特殊人群的营养价值

特殊人群的营养价值第1页/共82页

不同人群的营养

LifeCycle

Nutrition第2页/共82页1.NutritionDuringPregnancyThePhysiologyofPregnancy

Awoman’sbodyundergoesmanychangesduringpregnancytodevelopandmaintainthesystemsnecessarytosupportthegrowingfetus.第3页/共82页HormoneschangesGastrointestinalchangesDelayingastricemptyDecreasedgastricacidityDigestivediscomfortsmorningsickness,heartburnCardiovascularsystemBloodvolumeincreasesby50%IncreaseincardiacoutputDecreaseinalbuminconcentrationRenalfunctionchangesweightgain第4页/共82页总体重增加:11~13kg胎儿:3.3kg胎盘、羊水：1.5kg子宫：1.0kg血液：1.2kg乳房：0.4kg细胞间液：1.5kg脂肪：2~4kg第5页/共82页RecommendWeightGain

DuringPregnancyBMIbeforepregnancyWeightgainUnderweight(BMI<19.8)12.5~18.0Normalweight(BMI19.8~26.0)11.5~16.0Overweight(BMI>26.0~29.0)7.5~11.5Obesity(BMI>29.0)6.0~6.8第6页/共82页ThenutritionalneedsofpregnancyDuringpregnancy,awoman’snutrientintakeandbodystoresmustprovideallthenutrientsneedstosupportthegrowthanddevelopmentofthebabywhilecontinuingtomeetthemother’sneeds.第7页/共82页Energy

Atypicalpregnancyhasbeenestimatedtorequireanadditional55000kcalories.Additional200kcal/dayduringthesecondandthirdtrimesters.ProteinProteinneedsarealsoincreasedduringpregnancytoprovidefor

RNI:+5g/d1sttrimester+15g/d2ndtrimester+20g/d3rdtrimester

第8页/共82页MineralsCalcium

Pregnantwomenabsorbmoreofthecalciumtheyconsumeandloselesscalciumintheurinethandononpregnantwomen.Thefetusretainsabout30gramsofcalciumoverthecourseofgestation.Mostofthecalciumisdepositedinthelasttrimesterwhenthefetalskeletonisgrowingmostrapidlyandtheteethareforming.RNI800mg1sttrimester1000mg2ndtrimester1200mg3rdtrimesterfoodsource:milkanddairyproducts第9页/共82页IronIrondeficiencyanemialowbirthweightpretermdeliveryBabiesbornprematurelymaynothavehadtimetoaccumulatesufficientiron,butbabiesbornattermusuallyhaveadequateironevenifthemotherisdeficient.RNI15mg1sttrimester25mg2ndtrimester35mg3rdtrimesterfoodsource:redmeats,leafygreenvegetables,fortifiedcerealsironsupplement第10页/共82页Zinc

Zincdeficiencyduringpregnancyisassociatewithanincreasedriskoffetalmalformationandlowbirthweight.RNI11.5mg/d1sttrimesrer16.5mg/d2ndtrimester16.5mg/d3ndtrimesterIodine

Iodinedeficiencyduringpregnancyincreasestheriskofstillbirthspontaneousabortionandcanresultinconditionintheoffspringcalledcretinism(呆小病）.RNI

200μg/d第11页/共82页FolicAcidandVitaminB12FolicacidandvitaminB12areessentialforcelldivision,Adequatefolateintakesiscrucialevenbeforeconceptionbecauserapidcelldivisionoccursinthefirstdaysandweeksofpregnancy.Folateisbelievedtobeessentialforproperformationofneuraltube.

DeficienciesoffolateandvitaminB12canalsoresultinmegaloblasticanemia.Vitamins第12页/共82页megaloblasticanemia:reticulocytescellsmustbeconstantlyreplenishedvianewsynthesisofDNAandRNA第13页/共82页第14页/共82页VitaminAHighdietaryintakesofpreformedvitaminA(>10,000IU)cancausebirthdefectsinhumansandanimals.VitaminDVitaminC第15页/共82页MaternalMalnutritionandPregnancyOutcomeLowbirthweightPrematureIntrauterinegrowthretardationStillbirthIncreasedearlynewborndeathsMalformation第16页/共82页第17页/共82页Thephysiologyoflactation2.NutritionrequirementonLactation第18页/共82页MaternalNutrientNeedsduringlactationTheneedforenergyandmanynutrientisevengreaterduringlactationthanduringpregnancy.Thisisbecausethemotherisstillprovidingforallofthenutrientneedsofinfantwhoisgrowingfasterandismoveractivethenthefetus.第19页/共82页EnergyContainedinthemilkitselfNeededtosynthesizethecomponentsofthemilkRNI:+500kcalProteinTheproteinneededtoproducemilkincreasematernalproteinneedsRNI+20g第20页/共82页Water

