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Nutrition in Early Childhood

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Title: Nutrition in Early Childhood


1
Nutrition in Early Childhood
  • Dr. Sheela Sharma
  • MBBS, MD (Obstetrics and Gynaecology)

2
ENERGY
  • 5.1. ENERGY
  • Children need energy for deposition of tissues.
  • Energy is also required for physical activity of
    daily life.
  • When individual is in a state of complete rest,
    energy is expended
  • for basal metabolism. Carbohydrates, fats and
    proteins in
  • the food are the chief energy yielding nutrients
    and are
  • aptly labelled as macronutrients. Minerals and
    vitamins are
  • non energy yielding nutrients but most essential
    for cell
  • function. Because of their requirement in smaller
    quantities,
  • these are known as micronutrients. The energy
    obtained
  • from the food is usually expressed in terms of
  • Thermo chemical kilocalories. These are often
    loosely
  • referred to as kilocalories or simply Calories.

3
ENERGY
  • One gram of carbohydrate or 1 gram of protein
    provides 4 kcal or 16.7 KJ while 1 gm of fat
    releases 9 kcal or 37.7 KJ.
  • Infants require (up to 1 year of age) on an av
    103 kcal /kg/day.

4
Calorie requrement in Boys and Girls
  • Age boys girls
  • 1 to 2 years 1200 1140
  • 2 to 3 years 1410 1310
  • 3to4 year s 1560 1440
  • 4to5years 1690 1540
  • 5to6years 1810 1630
  • 6 to 7 years 1900 1700
  • lm8years 1990 1770
  • 8 to 9 years 2070 1830
  • 9 to 10 years 2150 1880
  • 10 to 11 years 2140 1910
  • 11 to 12 years 2240 1980
  • 12m 13 years 2310 2050
  • 13 to 14 years 2440 2120
  • 14 to 15 years 2590 2160
  • 15 to 16 years 2700 2140
  • 16 to 17 years 2800 2130
  • 17 to 18 years 2870 2140

5
Proteins
  • Protein is the second most abundant substance in
    the body,
  • next to water. These are made up of twenty
    different amino
  • aclds. The proteins differ in their arrangement
    and quantity
  • of amino acids. A few amino acids can be
    adequately
  • synthesized in the body (non-essential amino
    acids), while
  • others must be supplied in the diet (essential
    amino acids).
  • Essential amino acids include leucine,
    isoleucine, lysine,
  • methionine, phenylalanine. threonine, tryptophan
    and valr.
  • Histidine and arginine are essential during
    infancy because
  • the rate of their synthesis is inadequate for
    sustaining the
  • growth.

6
Proteins (contd)
  • Functions of protein. (i) Protein helps the child
    to
  • mw as the constituent amino acids are necessary
    /B , . . . for the synthesosf tlssues m the
    body.( ii) Protein is essential for
  • the formation of digestive juices. hormones,
    plasma
  • proteins, enzymes, vitamins and hernoglobin etc.
    (iii)
  • Proteins also act as powerful buffers to maintain
    acid base
  • equilibrium in the body. (iv) It is also a source
    of energy
  • for the body.
  • Excess protein, not used for building tissues or
  • providing energy, is convened by the liver in to
    fat and
  • stored in body tissues.

7
Proteins (contd)
  • Requirements Protein requirements of children
    given table (next slide). Indian estimates are
    higher as these are
  • calculatedin terms of the proteins actually
    present in Indian
  • diets. An average adult requires 1.0 g/kg body
    weight of
  • protein daily. During later half of pregnancy, an
    additional
  • protein intake of 15 g per day is required.
    During lactation,
  • an additional daily intake of 25 g during the
    fist six months

8
Protein requirement table
  • 2-3 months 2.25
  • 3 4 months 1.82
  • 4-5 months 1.47
  • 5-5 months 1.34
  • 6 9 months 1.30
  • 9-12 months 1.25
  • 1-2 years 1.15
  • 2-3 years 1.25
  • 3 4 years 1.13
  • 4 yeas 1.09
  • 5-5 years 1.06
  • 6 9 yeaan 1.0
  • 10-12 years 1.48
  • 13-15 years 1.0

9
NPU
  • These protein requirements are given in terms of
    mixed vegetable protein contained in Indian
    diets, the net protein utilization
  • (NPU) of which is assumed to be 65. If the
    protein in the
  • diet is obtained from animal sources like egg,
    meat, fish or
  • milk, lower intake of protein will usually be
    sufficient.
  • The NPU of a protein is the proportion of
    ingested nitrogen
  • that is retained in the body under specified
    conditions. NPU
  • is a combined measure of digestibility and the
    efficiency
  • of utilization of the absorbed amino acids.

