Nutrition across the life cycle

What to remember

• Nutrition needs change at every life stage. They rise most in pregnancy, lactation, infancy and adolescence because the body is building new tissue or making milk.
• The first 1,000 days (from conception to the child's second birthday) are the most important window. Poor nutrition in this period causes damage that is hard to reverse, such as stunting and low learning ability.
• Breast milk alone for the first six months, then breast milk plus safe home foods, is the base of child nutrition. Iron, folic acid, calcium and vitamin A are the key nutrients to protect in women and girls.

Nutrition in pregnancy

A pregnant woman must feed herself and build the placenta, the foetus and her own extra blood. Her needs for energy, protein, iron, folic acid, calcium, iodine and vitamin A are higher than normal. Extra energy is needed mainly in the second and third trimesters. The first trimester needs little extra energy but folic acid is very important.

Weight gain: a healthy woman with normal pre-pregnancy weight should gain about 10 to 12 kg over the whole pregnancy. Most of the gain comes in the second and third trimesters. Very low gain is linked with low birth weight. Too much gain is linked with high blood pressure and difficult delivery.

Key nutrients and their reasons:

• Folic acid: prevents neural tube defects (such as spina bifida) in the baby. It should be adequate before conception and in early pregnancy.
• Iron: prevents anaemia, which increases the risk of premature birth, low birth weight and bleeding at delivery. Iron and folic acid (IFA) tablets are given free through the public health system.
• Calcium: needed for the baby's bones and for the mother's own bone store.
• Iodine: needed for the baby's brain. Deficiency can cause cretinism. Iodised salt is used.
• Vitamin A: needed for vision and immunity, but very high doses of supplements are harmful in pregnancy.
• Protein: needed for growth of foetal and maternal tissue.

Common problems and simple diet advice:

Habits to avoid: alcohol, tobacco and unsafe self-medication. Tea and coffee reduce iron absorption when taken with meals, so keep them away from meal time.

Nutrition in lactation

Milk production needs more energy than pregnancy does (protein need in the third trimester is similar or higher). The mother also needs more vitamin A, vitamin C, B vitamins, calcium, iodine and fluids. The extra energy is highest during the first six months when the baby is exclusively breastfed. The mother must not diet strongly during this period. Milk quantity is helped by frequent suckling, enough fluids and enough food; the milk quality of nutrients like fat and protein stays fairly stable, but some vitamins in milk fall if the mother's diet is poor.

Foods that are traditionally promoted for lactating mothers (galactagogues) include green leafy vegetables, garlic, fenugreek (methi), cumin and fennel, and plenty of fluids. The stronger evidence is for adequate food, rest and frequent feeding.

Nutrition in infancy

Growth is fastest in infancy. Birth weight roughly doubles by about five months and roughly triples by one year. A baby with birth weight below 2.5 kg is called a low birth weight (LBW) baby.

Breastfeeding:

• Start within one hour of birth (early initiation).
• Colostrum is the thick yellow first milk. It is rich in protein, vitamin A and antibodies (IgA). It must never be thrown away. It is called the first natural vaccine.
• Exclusive breastfeeding means only breast milk, with no water, honey, formula or other food, for the first six months. Drugs, vitamins or oral rehydration solution may be given on medical advice.
• Breastfeeding should continue up to two years or beyond.

Advantages of breast milk: it is clean, ready at the right temperature, free, and has the correct nutrients. It contains antibodies and lactoferrin, and lowers the risk of diarrhoea, infection and later obesity. It helps the mother by lowering bleeding after delivery and delaying the next pregnancy to some extent (lactational amenorrhoea).

Comparison of human and cow's milk:

Infant formula and animal milk can be risky because of unsafe water, wrong dilution and infection. Cow's milk is not suitable as the main drink before one year.

Complementary feeding (weaning)

From the completion of six months, breast milk alone is no longer enough, especially for energy, iron and zinc. Semi-solid food is started along with continued breastfeeding. This is called complementary feeding. (Weaning refers to the process of moving from milk to family foods.)

