formula :
• Evaporated & homogenized cow’s milk : w/ vit. D but liitle of vit. C
• Fresh goat’s milk : deficient w/ vit. C, D, & folate littlestart.ca
• B6 deficient : destroyed during production

5 . VITAMINS
• Breastmilk: vit. B12 deficient for lactating mothers who followed
strictly vegan diet
• Vit. K deficiency: more common for breast-fed
• Formula & cow’s milk: vit. K 4X higher than breast milk
• Vit . K injection given as prophylactic at nursery
littlestart.ca

5. MINERALS
Calcium
• First 2-3 days of life : level of plasma
calcium & phosphorus fall significantly
• 10th day of life: stabilized, greater in
breast-fed
littlestart.ca
• Formula fed : retains 25-30 % of Calcium

5. MINERALS
Zinc
• Human milk & infant formula provide
adequate zinc : 0.3-0.5 mg/kg body weight
• Better absorption in human milk than
infant formula
littlestart.ca
• Normal infants don’t have zinc reserve

BREASTFEEDING
Benefits for the Infants

• Optimal nutrition for infant
• Strong bonding with mother
• Safe fresh milk
• Enhance immune system
• Reduced risk for acute otitis media, gatroenteritis, severe lower respiratory infection &
asthma
• Protection againts allergies & intolerances
• Promotion of the correct development of the jaw & teeth
• Association w/ higher intelligence quotient
• Reduced risk for sudden infant death
• Reduced risk for chronic disease such as obesity, DM, hypertension, heart disease,
childhood leukemia
BREASTFEEDING
Benefits for the Mother

• Increased energy expenditure- lead to pre-pregnancy weight
• Strong bonding with mother
• Faster shrinking of the uterus
• Reduced post partum bleeding & delays menstrual cycle
• Reduced risk for DM , ovarian & breast cancer
• Improve bone density & decreased risk for hip fracture happyfamilyorganics.com
• Money & time saved from formula preparation

FORMULA –FED INFANT
Commercial formulas
• Cow’s milk or soy product
• Heat treated non-fat milk designed to provide the necessary nutrients in a well absorbed
form & approximately close to the composition of human milk
Soy based Formula

Recommended for infants that don’t tolerate cow’s milk-based formulas , and :
123rf.com
• Children of vegetarian families

• Children w/ galactosemia or primary lactase deficiency , those recovering from
secondary lactose intolerance
• Infants who are potentially allergic to cow’s milk but have not shown clinical
manifestations of allergy.
FOODS FOR INFANTS
• Cereals fortified w/ iron

• Strained & junior vegetables & fruits
• Strained & junior meats
• Dessert items such as pudding & fresh dessert
parents.com
feedinglittels.com

COMMON NUTRITION PROBLEMS FOR INFANTS
OBESITY
• Weight above the 95th percentile in relation to height, sex & body built
• Infantile obesity secondary to excessive intake of food
Causes :
• Poor infant feeding practices
• Misuse of solid foods such as introducing it too soon
healthunits.com

BABY BOTTLE TOOTH DECAY

• Decay of upper anterior & sometimes the lower posterior teeth
Cause :
• Giving of sugar-sweetened beverages or fruit juices
in a bottle at bedtime
everydayfamily.com

COLIC
• Severe abdominal pain in infants
Manifestations:
• Healthy well-fed infants cry several hours a day
• Draw legs onto their abdomen
• Pass large amount of gas
Cause :
• Food allergy or intolerance
everydayfamily.com

THANK YOU!

Lesson 2:
Nutrition in Pre-Schooler
NUTRITION FOR
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PRESCHOOL AGE
• 3-6 years of age

• Changes occur in child’s growth & development
2-4 kg/year 1-2 kg/year

(1-2 y/o) ( 3-4 y/o)
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CHARACTERISTICS OF PRESCHOOL AGE
Growth rate slows
Requires less food
Appetite decrease
“FOOD JAGS” Eat only favorite foods

•
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CHARACTERISTICS OF PRESCHOOL AGE
Height relative to weight

( Ages ¾- 6 years)
Chubby toddler Leaner preschool

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COMMON NUTRITION PROBLEMS OF PRESCHOOL AGE
1. Protein-Energy Malnutrition (PEM)
Kwashiorkor Marasmus
everydayfamily.com

Kwashiorkor
Deficiency of protein but energy intake is adequate
Growth failure
Moon face
Edema
Skin lesions
Hair changes
Apathy Low resistance to infection

Marasmus
Prolonged restriction to energy & protein
Severe form of PEM
Extreme muscle
wasting

2. Iron deficiency anemia (IDA)
 55.7% occurrence in the Phils.

 Low Hgb or Hct in the blood
 Lack of dietary iron
jdcenter.com

2. Iron deficiency anemia (IDA)

 Paleness of the eyes, lips, fingernails, palm & skin
 Shortness of breath
 Easy fatigability
 Reduced ability to learn
 Irritability

3 Vitamin A deficiency
.
 Night blindness ( inability to see in dim light)

 Xeropthalmia (dryness of eyes)
 Rough dry skin & membranes
 Susceptible to infection
 Poor growth

4. Iodine - deficiency Disorders

 Inadequacy of dietary iodine
 Goiter
 Hot /cold intolerance
 Mental retardation
 Deaf-mutism
 Difficulty in standing or walking

5. Obesity
 Common in USA
 Philippines- 10 to 30 % prevalence
Risk factor
Hypertension
Coronary Heart Disease (CHD)
Diabetes

5. Obesity
Predisposing factors:
• Genetic or familial
• Metabolic hormonal abnormality
• Poor eating habits (sweets, sugar)
• Inactivity or sedentary lifestyle
( too much TV viewing)

6. Dental Caries
98 % prevalence in the Philippines
Cause : Intake of
sticky sugar
(e.g. Candies)

Dental Caries Prevention :
1. Daily oral hygiene

2. Restrict sugary foods
3. Flouridation of water
4. Use of flouride in toothpaste

FACTORS INFLUENCING FOOD INTAKE OF PRESCHOOL AGE
1. Family
 Role model for desirable eating habits
“The parent is responsible for what is offered;
the child is responsible for how much
to eat “

2. Societal Trends
 Employment of parents especially the mother
 Rely on others to cook, purchase fast foods or
convenience foods

2. Societal Trends
 Employment of parents especially the mother
 Rely on others to cook, purchase fast foods or
convenience foods

3. Media
 Affects children’s request for & attitudes to foods
“ Preschool are unable to distinguish commercial
messages to regular program “

INFLUENCE of TELEVISION to PRESCHOOL AGE
1. TV ads influences food purchases

2. Relationship TV watching & increased snacking
3. TV ads suggest inappropriate use of food has no
impact to health
4. TV encourages inactivity & passive use of leisure

4. Illness or Disease
 Cause of decrease appetite & limited food intake
Management : Special diet

CHARACTERISTICS OF DIET FOR PRESCHOOL AGE
 Food selection – good source of vitamin

A & C, protein, Iron & Calcium
 Avoid hard, sticky foods w/c may plug to throat –e.g.

candy, popcorn

 Foods- mildly flavored, cooked w/ moderate amount of

oils/fats, spread w/ butter or margarine, cut in small
pieces, lukewarm
 Use seasoning in moderation

 Excessive milk intake reduce the consumption of other

foods
 Lower fat of milk for healthy

children over 2 y/o

 The Environment – appropriate chair, suitable dishes, relaxed

& pleasant
 Give small frequent meals

FOOD PLAN (1-3 years old) 1070 calories
Food Groups Exchange Amount
Vegetables 1 ½ servings; ½ cup cooked per servings ; leafy green or yellow
Fruits 1-2 1-2 servings ; Vit C rich

Milk 1 1 serving : ½ cup evaporated/ 4 tbps powdered
Rice or 3-4 1 ½- 2 cup cooked rice

substitute
Meat,fish, egg 2 2 matchbox: liver/organs 1x/week; egg 2x/week; ½ cup cooked dried beans
or sustitute
Fat 6 6 teaspoons
Sugar or 3-4 3-4 teaspoons
sweets

THANK YOU!

Lesson 2
Nutrition in School Age
NUTRITION in
SCHOOL AGE

CHARACTERISTICS OF A SCHOOL AGE CHILD
• Ages 6-12 years

• With consistent, steady and
slow rate of physical growth
• Continuous maturation of
fine and gross motor skills

CHARACTERISTICS of a SCHOOL AGE CHILD
WEIGHT
 Annual ave. weight gain is
3-5 lbs.
 Major weight gain :
10-12 years for boys
& 9-12 years for girls

HEIGHT
“GROWTH SPURT”
(before puberty)
 Girls 10-12 years old
 Boys 12-14 years old

MORE MATURE
BODY PROPORTION
 Little head growth
 Trunk growth slows
 Limbs lengthen

COMMON NUTRITION CONCERNS
MALNUTRITION & LEARNING
 Undernutrition- easily fatigued

 Unable to sustain prolonged
physical effort
 Risk for infection school

attendance

UNDERWEIGHTNESS & RETARDED

GROWTH
 Less consumption of nourishing foods
 Incidence of parasitic infections
 Diarrhea- unavailable of potable water

MICRONUTRIENT
MALNUTRITION
 Dietary inadequacies in
minute amounts of key
vitamins and minerals

IRON DEFICIENCY ANEMIA (IDA)
 Lack of iron
Common nutrient deficiency negative

changes in behavior & performance in
OBESITY
Excessive accumulation of depot fat
Psychosocial Difficulties /(-) self image

RISK -Disease
Hypertension
Glucose intolerance
DENTAL CARIES
 Presence of sugar, frequency of

eating & retentiveness of food to
teeth
 Prevention: hard cheese nuts, egg,

sugarless chewing gum

LACTOSE INTOLERANCE
Unable to digest ingested lactose (present

in milk) in the small intestine
Diarrhea
abdominal cramping
flatulence

FOOD ALLERGIES
Specific reactions from abnormal
immunological response to food- severe or
life threatening
shortness of breath
stomach ache
vomiting
swelling of lips, tongue, face

FACTORS WHICH INFLUENCE FOOD INTAKE
FAMILY
 Role model for food acceptance and

feeding behavior that children
imitate

PEERS
 Food attitudes and choices are beginning

to be more influenced by those outside
the home

SCHOOLS
 Play a role in educating the child

on good eating habits
 Incorporate nutrition in subjects

MEDIA
 TV ads influence responsive
children
 Ads on nutrient-poor like
soda, snacks, fast foods,
snacks

CHARACTERISTICS of DIET
• Adequate source of calcium

& iron
• Provide foods to furnish
energy for vigorous activity

CHARACTERISTICS of DIET
• At all times, PARENTS –

encourage child to eat varied
foods :
 Good breakfast
 Nutritious lunch & snacks

FOOD PLAN for 7-9 y/o (1600 Cal)
Food Group Exchanges Amount
Vegetables 1-2 At least 1 serving : ½ cup per serving; green or

yellow
Fruits 2 2 serving ; Vit C rich

Milk 1-2 1-2 servings; ½ cup evaporated milk4 tbps non-fat/
low fat
Rice or Sustitute 8-10 4-5 cups cooked

Meat, Fish, Egg or Sustitute 3-4 3-4 matchbox: liver/organs 1x/week; egg 2x/week ;
½ cup cooked dried beans
Fat 4-6 4-6 teaspoons

Sugar or Sweets 5 5 teaspoons

SIGNS OF GOOD NUTRITION
• Normal weight for height

• Firm and well developed muscles
• Good posture
• Healthy skin
• No lesions
• Smooth and glossy hair
SIGNS OF GOOD NUTRITION
• Clear eyes
• Alert facial expression and good
disposition
• Sound sleep
• Good digestion & elimination
• Good appetite
THANK YOU!

