最全的营养和食品卫生学--特殊人群的营养ppt课件

特殊人群的营养 Dietary requirements for specific populations,李颖,营养与食品卫生学教研室 Department of Nutrition and Food Hygiene,specific populations,Pregnant women and lactating mothers Infants、 children 、adolescence and older people Athletes specific environment of groups,第一节 孕妇和母乳的营养与膳食 Nutrient and dietary requirements of pregnant women and lactation mothers,pregnancy,lactation,一、pregnant woman,（一）妊娠期的生理特点（physiological changs in pregnancy）,1内分泌 (endocrine) 2血液(blood) 3肾脏 (renal system) 4消化 (gastrointestinal system) 5体重 (body weight),（一）physiological changs in pregnancy,1内分泌 (endocrine) （1）人绒毛膜促性腺激素 （human chorionic gonadotropin，HCG） （2）人绒毛膜生长素 （human chorionic somatomammotropin，HCS） （3）雌激素 (estrogen) （4）孕酮（progesterone）,pregnant woman,Estrogen(pg/ml) 雌激素,HCG 绒毛膜促性腺激素,progesterone 孕酮,Regulation of hormone changes in pregnancy,Weeks of gestation,Weeks of gestation,Weeks of gestation,Weeks of gestation,TSH,(1) Blood volume,45%50%,15%20%,2 Blood,Physiologic Anemia of Pregnancy,Non-pregnant,Non-pregnantl,Late pregnancy,Late pregnancy,Plasma protein,Plasma albumen,(2) Plasma protein,70g/L,60g/L,40g/L,25g/L,Relatively dilution of blood,3Renal system,Renal plasma flow 75%,Glomerular filtration rate50%,Renal reabsorption,肾小球滤过率,肾小管的重吸收,肾血浆流量,蛋白质代谢产物尿素（urea）、 尿酸(uric acid)、肌酸(creatine)、 肌酐(creatinine)等排泄增多 ; 尿中叶酸、葡萄糖排出量增加，出现糖尿。,4Gastrointestinal system,Endocrine changes are probably responsible for the symptoms of nausea(恶心)、 vomiting(呕吐)、 water brash(反酸)、 dyspepsia(消化不良)、 constipation(便秘). Prolonged transit time of food increase nutrient absorption, such as calcium（钙）、iron（铁）、folic acid(叶酸)、Vitamin B12(维生素B12).,5Body weight,The nutritional cost of pregnancy,the products of conception , 胎儿(fetus)、羊水(amniotic fluid) 和胎盘(placenta),母体血液(mother blood), 细胞外液(extracellular fluid) ， 子宫(uterus),乳腺(mammary glands),5Body weight,（二）妊娠期的营养需要 (Nutrient requirements of pregnancy),1能量 (energy costs of pregnancy) Reference Nutrient Intakes (RNI):mid- and late- gestation: +0.83MJ. 2蛋白质(protein) Reference Nutrient Intakes (RNI): early, mid- and late- gestation:5g、15g、20g； 3脂类 (lipids) 20%30% of total energy,（二）Nutrient requirements of pregnancy,4矿物质(minerals) （1）钙(calcium)：,佝偻 (rickets) 骨质软化症(osteomalacia),Adequate intake(AI) ： Early gestation: 800mg， Mid-gestation: 1000mg， Late-gestation: 1200mg。,（2）铁(iron),minerals,New tissue formation,Haematopoiesis in the fetus and the mother,Typical blood losses at delivery,Physiological anemia of pregnancy,Haeme iron comes mainly from haemoglobin and myoglobin in meat, poultry, and fish,Adequate intake(AI)： 孕早期15mg/d， 孕中期25mg/d， 孕晚期35mg/d。,（3） 锌(zinc),Reference Nutrient Intakes (RNI) ： Early gestation: 11.5mg/d， Mid- late-gestation : 16.5mg/d。,minerals,（4）碘(iodine),Reference Nutrient Intakes (RNI) ： +200g/d。,呆小症(cretinism),胎儿畸形(fetal anomaly) 先天性缺陷(congenital defects),5Vitamins,（1） RNI of vitamin A ：800gRE/d(early-gestation), 900gRE/d(mid late-gestation)， UL(tolerable upper intake level):2400gRE/d。 （2）RNI of vitamin D：5g/d(early-gestation)， 10g/d， UL:20g/d。