第四章-特殊人群营养概要PPT课件

-,1,特殊人群的营养Dietaryrequirementsforspecificpopulations,李颖,营养与食品卫生学教研室DepartmentofNutritionandFoodHygiene,-,2,specificpopulations,PregnantwomenandlactatingmothersInfants、children、adolescenceandolderpeopleAthletesspecificenvironmentofgroups,-,3,第一节孕妇和母乳的营养与膳食Nutrientanddietaryrequirementsofpregnantwomenandlactationmothers,pregnancy,lactation,-,4,一、pregnantwoman,（一）妊娠期的生理特点（physiologicalchangsinpregnancy）,1内分泌(endocrine)2血液(blood)3肾脏(renalsystem)4消化(gastrointestinalsystem)5体重(bodyweight),-,5,（一）physiologicalchangsinpregnancy,1内分泌(endocrine)（1）人绒毛膜促性腺激素（humanchorionicgonadotropin，HCG）（2）人绒毛膜生长素（humanchorionicsomatomammotropin，HCS）（3）雌激素(estrogen)（4）孕酮（progesterone）,pregnantwoman,-,6,Estrogen(pg/ml)雌激素,HCG绒毛膜促性腺激素,progesterone孕酮,Regulationofhormonechangesinpregnancy,Weeksofgestation,Weeksofgestation,Weeksofgestation,Weeksofgestation,TSH促甲状腺激素,-,7,(1)Bloodvolume,45%50%,15%20%,2Blood,PhysiologicAnemiaofPregnancy,conception,Bloodvolume,Redcellvolume,-,8,Non-pregnant,Non-pregnantl,Latepregnancy,Latepregnancy,Plasmaprotein,Plasmaalbumen,(2)Plasmaprotein,70g/L,60g/L,40g/L,25g/L,Relativelydilutionofblood,-,9,3Renalsystem,Renalplasmaflow75%,Glomerularfiltrationrate50%,Renalreabsorption,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(uricacid)、肌酸(creatine)、肌酐(creatinine)等排泄增多;尿中葡萄糖、氨基酸、水溶性维生素排出量增加，出现糖尿。,-,10,4Gastrointestinalsystem,Endocrinechangesareprobablyresponsibleforthesymptomsofnausea(恶心)、vomiting(呕吐)、waterbrash(反酸)、dyspepsia(消化不良)、constipation(便秘).,Prolongedtransittimeoffoodincreasenutrientabsorption,suchascalcium、iron、folicacid、VitaminB12,-,11,5Bodyweight,Thenutritionalcostofpregnancy,胎儿(fetus)、羊水(amnioticfluid)和胎盘(placenta),母体血液(motherblood),细胞外液(extracellularfluid)，子宫(uterus),乳腺(mammaryglands),12kg,theproductsofconception:,Mother,-,12,5Bodyweight,-,13,（二）妊娠期的营养需要(Nutrientrequirementsofpregnancy),1能量(energycostsofpregnancy)ReferenceNutrientIntakes(RNI):mid-andlate-gestation:+0.83MJ(200kcal/d).2蛋白质(protein)ReferenceNutrientIntakes(RNI):early,mid-andlate-gestation:5g、15g、20g；3脂类(lipids)20%30%oftotalenergyEssentialfattyacidisrelatedtofetalorinfantbrainandretinaldevelopment.,-,14,Nutrientrequirementsofpregnancy,4矿物质(minerals)（1）钙(calcium)：,佝偻(rickets)骨质软化症(osteomalacia),Adequateintake(AI)：Earlygestation:800mg，Mid-gestation:1000mg，Late-gestation:1200mg。,-,15,（2）铁(iron),minerals,Newtissueformation,Haematopoiesisinthefetusandthemother,Typicalbloodlossesatdelivery,Physiologicalanemiaofpregnancy,Haemeironcomesmainlyfromhaemoglobinandmyoglobininmeat,poultry,andfish,Adequateintake(AI)：孕早期15mg/d，孕中期25mg/d，孕晚期35mg/d。,-,16,（3）锌(zinc),ReferenceNutrientIntakes(RNI)：Earlygestation:11.5mg/d，Mid-late-gestation:16.5mg/d。,minerals,（4）碘(iodine),ReferenceNutrientIntakes(RNI)：+200g/d。,呆小症(cretinism),胎儿畸形(fetalanomaly)先天性缺陷(congenitaldefects),iodisedtablesalt,-,17,5Fat-solublevitamine,（1）RNIofvitaminA：胎儿宫内发育迟缓、低出生体重及早产有关过量导致自发性流产和胎儿先天畸形800gRE/d(early-gestation),900gRE/d(midlate-gestation)，UL(tolerableupperintakelevel):2400gRE/d。