Nutrition in Children

1

Nutrition in Children
Presentation by Dr Kamel Zain Edeen.
Moderator Dr A.Hamam.
2

Basic Goals Of Nutrition - -Achievement of
satisfactory growth and avoidance of deficiency
state. - Prevent acute and chronic illness. -
Physical and mental development . - Provide
reserves for stress.
3
(No Transcript)
4

• Nutritional requirements
• The nutrient requirement of the child are
  influenced substantially by-
• 1 - Rate of growth in infant the rate is high
  and more in male than female
• 2 - Body composition
• the brain in infant account for 10 of body
  weight and needs 44 of total energy under basal
  conditions.
• - In adult the brain account for only 2 of body
  weight and contributes 19 of total basal energy
  expenditure.
• 3 - Composition of new growth new weight gain.
• - fat account 40 of weight gain between birth
  and 4 month but for only 3 between ages 24 and
  36 months.
• Because of the high nutrient requirements for
  growth and the body composition the young infant
  is especially vulnerable to undernutrition.

5

• Estimated average requirement (EAR)
• the nutrient intake estimated to meet the
  requirements of a specified indicator of adequacy
  in 50 of the individuals at a life stage in
  gender group.
• Recommended dietary allowance (RDA)
• the daily dietary intake sufficient to meet the
  requirement of 97 of individual in the life
  stage and gender group.
• Adequate intake (AI)
• approximation of the average intake.

6
Adequate intake
7

• Basic elements of nutrition

Water
Fats
minerals
Carbohydrate
Miscellaneous factors
Proteins
8
Water

• Water is essential for the existence and alack of
  it results in death in a matter of days.
• In infant 75 -80 of body weight is water .
• In adults 55 - 60 .
• Human needs for water are related to caloric
  consumption, to insensible loss and to specific
  gravity of urine .
• The daily consumption of fluid by the healthy
  infant is equivalent to 10-15 of body weight
  compared with 2-4 in the adult .
• Water balance depends on variables, such as the
  protein and mineral content of diet, that
  determine solute load presented for renal
  excretion, metabolic and respiratory rate, and
  body temp.
• Evaporation from the lung and skin accounts for
  40-50 of intake and renal excretion for 40-50
  of intake.

9

summary
HOME
10
Energy

• The unit of heat in metabolism is Calorie or
  Kilocalorie ( cal 1 kcal ), it is the energy
  content of food.
• What is the Kilocalorie ? ?
• It is the amount of heat necessary to raise the
  temp. of 1 kg of water from 14.5 to 15.5 C.
• The major determinants of energy expenditure are
  
• basal metabolism, metabolic response to food,
  physical activity and growth.

11

Energy

• The approximate average expenditures of energy in
  children
• 1- basal metabolism 50
• 2- physical activity 25
• 3- growth 12
• 3-fecal loss 8
• 4-thermic effect of food 5
• Thermic effect of food
• increase in metabolism over the basal rate by
  the ingestion and assimilation of food.
• Thermic effect of Protein 30, Fat 4,
  Carbohydrate 6

12
Energy

• Distribution of calories in human milk
• Protein 9 - 15, Carbohydrate 45 -55, Fat 35
  -45 .
• Distribution of cal. in older childern
• Protein 10 -15, Carbohydrate 55 - 60, Fat 30.
• How much kcal each gram of ingested food provide
  ? carbohydrate 4, protein 4, Fat SCH 5.3,
  MCH. 8.3, LCH 9.0 .

13

summary
HOME
14
Protein

• Protein requirement are essential for supplying
  amino acids for growth and repair of tissue
  cells, solutions for osmotic equilibrium.
• Protein requirements- 0-3 years 2.05 gm /kg/day.
• 3-5years
  1.1 gm/kg/day.

15
Protein

• Protein digestion
• Started in the stomach with the hydrochloric acid
  which provide the optimal pH for peptide cleavage
  by pepsin.
• In the Alkaline medium of the intestine, trypsin,
  chymotrypsin, and carboxypeptidase's from the
  pancreas hydrolyze these proteins and peptones to
  peptides and to some amino acids.