Adolescence is a transition period between childhood and adulthood. The
nutritional needs and concerns of this stage is considered as challenging
which is synonymous of their characteristics.
The following are the characteristics of this stage related to their nutrition
needs ( Jamorabo-Ruiz, Serraon-Claudio, 2010) :
1. accelerated growth and development ;
2. changing lifestyle, food habits and physical activities ;
3. psychological concerns resulting to eating disorders;
4. emotional stress associated with personal and academic responsibilities;
5. health concerns and vices that demands special nutrition such as smoking,
alcoholism and pregnancy.
Lesson 3
Nutrition in Adolescence
NUTRITION in
jcoleman.co.uk

HEIGHT Adolescence/ Puberty Stage
• Girls :
 2-8 inches (ave. 3 inches)
 Full height by onset of
Menarche
• Boys :
 4 – 12 inches
 Continual growth
BONE GROWTH @ Puberty
• Increased muscle
mass
• Increased body fat

GROWTH SPURT @ Puberty
• Girls : 10 to 11 y/o
Linear growth until 19 y/o
• Boys : 12 to 13 y/o
Linear growth until 20

Characteristics @ POST PUBERTY(Postpubescence)
• Average age : 16-18

• Maturation of secondary sex
organ functions
• Cessation of growth for girls

PSYCHOLOGICAL CHANGES
• Emotional, mental & social changes

• Affects total personality & food
habits
• FRAMEWORK : Health
education

PSYCHOLOGICAL CHANGES PREPUBERTY
• First stage 10-12 y/o

• Awareness to peer relationship
• Consciousness: body parts &
body image
• Trust parents & adult

PSYCHOLOGICAL CHANGES Late Adolescence
• Decide for personal & vocational

decisions
• Establish :
 body image & independence
 Intimacy & body image
• Plans for future
NUTRITIONAL NEEDS
Recommended Energy and

Nutrient Intake (RENI)
• Guides for planning meal
to adolescence

NUTRITIONAL NEEDS
CHO- 50 to 60 % of total calorie

10-12 y/o 13-15 y/0 16-18 y/o
Male 2140 kcal 2800 kcal 2840 kcal
Female 1920 kcal 2250 kcal 2050 kcal

NUTRITIONAL NEEDS
CHON
13-15 y/o 16-18 y/o
Male 63-71 grams/days 73 grams/day
Female 63-71 grams/day 59 grams/day

NUTRITIONAL NEEDS
MINERALS
• Ca & Fe – lacking for Fiipino teenagers
Male
Female 10-18 y/o Ca 1000mg/day
Fe 15 mcg

NUTRITIONAL NEEDS
VITAMINS
• Males (16-18 y/o) – increase
needs of Vit. A C & B
• B Vitamins – thiamin, niacin &
riboflavin

WATER (H2O)
12 glasses/day
• Accelerated growth & devt of
body cells
• Increased energy utilization
• Active exercise & sports
FEEDING PROBLEMS
• Evidences :
64.5 % (13-19 y/o)- Normal weight
• 31.2% Underweight
boys 40.3 %
girls 21 %
• 4.3% Overweight
girls 4.5 %
boys 4.2%
Feeding Problems
1. Irregular Meals & Snacking

• Skipping meals
• Late meals in school/work
• Food of choice

Irregular Meals & Snacking
• Health Education
• Guide in time management
• Prepare brown bag / lunch kit
• Teach on proper food choices
• Involve in meal planning
Feeding Problem
2. Establishing body image.

• Anorexia Nervosa
• Bulimia

Feeding Problem

Anorexia Nervosa
• Eating disorder
• Immoderate food restriction
• Irrational fear of gaining weight
• Distorted body image
• High level of GHRELIN in blood
Bulimia
Binge & Purge Cycle

Feeding Problem
3. Food Dislikes & Idiosyncrasies
• Fast food habits as result of
advertisement
• Peer influence

Feeding Problem
4. Influence of Substance abuses
• Characteristics of being
curious & adventurous
• Peer pressures

Challenges in Food & Activity Choices
L ittle knowledge of good nutrition negative
effect of food
O pportunity to be physically active
L ack of food selection & preparation skills
A vailability of low cost high fat high sugar
foods
Challenges in Food & Activity Choices
• Limited access to safe physical activity
options
• Bombardment of advertisement w/
unhealthy foods

Health Education for Adolescence
• Encourage RENI
• Involve in meal planning
• Keep variety of food at home
• Motivate to do regular physical
activity

THANK YOU!

NUTRITION IN EARLY ADULTHOOD

Early Adulthood
 Characterized by exploration and marked by shifts in lifestyle which
may affect meal patterns and eating habits
 Healthful diet is still significant as good nutrition continues to play
key role in supporting the completion of growth and maintaining
physical health
 Food intake during adulthood also impacts risk for future illness and
plays a part in the prevention of excess weight gain
 Research suggests that ease and convenience are highly valued by
young adults and that lack of time can be a common obstacle to
preparation of meals at home (Larson, et al., 2006)
Nutritional Recommendations
 Energy Needs-vary depending on body size and physical activity
Physical Activity Suggested kcal/K DBW
Male Female
 Sedentary 35 30
 Light 40 35
 Moderate 45 40
 Heavy 50
Other Important Guidelines

 Encourage young adults to improve their food preparation skills and regularly prepare meals at
home to enhance nutrient intake
 Eat more vegetables, fruits and root crops
 Consume calcium containing foods every day
 Limit intakes of salty and fatty foods. Use iodized salt instead of plain salt
 Consume recommended amounts of CHO
 Include high fiber foods
 Alcohol should be taken in moderation, about 1-2 drinks/day. 1 drink = 1 (12 oz beer) or 1 small
glass (4 oz) wine or 1 jigger gin
Life Cycle Nutrition:
Middle Adulthood
To maintain health and wellness during the middl- aged
years and beyond, it is important to:
Energy and Macronutrients
Micronutrients
Preventive/Defensive Nutrition
Suggested Diet:
Menopause
Dietary Nourishment Recommendations for Women
Experiencing Menopause:
REFERENCES
http://www.medicinenet.com/script/main/art.asp?articlekey=598
95
http://www.webmd.com/menopause/guide/staying-healthy-
through-good-nuitrition
THANK YOU!
The period of senescence or old age is characterized by
physiologic changes that has a negative effect on nutritional
status. Proper nutrition is of great important to the health of the
older person and on their ability to recover from illness.
The following are the characteristics of the senescence that
resulted to disturbed regulatory and functional mechanism of
the body :
1.Gastrointestinal - decreased taste thresholds, decreased
motility, diminished secretion of digestive, increase in gastric
pH, decreased number of absorbing cells that resulted to
constipation and poor nutrient absorption.
2. Circulatory - decreased myocardial ability to use oxygen,
loss elasticity of blood vessels, slow rate of blood flow in
the major organs of the body.
3. Excretory- diminished amount of functioning nephrons
and slow secretion of expected amount of waste results in
reduction in glomerular filtration rate and increase blood
urea nitrogen.
4. Endocrine- reduced sensitivity to insulin release, decrease
production of estrogen and testosterone, thyroxin and
pituitary hormones result in decreased cellular metabolism
and ability to withstand stress.
5. Nervous- diminished conductance of the nerve impulse and
decreases sensory sensitivity result in slow reflex reactions.
6. Respiratory - loss of pulmonary functional tissues and
weakening of respiratory muscles and decreased maximum
breathing capacity.
7. Musculo-skeletal- decreased in number and bulk of muscle
fibers, increased proportion of lime to water resulting to
brittle bone, decrease in muscular strength, stooped posture
and stiffened joints.
Lesson 3
Nutrition in Older
Person
Nutrition of the
cyprushealthyliving.com

Health Education

Nutrition for the Older Person
Gerontology – phenomena of aging
Geriatrics – treatment of
accompanying diseases of older
person

Nutrition for the Older Person
Elderly/Senior citizen - person

belongs to this age
Senile- clinically associated w/
mental & physical weakness

Effects of Aging on Nutrition
CHANGE EFFECT
Sensory Impairment
Decreased sense of Reduced appetite
taste
Decrease sense of Reduced appetite
smell
Loss of vision & Decreased ability to prepare
hearing food
Oral health/Dental Difficulty chewing, inflammation
problem

Effects of Aging on Nutrition
CHANGE EFFECT
Altered energy need Diet lacking in essential
nutrients
Decreased physical Progressive depletion of
activity lean body mass
Loss of appetite
Muscle loss Decrease functional
( Sarcopenia) ability- ADLs
Psychosocial Decreased appetite
( isolation)
Environmental Limited access to food
(financial) Poor quality diet

Nutrition in Practice

Helping People with
Disabilities

Intervention for Feeding Related Problems
Inability to suck :
• Use squeeze bottle – express liquids into the mouth
• Place spoon on center of the tongue & apply pressure
to stimulate sucking
• Apply rhythmic slow strokes on tongue-alter tongue
position & improve sucking

Inability to Chew
• Place foods between gums & teeth.
• Improve chewing skills w/ different textured

foods
EX.: fruit leathers
stimulate jaws
• Foods require
• minimal chewing.

Inability to Swallow
• Provide thickened liquids, pureed foods &
moist foods.
• Serve frozen fruit juice bars & ice cold
• Make sure patient’s jaw & lips close to
facilitate swallowing action
• Correct posture & head position if interfere
w/ swallowing
Inability grasp or coordinate movements
• Provide utensils w/ modified handles.

• Encourage use of hands for feeding
• Use plates w/ food guards to prevent
spilling

Impaired vision
• Place foods on similar
locations on the pate at
meals.
• Provide plates w/ food
guards to prevent spilling

REFERENCES
Cruz-Caudal, ML. 2019.Basic Nutrition and Diet Theraphy 2nd Edition.

C & E Publishing, Manila, Philippines
Jamorabo-Ruiz, A., Serraon-Claudio, V.2010. Basic Nutrition for Filipinos.

Merriam & Webster Bookstore, Inc, manila, Philippines

THANK YOU!

