life cycle nutrition: infancy, childhood, and adolescence
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Life Cycle Nutrition: Infancy, Childhood, and Adolescence. Chapter 16. Nutrition during Infancy. Infant growth during first year Reflects nutrient intake Birthweight changes Infant’s length Energy requirement Twice that of an adult. - PowerPoint PPT PresentationTRANSCRIPT
Chapter 16
Nutrition during InfancyInfant growth during first year
Reflects nutrient intakeBirthweight changesInfant’s length
Energy requirement Twice that of an adult
Weight Gain of Infants in Their First Five Years of Life
Nutrition during Infancy Energy nutrients
Birth weight should double by 5 months and triple by 12 months
Kcal needs : 100 kcal/kg, unlike ~30 kcal/kg for adults
6-12 months kcal include solid foodsCarbohydrates (glucose) especially needed for brain
Brain size proportionately larger than adult’sFat provides most of the energy in brst milk/formulaProtein- MOST important for growth
Basic building material of body’s tissues Protein overload stresses liver, kidneys
Acidosis, diarrhea, high serum ammonia & urea Feeding with nonfat milk or conc. formula
Nutrition during Infancy
Vitamins and mineralsNeeds are greater than adults
WaterPercentage of body weight as water highest as
young infantDehydration from vomiting, diarrhea, high
temperature require supplemental water or electrolyte fluid (Pedialyte)
Recommended Intakes of an Infant & an Adult Compared Based on Body Weight
Percentages of Energy-Yielding Nutrients in Breast Milk & in Recommended Adults Diets
6%
Protein
21%
55%
Fat
26%
39%
Carbohydrate
53%
Breast milk
Recommended adult diets
Key:
Slower growth
More activity
Breast MilkPractice of breastfeeding
Length of exclusive breastfeeding 6 monthsBreastfeeding and complementary foods 6-12
monthsFrequency and duration of feedingsBreast milk more digestible and less fillingEnergy nutrients
Lactose Oligosaccharides not in cow’s milk or formula Essential fatty acids Protein- less than cow’s milk, α-lactalbumin more
digestible
Breast Milk
Practice of breastfeedingVitamins and minerals
Vitamin D tends to be low in breast milk, supplement it
Iron less but highly bioavailable, due to lactoferrin
Immunological protectionColostrum Bifidus factors Antibodies and white blood cellsLactadherin inhibits replication of diarrhea
virus
Immunological Protection of Breast Milk
Allergy, infection and disease protectionColostrum Bifidus factors Antibodies and white blood cellsLactadherin inhibits replication of diarrhea virusLower incidence of allergic reactionsProtection against development of cardiovascular
diseaseProtection against excessive weight gainIntelligence
Controversial
Breast Milk
Breast milk banksDonation of breast milkScreeningLife-saving solution for fragile infants
Infant Formula
CompositionAttempt to copy
composition of breast milk
Iron-fortifiedNo protective
antibodiesSafe preparation
6% 9%
55%
Key:
49%
39%
Cow’s milk
29%
Breast milk
Infant formula
Protein
Fat
Carbohydrate
51%
42%
20%
Infant Formula
Risk of lead poisoningInfant formula standard set to “well-nourished
mothers during first or second month of lactation”Special formulas for preemies or genetic diseasesInappropriate formulas as total diet
Goat’s milkSoy milkRice milk
Nursing bottle tooth decay
Nursing Bottle Tooth Decay
Special Needs of Preterm Infants
1 of 8 births is pretermPreterm or premature
Incomplete fetal developmentLeading cause of infant deathsOften low-birthweight infants
Benefits of third trimester for infant’s nutrient stores
Preterm breast milk More protein, less volume Supplements can be added too
Introducing Cow’s Milk
Cow’s milk never advised before age 1Children 1 to 2 years of age
