LACTATION

The human milk of an adequately nourished lactating mother

offers nutritional immunological and psychological benefits not
paralled by bottle-feeding with milk formulas. Breast-feeding is
the preferred feeding choice for infants for at least the first 6
months of age. Hence, lactating mothers during the first 6 months
after the baby is born has higher intakes for some nutrients,
compared to the 7th to 12th months. Ideally breast-feeding should
be continued until the 12th month of age even if supplementary
weaning foods are given. On the average, a lactating mother
produces 750 to 1000mL of milk per day. Nutrient requirements of
the mother during lactation are increased to provide for normal
secretion of milk and for recovery from pregnancy and delivery.
The calorie requirement is increased by 300 to 400kcal/day for
lactation over that of the non-pregnant state for ages 19 years
and over. Similarly, intakes for protein, minerals(particularly
calcium), and vitamins are increased.

Infancy
The first 12 months of life are characterize by the most rapid rate
of growth and development of the entire lifetime during which the
infant should have tripled its birth weight and increased its length
by 50%. Thus, an infants nutritional needs merit special attention.
According to FNRI-DOST (2002), the energy requirements of
infants 3 to <6 months can be met by breastmilk. The
recommendation 6 to <12 months can be met bybreastmilk
together with the supplementary foods. The Philippine
Department of Health(DOH), the World Health Organization(WHO),
the American Academy of Pediatrics(AAP) and the American
Dietetic Association(ADA) recommends exclusive breastfeeding
for the first 6 months. According to the ADA(2009), whenever
medically possible, exclusive breastfeeing is given for the first 6
 months after delivery and supplementary foods are given with
breast-feeding in the next 6 months. Increases in initiation and
durationof breast-feeding are needed to realized the health,
nutritional,immunological, psychological, economical and
environmental benefits of breast-feeding.

Young Children
(1 to 6 y.o.)
The nutritional problem of the toddler from 1 to 3 years of age is
only an extension of his or her needs from infancy. The primary
concern is to increase gradually the kind amount of food and to
lessen the number of feedings to three meals with in-between
snacks. Significant in this period is the establishment of proper
food habits at home, hence the need for nutrition education for
mothers. The age group composed of 1 to 6 year-old children
constitutes a far more nutritionally vulnerable group than infants.
Children at this stage need considerable amount of energy and
nutrient requirements to support their growth and development
but they have small stomachs, which prevents them from
consuming large quantities of food. Developing food habits and
nutritious food choices are crucial in these age periods. These
ages are the most formative years of child development in all
aspects of personality (physical, mental, and social). For nutrient
requirements of young children ages 1 to 3 and 4 to 6 years old. A
preschooler with good nutrition manifests the following signs: 1)
alert, vigorous and happy (not irritable and restless); 2) has
endurance during activity; 3) sleeps well; 4) has normal height
and weight for age; 5) stands erect, arms and legs straight; 6) has
clear, bright eyes; 7) smooth, healthy skin;8) lustrous hair; 9) firm
and well-developed muscles; and 10) good attention span.

Children
 (7 to 12 y.o.)
Children need more nutritious foods in proportion to their weight
than do adult because they are growing and developing bones,
teeth, muscles, 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. Signs of good nutrition in middle childhood are as
follows: 1) well developed body with normal weight and height; 2)
firm and well-developed muscles; 3) good posture; 4) health skin,
no lesions and dyspigmentation; 5) smooth and glossy hair; 6)
clear eyes; 7) alert facial expression and good disposition; 8)
sound sleep; 9) good digestion and elimination; and 10) good
appetite. Proper nutrition improves not only overall health status,
but stays the learnings, responsibilities and attention span of
school children. Feeding this age group is said to be the best and
most cost-effective health preventive measure private nutrition
agencies and government programs should support.

Adolescents
The adolescent period is characterized by an accelerated growth
rate and intense activity due to physical, social, emotional, and
mental changes. It is transition period between childhood and
adulthood. Girls mature earlier than boys. The nutritional needs of
adolescents are conditioned primarily by the building of new
tissues, the demands of increased physical activity, and to some
extent and emotional changes attending maturation. Important to
this period is body image and the influence of peer pressure. In
general, the growing adolescent requires a high caloric intake, an
abundance of good-quality protein, and a liberal intake of the
onset of menstruation, adolescent girls have specific nutrient
needs, especially for iron, protein, and other nutrients essential
for blood formation.
 Adult and Older Persons
Adulthood is the period of life when one has attained full growth
and maturation. The onset of this stage varies among individuals,
and there are no clear-cut age boundaries. However, in relation to
dietary needs, adulthood pertains to the years between ages 20
and 64 without stresses, such as pregnancy, lactation, and
convalescence. Proper nutrition has to be emphasized in
adulthood, since it is the largest period of the life cycle and
possibly the years of peak productivity. The population in this age
group that needs special mention is the female adults up to age
40, who bear children and those who use oral contraceptive
drugs. Ideally, one should reach adulthood with broad familiarity
with and acceptance of different foods, as well as sound food
habits. Adults tend to resist changes in their food habits, hence
the importance of proper training both in food selection and in
regularity of eating as early in life as possible. Another aim of
good nutrition throughout adulthood is the maintenance of a
healthy body weight. It is recommended that the daily calorie
allowances can be reduced with increasing age and to observe a
heart healthy diet.