Fibers in foods can be met through consumption of which of the following?
WHOLE GRAINS&LEGUMES
Monica is 32 years old, she works in an advertising office, and does not usually exercise.
Today she ate 6 servings from the bread group, 2 servings from the vegetable group, 2
servings from the fruit group, 2 servings from the milk group, 2 servings from the meat group.
Monica did not eat enough of servings of what group? VEGETABLE GROUP
The expected weigh gain in pregnant mother is: 25 OR 28

In lacto-vegetarian diets includes the following except: EGG
Recommended daily servings for teen boys as compared with teen girls: LARGER FOR
MOST FOOD GROUPS
The major problem with fast food chain services for adolescents is that these
are: OFTEN IN HIGH FAT AND ENERGY CONTENT
Karen had underwent surgery, her doctor advised her to have a diet that offers both
clear & opaque liquids foods & some semi-liquids at body temperature. As a nurse,
you know that this diet is which of the following? FULL LIQUID DIET
This is a kind of Diet where the food and nutrients are delivered via the tube directly into the
GIT. ENTERAL NUTRITION
Diet will make stool less bulky & less frequent; it also decreases the rate at which stool passes
through the body. SOFT DIET
This kind of diet Provides extra kilocalories above the normal prescribed level for an
individual. HIGH CALORIE DIET
These sample food are under which type of diet; cereal, ensaymada and porridge. SOFT DIET
Which of the following strategies may help promote an adequate oral intake in hospitalized
patients? OFFER STANDBY ALTERNATIVES MENU IN DIET WHEN THE PATIENT
The after the patient's surgery nurse explains that "Thin liquids are the most difficult
consistency to control for people who have swallowing difficulties. Thickened liquids have a
more cohesive consistency that is easier to manage." As a student nurse you know that the
nurse's health teaching is INCORRECT, THIN LIQUIDS ARE EASIER TO SWALLOW
Which statement indicates the patient understands nutrition recommendations regarding

carbohydrate intake? IT IS IMPORTANT TO CONSUME THE CORRECT AMOUNT OF
CARBS
When developing a teaching plan for a client on a low-sodium diet, which of the following
foods would the nurse advise the client to limit? PROCESSED CHEESE
Mathew pass out watery stool for 6X since early AM. He complaint of abdominal cramping. Based on history
taking, he ate at the fast food near the school a day before the onset of this medical condition. Which of the
following foods can worsen Matthew's diarrhea ? ALL CHOICES EXCEPT APPLE
Matthew takes medications which prompted him not to have an alternate diarrhea &
constipation for the past 2 days. Which of the following intervention/s can best be
given to him ? ALL THE CHOICES
Mariz was advised to have fibers on her diet. Which of the following process should be
considered to avoid the side effects in giving fibers ? ADDED GRADUALLY
Fibers in foods can be met through consumption of which of the following? WHOLE
GRAINS&LEGUMES
Mr. X, 60 y/o, client from Brgy. Sipat. He was diagnosed of Type 2 Diabetes mellitus. The glucose in the blood during the
pathophysiological occurrence in diabetes exceeds the renal threshold. This may result to excessive loss of fluid & electrolytes
w/c is associated w/ diuresis. Related to this, which of the following clinical manifestation does Mr. X experiences ?
POLYURIA
In diabetes, there is an insulin deficiency & breakdown of protein & fats. This may
lead to which of the clinical manifestation does Mr. X experiences? MUSCLE
WASTING
Mr. X verbalizes that he always ask a glass of water to drink . This is due to excess
of fluid associated w/ osmotic diuresis. This may lead to which of the clinical
manifestation that Mr. X experiences? POLYDIPSIA
The goal of nutrition therapy for Mr. X pertains to which of the following, EXCEPT:
INCREASE
Eating disorder among adolescence is psychological in nature

TRUE
Diet Therapy

MSN
Before we start let’s talk about Normal Diet…..
What is Normal Diet?

- This is the basis of all modifications of diets for age
and sickness.
- It is planned according to the recommended daily
dietary intakes which is designed to meet the
needs of all healthy persons and may not meet the
needs of sick person.
Why do we modify NORMALS DIET?
1. Provide change in consistency (eg. Fluid, soft

etc.
2. Provide foods bland (no/ minimlal taste) in
flavour
3. Change the interval of feeding
4. Increase or decrease energy content
5. Increase or decrease other nutrients e.g nutrients
6. Increase or decrease fibre
Standar
d
Hospital
Diets
Standard Hospital Diets:
A. Regular Diet
B. Liquid Diet
C. Soft Diet
D. Mechanically soft
E. Bland Diet
A. REGULAR DIET
- Must be the basis for all modified diets.
- Allows all types of food that will
promote health & lower risk of

developing major, / diet
related
chronic diseases.
When to use?
- clients health & medical
when
condition does not require any
restriction
A. REGULAR
Guidelines: DIET
- Use Food Guide Pyramid
- Buy foods that are available,
cheap & in season
- Include at least 2- 3 servings of
vegetables & fruits daily
- Include lean meat, chicken
without skin, fish, seafood &
dried beans
A. REGULAR DIET
B. CLEAR
- Temporary LIQUID
diet containing
that are clear & liquid
DIET
food & liquids
- Designed to provide adequate amount of

fluid & electrolytes
- Minimizes stimulation of the GIT
When to use?
- as initial feeding progression (bet. IVF
& full diet)
- Pre diet for surgery to
reduce fecal matter
B. CLEAR LIQUID DIET
Guidelines:
- All fruits juicesshould be clear &
strained
- Choose only those clear & liquid that re
within body temperature
C.
- LimitsSOFT DIET
food items
swallow
that are hard to chew &
- Moderately low in cellulose

(indigestible carbohydrates) &
connective tissues
- Restricted fried foods
When to use?
- transition from diet liquid
from regular diet to
- for extremely weak client
C. SOFT
Guidelines: DIET
- NO fried, greasy, raw fruits, raw
vegetables, chewy, coarse, cereals &
highly seasoned food
- Allowed: All types of milk
- Allowed: Moist tender meats, fish,
chicken & organ meats
D. MECHANICALLY
- Similar to soft diet but can have friedSOFT
soft DIET
foods, seasonings, spices & fibrous food.
When to use?
- For clients with chewing/ swallowing
problems
- Dysphagia, cancer, congenital defects
in oral cavity, Guillain Barre Syndrome,
Myasthenia Gravis & Stroke.
D. MECHANICALLY SOFT DIET
Guidelines:
- All foods in regular diet can be
consumed except for items that cannot
be tolerated
- Allowed: All dairy products, smooth
yogurts, pudding & custards
- Allowed: Soft rolls, breads
- Fruits & vegetables may be pureed or
cooked soft
E. is BLAND
- This DIET
diet usually soft in texture, low in
fiber and had no to mildly seasoned
food.
When to use?
- For clients with nausea and vomiting.
- Ulcers, GERD, heartburn or after
stomach surgery.
E. BLAND DIET
Guidelines:
- Allowed: Milk & dairy products, low fat
or fat free only
- Allowed: breads, no salt crackers,
eggs, tofu, steamed
chicken, fish, steamed
AVOID:
- Avoid dairy products, raw vegetables,
salads, whole grain cereals, pickles,
anything spicy and highly seasoned food.
https://slideplayer.com/slide/10158588/
According to Center of Disease Control & Prevention (CDC), the term Medical
Nutrition Therapy or MNT is a key component of diabetes education and management. The
organization defined MNT as a “nutrition-based treatment provided by a registered dietitian
nutritionist.” It includes “a nutrition diagnosis as well as therapeutic and counseling
services to help manage diabetes.”
CDC stated that Medical Nutrition Therapy must be provided by a registered
dietitian to the client. MNT are described by the organization as:
Is an intensive, focused, and comprehensive nutrition therapy service.
Involves in-depth individualized nutrition assessment.
Relies heavily on follow-up to provide repeated reinforcement to aid with behavior change.
Establishes goals, a care plan, and interventions.
Plans for follow-up over multiple visits to assist with behavioral and lifestyle changes
relative to each individual’s nutrition problems and medical condition or disease(s)
All Therapeutic Diets are modifications of the normal diet
made in order to meet the altered needs resulting from
disease. (Mudambi, S., & Rajagopal, M.V., 2007). Previously
you learned about normal diet are composed of five basic
food groups and is planned to meet the recommended dietary
allowances (RDA)
As nurses we have to understand that Therapeutic Diet
is planned to meet or exceed the dietary allowances of a
normal person as the aim of Diet Therapy is to maintain
health and help the patient to regain nutritional wellbeing.
(Mudambi, S., & Rajagopal, M.V., 2007).
Diet Therapy

MSN
Fat- Controlled, Mineral
Modified Diet for
Cardiovascular Diseases
**no copyright infringement is intended
Cardio Vascular Disease
Disease of the heart & vessels
Most common – Coronary Heart Disease

(CHD)
Cause of CHD – Atherosclerosis

Atherosclerosis
Restrict Blood flow in Arteries
Deprivation of Oxygen & Nutrients
Destroy of Heart tissue
Myocardial infarction (MI)
Heart Attack
Atherosclerosis

Therapeutic Lifestyle Changes
1.DIET
Limit saturated fats to 7% kcal
Cholesterol to less 200 mg/day
Maintain : 25-30% kcal
Replace Saturated fats w/
CHO
 (grains, legumes, vegs &
fruits)
Unsaturated fats- fish,
vegetable oil, nuts

CVD DIET STRATEGIES
Avoid trans-fat in processed foods
Soluble fibers- oat, barley, beans &
fruits
Psyllium seed husk as food
supplements
Regularly- food w/ plant
sterols
FISH- CHD risk reduction
diet
CVD DIET STRATEGIES
Reduce BP
fruits, vegetables, low fat milk,
nuts, & whole grains
Alcohol
1 drink for women & 2 drinks for
men daily
2. Physical Activity
30 minutes moderate intensity

endurance activity
2,000 kcalories expenditure
Smoking cessation
3. Weight Reduction
Goal : prevent weight gain, reduce body

weight, maintain lower body weight
Weight loss : 10 % of original body

weight
Hyperlipidemia
Increased level of cholesterol &
triglycerides
Development of atherosclerosis
Therapeutic Lifestyle Change (TLC) Diet
Cholesterol &
Saturated Fat-
Restricted
Diet

Dietary Guidelines
Reduce weight ( if over & obese)
Balance energy intake &
expenditure
Dietary cholesterol restricted to
200 mg/less per day
Saturated fat, less than 7% of total
Cal
Dietary Guidelines
Total fat
- 25 to 35 % of total Cal
CHON
- 50 to 60 % total Cal
Dietary fiber
- 20 to 30 g/day
Protein
- 15 % total Cal
Dietary Guidelines
Total fat
- 25 to 35 % of total Cal
CHON
- 50 to 60 % total Cal
Dietary fiber
- 20 to 30 g/day
Protein
- 15 % total Cal
Trans Fatty Acid
Hardened fats
Sources :
1.Food prepared w/ partially
hydrogenated vegetable oil ( cookies,
crackers, snack cakes)
2. Commercially prepared fired foods
such breaded meat, doughnut
Trans Fatty Acid
Sources :
3. Some margarines
4. Fried food served in restaurants &

fast food such as French fries,
chicken nuggets, fish patties, fried
pies
Food Plan for 1800
Food group Amount
Cal 5 servings; 2 should be leafy & yellow
Vegetable 3 exchanges; 1 should be vit C ric
s Fruits 1 exchange
Milk; Non-
fat 5 exchanges ; 2 from Fish; Lean meat
1x/week; use chicken breast, tofu & gluten
Meat or Fish exchange more often
Low fat group ( Nut, 1 exchange ; egg 1-2x/week
Seeds, Legumes)
Medium Fat group 9 exchanges
3 exchanges
Fats
PUFA(corn oil, soy 5Exchanges
bean oil)
MUFA (Olive oil, 1 exchanges
canola
, avocado oil)
Medium chain fatty 1 teaspoon
acid ( coconut oil)
240 mg
Meal Pattern & Menu Plan
BREAKFAST Sample Menu
Fresh fruit /dessert Fresh fruit, 1 pc
Meat, egg, substitute Banana heart burger, 1 pc w/ lettuce
& tomato
Rice, cereal, bread Wheat bread, 2 slices
Rolled oats, 1 cup
Hot beverage Non-fat milk, 2 tbsp
Sugar, 1 tsp
LUNCH
Soup Chicken veggie soup
Meat, fish, poultry, substi Stir-fried Fish & tofu, 1 cup
Vegetable Fresh veggie salad, 1 cup w/ vinegar
dressing
Rice or substi 1 cup
Fruit or dessert fresh fruit, 1 pc