,5Vitamins,（3）Vitamin B： VB1 beriberi VB2 iron deficiency anemia folic acid neural tube defects,400ug of folic acid per day or a diet rich in folates,3-4/1000 pregnancies,less than 1/1000 pregnancies.,（三）妊娠期营养对母体和胎儿的影响 (Influence of maternal nutritional status on mothers and fetus),1. influence of maternal malnutrition on mothers,iron、 folic acid、vitamin B12,Calcium 、 vitamin D,Protein vitamin B1,(nutritional anemia、gestational hypertension Diabates mellitus ),anemia、Hypoproteinemia、 calcium deficiency,2妊娠期营养状况对胎儿和婴儿健康的影响,Influence of maternal nutritional status on fetus and infants,（1）低出生体重 （low birth weight，LBW）,Birthweight of less than 2.5kg,Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia.,（2）先天性畸形（congenital malformation）,Folic acid,neural tube defects,Influence of maternal nutritional status on fetus and infants,（3）脑发育受损 (Brain damage)： maternal nutritional status （protein energy） （5）巨大儿 (macrosomia) nutrient supplementation of healthy pregnant women maternal obesity postpartum,brain development intelligence development,developing gestational diabetes, pregnancy-induced hypertension.,labour in the obese to be prolonged and unsuccessful.,Placental transfer,Carbohydrate:,Mother fetus,Protein amino acids,Lipids:,Concentration-dependent diffusion,Vitamin A:,Bound to retinol binding protein,Vitamin D:,Calcium:,（四）妊娠期的合理膳食原则,1妊娠早期的合理膳食 (rational diet during early gestation) 2妊娠中、晚期的合理膳食 (rational diet during mid late-gestation),二、乳母 (lactating mother),(一) 哺乳期的生理特点(Physiological characteristics):,Colostrum (the first milk):,the first postpartum week, thick yellow fluid with Lactoferrin, secretory immunoglobulin A (sIgA) Low in volume, high in protein Volume of milk is only 50 to 100ml per feed,Transitional milk:,Mature milk :,Over 2 weeks of lactation, increased protein、 lactose and fat content Milk volumes: about 750ml to 850 ml per 24 hours,From 7 days postpartum to 14 days postpartum about 500ml of milk volumes in a day,Nutritional problems associated with breastfeeding,（二）哺乳对乳母健康的影响,1. 近期影响 （1）促进产后子宫恢复： （2）避免发生乳房肿胀和乳腺炎 （3）延长恢复排卵的时间间隔 2. 远期影响 （1）哺乳与肥胖的关系(lactation and obesity)： （2）哺乳与骨质疏松的关系(lactation and osteoporotic) （3）哺乳与乳腺癌的关系(lactation and breast cancer),（三）Nutritional requirement of lactation,1Energy: RNI: increase 2090kJ(500kcal) 2Protein: RNI: increase 20g 3Lipids: 20%25% 4Minerals: （1）calcium： AI 1200mg/d （2）Iron： AI 25mg/d。 （3）Iodine and zinc: AI 200g/d,21.5mg/d 5. Vitamine: 6Water: increment 1L,（四）哺乳期的合理膳食原则,中国居民膳食指南中关于乳母的膳食指南特别强调： 保证供给充足的能量；增加鱼、肉、蛋、奶和海产品的摄入。 1产褥期膳食 2乳母的合理膳食原则,第二节 特殊年龄人群的营养与膳食 Nutrition and diet of populations in specific age,一、 Nutrition and diet of infants （一） physiological characteristics 1Growth and development 2Digestion and absorption 3. Renal system 4Brain and nervous system,1. 唾液分泌量少，唾液中淀粉酶的含量低，不利于消化淀粉。 2. 婴幼儿咀嚼食物的能力较差。 3. 由于胃幽门括约肌发育良好，贲门括约肌发育不良，易引起溢乳和呕吐。 4. 婴幼儿肠壁屏蔽功能较差，肠腔中微生物、毒素以及过敏物质可渗入 肠壁进入血液而致病。 食物在肠腔内时间较长，有利于食物的消化吸收;发生大便滞留或功能性肠梗阻 5. 胆汁分泌较少，影响脂肪的消化吸收。 6. 肠激酶和肽酶，有助于蛋白质的消化和吸收。 7. 胰淀粉酶分泌少量,胰脂酶含量较少,脂肪消化能力较弱，但胰蛋白酶和 胰凝乳酶在出生时已很充足。乳糖酶和蔗糖酶，有利于乳糖和蔗糖的吸收,（二）Nutritional requirments in infants,1Energy:,（4）生长发育消耗能量energy consumption,2Protein,（1）基础代谢 basal metabolism,（2）食物特殊动力作用specific dynamic action,（3）活动activity:,（5）排泄消耗excretion consumption,3Lipids,RNI: 婴儿为1.53.0g/（kgd），12岁幼儿为35g/d，23岁幼儿为40g/d。,6月龄以内为45%50%， 6月龄2岁为35%40%， 2岁以上为30%35%。,4.carbohydrate:,40%50%，随着年龄增长，碳水化合物供能占总能量的比例上升至50%60%。