10
Protein Quality
  • Protein Quality
  • A complete protein contains all of the essential
    amino acids
  • in relatively the same amount as humans require
    for
  • maintenance of good health and optimal growth.
    Protein
  • in the food is obtained either from the animal or
    vegetable
  • sources. The proteins of animal origin generally
    have a
  • higher content of essential amino acids. 'These
    are,
  • therefore, classified as biologically complete
    protein.
  • Proteins from vegetable sources are often
    biologically
  • incomplete, as these usually lack one or more of
    the
  • essential amino acids. However, proteins of
    !,egetable origin
  • may be used together in a judicious combination
    so that
  • limiting essential amino acidin one of these is
    compensated
  • for by an excess of that amino acid in the
    complementing
  • protein. Proteins of rice and potato are
    considered good
  • vegetable proteins.

11
Protein Quality
  • A high quality protein should be complete as well
    as
  • digestible. This is measured best by the
    biological value of
  • the protein. Biological value (BV) is calculated
    as thc
  • fraction of absorbed nitrogen retained in the
    body for
  • growth or maintenance. Egg protein is considered
    a
  • referenceprotein in this context as it is
    complete and well
  • digested. The biological value of egg protein is
    100. BV of
  • milk, rice and fish are 75, 67 and 75
    respectively. The
  • combination of vegetable proteins may provide all
    the
  • essential amino acids as in the reference
    protein. For
  • example protein from !egumes has an excess of
  • which can compensate for the low lysine content
    of wheat
  • protein.

12
LIPIDS
  • Lipids are a concentrated source of energy and
    provide insulation to the body. These also act as
    carriers for fat soluble vitamins.
  • A healthy European or American obtains 35 to 40
    percent of his caloric needs from fats. Diet of
    persons in the less affluent societies may
    provide less than 10 percent of calories from
    fat. Lipids include triglycerides

13
LIPIDS (contd)
  • LIPIDS TRIGLYCERIDES (FATS AND OILS)
    PHOSPHOLIPIDS(LECITHIN) STEROLS(CHOLESTEROLS)
  • TRIGLYCERIDES SATURATED FA (animal sources
    COCONUT solid at room temp) UNSATURATED FATTY
    ACIDS (vegetable nuts seed sources liquid at
    room temp)
  • UNSATURATED FA Mono saturated FA (oleic acis)
    PUFA

14
PUFA
  • PUFA OMEGA 6 FA (linoleic acid arachidonic
    acid) Omega 3 FA (linolenic acidEPADHA)
  • PUFA can not be adequately synthesized in the
    body hence should be supplemented in the diet

15
FUNCTIONS OF PUFA
  • Important component of cell membranes
  • They lower the blood cholesterol and triglyceride
    concentration.

16
LIPIDS (CONTD)
  • Deficiency of EFA in the diet may result in
    growth retardation, reproductive failure, skin
    disorders, increased susceptibility to
    infections, decreased myocardial contractility,
    renal hypetension and hemolysis.
  • Selective deficiency of omega-6 fatty acids leads
    to skin changes
  • while lack of omega-3 results in neurological and
    visual symptoms.

17
LIPIDS (CONTD)
  • Lecithin is the most important phospho lipid. It
    is a major constituent of cell membranes.
    Lecithins are not essential in diet as they can
    be synthesized in the body by liver.
    Phospholipids also act as emulsifying agents.

18
LIPIDS (CONTD)
  • cho l e s t e r o l is a lipid essential for good
    health.
  • Cholesterol deficiency does not usually occur as
    it can
  • also be synthesized in the human body in the
    liver from
  • carbohydrates, protein or fat. It is an important
    constituent
  • of cell membrane. Cholesterol can be transformed
    into
  • related compounds like hormones, bile and vitamin
    D.
  • Cholesterol is found only in animal foods
    including eggs,
  • liver, kidney, cheese and ghee. EPA are essential
    for
  • transport and breakdown of cholesterol. Excess
    cholesterol
  • is stored and may lead to atherosclerosis.

