Proper nutrition is incredibly important all
throughout a person’s life. As life progresses, nutritional needs and
challenges can change dramatically. All of these changes, however, are linked
throughout a human’s lifecycle. For instance, not getting enough calcium as an
infant could eventually result in brittle bones or osteoporosis as an adult.
For this reason, it is important to study the nutritional needs of all ages,
and to be aware of the nutritional deficiencies that all people may face at
some point in their lives.
Infants, children, adolescents, adults, and the
elderly have similar basic nutritional needs, but at each time of life there
are specific issues that affect nutritional requirements (eg, pregnancy and
Nutrition in Pregnancy
A woman’s nutritional needs increase during times
of pregnancy and while breastfeeding. It is important for a woman to be in good
health prior to and during pregnancy. The way to that optimal health is through
good nutrition. It is recommended that a woman of normal weight at the
beginning of pregnancy consume an extra 150 to 200 calories per day during the
first few months of pregnancy. The recommended amount increases to about 300
extra calories per day during the third trimester and during lactation. Caloric
intake beyond an extra 300 calories is not necessary in most cases and can
result in excessive weight gain.
The global recommendation for at least five
servings of fruits and vegetables, along with whole grains, protein, and
low-fat dairy products applies during pregnancy and lactation as well. In
addition, pregnancy and lactation increase the need for some nutrients, the
most important of which are folic acid, iron, calcium, vitamin D, and protein.
A deficiency of folic acid can result in neural
tube defects (eg, spina bifida) in the fetus. Sufficient folic acid is critical
for at least three months before conception and during pregnancy and lactation;
the recommendation is for 800 mcg. During pregnancy, a deficiency of iron,
which is the most commonly deficient nutrient in the United States, can lead to
underweight or preterm babies. For pregnancy, the recommendation is 27 mg per
day; while breastfeeding, 10 mg per day. Calcium and vitamin D, which work
together, are necessary for proper bone development of the fetus. Pregnant
women over age 19 need 1,000 mg of calcium per day; under age 19, it increases
to 1,300 mg per day. The recommendation for vitamin D is 600 International
Units (IU) per day. Protein, of course, is necessary for the building of
tissues in the fetus as well as for maintaining the mother’s body tissues;
about 71 grams per day is recommended during both pregnancy and lactation. A
deficiency of zinc also can lead to health problems for the infant.
Infants and children must
consume sufficient nutrients to sustain their growth. The rate of growth can
vary considerably from one infant to another, but generally infants are
expected to double their birth weight in six months and triple it in twelve
months. For most infants, breastfeeding alone until four to six months of age
will provide all the nutrients needed. Pediatricians recommend that infants
begin receiving solid foods starting around four to six months of age.
When solid foods are
introduced at around four to six months of age, one food at a time should be
introduced with a period of about seven days between each food introduction. Introducing
foods in this way will make it easier to identify possible food allergens.
Certain foods that tend to cause allergies should not be given to infants;
these include eggs, nuts, and shellfish. Honey should not be given to infants
under one year of age because it can contain a botulism toxin that is not
harmful to adults but can cause problems in infants.
Premature infants may
need more supplementation than those born at full term; iron is one nutrient
that may need to be supplemented earlier in premature infants. An infant
receives enough iron from his or her mother during the last three months of
gestation to last until about four months old. If an infant is born preterm, he
or she may not have had the time needed in the womb to receive enough iron
Prematurity can affect
the nutritional status of an infant. An infant born prematurely may not have
developed enough of a sucking reflex to breastfeed properly; yet breastfeeding,
if possible, is the ideal for any infant whether premature or not. This problem
can be overcome by pumping breast milk and feeding it to the infant with a
bottle to ensure that it gets enough nourishment; at the same time, the infant
should be breastfed as much and as often as possible to encourage development
of the sucking reflex.