Meal Pattern & Menu Plan
SUPPER Sample Menu
Soup Mungo Bean soup w/ malunggay
Meat, Fish, Poultry, substi Baked chicken breast, 1 slice
Vegetable Stir-fried mixed vegetable, 1 cup
Rice or substitute Rice, 1 cup
Fruit or dessert Fresh fruit, 1 pc
SNACKS Sample Menu

AM : Boiled corn, 1 pc
Gulaman juice, 1 glass
PM : Oatmeal cookies, 4 pcs
camote tops juice, 1 glass
Diet for Renal Disease

Diet Description
 Adjustment in the intake of :
Protein
Potassium
Phosphorus
Sodium
Calcium
Adequate
intake :
AMINO Acid
Urolithiasis (Calcium Oxalate Stone)
Inadequate fluid intake
Highly acidic / highly alkaline urine
Super saturation of minerals &

acid salt
( calcium & uric
acid)
Form solidCrystallize
mass Kidney stones
Diet for Urolithiasis
(Calcium Oxalate Stone)
Calcium Controlled Diet

Diet for Urolithiasis (Calcium Oxalate
Stone)
Limit intake of milk and foods
containing large amount of milk
Sufficient fluid intake to maintain

urine volume of 2500 ml/ 24 hors
Food Plan for 1800 Cal
Food Group Exchange Amount
Vegetables 4 At least 3 servings: ½ cup per
serving: 1 should be leafy green or
yellow
Fruits 5 5 servings: 1 should be vit C rich
Rice or substi 9 4 ½ cup cooked
Meat, fish, egg, 5½ 5 ½ matchbox size : liver/ glandular
substi organ 1x/week: egg 2x/week: ½ cup
cooked dried beans in pce of 1 meat
& fish exchange
Fat 6 1/2 6 ½ teaspoons
Sugar or sweets 6 teaspoons
Food Plan for 1800 Cal
BREAKFAST SAMPLE MENU
Fruit or juice Fresh fruit in season
Egg or substitute Pouched egg
Rice/ bread w/ butter/ Buttered toast & oats
margarine/jam
Hot beverage Hot tea
LUNCH SAMPLE MENU
Meat, fish. Poultry, substi Chicken tinola w/ sayote

Rice or substi Rice
Fruit or dessert fresh fruit in season
Suggested Meal Pattern & Meal Plan
SUPPER SAMPLE MENU
Meat, fish, poultry, substi Fish steak

Vegetable Lumpia ubod
Rice or substitute Rice
Fruit or dessert Fresh fruit in season
SNACKS SAMPLE MENU
AM : Nilagang saging na saba

Soya milk
PM : Sapin-sapin
Fruit aide
Cancer
- Characterized by the uncontrolled growth and
spread of abnormal cells which continue to
reproduce forming a mass of tissue known as tumor.
- A malignant tumor interrupts body functions and takes away

the food and blood supply from normal cells.
Common Dietary Problem and Solutions
Fatigue
Prepare easy meals such as
scrambled eggs, toast and
canned fruit
Eat a good breakfast
Use frozen or canned foods
Drink commercial liquid
supplements or milkshakes

Altered Taste
Try lemon juice or vinegar on
vegetables
Emphasize cold foods such
as ice cream
Keep cans of fruits in the
refrigerator
Experiment with spices and
marinades for meat
Add bacon bits to flavor

No Appetite
Include snacks; emphasize

small frequent meals
Include high calorie drinks
like milkshakes
Keep sugar based candy at
bedside (brush teeth first,
rinse mouth with water
regularly)
Nausea and Vomiting
Use antiemetic medications
before meals (at least 30
minutes before eating)
Avoid fatty foods
Avoid concentrated sweets;
salty foods may be better
tolerated
Sip liquid slowly
Avoid reclining directly after
meals; use propped pillows in
bed
Avoid food with strong odor
Stomatitis or Esophagitis
Eat soft foods
Add gravy, butter, or sauces to dry
foods
Avoid very salty, spiced or acidic
foods
Use a straw for beverages
Have a health care provider
prescribe artificial saliva

Diet Therapy

MSN
Therapeuti
c Diets
FIBER INTAKE
Consumption of
whole grains,
legumes, nuts and
seeds , fruits &
vegetables

SOLUBLE FIBER INSOLUBLE FIBER
Viscous fibers • Increase the fecal

Slow passage of weight & spread the
food through the GI passage of wastes
tract through the large
intestines
Increase satiety &
delays glucose
absorption
Soluble Fiber
Lowers blood cholesterol levels
Fibers bind & reduce

re-absorption of bile acids
Increased Intestinal Gas
(FLATULENCE)
Side effects of consuming high fiber diet
Undigested fiber pass into the colon
Fermented by bacteria
Produce GAS as by-product

Intervention: FLATULENCE
Fiber-containing food
that cause intestinal
gas – added gradually
& portion increased
as tolerance
improves

Foods that Increased Intestinal Gas
Apples Cabbage Dried beans and

peas
Beer Carbonated Fruit juices
Beverages
Brocolli Cauliflower Leeks
Brussels sprouts Corn Milk Products (if
lactose intolerant)
Onions Peanuts Pears
Potatoes Turnips
Disorders of Bowel Function
Constipation
Diarrhea
Irritable Bowel
Syndrome

Constipation
Difficulty of
passing stools
Infrequent bowel
movements
(fewer than 3
/week)
Common side
effects of
medications

Constipation: Diet Therapy
Gradual increase in fiber intake

High fiber : increase stool
weight & promote more rapid
transit of materials through the
colon
Diarrhea
Passage of
frequent watery
stools
Complications of
various medical
problems
Severe/persistent
diarrhea can
cause dehydration
& electrolyte
imbalance

Diarrhea: Diet Therapy
Treatment depends on
cause, severity & duration
Rehydration therapy
Low fiber may improve
symptoms
Fiber restriction during active
intestinal inflammation
Foods that worsen Diarrhea (Source:
American Dietetic Association)
Apple juice Grapes

Caffeine containing Honey
beverages
Coffee Milk & milk products
Dates Pear juice

Fried Foods Prune juice
Fructose-sweetened drinks Sugar free candies
Foods that worsen Diarrhea (Source:
American Dietetic Association)
Apple sauce Peanut butter

(smooth)
Bananas Potatoes
Barley Rice (boiled)
Cheese Soda crackers
Oat bran Tapioca
Oatmeal Yogurt
Irritable Bowel Syndrome
Chronic & recurring

intestinal
symptoms
Associated w/ abdominal
pain & alternating
diarrhea & constipation

Irritable Bowel Syndrome: Diet Therapy
Increase fiber diet to reduce

constipation
Fiber containing foods should be
added gradually to minimize intestinal
gas
Avoidance of milk products (lactose
intolerance)
Avoid caffeine & alcohol
High Fiber Diet Menu
BREAKFAST:
1 c multigrain cereal
½ strawberries
1 c fat free milk
2 slices whole wheat toast
2 tbs peanut butter
1 c coffee
LUNCH:
1 c black bean soup

3 oz broiled chicken
½ c steamed broccoli
½ baked sweet potatoes
1 fresh pear
1 whole wheat dinner roll
1 tsp margarine
DINNER: SNACK:
3 oz steamed fish 3 c popcorn

½ c brown rice 1 c pineapple
½ c peas juice
1 whole wheat dinner roll
2 tsp margarine
1 piece carrot cake
1 c. fat-free milk
Diabetes Mellitus
CHO Controlled
Diet
Prevalence of Diabetes in the
Philippines
Diabetes is the 6th leading cause of
deathamong Filipinos based on the
data from 2013 Philippine Health
Statistics
”Diabetes keeps on increasing in prevalence, but
we shouldn’t give up the fight against the disease.
It may be chronic and incurable, but diabetes can
be managed. We need to strengthen multi-
stakeholder collaboration in increasing awareness
of this disease and for people to follow a healthy
lifestyle,” Health Secretary Francisco Duque III
emphasized.
Clinical Manifestations

Management
Diet
Insulin
Exercise
Nutrition therapy for DM
Goals :
Maintain near blood glucose level

Normalize serum lipoprotein levels & BP
Allow & maintain reasonable body weight
Promote over-all health
Nutrition Therapy:
Nutrient
Recommendations
TOTAL CHO INTAKE:
More grams of CHO intake- the

greater glycemic response
Basis for CHO recommendations :

type of DM, degree of glucose
tolerance, individual preferences
Nutrition Therapy:
Nutrient
Recommendations
CHO Sources :
High fiber whole grains product than
high processed starchy foods
FIBER :
Fiber -rich such as legumes cereals,
fruits & vegetables
Very high intake of fiber (50 grams or
more)
Nutrition Therapy:
Nutrient
Recommendations
SUGARS:
Table sugar (sucrose)- from glucose &

fructose lower glycemic effect
Artificial sweeteners ( aspartame, saccharin)
safe to use, no digestible CHO
* sugar & sugary foods – counted as part of

CHO allowance
Nutrition Therapy:
Nutrient
Recommendations
DIETARY FIBER :
Diabetic high risk of CVD

Saturated fat intake limit to less
than 7 % of total kcal
Trans fat minimize
Cholesterol limited to 200 mg
daily
Nutrition Therapy:
Nutrient
Recommendations
CHON
Intake ranges from 15 to 20 % of total

kcal
No more than 0.8g/kg body weight =
w/ nephropathy
High protein – detrimental to kidney
function
Nutrition Therapy:
Nutrient
Fat Recommendations
Saturated fat < 7 % of daily

calories
Intake of trans fat should be
minimized
Nutrition Therapy:
Nutrient
Recommendations
Cholesterol : < 200 mg/day
Fiber
25-35 g/day (14 g per 1000kcal)
Sodium
<2300 mg/day for HPN &
normotensive
Nutrition Therapy:
Nutrient
Recommendations
Vitamins & Minerals
Same as gen. population

Chromium & Vit E and C -
recommended

Nutrition Therapy:
Nutrient
Recommendations
ALCOHOL Use in Diabetes :
Daily limit for women – 1 serving &