19
LIPIDS (CONTD)
  • Recommended intake. Total fat intake should
    provide
  • no more than 30 percent of daily energy intake.
    Saturated
  • fats should not exceed 10 percent of total fat
    intake. A
  • minimum of 3 percent of energy should be derived
    from
  • linoleic and 0.3 percent from linolenic acid.
    Cholesterol
  • intake should be limited to a maximum of 300 mg
    per day.
  • Excess fat contributes to obesity, NIDDM, cancer,
  • hypertension and atherosclerosis it is better to
    avoid excess of total fats, saturated fats and
    cholesterol, in that order of priority.

20
LIPIDS (CONTD)
  • LIPIDS in circulation are bound with proteins
    that serve
  • as transport vehicles. The lipid-protein complex
    is called
  • lipoprotein. Four main types of lipoproteins are
    formed
  • differing in their size and density. These are
    known as
  • chylomicrons (rich in triglycerides), high
    density
  • Lipoproteins (H DL), low density lipoprotein
    (LDL) and very
  • low density lipoprotein (VLDL). Lipoproteins with
    a higher
  • percentage of lipids have a lower density i.e.,
    LDL and
  • VLDL those with a higher percentage of proteins
    have a
  • higher density (HDL). Composition of these
    lipoproteins
  • is depicted in Table 5.3.

21
LIPIDS (CONTD)
  • High levels of chylornicrons and LDL are
    associated
  • with a higher risk of cardiovascular diseases.
    HDL is a
  • protective lipoprotein and high levels tend to
    protect agalnst
  • the hem diseases.
  • Cells all over the body remove fat from the
    passing by
  • chylomicrons. Few remnants, that loiter for long,
    are
  • removed by the liver. Liver is also an active
    site of iipid
  • synthesis. The synthesized lipids are transported
    as VLDL
  • to various organs that need them. The body cells
    remove
  • triglycerides from the VLDL and convert them to
    LDL.
  • Liver cells also have special receptors that
    remove LDL
  • fro circulation.

22
CARBOHYDRATES
  • Carbohydrates provide energy, contribute to taste
    and
  • texture of foods, preserve foods and are
    essential for
  • digestion and assimilation of other foods. They
    also protect
  • the proteins from being used for energy.
    Monosaccharides
  • (glucose, fructose, galactose, ribose,
    deoxyribose) and
  • disaccharides (sucrose, lactose and maltose) are
    known
  • as simple carbohydrates while polysaccharides
    (starch,
  • glycogen, fiber) are referred to as complex
    carbohydrates.
  • Grains are the richest food source of starch. A
    starch
  • typically consists of thousands of glucose
    molecules linked
  • together. Other important source of starch are
    legumes
  • (beans and peas) and tubers (potato, cassava
    etc.).
  • Glycogen is a more complex storage form of
    glucose an6
  • is not found in plants. Body converts all
    carbohydrates
  • (except those coming from fiber) to glucose.
    Glucose is
  • used as a fuel by brain and muscle tissue or
    convened tc
  • glycogen and stored by liver and muscles. Excess
    carbohydrates are converted to fat.

23
CARBOHYDRATES
  • Carbohydrates constitute 55-60 of total energy
    intake and preferably obtained from grains,
    legumes, vegetables and fruits. Such a diet is
    lower in fat and energy and higher in fiber,
    vitamin and minerals.
  • These diets also contribute to lower rates of
    under nutrition, obesity, tooth decay,
    cardiovascular disease and diabetes.
  • Excessive carbohydrate consumption in form of
  • concentrated sweets is associated with dental
    caries.
  • obesity, ischemic heart diseases and cataract
    (glucose
  • cataract ln diabetes, galactose cataract in
    galactosemia).
  • Lack of carbohydrates may produce ketosis, loss
    of
  • energy, depression and breakdown of body proteins.

24
FIBRE
  • High fiber diet is advocated for chronic
    constipation, diabetes, obesity and
    hypercholesterolemia.
  • Low fiber diet is particularly useful in
    irritable bowel syndrome, chronic colitis and
    partial chronic G1 obstruction.

25
FIBRE
  • Fiber components include polysaccharides such as
  • cellulose, hemicellulose, pectins, gums,
    mucilages and non
  • polysaccharide lignins. Fibers are considered
    important
  • because of their water-holding capacity, bile
    acid binding
  • capacity and for the growth of the normal
    microflora of
  • the intestines. Water soluble fiber e.g., gums
    and pectins
  • help in lowering blood cholesterol and limit
    glucose
  • absorption. Fibers insoluble in water result in
    softening of
  • stools and acceleration of intestinal transit
    time.