Failure to Thrive
describes a situation when a child’s or an infant’s rate of weight gain is
significantly less than normal. There can be wide variations in the rates of
children’s growth, but with Failure to Thrive, usually the weight is below the
third percentile in growth charts. If the condition is short-term and is
treated, the child will develop normally. If Failure to Thrive lasts for a long
time, however, normal growth and development will be affected. There can be
many reasons for Failure to Thrive, including medical problems or environmental
causes, which lead to psychosocial problems. Some of the medical reasons may
include chromosome abnormalities, endocrine or central nervous system problems,
and gastrointestinal problems. Environmental problems may be poor eating
habits, poverty, emotional deprivation, and caregivers’ ignorance of proper
feeding. If caregivers’ ignorance is a factor, nutritional education of the
caregivers is necessary.
Healthy food requirements for children are
basically the same as for adults. Since children are growing, they may need
more energy foods than adults do; however, those energy foods should be from
healthy sources of food such as whole grains, fruits and vegetables, dairy, and
protein. Childhood obesity is a widespread problem related to the consumption
of high-fat and high-sugar convenience foods plus lack of regular exercise
among children. It is estimated that one in three children in the United States
is obese or overweight. The Department of Health and Human Services is
attempting to address the epidemic of childhood obesity with educational and
informational resources for parents.
Issues in Adolescence
Adolescence, a period of roughly ten years from
about age 11 to age 21, is a time of rapid growth. Infancy is the other time of
life when growth is most rapid. In infancy, the growth is mainly physical, but
with adolescence, there are rapid emotional and mental changes as well. It is
during adolescence, particularly late adolescence, when the most bone mass is
accumulated. It is estimated that 40% of total bone mass is accumulated during
late adolescence. Studies suggest that if bone mass accumulation is not
maximized during adolescence, it can lead to osteopenia and osteoporosis later
For maximum bone accumulation, there must be sufficient
calcium intake during adolescence. At present, the suggested level of calcium
intake in adolescence is 1300 mg per day; that figure may increase in the near
future. Many adolescents do not get enough calcium to ensure good bone mass
levels. In addition, high-phosphate sugary soft drinks, which are popular with
adolescents, work against the sufficient accumulation of calcium as bone forms.
Adolescence is a time of rapid emotional and
physical change, when the body is changing from that of a child to an adult.
The need for many nutrients increases during adolescence, but adolescence is
also the time of life when eating disorders are most likely to appear. The
rapid growth in adolescence with increased need for nutrients along with the
extreme restriction of proper nutrients that the eating disorders produce can
lead to severe consequences.
Anorexia nervosa and bulimia nervosa are the two
most common eating disorders seen in adolescence. These eating disorders are
more common in female adolescents than in males, although there is some concern
that they may be increasing among male adolescents.
In anorexia nervosa, the individual severely
restricts her food intake so that her weight drops to an unhealthy level. A
sufferer of this condition has a distorted self-image; the adolescent believes
that she is fat no matter how much weight she loses. Along with the severe
weight loss, important macronutrients and micronutrients are missing and out of
balance, which can lead to serious results—in extreme cases, even death. It is
estimated that about 1% of the adolescent female population in the U.S.
suffers from anorexia nervosa.
Bulimia runs a slightly different course. Binging
and purging describes bulimia; the person regularly eats beyond satiation, then
makes herself vomit or misuses laxatives to force her bowels to empty
(purging). It is estimated that up to 20% of college-age females practice these
techniques occasionally, but 2% to 4% engage in these activities regularly
enough to meet the criteria for bulimia. While anorexics tend to be thin to the
point of emaciation, bulimics often maintain a normal weight. The distorted
self-image, however, is present in bulimia as in anorexia nervosa.
Bulimia usually does not produce the extreme
nutritional deficiencies that anorexia nervosa does, especially if the
individual maintains a near normal weight. The psychological issues present in
anorexia are also present with bulimia and must be addressed during treatment.
In both conditions, the sufferers’ attitudes toward food are distorted, and
treatment interventions must help them develop a more realistic and less
obsessive attitude about food. The patient is not treated alone; interventions
should include families and address family dynamics as well as focusing on the
individual. This is true for both anorexia nervosa and bulimia.
There are oral signs that appear with bulimia.