,（1） Calcium: （2） Iron: low iron in human milk （3） zinc: （4） VA: （5） VD: （6） Other nutrient:硫胺素(thiamine)、核黄素(riboflavin)和尼克酸(nicotinic acid), VC VE,5Minerals and vitamins,（三）婴幼儿喂养(infants feeding),1婴儿喂养方式 母乳喂养（breast feeding） 人工喂养（bottle feeding） 混合喂养（mixture feeding）,（l）breast feeding：,1）营养成分最适合婴儿的需要，消化吸收利用率高： 母乳以乳清蛋(lactalbumin)白为主，酪蛋白（casein）； 母乳中必需氨基酸比例适当，牛磺酸含量较高； 母乳中含有乳脂酶； 母乳中富含乳糖（lactose）； 母乳中的矿物质含量明显低于牛乳； 母乳铁和锌的生物利用率都高于牛乳。,2) Anti-infective properties:,macrophages lymphocyes neutrophils,Human milk contains cells,protect infants against infection in the first months of life,Secretory IgA,prevents adherence of viruses and bacteria to mucosal cells,allow destruction of pathogens by the phagocytic components,lactoferrin,facilitate absorption of some nutrients,inhibit microorganism growth and multiplication,breast feeding,3）不容易发生过敏 Unreadily develop allergy in infants 4）经济、方便、卫生 Low cost 、convenience 、clean 5）促进产后恢复、增进母婴交流 Facilitate recovery of postpartum and mother-infant communication：,breast feeding,（2）Bottle feeding：,对乳类蛋白质过敏的患儿则可选用以大豆为蛋白质来源的配方奶粉,苯丙酮尿症患儿要选用限制苯丙氨酸的奶粉,乳糖不耐症(lactose intolerance)的患儿要选用去乳糖的配方奶粉,（3） mixture feeding,采用补授法(supplemental feeding)，即先喂母乳，不足时再喂以其他乳品 1）婴儿配方奶粉配制的要求和特点： 增加脱盐乳清粉或降低牛奶酪蛋白。 添加与母乳同型的活性顺式亚油酸和适量-亚麻酸 -乳糖和-乳糖按4:6的比例添加，适当加入可溶性多糖； 脱去牛奶中部分Ca、P、Na盐，将K/Na比例调整至2.53.0、 Ca/P比例调整至2，以减少肾溶质负荷并促进钙的吸收 配方奶粉中通常应强化VA、VD及适量的其他维生素， 对牛乳蛋白过敏的婴儿，可用大豆蛋白作为蛋白质来源生产配方奶粉，以避免过敏症的发生。,2断奶过渡期喂养 Feeding during weaning transition period,1）淀粉类辅食 starch complement: 2）蛋白质类辅食 protein complement: 3）维生素、矿物质类辅食 vitamin and minerals complement： 4）能量类辅食 complementing energy foods：,二、学龄前儿童营养与膳食 Nutrition and diet of pre-school children,Digestion and absorption in preschool children enable them to consume the same foods as adults but nutrient needs and feeding skills are different. Preschool children do not consume food overnight, therefore should be fed three meals a day and perhaps two between-meal snacks. All over the world children seem reluctant to eat leafy vegetables,（二）Nutritional requirment of pre-school children,Energy: fat intakes reduce from 35%40% to 30%35%,Calcium : AI 800mg/d Iron : AI 12mg/d Iodine: RNI 90g/d Zinc: RNI 12mg/d,四、青少年营养与膳食 Nutrition and diet of adolescence,三、学龄儿童的营养与膳食 Nutrition and diet of school children,Nutritional problems in children and adolescents :,Failure to thrive (FTT) 生长停滞,obesity 肥胖,Iron deficiency anaemia 铁缺乏,Anorexia 厌食症,五、老年营养与膳食 Nutrition and diet in older people,（一）Physiological characteristics:,1基础代谢率（BMR） 2心血管系统功能 3消化系统功能 4体成分改变 5代谢功能降低 6体内氧化损伤 7免疫功能下降,（二） Nutritional requirements of older people,1. Energy,2. Protein: 1.01.2g/kg，蛋白质供能占总能量的12%14%。,3. Fat: 脂肪供能占膳食总能量的20%30%为宜,4. Carbohydrate: 能量占总能量55%65%为宜,5. Minerals: calcium (AI): 1000mg/d iron (AI) : 15mg/d sodium： 6g/d,6. Vitamine,第三节 运动员的营养与膳食 (Nutrition and diet of athletes),（一）Physiological characteristics:,1. 心血管系统 (cardiovascular system）,2. 神经系统 (nervous system),4免疫系统 (immune system),3消化系统 (digestive system),5内分泌系统 (endocrine system),二、运动员的营养需要 Dietary considerations for sport and exercise,（一）Energy: 多数项目的运动员每天能量需要量在14.619.6MJ范围内，如果按体重计算，在210280kJ/kg范围。 （二）Protein: 支链氨基酸包括缬氨酸、亮氨酸、异亮氨酸 1. 降低大脑的5羟色胺的产生，可减轻脑力疲劳； 2.减缓肌肉疲劳，加速恢复； 3.支链氨基酸刺激胰岛素的产生，促进肌肉显著增加蛋白合成，降低分解代谢。 蛋白质的摄入水平根据不同运动有所区别（1216）。,（六）Minerals：研究证实，钠、钾、钙和镁在维持神经信息传导和肌肉收缩中起着重要的作用。,（三）Fat ：能量密度高、体积小、增加饱腹感 ，节约糖原和蛋白质的作用，我国推荐运动员脂肪的摄入量占总能量的25%30%，游泳和冰雪项目可增加至35%。,（四）Carbohydrates：我国推荐运动员膳食碳水化合物提供的能量占总能量的55%65%，高强度、高耐力和缺氧运动项目可增至70%。,（五）Water：由于运动而引起体内水分和电解质丢失过多的现象称之为