nutrition after birth “nutrition and growth of children affects not only their survival but also...
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NUTRITION AFTER BIRTH
“Nutrition and growth of children affects not only their
survival but also their quality of life.”
Rama Bhat, M.D.Professor of Pediatrics.UIC Medical Center.
Learning Objectives
• Nutritional Requirement from Birth to Adolescence.
• Breast Milk and Breast Feeding.• Evaluation of Nutritional Status.• Nutrients Inadequately supplied in
Children.• Nutrition related problems in
Childhood.
Pediatric Nutrition
Nutritional requirements can be considered on the basis of:
a). Age.b). Body size.c). Growth rate.d). Caloric intake.e). Physiologic losses.
Days required to double birth weight
Species Days Lactose (%) Fat(%) Protein(%)
Human 180 7.0 3.8 0.9
Horse 60 6.2 1.9 2.5
Cow 47 4.8 3.7 3.4
Goat 19 4.1 4.5 2.9
Rat 6 3.0 15.0 12.0
ENERGY
AGE (YRS) WT (KG) HT ( CM ) ENERGY (Kcal/KG)
0 – 0.5 6 60 108
0.5 –1.0 9 71 98
1.0 – 3.0 13 90 102
4.0 –6.0 20 112 90
7.0 – 10.0 28 132 70
ENRGY EXPENDITURE
0
20
40
60
80
100
120
1 3 6 9 12 15 18
TOTAL
BASAL
ACTIVITY
GROWTH
THERMIC
WASTE
CHANGE IN ENERGY EXPENDITURE WITH AGE.
AGE (YRS)
CA
LO
RIE
S P
ER
KG
OF
BO
DY
WE
IGH
T
ENERGY DISTRIBUTION
CARBOHYDRATE 50% - 60%
FAT 30%- 40%
PROTIEN 10% - 15%
PROTEIN
• Dietary protein provides energy and amino acids for the synthesis of body proteins and other tissue constituents.
• Many factors affect dietary protein requirement
• 95% of animal and 60- 80% of vegetable protein is digestible.
• In a mixed diet, proteins supply 10-15% of daily energy requirement.
RECOMMENDED DIETARY INTAKE (RDI)FOR PROTEIN
0 - 1 2.6 2.2
1 - 2 2.2 2.0
2 - 3 1.8 1.8
3 - 4 1.5 1.6
RDI
Age ( months) g/kg/d g/100 kcal
PROTEIN REQUIREMENT(RDA)
Age in years Weight (kg) Protein (gm)0.0 - 0.5 6 130.5 - 1.0 9 14
1 – 3 13 164 – 6 20 247 - 10 28 28
11 - 14 45 4515 - 18 66 59
PROTEIN REQUIREMENT
0
0.5
1
1.5
2
2.5
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Age (yrs)
Pro
tein
gm
/kg
BODY FAT ( KG)
Age in years Male female Birth 0.49 (14%) 0.49 (15%)
1.0 2.3 (22%) 2.2 4 2.7 2.8 8 3.3 (13%) 4.3 (17%)
12 8 10 14 10 13 18 9 (13%) 13 (23%)
FAT• A concentrated form of energy.
• EFA is necessary for the synthesis of various Eicosanoids (prostaglandins,Thromboxanes & Leukotrienes).
• Necessary for the formation of cell membranes.
• Total intake should not exceed >30% of total calories (for children over 2 years old).
• Intake of dietary cholesterol should not exceed 300 mg/day.
Range of average Water Requirements of Childrenat Different Ages under Ordinary Conditions
Age Avg. body Water per kgweight (kg) of body wt in
24 hr(ml) 3 d 3.0 80-10010 d 3.2 125-150 3 mo 5.4 140-160 6 mo 7.3 130-155 9 mo 8.6 125-145 1 yr. 9.5 120-135 2 yr. 11.8 115-125 4 yr. 16.2 100-110 6 yr. 20.0 90-100 10 yr. 28.7 70-85 14yr. 45.0 50-60 18 yr. 54.0 40-50
ENERGY, PROTEIN, AND FLUID NEEDS IN PEDIATRIC PATIENTS
50 - 600.840 (GIRLS)
50 - 600.94515 – 18 (BOYS)
70 - 851.047 (GIRLS)
70 - 851.05511 – 14 (BOYS)
70 - 851.0707 – 10
114 - 1151.21021 - 3
120 - 1502.21080.0 – 0.5
Fluid Requirement (ml/kg)
Protein Requirement (g/kg)
Average Energy
Allowance (kcal/kg)
Age (yrs)
CURRENT RECOMMENDATIONS FORFEEDING INFANTS
• Nursing period (4-6M): Human milk or formula only.
