01.04 Nutritional Requirements

This lesson is going to cover nutrition requirements in healthy individuals. 

We are going to be talking about children age 4-13, adolescents age 14-18, pregnancy, older adults and athletes.

Let’s start with children ages 4-13.  Think of a preschooler standing next to a middle schooler. That’s a big difference in size with both height and weight, right?  4-13 is a long age range.  So it makes sense that the recommendations will change a lot during this stage in life. The recommended calorie level is going to vary, based on their metabolic rate, rate of growth (think how many growth spurts boys and girls age 4-13 go through!  And their physical activity level is going to vary a lot over these years. The general recommendation is 1200 calories for females ages 4-8 and 1600 females age 8-13.  For males, it is a little higher at 1400-1600 for ages 4-8 and 1800 for ages 9-13.  Adequate calorie intake will provide adequate growth and development, without having too less or too much resulting in improper growth or unwanted weight loss or gain.  Activity level also determines the recommended CHO level.  The general recommended amount is 130 g/day; or 45-65% of total calories. Protein recommendations are 19 g/day for both malesand females ages 4-8 and almost double to 34 g/day for ages 9-13.  The goal for percent of calories from protein is 10-30%.  Lastly, the recommended fat intake stays consistent at 25-35% of total calories.    

With all of this rapid growth, we can see why Fe, an important component of Hgb that

moves O2 from the lungs to the rest of the body plays an important role in 4-13-year-olds.  The recommended daily intake is 10 mg for boys and girls age 4-8 and drops down to 8 mg for ages 9-13, before it bounces up in adolescence.  Think of all the mineralization and maintenance of this growing bone during this time.  That’s what makes calcium and Vitamin D so important.  Calcium rec is 1000 mg for boys and girls ages 4-13 and jumps up to 1300 mg for ages 9-13.  Vitamin D is 600 IU for males and females between ages 4-13 (same as adults!!!)  Yes, that little kindergartner needs just as much vitamin D as their parents!!

Next let’s look at adolescents age 14-18.  Think of a high school freshman standing next to a college freshman.  Big different, right?  Similar to the recommendations for children, calorie levels vary based on metabolic rate, rate of growth, body composition and physical activity level.  The general recommendation is 1800 calories for females and 2200-3200 calories for males.  Best evaluated by progression of growth over time.  The macronutrient recs same as adult except for protein.  Carbohydrate recs vary based on activity level (i.e. athletes).  Just like with children and adults, 130 g/day is the general recommendation; 45-65% of daily calories.  Protein recs are 46 g/day females and 52 g males.  Protein % of calories are the same at 10-30% of total calories.  Fat recommendations hold steady at 25-35% of total calories.

Iron needs are increased during adolescence due to all that lean body mass deposition, increased red blood cell (RBC) volume, and to support females for iron loss during menses.  The female recs are 15 mg for females age 14-18.  Remember the recommendation was only 8 mg for 9-13-year-olds.    The male recommendations only go up slightly to 11 mg.  Calcium intake during this time is critical due to accelerated muscular, skeletal and endocrine development.  Bone mass is acquired at much higher rates during adolescence than any other time of life (up to 4X higher rate).  Females accrue approximately 92% of bone mass by age 18 – 92%!!! making adolescence a critical time for osteoporosis prevention.  That is why it has been called the pediatric disease with geriatric consequences.  Calcium recommendations stay at 1300 mg for 14 to 18-year-olds.  Zinc is essential for growth and sexual maturation.  9 mg for females and 11 mg for males are the recommendation.  Folic acid is needed to support all that accumulating lean body mass and as a preventive measure in females of reproductive age.  400 mg for males and females is recommended.