Whole milk 4% (red cap) milkIf it seems to be linked to chest and nasal
congestion, try goat’s milk, much closer to human milk
Benefits of goat's milkChildren aged 2 to 5
Gradual transition from whole to lower-fat milks
Introducing Solid Foods
When to beginBetween 4 and 6 months
Developmental capabilityPurpose of solid foods
Food allergiesSingle-ingredient foodsOne at a time in small portionsWaiting period before next food is introduced
Introducing Solid Foods
Choice of infant foodsProvide variety, balance, and moderationCommercially prepared vs. homemade foods
Food labelsNo fat information listed or needed for children
younger than two Need for fat due to growth rate and essential fatty
acids for brain development
Introducing Solid FoodsFoods to provide iron
Breast milk or iron-fortified formulaIron-fortified cerealsMeat and meat alternates
Foods to provide vitamin CFruits and vegetablesLimit 100% juice to 4-6 oz/day
Foods to omitHoney and corn syrupSoda, sweetened “fruit drinks”-- C-fortified or
not
Introducing Solid Foods
Vegetarian dietsNewborn is a lacto-vegetarianBeyond six months
Vegan diets slow down growth and development Well-balanced vegetarian diet is doable; continue
iron supplement and/or children’s MVI
Foods at 1 yearCow’s milk- 2-3 cups/day- no more
Displacement of iron-rich food sources by milk can lead to anemia
Mealtimes with ToddlersDeficiencies of vitamin D, vitamin B12, iron,
and calcium may develop. Energy-dense foods are required.
Feeding guidelines currently in vogueDiscourage unacceptable behaviorLet toddler explore and enjoy foodsDon’t force food on childrenProvide nutritious foods
Let child choose which ones and how muchLimit sweetsDon’t turn dining table into battleground
Nutrition during ChildhoodAnnual growth
HeightWeight
Body composition and shape changesEnergy needs, nutrient needs, and appetites during
childhood vary because of growth and physical activity. Hunger and nutrient deficiencies affect behavior.
Concerns include lead poisoning, high energy, sugar and fat intakes, iron deficiency, caffeine consumption, food allergies, and food intolerances. Adults and schools need to provide children with nutrient-dense foods.
The body shape of a 1 year old (left) changes dramatically by age 2 (right). The2 year old has lost much of the baby fat; the muscles (especially in the back,buttocks, and legs) have firmed and strengthened; and the leg bones havelengthened.
Energy and Nutrient Needs in Childhood
Appetites diminish around 1 year of age1 yr to adolescence: ↑2-3 inches, ↑5-6 lbs
Food intakes coincide with growth patternsEnergy intakes vary from meal to meal
Energy needs vary widely1 yr old- 800 kcal/d6 yr old- 1600 kcal/d
Growth and physical activity Difficulty meeting energy needs
Energy and Nutrient Needs in Childhood
Carbohydrate and fiberRecommendations are the same for children
and adultsFiber recommendations in proportion
Fat and fatty acidsDRI Committee recommendation
Fat should be 30-40% of total kcal for 1 to 3 year olds
Fat 25 - 35 % of total kcal for 4 to 18 year olds (same as adults)
Energy and Nutrient Needs in Childhood
Protein recommendationsConsiderations
Nitrogen balance Quality of protein Added needs of growth
Vitamins and mineralsNeeds increase with ageIron and vitamin DSupplements
Energy and Nutrient Needs in Childhood
Planning children’s mealsVariety of foods from each food groupNo added salt, sugar, or seasonings.
Amounts suited to appetite and needsFeeding Infants and Toddlers Study (FITS)
Findings Greater variety of nutrient-dense vegetables and
fruits are needed Inadequate intakes of vitamins and minerals
What have we learned from FITS 2008?