26
MICRONUTRIENT(S)
  • INTRODUCTION
  • micronutrients are nutrients needed in tiny
    amounts, may, be a few mg or micrograms per day
    and include various minerals and vitamins. They
    do not contribute to the energy intake but normal
    healthy living is not possible without them.

27
MICRONUTRIENT(S)
  • Micronutrient Deficiency A Global Issue
  • Micronutrient malnutrition continues to affect
    over 2000
  • millon people worldwide. There are several
    reasons for
  • such deficiencies. The population may be
    deficient because
  • have poor access to 111icronutrient rich food due
    to \
  • poverty, defective crop growing pattern, \i"
    deficient soil quality, inappropriate climate or
    geographical isolation.
  • Traditional dietary fads may also hinder intake,
    absorption
  • or utilization of micronutrient rich foods.

28
MICRONUTRIENT(S)
  • Micronutrient deficiency is clinically evident
    only in the later stage of the disease and
    therefore may result in grave consequences. The
    end results of such deficiencies include learning
    disability, impaired work capacity, increased
    susceptibility to infections and greater risk of
    dying. For the nation it means increased
    investment on health services, inferior economic
    productivity and poor gains on educational
    ventures.

29
MICRONUTRIENT(S)
  • Vitamins
  • Vitamins are essential for life and maintenance
    of normal health. These act as cofactor in many
    enzyme systems and are therefore cardinal for
    various bodily functions such as energy
    production, hemopoiesis, reproduction,
    neurological functions, hydroxylation and
    synthesis of fats,

30
VITAMINS
  • Any aberrations in these critica l mechanisms
    cause profound changes in the nervous system and
    integrity of skin, mucous membrane, synthesis and
    repair of connective tissues and drug metabolism.

31
VITAMINS
  • Vitamins are required in very minute quantities
    in the
  • diet. The fetus and the infant get adequate
    vitamins from
  • the mother during pregnancy and lactation.
    Dietary intake
  • of vitamins may be low or marginal during infancy
    and
  • early childhood. There is increased requirement
    of vitamins
  • in preterm babies, during post-operative stress,
    infections
  • and in some genetic metabolic disorders.
    Intestinal
  • absorption of vitamins is impaired in chronic
    diarrhea,
  • malabsorption, and bacterial overgrowth in
    intestines.
  • Certain drugs may have an adverse effect on the
    enzyme
  • systems, which require the vitamin. Thus, these
    may
  • inactivate the vitamin and its effects.

32
VITAMINS
  • \/itamins are classified into two broad groups
    viz., fatsoluble and the water-soluble vitamins.
  • Fat-soluble vitamins include vitamin A, vitamin
    D, vitamin E, and vitamin K.
  • Vitamin B complex and vitamin C are the
    water-soluble

33
MINERALS
  • These are small inorganic elements and are
    indestructible unlike other major nutrients and
    vitamins Calcium, phosphorus, potassium, sodium,
    chloride. magnesium and sulfur are known as
    macrominerals and are usually required in amounts
    more than 100 mg per day. as they are present in
    relatively higher amounts in body tissues.

34
TRACE ELEMENTS
  • The tern trace is applied to concentrations of
    element not
  • excceding 250 micro g per g of matrix. The
    definitive feature
  • of a nutritionally significant trace element is
    either its
  • essential intervention in physiological processes
    or its
  • potential toxicity when present at low
    concentrations in
  • tissues, food or drinking water. A WHO expert
    consultation
  • has divided nutritionally significant trace
    elements into three
  • groups (i) essential elements such as Iron,
    Iodine, Zinc,
  • Selenium, Copper, Molybdenum and Chromium (ii)
  • elements which are probably essential, i e . ,
    Manganese,
  • Silicon, Nickel, Boron and Vanadium and
    potentially toxic elements that have essential
    functions at low levels. F, Pb, Cd, Hg, As, Al,
    Li, Sb.

35
VITAMIN A DEFICIENCY
  • Vitainin A deficiency (VAD) results in blinding
    several
  • hundred thousand children a year. It is now
    recognized
  • not only to harm the eyes but also to increase
    childhood
  • and maternal mortality. Globally. 21 ol children
    have
  • vitamin A deficiency and suffer increased rates
    of death from diarrhea, measles and malaria.
    About 800,000 deaths
  • In chldren and women of reproductive age are
    attributable
  • to vitamin A deficiency which, along with the
    direct effects
  • on eye disease, account for 1.8 of global DALYs.
  • (disability adjusted life yeas). This appears to
    be lower
  • than previous estimates, possibly because of
    vitamin A
  • supplementation or food fortification programs
    during the
  • last decade.

