NUTRIENTSNUTRIENTSandand

ASSESSMENT ASSESSMENT

Myrna D.C. San Pedro, MD, FPPSMyrna D.C. San Pedro, MD, FPPS

NUTRITIONNUTRITION

Combination of processes by Combination of processes by which the living organism receives which the living organism receives & uses the materials necessary for & uses the materials necessary for growth, maintenance of functions growth, maintenance of functions & repair of component parts & repair of component parts

METABOLISMMETABOLISM

All the changes in the foodstuffs All the changes in the foodstuffs from absorption in the digestive from absorption in the digestive tract until elimination by the tract until elimination by the excretory organs excretory organs

Nutrient Requirement:Nutrient Requirement: the amount the amount to replace obligatory losses & support to replace obligatory losses & support synthesis of new tissues; varies by synthesis of new tissues; varies by age, sex, size & growth rateage, sex, size & growth rate

Energy Requirement/Expenditure:Energy Requirement/Expenditure:1.1. Basal Metabolic Rate (BMR)Basal Metabolic Rate (BMR)

2.2. Specific Dynamic Action of food (SDA)Specific Dynamic Action of food (SDA)

3.3. Body activityBody activity

4.4. Growth allowanceGrowth allowance

5.5. Losses per excretaLosses per excreta

Basal Metabolic Rate (BMR)Basal Metabolic Rate (BMR) Energy expenditure of an awake individual Energy expenditure of an awake individual

at rest in a thermoneutral environment at rest in a thermoneutral environment after an overnight or 14 hours fastingafter an overnight or 14 hours fasting

Most closely related to lean body mass Most closely related to lean body mass Factors: metabolic disorders, surgery, Factors: metabolic disorders, surgery,

infections, anorexia or fever; for example, infections, anorexia or fever; for example, basal metabolism increases by about 10% basal metabolism increases by about 10% for each centigrade of feverfor each centigrade of fever

50-100%50-100% of resting metabolic rate of resting metabolic rate in in infantsinfants and and 20-25% in adults20-25% in adults goes to goes to maintenance of temperaturemaintenance of temperature

In infants about 55 kcal/kg/dayIn infants about 55 kcal/kg/day which which decreases to decreases to 25-30 kcal/kg/day at maturity25-30 kcal/kg/day at maturity

Specific Dynamic Action Specific Dynamic Action (SDA)(SDA)

The obligation to expend energy The obligation to expend energy to digest & assimilate foodto digest & assimilate food

Highest for proteins & lowest for Highest for proteins & lowest for carbohydratescarbohydrates

About About 5 kcal/kg/day5 kcal/kg/day

Body activityBody activity (exercise & physical (exercise & physical activity):activity): average allowance during average allowance during the first year is the first year is 25 kcal/kg/day25 kcal/kg/day

Growth allowanceGrowth allowance:: during the first during the first 4 months is about 4 months is about 15-20 kcal/kg/day15-20 kcal/kg/day which which decreases to 12 kcal/kg/daydecreases to 12 kcal/kg/day at the end of the first yearat the end of the first year

Fecal lossFecal loss: 8 kcal/kg/day: 8 kcal/kg/day in the in the form of unused fats & proteinsform of unused fats & proteins

Thus, the energy requirement of the Thus, the energy requirement of the infant or child is the level of intake infant or child is the level of intake which canwhich can

maintain appropriate body size & composition

include deposition of new tissue

meet the energy required for physical activity

and the thermic effect of food

Daily RequirementDaily Requirement

Approximately 80-120 Approximately 80-120 kcal/kg body weight for the kcal/kg body weight for the 1st year of life with 1st year of life with subsequent decreases of subsequent decreases of about 10 kcal/kg body weight about 10 kcal/kg body weight for each succeeding 3-year for each succeeding 3-year periodperiod

Recommended Dietary AllowancesRecommended Dietary Allowances(RDAs, USA)(RDAs, USA)

Other terms are Recommended Dietary Other terms are Recommended Dietary Intakes (RDIs, UK) and Safe Levels of Intake Intakes (RDIs, UK) and Safe Levels of Intake (FAO/WHO)(FAO/WHO)

The levels of intake of essential nutrients The levels of intake of essential nutrients that are judged by the Food and Nutrition that are judged by the Food and Nutrition Board, based on scientific knowledge, to be Board, based on scientific knowledge, to be adequate to meet the known nutrient needs adequate to meet the known nutrient needs of practically all healthy personsof practically all healthy persons