Where we’re improving Mothers are breastfeeding longer Fewer numbers of infants and toddlers are consuming sweets
Where we still need improvement25% of toddlers are not consuming a single serving
of fruit and 30% don’t eat a single serving of vegetables on a given day
Preschoolers are consuming more white potatoes than the healthier dark green or orange vegetables
Sodium intakes are above the upper limit for 70% of 2 year olds and 84% of 3 year olds
Preschoolers 24–48 months are consuming more than the recommended amount of saturated fat
Food Guide Pyramid for Young Children
Hunger and Malnutrition in Children
Even mild malnutrition affects intellectual performance
Very low-income familiesGreater risk of hunger and malnutrition
Meal skipping and academic performanceBenefits of breakfast consumption
Iron-deficiency and behaviorBehavior, attention span, and learning abilityTesting for iron status
Effects of deficiency occur before blood effects occur
Physical Signs of Malnutrition in Children
The Malnutrition-Lead Connection
Malnourished children are vulnerable to lead toxicity
Low intakes of certain nutrients increases risk of lead toxicityCalcium, zinc, vitamins C and D, and iron
Commonalities between iron deficiency and lead toxicityDisrupts normal brain development
The Malnutrition-Lead Connection
Effects of lead toxicityLearning disabilities Behavioral problems
Lead accumulation in bodyBones, brain, teeth, and kidneys
Federal laws have reduced lead exposureLead exposure is still a threat
Hyperactivity and “Hyper” Behavior
HyperactivityInterferes with social development / academic
behaviorNo evidence that sugar causes hyperactivityDietary changes and alternative therapies do not
solve true hyperactivity Sugar Certain food additives may contribute to hyperactivity
Symptoms tend to improve as child gets olderMisbehaving or “Hyper” Behavior
Use consistency in diet, schedule, sleep, exercise
Food Allergy and Intolerance
Prevalence of true food allergies in children is 3% - 5%Tend to diminish with age
True food allergyImmunologic response to food with the production
of antibodies, histamines, and other defensive agents
Reaction may be immediate or delayedDetecting food allergies
Testing for antibodiesTreatment
Food Allergy and IntoleranceAnaphylactic shock- life-threatening allergic
reactionMost common offending foods- usually a protein
Eggs, milk, soy, peanuts, tree nuts, wheat, fish, and shellfish
Often outgrow allergies to eggs, milk, and soySymptom of impending anaphylactic shock- airway
constrictionEpinephrine injections (adrenalin) as antidote
Food labelingEight most common allergy-causing foods required
to be listed, including possible cross-contamination Possible new technological solutions
Food Allergy vs. Intolerance
Food intolerance is not a food allergySigns of adverse reactions to foods
Stomachaches, headaches, rapid pulse rate, nausea, wheezing, hives, bronchial irritation, coughs, and other discomforts are.
Presence of symptoms but no antibody production
Causes of adverse reactions to foods Digestive enzyme deficiency Lactose intolerance: insufficient lactase to cleave
lactose into glucose and galactose
Childhood Obesity
Number of overweight children has dramatically increased per CDC Growth ChartsOverweight defined
Above 85th percentileObesity defined
Above 95th percentileSevere obesity defined
Above 99th percentile
Fig. 16-10, p. 550
1 year: 800 kcalories.6 years: 1,600 kcalories.10 years: 2,000 kcalories
Needs vary widely because of growth and physical activity.
Childhood ObesityOverweight children have higher potential of
becoming obese adultsRamifications
Genetic and environmental factorsParental obesity, role modeling > geneticsDiet and learned food behaviorsPhysical inactivity- TV, gaming, texting, computerConvenience foods and meals eaten away from
homeAvailability of refined sugars, starches- popular
snacks
Childhood ObesityGrowth
Characteristic set of physical traits Begin puberty earlier Stop growing at a shorter height than peers Greater bone and muscle mass, stockier
Physical healthAbnormal blood lipid profileIncreased risk for Type 2 diabetes,
hypertension and respiratory diseases Earlier age of onset for DM, Htn, CHF
Childhood Obesity
Psychological developmentEmotional and social problems
Stereotyped by peers and others DiscriminationPoor self-imagePassive approach to lifeLess participation in sports and other
exercise
Childhood Obesity
Integrated approach with diet, physical activity, psychological support, and behavioral changes
Prevention and treatment of obesityPrevention before adolescence is keyTreatment must consider many aspects of the
problemImprove long-term physical health through
permanent healthy lifestyle habitsSuccessful approaches are multi-dimensional
Prevention and Treatment of Childhood Obesity
Reduce rate of weight gain; weight loss is usually not recommended for growing children
Limit sugar-sweetened beverages. Eat fruits and vegetables every day. Eat age-appropriate portions of food. Eat foods low in energy density. Eat a nutritious breakfast. Eat a diet high in calcium.