Whenfluidintakeislow,themother’surinewillbecomemoreconcentratedtoconservewaterformilkproduction.Toavoiddehydrationandensureadequatemilkproduction,fluidintakshouldbeincreasedbyabout1L/d.第21页/共82页RNIsofsomeelementandvitamineslactationpregnantnon-pregnantCalcium1200mg1200mg800mgIron25mg35mg20mgVit.A1200µg700µg700µgVit.B11.8mg1.5mg1.3mgVitB21.7mg1.7mg1.2mg第22页/共82页Energy1.Basalmetabolicrequirement2.Specificdynamiceffect3.Physicalactivity4.Tissuegrowth5.Fecalloss

3timesgreaterthaninadults,85~95kcal/kg40~50%comefromfathighenergydensitysmallstomachimportantfornervoussystemdevelopment3.Infantnutrition第23页/共82页Protein

Tissuegrowth1.6~2.2g/kgTotalproteinintakeshouldnotexceed20%ofenergyneeds.Fat

energy/%

0~0.5year：45%~50%0.5~:35%~40%EFAdevelopmentofnervoussystem第24页/共82页MineralsandVitaminsSpecialemphasisoncalciumandironIronIron-fortifiedinfantformulasIron-fortifiedcerealWaterNeedgreaterthanthatofanadultInfant120~150ml/kg/day第25页/共82页BreastFeeding第26页/共82页NutritionalQualitiesofHumanMilkHumanmilkisverydifferentincompositionfromcow’smilkUnlessaltered,cow’smilkshouldnotbeusedininfantfeedinguntiltheinfantis12monthsold.第27页/共82页2.compositionofbreastmilk

proteinapproximate1/3asincow’smilk

wheyproteins:casein=80:20(18:20incow’s)smallerandmoreflocculentcurdeasierdigestion,greaterabsorption,softstoolslipidsmostvariablemacronutrientinhumanmilkfineemulsificationactivelipasehigherdegreeofunsaturation

第28页/共82页carbohydratelactoseishigherlowerintestinalPHimprovetheabsorptionofnitrogen,calciumandmagnesiumencouragesthegrowthoffermentativeratherthanputrefactivebacteriacomponentsofmyelinandcollagen

第29页/共82页minerals

calcium:phosphorus2:1(1:1incow’smilk)copperishigherironisslightlyhigher,utilizedmoreefficientlyvitaminstwiceasmuchvitaminAandniacinfourtimesasmuchasascorbicacidandvitEvitaminDislow第30页/共82页ImmunefactorS-IgA免疫球蛋白Lactoferrin乳铁蛋白Lactobacillusbifidus双歧因子Lysozymes溶菌酶第31页/共82页Immunefactorsofhumanmilkandcow’smilk

immunefactorshumanmilkcow’smilkLactoferrin(g/L)1.5痕量

Lysozymes(g/L)0.50.0001lgA（g/L）

1.00.03lymphocyte(个/ul）

8000Lactobacillusbifidus(个/ul）

有

未检出第32页/共82页第33页/共82页第34页/共82页

◆

初乳(colostrum)antibodieslactobacillusbifidusfactorfacilitatesthepassageofmeconium(胎粪)

◆

过渡乳(transitionalmilk)

◆

成熟乳(maturemilk)

第35页/共82页compositionofcolostrumandmaturemilkcolostrummaturemilkprotein（g/L）

22.9010.60S-IgA(mg/L)21.0010.00Lactose(g/L）

57.0071.00lipids（g/L)29.5045.40zinc（mg/L)5.591.18retinol（mg/L）

1.610.27第36页/共82页AdvantagesofBreastfeedingProvisionofimmunologicandenzymaticcomponentsOptimalnutrientcompositionPromotesmaternal-infantbondingPromotesfacial/musculardevelopmentDecreasedincidenceofrespiratoryandgastrointestinalinfectionsPossiblereducedincidenceofchronicdiseaseslaterinlifeInexpensiveandconvenientEasyforinfanttodigest第37页/共82页母乳喂养——幸福的源泉