An important element is that recommended An important element is that recommended intakes must be adequate for population intakes must be adequate for population groups implying that safety margins are groups implying that safety margins are inherent in these recommendationsinherent in these recommendations

MAJOR NUTRIENTSMAJOR NUTRIENTS

1.1. CarbohydratesCarbohydrates

2.2. ProteinsProteins

3.3. FatsFats

4.4. VitaminsVitamins

5.5. MineralsMinerals

6.6. WaterWater

Energy is provided by the followingEnergy is provided by the following

1.1. Carbohydrates:Carbohydrates:60% (45-65%) of the diet60% (45-65%) of the diet1gm provides 4 kcal1gm provides 4 kcal

2.2. Proteins:Proteins:11% (9-15%) of the diet11% (9-15%) of the diet1gm provides 4 kcal1gm provides 4 kcal

3.3. Fats:Fats:35% (25-45%) of the diet35% (25-45%) of the diet1gm short-chain provides 5.3 kcal1gm short-chain provides 5.3 kcal1gm medium-chain provides 8.3 kcal1gm medium-chain provides 8.3 kcal1gm long-chain provides 9 kcal1gm long-chain provides 9 kcal

Carbohydrates’ FunctionsCarbohydrates’ Functions1.1. Readily available source & Readily available source &

supply most of the body’s supply most of the body’s energy needsenergy needs

2.2. AntiketogenicAntiketogenic3.3. Structure of cellsStructure of cells4.4. Store calories as glycogenStore calories as glycogen5.5. Convert to fatConvert to fat6.6. Amino acid synthesisAmino acid synthesis7.7. Cellulose as roughageCellulose as roughage

Proteins’ FunctionsProteins’ Functions

1.1. Supply amino acids for growth & Supply amino acids for growth & repair of body tissuesrepair of body tissues

2.2. Supply ions in acid-base balanceSupply ions in acid-base balance3.3. Part of hemoglobin, nucleoproteins, Part of hemoglobin, nucleoproteins,

glycoproteins & lipoproteinsglycoproteins & lipoproteins4.4. As enzymes, hormones, antibodies As enzymes, hormones, antibodies

& cellular respiratory substance& cellular respiratory substance5.5. Protective structure (nails & hair)Protective structure (nails & hair)6.6. Source of energy when there is Source of energy when there is

shortage of fats & carbohydratesshortage of fats & carbohydrates

Daily Protein RequirementDaily Protein Requirement2002 Dietary Reference Intakes

(DRIs) Updates from the (US) Food and Nutrition Board of the National

Academy of Sciences (gm/kg BW/day)

1978 FNRI Publications,

Daily Requirements of Filipinos

(gm/kg BW/day)

0-6 mo ---- (2.2, WHO) 0-5 mo 3.5

6-11 mo 3

1 to 3 yr 1.1 1-2 yr 2.5

4 to 13 yr 0.95 (1 for 7 yr WHO) 3-6 yr 2

7-15 yr 1.5

14 to 18 yr

0.85 (0.75, WHO) 16-19 yr 1.2

As a point of reference, 3 ounces of As a point of reference, 3 ounces of lean beef, which is a serving the size lean beef, which is a serving the size of a deck of cards, provides 30 of a deck of cards, provides 30 grams of protein. A cup of grams of protein. A cup of milk milk contains 8 gramscontains 8 grams of protein. of protein.

Essential Amino AcidsEssential Amino Acids

Essential nutrient: A substance necessary Essential nutrient: A substance necessary for normal metabolic functioning but for normal metabolic functioning but cannot be synthesized by the body and cannot be synthesized by the body and must be obtained from the dietmust be obtained from the diet

24 amino acids identified24 amino acids identified 9 are found to be 9 are found to be essentialessential for children: for children:

histidine, isoleucine, leucine, lysine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, methionine, phenylalanine, threonine, tryptophan & valinetryptophan & valine

Arginine, cystine & taurineArginine, cystine & taurine are essential are essential for for LBW infantsLBW infants

Evaluating Protein QualityEvaluating Protein Quality1.1. Protein Efficiency Ratio (PER):Protein Efficiency Ratio (PER): Wt gained/gm Wt gained/gm

protein consumedprotein consumed; the U.S. FDA used the PER as ; the U.S. FDA used the PER as the basis for the % of the USRDA for protein on the basis for the % of the USRDA for protein on food labels but PER was based upon the a. a. food labels but PER was based upon the a. a. requirements of growing rats, which are different requirements of growing rats, which are different from humansfrom humans