Good complementary food should be:

• Soft and semi-solid at first, then thicker, then family food
• Energy dense, with added oil, ghee or jaggery
• Made from local, low-cost foods such as rice, ragi, dal and mashed vegetables
• Fed with clean hands, clean utensils and safe water
• Given in small amounts at first, increasing in frequency as the child grows

A mixed food such as rice with dal and a little oil gives a combined protein of better quality because cereals and pulses complement each other's amino acids. Add one new food at a time to check for allergy. Do not add salt, sugar or honey to the first foods. Sweet drinks and packaged snacks reduce appetite and nutrients.

Frequency guide: two to three feeds a day at six to eight months, three to four feeds with snacks at nine to eleven months, and the family meal pattern with snacks after one year. Feed actively and with patience (responsive feeding).

Pre-school and school-age children

Pre-school (one to five years): growth is slower, appetite is uneven, and children become fussy eaters. They need small, frequent meals with energy dense food. Milk should not replace solid meals. Vitamin A supplementation is given in programmes, along with deworming and IFA syrup. Anganwadi hot cooked meals and take-home rations serve this age group.

School age (six to twelve years): steady growth, high activity, and a need for protein, calcium, iron and iodine. A good breakfast improves attention in class. Mid-day meal programmes support this age group. Junk food, sugary drinks and long screen time increase the risk of obesity.

Adolescence

Adolescence is a period of rapid growth (the growth spurt) and sexual maturity. Needs for energy, protein, iron, calcium and zinc increase. Girls need more iron after menarche because of monthly blood loss. Boys need more energy and protein for muscle growth. Common problems are anaemia, underweight, obesity, eating disorders such as anorexia nervosa and bulimia, and unhealthy food choices.

Programmes: weekly iron and folic acid supplementation for adolescents with deworming twice a year, and nutrition education. Early marriage and early pregnancy in girls harm both mother and child because the girl's own growth is not yet complete.

Adult and elderly nutrition

Adults need a balanced diet to maintain weight, work capacity and health. Needs vary with the type of work: sedentary, moderate or heavy. Fibre, fruits, vegetables, limited salt, sugar and fat help to prevent lifestyle diseases such as diabetes and heart disease. Menopause lowers oestrogen and increases the risk of bone loss, so calcium and vitamin D are important.

Elderly (60 years and above): energy needs fall because of lower activity and less muscle, but needs for protein, calcium, vitamin D, B12 and fibre remain high. Problems include poor teeth, reduced taste and smell, constipation, osteoporosis, loss of appetite and loneliness. Advice: soft, easy to chew food, small frequent meals, plenty of fluids, less salt and fat, and attractive food.

Exam traps

• Colostrum is the first milk, not mature milk; it is high in protein and antibodies, low in fat and lactose.
• Exclusive breastfeeding is six months; complementary feeding starts after six months are completed (at six months of age), not at four months.
• Weaning means the shift to family foods; it does not mean stopping breastfeeding suddenly.
• Human milk has more lactose but less protein than cow's milk.
• Folic acid prevents neural tube defects; iodine deficiency prevents normal brain development; they are not interchangeable.
• Extra energy in pregnancy is needed in the second and third trimesters, not mainly in the first.
• Lactation needs more energy than pregnancy.
• Tea with meals reduces iron absorption; vitamin C increases it.

One-liners

• 1. The first 1,000 days run from conception to a child's second birthday.
• 2. Breastfeeding should start within one hour of birth.
• 3. Colostrum is called the first natural vaccine.
• 4. Exclusive breastfeeding lasts for six months.
• 5. Low birth weight means a birth weight below 2.5 kg.
• 6. Folic acid prevents neural tube defects.
• 7. Iron-folic acid tablets are given in pregnancy to prevent anaemia.
• 8. Birth weight triples by about one year.
• 9. Cereal and pulse together give better protein quality than either alone.
• 10. Adolescent girls need more iron because of menstrual blood loss.
• 11. Honey, water and other foods are not given in the first six months.
• 12. Elderly people need less energy but the same or higher protein and calcium.