2 drinks for men
 Alcohol cause
hypoglycemia- interfere w/
liver production
Excessive alcohol – cause
hyperglycemia
FOOD PLAN FOR1,800 Cal
Food Group Exchange Amount

Vegetables 4 At least 3 servings: ½ cup cooked per
serving 1 serving green leafy /yellow
Fruits 3 3 servings; 1 shld vit C rich
Milk 1 1 serving : ½ cup evaporated milkor 4

tbsp non-fat/low-fat
Rice /substi 10 5 cups cooked rice

Meat, Fish, 4 4 matchbox sizes; liver/glandular organ
1x/wk; egg 2x/wk; ½ cup cooked dried
egg or substi
beans in place of 1 meat & fish exchange
5½ 5 ½ teaspoon
Fat -
-
Sugars or
sweets
Suggested Meal Pattern
& Menu for DM
Fresh fruit / fruit juice Meat, fish, poultry/ substi Rice /
BREAKFAST
bread/ butter/margarine/jam SAMPLE MENU
Hot beverage
LUNCH Papaya
Fried daing na bangus
Soup
Meat, fish, poultry,substi Vegetable Boiled rice
Rice substi Fruit or dessert Coffee or tea
SAMPLE
MENU
Vegetable soup
Chicken curry
Cabbage-carrot guisado
Rice
Fresh fruit in season
Suggested Meal Pattern
& Menu for DM
SUPPER SAMPLE MENU
Meat, Fish, Poultry, substi Lean Pork sinigang

Vegetable Kangkong, sitaw, radish
Rice or substi
Rice
Fruit or dessert
Fresh fruit in season
SNACKS
SAMPLE MENU
AM : Ensaymada, plain
Low fat milk
PM : Arroz caldo w/
boiled egg
The recommended increase in the nutritional requirement during
pregnancy is due to craving during conception.

True
An increase of 300 kcal/day is recommended in 2nd and
3rd trimester- true
Iron deficiency anemia is the most widespread nutritional in the

Philippines-true
Growth spurt among girls at school age occurs between 12-14

years’ old- false
What is the annual average weight gain for school age child?-3/5lbs
Based on the nutritional needs of adolescent, what is the percentage of the

CHO in the total caloric requirement- 50/60%
Based on the nutritional needs of adolescent ages 13-15 y/0, what is the
percentage of the CHON in the total caloric requirement- 63/71%
This are the common mineral that are lacking among Filipino teenagers:- CA&FE
Dental problem- DIFF CHEWING
DECREASED SENSE OF SMELL- REDUCED APPETITE
LOSS OF VISION- DECREASED ABILIT TO PERFORM
DECREASED SENSE OF TASTE- REDUCED APPETITE
DECREASED PHYSICAL ACTIVITY- LOSS OF APPETITE
PSYCHOSOCIAL ISOLATION- REDUCED APPETITE
FINANCIAL CONCERN- LIMITED ACCESS TO FOOD

Enteral Nutrition (EN)
Routes of Tube Feeding (TF)
1. Naso-gastric tube (NGT)- Enters the nostril and ends in the
stomach for digestion of nutrients. It is used for short-term feeding
within 3 to 6 months.
2. Percutaneous endoscopic gastrostomy (PEG)- Inserted into a
stoma through the abdominal wall and ends in the stomach. It is
used for long-term feeding in 6 months to a year.
Routes of TF
3. Gastrostomy (GT)- It is more stable than PEG.
4. Jejunostomy (JT)- Inserted through a stoma and ends in the
jejunum for absorption of nutrients. It is indicated when there is an
impaired digestion in the stomach.
Administration of Feeding
1. Continuous-Infused every hour by via enteral pump
(VEP). It is recommended for critically-ill patients, and
those with delayed gastric emptying.
2. Intermittent- Given every 4-6 hours interval, and may
run for 1-2 hours VEP. It allows bowel rest in between
feedings. It is indicated for those who are noncritically ill.
3. Bolus- Large volume is fed using a syringe or vial in a
short time. It is used for home feeding.
Types of Tube Feeding
1. Home brew-Blenderized natural foods with amounts as specified by a dietitian. The relative or
caregiver is instructed on how to prepare the feeding at home to prevent spoilage.
2. Commercial formula
a. Polymeric- Standard formula with intact nutrients that are digested in the stomach. It is used
for NGT, PEG or GT feeding.
Example: Ensure, Nutren
b. Hydrolyzed- Predigested formula with broken down nutrients ready for absorption in the
small intestine. It is recommended for feeding via JT.
Example: Peptamen, Alitraq
2. Commercial formula
c. Disease-specific- It is indicated for disease conditions like cardiovascular disease (CVD),
diabetes, renal disorder and cancer.
Example: Glucerna, Novasource, Prosure
d. Modular- It adds calories and specific nutrients to the other types of commercial feeding.
Example: Beneprotein, Juvenaid
Feeding Volume, Flushing and Schedule
1. Feeding Volume- It is the amount of feeding to be given to the patient at a specified time.
Volume= Calories ÷ Dilution ÷
Number of equal feedings (EF)
Example: TF 1500 cal 1:1 in 6 EF
TF 1500 cal ÷ 1 ÷ 6 EF= 250 ml every 4 hours
Note: May round off volume to + 5ml for easier preparation of feeding.

Feeding Flushing
It is estimated to be about 20% of the total volume of feeding. It may vary depending on the total fluid requirement (TFR) ordere
by the doctor. It may be given after feeding, or before and after each feeding. Free water (FW) or plain non-saline solution (PNSS
may be used.
Feeding Flushing
Flushing= Calories ÷ Dilution x 0.20 ÷ Number of EF
Example: TF 1500 cal ÷ 1 x 0.20 ÷ 6
EF= 50 ml FW after feeding

Feeding Schedule
It depends on the time feeding was started, and number of feedings.
Example: TF 1500 cal 1:1 in 6 EF, started at 8AM
Schedule: 8AM- 12NN- 4PM- 8PM12MN- 4AM
Probiotic
It may be added to the flushing to maintain gut function. It works for both cases of diarrhea and constipation. Available products
are liquid or powder, and contain different types and number of strains of good bacteria. Examples are Erceflora and Bioflora.
Nutrition in Adolescence
Nutrition in the Life Stages

School of Nutrition and Hospitality Management
277
Teenagers in the 80’s
Teenagers in the 21st’s

Adolescents with special needs
279
Pregnant adolescent
• Pregnant during adolescence demands increased nutrient needs from both the pregnancy state, as well
as for her growth and development.
• If the adolescent has been undernourished and anemic before conception, her nutritional needs are
even greater.
Adolescent athlete
These include the kind, length of time or duration of the
activity, intensity and frequency of performing a specific
activity.
The adolescent athlete is particularly vulnerable to food fad
and myths that would enhance performance.
Inappropriate use of nutritional supplements and other
“ergogenic aids” will do more harm than good.
Substance abuse
• Addiction to street drugs, alcoholic drinks and tobacco is a current major health problem worldwide.
• The effects of these substances to the nutritional status of an individual depend on the kind, dose or
concentration, frequency of use, duration of habitual use and general state of health.
• It causes loss of appetite.
• Many adults have started their addiction problem when they were young teenagers.
Substance use and possibly abuse (alcohol, drugs,
cigarettes)
These substances affect the way nutrients are used up by the body.
Smoking is related to diseases like cancer, hypertension, and heart disease. It directly harms the lungs.
Smoking reduces the feeling of hunger. It increases the risk of undernutrition and also increases the need for
Vitamin C.
283
Substance use and possibly abuse (alcohol, drugs,
cigarettes)
Alcohol and use of drugs may cause malnutrition, especially when these are used in place of meals. Not only do
these cause malnutrition, they can also cause permanent harm to the body and may even cause death.
284
Acne
• The occurrence of acne is considered part of a normal development during adolescence.
• It is initiated by the influence of testosterone on the sebaceous (oil) glands of the skin.
• Other factors that contribute to the appearance of acne are: stress, composition of the skin tissues, and
stage of menstrual cycle.
Skipping meals
Similar to school children, teenagers skipped breakfast due to several reasons such as:
1. waking up late and would just wait for mid-morning snack or lunch time to eat
2. lack of appetite
3. choosing sleeping over eating
4. spending more time on personal appearance
5. not wanting to eat alone
6. beliefs such as not eating breakfast would make them thin
7. no one prepares breakfast at home
8. too tired to eat their breakfast
286
Poor food choices
The following are observed from teenagers:
1. buying food which is high in fat, sugar or salt
2. fear of gaining weight
3. fear of eating certain food because it might cause pimples
4. belief that eating a packed lunch is “baduy”
5. giving less importance to food, e.g., using allowance to buy other things such as cell phone load
6. trying to finish eating fast enough so as not to be late for class
287
Poor snacking behavior
Some examples of these behavior are as follows:
1. buying from fast food outlets food which are high in fat, sugar and salt
2. buying street foods such as kwek-kwek and fish balls
3. choosing soft drinks, chips, and sweets over nutritious snacks
288
Practice of fad diets
Fad diets are popular ways of eating adopted by teenagers.
Fad diets are common among teenagers because they like adventure and try new things.
Girls would try diets that help them lose weight fast because they do not want to be fat. Boys would try diets
that would make their muscles grow bigger and stronger.
Fad diets are not recommended because these are not considered healthy. Wrong information and beliefs on
food will influence the adolescents to make the wrong choices.
289
Practice of fad diets
Fad diets can result to “yo-yo” effect of dieting or “mabilis na pagbabago-bago ng timbang”.
Irregular meals are eaten or fasting is done to lose weight. Instead of the usual rice and viand (ulam), teenagers
eat biscuits and drink water.
Without the right kind and amount of nutrients, the adolescent will become thin and sickly. This does not work
for a long time. Hunger will cause them to eat again and gain weight.
The weight gain will push the adolescent to go on a diet again.
290
Adolescent nutrition
291
Energy
• Actual needs for adolescents vary with physical activity and stage of maturation.
• The RDAs for energy do not include a safety for increased energy needs, such as illness, trauma and stress,
and are considered to be only average needs.
• Relating energy needs to height is the preferred index for determining calorie needs.
Energy
Energy (calories) is needed to sustain rapid growth and development.
There should be a balance in food intake and physical activity. Otherwise, adolescents might be at risk to
overweight, obesity, or undernutrition.
293
Can be as high as 4000 calories in males related to lean body mass and activity level.
Much lower in females compared to males due to size differences, higher body fat and decreased physical
activity.
Protein
• Protein needs like energy, correlate more closely with the growth pattern than with
chronological age.
• The period of accelerated growth and development and when growth spurt occurs,
vary among males and females.
• Protein allowances for females and males within 13-15 years of age are 56 grams
and 60 grams/day, respectively.
• In late adolescence, males 16-19 age group needs more protein (69g/day) while it
remains the same (56 g/day) for the females.
• Protein supplies about 15 to 20 percent of total calories/day.
Minerals
A 15-year old female, with normal monthly menses loses about
175 mgs iron for the year.
Iron is needed to produce blood and build muscles during growt
and development. The weight gain and onset of menstruation in
girls require more iron in the body.
Iron needs increase – females start menstruating and lose iron
while males increase lean body mass.
Minerals
Calcium needs increase – for proper bone development.
Calcium should also be emphasized for building peak bone mass.

