Transcript 06_-_Nutrition

Nutrition
Dr.Khalid Hama salih,
Pediatrics specialist
M.B.Ch.; D. C.H
F.I.B.M.S.ped
Nutrition: the study of nutrients in food, how
the body uses nutrients, and the relationship
between diet, health and disease.
 Major food manufacturers employ
nutritionists and food The food we eat
determines the way we look, and to some
extent the way we feel, think, and behave
scientists.
Nutritional disorders are not confined to
children living in areas of famine and
starvation , they are also found in children
living in developed countries .
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Weight wise:nutritional requirement of
children are relatively higher than in adult due
to :higher basal metabolic rate active growth
Building of store & more physical activity
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Why is Nutrition Important?
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Energy of daily living
Maintenance of all body
functions
Vital to growth and
development
Therapeutic benefits
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Healing
Prevention
Nutritional requirement :
Denote physiological requirement of various
nutrient to maintain normal metabolism.
 Basal metabolic rate(BMR):minimum energy
requirement to maintain essential physiological
function f the body at rest, is highest in
infancy55cal/kg/day decrease with age 2530cal/kg/day in late childhood
 Normal child spend:50% of energy
requirement for BMR,25%for physical
activity,12% for growth,5% for digestioinof
food,8%for fecal losses
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Ideal diet should provide 50-60% as CHO,
20-30% asfat& 10-15% as protein
Each gram of
protein,fat,CHOprovide4,9,4calories
respectively.
Normal energy requirement:
1st <10kg
100cal/kg
2nd10-20kg
1000+50cal/kg
3rd >20kg
1500+20cal/kg
COMPOSITION OF FOOD
Food is composed of the same chemicals that
make up our bodies (water, salts, proteins, and
so on).
When we talk about diet, foods are classified
according to the kinds of nutrients they provide.
These nutrients classified as:
1.Macronutrient or proximate
principlese.g:proteins,fat,carbohydrate
2.micronutriente.g:vitamine & minerals
PROTEINS
These are the basic substances of our bodies –
constitute 20% of body wt ,are important source
of energy as wellas required for:
A. body building i.e growth of muscle&tissue
B. repair &maintains of tissue
C. synthesis of substance e.g:AB,enzyme
,hormoine,HB,
D.maintaince of osmotic
SOURCES
Soya
Milk
beans
Dried
peas
Nuts
Pulses
protein requirement are differ from age to age and
from condition to other .usually:1.8-1.5mg/kg
Amino acids are essential nutrients in forming
cell protoplasm , there are 9 essential A.A. which
are essential for the growth .histidine essential only
for infant
* Arginine , cystine , taurine are essential for low
birth wt infants .
Deficiency of protein is specially harmful in childhood.
It can lead to impairment of physical and mental
growth.
Children with deficiency are more likely to get frequent
infections
FATS
Fats are very concentrated sources of energy.
They give twice as much energy as either proteins
or carbohydrates.
Those fats which exist in Nature in the solid state
are called fats.
Those which are liquid by nature are called oils.
a.as vehicle for fat-soluble vit.
b.suorce of essencial fatty acid
c.temperature regulation .
d. increase palatability of ffod
SOURCES(vegetable sources) include :groundnut,
gingerly, rape seed, coconut oil). Ghee (animal source).
Some vegetable oils are hydrogenated.
They are treated with particular temperature and
pressure in the presence of a chemical.
After this process they can be kept even in hot
climates.
During the process, the vegetable oils lose certain
essential components which promote growth
and keep the skin healthy.
CARBOHYDRATES
Carbohydrates are more commonly known as starches
and sugars.
are consumed either as freesugare.g:monosaccharides(glucose,fructose&galactose
)&disaccarides(sucrose,maltose,lactose)or as complexsugarei.e polysaccharides e.g starch
They provide heat and energy.
Glucose is the fuel for the activity of all the cells.
Carbohydrates also provide bulk or fiber or roughage.
This is in the form of cellulose, which is the fibrous
material present in many fruit and vegetables.
SOURCES: glycogen,cereals, starchy vegetables such as potatoes
VITAMINS
Vitamins are complex chemical substances
required by the body in very small amounts.
There are about a dozen vitamins which are
essential to good health.