每年的8月1日至7日

第38页/共82页IntroducingSolidFoodsNutritionalneedPhysiologicalcapabilitiesPhysicalabilityPreventingallergies第39页/共82页

幼儿营养与膳食

nutritionanddietaryofpreschoolchildren

第40页/共82页Incontrasttotherapidandusuallysmoothgrowthinthefirstyear,theperiodfromonetosixischaracterizedbyaslowerrateofincreaseinbothstatureandweight.Theslowingoftherateofgrowthresultsinalesspressingdemandfornutrientsthanwasobservedinthefirstyear.Maturationoffunction,controlofthebody,anddevelopmentofsocialandcognitiveabilitiesaremorepronouncedthansomaticgrowthduringthepreschoolyears.characteristics

第41页/共82页

Newborn6mo.12mo.Increment1styear2ndyear3rdyearNext3yWeight(Kg)3.0696(200%)2.522Height(Cm)50667525(50%)10-127-87Headcircumference34

461221.2<1cmBrainweight(g)3706509501.5fold

Stomachcapacity(ml)30-3520030010fold

1.physicalgrowth第42页/共82页

calcificationeruptionsheddingBeginsatcompletedmaxillarymandibularmaxillarymandibularCentralincisors5fetal18-246-85-77-8ys.6-7ys.Lateralincisors5fetal18-248-117-108-97-8Cuspids6fetal30-3616-2016-2011-129-11Firstmolars5fetal24-3010-1610-1610-1110-12Secondmolars6fetal3620-3020-3010-1211-13第43页/共82页2.physiologicaldevelopmentrelatedtonutritionFinemotorcoordinationalsoprogressrapidly,andmanipulationofobjects,includingfood,becomesmoreproficient.第44页/共82页3.Psychosocial-biologicalinteractionsIncreasingindependence,ability,andsocializationEffectofsocial,economic,andeducationaldisadvantagesoftheenvironmentbecomemanifestDevelopmentofattitudestowardfoodpatternsofeatingbehaviorbesetduringthisperiodSettingagoodexampleisveryimportant第45页/共82页MilkandmilkproductsCerealgrainMeat,fish,poultry,eggsandsoybeanVegetablesandfruitsSnackfoodFoodchoice第46页/共82页第47页/共82页HealthyeatingisimportantinthisperiodProvidetheenergyandnutrientsneededtogrowanddevelopDevelopasenseoftasteandanacceptanceandenjoymentofdifferentfoodsInstillattitudesandpracticeswhichmayformthebasisforlifelonghealth-promotingeatingpatterns第48页/共82页InfluencesonFoodChoicesFamilyLifelonghabitsandattitudesestablishedduringtheperiodofindependence.Sharedmeals=betterdiets.Peers(particularlystrongforadolescents)Media第49页/共82页FeedingtheYoungChild Appetiteandfoodintakemayvarytremendously.Snackscontributesignificantlytototalday’sintake.Foodjagsarepartofnormaldevelopment.Chokingrisks第50页/共82页幼儿膳食的基本要求1.Well-balancediet(平衡膳食)protein10-15%lipids25-30%carbohydrates50-60%provideawidevarietyofnutritiousfoodsforchildrentoselectgivechildrenalargeproportionofcontrolovertheirfoodintake,especiallymealsizehavefastfoodsasanoccasionaltreatnotasaneverydayfood.2.Rationalcooking(合理烹调)适合幼儿消化功能特点减少烹调过程中营养素的损失第51页/共82页3.合理的进餐三餐一点

:早餐

20-25%

中餐

30-35%

午点

10-15%

晚餐

30%helpchildrenadapttothesocialtimingofmealshavemealtimesatanappropriatetimeforyoungchildren4.

培养良好的饮食习惯

定时、定点、定量进餐，不暴饮暴食

不偏食、挑食

培养使用杯、匙、碗、筷自己进食

不以食物作为奖惩手段

avoidusingrewardsorforcingorcoercingachildtoeatavoidforcefeedingchildrenavoidoverfeeding第52页/共82页5.良好的进餐环境

havemealtimestogetherasafamily(whenpossible)limitdistractionsatmealtimes6.