Practice questions

1. The period from conception to the child's second birthday, important for nutrition, is called the

   1. first 100 days
   2. golden hour
   3. neonatal window
   4. first 1,000 days
   Answer

   D. first 1,000 days

   The first 1,000 days run from conception to age two.

2. Exclusive breastfeeding means giving only breast milk for the first

   1. three months
   2. four months
   3. one year
   4. six months
   Answer

   D. six months

   WHO and national guidelines advise six months of exclusive breastfeeding.

3. The thick yellow first milk after delivery is called

   1. hindmilk
   2. transitional milk
   3. foremilk
   4. colostrum
   Answer

   D. colostrum

   Colostrum is rich in protein, vitamin A and antibodies.

4. Breastfeeding should be started after delivery within

   1. twelve hours
   2. six hours
   3. twenty-four hours
   4. one hour
   Answer

   D. one hour

   Early initiation within one hour helps the baby and the mother.

5. A baby whose birth weight is below 2.5 kg is called a

   1. macrosomic baby
   2. post-term baby
   3. small head baby
   4. low birth weight baby
   Answer

   D. low birth weight baby

   Low birth weight is defined as less than 2.5 kg at birth.

6. Folic acid supplements before and in early pregnancy mainly help prevent

   1. neural tube defects
   2. goitre in the mother
   3. night blindness in the baby
   4. rickets in the baby
   Answer

   A. neural tube defects

   Folic acid deficiency causes neural tube defects such as spina bifida.

7. A healthy woman of normal weight is advised to gain about how much weight during the whole pregnancy?

   1. 30 to 35 kg
   2. 20 to 25 kg
   3. 10 to 12 kg
   4. 2 to 4 kg
   Answer

   C. 10 to 12 kg

   A gain of about 10 to 12 kg is the usual advice.

8. The main protein in human milk is

   1. gelatin
   2. lactalbumin
   3. gluten
   4. casein
   Answer

   B. lactalbumin

   Human milk protein is mainly lactalbumin, which is easy to digest; cow's milk is mainly casein.

9. Compared with cow's milk, human milk contains

   1. more lactose and less protein
   2. no lactose and more fat
   3. less lactose and more protein
   4. more protein and more minerals
   Answer

   A. more lactose and less protein

   Human milk has higher lactose and lower protein and minerals than cow's milk.

10. Birth weight of a healthy infant becomes about double at

    1. two months
    2. twelve months
    3. one month
    4. about five months
    Answer

    D. about five months

    Birth weight doubles at about five months and triples at about one year.

11. Semi-solid complementary foods should be started after the baby completes

    1. four months
    2. nine months
    3. six months
    4. two months
    Answer

    C. six months

    From six months breast milk alone is not enough, so complementary food is added.

12. Which combination in a meal gives the best quality of protein?

    1. potato with salt
    2. rice with dal
    3. rice with sugar
    4. wheat with oil
    Answer

    B. rice with dal

    Cereals and pulses supplement each other's limiting amino acids.

13. Adolescent girls need more iron than boys mainly because of

    1. monthly blood loss in menstruation
    2. faster bone loss
    3. lower body weight at birth
    4. higher fat intake
    Answer

    A. monthly blood loss in menstruation

    Menstrual blood loss increases iron need in girls after menarche.

14. Which of these reduces iron absorption when taken with a meal?

    1. amla
    2. lemon juice
    3. guava
    4. tea
    Answer

    D. tea

    Tannins in tea bind iron; vitamin C-rich foods improve absorption.

15. Which nutrient need is highest in the elderly relative to their reduced energy need?

    1. refined starch
    2. saturated fat
    3. calcium and protein
    4. sodium and sugar
    Answer

    C. calcium and protein

    Energy need falls with age but protein, calcium and vitamin D needs stay high.

16. Lactation needs more energy than pregnancy because

    1. the baby needs a bath
    2. milk production needs energy and protein
    3. the mother must gain more weight
    4. foetal bones form faster
    Answer

    B. milk production needs energy and protein

    Making milk is an energy-costly process, especially in the first six months.