Minerals
Calcium needs for both males and females from ages 10 to 19 years remain the same; 700 mg/day.
Calcium must be provided in the diet because 45% of the bone mass is formed during this stage. When the
bone tissues of the skeleton have fully matured, peak bone mass is achieved.

All the calcium for the growth of the skeleton must be taken from the diet. It must be noted that the diet must
provide enough calcium to help attain good peak bone mass. Aside from calcium, other vitamins and minerals
such as Vitamin D, phosphorus, and magnesium will help build strong bones.
298
Minerals
Zinc is known to be essential for growth and sexual maturation during puberty. It also helps bone formation and
prevents bone loss.
Iodine is important during adolescence because of growth spurt and increased iodine requirements during
pregnancy.
299
Vitamins
• The needs for thiamin, niacin and riboflavin correlate with energy intake
Vitamins
The release of energy from carbohydrates requires certain B vitamins such as thiamine, riboflavin, and niacin.
Because of higher energy demands, more of these vitamins are needed.
Folic acid and Vitamin B12 are also necessary for growth and sexual maturation.
The faster rate of skeletal growth means that the body needs more Vitamin D. Cell growth requires more
Vitamins A, C, and E.
301
Water
• The need for water as a food and nutrient helps in the accelerated growth and development of body
cells; increased energy utilization and other metabolic processes, active exercise and sports, are the
reasons for adequate water supply during adolescence.
Nutrition in Adults

303
Adulthood
Regarded as a phase of stabilization in the development process which separates the period of progressive
development from senescence
Period of relatively rapid transformations which though less dramatic than the changes in childhood and
adolescence
304
Adulthood
It is the period of life when one has attained full growth and maturity especially in size, strength, or intellectual
capacity
The onset of this stage varies among individuals and there are no clear-cut boundaries.
305
Adulthood
Period of considerable metabolic activity as well as of continuing development of the functions of the
organisms
Usually at the ages of 20 to 25 years
306
Stage of adulthood
is the longest and most productive stage in the life cycle
1) 19 to 30 (young adulthood);
2) 31 to 50 (adulthood);
3) 51 to 70 (middle-age adulthood); and
4) beyond 70 years of age.
307
Rationale for the dietary recommendations
Adulthood spans a number of decades during which nutritional needs change very little, but family
circumstances and lifestyle often undergo substantial change
308
Rationale for the dietary recommendations
Marital status, living environment, job setting and responsibilities, income and a variety of other factors
significantly affect specific food choices and long-term dietary patterns
Major focus during these years in health promotion and disease prevention
309
Energy
Males need more energy because of their larger body size and muscle mass, physical activity and for metabolic
needs
Lean body mass is the most metabolically active tissue in the body composition
310
Protein
Adult protein allowances are based on a daily protein intake of approximately 0.75 to 0.8 g per kg body weight
for both sexes and all three age groups
In the Philippines, protein allowance for adults is 1 g per kg of body weight
311
Minerals
Adult allowances are sufficient if provided on a continuing basis by a well-balance diet
Iron. Increased in women during reproductive years to prevent deficiency due to menstrual loss
312
Minerals
Calcium. Increased to ensure peak skeletal bone mass which is attained roughly at age 35; for older adultsm
especially postmenopausal women, to prevent calcium loss from bone and the development of osteoporosis
313
Vitamins
Intake of the adult vitamin allowances is usually met by ordinary well-balanced diets
314
315
Key points
Adults need energy for work. Calorie intake needs to be balanced with physical activity to avoid weight gain.
Men and women need the same nutrients. However, there are certain nutrients that women need at higher
amount than men due to the different body types and biological needs.
1. Adult women need more calcium as they are more prone to osteoporosis.
2. Adult women need more iron than men because of the monthly menstrual cycle.
316
Key points
Adults should avoid eating too much food high
in sodium (salty foods) to prevent high blood
pressure or hypertension
Read the food label to find the amount of

sodium in packaged foods.
317
Key points
Choose foods with “sodium free,” “low
sodium,” “reduced or less sodium,”“no salt
added,” or “light in sodium” written on the
label
Adults should avoid eating too much fatty

foods and those high in cholesterol
318
Key points
The two types of cholesterol
- HDL (high density lipoprotein) is also
known as “good cholesterol” which carries
fat and cholesterol away from the arteries
to the liver which is then removed from the
body
319
Key points
- LDL (low density lipoprotein) is also
called “bad cholesterol” which brings
cholesterol into the arteries and causes
them to become blocked.
320
Key points
- Narrowed and blocked arteries can lead to irregular
heartbeat, abnormal blood pressure, heart attack,
stroke, kidney disease, blindness, and poor blood
circulation.
- The best way to lower blood cholesterol is to cut
back on saturated fats which are mainly found in
fatty meats, chicharon, cookies, and candy bars,
among others.
321
HL to the MAX
1. Don’t smoke (Huwag Manigarilyo)
2. Don’t drink alcohol (Iwas Alak)
3. No to illegal drugs (Talo Ka sa Droga)
4. Eat low-fat, low-salt, high-fiber diet (Wastong Pagkain)
5. Prevent hypertension (Bantay Presyon)
6. Do physical activity (Katawang Aktibo)
7. Manage Stress (Bawas Stress)
Physical activity
any activity done at work or at home like household chores.
Exercise is a more formal physical activity which involves a planned, structured, and repetitive movement done
to improve or maintain physical fitness.
324
Benefits of physical activity
Improvement in health
Decrease of premature death risk
Improve physical and emotional well-being,
Lower the chances of having heart disease such as hypertension, obesity, and high levels of sugar, and
cholesterol in the blood
325
Adult health, wellness and
lifestyle
The priority of a young adult is to establish lifestyle patterns that promote personal health and reproductive
capacity and a state of well-being and fitness for a lifetime
326
Health
Complete physical, mental and social well-being, and not merely the absence of disease or dysfunction
327
Wellness
In addition to being healthy, seeks to develop the maximal potential of individuals within their own
environment
Indicates a positive dynamic state as a person strives toward a higher level of function
328
Lifestyle
A person’s unique pattern of living, which depending on its form can be negative or positive in its health results
These patterns reflect our values and beliefs
329
Addiction
State of being enslaved to some undesirable practice that is physically or psychologically habit-forming to the
extent that its cessation causes severe trauma
330
Stress
A specific physiologic or psychologic reaction to a life event
Can result in adverse physiologic symptoms including gastrointestinal distress, irregular sleep patterns,
increased muscle tension with resulting balance or backache, cardiovascular responses resulting in constriction
of blood vessels and rapid pulse
331
Non-communicable diseases
Diet-related illnesses
Key points:
- NCDs can lead to premature death in adults;
- NCDs have common risk factors such as smoking, obesity,
physical inactivity, poor diet, and excessive alcohol intake; an
- NCDs can be prevented by practicing a healthy lifestyle.
332
Risk factors to NCDs
Source: WHO
Risk factors related to nutrition:
high blood pressure
high concentrations of cholesterol in the blood
inadequate intake of fruits and vegetables and other fiber-ri
foods
overweight and obesity
Lifetime dietary habits
Previous nutritional habits affect health maintenance through older adulthood;
Poor nutritional habits may have contributed to the development of chronic disease with resultant medic
treatment causing significant system impact.
Nutrition in Elderly

336
Nutrition during aging
338
Concepts of nutrition to apply
Different food items contain different nutrients;
Eating a variety of food everyday provides all the nutrients needed;
All people need the same nutrients but in different amounts; and
Moderation is key, not that too much or too little of variety of foods
339
Calories
As older adults age, they need fewer calories to maintain their weight.
The right balance between eating too much or too little should be achieved.
Eating too much can lead to obesity, which raises the risk for high blood pressure, diabetes, heart attack, and
stroke.
Eating too little, on the other hand, can lead to weight loss, weakness, and fatigue.
340
Energy
• The demand for calories is decreased because of the reduced metabolism and physical activity
• Food sources need to be very nutrient dense
• FAO recommends a decrease of 7.3% for each decade of 50-59 and 60-69 and 10% for 70 years and
above .
Carbohydrates and fats
Carbohydrate is needed to prevent the use of body proteins as an energy source.
Fat intake should be limited but not removed from the diet because it is the most concentrated source of
energy.
Trans-fat is found in margarines, shortenings, and hydrogenated vegetable oils and foods made with this type of
fat.
342
Check food labels of the food containing trans-fat.
Limit the use of saturated and trans-fat as they raise the level of low-density lipoprotein or “bad cholesterol”.
Lessen sugar intake as it contributes to the calories.
343
 Around 50-60% of the total kcal
→ should come from carbohydrates primarily in the form of starches rather than sugars
→ about 20-25% from fat (2% of which are in the form of polyunsaturated fatty acids).
 Sucrose and saturated fatty acids
↗ are known to increase the triglyceride and cholesterol levels in the blood.
digestion and absorption of fat tends to be
↗
slow down in the aged

Protein
This nutrient is needed as the body of the older adult is more easily injured and requires protein for healing.
Protein can help keep muscles intact and acts as reserves in case of illness or surgery.
It can also help maintain a healthy immune system.
346
Protein
 Its allowance for the aged is maintained at
1.12gm/kg body weight
 based on a net protein tissue wasting and susceptibility to disease and infection.
Vitamins and minerals
The ageing process may slow down the absorption of vitamins and minerals.
Some nutrients are needed in higher amounts, while some stay the same. For
example, Vitamin A absorption increases with aging, while Vitamin D and Vitamin
B12 deficiencies become more prevalent.
Supplements, based on the daily requirement, may be necessary if not consumed
in diet.
348
 Dietary vitamin B12, calcium, iron and zinc
 have impaired gastrointestinal
bioavailability during aging
 Thiamin is important
 because it counteracts the poor appetite
commonly found among the aged
 helps regulate the muscle tone of the
gastrointestinal tract and the normal
functioning of the nerves.
 Vitamin D
 found to be deficient among elderly people
 This is often brought about by liver injury, antibiotic therapy, poor intestinal absorption, an
inadequate exposure to sunlight
One quart of milk supplies about 1200 mg calcium and 400 IU Vit. D.
Geriatric pills and other multiple vitamin-mineral supplements are to be
taken under prescription of a physician due to danger of overdose.
Mineral
IRON
• may need iron supplement
• iron deficiency with chronic blood loss
• antacids and low stomach acid secretion decrease
Dietary fiber
Older adults should eat food rich in dietary to prevent constipation or “pagkatibi” caused by lack of physical
activity, poor diet, too little fluid intake, and medications.
Dietary fiber travels through the digestive system, absorbs water, and forms the bulk needed for normal
elimination of solid waste.
353
Water
This nutrient is necessary to prevent dehydration. However, older adults may drink
less water than what they need because of disease, poor mobility, or bladder
control problems.
Other causes may include medications, such as diuretics or “pampa-ihi” and