Next up is pregnancy.  And guess what.  With a human growing inside a human, pregnancy brings some different nutritional requirements.  Overall, it is important to take a prenatal supplement and to eat a variety of foods to get all the necessary nutrients.  The calorie needs depend on pre-pregnancy weight and nutritional status.  If someone’s pre-pregnancy weight in underweight, they may need additional calories beyond the typical recommendations.  If the pre-pregnancy weight is overweight, they may need less calories than the recommendations.  So let’s look at an example, a 5'7" female, age 28, 150 lbs pre-pregnancy (MyPlate Plan).  Her first trimester calorie intake recommendation would be the same during the first trimester as it would if she wasn’t pregnant – 2400 calories.  Her second trimester would be a 200 calorie increase from first trimester – 2600 calories.  Her third trimester would include a 200 calorie increase from second trimester – 2800 calories. 

So what does that look like for food?  Let’s look at her MyPlan.  2400 calories would be 2 cups fruit, 3 cups vegetables, 8 oz grains, 6.5 oz. protein and 3 cups from dairy. That 200-calorie difference to 2600 calories is going up to 3.5 cups vegetables and 9 ounces grains.  All other food groups stay the same.    2800 calories has her fruit increase to 2.5 cups, vegetables up to 3.5 cups, grains would be 10 oz and her protein would be 7 oz.  Dairy stays the same.  So you can see, not a big difference in total calorie intake.  And it’s important they are quality calories.

Iron intake during pregnancy helps with the increased amount of blood to supply oxygen to the fetus.  Maternal iron deficiency is the most common nutrition deficiency during pregnancy.  Pregnant women need at least 27 mg iron each day (compared to 18 mg non-pregnant).  Calcium is needed for the healthy development of a baby's bone, teeth, heart, nerves and muscle.  If inadequate calcium is consumed, it can be taken from her bones for the baby.  1000 mg daily is the daily recommendation.  Folic acid during pregnancy reduces the risk of birth defects that affect the spinal cord.  All women of childbearing age, even if not planning to become pregnant, and pregnant women should consume at least 400 mcg daily. 

People may have their own definition of “old” and that can change as people themselves get older.  For nutrient recommendations, it is 51+.  Calcium recommendations increase to 1200 mg for females at age 51+ and males at 71+ (1000 mg previously for both).  Vitamin D recommendations for females and males at age 71+ increase to 800 IU (previously 600 IU). 

The last group we are going to look at is athletes.  Calorie recommendations vary on based on their age, gender, body composition, type of sport, goals, position played within a sport, etc.  Such as football, a defensive lineman and a wide receiver, their needs are going to be a lot different.  Or a marathon runner compared to a runner doing an explosive 100 m sprint.  With all sports, it is important to support the athlete’s energy expenditure, maintain strength, muscle mass, endurance and overall health.   

Guess what a great source of energy for athletes is?  Yup, carbohydrates.  Carbohydrate, like calories,will also vary based on type of sport, position played, etc. And their training schedule.  A general suggestion is 6-10 grams carbohydrates per kg of body weight per day for athletes getting ~2-3 hours of moderate to high intensity exercise per day. 

With athletes, it’s best to evaluate their diet first before considering supplements because protein needs can typically be met through diet alone.  The recommendation is 1.2 – 2.0 grams of protein per kilogram (g/kg) of body weight.  Higher than the .8/6 kg for non-athletes. To optimize muscle growth, they should consume ~15 – 25 grams of high-quality protein within two hours after training.  Protein should be consumed throughout the day with high-quality meals and snacks. 

Fluids should be consumed throughout the day (every day), not just right before exercise to stay well hydrated.  During exercise, <60 minutes water only is adequate; >60 minutes, or multiple sessions a day (football 2-a-days or a soccer tournament when there are more than one game the same day), a sports drink may be needed in addition to water.  If hot and humid environment, additional fluids and electrolytes may need to be considered.  Fluids should be replenished soon after exercise is completed.  A general rule of thumb is ~16 oz fluid for each pound lost during exercise.

In summary, nutritional needs are different at different ages/stages of people’s lives.  Children have unique requirements due to their rapid growth and development.  As well as adolescents with their continued growth and development, including puberty.  Pregnancy recommendations (of course) are to support baby growth and development and the woman’s health throughout the pregnancy.  Older adults have a few different nutrient requirements that go up as they get older.  Athletes needs are based on a lot of variables of them and their sport(s).

We love you guys! Go out and be your best self today! And as always, Happy Nursing!