2.2. Biologic Value (BV) of protein:Biologic Value (BV) of protein: Amount of Amount of nitrogen accumulated compared with nitrogen nitrogen accumulated compared with nitrogen absorbedabsorbed; indicates effectiveness of utilization ; indicates effectiveness of utilization but does not take into account certain factors but does not take into account certain factors influencing digestioninfluencing digestion

3.3. Net Protein Utilization (NPU):Net Protein Utilization (NPU): Percentage of Percentage of nitrogen consumed that is retained by the bodynitrogen consumed that is retained by the body; ; influenced by factors other than inherent a. a. influenced by factors other than inherent a. a. composition such as reduced digestibility caused composition such as reduced digestibility caused by overheating lowering protein value by by overheating lowering protein value by decreasing availability of several essential a. a.decreasing availability of several essential a. a.

Evaluating Protein QualityEvaluating Protein Quality

4.4. Amino Acid Score (AAS):Amino Acid Score (AAS): A chemical A chemical technique measuring indispensable a. a. in a technique measuring indispensable a. a. in a protein and comparing values with a protein and comparing values with a reference protein; considered fast, reference protein; considered fast, consistent, and inexpensiveconsistent, and inexpensive

5.5. Protein Digestibility Corrected Amino Acid Protein Digestibility Corrected Amino Acid Score (PDCAAS ):Score (PDCAAS ): Amino Acid Score w/added Amino Acid Score w/added digestibility component; current accepted digestibility component; current accepted measure based on the amino acid measure based on the amino acid requirements of humans; limitations: takes requirements of humans; limitations: takes no account of where the proteins have been no account of where the proteins have been digested and may also be considered digested and may also be considered incomplete since human diets almost never incomplete since human diets almost never contain only one kind of proteincontain only one kind of protein

Fats’ FunctionsFats’ Functions1.1. A concentrated & reserve source of energyA concentrated & reserve source of energy2.2. Physical protection for vessels, nerves, Physical protection for vessels, nerves,

organsorgans3.3. Insulate against changes in temperatureInsulate against changes in temperature4.4. Structure of body tissues, cell membranes Structure of body tissues, cell membranes

& nuclei& nuclei5.5. Carry the fat-soluble vitamins (A, D, E, K)Carry the fat-soluble vitamins (A, D, E, K)6.6. Give appetite appealGive appetite appeal7.7. Aid satiety (delay emptying time of the Aid satiety (delay emptying time of the

stomach)stomach)8.8. Spare proteinSpare protein9.9. Supply Supply linoleic acidlinoleic acid, the essential fatty acid, the essential fatty acid

Essential Fatty Acids (EFAs)Essential Fatty Acids (EFAs) Linoleic acid (LA) & linolenic or alpha-linolenic acid Linoleic acid (LA) & linolenic or alpha-linolenic acid

(LNA or ALA) are the 2 EFAs; LA can be converted to (LNA or ALA) are the 2 EFAs; LA can be converted to both arachidonic and linolenic acidsboth arachidonic and linolenic acids

Necessary for growth, skin & hair integrity, Necessary for growth, skin & hair integrity, regulation of cholesterol metabolism, lipotropic regulation of cholesterol metabolism, lipotropic activity, decreased platelet adhesiveness and activity, decreased platelet adhesiveness and reproduction; diets w/<1-2% cal will affect growth reproduction; diets w/<1-2% cal will affect growth rate, cause dry scaly rash w/ intertrigo and poor rate, cause dry scaly rash w/ intertrigo and poor wound healing wound healing

LA is abundant in soy oil, sunflower, safflower & LA is abundant in soy oil, sunflower, safflower & sesame seeds, corn oil, and most nuts while LNA is sesame seeds, corn oil, and most nuts while LNA is found abundantly in flax, small quantities in found abundantly in flax, small quantities in walnuts, cold pressed canola oil, wheat germ and walnuts, cold pressed canola oil, wheat germ and dark green leafy vegetablesdark green leafy vegetables

The right ratio of LA to ALA in the diet, about 3:1 or The right ratio of LA to ALA in the diet, about 3:1 or 2:1, is important; an imbalance may lead to a 2:1, is important; an imbalance may lead to a variety of mental disorders, including hyperactivity, variety of mental disorders, including hyperactivity, depression, brain allergies, and schizophreniadepression, brain allergies, and schizophrenia