Which act as co-factorsw in many enzyme
system&dividedin to 2 groups
1.Fat soluble vit.ADEK
2.Water soluble:B_complex group&vit.c.
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However, a well balanced diet supplies all the
vitamins, their actions, symptoms of
deficiency, and sources have been given below
Some Vitamins in Relation to Man
Vitamins
Symptoms of
deficiency
A
Night blindness
B1
•Weakness
•Altered nerve
function
•beriberi
B2
Pellagra
(dermatitis,
diarrhea,
dementia)
Action in body
Good sources
Normal vision
Maintaince integrity
of epithelial,removal
of free-radical
Normal nerve
function
Carrots,
mango,
papaya
Normal metabolism
of proteins, fats &
carbohydrates
Whole cereals
milk,egg
Whole cereals
milk
Vitamins
Symptoms of
deficiency
Action in body
Good
sources
B6
•Periphral
Normal CNS
neuritis ,seizure function
Widely
distributed
Folic
acid
Anemia
Green leafy
vegetables
Normal nucleic
acid synthesis
production of red
cells
Vitamins
Symptoms of
deficiency
Ascorbic Scurvy –
acid /C fatigue,
hemorrhage,
abnormalities of
bones
D
Rickets –
defective bones
and muscles
Action in body
Wound healing
increased
resistance to
infection
•Normal growth
of bones and
teeth.
•Normal muscle
tone
Good
sources
Fresh fruit
(oranges,
lemons,
‘amala’
gooseberry)
Milk and
milk
products
MINERALS
Minerals required by the body include calcium,
iron, and iodine (though iodine is usually
described as a ‘trace element’.
Calcium
Is necessary for the maintenance of the teeth and
bones, for clotting of blood, and for muscular
contraction.
Sources: milk and mild products, dried fruit
(specially dates), fresh fruit (‘sitaphal’ or
custard apple), and certain cereals, such as ragi.
Iron
Is a component of hemoglobin (the red coloring
substance in the blood), and of myoglobin (the
red coloring substance in the muscles).
It is concerned with oxygen transport and cellular
respiration.
Deficiency of iron affects the formation of Hb,
which is present in lower than normal amounts.
This is called anemia.
Sources: dried fruit, nuts, jaggery, dried peas and
beans, and green leafy vegetables.
Iodine
Is important as it is used by the thyroid gland to
synthesize the hormones, thyroxine and
triiodothyronine.
These two hormones influence the body growth and
metabolism.
Deficiency of iodine leads to low levels of thyroid
hormone in the blood.
Hence the feedback or check on the anterior pituitary
and hypothalamus is removed.
Hence the hypothalamus releases the releasing hormone
(RH), which brings about release of the stimulating
hormones (SH) of the anterior pituitary.
The SH stimulate the thyroid gland, which
increases in size – this is called goiter.
Though enlarged, it is unable to produce the
hormones, till iodine is provided.
Sources: sea salt, sea food, cereals, and
nowadays ‘iodized salt’
Zinc :is essetial component of many
enzymee.g:carbonic anhydrase,alkaline
phosphatase.widely distributed in tissue :80 80-90Mg/dl normal plasma
 Zinc is essential for :
 1.normal growth
 2.normal immunity
 3wound healing
 4.synthesis of hormone
Sources:meat,milk,nut,legume
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Flourine:is the most abundant element in
nature,about96% of bady flourine is present in
bone&teath
Flourine is required for mineralization of
bone&dental enamel
Drinking water is the principle source for it
HEALTHFUL FOODS
Supplement to Breast Fed Infant
UNHEALTHFUL FOODS
Fast food
Canned
food
Saturated fat
Breast feeding
prepared by:
Dr.KHALID H.SALIH
If we could give every individual the right
amount of nourishment and exercise, not too
little and not too much, we would have found
the safest way to health.