One oral sign of bulimia is a characteristic erosion of the lingual surfaces of
the teeth, especially the maxillary teeth. This erosion is due to the acid
produced by frequent vomiting. Other oral signs are cracked lips, irritation of
the throat, and swollen salivary glands due to the acid reflux. If the enamel
erosion is severe, restorations may protrude beyond the enamel surface. Patients
may be suffering from pain in the oral cavity, which can make eating difficult
and thus hamper recovery from either disorder. Dental professionals should be
aware if these signs are present, question the patient carefully, and refer for
treatment when necessary.
For a patient who suffers from bulimia, there are
suggestions that the dental professional can make to minimize the effects of
vomiting. Rinsing with bicarbonate of soda as a mouthwash after vomiting will
help neutralize the acids in the oral environment. Brushing immediately after
vomiting episodes should be discouraged because brushing after vomiting can
lead to abrasion. Fluoride treatments may be prescribed to help protect the
Treatment for both anorexia nervosa and bulimia
consists of a multi-disciplinary approach. The physical manifestations must be
treated as well as the psycho-social aspects. At the root of these conditions
are psychological issues that must be addressed. Treatment often continues for
years into young adulthood. Relapses are quite common and patients are often
resistant to treatment methods. The psychological and emotional issues can last
into adulthood and can be very difficult to overcome.
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Issues in Adulthood
Research over the past 60 to 70 years has challenged
much of what was previously believed in the U.S. about diet and nutrition. The
custom of three “square” meals a day, centered around meat, gravies, and heavy
starches, has evolved into an emphasis on fruits, vegetables, and whole grains
with some low-fat dairy as the basis for a healthy diet. The prevalence of
obesity, diabetes, and heart disease today illustrates the problem that many
still have not adopted the recommended changes in eating patterns.
Recent and ongoing research studies are concentrating
on the abilities of various types of food to prevent heart disease and cancer.
Some results have suggested that certain foods play a role in prevention. Diets
high in saturated fats are linked with high blood cholesterol levels, which are
associated with heart disease. Studies have shown that diets containing more
polyunsaturated fats, on the other hand, tend to lower the risk of heart
disease. It is recommended that people limit saturated fats and increase their
intake of polyunsaturated fatty acids like omega-3 fatty acids. This applies to
everyone, but it is especially important for those who are at risk of heart
Several foods have been linked with cancer
prevention; garlic, red wine, and tea are a few. Foods high in anti-oxidants,
calcium, and vitamins A, C, D, and E have also been the subjects of cancer
prevention studies. Some studies have suggested that calcium and garlic, for
instance, can help prevent colorectal cancer. Thus far, the research is
inconclusive and more studies and clinical trials are needed to confirm the
early results. At present, ingesting excessively high amounts of any of these
substances or nutrients is not recommended (especially the fat-soluble vitamins
A, D, and E). Even “good” nutrients like calcium can be toxic in very high
doses. Supplements, while they may have a place for certain situations, are not
a good replacement for nutrients that can be acquired through a varied diet.
The best practice is to consume a varied diet centered on fruits, vegetables,
and whole grains (the DASH diet is a good example), and to try to get as many
nutrients as possible through diet rather than supplements.
Proper nutrition is very important for healing
after surgery or an injury. Poor nutrition can delay healing. For best results
after surgery, health professionals now emphasize proper nutrition before as
well as after a scheduled surgical procedure. Often, a dietician may be part of
the surgical team, especially in cases where nutrition may be an issue (eg, chronic
disease or alcohol abuse). In some cases, the surgical procedure may be
postponed to give the patient—in concert with a health professional—time to get
into a better health state. This is becoming a more common practice even in
dental offices, especially periodontal and oral surgery practices. Some
nutrients that have been suggested to directly affect wound healing include
adequate protein, vitamins A and C, and possibly zinc.
A problem that has been receiving some attention
recently is that of polypharmacy, which can be defined as prescribing or using
several different drugs for different conditions. Polypharmacy generally
applies to older adults, who may be more likely to have multiple health
conditions and, therefore, several drug prescriptions. It can be a problem for
younger adults as well. With polypharmacy, the interaction between the
different medications can increase unwanted side effects, reduce the
effectiveness of the medications, and even produce toxic effects. This becomes
even more problematic if an individual is having prescriptions filled by multiple
pharmacists. The different pharmacists may not be aware of all the medications
being taken by that individual.