Omega-3 and Omega-6 FatsOmega-3 and Omega-6 Fats Polyunsaturated fatty acids (PUFA) containing more Polyunsaturated fatty acids (PUFA) containing more

than one than one ciscis double bond double bond ALA (18:3n-3) belongs to the omega-3 family of ALA (18:3n-3) belongs to the omega-3 family of

fatty acids while LA (18:2n-6) belongs to the fatty acids while LA (18:2n-6) belongs to the omega-6 family; from these 2 EFAs can be omega-6 family; from these 2 EFAs can be manufactured other (non-essential) omega-3 and manufactured other (non-essential) omega-3 and omega-6 fatty acidsomega-6 fatty acids

Important structural components of cell Important structural components of cell membranes, that, when incorporated into membranes, that, when incorporated into phospholipids, affect cell membrane properties phospholipids, affect cell membrane properties such as fluidity, flexibility, permeability and the such as fluidity, flexibility, permeability and the activity of membrane bound enzymes activity of membrane bound enzymes

Lowers LDL cholesterol & decreases CV disease riskLowers LDL cholesterol & decreases CV disease risk Can modulate the expression of a number of genes, Can modulate the expression of a number of genes,

including those involved with fatty acid metabolism including those involved with fatty acid metabolism and inflammationand inflammation

EicosanoidsEicosanoids derived from derived from DGLA, AADGLA, AA and and EPAEPA play critical roles play critical roles in immune and inflammatory responses by being formed into in immune and inflammatory responses by being formed into prostaglandins and leukotrienes although EPA eicosanoids are prostaglandins and leukotrienes although EPA eicosanoids are less potent inducers of inflammation, blood vessel less potent inducers of inflammation, blood vessel constriction, and coagulation than those derived from AA constriction, and coagulation than those derived from AA

DHADHA and and AAAA are high in the phospholipids of are high in the phospholipids of brain gray matter suggesting their importance to brain gray matter suggesting their importance to CNS function such that depletion of DHA in the CNS function such that depletion of DHA in the brain can result in learning deficitsbrain can result in learning deficits

Also, Also, EPAEPA and and DHADHA supplementation during supplementation during pregnancy has beneficial effects on long-term pregnancy has beneficial effects on long-term cognitive development in childrencognitive development in children

DHADHA appears to be important for visual and appears to be important for visual and neurological development but it is not yet clear neurological development but it is not yet clear whether feeding infants formula enriched with whether feeding infants formula enriched with DHA and AA enhances visual acuity or DHA and AA enhances visual acuity or neurological development in preterm or term neurological development in preterm or term infantsinfants

There is evidence, though, that human There is evidence, though, that human conversion of conversion of EPAEPA and, particularly and, particularly DHA,DHA, is is relatively inefficient suggesting that EPA and DHA relatively inefficient suggesting that EPA and DHA may also be essential under some conditions may also be essential under some conditions

VitaminsVitamins Organic compounds in minute Organic compounds in minute

amounts that catalyze cellular amounts that catalyze cellular metabolismmetabolism

16 vitamins, 8 of which are 16 vitamins, 8 of which are considered necessary for human considered necessary for human nutrition:nutrition: retinal, thiamin, retinal, thiamin, riboflavin, niacin, cobalamin, riboflavin, niacin, cobalamin, folacin, ascorbic acid & vitamin D folacin, ascorbic acid & vitamin D

There is presumptive evidence that There is presumptive evidence that pyridoxine & tocopherolpyridoxine & tocopherol may be may be necessary for infant nutritionnecessary for infant nutrition

MineralsMineralsMacromineralsMacrominerals

Sodium 1gm or Sodium 1gm or 2mEq/kg2mEq/kg

Potassium 1-2gm or Potassium 1-2gm or 1.5mEq/kg1.5mEq/kg

Calcium 0.6gm/dayCalcium 0.6gm/day Magnesium 150-Magnesium 150-

300mg/day300mg/day Chlorine 0.5gm/dayChlorine 0.5gm/day PhosphorusPhosphorus Sulfur 0.5-1gm/daySulfur 0.5-1gm/day

MicromineralsMicrominerals Iron 1mg/kg/dayIron 1mg/kg/day Iodine 34-45 mcg/dayIodine 34-45 mcg/day Copper 0.5-1mg/kg/dayCopper 0.5-1mg/kg/day Fluorine 0.5-1mg/dayFluorine 0.5-1mg/day Zinc 3-5mg/kg/dayZinc 3-5mg/kg/day Cobalt 1-2mcg/dayCobalt 1-2mcg/day Manganese 0.05-1.5mg/dayManganese 0.05-1.5mg/day Chromium 0.02-0.10mg/dayChromium 0.02-0.10mg/day Selenium 0.02-0.10mg/daySelenium 0.02-0.10mg/day Molybdenum Molybdenum

