Transcript nutrition in childhood & adolescence

NUTRITION
IN CHILDHOOD &
ADOLESCENCE
DR RAB NAWAZ
MBBS, MPH, PGD (Nutrition),
Bannu Medical College Bannu,
NWFP, PAKISTAN
Food Guide Pyramid
The Food Pyramid, developed by the US Department of
Agriculture (USDA), is an excellent tool to help you make
healthy food choices. The food pyramid can help you choose
from a variety of foods so you get the nutrients you need, and
the suggested serving sizes can help you control the amount of
calories, fat, saturated fat, cholesterol, sugar or sodium in your
diet.
 Grains, Bread, Cereal and Pasta form the Base
 Fruits and Vegetables
 Lean Meat and Fish, Beans, Eggs
 Dairy Products
 Fats and Sweets
Food Guide Pyramid (2)
What counts as ONE serving
 Grain group:
1 slice of bread, ½ cup of cooked rice, ½ cup of
cooked cereals, 1 ounce of ready to eat cereal.
 Fruit/ Vegetable group:
½ cup of chopped raw or cooked
vegetables, ½ cup of raw leafy vegetable, 1
piece of fruit or one melon wedge, ¾ cup of juice, ½ cup of
canned fruit, ¼ cup of dried fruit
 Meat group:
2-3 ounce of cooked lean meat, poultry or fish, ½
cup of cooked dried beans or 1 egg (counts 1 ounce of lean
meat), 2 tablespoon of peanut butter (counts 1 ounce of lean
meat)
 Milk group:
1 cup of milk or yogurt, 2 ounces of cheese
 Fats & Sweets group:
limit calories from these.
4-6 years old children can eat these serving sizes. For children
below 4 years, a total of 2 servings from the milk group each
day.
CHILDHOOD
From age 1 through the beginning of adolescence.
Growth in childhood slower than infancy.
Weight gain about 5 pounds and grow 2-3 inches annually.
Three groups on the basis of age and development
Toddlers (Age 1-3 years)
Preschoolers (Age 4-5 years)
School children (Age 6-10 years)
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Energy & Proteins RDAs for children
Age (y)
g/day
1-3
4-6
7-10
Kcal/kg
102
90
70
1300
1800
2000
Kcal/day
1.2
1.1
1.0
Proteins g/kg
Proteins
16
24
28
On average 1 year old child requires 1000-1300 Kcal/day. This energy requirement
doubles by 10 years age.
Vitamins and minerals
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With cooperation of healthy child a well planned diet provide most nutrients except
iron.
RDA for iron during childhood (1-3 years) is 7 mg.
RDA for iron during childhood (4-8 years) is 10 mg.
As iron is low source of iron, so much consumption of milk contribute to low iron
intake. Milk should be limited to 3-4 cups which allows room for diet rich in iron
like lean meats, legumes, fish, poultry and cereals etc.
A child diet may also be deficient in other micronutrients like zinc, vitamin D & E.
Those children who are on low fat diets i.e. low fat dairy products suffer more.
Outside influences such as TV viewing, affect children preferences for low nutrient
density foods.
Nutritional concerns of childhood
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Hunger
Malnutrition, Micronutrients and PEM.
Deficiencies of vitamins A, D, Zinc, Iron and proteins.
These result in illnesses, stunted growth, limited development and in case of vitamin
A deficiency possibly permanent blindness.
ADOLESCENCE
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It is the time between the onset of puberty and adulthood.
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Boys grow about 8 inches, gain about 45 pounds and increase their lean body mass.
Girls grow about 6 inches, gain about 35 pounds and increase their body fat.
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Growth through adolescence is hormone driven. Growth spurts for girls begin
between ages 10.5 and 11 years with a peak in the rate of growth at around age 12.
For boys growth spurts usually begin between ages 12.5 and 13 and peak at around
age 14. This period of maximal growth lasts about 2 years.
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Adolescence is an uncomfortable time for the teen who is concerned with body
image
or body changes or athletic activities.
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Low nutrient snacks are a large part of the diet and adequate amounts of fruits and
vegetables are missing.
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Factors that determine food selection and consumption include the desire to be
healthy, fitness goals, amount of discretionary income, social practices and peers.
Nutrient needs of adolescents
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Growth not age should be ultimate indicator of nutrient needs.
Energy needs are greater during adolescence than at any other time of life with
exception of pregnancy & lactation.
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Energy & Proteins RDAs
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Males
Age (yrs)
11-14
15-18
Females
Age (yrs)
11-14
15-18
Kcal/kg
55
45
Kcal/day
2500
3000
Proteins g/kg
1.0
0.9
Proteins gm/day
45
59
Kcal/kg
47
40
Kcal/day
2200
2200
Proteins g/kg
1.0
0.9
Proteins gm/day
46
44
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Vitamins & Minerals
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Higher vitamins and minerals needs.