17. Honey or water should not be given to a baby below six months because they

    1. carry infection risk and displace breast milk
    2. prevent colostrum from forming
    3. are not sweet enough
    4. increase the baby's iron
    Answer

    A. carry infection risk and displace breast milk

    They can introduce germs and reduce suckling, lowering milk supply.

18. Which complementary feeding practice is correct for a seven-month-old baby?

    1. stop breastfeeding and give cow's milk only
    2. give only fruit juice
    3. give tea with biscuits
    4. give mashed dal-rice with a little oil along with breastfeeding
    Answer

    D. give mashed dal-rice with a little oil along with breastfeeding

    Energy dense soft food with continued breastfeeding is recommended.

19. A woman has severe heartburn and nausea in the first trimester. The best simple advice is

    1. fried food for energy
    2. fasting till noon
    3. small, frequent, dry meals
    4. one large meal a day
    Answer

    C. small, frequent, dry meals

    Small frequent meals reduce nausea; fatty and spicy food worsens it.

20. A 14-year-old girl has pallor and fatigue. Which food habit helps most?

    1. tea after every meal
    2. ragi and green leafy vegetables with lemon
    3. only white rice and sugar
    4. fried snacks and soft drinks
    Answer

    B. ragi and green leafy vegetables with lemon

    Iron-rich foods with vitamin C improve haemoglobin; tea blocks iron.

21. A mother says her baby of eight months is fed only cow's milk diluted with water. The main risk is

    1. excess vitamin A
    2. too much protein
    3. poor energy and iron intake with infection risk
    4. too many antibodies
    Answer

    C. poor energy and iron intake with infection risk

    Diluted milk lacks energy, iron and safe handling; breast milk and thick foods are better.

22. Which statement about the elderly is correct?

    1. They need no calcium
    2. They need more energy than adults
    3. They should avoid all protein
    4. They need soft, easy to chew food and plenty of fluids
    Answer

    D. They need soft, easy to chew food and plenty of fluids

    Dental problems and constipation are common in old age.

23. Menopause increases risk of bone loss mainly because of

    1. fall in oestrogen
    2. excess calcium intake
    3. rise in thyroxine
    4. rise in insulin
    Answer

    A. fall in oestrogen

    Lower oestrogen speeds up bone loss, so calcium and vitamin D are needed.

24. Pre-school children eat small, uneven meals. The best approach is

    1. small frequent energy dense meals
    2. replace meals by milk
    3. force-feed large meals
    4. give tea and biscuits
    Answer

    A. small frequent energy dense meals

    Their stomach is small and appetite varies, so frequent nutritious meals are used.

25. Weekly iron-folic acid supplementation is given to

    1. adolescents
    2. only infants
    3. only elderly men
    4. only newborns
    Answer

    A. adolescents

    Adolescent weekly IFA with deworming is a standard public health measure.

26. Which is a normal, expected benefit of breastfeeding for the mother?

    1. more risk of anaemia
    2. higher blood pressure
    3. loss of milk sugar
    4. less bleeding after delivery
    Answer

    D. less bleeding after delivery

    Suckling triggers oxytocin, which contracts the uterus and reduces bleeding.

27. Iodine deficiency in pregnancy mainly threatens the baby with

    1. rickets
    2. scurvy
    3. brain damage (cretinism)
    4. night blindness
    Answer

    C. brain damage (cretinism)

    Iodine is needed for foetal brain development.

28. Which of these is NOT advised for a pregnant woman?

    1. green leafy vegetables
    2. alcohol and tobacco
    3. iron-folic acid tablets
    4. tetanus vaccination
    Answer

    B. alcohol and tobacco

    Alcohol and tobacco harm the foetus.

29. Consider the statements about colostrum: 1. It is rich in antibodies and protein. 2. It should be discarded before breastfeeding starts. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Colostrum is valuable and must be given; discarding it is harmful.

30. Consider: 1. Exclusive breastfeeding allows medicines on medical advice. 2. Exclusive breastfeeding includes giving water after the third month. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Exclusive breastfeeding allows only medicines, vitamins or ORS on medical advice; no water.