36
VITAMIN A DEFICIENCY
  • Vitamin A is a subgroup of retinoids exhibiting
    the biological activity of retinol. Naturally
    occuring retinoids include retinol (vitamin A
    alcohol), retinyl ester (vitamin A ester),
    retinal (vitamin A aldehyde) and retinoic acid
    (vitamin A acid). Retinoic acid is the most
    active form of the vitamin.

37
VITAMIN A DEFICIENCY
  • Physiology. Vitamin A is essential for normal
  • maintenance and function of body tissues, for
    vision,
  • Cellular integrity, immune competence andgmwth.
    Vitamin
  • A deficiency is therefore a systemic disease,
    most specific
  • effects involving the eye. Vitamin A is also
    termed as an
  • anti-infective vitamin. This is attributed to its
    role in
  • maintaining integrity of epi thelial tissue for
    resisting invasion by pathogens and for
    functional immune response.

38
VITAMIN A SOURCES
  • Sources. Rich sources of pre-formed vitamin A or
    retinol are cod liver oil, shark liver oil and
    liver Moderate sources are butter, ghee (butter
    oil). and egg yolk. Best source of carotene is
    red palm oil.
  • Provitamin A carolenoids are present in good
    amounts in carrots, green leafy and yellow red
    vegetables and ripe mangoes.

39
VITAMIN A DEFICIENCY SUBCLINICAL
  • Subclinical deficiency. Respiratory system,
    urinary tract, intestinal epithelium and immune
    system are affected before the deficiency
    manifests clinically.
  • Subclinical vitamin A deficiency contributes to
    an increased severity of certain infections and
    an increased risk of dying from these.

40
VITAMIN A DEFICIENCY Early FEATURES
  • EARLY features. Defective dark adaptation is the
    most characteristic early clinical feature.
    resulting in night blindness.

41
VITAMIN A DEFICIENCY XEROPHTHALMAI
  • Prolonged deficiency of VIT A in dlet results in
    a syndrome of xerophthalmia, especially prevalent
    in 6-36 month olds. It is often combined with
    general malnutrition. There is pigmentation of
    the caruncle with loss of normal lustre and moist
    appearance of palpebral conjunctiva, which
    appears dry and wrinkled. Bitot spots appear as
    chalky grey spots on the temporal side of
    cornea-scleral junction. Cornea is softened and
    ulcerated (keratomalacia). Eventually it is
    infected and perforation of cornea occurs,
    resulting in opacification and blindness. On
    fundoscopy, pale yellow spots can be visualised
    near the course of retina1 vessels and also in
    the periphery.

42
VITAMIN A DEFICIENCY OTHER FEATURES
  • OTHER FEATURES Skin becomes scay and toad like.
    Toad skin is now believed to be due to essential
    fatty acids deficiency. Squamous metaplasia of
    respiratory mucosa makes these children more
    prone to respiratory infections. Alterations in
    mucosa of renal pelvis urinary bladder predispose
    to formation of renal and , vesical calculi.
    Atrophy of the germinal epithelium may .
    interfere with the reproductive functions.
    Vitamin A deficiency may rarely lead to
    hydrocephalus.

43
VITAMIN A DEFICIENCY
  • Factors influencing vitamin A status. lntake of
  • lt 180 micro g of retinol per day places a person
    at risk of vitamin A deficiency. Diarrhea. worms
    an'd other intestinal orders impair vitamin A
    absorption, while measles, resi r a t o r y tract
    infections and other febrile illnesses, increase
    the metabolic demands. PEM interferes with
    absorption, storage and utilization of vitamin A.
    In protein deficiency, RBP is not synthesized in
    adequate amounts.

44
VITAMIN A DEFICIENCY
  • Retinol is actively accumulated in the last
    trimester of pregnancy. Levels of retinal in the
    breast milk are almost equal to the concentration
    of vitamin A in the maternal serum. Preterm
    infants have lower retinal levels and are at high
    risk for developing vitamin A deficiency
    specially at a time when epithelia1 cell function
    is of greatest significance.

