Nutrition in children
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This document discusses normal nutrient requirements and the nutrient values of common foods. It defines nutrition and the important macro/micronutrients required by the body, including carbohydrates, proteins, fats, vitamins and minerals. It provides recommendations for daily intake of these nutrients based on age, gender and other factors. Nutrient requirements are especially important for growth in children and infants. The document also discusses the roles and dietary sources of specific nutrients.
Nutrition in children
- 1. Normal nutrient requirements(RDA) and Nutrient value of common food items. PRESENTED BY: Kumar abhinav Dr Purbasha Mishra Moderator : Dr Pallavi Goyal
- 2. • Nutrition means Supply of nutrients for the release of energy and growth of the body. • Nutrients are the chemical substances required for the production of energy, for the growth and for building of body. • Nutrition is procurement of these nutrients.
- 3. • The important nutrients required for the body are:- a) Macro-nutrients: Some nutrients like carbohydrates, proteins, fats and mineral like sodium are required in large. b) Micro-nutrients: Some nutrients like vitamins and minerals like iron, zinc molybdenum etc are required in very minute doses (even in micrograms).
- 4. • Dietary intake not only meets energy requirements but also provides macronutrients and micronutrients essential for sustaining the functioning of multiple vital processes. • Malnutrition and under-nutrition are the leading worldwide cause of acquired immunodeficiency and the major underlying factor for morbidity and mortality globally for children <5 yr of age.
- 5. • The nutrient requirements of children are influenced by • (1) growth rate, (2) body composition, and (3) composition of new growth. • These factors vary with age and are especially important during early postnatal life. • Because of the high nutrient requirements for growth and the body composition, the young infant is especially vulnerable to undernutrition. • Slowed physical growth rate is an early and prominent sign of undernutrition in the young infant.
- 6. • DRI (daily recommended intake ) is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These reference values, which vary by age and gender, include: 1) Recommended Dietary Allowance (RDA): an estimate of the daily average nutrient intake to meet the nutritional needs of >97% of the individuals in a population, and it can be used as a guideline for individuals to avoid deficiency in the population. 2) The estimated average requirement (EAR): is the average daily nutrient intake level estimated to meet the requirements for 50% of the population.
- 7. 3) Lower Reference Nutrient Intakes (LRNIs): is the amount of a nutrient that is enough for only a small number of people in a group who have low requirements (2.5%) i.e. the majority need more. 4) Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy. 5) Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.
- 11. ENERGY • The major determinants of energy expenditure are in children:- (1) basal metabolic rate, (2) metabolic response to food (energy required for digestion and absorption), (3) physical activity, and (4) growth. Estimated energy requirement (EER): is the average dietary energy intake predicted to maintain energy balance in a healthy individual and accounts for age, gender, weight, stature, and physical activity level
- 12. •The EER was determined based on empirical research in healthy persons at different physical activity levels, including levels different from the recommended levels . They do not necessarily apply to children with acute or chronic diseases. •Because adequate data on requirements for physical activity in infants and children are unavailable and because individual growth requirements vary, recommendations have been based on calculations of actual intakes by healthy subjects.
- 16. CARBOHYDRATES • Energy equivalent 4 kcal/g. Dietary carbohydrates include a) Monosaccharides, (glucose, fructose), b) Disaccharides (sucrose, lactose), c) Oligosaccharides, d) polysaccharides (starch), and sugar alcohols. • Although an UL for carbohydrates has not been set, a maximal intake of <25% or <10% of total energy intake from added sugars has been proposed in various dietary guidelines.
- 17. •Higher intakes of added sugar (eg sucrose and high-fructose corn syrup) can displace other macro- and micronutrients and increase risk for nutrient deficiency. •They increase the risk for obesity, diabetes, and dental caries. •They also increase LDL and triglyceride production in the liver and serum uric acid levels which increases systolic blood pressure and is associated with fatty liver disease and metabolic syndrome. •And are also associated with diarrhea, abdominal pain, and failure to thrive in children when in excessive intake.
