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C h i l d r e n ’ s H o s p i t a l

c. C h i l d r e n ’ s H o s p i t a l. NUTRITION DURING INFANCY. Haiqi Li. Children need food of appropriate quantity and quality for optimal growth and development. The nutritional vulnerability. Infants and children are more vulnerable

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C h i l d r e n ’ s H o s p i t a l

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  1. c Children’sHospital NUTRITION DURING INFANCY Haiqi Li

  2. Children need food of appropriate quantity and quality for optimal growth and development

  3. The nutritional vulnerability Infants and children are more vulnerable to poor nutrition than are adults Low nutritional stores High nutritional demands for growth Rapid neuronal development Illness

  4. Age energy intake 4 months 30% 1 year 5% 3 years 2% Energy demands for growth

  5. INTRODUCTION OF NUTRITION FEEDING OF INFANTS Breast-feeding Partial breast-feeding Comparisons of milks Weaning period NUTRITIONAL ASSESSMENT

  6. Key points Nutrients requirements : Pro,Energy,Vits The benefits of human milk Food change

  7. INTRODUCTION OF NUTRITION Threpsology

  8. Category of nutrients （2000 Chinese Dietary Reference Intakes） Energy： Macronutrients:PRO、FAT、CHO Micronutrients:minerals vitamins (Fat-soluble-vitamins, water-soluble-vitamins) Other diet elements:cellulose,water

  9. RNIs(Recommended Nutrient Intake ), are defined as the levels of intake of essential nutrients. RNIs =*EAR+ 2SD * Estimated Average Requirement

  10. CHO FAT PROTEIN Macronutrients Energy produced

  11. Gross Energy Intake Activity Energy Stored “growth” **TEF Metabolizable Energy Intake Growth *BMR Tissue Synthesis Excreta *Basal metabolism rate **Thermic effect of food

  12. REQUIREMENTS OF TOTAL ENERGY (EAR) 0 12m95 kcal/kg.d 1y 1100 kcal/d 2y 1200 kcal/d 3y 1350 kcal/d 5y 1600 kcal/d 7y 1800 kcal/d 10y 2100 kcal/d ≈100 kcal/kg.d (2000 Chinese Dietary Reference Intakes)

  13. Protein in diet described as essential(8+1) and nonessential (13) amino acids EAAs leucine isolucine lysine methionine Phenplalane threonine trytophan valine +histidine

  14. Good quality of PRO Complete protein: the protein in a food supplies enough of the essential amino acids The sourcesof complete proteins

  15. The amount of recommended daily protein depends upon age, medical conditions and the type of diet one is following.

  16. Reference values for protein requirements Age Protein(g/kg/d) 0-6m 2.2 6-12m 2.0 1-3ys 1.8 4-6ys 1.5 7-10ys 1.2 11-14ys 1.0 15/18ys 0.8

  17. A high-protein diet may put a strain on the kidneys Side Effects 8-15% of total energy intake comes from protein.

  18. CARBOHYDRATE(CHO) The major resources of the energy (45-55%)

  19. Side Effects Excessive carbohydrates can cause an increase in the total caloric intake, causing obesity. Deficient carbohydrates can cause a lack of calories (malnutrition), or excessive intake of fats to make up the calories.

  20. FAT One of the three nutrient supplied the calories to the body. ? The calories provided by fat

  21. Saturated fats :animal vegetable Unsaturated fats :monounsaturated from plantspolyunsaturated(fish oil, plants )

  22. Linoleic acids is the most important “essential” fatty acids, especially for growth and development of infants.

  23. Side Effects Eating too much saturated fat is one of the major risk factors for heart disease. Fat serves as the storage substance for the body’s extra calories , which will be the risk of obesity.

  24. Distribution of Energy produced infant(40-45%)

  25. Micronutrients: minerals vitamins

  26. Minerals Macro elements Ca、P、Mg 、Na CL、K、S Trace elements Fe、I、Cu、Zn、 F、Cr、Se

  27. <6 Months infant recommended daily intake for minerals Calcium 360 mg Copper 0.5-0.7 mg Phosphorus 240 mg Sodium 115-350 mg Zinc 3 mg Iron 10 mg Iodine 40 ug

  28. Vitamins Definition A group of substances essential for normal metabolism; growth and development; and regulation of cell function. Vitamins work together with enzymes, co-factors (substances that assist enzymes), and other substances.