（2）RNIofvitaminD：过量导致高钙血症，甚至维生素D中毒5g/d(early-gestation)，10g/d，UL:20g/d。,-,18,Water-solublevitamine,（3）VitaminB：VB1beriberiVB2irondeficiencyanemiafolicacidneuraltubedefects,400ugoffolicacidperdayoradietrichinfolates,4/1000pregnancies,lessthan1/1000pregnancies.,35,-,19,Placentaltransfer,Carbohydrate:,Motherfetus,Proteinaminoacids,Lipids:,Concentration-dependentdiffusion,VitaminA:,Boundtoretinolbindingprotein,VitaminD:,Calcium:,-,20,（三）妊娠期营养对母体和胎儿的影响(Influenceofmaternalnutritionalstatusonmothersandfetus),1.influenceofmaternalmalnutritiononmothers,iron、folicacid、vitaminB12,Calcium、vitaminD,ProteinvitaminB1,(nutritionalanemia、gestationalhypertensionDiabatesmellitus),anemia、Hypoproteinemia、calciumdeficiency,-,21,2妊娠期营养状况对胎儿和婴儿健康的影响,Influenceofmaternalmalnutritionalstatusonfetusandinfants,（1）低出生体重（lowbirthweight，LBW）,Birthweightoflessthan2.5kg,Recentstudieshavedemonstratedanassociationbetweenlowbirthweightandchronicandmetabolicdisordersinadulthoodsuchastype2diabetes,hypertension,anddyslipidemia.,-,22,Influenceofmaternalnutritionalstatusonmotherandinfants,macrosomia(巨大儿)maternalobesitypostpartumdevelopinggestationaldiabetes,developingpregnancy-inducedhypertension.labourintheobesetobeprolongedandunsuccessful.,-,23,（四）妊娠期的合理膳食原则,1妊娠早期的合理膳食(rationaldietduringearlygestation)2妊娠中、晚期的合理膳食(rationaldietduringmidlate-gestation),40,-,24,1.泌乳活动Lactatingactivity2.乳母要动用机体储备补充乳汁Mobilizingnutrientreservetomilk(VAVBCaZn)3.乳母的基础代谢率增高Basalmetabolicrateincreaseinlactatingmother,二、乳母(lactatingmother),(一)哺乳期的生理特点(Physiologicalcharacteristics):,-,25,Contentofmilkindifferentpostpartumstages,Colostrum(thefirstmilk):,thefirstpostpartumweek,thickyellowfluidwithLactoferrin,secretoryimmunoglobulinA(sIgA)Lowinvolume,highinproteinVolumeofmilkisonly50to100mlperfeed,Transitionalmilk:,Maturemilk:,Over2weeksoflactation,increasedprotein、lactoseandfatcontentMilkvolumes:about750mlto850mlper24hours,From7dayspostpartumto14dayspostpartumabout500mlofmilkvolumesinaday,-,26,Nutritionalproblemsassociatedwithbreastfeeding,-,27,（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(lactationandobesity)：（2）哺乳与骨质疏松的关系(lactationandosteoporotic)（3）哺乳与乳腺癌的关系(lactationandbreastcancer),-,28,（三）Nutritionalrequirementoflactation,1Energy:RNI:increase2090kJ(500kcal)2Protein:RNI:increase20g3Lipids:20%25%4Minerals:（1）calcium：AI1200mg/d（2）Iron：AI25mg/d。（3）Iodineandzinc:AI200g/d,21.5mg/d5.Vitamine:6Water:increment1L,-,29,（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,50,-,30,第二节特殊年龄人群的营养与膳食Nutritionanddietofpopulationsinspecificage,一、Nutritionanddietofinfants（一）physiologicalcharacteristics1Growthanddevelopment2Digestionandabsorption3.Renalsystem4Brainandnervoussystem,1.唾液分泌量少，唾液中淀粉酶的含量低2.婴幼儿咀嚼食物的能力较差3.贲门括约肌发育不良4.婴幼儿肠壁透过性强胃肠蠕动不协调5.胆汁分泌较少6.能产生肠激酶和肽酶7.胰淀粉酶分泌少量,胰脂酶含量较少,胰蛋白酶和胰凝乳酶充足，丰富的乳糖酶和蔗糖酶,-,31,（二）Nutritionalrequirmentsininfants,1Energy:,（4）生长发育消耗能量energyconsumption,2Protein,（1）基础代谢basalmetabolism,（2）食物特殊动力作用specificdynamicaction,（3）活动activity:,（5）排泄消耗excretionconsumption,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%。