16
Protein
Essential Amino acids for INFANTS -

• Threonine, valine, leucine, isoleucine, lysine,
  tryptpophan, phenylalanine, methionine, and
  histidine.
• Essential Amino acids for Low birth weight
  infants -
• Arginine, cystine, and taurine .
• -New tissue cannot be formed without all the
  essential Amino acids simultaneously present in
  the diet.

17
Protein

• Biologic value of protein
• Indicates effectiveness of utilization .
• Proteins of High biologic value
• Proteins which have the quantity and
  distribution of essential amino acids appropriate
  for resynthesis of body tissues and produce
  little waste.
• Protein requirement increases in the presence of
  unusual skin or gut losses, burns, trauma and
  severe sepsis, and during times of catch up
  growth accompanying recovery from malnutrition.

18
Protein

• Adverse effect of excessive protein intake
• - Increase loss of renal mass.
• - Increase BUN, acidosis, hyperammonemia.
• - Failure to thrive, lethargy and fever in infant.

19

summary
20

summary
HOME
21
Carbohydrate

• Function
• Carbohydrate supplying the necessary bulk of diet
  and most of the body's energy needs.
• Energy density 4 kcal/kg.
• In human milk -40 of caloric intake lactose .

22
Carbohydrate

• Digestion
• Carbohydrates digestion started in the mouth by
  salivary amylase and continued in the intestine
  by the pancreatic amylase.
• Carbohydrates are oxidized as glucose but are
  consumed in various forms
• -Monosaccharide
• glucose, fructose, galactose.
• -Disaccharides
• lactose, sucrose, maltose, isomaltose.
• -Polysaccharides -
• starches, dextrin, glycogen, gums, cellulose.
• Most of the absorbed sugar is converted to
  glycogen in the liver and some glucose may be
  oxidized directly in the brain .
• In the absence of carbohydrate the body uses
  proteins and fats for energy's.
• Storage as glycogen in the liver and muscles.

23
Carbohydrate

• Carbohydrate metabolic disorders-
• Diabetes mellitus, glycogen storage disease,
  galactosemia, fructose intolerance, enzymes
  deficiencies ( lactase, sucrase, maltase,
  isomaltase).

24

summary
HOME
25
Fats

• Fats are the concentrated source of energy, their
  metabolic product form un integral part of
  cellular membranes.
• Up to 50 of energy in human milk are from The
  Fat.
• - 98 of these fats in the form of triglycerides
  which have un energy density of 9 kcal/gm.
• - 2 include free fatty acids, monoglycerides,
  diglycerids, cholesterol, and phospholipids (
  lecithin, cephalin, sphingomyelin).

26
Fats

• Function
• - Absorption of fat soluble Vitamins
• - Essential fatty acids necessary for brain
  development.
• - Synthesis of prostaglandins and leukotriens.
• - Physical protection of vessels.
• - Necessary for growth, skin and hair integrity,
  regulation of cholesterol metabolism and
  decreased platelet adhesiveness and reproduction.

27
Fats

• Essential fatty acids
• - Polyunsaturated fatty acids derived from
  linoleic acids and linolenic acids which present
  in human milk and brain cells.
• Human milk contains 40 of fatty acids as
  monounsaturated - 10 MCH triglycerides.
• Character of MCH triglycerides-
• Sufficiently soluble that micelle formation is
  not required for them to diffuse through the
  membrane.
• -Much readily absorbed than LCT and directly
  transported to the liver and rapidly metabolized.
• They don't require carnitine to inter the
  mitochondria

28
Fats

• Calories-
• One gram of short chain fatty acids
• - 5.3 kcal.
• - MCHFA
• 8.3 kcal.
• LCHFA
• 9.0 kcal.

29

HOME
30
Miscellaneous factors

• Fibers
• Recommended dietary intake is 0.5gm/kg/24h.
• Low fiber diet may be associated with
  constipation, appendicitis, diverticulitis, and
  other intestinal disorder.
• High fiber diet leads to decrease absorption of
  cholesterol, zinc.

31
Miscellaneous factors

• Availability
• The main causes of malnutrition in children are
  poverty, ignorance, and lack of practical
  education in buying, and preparing of food.
• Satiety
• -Whole milk ,cream ,eggs, and fatty foods have
  high satiety value.
• - Sugar increases the flow of gastric juice and
  delays emptying of the stomach and increasing
  satiety

HOME
32

Thank You
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)