  29. There are 13 vitamins needed by the body:Vitamins A, C, D, E, K, and the B vitamins. FAT-SOLUBLE VITAMINS(4) : Vitamin A ,D,E,K WATER-SOLUBLE VITAMINS(9): VitaminB1,2,3 ,6,12 C, H, Folate Pantothenic acid,

  30. Vitamin A is found in milk, cheese, cream, liver, kidney, and cod and halibut fish oil. Beta carotene is a precursor to vitamin A . The body can synthesize vitamin D when the skin is exposed to sunshine.

  31. Vitamin B1 is found in fortified breads, cereals, pasta, whole grains (especially wheat germ), lean meats (especially pork), fish, dried beans, peas, and soybeans. Most other fruits and vegetables contain some vitamin C.

  32. Vitamin A 0.4 mg  (400 ug, 1500-2000 IU) Vitamin D 0.01 mg  (10 ug, 400 IU) Vitamin C 35 mg  (35000 ug) Vitamin E 4 mg  (4000 ug) Vitamin B1 (thiamin) 0.3 mg  (300 ug) Vitamin B2 (riboflavin) 0.5 mg  (500 ug) Folic Acid 0.04 mg (40  ug) Vitamin B12 0.0006  mg (0.6 ug) Vitamin K 12 ug Infant recommended daily intake for vitamins

  33. Energy intake(EAR) 100 kcal/kg.d RNI Protein 2.2-2.0g/kg/d Calcium 360 mg Zinc 3 mg Iron 10 mg Iodine 40 ug Vitamin A 0.4 mg  (400 ug, 1500-2000 IU) Vitamin D 0.01 mg  (10 ug, 400 IU) Vitamin C 35 mg  (35000 ug) Vitamin B1 (thiamin) 0.3 mg  (300 ug)

  34. Other diet elements: cellulose water

  35. Cellulose ( Diet - fiber ) 2 forms of fiber: soluble and insoluble Soluble fiber slows digestion and the rate of nutrient absorption from the stomach and intestine. Insoluble fiber speeds the passage of foods through the stomach and intestines and adds bulk to the stool.

  36. Functions To provide a feeling of fullness and adds bulk in the diet. To prevent constipation To prevent or treat diverticulosis, diabetes, and heart disease

  37. The recommendation for older children, adolescents and adults is 20 to 35 grams per day. Younger children will not be able to eat enough calories to achieve this, but introducing whole grains, fresh fruits and other high fiber foods is suggested.

  38. Side Effects Too much fiber may interfere with the absorption of minerals including iron, zinc, magnesium, and calcium.

  39. FEEDING OF INFANTS

  40. BREAST-FEEDING

  41. WHO definition Exclusive breastfeeding is fed no foods or fluids, even water. Partial breast-feeding isdefined as breast milk plus either solid foods or other milks.

  42. Two patterns for partial breast-feeding To supply with formular within 4~6 months Fordeficient B.M intake To replace B.M with formular after 4~6 months preparation for weaning

  43. Components of human milk Colostrum : "first milk"; immature milk produced in 4-5 days post-partum Transitional  Milk: 2weeks The composition is midway between colostrum and mature milk . Mature Milk:

  44. The changes of the components during nursing (g/L) colostrum middle maturity PRO 22.5 15.6 11.5 FAT 28.5 43.7 32.6 CHO 75.9 77.4 75.0 Mineral 3.08 2.41 2.06 Ca 0.33 0.29 0.35 P 0.18 0.18 0.15

  45. The compositions of mammary secretions changes continuously throughout the sucking period. The changes of the compositions during the sucking period（g/L） I II III Pro 11.8 9.4 7.1 Fat 17.1 27.7 55.1 hindmilk foremilk

  46. The advantages of breast-feeding Immunology Nutritional properties Growth factors Others

  47. IMMUNOLOGY Breast milk contains valuable antibodies from the mother that can help the baby resist infections.

  48. Breast-feeding are half as likely as artificially fed infants to have ear infections in the first year of life. reduces the incidence and lessens the severity of bacterial infections. reduce the risk for subsequent inflammatory bowel disease and childhood lymphoma. less likely to have diarrhea.

  49. Immunology functions on the major nutrients of human milk for the infant Nutrients Amount Function Protein SIgA 50-100/mg/dl Immune protection IgM 2mg/dl Immune protection IgG 1mg/dl Immune protection Lactoferrin 100-150mg/dl Anti-infective Lysozyme 5-25mg/dl Anti-infective casein 200-300mg/d Inhibits microbial adhesion to mucosal membranes Carbohydrate Oligosaccharides 1.0-1.5g/L Microbial ligands Glycoconjugates - Microbial and viral ligands Fat FFA - Anti-infective

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