注意饮食卫生第53页/共82页ABC1.Presentsapplesauce2.Criesandwhines,pointstotherefrigerator3.“whatdoyouwant”4.Cries,pointstocupboard5.“Doyouwantacracker?”6.Cries,pointstorefrigerator7.“Whatdoyouwant?No,youcan’thaveicecream.”8.Childscreams9.”OK,hereissomeicecream.”10.Stopcrying第54页/共82页ABC1.presentapplesauce2.Cries,pointstocupboard3.leavesroom(canseechildbuthecan’tseeher)4.slowingstopscrying,startseatingapplesauce5.Returnsandsays“Whatabigboy!”6.Childlaughsandkeepsoneating第55页/共82页

青春期的营养和膳食

nutritionanddietaryofadolescents

第56页/共82页青春期早期：growthspurt

青春期中期：sexualmaturation青春期晚期：physicalgrowthmaturity

青春前期

青春后期第57页/共82页青春期少女的生理和心理

青春期的生理特点1．身高和体重生长突增（growthspurt）体成分（bodycomposition）

Thegrowthspurtusuallybeginsaround10yearsofageingirlsand12yearsofageinboys.Inbothsexes,anaverageof23cmisaddedtoheightand20-26kgtoweight.Beforeadolescence,bothgirlsandboyshaveanaverageof18%bodyfat.Duringadolescencethisincreasestoabout28%ingirlsanddecreasestoabout15%inboys.第58页/共82页2．性器官的发育和第二性征的出现性器官内生殖器官：阴道、子宫、输卵管和

卵巢外生殖器官：阴阜、大、小阴唇和阴蒂第二性征：乳房、阴毛、腋毛3.各组织、器官、系统的发育第59页/共82页性腺腺垂体神经垂体

下

丘

脑

组织肾上腺甲状腺LH－RH

FSH-RHGRHPIFPRFGRIHGRHTRH雌激素孕激素睾丸酮LH

FSH

ACTH

GH

TSH

PRL

肾上腺皮质素雄激素兴奋抑制青春期内分泌调节示意图神经中枢甲状腺素第60页/共82页

青春期的营养需要

NutrientRequirements影响因素：1.发育早晚

2.体力活动水平

3.个体差异第61页/共82页第62页/共82页1.Energy16岁10.0MJ（2390Kcal）

18岁

8.8MJ(2100Kcal)2.

Proteinpositivenitrogenbalance1.6～1.9g/kg80g(>70g)第63页/共82页Minerals

1).Calciuml

Bonegrowsinvolumeanddensityaswellaslengthl

lengthincrease0.25mm/dl

Weightincrease1.2g/d,from1500g-→3000gRDA13～

1200mg/d16～

1000mg/d18～

800mg/dAI11～

1000mg/d14～

1200mg/d18～

800mg/dUL11～

200014～

200018～

2000第64页/共82页2).Ironironisneededfor:l

growthofbodytissuesl

increaseinbloodvolumel

replacementofironlossesinmenstrualbloodiron-deficiencyanemiaRDA10～

12mg/d13～

20mg/d18～

12mg/dAI11～

18mg/d14～

25mg/d18～

20mg/dUL505050

第65页/共82页3).ZincRDA10～

15mg/dRNI11～

15mg/d14～

15.5mg/d18～

11.5mg/dUL11～

3414～

3518～

374).Iodine

goiterRDA10～

120μg/d13～

150μg/dRNI11～

120μg/d14～

150μg/dUL11～

80014～

80018～

1000第66页/共82页四．维生素(Vitamins)1.

Vit.A2.

Vit.D3.

Bvitamins4.

Vit.C第67页/共82页一日食谱举例第68页/共82页AnorexianervosarefusaltoeatenoughtomaintainanormalbodyweightintensefearofgainingweightorbecomingfatSufferersareoftheimpressionthattheyarefatandoftenseethemselvesasbeingfateventhoughtheyareobviouslyunderweight.exercisevigorouslyoruseslimmingpillsoftenstopmenstruating.oftenverysecretiveabouttheireatinghabits.第69页/共82页第70页/共82页Thatautumn,HeatherwasrejectedbyOxford.Bynowitwasevidentthatshewasverythin.AtChristmas,herbehaviourledtomajorupsetsandrowsinthefamily.Finally,earlyintheNewYear,herparentspersuadedhertoseethefamilydoctor.Whenweighedatthesurgery,shewasjustundersixstones(37kg).Itwasclearnowthatshewassufferingfromanorexianervosa.第71页/共82页第72页/共82页老年营养

Thechangesofagingchangesincellsandor