• Transitional period: Specially prepared foods are introduced
• Modified Adult period: Mostly table food.
HEALTHY PEOPLE 2000
Goals:
• 75 % of moms to breast feed their infants in early post partum period
• 50 % of moms to breast feed until theirbabies are 5 - 6 months old.
Rates of Breast feeding in USA
1971 24.7% 1984 59.7% 1989 52.2% 2001 69.5%
Racial &Ethnic Disparities In Breast Feeding
Days required to double birth weight
Species Days Lactose (%) Fat(%) Protein(%)
Human 180 7.0 3.8 0.9
Horse 60 6.2 1.9 2.5
Cow 47 4.8 3.7 3.4
Goat 19 4.1 4.5 2.9
Rat 6 3.0 15.0 12.0
BENEFITS OF HUMAN MILK VS COW’S MILK
Proteins Lipids
More Whey proteins Less sat. fatsLess casein More medium chain FAHigher cysteine/methionine More lipase enzymeLess phenylalanine More Linoleic acidMore taurine More fat in hind milkMore peptidase
Minerals
Less calciumLess sodiumHigher Ca/phosphorusMore bioavailable Fe & Zn.
DEFENSE FACTORS IN HUMAN MILK
Antimicrobial Antiinflammatory
Secretory IgA Antioxidants, vitE vit ALactoferrin EGF Lysozyme CatalaseOligosaccharides G-peroxideComplement C 3 AntiproteasesFibronectinMucins
Healthy people 2010
• Goals: - Breast feeding initiation: 75% - Breast feeding at 6 months: 50% - breast feeding at 12 months: 25%
DEFENSE FACTORS IN HUMAN MILK
Immunodulators Leukocytes
Nucleotides NeutrophilsCytokines Macrophages
Lymphocytes
HOSPITAL ADMISSIONS FOR 100 INFANTSFOR THE FIRST 18 MONTHS BY FEEDING TYPE
Feeding Type
Breast ( N=670) Artificial ( N = 388)Diagnosis
Respiratory infect. 7.0 13.7
Gastroenteritis 3.6 5.2
Other infections 1.5 2.1
FEEDING DURING 1st YEAR
Age(months) # of feedings /24 hrs
0 - 1 6 - 8 2 - 6 4 - 5 7 - 10 3 - 4 11 - 12 3 Age(months) Volume / feed (ozs) 1 2 - 4 2 5 3 5 - 6 4 6 - 7 5 - 12 8
Social Impact of Breast feeding
• Savings/year $ 750 - 1200 / yr.
• National savings $ 950 Million/yr.
Breast Feeding
Contraindications:
•Galactosemia•Maternal drug abuse•Maternal tuberculosis•HIV positive mother•Medications: Cancer chemotherapy
Radioactive isotopes
OBSTACLES TO BREAST FEEDING
•Physician apathy and misinformation•Lack of prenatal education•Disruptive hospital policies•Early hospital discharge•Lack of appropriate followup•Maternal employment•Commercial promotions of formulas•Television and magazine advertising
Month Food Items
1 - 4 Breast milk or formula4 - 6 Iron-fortified cereal6 - 7 Strained fruits; begin
introducing cup7 - 8 Strained vegetables8 - 9 Start finger foods and
chopped (junior) foods 9 Meats, citrus juice 10 Bite -sized cooked
foods 12 All table foods
USE OF COW’S MILK
Cow’s milk should not be used until the infantreaches 1 year of age.
• Feeding Cow’s milk may cause:
• Increases renal solute load.
• Low vitamin C and iron.
• Low EFA
• Increased incidence.