,-,32,（1）Calcium:（2）Iron:lowironinhumanmilk（3）zinc:（4）VA:（5）VD:（6）Othernutrient:硫胺素(thiamine)、核黄素(riboflavin)和尼克酸(nicotinicacid),VCVE,5Mineralsandvitamins,-,33,（三）婴幼儿喂养(infantsfeeding),1婴儿喂养方式*母乳喂养（breastfeeding）人工喂养（bottlefeeding）混合喂养（mixturefeeding）,-,34,（l）breastfeeding：,1）营养成分最适合婴儿的需要，消化吸收利用率高：母乳以乳清蛋白(lactalbumin)为主，60%(牛奶20%)支链氨基酸半胱氨酸免疫球蛋白和双歧因子酪蛋白（casein）；40%（牛奶80%）结合了重要的矿物元素，如钙、磷、铁、锌等，酪蛋白一种大型、坚硬、致密、极困难消化分解的凝乳,-,35,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。,-,36,2)Anti-infectiveproperties:,macrophageslymphocyesneutrophils,Humanmilkcontainscells,protectinfantsagainstinfectioninthefirstmonthsoflife,SecretoryIgA,preventsadherenceofvirusesandbacteriatomucosalcells,protection,lactoferrin,facilitateabsorptionofsomenutrients,inhibitmicroorganismgrowthandmultiplication,breastfeeding,-,37,3）不容易发生过敏Unreadilydevelopallergyininfants4）经济、方便、卫生Lowcost、convenience、clean5）促进产后恢复、增进母婴交流Facilitaterecoveryofpostpartumandmother-infantcommunication：,breastfeeding,-,38,苯丙氨酸,酪氨酸,苯丙氨酸羟化酶,儿茶酚胺，黑色素和甲状腺激素,乳糖不耐症(lactoseintolerance)的患儿要选用去乳糖的配方奶粉,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,（2）Bottlefeeding：,-,39,（3）mixturefeeding,采用补授法(supplementalfeeding)，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。,-,40,2断奶过渡期喂养Feedingduringweaningtransitionperiod,1）淀粉类辅食starchcomplement:2）蛋白质类辅食proteincomplement:3）维生素、矿物质类辅食vitaminandmineralscomplement：4）能量类辅食complementingenergyfoods：,10,-,41,二、学龄前儿童营养与膳食Nutritionanddietofpre-schoolchildren,Digestionandabsorptioninpreschoolchildrenenablethemtoconsumethesamefoodsasadultsbutnutrientneedsandfeedingskillsaredifferent.Preschoolchildrendonotconsumefoodovernight,thereforeshouldbefedthreemealsadayandperhapstwobetween-mealsnacks.Allovertheworldchildrenseemreluctanttoeatleafyvegetables,-,42,（二）Nutritionalrequirmentofpre-schoolchildren,Energy:fatintakesreducefrom35%40%to30%35%,Calcium:AI800mg/dIron:AI12mg/dIodine:RNI90g/dZinc:RNI12mg/d,-,43,四、青少年营养与膳食Nutritionanddietofadolescence,三、学龄儿童的营养与膳食Nutritionanddietofschoolchildren,Nutritionalproblemsinchildrenandadolescents:,Failuretothrive(FTT)生长停滞,obesity肥胖,Irondeficiencyanaemia铁缺乏,Anorexia厌食症,-,44,五、老年营养与膳食Nutritionanddietinolderpeople,（一）Physiologicalcharacteristics:,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,-,45,（二）Nutritionalrequirementsofolderpeople,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/diron(AI):15mg/dsodium：6g/d,6.Vitamine,20,-,46,第三节运动员的营养与膳食(Nutritionanddietofathletes),（一）Physiologicalcharacteristics:,1.心血管系统(cardiovascularsystem）,2.神经系统(nervoussystem),4免疫系统(immunesystem),3消化系统(digestivesystem),5内分泌系统(endocrinesystem),-,47,二、运动员的营养需要Dietaryconsiderationsforsportandexercise,（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）。,-,48,（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运动性脱水（exerciseinduceddehydration）,（七）Vitamin：运动训练使胃肠道对维生素吸收功能下降；体内维生素代谢周转速率加快；汗液、尿液中维生素排出量增加；大运动量训练使得维生素需求量增加等。,-,49,第四节特殊环境人群的营养与膳食,一、高温环境人群的营养与膳食高温环境（hightemperatureenvironment）是指35以上的生活环境和32以上或气温在30以上、相对湿度超过80%的工作环境，如夏季野外作业、炼钢、集训和行军等。,-,50,（一）Physiologicalcharacteristics:,