Prevention and Treatment of Childhood Obesity
Eat a diet balanced in carbohydrate, fat, and protein.
Eat a high-fiber diet.Eat together as a family.Limit the frequency of eating out.Limit television watching.
Physical activityEngage in at least 60 minutes of activity per day.
Limit sedentary activities At least one hour of daily physical activity Parental example
Physical Activity Pyramid for Kids
Childhood ObesityPsychological support
Parental and caregiver involvement Parental attitudes about food
Behavioral changesFocus on how to eat, not what to eatLearn to ignore junk food advertising
DrugsSibutramine and orlistat a0pproved for
children & adolescent sBariatric surgery
Food Skills ofPreschool Children
Mealtimes at Home Choking prevention
Adult should be present when child is eatingGet playing done first
More attentive during meal timesSnacking
Limit access to concentrated sweets, including juice
No snacking within 1-2 hrs of meal Preference for sweets and salty, fatty food is innate
(chicken nuggets, nachos, tater tots/french fries, ice cream, cake, juice) but not necessarily healthy
Old School unpopular but still Safe and Effective
“As long as your feet are under my table, you will eat what is set before you.”
“There are children starving in India. Now be grateful that you even have food.”
“You’re not getting up from the table until your plate is clean.”
Parent doesn’t have to be a short-order cook. The whole family eats the same meal.
Fussy eating is nipped in the bud, so child’s taste buds can learn to appreciate a wide variety of flavors.
Teach children to cook. It’s a basic life skill.
Let them control the amount of seasoning.
Following a recipedevelops a part ofthe brain that can read and follow instructions.
Mealtimes at Home Preventing dental caries
Behaviors to encourage Brush and floss after meals Brush or rinse after eating snacks Avoid sticky foods? What about dried fruit? Select crisp or fibrous food frequently
Role modelsEat right yourself. Grocery shop without the kids whenever possible.If they want a food advertised on TV, buy the
smallest box or bag and use the food as a special treat or reward.
Nutrition at SchoolMeals at school
Administered by USDA School Breakfast Program National School Lunch Program 1/3 RDA for energy, protein, vitamin A, vitamin C, iron,
and calcium. Dietary Guidelines for Americans
Educational benefits Glucose to the brain Hunger is a distraction
Nutrition at SchoolCompeting influences at school
Short lunch periods and long waiting linesEmbarrassment over eligibility for free lunchSnack bars, school stores, and vending
machinesAthletic fundraisers vs state laws and school
policies.Federal legislation
Wellness policiesChild and Adult Care Food Program (CACFP)
Nutrition during AdolescenceGrowth and development
Adolescent growth spurt Growth patterns of males (12-13 yrs) vs. females (10-11 yrs) Height changes- + 8in. for males, + 6” for females Weight changes- more fat for females, more LBM for males
Energy and nutrient needsNeeds are greatNeeds vary greatly
Factors influencing energy needs Girls vs. boys
Obesity during adolescence
Nutrition during AdolescenceEnergy and nutrient needs- Vitamin D, Fe, Ca
Vitamins RDAs or AIs for most vitamins increase Need as much Vitamin D as an adult
Iron Boys for LBM Girls for menstruation Growth spurt for both
Calcium Peak bone mass building is NOW.
