CHILD AND ADOLESCENT NUTRITION Definition: Nutrition = modifications of food`s components in the body to maintain life.The processes of growth, maintenance of organs and systems are due to dietary nutrients, plastics, energy and biocatalyst.
CHILD AND ADOLESCENT NUTRITION Nutritional needs: - quantity (energy, calorific value); - quality.
Quantitative nutritional needs (energy) Life processes in the body are made of energy expenditure.The main energy sources are carbohydrates and lipids.Energy needs: - maintenance needs - needs for thermoregulation - physical activity or muscle activity - needs for growth
ENERGY NEEDS 1. Maintenance needs for basal metabolism = needs and the needs of operation:a) basal metabolism (MB) = total body energy expenditure for breathing, heart contractions, secretions, etc.. M.B. MB 2 x baby = adult. M.B. lower in premature and dystrophic. M.B. increase in feverish.
Maintenance needs b) Operational needs = needs for food specific dynamic action (SDA) and losses through excretion.SDA = calories expended in food digestion and utilization. higher energy expenditure after ingestion of protein and lower fat and carbohydrate intake after small increase in weight → high protein regimens.
Maintenance needs • similar diets meals → consuming lower calorie when the number is higher.Losses increased excretion:- artificial nutrition (hyperosmolar formulas)- diarrhea.
ENERGY NEEDS 2.The needs for thermoregulation depends on: - large body size in relation to weight; - skin thinness; - ambient temperature.3. Physical activity and muscle activity requires energy to the intensity and duration of effort.
ENERGY NEEDS 4. Growth needs vary with: - age (the higher the more the child is less) - child health, - individual peculiarities.The caloric needs are covered by the body by burning food that provides on average:4 kcal per 1 gram of protein;4 kcal per 1 gram carbohydrates;9 kcal per 1 gram fat.
Growth Needs Child's overall energy ratio diminishes with age: - in the first trimester of life: 110-120 kcal / kg / day; - in the second quarter: 100-110 kcal / kg / day; - third and fourth quarter: 90-100 kcal / kg / day; - child 1-3 years: 90 kcal / kg / day; - preschool: 80 kcal / kg / day; - school: 50-60 kcal / kg / day.Before puberty, growth is accelerating the need to increase caloric intake.
Growth Needs Hiperglucidic scheme and / or infant hiperlipidic↓stimulates lipidogenesis↓± hyperplasia, hypertrophy of adipose cells↓ early obesity
Growth Needs Hypocaloric diets:→ malnutrition→ depressants sympathetic nervous system → saving operating needs and thermogenesis.Optimal caloric intake: carbohydrates 45% of total calories, 33-40% lipids, 12-15% protein.
QUALITATIVE NUTRITIONAL NEEDS Plastic factors: protein and some minerals; Factors energy: carbohydrates and lipids; Biocatalyst factors: vitamins, minerals, water.Protein: • necessary for growth, • sole source of nitrogen and indispensable amino acids.Carbohydrates: - elements easily digestible energy, - necessary for lipid metabolism.
QUALITATIVE NUTRITIONAL NEEDS Lipids: - important source of energy in a small footprint - soluble vitamins and unsaturated fatty acids. Qualitative nutritional needs of infants:
QUALITATIVE NUTRITIONAL NEEDS "food balance" = optimal ratio between the principles of food: P: L: G = 1:2:4 (newborn and infant). P: L: G = 1:1,2:3,5 (child 1-3 years).
Proteins • not stored in the body → required daily intak - protein diet free total → more than 48 hours in infants and young children factors that alter protein intake: - adaptability of the body; - carbohydrate intervention as saving factor protein; - biological value and protein digestibility (90% for animal and 50-80% for vegetable).
Proteins Sources: meat, cheese, fish, liver, eggs pasta, vegetables, fruits (smaller amounts)Essential amino acids (9) phenylalanine, lysine, leucine, isoleucine, threonine, tryptophan, methionine, valine, histidine - body can not synthesize or manufacture them in sufficient quantity; - must exist in certain proportions for protein resynthesis health state.
