特殊人群的營養(yǎng)價值

特殊人群的營養(yǎng)價值第1頁/共82頁

不同人群的營養(yǎng)

LifeCycle

Nutrition第2頁/共82頁1.NutritionDuringPregnancyThePhysiologyofPregnancy

Awoman’sbodyundergoesmanychangesduringpregnancytodevelopandmaintainthesystemsnecessarytosupportthegrowingfetus.第3頁/共82頁HormoneschangesGastrointestinalchangesDelayingastricemptyDecreasedgastricacidityDigestivediscomfortsmorningsickness,heartburnCardiovascularsystemBloodvolumeincreasesby50%IncreaseincardiacoutputDecreaseinalbuminconcentrationRenalfunctionchangesweightgain第4頁/共82頁總體重增加:11~13kg胎兒:3.3kg胎盤、羊水：1.5kg子宮：1.0kg血液：1.2kg乳房：0.4kg細(xì)胞間液：1.5kg脂肪：2~4kg第5頁/共82頁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頁/共82頁ThenutritionalneedsofpregnancyDuringpregnancy,awoman’snutrientintakeandbodystoresmustprovideallthenutrientsneedstosupportthegrowthanddevelopmentofthebabywhilecontinuingtomeetthemother’sneeds.第7頁/共82頁Energy

Atypicalpregnancyhasbeenestimatedtorequireanadditional55000kcalories.Additional200kcal/dayduringthesecondandthirdtrimesters.ProteinProteinneedsarealsoincreasedduringpregnancytoprovidefor

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

第8頁/共82頁MineralsCalcium

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

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

Iodinedeficiencyduringpregnancyincreasestheriskofstillbirthspontaneousabortionandcanresultinconditionintheoffspringcalledcretinism(呆小?。?RNI

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

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

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

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

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

energy/%

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

proteinapproximate1/3asincow’smilk

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

第28頁/共82頁carbohydratelactoseishigherlowerintestinalPHimprovetheabsorptionofnitrogen,calciumandmagnesiumencouragesthegrowthoffermentativeratherthanputrefactivebacteriacomponentsofmyelinandcollagen

第29頁/共82頁minerals

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

immunefactorshumanmilkcow’smilkLactoferrin(g/L)1.5痕量

Lysozymes(g/L)0.50.0001lgA（g/L）

1.00.03lymphocyte(個/ul）

8000Lactobacillusbifidus(個/ul）

有

未檢出第32頁/共82頁第33頁/共82頁第34頁/共82頁

◆

初乳(colostrum)antibodieslactobacillusbifidusfactorfacilitatesthepassageofmeconium(胎糞)

◆

過渡乳(transitionalmilk)

◆

成熟乳(maturemilk)

第35頁/共82頁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頁/共82頁AdvantagesofBreastfeedingProvisionofimmunologicandenzymaticcomponentsOptimalnutrientcompositionPromotesmaternal-infantbondingPromotesfacial/musculardevelopmentDecreasedincidenceofrespiratoryandgastrointestinalinfectionsPossiblereducedincidenceofchronicdiseaseslaterinlifeInexpensiveandconvenientEasyforinfanttodigest第37頁/共82頁母乳喂養(yǎng)——幸福的源泉

每年的8月1日至7日

第38頁/共82頁IntroducingSolidFoodsNutritionalneedPhysiologicalcapabilitiesPhysicalabilityPreventingallergies第39頁/共82頁

幼兒營養(yǎng)與膳食

nutritionanddietaryofpreschoolchildren

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

第41頁/共82頁

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頁/共82頁

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頁/共82頁2.physiologicaldevelopmentrelatedtonutritionFinemotorcoordinationalsoprogressrapidly,andmanipulationofobjects,includingfood,becomesmoreproficient.第44頁/共82頁3.Psychosocial-biologicalinteractionsIncreasingindependence,ability,andsocializationEffectofsocial,economic,andeducationaldisadvantagesoftheenvironmentbecomemanifestDevelopmentofattitudestowardfoodpatternsofeatingbehaviorbesetduringthisperiodSettingagoodexampleisveryimportant第45頁/共82頁MilkandmilkproductsCerealgrainMeat,fish,poultry,eggsandsoybeanVegetablesandfruitsSnackfoodFoodchoice第46頁/共82頁第47頁/共82頁HealthyeatingisimportantinthisperiodProvidetheenergyandnutrientsneededtogrowanddevelopDevelopasenseoftasteandanacceptanceandenjoymentofdifferentfoodsInstillattitudesandpracticeswhichmayformthebasisforlifelonghealth-promotingeatingpatterns第48頁/共82頁InfluencesonFoodChoicesFamilyLifelonghabitsandattitudesestablishedduringtheperiodofindependence.Sharedmeals=betterdiets.Peers(particularlystrongforadolescents)Media第49頁/共82頁FeedingtheYoungChild Appetiteandfoodintakemayvarytremendously.Snackscontributesignificantlytototalday’sintake.Foodjagsarepartofnormaldevelopment.Chokingrisks第50頁/共82頁幼兒膳食的基本要求1.Well-balancediet(平衡膳食)protein10-15%lipids25-30%carbohydrates50-60%provideawidevarietyofnutritiousfoodsforchildrentoselectgivechildrenalargeproportionofcontrolovertheirfoodintake,especiallymealsizehavefastfoodsasanoccasionaltreatnotasaneverydayfood.2.Rationalcooking(合理烹調(diào))適合幼兒消化功能特點減少烹調(diào)過程中營養(yǎng)素的損失第51頁/共82頁3.合理的進(jìn)餐三餐一點

:早餐

20-25%

中餐

30-35%

午點

10-15%

晚餐

30%helpchildrenadapttothesocialtimingofmealshavemealtimesatanappropriatetimeforyoungchildren4.