- 18. Dietary fibers • Fiber consists of nondigestible carbohydrates mostly derived from plant sources • they escape digestion and reach the colon nearly 100% intact. • Classification:- previously classified as being water soluble versus insoluble. Soluble fibers (pectins, mucilages, oat bran) bind bile acids and reduce lipid and cholesterol absorption. Pectins also slow gastric emptying and the rate of nutrient absorption. Insoluble fibers (cellulose, hemicellulose, and lignin- non-carbohydrate) Increase stool bulk and water content and decrease gut transit time.
- 19. •The DRI classification:- dietary fiber (nondigestible carbohydrates and lignin that are intrinsic and intact in plants) functional fiber (with known physiologic benefits in humans), and total fiber (dietary plus functional). •by-products of colonic fermentation are:- 1) carbon dioxide, methane (in addition to other gases), 2) Oligofructases (also known as prebiotics-substrates that nourish beneficial commensurate gastrointestinal microbiota), and 3) short-chain fatty acids (SCFAs)(acetate, butyrate, and propionate).
- 20. •An UL has not been established for fibers, which are not thought to be harmful to human health. A general rule of thumb used for fiber intake in children (>2 years) is: age (in years) + 5 = grams of fiber intake per day.
- 23. PROTEINS • Amino acids and ammonium compounds are usable as sources of nitrogen in humans. Amino acids are provided through the digestion of dietary protein. They have structural and functional role in our body. • As there are no major stores of body protein, a regular dietary supply of protein is essential. • Energy equivalent of proteins 4 kcal/g. • An UL for protein has not been set. Intake of proteins or specific amino acids needs to be limited in some health conditions, such as renal disease and metabolic diseases, such as phenylketonuria and maple syrup urine disease, in which specific amino acids can be toxic.
- 24. • Based on our requirement, amino acids are classified into Essential amino acids; and Non-essential amino acids. Examples of essential amino acids :- are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine; Examples of Non-essential amino-acids :- are Alanine, Arginine, Aspartic acid etc. •Histidine, cysteine, tyrosine and arginine is essential amino acid in newborns because of enzyme immaturity only for infants but not adults.
- 25. • The proteins from animal are called as Biologically complete proteins. • Proteins from vegetable are called as Biologically incomplete proteins. Function of proteins • Proteins are used in - –various metabolic pathways as enzymes. –Chemical coordination as hormones. –body building. –repair and maintenance of tissues. –maintenance of osmotic pressure. –the production of energy
- 26. • FATS • Fat is the most calorically dense macronutrient, providing approximately 9 kcal/g. • Triglycerides are the most common form of dietary fat and are composed of 1 glycerol molecule and 3 fatty acids.
- 27. • Acceptable Macronutrient Distribution Ranges(AMDR)- for fats is 30-40% of total energy intake for children 1-3 yr and 25-35% for children 4- 18 yr of age. • They also provide essential fatty acids, play structural and functional roles; and precursors for cell membranes, hormones, and bile acids. • Fats are for energy storage. • It facilitates absorption of fat-soluble vitamins A, D, E, and K. • Decreasing simple sugars and increasing complex carbohydrate intake reduce serum triglyceride levels which a risk factor for cardiovascular disease and part of the metabolic syndrome.
- 28. • RDA of fats • Saturated and monounsaturated fats can be synthesized endogenously so there is no AI or RDA set for these dietary components. • Trans fats have no known beneficial effects in humans; therefore, no corresponding AI or RDA has been set. • cholesterol, saturated, or trans fats have a positive linear association between intake and risk for cardiovascular disease so a threshold level has not been set at which risk is increased. • Long-chain PUFAs such as DHA and ARA play a variety of structural and functional roles; they influence membrane fluidity and function as well as gene expression, and modulate the inflammatory response.