Proteins • essential amino acid needs in infants = 10 x adult proper diet → at least 50% of the total protein are animalAmino acid semiesential: under certain conditions the body's ability to synthesize from their precursors.
Proteins Cystine, taurine(derived from methionine) and tyrosine (derived from phenylalanine) should be considered essential amino acids in the neonatal period and low birth weight baby.Non-essential amino acids: alanine, arginine, glutamine, glycine, glutamic acid, asparagine, aspartic acid, cysteine (cystine), tyrosine, proline, serine →contribute to meeting the needs of the body nitrogen
Proteins In breast fed infants protein requirement is lower than in the bottle fed (high biological value and digestibility of human milk proteins rapidly).For ideal maximum use of the protein → 32-35 kcal compared to 1 g protein.
Proteins Plastic roles:- constitution of cells,- composition: hormones, enzymes, factorscoagulation- renewal of cells and tissues,- physical strength and intellectual- processes of the body's defenses against infection and poisoning.
Proteins Functional Roles: - circulating bilirubin, metals (Fe, Cu, Zn, Co, I), metabolites and blood gases; - fluid exchange between capillaries and cell gap, device is muscle contraction; - maintenance of colloid-osmotic pressure of plasma; - acid-base balance.
Proteins Excess protein - exceeds the capacity of the kidney excretory → ↑ glomerular filtration → kidney hypertrophy. - causes hypertrophy of cell → fat storage → obesity in adults. - hyperammonemia → low IQ.
Proteins Protein deficiency: - slow growth rate; - reduction of enzymatic synthesis, hormonal and humoral immunologic factors; - clinical: swelling hypoproteinemia and protein malnutrition (kwashiorkor).
Carbohydrates - energy substrate for all cells, - plastic role in human body structure serve to biosynthesis of: -glycogen, -galactocerebrosis brain -glucoproteins, -glucolipids, -amino acids -fatty acids.
Carbohydrates Food carbohydrates:- monosaccharides (glucose, fructose and galactose) - glucose polymers - disaccharides (lactose, sucrose and maltose) - polysaccharides (starch and glycogen).
Carbohydrates Glucose: - in fruits, vegetables, honey, - fetal transplacental transfer of glucose - dependent of mother glycemia; - control of glucose homeostasis is fully in 2-5 weeks after birth, including premature; - glucose polymers are an adequate source of carbohydrate for premature infants and infants with malabsorption, and is easily hydrolyzed in the gut.
Carbohydrates Fructose: in fruits, vegetables, honey or derived from hydrolysis of sucrose.Galactose: - derived from hydrolysis of milk lactose, - favorably influence brain development in newborn and infant.
Carbohydrates Lactose: - quantities in human milk > cow's milk only, - important role in infant brain development.Sucrose: - high power sweetening - child with customary sweetness, - promote obesity.
Carbohydrates Maltose: - the seeds sprouted grains - produced by hydrolysis of starch - slowly hydrolyzed by maltase → 2 glucose molecules - is well tolerated.Starch: - cereals, tubers, roots, bananas, - its hydrolysis is initiated by salivary and pancreatic amylase.
Carbohydrates Glycogen: - storage form of carbohydrate in the liver and muscle - starch-like structure - hydrolyzed by the same enzymes.Fiber: - wall polysaccharides in plant - resist the hydrolytic action of human digestive enzymes, - digestibility dependent chemical structure, how to prepare, while standing in the intestinal flora and colon.
Carbohydrates The main action of dietary fiber: - increases fecal volume and accelerates intestinal transit bowl; - regulates appetite - effect of satiety; - amended by binding to intestinal bacterial flora; - increased excretion of fat, protein and calories in the stool;
Carbohydrates The main action of dietary fiber: - increase the removal of cations by reducing the absorption of Zn, Fe, Ca, Mg, Na and K; - binds cholesterol and bile acids in the gut; - decrease the absorption of carbohydrates through the formation of gels and modulates tissue sensitivity to insulin.Sources of dietary fiber: bran cereals, fruits, vegetables.
Carbohydrates The quantity and quality of carbohydrate intake during the first months of life is crucial for life and any error during the formation of brain cells is irreparable.