培養(yǎng)良好的飲食習(xí)慣

定時、定點、定量進(jìn)餐，不暴飲暴食

不偏食、挑食

培養(yǎng)使用杯、匙、碗、筷自己進(jìn)食

不以食物作為獎懲手段

avoidusingrewardsorforcingorcoercingachildtoeatavoidforcefeedingchildrenavoidoverfeeding第52頁/共82頁5.良好的進(jìn)餐環(huán)境

havemealtimestogetherasafamily(whenpossible)limitdistractionsatmealtimes6.

注意飲食衛(wèi)生第53頁/共82頁ABC1.Presentsapplesauce2.Criesandwhines,pointstotherefrigerator3.“whatdoyouwant”4.Cries,pointstocupboard5.“Doyouwantacracker?”6.Cries,pointstorefrigerator7.“Whatdoyouwant?No,youcan’thaveicecream.”8.Childscreams9.”O(jiān)K,hereissomeicecream.”10.Stopcrying第54頁/共82頁ABC1.presentapplesauce2.Cries,pointstocupboard3.leavesroom(canseechildbuthecan’tseeher)4.slowingstopscrying,startseatingapplesauce5.Returnsandsays“Whatabigboy!”6.Childlaughsandkeepsoneating第55頁/共82頁

青春期的營養(yǎng)和膳食

nutritionanddietaryofadolescents

第56頁/共82頁青春期早期：growthspurt

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

青春前期

青春后期第57頁/共82頁青春期少女的生理和心理

青春期的生理特點1．身高和體重生長突增（growthspurt）體成分（bodycomposition）

Thegrowthspurtusuallybeginsaround10yearsofageingirlsand12yearsofageinboys.Inbothsexes,anaverageof23cmisaddedtoheightand20-26kgtoweight.Beforeadolescence,bothgirlsandboyshaveanaverageof18%bodyfat.Duringadolescencethisincreasestoabout28%ingirlsanddecreasestoabout15%inboys.第58頁/共82頁2．性器官的發(fā)育和第二性征的出現(xiàn)性器官內(nèi)生殖器官：陰道、子宮、輸卵管和

卵巢外生殖器官：陰阜、大、小陰唇和陰蒂第二性征：乳房、陰毛、腋毛3.各組織、器官、系統(tǒng)的發(fā)育第59頁/共82頁性腺腺垂體神經(jīng)垂體

下

丘

腦

組織腎上腺甲狀腺LH－RH

FSH-RHGRHPIFPRFGRIHGRHTRH雌激素孕激素睪丸酮LH

FSH

ACTH

GH

TSH

PRL

腎上腺皮質(zhì)素雄激素興奮抑制青春期內(nèi)分泌調(diào)節(jié)示意圖神經(jīng)中樞甲狀腺素第60頁/共82頁

青春期的營養(yǎng)需要

NutrientRequirements影響因素：1.發(fā)育早晚

2.體力活動水平

3.個體差異第61頁/共82頁第62頁/共82頁1.Energy16歲10.0MJ（2390Kcal）

18歲

8.8MJ(2100Kcal)2.

Proteinpositivenitrogenbalance1.6～1.9g/kg80g(>70g)第63頁/共82頁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頁/共82頁2).Ironironisneededfor:l

growthofbodytissuesl

increaseinbloodvolumel

replacementofironlossesinmenstrualbloodiron-deficiencyanemiaRDA10～

12mg/d13～

20mg/d18～

12mg/dAI11～

18mg/d14～

25mg/d18～

20mg/dUL505050

第65頁/共82頁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頁/共82頁四．維生素(Vitamins)1.

Vit.A2.

Vit.D3.

Bvitamins4.

Vit.C第67頁/共82頁一日食譜舉例第68頁/共82頁AnorexianervosarefusaltoeatenoughtomaintainanormalbodyweightintensefearofgainingweightorbecomingfatSufferersareoftheimpressionthattheyarefatandoftenseethemselvesasbeingfateventhoughtheyareobviouslyunderweight.exercisevigorouslyoruseslimmingpillsoftenstopmenstruating.oftenverysecretiveabouttheireatinghabits.第69頁/共82頁第70頁/共82頁Thatautumn,HeatherwasrejectedbyOxford.Bynowitwasevidentthatshewasverythin.AtChristmas,herbehaviourledtomajorupsetsandrowsinthefamily.Finally,earlyintheNewYear,herparentspersuadedhertoseethefamilydoctor.Whenweighedatthesurgery,shewasjustundersixstones(37kg).Itwasclearnowthatshewassufferingfromanorexianervosa.第71頁/共82頁第72頁/共82頁老年營養(yǎng)

Thechangesofagingchangesincellsandor