Hippocrates
Principles of feeding
• Feed according to expected wt
• GIT should be used whenever possible
• Milk should not be diluted
• No sugar should be added to the bottle feed
• Weaning food should be started at 4-6mon
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Composition of Breast Milk
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Minerals
Vitamins
Fat
Carbohydrates
Protein
Water
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Anti-Allergenic Properties
Anti-Parasitic Properties
Anti-Viral Properties
Anti-Bacterial Properties
Hormones
Growth Factors
Enzymes
Alive
Approx.300+ more Factors
than ABM
Summary of differences between
milks
Protein
Human milk
Animal milks
correct amount, easy too much, difficult to
to digest
digest
enough essential fatty lacks essential fatty
acids, lipase to digest acids, no lipase
Fat
Infant formula
partly corrected
no lipase
Water
enough
extra needed
may need extra
Anti-infective
properties
present
absent
absent
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health
Organization, 1993 (WHO/CDR/93.6).
Slide 2.2
Breast milk composition
differences (dynamic)
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Gestational age at birth
(preterm and full term)
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Stage of lactation
(colostrums and mature milk)
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During a feed
(foremilk and hind milk)
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Day & night milk
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Summer & winter
Slide 2.4
Slide 2b
Colostrum
Property
Antibody-rich
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Many white cells
Purgative
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Growth factors
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Vitamin-A rich
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Importance
 protects against infection and
allergy
 protects against infection
 clears meconium; helps prevent
jaundice
 helps intestine mature; prevents
allergy, intolerance
 reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin Arelated eye diseases
Slide 2.5
Slide 2c
Technique of Breast Feeding
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Feedings should be initiated as soon after
birth as possible
Mothers who wish to initiate breast-feeding
in the delivery room should be supported in
doing so.
the infant's desire for food will vary at
different times of the day(The time
required for an infant's stomach to empty
may vary from 1–4 hr or more during a
single day)
By the end of the 1st wk of life, most
healthy infants will be taking 60–90
mL/feeding and want 6–9 feedings/24hr
ADVANTAGES OF BREAST-FEEDING
1.Human milk is uniquely adapted to the infant's needs
and is the most appropriate milk for the human infant
2.It is always available at the proper temperature and
requires no preparation time
3.It is fresh and free of contaminating bacteria
4.Breast-feeding is associated with fewer feeding
difficulties incident to allergy and/or intolerance to
bovine milk.
5.Human milk contains bacterial and viral antibodies,
including relatively high concentrations of secretory
immunoglobulin A
6.It also contains substances that inhibit the growth of
many common viruses as well as bacteria
Advantage -----7.It also contains antibodies that are thought to provide local
gastrointestinal immunity against organisms entering the
body via this route.
8.Macrophages in human milk may synthesize complement,
lysozyme, and lactoferrin
9.breast milk contains lactoferrin, an iron-binding whey protein
that is normally approximately ⅓ saturated with iron and has
an inhibitory effect on the growth of Escherichia coli
10.lower pH of the stool of breast-fed infants is thought to
contribute to the favorable intestinal flora of infants
11.Human milk also contains bile salt-stimulated lipase, which
kills Giardia lamblia and Entamoeba histolytica
12.passive transfer of T-cell immunity.
13.Breast milk will supply all the necessary nutrients except
fluoride, The vitamin K and vitamin D.
14.The psychologic advantages of breast-feeding for both
mother and infant are well recognized
Contraindications of Breast Feeding :
1.Contraindications related to mother like septicemia ,
nephritis , eclampsia , profuse hemorrhage , active
tuberculosis , typhoid fever , breast cancer and malaria
2.Contraindications related to infant like galactosemia .
Determination of adequacy of milk supply :
The following signs indicate adequate breast milk
feeding :1)
Infant sleep 2-4 hr after nursing .
2)
Infant gaining weight .
3)
Good urine output .
Supplement to Breast Fed Infant:
• Give Vit. K1 to all babies(1mg Vit K)
• Give Vit. D to all breast fed babies(400 IU/day)
• Give Iron to all breast fed babies by 6 mo
Disadvantages of Breast Feeding:
• Unknown intake-volume of milk.
• Transmission of infection-CMV, hepatitis, HIV,TB
• Breast milk Jaundice-mild self limiting
• Transmission of drugs-antithyroid, anti cancer
• Nutritional inadequacies-prolong BF without
introduction of solids lead to poor weight gain,
rickets
• Vit K deficiency—hemorrhagic disease of newborn
• Less flexible, emotional upset if unsuccessful
?Quiz
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Calculate the normal energy & fluid
requirement for 2 year old child (12kg) ?