31. Consider: 1. Human milk has more lactose than cow's milk. 2. Cow's milk has more casein than human milk. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are true; human milk is lactose-rich and cow's milk is casein-rich.

32. Consider: 1. Extra energy is needed mainly in the second and third trimesters. 2. A pregnant woman should gain no weight at all. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Moderate weight gain of about 10 to 12 kg is normal and needed.

33. Consider: 1. Breastfeeding stops when complementary feeding begins. 2. Complementary feeding begins after six months of exclusive breastfeeding. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Breastfeeding continues up to two years or beyond along with complementary foods.

34. Consider: 1. Adolescent girls are at risk of anaemia. 2. Early pregnancy in adolescent girls is harmful to mother and child. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both statements are correct.

35. Consider: 1. Elderly people need no protein. 2. Elderly people should take enough fluids. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Protein need remains; fluids prevent constipation and dehydration.

36. Consider: 1. Tea improves iron absorption. 2. Vitamin C improves iron absorption. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Tea reduces iron absorption.

37. Consider: 1. Birth weight triples by about one year. 2. Birth weight halves by six months. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Weight does not fall; it doubles at five months and triples at one year.

38. Consider: 1. School-age children have no need for calcium. 2. Mid-day meals support school-age children. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Calcium is needed for bone growth in school-age children.

39. Match the nutrient (I) with its main role in pregnancy (II). I: a. Folic acid b. Iron c. Iodine d. Calcium. II: 1. Foetal brain development 2. Foetal bones 3. Neural tube formation 4. Prevents anaemia.

    1. a-1, b-3, c-2, d-4
    2. a-4, b-3, c-2, d-1
    3. a-3, b-2, c-4, d-1
    4. a-3, b-4, c-1, d-2
    Answer

    D. a-3, b-4, c-1, d-2

    Folic acid-neural tube; iron-anaemia; iodine-brain; calcium-bones.

40. Match the stage with a key need. I: a. Infancy b. Adolescence c. Lactation d. Old age. II: 1. Fast growth, breast milk 2. Iron for girls, growth spurt 3. Extra energy and fluids for milk 4. Soft food, calcium.

    1. a-3, b-2, c-1, d-4
    2. a-1, b-3, c-2, d-4
    3. a-2, b-1, c-4, d-3
    4. a-1, b-2, c-3, d-4
    Answer

    D. a-1, b-2, c-3, d-4

    Each stage has its own priority.

41. Match the deficiency (I) with its effect in children (II). I: a. Iodine b. Vitamin A c. Iron d. Vitamin D. II: 1. Rickets 2. Night blindness 3. Anaemia 4. Brain damage.

    1. a-4, b-1, c-3, d-2
    2. a-1, b-2, c-3, d-4
    3. a-4, b-2, c-3, d-1
    4. a-3, b-2, c-4, d-1
    Answer

    C. a-4, b-2, c-3, d-1

    Iodine-brain damage; vitamin A-night blindness; iron-anaemia; vitamin D-rickets.

42. The number of days of exclusive breastfeeding recommended is closest to

    1. about 90 days
    2. about 30 days
    3. about 365 days
    4. about 180 days
    Answer

    D. about 180 days

    Six months is about 180 days (6 x 30).

43. Which mineral is added to common salt in India to prevent iodine deficiency disorders?

    1. iron
    2. zinc
    3. iodine
    4. fluorine
    Answer

    C. iodine

    Iodised salt is used to control iodine deficiency disorders.

44. If a baby weighs 3 kg at birth, the approximate weight at one year (about triple) is

    1. 6 kg
    2. 4.5 kg
    3. 12 kg
    4. 9 kg
    Answer

    D. 9 kg

    3 kg x 3 = 9 kg.

45. A pregnant woman gains 11 kg in total. If she gained 1 kg in the first trimester, how much was gained in the later two trimesters?

    1. 1 kg
    2. 10 kg
    3. 11 kg
    4. 12 kg
    Answer

    B. 10 kg

    11 - 1 = 10 kg; most weight is gained after the first trimester.