45
TREATING VAD
  • Specific. Immediately on diagnosis, oral vitamin
    A is
  • administered in a dose of 50,000, 1 lakh, and 2
    lakh
  • international units in children aped lt 6 months,
    6-12
  • months, and gt 1 year, respectively. The same dose
    is
  • repeated next day and 4 weeks later. Parenteral,
    watersoluble vitamin A administration is
    recommended (in half gtdoses suggested above for
    6-12 months and Uth in
  • lt6 months of age) in cases with impaired oral
    intake,
  • persistent vomiting and severe malabsorption. Oil
    based
  • injections should not be used to treat
    xerophthalmia.

46
PREVENTING VAD
  • Infants who are not breasrfed should receive a
    50,000 IU supplem e n t of vitamin A by 2 months
    of age (or two doses of 25,000 IU each with I
    month interval in between) in areas of endemic
    vitamin A deficiency. Every infant should be
    administered one dose of I lac units of vitamin A
    along with measles vaccine at 9 months followed
    by four more doses of 2 lakh 1U each at 18, 24.
    30 and 36 months.

47
IRON DEFICIENCY ANAEMIA
  • Iron deficiency affects about two billion people
    globally. Recent estimates find that Iron
    deficiency anemia (IDA) is responsible for a
    fifth of early neonatal mortality and a tenth of
    maternal mortality. It also affects growth and
    development, limits the leaming capacity, reduces
    cognitive development and reduces work capacity
    of the affected.

48
IRON SOURCES
  • Av in liver, kidney, egg yolk, green vegetables,
    and fruits.

49
IDA TREATMENT
  • The optimal dose of elemental iron is 3 -6 mg per
    kg of body weight given orally in three divided
    does. With this hemoglobin level should rise by
    about 0.4 g!dL per day. Iron absorption improves
    in presence of vitamin C, when given on empty
    stomach or in between the meals.
  • The phytates in cereals and phosphates in the
    milk diminish iron absorption. Therefore, iron
    should not be given just after the milk-feeds or
    after food.

50
IDA TREATMENT
  • With iron therapy, the activity of iron
    containing enzymes in the cells improves. The
    child becomes less irritable and his appetite
    improves within 24 hours. Initial bone marrow
    response is observed within 48 hours. Rise ret i
    c u l o c y t e count occurs by the second to
    third day.
  • This is followed by elevation of hemoglobin
    level. It may take up to two months depending on
    the severity of anemia. Body iron stores are
    repleted after correction of the hemoglobin
    levels.

51
IDA Prevention and Control
  • In childhood, 10 mg of elemental iron is
    required every
  • day. Children fed purely on milk diet are prone
    to develop
  • anemia. To prevent anemia, supplementary foods,
  • especially rich in iron should be administered to
    the child
  • from 4 months of age. Pulses, beans, peas, green
    leafy
  • vegetables are fairly good sources of iron. Iron
    in the egg.
  • however is not easily absorbed.
  • Preterm and low birth weight infants with low
    iron
  • stores should receive 10-1 5 mg of elemental iron
    daily.

52
IDA Prevention and Control
  • Iron needs are increased during puberty because
    of pubertal growth spurt and excessive bleeding
    during menarche in the girls. Therein, iron
    supplements are necessary during adolescence for
    preventing anemia of puberty.
  • Several studies have shown that fortified salt
    has been able to prevent anaemia.

53
IODINE DEFICIENCY DISORDERS (IDD)
  • Iodine deficiency disorders (IDD) refers to the
    wide spectrum of effects of iodine deficiency on
    growth and development. It includes endemic
    goiter, endemic cretinism, impaired mental
    function in chilben and adults with goiter and
    increased stillbirths and perinatal and infant
    mortality. Evidence is now available that these
    conditions can be prevented by correction of
    iodine deficiency.

54
IODINE DEFICIENCY DISORDERS (IDD)
  • Iodine Essential Trace Element Iodine is an
    essential component of thyroid hormones. Sea
    foods and vegetables grown on iodine rich soil
    are good sources of iodine. Soil in Himalayan
    regions has low iodine content due to leaching
    caused by deforestation. Low lying areas subject
    to flooding or high rainfall, such as Ganges
    valley in India and Bangladesh are also severely
    iodine deficient.

55
IODINE DEFICIENCY DISORDERS (IDD)
  • Requirement. A daily iodine intake of 50 micro g
    (1-12 mo), 90 micro g ( 1-4 yr), 120 micro g
    (7-12 yr) and 150 micro g From 12 yr onwards is
    is recommended. The requirement should be doubled
    in case of presence of goiterogens in the diet.
    Cassava, maize, bamboo shoots, sweet potatoes and
    millets are important sources of IODINE.