- 30. Essential fatty acids •Humans cannot synthesize the PUFAs precursor omega ω3 (α-linolenic acid; ALA) and ω6 (linoleic acid; LA), and are dependent on diet for these. •Essential fatty acids are enzymatically elongated and desaturated into longer-chain fatty acids; ω3 PUFAs :-ALA can be converted to eicosapentaenoic (EPA) and docosahexaenoic (DHA). DHA is found in breast milk and is important for brain development and visual maturity. ω6 PUFAs:- LA is converted to arachidonic acid(ARA) inflammatory response.
- 32. • Micronutrients i. Major Minerals:- Sodium, potassium, calcium, phosphorous, magnesium and chloride. ii. Trace elements:- Iodine, Iron, Zinc, Copper, Selenium, Manganese, Molybdenum, Chromium, Cobalt (as a component of vitamin B12),and fluoride. iii. Vitamins:- an organic molecule that is an essential micronutrient needed by an organism in small quantities for the proper functioning of its metabolism. Essential nutrients cannot be synthesized in an organism or only in insufficient quantities.
- 33. Major Minerals Calcium: Dietary sources:- Dairy products, legumes, broccoli, green leafy vegetables. Deficiency: Can occur in premature infants without adequate supplementation and in lactating adolescents with limited calcium intake or in patients with steatorrhea. Can lead to Osteopenia or osteoporosis, tetany.
- 34. Phosphorus Dietary sources:- meats, eggs, dairy products, grains, legumes, and nuts; high in processed foods and sodas. Deficiency :- Rare, but can occur in premature infants on unfortified milk and Also in patients with protein- energy malnutrition. Can cause osteoporosis, rickets and sometimes hypercalcemia, Muscle weakness, bone pain, rhabdomyolysis, osteomalacia, and respiratory insufficiency.
- 35. Magnesium Dietary sources: vegetables, cereals, nuts. Deficiency : Occurs as part of re-feeding syndrome with protein-energy malnutrition or in Renal disease, mal-absorption, or magnesium wasting medications. May cause secondary hypo-calcaemia, Neuromuscular excitability, muscle fasciculation, neurologic abnormalities, and ECG changes.
- 36. Sodium Dietary sources: processed foods, table salt. Deficiency: Results from loss in diarrhea and vomiting. Can lead to Anorexia, vomiting, hypotension, and mental apathy. Severe malnutrition, stress, and hypermetabolism may lead to excess intracellular sodium, affecting cellular metabolism.
- 37. Chloride • Dietary sources:- table salt or sea salt, sea-weed, many vegetables. • Deficiency:- Can occur in infants fed low chloride containing diets, or in children with cystic fibrosis, vomiting, diarrhea, chronic diuretic therapy, or Bartter syndrome. Can lead to failure to thrive and especially poor head growth; anorexia, lethargy, muscle weakness, vomiting, dehydration, hypovolemia.
- 38. Potassium Dietary sources:- nuts, whole grains, meats, fish, beans, fruits and vegetables, especially bananas, orange juice. Deficiency:- Occurs in protein-energy malnutrition (eg:- refeeding syndrome), excessive potassium is excreted in urine in any catabolic state, during acidosis, from diarrhea, and from diuretic use. Hyperkalemia may result from renal insufficiency. Can cause:- Muscle weakness, mental confusion, arrhythmias.
- 39. Trace elements Zinc Dietary sources: human milk, meats, shellfish, legumes, nuts, and whole-grain cereals. Clinical features:- •Mild: impaired growth, poor appetite, impaired immunity. •Moderate to severe: mood changes, irritability, lethargy, impaired immune function, increased susceptibility to infection; acro-orificial skin rash, diarrhea, alopecia. Response to zinc supplement is gold standard for diagnosis of deficiency.
- 40. Zinc deficiency
- 41. • IRON • Critical component of enzymes, cytochromes, myoglobin, and hemoglobin. • Iron deficiency is the most common nutritional deficiency in United States. • Severe iron deficiency causes anaemia, behavioral and cognitive effects, but recent evidence suggests that even iron deficiency without anaemia may cause behavioral and cognitive difficulties. Some effects, such as the development of abnormal sleep cycles, may persist even if iron deficiency is corrected in infancy. • Lead poisoning can cause iron-deficiency anaemia and should be explored as cause for at-risk infants and children.