Nutrition during Adolescence
Food choices and health habitsIrregular eating scheduleBenefits of eating meals with familySkipping breakfastFast foodParental gatekeepers
Controlling type and availability of food at homeSnacks
1/4th of average teenager’s daily food intake Tend to be high in sugars, saturated fat, sodium, low
in fiber
Nutrition during AdolescenceFood choices and health habits
Beverages Soft drink consumption and milk displacement Choice affects bone density at a critical period
Eating away from home comprises 1/3 of adolescent meals If lunch was heavy, dinner can be lighter
Peer influence Choices often reflect opinions and actions of peers Milk as “babyish” Socializing in the quad instead of eating lunch
Nutrition during AdolescenceFood choices and health habits
Drug abuse destroys nutrients in the body, Alcohol abuseSmoking
Down to <30% for cigarette in past month Influences hunger, body weight, and nutrient status Smokers tend to eat less fruits/vegetables
Smokeless tobacco Health problems Other drawbacks
Childhood Obesity and the Early Development of Chronic Diseases
IntroductionAdult heart disease has become a major pediatric problem
U.S. children diagnosed with obesity and serious “adult diseases”Development of type 2 diabetes Risk is 30-40%Risk of kidney disease and short lifespan also
increasesRole of genetics
A “permissive” role (a potential) rather than a “determining” role (a fate)
Early Development of Type 2 Diabetes
Obesity is the most important risk factorType 2 diabetes is most likely to occur if
ObeseSedentaryFamily history of diabetes → resignation to and expectation of diabetes → continue family’s
eating behaviors
Early Development of Type 2 Diabetes
Physiological changesCells become insulin-resistant
Reducing amount of glucose entering cellsCluster of symptoms develops from insulin-
resistance Hypertension, dislipidemia Promotes early development of cardiovascular
disease (CVD)
Prevention and treatmentDepends on weight management of the child
Early Development of Heart Disease
Symptoms of heart disease rarely appear before age 30Disease begins much earlier
Atherosclerosis1)Development of fatty streaks on arterial walls before age
10
2)Progressive thickening with fatty plaque on arterial walls, strengthened by fibrous tissue during teens
3)Calcification of fibrous plaques in early adulthood
4)Heart disease rate rises at 45 yrs for men and 55 yrs for women May eventually block flow of blood to heart
Is not inevitable; early lesions can progress or regress
1 The coronary arteries deliver oxygen and nutrients to the heart muscle.
Plaque
1
2
2 Plaques can begin to form in a person as young as 15.
A healthy artery provides an open passage for the flow of blood.
33 When these
arteries become blocked by plaque, the part of the muscle that they feed will die.
Plaques form along the artery’s inner wall, reducing blood flow. Clots can form, aggravating the problem.
Early Development of Heart Disease
Blood cholesterolDifferences begin to emerge in childhoodTends to rise with increase in dietary saturated
fat and trans fat intakesObesity
LDL increases; HDL decreasesSelective screening of children and adolescents
who are overweight or obese or have family history of middle-age heart disease
Early Development of Heart Disease
Blood PressureHypertension accelerates development of
atherosclerosisConsiderations for children before diagnosis
Age, gender, and heightMay develop in first decades of life
Regular aerobic activity Lose weight Restrict sodium
Physical Activity
Association between blood lipids and physical activity, same as adults
Physical inactivity in youth often leads to physical inactivity in later years
Obesity and cholesterol statistically correlate with amount of TV time
Dietary Recommendations for Children
Eat a variety of foods and maintain a desirable weight
Limiting fat and cholesterolNot for infants or children under 2
Moderation, not deprivationBalance meals- lean animal protein,
fruits/vegetables, whole grainsAvoid extremes
Diet first, Htn drugs and statins later if indicated
Why is it “adult” to smoke?
SmokingMany children light up for the first time in
grade school80% of adult smokers began before age 18
Death from smoking-related causes to 50% of those teens who continue smokingImmediate health consequences of
smokingShortness of breathBad breath
If smoking is “adult”, why do most adult smokers want to quit?