56
IODINE DEFICIENCY DISORDERS (IDD)
  • ENDEMIC CRETINISM occurs with an iodine intake
    is lt25 micro g /day in contrast to a normal
    intake of 80-150 micro g/day
  • affecting up to 10 of populations living in
    severely iodine deficient areas is associated
    with endemic goiter and characteristic clinical
    features, which include deaf-mutism, squint,
    mental retardation, characteristic spastic or
    rigid neuromotor disorder (spastic diplegia) and
    dwarfism

57
IODINE DEFICIENCY DISORDERS (IDD)
  • Two types of endemic cretinism are described
  • The neurological cretinism characterized by
    deaf-mutism, squint, proximal spasticity and
    rigidity more in the lower extremities, disorders
    of stance and gait with preservation of
    vegetative functions, occasional signs of
    cerebellar or Oculomotor disturbance and severe
    mental deficiency.
  • Myxedemarous cretinism is characterized by
    retarded psychomotor development, severe short
    stature, coarse facial features and myxedema
    without deaf-mutism

58
ZINC DEFICIENCY
  • Zinc is present in all organs of the body ,
    tissues, fluids and secretions of the body. The
    element is necessary for the RNA, DNA and
    ribosome stabilization. Zinc is critical for the
    functioning of the bio membranes.
  • Animal foods such as red meat and pork are rich
    in zinc. Cheese, whole wheat, nuts and legumes
    also provide zinc.

59
ZINC DEFICIENCY
  • Preadolescent children must receive 10 mg of zinc
    per day.
  • Deficiency States. Severe zinc deficiency leads
    to growth retardation, hypogonadism, anorexia.
    alopecia, acral dermatitis, acrodermatitis
    enteropathica, behavioral changes and increased
    susceptibility to infections secondary to
    defective cell mediated immunity. Mild zinc
    deficiency is associated with a reduced growth
    rate and impaired resistance to infections. Zinc
    deficiency in pregnant women has been linked with
    premature delivery.

60
FOLIC ACID
  • Folic acid is a B group vitamin, first isolated
    from spinach leaf in 1941. It occurs naturally as
    folates, which are
  • temperature and storage sensitive and cooking
    causes significant fall in their concentration.
    Recommended daily allowance is 100 micro g.
  • Sources rich in folates are liver. green leafy
    vegetables.

61
FOLIC ACID
  • Foiic acid deficiency is also associated with
    increased thrombotic events, which may be related
    to increased homocysteine levels. A recent
    meta-analysis
  • showed that 500-5000 micro g/d of folic acid
    intake reduces
  • Homocysteine levels by 25. Folic acid seems to
    be protective against development of
    atherosclerosis and other vascular disease by
    virtue of its homocysteine lowering effect.

62
FOLIC ACID FOR PREVENTING NEURAL TUBE DEFECT (NTD)
  • all women should receive folic acid before or
    immediately after conception to have the desired
    effret,
  • The ultimate goal of achieving better folate
    status in women of reproductive age group may be
    achieved by increasing the folate rich food
    intake, supplementation or food fortification.
    Folic acid also prevents pre term delivery,
    placental abruptions, infarctions and helps in
    increasing birth weight.

63
FOLIC ACID FOR PREVENTING NEURAL TUBE DEFECT (NTD)
  • In 1992, the US Public Health Services
    recommended that all women capable of being
    pregnant should consume 400 micro g of folic acid
    through childbearing age to reduce the risk of
    having pregnancy affected with NTD. Society of
    Obstetrics and Gynecology of Canada Expert
    Advisory Group on Folic Acid in prevention of NTD
    recommended that all women of child bearing age
    should consume 400 micro g of folic acid to
    prevent the first occurance starting before
    conception and continued till the end of 12th
    week of gestation. A daily intake of 4000 micro g
    of folic acid was recommended in previously
    affected pregnancies starting from one month
    before to 3 months

64
VITAMIN B COMPLEX B1
  • Thiamine exists in tissues mostly in the form of
    thiamine pyrophosphate (TPP), also known as
    carboxylase. It is , required for the synthesis
    of acetylcholine deficiency results in impaired
    nerve conduction. It is a cofactor in
    carbohydrate and protein metabolism. In thiamine
    deficiency, utilization of pyruvic acid is
    decreased.
  • Therefore pyruvic acid and lactic acid accumulate
    in the tissues and their blood levels are
    increased.