0.05-0.15mg/day0.05-0.15mg/day

MacromineralsMacrominerals Sodium, Chloride, PotassiumSodium, Chloride, Potassium work together to work together to

regulate the flow of fluids in the body & help regulate the flow of fluids in the body & help regulate the nervous system, muscle functions & regulate the nervous system, muscle functions & nutrient absorption in the cellsnutrient absorption in the cells

CalciumCalcium is needed for bone rigidity & helps in is needed for bone rigidity & helps in blood clotting, muscle contraction & normal blood clotting, muscle contraction & normal nerve functions.nerve functions.

PhosphorousPhosphorous aids in all phases of calcium aids in all phases of calcium metabolism & helps build strong bones & teethmetabolism & helps build strong bones & teeth

MagnesiumMagnesium helps regulate body temperature, helps regulate body temperature, muscle contractions & the nervous system & muscle contractions & the nervous system & helps cells utilize carbohydrates, fats, and helps cells utilize carbohydrates, fats, and proteinsproteins

SulfurSulfur helps in detoxification reactions & is helps in detoxification reactions & is present in the amino acids in proteins & a present in the amino acids in proteins & a component of constituents of component of constituents of mucopolysaccharides & essential compoundsmucopolysaccharides & essential compounds

MicromineralsMicrominerals IronIron combines with protein to form hemoglobin combines with protein to form hemoglobin Iodine Iodine is needed by thyroid gland to produce thyroxineis needed by thyroid gland to produce thyroxine CopperCopper is necessary in the formation of hemoglobin is necessary in the formation of hemoglobin FluorineFluorine helps reduce incidence of tooth decay helps reduce incidence of tooth decay Zinc Zinc plays an important role in the formation of plays an important role in the formation of

protein, thus, assists in wound healing, blood protein, thus, assists in wound healing, blood formation and general growth & maintenance of all formation and general growth & maintenance of all tissuestissues

CobaltCobalt is a component of vitamin B12 is a component of vitamin B12 Manganese Manganese is necessary for normal development of is necessary for normal development of

bones and connective tissuesbones and connective tissues ChromiumChromium maintains normal glucose uptake into cells maintains normal glucose uptake into cells

& helps insulin bind to cells& helps insulin bind to cells SeleniumSelenium w/vitamin E protects cells from destruction w/vitamin E protects cells from destruction MolybdenumMolybdenum is a component of xanthine oxidase and is a component of xanthine oxidase and

aldehyde oxidasealdehyde oxidase

WaterWater Essential for lifeEssential for life Two-thirds of body weight, 75-80% in Two-thirds of body weight, 75-80% in

infants while 55-60% in adultsinfants while 55-60% in adults Daily consumption by a healthy infant Daily consumption by a healthy infant

is 10-15% BW versus 2-4% BW in adultis 10-15% BW versus 2-4% BW in adult Of fluid intake: water retention 0.5-3%, Of fluid intake: water retention 0.5-3%,

evaporation from lungs & skin 40-50%, evaporation from lungs & skin 40-50%, fecal losses 3-10% & renal excretion fecal losses 3-10% & renal excretion about 40-50% or moreabout 40-50% or more

Fruits & vegetables 90% water Fruits & vegetables 90% water

ASSESSMENT OF NUTRITIONAL ASSESSMENT OF NUTRITIONAL STATUS OF CHILDRENSTATUS OF CHILDREN

1.1. HistoryHistoryDietary history of mother & childDietary history of mother & childHistory of height & weight changesHistory of height & weight changes

2.2. Anthropometric indicatorsAnthropometric indicatorsEvidence of deviations from average Evidence of deviations from average height & weight height & weightEvidence of depletion of fat depotsEvidence of depletion of fat depotsEvidence of decrease in muscle massEvidence of decrease in muscle mass

3.3. Change in psychic reactionChange in psychic reaction4.4. Reaction to infectionReaction to infection5.5. Evidence of specific deficienciesEvidence of specific deficiencies