Carbohydrates Carbohydrate needs: - premature: 6 -8 g / kg / day (first week - transient lactase deficiency), then 12 g / kg / day; - new - born IUGR: 18-25 g / kg / day in the neonatal period to combat hypoglycemia; - infant and young child: 12 g / kg / day; - preschool: 10 g / kg / day; - school: 8 g / kg / day.
Carbohydrates Deficiency of carbohydrate, in terms of adequate intake of protein, determined using protein for energy purposes by their gluconeogenesis and avoid the structural role.Excess sugar leads to obesity and diabetes mellitus by insulin depletion.Excess milk lactose in some formulas produce osmotic diarrhea.Excess starch creates imbalance of nutritional factors with development dystrophy by hypoproteinemia.
Lipids • energy and nutrients with plastic role (the nervous system myelination)dietary fat: - triglycerides, - phospholipids - cholesterol - metabolic derivatives of fats.
Lipids Triglycerides (TG) - most of the food ration; - have animal origin (milk, butter, egg yolk, meat, offal) and vegetable (soybean oil, corn, sunflower, olive); - TG animal nature prevails in saturated fats such as vegetable and in the predominant polyunsaturated fatty acids.
Lipids Saturated fatty acids: increased plasma cholesterol levels and promote atherosclerosis.Unsaturated fatty acids: - monounsaturated: oleic acid (role in myelination) - polyunsaturated (omega-6 series - linoleic and gamma-linoleic acid and omega 3 series - alpha linolenic acid). - considered essential, - structural components of membranes, - precursors of prostaglandins, leukotryenes and trombhexanilor → growth and cell function.
Lipids Important role in: - diencefalo-pituitary hormones, the serum lipoproteins; - trophicity of the skin and appendages; - structural and functional integrity of the arterial wall and platelets.
Lipids Linoleic acid: - olive oil, soy, corn, sunflower, cotton, - reduce plasma levels of LDL cholesterol.Linolenic acid: - fish oil, corn, soybean, sunflower, - major component of the phospholipids of brain and retinal cell membranes.
Lipids Cholesterol: - component of all cell membranes - in myelin structure, steroid hormones, vitamin D, - role in the formation of bile salts.Food sources: milk, butter, cream cheese, offal, egg yolk.
Lipids Fiber increases intestinal elimination of cholesterol ingested. Cholesterol food shortage → nerve structures are not affected (endogenous synthesis).Fat needs: - infant: 4-6 g /kg /day; - child 1-3 years: 4-5 g /kg /day; - school: 2 g /kg /day.
Lipids Deficiency of fat: → reduce energy intake disrupts the growth process, decreases absorption of fat soluble vitamins.Linolenic acid deficiency: - peripheral neuropathy - reduction of visual acuity, - trophic disorders of the skin and hair, - adesivity platelet growth.
Lipids Linoleic acid deficiency:- dermatitis,- trophic appendages disorders,- hypertension,- hyperlipidemia and hypercholesterolemia.
Lipids Excess fat: increased intake of calories obesity → often associated with hypertension.Establishing a fair ration of fat quantity and quality is the most effective prevention of adult atherosclerosis.
Water and Mineral Salts Needs The presence of water: - most urgent need of body - greater need as the body is younger: newborn: 180-200 ml / kg / day infant: 150ml/kg/day, child 1-3 years: 100-125ml/kg/day. Fluid balance = balance between intake and excretion of fluids.
Water and Mineral Salts Needs Contribution: - fluid intake; - water from food constitution; - water from combustion.Losses: - urine; - faeces; - sweating; - skin perspiration; - breathing.
Water and Mineral Salts Needs Distribution of body fluids in newborn and infant: water = 75% total body weight, → 40% of the total water in the extracellular fluid.Dehydration occurs due to extracellular water.
Water and Mineral Salts Needs The need for water increases in the following conditions:- ambient temperature increase;- in newborn;- phototherapy;- fever;- diarrhea / vomiting;- decrease in ambient humidity;- feeding with formula milk high calories and hyperosmolar type.