65
VITAMIN B COMPLEX B1
  • Sources. Dried yeast, whole grain cereals,
    pulses, oil and groundnuts are good sources.
    Meat, fish And green vegetables are relatively
    poor sources.

66
OVER TO HANDOUTS
  • VITAMIN B COMPLEX, C, D, E, and trace elements.

67
PROTEIN ENRGY MALNUTRITION (PEM)
  • Undernutrition is widely recognized as a major
    health problem in the developing countries of the
    world. Severe PEM, often associated with
    infection contributes to high child mortality in
    underprivileged communities. Further, early
    malnutrition can have lasting effects on growth
    and functional status. The frequency of
    undenutrition cannot be easily estimated from the
    prevalence of commonly recognized clinical
    syndromes of malnutrition such a marasmus and
    kwashiorkor because these constitute only
    proverbial tip of the iceberg. Cases with mild to
    moderate undenutrition are likely to remain
    unrecognized because clinical criteria for their
    diagnosis are imprecise and difficult
  • to interpret accurately.

68
PROTEIN ENRGY MALNUTRITION (PEM)
  • Assessment of nutritional status by anthropometry
    is the simplest and most useful tool for
    assessing the nutritional status of children.
    Anthropometric measurements like weight, height
    and mid-arm circumference should be compared to
    the anthropometric norms for the corresponding
    age in the well nourished and healthy children of
    the community.

69
PROTEIN ENRGY MALNUTRITION (PEM)
  • Protein-energy malnutrition (PEM) is the most
    widely prevalent form of malnutrition among
    children. Nutritional status of children is an
    indicator of nutritional profile of the entire
    community. PEM affects every fourth child
    world-wide. 150 million (26.7) are underweight
    while 182 million (32.5) are stunted.
    Geographically. more than 70 of PEM children
    live in Asia, 26 in Africa and 4 in Latin
    America and the Caribbean.

70
PEM Etiliology
  • Poverty
  • Low Birth Weight
  • Infections
  • Population growth
  • Feeding habits
  • High Pressure Ad for Baby Foods
  • Social Factors

71
CLINICAL MANIFESTATIONS OF PEM
  • Nutritional marasmus and kwashiorkor are two
    extreme forms of malnutrition. Such extreme forms
    account for a small proportion of cases of
    malnutrition. A much larger number of subjects
    suffer from mild to moderate nutritional deficit.

72
PREVENTION OF PEM
  • Prevention at family level
  • Exclusive breast feeding for first 6 months.
  • Nutrition supplements after the age of 6 months.
  • Complementary foods should be a judicious mixture
    of cereals and legumes Food should be energy
    dense thick consistency and given hygienecally.
  • As much milk, meat, eggs should be offered with
    the complementary food to enhance the net dietary
    protein value.

73
PREVENTION OF PEM
  • Vaccine preventable diseases should be prevented
    by immunizations.
  • Proper birth spacings between two pregnancies.

74
PREVENTION AT COMMUNITY LEVEL
  • Early detection of malnutrition and intervention
  • Growth monitoring
  • Integrated health packages (immunization
    kemoprophylaxix periodic devermin)
  • Nutrition education.
  • Technological measures iodizing the common salt,
    prevention of night blindness through vit A
    supplementation and distribution of folic acid
    and tron tablets.

75
OBESITY
  • It is form of development driven malnutrition.
  • CAUSES
  • EXOGENEOUS or ENDOGENEOUS
  • ENDOGENEOUS CAUSES less than 10 of the total

76
EXOGENEOUS OBESITY
  • Dietary factors large infrequent meals high
    calorie density junk foods
  • Habits psychogenic causes more indoor games
    watching TV
  • Decreased energy expenditure.
  • Genetic factors 1 ob gene which affects the
    appetite set point and metabolic rate

77
MANAGEMENT OF OBESITY
  • Diet calorie intake in between snacks junk
    foods should be curtailed high fibre low
    calorie encouraged
  • Greater physical activity
  • Behaviour modification constant encouragement
    help of a psychologist
  • Drugs and surgical methods are NOT encouraged.

78
PREVENTION OF OBESITY UNIVERSAL APPROACH
  • SOCIAL CULTURAL POLITICAL PHYSICAL AND STRUCTURAL
    ENVIRONMENT to focus on prevention of rise in
    BMI.
  • Issue of obesity should be addressed during every
    well child examination.
  • Parents are asked NOT to overfeed the child.
  • Food should NOT be used for comfort or reward.
  • Sugared food should be avoided completely.
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