Three nutrients of importance i.e. vitamin A, iron and calcium.
AI for calcium 1300 mg/day, for iron is 11 mg/day (boys) and 15 mg/day (girls).
Improving fruit & vegetable intake will help in obtaining adequate vitamin A.
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PREGNANCY
Time of tremendous changes, guided by changing levels of hormones. Uterine,
breast and adipose tissues grow, blood volume expands and gastrointestinal motility
slows. All these changes have nutritional and dietary implications for pregnant
women.
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Weight gained during pregnancy is a combination of fetal and maternal tissues and
fluids. Weight gain recommendations are based on BMI prior to pregnancy. Women
of normal weight (BMI=19.8-26) should gain 25-35 pounds over the course of
pregnancy Most of this weight gain occurs during the second & third trimester.
Nutrition related components of preconception care
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Risk assessment: Age, Diet, Substance use, existing medical condition, Barriers to
prenatal care and PHC.
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Health Promotion: Healthful diet and refraining from substance use. Compliance
with prenatal care.
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Interventions: Referral to hospitals with highly equipped and trained staff. Nutrition
counseling, supplementation or referral to improve diet as needed.
Nutrient needs of Pregnancy
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A pregnant woman requires added calories to grow and maintain not just her
developing fetus but also the placenta, increased breast tissue and fat stores.
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Growth & development of the fetus also requires nutrients—carbohydrates, and fat
as a source of energy while proteins, vitamins and minerals to support growth and
cell differentiation.
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Nutritional Recommendations for Pregnancy
Energy (Kcal)
Proteins
Vit A (ug)
Vit D (ug)
Vit E (mg)
Vit (K (ug)
Thiamine (mg)
Riboflavin (mg)
Niacin (mg)
Vit B6
Folate (ug)
Vit B12 (ug)
Choline (mg)
Vit C (mg)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Iron (mg)
Zinc (mg)
Iodine (ug)
Copper (ug)
Non-pregnant
Pregnant
2200
46
700
5
15
90
1.1
1.1
14
1.3
400
2.4
425
75
1000
700
310
18
8
150
900
2500
60
770
5
15
90
1.4
1.4
18
1.9
600
2.6
450
85
1000
700
350
27
11
220
1000
% Increase
14
30
10
0
0
0
27
27
29
46
50
8
6
13
0
0
13
50
38
47
11
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Folic acid supplementation before pregnancy reduces the risk of
neural tube defects such as spina bifida.
Excessive intake of some vitamins (A) and use of drugs increase
the risk of poor pregnancy outcome.
The energy RDA increases by 300 Kcal/day for the 2nd & 3rd
trimesters.
Protein needs increases by about 10 gm/day while CHO & fats
as for non pregnant women.
The diet should contain CHO & fats in the same proportion as
recommended for non pregnant women.
Using the FGP pregnant women who consume enough energy
should be able to meet all their nutrients needs except iron &
folate. They should get extra calories mainly from grains, fruits
and vegetables.
LACTATION
Breast feeding mother must choose a varied, healthful and nutrient dense diet.
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Need for energy and many nutrients is higher during lactation than during
pregnancy.
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RDA values suggest an additional 500 Kcal and 12-15 grams of proteins each day.
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RI levels for minerals are generally higher during lactation than during pregnancy.
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Fluids are also important for adequate milk production.
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Food choices during lactation should follow the USDA Food Guide Pyramid and
emphasize nutrient dense foods.
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With good choices and adequate intake a lactating mother may not need vitamin or
mineral supplementations.
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The main CHO in breast milk is lactose while triglycerides are the main source of
energy in breast milk.
Benefits of Breastfeeding
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For infants
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For mothers
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For country
Advantages of human milk over cows milk
Proteins: more whey less casein, less phenylalanine, more peptidases
Lipids: more lipase enzymes, more Linoleic acid, higher polyunsaturated to saturated
fatty acid ratio, more cholesterol.
Minerals:
Less calcium, less sodium, higher calcium to phosphorus ratio, iron
and zinc in more available form
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Unless the lactating mother reduce their physical activity, breastfeeding
women need about 500 more Kcal/day than they did when they were not
pregnant. Obtaining adequate energy and using the Food Guide Pyramid to
balance choices most lactating women can obtain all the nutrients they need
from their diet. Alcohol, cigarettes and drugs should not be used while
breast feeding.
Nursing mothers should eat plenty of vegetables (source of many
micronutrients)
Vegetables of cabbage family causes colic symptoms in breastfed children.
Other foods with bad reputation include peanut butter, chocolate, egg
whites and nuts. But removal of these foods from the diet should be done
only under the supervision of a registered dietitian.
Vegan women and who do not follow diet guidelines, should take vitamin
B12 supplement.
Those women who do not get regular sun exposure or do not drink milk or
other fortified foods should get vitamin D supplementation.
For most nursing mothers dietary counseling is the preferred way to
address nutrient imbalances.