ANTHROPOMETRIC INDICATORS OF ANTHROPOMETRIC INDICATORS OF NUTRITIONAL STATUSNUTRITIONAL STATUS

1.1. Weight:Weight: index of acute nutritional statusindex of acute nutritional status 2.2. Height or length:Height or length: unaffected by excess unaffected by excess

fat or fluid; fat or fluid; assesses growth failureassesses growth failure 3.3. Weight for height measurement:Weight for height measurement:

more accurately more accurately assesses body buildassesses body buildA.A. Measure child’s heightMeasure child’s heightB.B. Find age for which measured height is Find age for which measured height is

on the 50th % on the growth curveon the 50th % on the growth curveC.C. Child’s actual weight (numerator)Child’s actual weight (numerator)

50th% wt based on age of plotted 50th% wt based on age of plotted ht ht (denominator) (denominator)

4.4. Head circumference:Head circumference: influenced by influenced by nutrition till age 36 mo; measurements nutrition till age 36 mo; measurements < < 5th% may5th% may indicates chronic undernutritionindicates chronic undernutrition during fetal life & early childhoodduring fetal life & early childhood

5.5. Skinfold thickness(TSF):Skinfold thickness(TSF): provides an provides an estimation of total body fatestimation of total body fat

6.6. Mid-arm circumference (MAC)/Mid-arm Mid-arm circumference (MAC)/Mid-arm muscle circumference (MAMC):muscle circumference (MAMC): with with TSF, TSF, determines muscle areadetermines muscle area & fat area & fat area**MAMC = MAC – (3.4 x TSF)**MAMC = MAC – (3.4 x TSF)

7.7. Bone age:Bone age: epiphyseal closure; percentage epiphyseal closure; percentage of maturity attained of maturity attained indicates potential for indicates potential for catch-up growth catch-up growth

8.8. Growth Velocity (GV)Growth Velocity (GV) Evaluates change in rate of growth over a Evaluates change in rate of growth over a

specific time period expressed in cm/yr; specific time period expressed in cm/yr; more sensitive way of more sensitive way of assessing growth assessing growth failurefailure or slowed growth or slowed growth

Formula:Formula:GV (cm) = GV (cm) = HH2 2 (cm) – H(cm) – H11 (cm) (cm)

T (yr)T (yr)wherewhereHH11 = initial height in centimeters = initial height in centimetersHH22 = height at next measurement = height at next measurementT T = period between two = period between two

measurements in yearsmeasurements in years

9.9. Body Mass Index (BMI)-for-AgeBody Mass Index (BMI)-for-Age An effective An effective screening toolscreening tool specific for age specific for age

and gender but not a diagnostic tooland gender but not a diagnostic tool Formula:Formula: Weight (kg)/[Height (m)]Weight (kg)/[Height (m)]2 2

Calculation: Calculation: [weight (kg)/ height [weight (kg)/ height (cm)/height (cm)] x 10,000(cm)/height (cm)] x 10,000

BMI-for-age cut-offs:BMI-for-age cut-offs:>> 95 95thth % % OverweightOverweight8585th - th - < 95< 95thth % % Risk of overweightRisk of overweight< 5< 5thth % % UnderweightUnderweight

BMI-for-age correlates w/ clinicalBMI-for-age correlates w/ clinicalrisk factors in CVS diseaserisk factors in CVS disease such as such as hyperlipidemia, elevated insulin & hyperlipidemia, elevated insulin & high blood pressure during middle agehigh blood pressure during middle age

Can you Can you seesee risk? risk?

Age=3 y 3 wks Age=3 y 3 wks boyboyHeight=100.8 cmHeight=100.8 cmWeight=18.6 kgWeight=18.6 kgBMI=18.3 BMI=18.3 BMI-for-age BMI-for-age = >95= >95thth % %

Age=4 y girlAge=4 y girlHeight=99.2 cm Height=99.2 cm Weight=17.55 kg Weight=17.55 kg BMI=17.8BMI=17.8BMI-for-ageBMI-for-age= between 90= between 90thth –95 –95thth % %

Age= 4 y 4 wks Age= 4 y 4 wks girlgirlHeight=106.4 cmHeight=106.4 cmWeight=15.7 kgWeight=15.7 kgBMI=13.9BMI=13.9BMI-for-ageBMI-for-age= 10= 10thth % %

AOverweigh

t

B Normal

CAt risk for

overweight

BMI-for-AgeBMI-for-Age

During early childhood, During early childhood, BMI decreases reaching a nadirBMI decreases reaching a nadir (the so-called (the so-called reboundrebound point) point) between 4 and 7 years of between 4 and 7 years of age, then increases to 20 years of ageage, then increases to 20 years of age reflecting the reflecting the normal changes in body composition during puberty.normal changes in body composition during puberty.

A

B

C