- 42. • Iron present in animal protein is more bioavailable than that found in vegetables and other foods because it is already incorporated into heme moieties in blood and muscle. • Management of iron deficiency with or without anaemia includes treatment doses of 3–6 mg/kg body weight of elemental iron. • An average of 0.8 mg of iron must be absorbed each day during the first 15 yr of life. • Since, <10% of dietary iron usually is absorbed, a dietary intake of 8-10 mg of iron daily is necessary to maintain iron levels.
- 43. Selenium Dietary sources:- seafood, meats, garlic (geochemical distribution affects levels in foods). Clinical features:-Skeletal muscle pain and tenderness, macrocytosis, loss of hair pigment. Keshan disease, an often fatal cardiomyopathy in infants and children.
- 44. Copper Dietary sources: human milk, meats, shellfish, legumes, nuts, and whole-grain cereals. Clinical features:-Osteoporosis, enlargement of costochondral cartilages, cupping and flaring of long bone metaphyses, spontaneous rib fractures. • Neutropenia and hypochromic anemia resistant to iron therapy. Defect of copper metabolism (Menkes kinky hair syndrome) results in severe CNS disease.
- 45. Iodine Dietary source:- iodized salt. Clinical feature:- Cretinism a) Neurologic endemic cretinism (severe mental retardation, deaf mutism, spastic diplegia, and strabismus) occurs with severe deficiency. b) Myxedematous endemic cretinism occurs in some central African countries where signs of congenital hypothyroidism are present.
- 47. Flouride Source:-Flourinated water supply Function: incorporated into the hydroxyapatite matrix of dentin. Clinical feature:-Low intake increases incidence of dental caries. • Excess fluoride intake results in fluorosis.
- 49. Vitamins •Fat-Soluble Vitamins :- Deficiencies in these vitamins develop slowly because the body accumulates stores of fat- soluble vitamins; but prematurity and some child health conditions can place infants and children at risk. Excessive can cause toxicity. •Water-Soluble Vitamins :- Risk of toxicity is not as that of with fat-soluble vitamins because excesses are excreted in the urine. But deficiencies of these vitamins develop more easily than of fat soluble vitamins because of limited stores, with the exception of vitamin B12. •Carnitine is synthesized in the liver and kidneys from lysine and methionine. In certain circumstances synthesis is inadequate, and carnitine can be considered a vitamin.
- 55. Pellagra
- 56. Hyper-pigmentation of Palms, Tongue, Knuckles – Cobalamine (Vit B12) deficiency
- 58. Vitamin D:- Breast milk is a poor source of vitamin D, its insufficiency is common in infants and children. •The American Academy of Pediatrics recommends vitamin-D intake of 600 IU/day for infants and children. Vitamin K:- is important for bone health, and also important cofactor for coagulation factors (factors II, VII, IX, and X; protein C; and protein S). Deficiency assessed by:- a) prothrombin time, b) protein in the absence of vitamin K (PIVKA-II), and c) the vitamin K–dependent coagulation factor levels. Neonates are at risk for vitamin K deficiency, leading to an increased risk for hemorrhagic disease of the newborn. Vitamin K prophylaxis at birth is recommended for all newborn infants.
- 60. GROUP PARTICULARS BODY WEIGHT KG NET ENERGY Kcal/d PROTEIN g/d VISIBLE FAT g/d CALCIUM mg/d Iron mg/d
- 61. GROUP PARTICULARS RETINOL B-CAROTENE THIAMIN mg/d RIBOFLAVIN mg/d NIACIN EQUIVALENT mg/d PYRIDOXIN mg/d ASCORBIC ACID DIETARY FOLATE VIT B12 mg/d MAGNESIUM mg/d ZINC mg/d
- 62. Amounts of foods to offer
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