SERVINGS PER DAY
Women & some Children,teen girls Teen boys &older adults active women,men active men
Calorie level ~1600 ~2200 ~2800
Bread group 6 9 11
Veggie group 3 4 5
Fruit group 2 3 4
Milk group 2 - 3 2 - 3 2 - 3
Meat group 2 2 3 Total (ounces) 5 6 7
Source: US Department of Agriculture.
Adolescent Nutrition
17%(39 Million) of the population in United States are aged
between 10-19 years..Reasons for nutritional problems:
Anorexia, Physical Activity, Obesity, Food Habits, Pregnancy,
Growth spurts.
POLICIES DIRECTED TOWARDS IMPROVING THE
GROWTH OF CHILDREN• Promote and support breast feeding.• Monitor growth and development.• Introduce appropriate micronutrient
rich complementary food at 6 months of age.
• Prevention of obesity.• Identify infant at risk of growth failure.• Education of parents.
Adolescent Nutrition
• 14% ( 36.5/million) of US population are 10-19 years old.
• Reason for nutritional problems
Factors Influencing Nutritional needs in
Adolescents • Onset of puberty - Increase growth
rate• physical activity• changes in body composition.
- Increase in body fat in girls - Increase in lean body mass(LBM) in boys.
Nutritional Concerns During Adolescence
• Food habits: - skipping meals - snacking - consumption of fast
foods • Results of poor nutrition:
- protein intake- vegetarianism. - calcium needs. - iron and zinc - obesity - 14% (1999 survey)
Obesity
Definition:BMI 85-95th percentile - At risk for overweightBMI > 95th percentile - Overweight
BMI ( Kg.m2)Age in yrs 6 8 10 12 16
Male Female
16.5 17.8 16.1 17.5
18.1 20.2 18.2 20.4
19.7 20.5 20.2 23.0
21.3 25.0 22.3 26.0
24.6 28.7 24.7 29.1
Prevalence of Obesity (BMI>95th percentile
Age 6-11 years 12 -17 yearsGroups
male Female Male Femaleall 11.3±1.8 12.8±1.9 10.6±1.3 8.8±1.4white 10.4±2.4 14.4±2.7 9.8±2.0 8.3±3.1AA 13.4±2.3 9.3±2.4 16.9±2.8 14.4±3.1Hispanic 17.7±2.3 12.8±3.2 14.3±1.7 8.7±2.5
Management
• Goal: to diminish morbidity and mortality risk.
1- Diet: - Prepubertal: 300 - 400 cal/day lower than required.
- Older children: 500 - 700 cal/day lower. Goal is to loose 300- 500 gm weight loss/wk
2- exercise:3- Surgical:4- Pharmacotherapy:
INDICATORS OF NUTRITIONAL STATUS
Head circumference for age
<5th percentile>95th percentile
Stunting/ shortnessLength or height for age
<5th percentile
UnderweightWeight- for lengthBMI for age
<5th percentile
NEW IN THE CDC GROWTH CHARTS
charts extend to 20 years 3rd and 97th percentile available. Lower limits of length (45 vs. 49 cm)
and height (77 vs. 90 cm) extended. BMI-for- age charts (2-20 years) added. 85th percentile (at risk of overweight)
added.
Estimated protein intake of breast-fed infants
Age Milk consumption Protein intake(months) (ml/d) (g/kg/d)
0 - 1 630 2.09
1 - 2 773 1.59
2 - 3 787 1.15
3 - 4 810 1.06
WATER, FAT, PROTEIN CONTENT OF THE FETUS
Weight (gms)
GA (wk)
H2O (gms)
Fat ( gms)
Protein (gms)
500 22 433 6 43
1000 27 850 23 86
2000 32 1598 120 188
3000 38 2217 330 334
PROTEIN CONTENT OF MILKFROM SOME MAMMALS
Species Protein(%)
Humans 1.0Horse 2.5Goat 2.9Cow 3.4Sheep 5.5Reindeer 11.5
Distribution of energy in human milk
Stages of Fat Protein Lactose Total energylactation (%) (%) (%) (kcal/100ml)
Colostral 44 17 39 56
Transitional 48 9 43 60
Mature 50 7 43 61