NCP
(Nutrition Care Process)
According to ADA 2008, Nutrition Care Process is a road map to
quality nutrition care which provides a systematic problem solving
method that health professionals use to critically think and make
decisions to address nutrition problems and provide safe and
effective quality nutrition care.The relationship between the
client and dietetics professional(s): collaborative, client-focused,
individualized. According to ASPEN, Nutrition Risk Screening is
 rapid and simple process conducted by admitting staff or
community healthcare teams. Nutrition Screening address four
basic questions: Recent Weight Loss, Recent Food Intake, Current
Body Mass Index(BMI), and Disease Severity. Nutrition Screening
also covers the following areas: Physical ability to ingest food,
food intolerance and/or dietary modifications, alcohol use/abuse,
and polypharmacy. Patients identified as being at nutritional risk
need nutrition assessment. Patients not at nutritional risk are
periodically reevaluated on the basis of criteria established by the
individual institution. Nutrition Assessment is a dynamic process
that evolves throughout the NCP as the pt.s status changes or
new information is available. Data Sources/Tools for Assessment:
screening of referral form, patient/client interview, medical or
health records, consultation with other caregivers, including
family members, community-based surveys and focus groups.
Categories of Nutrition Assessment Data: patient history,
anthropometric measurements, physical examination/clinical
findings, biochemical data, medical testsand procedures, and
diet/nutrition history. Nutrition Diagnosis is a crucial element of
providing quality nutrition care. It is a food and nutrition
professionals identification and labeling of an existing problem
that the food and nutrition professional is responsible for treating
independently. Nutrition Intervention are purposely-planed
actions designated with the internet of changing a nutrition-
related behavior, risk factor, environmental condition, aspect of
health status for an individual, a target group, or population at
large. Nutrition intervention is primarily aimed at etiology or
effects of nutrition diagnosis and may be directed as s/s to
minimize their impact. Nutrition Monitoring & Evaluation is a
follow-up. It determines whether participant is meeting nutrition
intervention goals or desired outcomes. It identifies the amount of
progress made. It identifies outcomes relevant to the nutrition
diagnosis and intervention plans and goals.
 Nutrition in the Health Care Setting
Dietetics
is a combined science and art of regulating the planning,
preparing and serving of meals to individuals or groups under
various conditions of health and disease according to the
principles of nutrition and management with due
consideration to economic, social, cultural and psychological
factors.
Diet Therapy
is concerned with the use of food for therapeutic
purposes. It includes the modification of the normal diet to meet
the physiological requirements of the sick individual.
Nutrition Therapy
refers to interventions used in the treatment of a disorder
or illness and includes diet therapy, nutrition counseling, and/or
the use of specialized nutrition therapies such as supplementation
and nutritional support.
Diet
food and drink consumed regularly by an individual. It is
not limited to just a weight-loss diet.
Dietitian/Clinical Dietitian/Medical
Nutrition Therapist
is the translator of nutritional principles for any individual
or group in health or in illness.
Therapeutic Diet
is a diet modified or adopted from the normal diet to
suit specific disease conditions; one designed to treat or cure
disease, or to support medical management of a disease.
Diet Order
a physicians written statement in the medical record of what
a client should receive
*to avoid confusion, physicians should provide clean and
precise diet orders.
Diet Prescription
- same as Diet Order, Diet Specification
Diet Manual
a book that describes the foods allowed and restricted in a
diet, outlines the rationale and indications for use of each diet,
and provide sample menus.
*the dietary department uses the manual to design menus
for each diet.
therapeutic diets are special diets developed to treat disease
or metabolic disorders.
Examples of Therapeutic Diets
Regular diet - Balanced diet ;also called general full,
normal diet. Formerly called DAT (diet as tolerated)
Liquid diet-Nutritionally inadequate and should be used
for short periods of time only.
Soft diet-foods must require little chewing and be easy
to digest. Does not include pureed foods.
Diabetic diet- for people whose body does not produce
enough insulin to metabolize carbohydrates.
Calorie controlled diet
Low cholesterol diet
Vegetarian diet-Plant-based meals consisting of a
variety of whole grains, legumes, nuts, vegetables,
fruits, and for some, eggs and dairy products.
Fat restricted (low-fat) diet-Limits fat to 10-15% of total
calories. Fat restriction implies that both visible fats and
fats incorporated into foods are limited.
Sodium restricted diet-(low sodium or low salt diet)
Used for patients with cardiovascular diseases such as
high blood pressure or congestive heart disease or
kidney disease.
High Protein diet-used for children and adolescents who
need additional growth, pregnant women, patients
 before and/or after surgery, patients suffering from
burns, fevers, or infections.
Bland diet-A diet that eliminates foods known to
stimulate gastric acid secretion/motility, irritate the
gastric mucosa or cause indigestion.
Low residue diet-Diet similar to a low-fiber diet, but
typically includes restrictions on foods that increase
bowel activity, such as milk and milk products and
prune juice
Enteral diet-A type of nutrition support that provides
liquid formula diets by mouth or by tube into the GI
tract for persons unable or unwilling to ingest or
tolerate conventional foods.
Parenteral diet-A type of nutrition support that provides
nutrients to those who are unable to assimilate them
via the gastrointestinal tract.