laxatives “pampa-dumi”; kidney problems, diarrhea, poor absorption, or decreased
sense of thirst.
354
Water
• With slow excretion of waste water, water becomes important as a carrier
• Helps control constipation, reduced gastric motility, diminished bulk or fiber in the diet.
• Dehydration. Elderly have a decreased sense of thirst and can become dehydrated
Warning signs of poor nutrition
Disease (presence or absence)
Eating poorly
Tooth loss/mouth pain
Economic hardship
Reduced social contact
Multiple medications
Involuntary weight loss/gain
Need of assistance in self-care
Elder years above age 80
Source: National Food Service Management Institute
Participants can refer the older adults to the Rural Health Unit (RHU) or doctor if three or more of these
356 warning signs are seen. The BNSs can also advise the family members of the older adult to seek the
assistance of medical service providers.
Benefits of regular physical activity or movemen
among older persons
1. Helps relieve body pain and inability to move
2. Improves state of mind and body, which help
manage or prevent depression and anxiety
3. Provides opportunities to make new friends,
maintain social networks, and interact with
other people of all ages
4. Strengthens balance, coordination, control of
movement, flexibility, and endurance. It can also
reduce the risk of falls or “pagkadulas”.
357
Benefits of giving dietary advice to older person
1. It is not too late to give dietary advice to older adults because the prevalence of heart disease, diabe
hypertension, obesity, and arthritis is highest in this population group.
358
2. At age 65, men and women in high-income countries still have a life expectancy of around 15 and 19
years, respectively. The older they get, the longer they are expected to live. By the time men and
women reach age 75, life expectancy is still 9 and 11 years, respectively.
359
3. Studies show that by working on the risk factors, even during the later years, older adults become
active, alert, and less dependent. Examples of risk factors that can still be controlled include smok
weight loss, eating salty food, and those with saturated fat.
360
Nutritional armamentarium for the
elderly
1. Analyze food habits carefully through diet history and interview
2. Wide variety of foods easy to identify
3. Soft, easy to chew, smaller bites sizes
4. Small frequent feeding
361
Nutritional armamentarium for the
elderly
5. Fluid prescription is a must
6. Be aware of megadosage of nutrition supplementation
7. Increase seasoning and beautiful presentations
8. Checking and following up the recommendation
9. Lots of love for the work you do
362
Outside influences
• The loss of friends and family may result in decreased socialization and loss of opportunities for social
eating;
• Clients who must rely on others to gain access to food procurement or assist with food preparation are
at risk for nutritional alterations
Lifetime dietary habits
Previous nutritional habits affect health maintenance through older adulthood;
Poor nutritional habits may have contributed to the development of chronic disease with resultant medic
treatment causing significant system impact.
INFANCY
Early childhood encompasses infancy and the toddler years, from birth through age three. The remaining part of
childhood is the period from ages four through eight and is the time when children enter school. A number of
critical physiological and emotional changes take place during this life stage. For example, a child’s limbs
lengthen steadily, while the growth of other body parts begins to slow down.Emotional and psychological
changes occur as well. Children’s attitudes and opinions about food deepen. They not only begin taking their
cues about food preferences from family members, but also from peers and the larger culture. All of these factors
should impact the nutritional choices parents make for their children. This time in a child’s life provides an
opportunity for parents and other caregivers to reinforce good eating habits and to introduce new foods into the
diet, while remaining mindful of a child’s preferences. Parents should also serve as role models for their children,
who will often mimic their behavior and eating habits.

Good nutrition during the first 2 years of life is vital for healthy growth and development. Starting good nutrition
practices early can help children develop healthy dietary patterns. An undernourished mother who will give birth
to a low birth-weight baby will grow as an undernourished child, then to an undernourished teenager and finally
to an undernourished pregnant woman. Negligence and lack of care for a girl child during childhood and
adolescence, complicates cycle of good nutrition
askdrsears.com
NUTRITION IN INFANCY
Ethel May Onas, RND
Signs of Good
Nutrition
Has steady gain in weight and height;
Has firm, full flesh, bright eyes, and pinkish cheeks and nails; •
Is happy and active when awake;
Sleeps well; and
a Has normal elimination or “regular na pagdumi”.
Infant is getting enough to eat if
Urination 6 or 8 times a day. Most breastfed infants will have at leas
or 2 stools during the first few weeks and may have as many as one
every feeding.
Adequate weight gain
Good color and skin tone
Feeding every 1 ½ to 3 hours, after which baby seems content
Nutrient Requirements
PDRI 2015
Nutrient Requirements during Infancy
PDRI 2015
371
Nutrient Requirements
during Infancy
PDRI 2015
Policy Initiatives
International Code of Marketing of Breast-milk Substitutes (1981)
Innocenti Declaration (1990)
Baby-friendly Hospital Initiative (1991)
Global Strategy for Infant and Young Child Feeding
373
Exclusive Breastfeeding
Breastfeeding provides ideal food for the healthy growth and development of infants
Infants should be exclusively breastfed for the first six months of life
374
Definition of Exclusive Breastfeeding
Exclusive breastfeeding means giving a baby

only breast milk, and no other liquids or
solids, not even water. Drops or syrups
consisting of vitamins, mineral
supplements or medicines are
permitted.
375
Composition of Milk
What is the difference between the amount of protein in human milk and the animal milks?
What happens if humans babies eat too much casein?
Protetion against infection
Composition of milk varies according to age of the
baby and from the beginning to the end of the feed
After few days- colostrum changes into mature milk
There is a larger amount of mature milk and the breast is full ,hard an
heavy
COLOSTRUM
FOREMILK HINDMILK
Thinner milk
Produce in large
Whiter milk that
amount is produced at
Even if climate is hot, later feed
they don’t need water
Contains plenty of
Contains more fat
protein, lactose, water than foremilk-
and nutrients WHITER
STORAGE OF
EXPRESSED MILK
CUP FEEDING
WHY ARE CUPS SAFER THAN
BOTTLE FEEDING
Cups are easy to clean with soap and water if boiling is not possible
Cups are less likely than bottles to be carried around for a long time giving bacteria to breed
Cups feeding is associated with less risk ofdiarrhea , ear infection and tooth decay
The person who feeds a baby by cup has to hold the baby and look at him, and give some of the contact that
he needs
Does not interfere with suckling with the breast
A cup enables a baby to control his own intake
How to feed a baby by cup
Wash your hands

Hold the baby siting upright or semi upright on your lap
Place the estimated amount of milk for one feed into
the cup
Hold the small cup of milk to the baby’s lip
Tip the cup so that the milk just reaches the baby’s lips
The cup rests lightly on the baby’s lower lip , and the edges
of the cup touch the outer part of the baby’s upper lip
How to feed a baby by cup
The baby becomes alert and opens his mouth

and eyes
A full term baby suckles the milk
Do not pour the milk into the baby’s mouth .

Just hold the cup to his lips and let him take it
himself
Signs that a baby is full
When he closes his mouth and will not take anymore of this feed
If he has taken the calculated amount he may take more next
time or he may need feeds more often
Amount of milk to give to babies
Babies who weighs 2.5 kg or more
150 ml milk per body weight per day
Divide the total into 8 feeds, and givs 3-hourly
Babies who weighs less than 2.5 ( LBW)
Start with 60 ml/kg body weight
Increase the total volume by 20 ml/kg perday, until the baby is taking a total of 200 ml per kg per day
Divide the total into 8-12 feeds, to feed every 2 to 3 hours
Continue until the baby weighs 1800g or more, and is full breastfeeding
Calculate the volume of milk, per feed , for a two-week-old baby
Baby weighs 3.8 kg
The volume of milk the baby needs in 24 hours is 150 ml per kg
HOW MUCH MILK WILL THE BABY

NEEDS?
150 ml x 3.8 kg = 570 ml in 24 hours
If the baby feeds every 3 hours he will take 8 feeds in 24 hours
How much milk should the baby be offered ea

feed?
570 ml / 8 feeds = 71.25 ml
= 75 ml
What if mothers do not have equipment for
measuring volumes?
GALACTOGOGUE
Tinola - malunggay, papaya,

bawang, luya,
-Lactation cookies- oatmeal
-Dark green leafy veggies
-Nuts and seeds
COMPLEMENTARY
FEEDING
Key Message 1 28/2
Breastfeeding for two years or longer helps a child to develop and

grow strong and healthy
28/3
Definition of complementary feeding
•Complementary feeding means

giving other foods in addition to
breast milk
•These other foods are called
complementary foods
28/4
Energy required by age and the amount

supplied from breast milk
100 Energy Gap

0
Energy (kcal/day)
800
600
Energy
400 from breast
milk
200
0
0-2 m 3-5 6-8 9-11 12-23
m Age (months)
m m m
Key Message 2 28/5
Starting other foods in addition to

breast milk at 6 completed
months helps a child to grow well
Key Message 2 28/5
Starting other foods in addition to

breast milk at 6 completed
months helps a child to grow well
Starting other foods too soon 28/6
Adding foods too soon may

•take the place of breast milk
•result in a low nutrient diet
•increase risk of illness
less protective factors
other foods not as clean
difficult to digest foods
•increase mother’s risk of pregnancy
Starting other foods too late 28/7
Adding foods too late may

•result in child not receiving required nutrients
•slow child’s growth and development
•risk causing deficiencies and malnutrition
Gaps to be filled by complementary feeding
Breastmilk provides important amounts of energy and
nutrients even in the 2nd year
None of the columns are full
Biggest gaps are iron and energy
Recommendations for the non-breastfed from 6 months
AMOUNTS OF FOOD TO
OFFER
Age Texture Frequency Amount of food an
average chld will
usually eat at each meal
6-8 months Thick porridge with well 2-3 meals per day plus Start with 2-3
mashed foods frequent breastfeeds tablespoonfuls per feed
Continue with mashed Depending on the child’s Increasing gradually to ½
family food appetite ,snacks may be of a 250 ml cup
offered
9-11 months Finely chopped or 3-4 meals plus ½ of a 250 ml cup or