Considerations in Aging
As people age, they experience changes that can
affect their nutrient intake and how efficiently their bodies use nutrients.
For instance, it is not unusual for an older person’s sense of taste and smell
to diminish, which can lead to loss of interest in food and eating. This can
become a vicious cycle because a lack of certain nutrients (eg, zinc) can
affect a person’s sense of taste and smell, so the reduction in intake of
nutrients further exacerbates the reduced taste sensations.
Xerostomia (ie, dry mouth) is another condition
that is often found in the older population. Xerostomia is most often a side
effect of medications, especially medications for hypertension and other
conditions that affect older individuals. Autoimmune conditions, cancer, and
cancer treatments can also cause this condition. A person’s sense of taste can
be affected, and xerostomia can also be associated with changes in both the
hard and soft oral tissues. Caries susceptibility increases with the condition,
and soft tissue lesions and cracked lips can be found in individuals who are experiencing
severe xerostomia. The discomfort and pain associated with the soft tissue
lesions can make eating uncomfortable, which can lead to nutritional
Some suggestions that the dental professional can
make to help reduce the effects of xerostomia include: sipping water often;
Biotene products for dry mouth; artificial saliva products; using an
alcohol-free mouthwash (there are many on the market today); and avoiding dry
or chewy foods. Pilocarpine can be prescribed to help reduce xerostomia. Often
a patient who is experiencing this condition will suck on hard candies or chew
gum to stimulate saliva production. In such situations, suggest using candies
and gum that are sweetened with xylitol instead of sugar.
Gastrointestinal function generally does not
change greatly in healthy elderly individuals because of the large functional
reserve that is present in the gastrointestinal tract. Nevertheless, there are
some gastrointestinal changes that accompany aging. Diverticulitis affects more
than 50% of people over age 70, but not all experience symptoms. The digestive
process tends to slow down in older individuals; as a result, about 35% of
individuals over the age of 65 experience some constipation. Stomach and colon
cancer rates increase in the older population.
Some studies have shown that nutritional status
declines in the elderly due to gastrointestinal changes. This seems to be more
of a problem in the elderly who live in care settings or are hospitalized.
Declining nutritional status seems to be associated with factors other than
gastrointestinal changes alone. Elderly people who feel isolated and who do not
have much contact with others may suffer from depression or anxiety disorders.
If they do not have help with meal preparation and other tasks, it can affect
their nutritional health status.
According to the American Psychological
Association, elderly people generally are not as cognitively impaired as widely
believed. There may be some slight decline, but usually it is not enough to
affect daily living tasks. Also, according to the APA, six percent of older
adults suffer from anxiety disorders, but depression is less prevalent among
non-institutionalized older adults than it is in younger populations.
Research shows that aging has a significant
effect on immunity, and that the immune response decreases as adults age. This
decreasing immune response generally involves a diminishing production of
T-cells because the thymus shrinks as an individual ages. This may be
associated with the increased susceptibility to infection that some older
people have. It may also play a role in the increased risk of cancer that is
seen in the elderly.
Nutritional status has a definite effect on
immune function, and many experts suggest that older adults take a
vitamin/mineral supplement to increase immune function. Studies have shown that
a nutritional supplement will increase the immune response and, therefore,
improve the health of older adults. According to one study by the Council for
Responsible Nutrition, many older adults are deficient in vitamins D and E,
calcium, folate, and several minerals. Supplementation with these nutrients
increased the immune response in these older individuals.
Nutritional resources are available online to help
people with nutrition questions and with tools for ensuring that they get
adequate nutrition in their diets. The Food and Nutrition Center,
a division of the U.S. Department of Agriculture, has a very useful website (http://fnic.nal.usda.gov/) with information and resources for consumers as
well as for professionals. The website is user-friendly and contains helpful
suggestions for healthy eating.