mashed foods, and foods breastfeeds bowl
that baby can pick up Depending on the child’s
appetite ,snacks may be
offered
12-23 months Family foods, chopped 3-4 meals plus ¾ cup to one cup ml cup
or mashed if necessary breastfeeds or bowl
Depending on the child’s
appetite ,snacks may be
offered
Diet Recommendations
421
422
423
BREASTFEED BEFORE GIVING OTHER FOODS
a. active, fresh , timely and
adequate
b. timely, appropriate, safe and
adequate
c. timely , colourful, safe and
Nutrition during Preschool
Nutrient Needs
1-3 years 4-6 years
Energy/Nutrient
PDRI PDRI
Energy, kcal 1070 1410
Protein, g 28 38
Vitamin A, RE 400 400
Vitamin C, mg 30 30
Thiamin, mg 0.5 0.6
Riboflavin, mg 0.5 0.6
Niacin, NE 6 7
Nutrient Needs
1-3 years 4-6 years
Energy/Nutrient
PDRI PDRI
Folate, ug 160 200
Calcium, mg 500 550
Iron, mg 8 9
Iodine, ug 90 90
Energy
≈The energy requirements for individual children are determined by Resting Energy Expenditure (REE), rate of
growth, and activity.
≈The contribution of physical activity to total energy expenditure is quite variable among children and in
individual children from day to day.
≈During periods of catch-up growth, daily intakes of 150 to 250 kcal/kg/day of body weight have been
recommended.
430
Protein
≈The protein needs of children include those for maintenance of tiss
for changes in body composition, and for synthesis of new tissue.
≈An evaluation of a child’s protein intake must be based on: 1) the
adequacy of growth rate, 2) the quality of protein in the foods eaten
combinations of foods that provide complementary amino acids whe
consumed together, and 4) the adequacy of the intake of vitamins,
minerals, and energy.
431
Calcium
≈Calcium is essential for bone growth and mineralization.
≈More than 98% of body calcium is bone.
≈Lactose increases absorption, binders such as phytic acid and oxalic acid reduc
absorption, and the level of dietary protein affects the urinary excretion of calci
≈As levels of protein intake increase levels of urinary calcium increase.
≈Recommendations for children are set at 800 mg/day, since growing children
need two to four times as much calcium per unit of body weight as adults requi
432
Zinc & Iron
Zinc
≈ For normal protein synthesis and growth.
Iron
≈ Iron deficiency is the most common nutritional deficiency.
≈ It may result from inadequate iron intake, impaired absorption, a large hemorrhage, or
repeated small blood losses.
≈ IDA is a preschool child causes delayed mental and physical development and decreased
resistance to infection.
≈ Iron requirements of individual children vary with rates of growth and increasing total iron
mass, iron stores, variations in menstrual losses of iron in adolescent females, and the tim
of the growth spurt of adolescents.
433
Vitamin A
≈For maintenance of normal vision
≈Promotes the differentiation of the epithelial cells of the body’s skin and linings of all tissues from invasive
microorganisms and other harmful particles
≈Promotes growth
≈Promotes immunity by maintaining the integrity of the epithelial tissues
≈Influences the expression of over 300 genes
434
Nutrition in School children
435
Nutritional requirements in school-
age
436
Nutritional requirements of school-
age children
Based on PDRI 7-9 yrs 10-12 yrs
Calories 1600 2140

Protein (gm) 43 54
Vitamin A (ug) 400 400
Vitamin A (mg) 35 45
Calcium (mg) 700 1000
Iron (mg) 11 13
Iodine (ug) 120 120
Nutritional requirements of
school-age children
Children need nutritious foods in proportion to their weight than do
adults because they are growing and developing bones, teeth, musc
and blood;
They can be at risk for malnutrition when they have poor appetite of
long duration, accept a limited number of foods or dilute their diets
significantly with nutrient-poor foods.
Nutritional requirements of
school-age children
The RENI for Filipinos classified school children into two groups: the 7-9 years old and the 10-12 years old. The
older group is called pre-adolescents.
Their dietary allowances are grouped according to sex

Energy
• Is determined by age, basal metabolism and activity
• Allowances for school children decline gradually to approximately 80-90 kcal/kg for the 7-9 age grou
70-80 kcal/kg for the 10-12 age group
• The need for energy and nutrients are the same for boys and girls 7-9 years, at age 10-13 years boys
higher needs.
Protein
• An adequate protein intake is needed to cover the
requirements for periods of rapid growth.
• A minimum of 8% of the total energy requirement is
necessary since children are susceptible to recurrent
infections;
• They need higher amounts of high biological value
protein.
The most important minerals that may be limiting at this age are calcium
iron;
Calcium is needed for continued mineralization of bone and prevention o
osteoporosis;
Iron is essential for growth and development and prevention of anemia.
Physicians do not recommend routine vitamin and mineral supplementati
for healthy children except for fluoride supplementation in areas not
fluoridated;
Computation of DBW
443
Computation of TER
444
PREGNANCY
The recommended increase over the normal
nutrient need of the woman to meet the
demands of pregnancy
varies from one nutrient to another as
shown in the table the nutritional
requirements are increased during
pregnancy.
a. To meet the normal requirements of the
mother;
b. To meet the nutrient needs of the
growing fetus and other
maternal tissues; and
c. For building reserves in preparation for
delivery and lactation.
Rationale for increasing specific nutrient requirements
•Energy: additional energy is required during pregnancy for the
- Growth of the fetus, placenta and maternal tissues and their maintenance;
-Increase in BMR; better utilization of dietary protein and good pregnancy outcome;
• The addition of 300 kcal/day during the second and third trimesters of pregnancy is
recommended; this amounts to the total of 56,100 kcal for the entire pregnancy which is
close to the total cost of pregnancy found in a Philippines study.
•Protein: increases by an average of 8g/day throughout pregnancy to
- Meet the needs of the developing maternal tissues, support the growth of the fetus and the
placenta, and
- Protect the pregnancy course and outcome against risk associated with low protein intakes.
• Vitamin A: essential for the health of the epithelial tissues including the skin and the membranes
that like glandless
duets and passages of the gastrointestinal, urinary and respiratory tracts; the RNI of 800 µg RE/day
for the pregnant
woman also accounts for the vitamin A storage in the fetal tissue.
•Vitamin C: an extra 10 mg/day is recommended for the pregnant woman to maintain the integrity
of fetal
membranes and tissue structure.
•Thiamin, riboflavin, and niacin: are important during pregnancy particularly with reference to
carbohydrate,
protein and lipid metabolism
•Folate: the recommended intake for the pregnant woman which is a total of 600 µg DFE daily or an
additional 200
µg/day is based on folacin‟s role in promoting normal fetal growth (DNA synthesis) and in erythrocyte
maturation, and
preventing neural tube defects.
•Calcium: an additional allowance of 50 mg or a total of 800 mg is recommended to promote adequate
mineralization of
fetal skeleton and deciduous teeth of the fetus.
•Iron: the daily requirement for pregnant women is higher than what can be provided by the usual diet
alone, this, supplementation is recommended, this amount is needed to
-Allow for build-up of iron stores,
-Allow for the expansion of the red cell mass, and
-Provide for the needs of the fetus and the placenta;
-Infants are born with high hemoglobin levels and with a supply of iron stored in the lover at the
expense of maternal iron reserves if mother‟s iron intake is low.
•Iodine: an additional allowance of 50 µg/day is recommended so as not to compromise the
development of the fetus; iodine deficiency in pregnancy has been known to result in cases of
cretinism.
•Other minerals and vitamins
- Zinc: the increase in zinc requirement is minimal during the first trimester of pregnancy (0.6
mg/day), but by the
third trimester the requirement is more than twice that of the non pregnant woman (4.5 mg/day)
to provide
the needs for maternal and embryonic or fetal tissue growth.
•Vitamin B6: a total of 1.9 mg/day through the pregnancy will take care of the fetal, placental
and maternal needs and its bioavailability in food.
•Water and electrolytes
-Water: an additional 300ml/day is recommended because of the expanding extracellular fluids,
the
needs of the fetus and the amniotic fluid.
- Sodium: the increase in extracellular fluids calls for an increase in body sodium, this restriction
of sodium intake is not recommended as a routine procedure; sodium restriction stresses the
renin-angiotensin aldosterone mechanism in order to maintain homeostasis; the additional needs
Rationale for Increasing Specific Nutrient Requirements During Lactation:
• Calories- necessary for the production of milk in adequate amounts, to supply the energy
content of the milk secreted plus the mother‟s own energy needs.
• Protein- necessary for the production and increased secretion of milk.
•Calcium is necessary to replenish and avoid depletion of the mother‟s calcium stores.
•Iron- the need for iron does not increase above that for pregnancy. There is only a small
amount of iron transferred to human milk and this is well utilized by the infant.
•Iodine has been shown to increase milk flow.
•Vitamin A- there is comparatively small storage of Vitamin A by the infant at birth and human
milk becomes the main source of both Vitamin A and carotenoids
• Thiamine- a deficiency in thiamin may cause infantile beri-beri among breast-fed infants.
• Riboflavin- human milk provides the infant with a high level of this nutrient
As part of a healthy diet, which of the following foods has been highlighted as helping to cut the risk of
coronary heart disease- OILY FISH
Which of the following factor is not a predictor of a child and adolescent obesity: NUMBER OF SIBLINGS
The following are true about calorie-controlled diet, except: CARBS
A diet high in saturated fats can be linked to which of the following? CARDIO
The “rule of 15” therapy is indicated for client with: HYPOGLYCEMIA
Overweight and obesity are major risk factors for the disease such as DIABETES
Poor diet and a sedentary lifestyle are the major cause of: OBESITY
Symptoms of the classic allergy response include all of the following, except: VOMITING
Food allergen can be identified by all of the following, except: CHILDS LIKES AND DISLIKES
Characteristic of successful dieters include all of the following except: ELIMINATING ALL CARBS
LOW SALT- SODIUM RESCTRICTION
LOW FAT- REGULATES THE AMOUNT
SOFT DIET- CONGEE
MECHANICAL SOFT- GROUND MEAT
CLEAR LIQUID- HARD CANDY

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By: Kriselda Manzano- Saracho, RN,

By: Kriselda Manzano- Saracho, RN,

Indication Poor dentures, oral lesions or surgery, chewing difficulty

Soft-cooked rice, Ground meat, Chopped vegetables,

After surgery, fever, mild infection, GI disturbance

Description Regulates the amount and kind of fat. Must be planned to

For patients with fatty liver, gall bladder, disease, irritable

Foods Allowed Boiled, steamed, roasted foods

Salt Choices: Each choice is 500 mg sodium

For patients with fatty liver, gall bladder

Coffee, chocolates, milk and dairy,

Easily digested and absorbed, leaving

Spastic constipation, diarrhea, ulceration

High CHO and low fat, since CHO favor

Indication Gouty arthritis, elevated uric acid levels

Foods Not Allowed Red meat, Organ meat, Fin fishes,

Description Oxalic acid occurs primarily in food of plant origin

Indication High tendency to form oxalic acid kidney stones

Chocolate milk, cocoa, tea, Baked beans canned in

Nutritional Requirements in this stage of the women’s life:

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

• Use to develop plan to resolve problems on food &

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

• Requirements : First 4 months – average 3.5 g/day

• Requirement for Infants: fatty acids, linoleic acid, arachidonic acid

• 37% in human milk

* Metabolic rate 2X greater relative to body weight

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

• B6 deficient : destroyed during production

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

• Formula fed : retains 25-30 % of Calcium

• Normal infants don’t have zinc reserve

Benefits for the Infants

Benefits for the Mother

• Money & time saved from formula preparation

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

Soy based Formula

• Children of vegetarian families

• Cereals fortified w/ iron

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

BABY BOTTLE TOOTH DECAY

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2018

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

• 3-6 years of age

2-4 kg/year 1-2 kg/year

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

Growth rate slows

Requires less food

“FOOD JAGS” Eat only favorite foods

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

Height relative to weight

Chubby toddler Leaner preschool

CENTRO ESCOLAR UNIVERSITY FOR INTERNAL CIRCULATION ONLY 2019

1. Protein-Energy Malnutrition (PEM)