NGD- Week 1 Notes

7/28/2019 NGD- Week 1 Notes

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Nutrition, Growth and Development Week 1- Nutrition

WEEK OBJECTIVES

1. Describe the nutritional, energy, and fluid requirements for infancyand childhood for normal growth and development. Source: Texas Heart Institute Heart Information Center

a. Fibre: Describe the role of fibre in health and prevention of disease. Identify the major sources of fibre in the diet of children.

o Fiber is a form of complex carbohydrateo A diet high in fiber has been shown to reduce cholesterol levels,

protect against heart disease, cancer, stomach/bowel problemso 2 forms of fiber: soluble and insoluble

soluble fiber is found in oatmeal, dried beans, peas, fruits,apples, strawberries, citrusinsoluble fiber is found in cereals, whole grains, rice andvegetables

b. Carbohydrates: Explain the role of carbohydrates as a source of energy. Identify the sources of carbohydrates. (lectures)o Carbohydrates are the main source of fuel in a balanced diet. The body

converts carbohydrates to glucose, which can be used right away orcan be stored in glycogen in muscle and liver. Glycogen can be quicklychanged back to glucose as needed. Once your body has made enoughglycogen, the leftover glucose is stored as fat.

Sugars are simple carbohydrates: glucose, sucrose, galactose.Milk, fruit and sugar added to foods are sources of simple carbs,and are an immediate source of energy.

Fruit, soda, refined and brown sugar, honey, syrupStarches and fiber are complex carbohydrates.

Bread, cereal, corn, peas, potatoes, pasta and rice

c. Proteins: Outline the differences between dispensable andindispensable amino acids. Explain the major roles of proteins in thebody. (lectures)

Indispensible (or essential AA) are necessary in the diet as they cannotbe made in the body

o Histidine, isoleucine, leucine, lysine, methionine, valine,phenylalanine, threonine, tryptophan

Dispensible (or non essential AA) are not necessary in the diet as thebody can make them

o

All the othersFunction: immune function, enzymes, transport nutrients throughoutthe body, hormone, fluid balance (albumin), transporting O2, source of energy (4kcal/gm)

d. Lipids: Describe the different types of dietary fats and how they aremetabolized; explain the role of fat in the diet. Explain the role thatessential fatty acids play in the diet, in health and in disease.

o Saturated fat

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014


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Raises cholesterol, increases heart disease riskButter, fat from red meat, tropical oils (coconut oil)

o Trans fatsPartial hydrogenation of unsaturated fatty acids (as occursduring food manufacturing) produces trans fatty acids,which are solid or semisolid at room temperature.Main source of trans fatty acids is partially hydrogenatedvegetable oils, used in manufacturing certain foods (eg,cookies, crackers, chips) to prolong shelf-life.

Trans fatty acids may elevate LDL cholesterol and lowerHDL; they may also independently increase the risk of coronary artery disease.

o Unsaturated fatOmega 3 fatty acids: linolenic acid

Can be converted to DHA and EPA in the body Found in fish oil, flaxseed oil, canola and soybean oil

o Marine fish oils also provide other omega 3 fattyacids in large amounts

Omega 6 fatty acids: linoleic acid Can be converted to ARA in the body Found in plant oils, vegetable oils (safflower, sunflower,

corn, soya)

e. Energy: Describe the fluid and calorie requirements for infants,children, and youth. Explain how and why energy requirements varythroughout the lifespan.



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f. Explain the importance of breastfeeding and discuss the advantagesof breast milk in infant health.

Nutritional benefits of breastfeeding includeo Better protein quality and digestibilityo fat quality and digestibilityo energy/intake regulationo

decreased infectiono decreased eczema risko may have benefits to intelligenceo may or may not decrease obesity rates

3. Describe the role that nutrition and healthy, active living play in childdevelopment

Long term impacts of inactivity and poor nutrition in children:

Chronic disease

o Cardiovascular disease, type II diabetes, osteoporosis, dental carries,cancer

Overweight and obesity

o Respiratory difficulties, chronic MSK problems, skin disease, infertility



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Academic difficulties

Mental health problems

Reduced quality of life

Nutrition

Eating breakfast leads to improved academic performance

o Kids who skip breakfast show slower memory recall and increasederrors

Undernourished kids tend to have lower scores on tests and are more likelyto repeat a grade

Severe malnutrition in early life negatively affects intellectual developmento Kids with malnutrition or current under-nutrition did even more poorly

o Decreased diet quality is a predictor of poor test scores

Healthy active living

Results of increasing physical activity in school aged children:

1. Heart Health

o Lower levels of triglycerides, fibrinogen, homocystine, C-reactiveprotein

o Higher aerobic fitness levels and increased arterial compliance

2. Healthy Weight Reduction in BMI

3. Healthy Bones Increased bone density

4. Healthy Self No significant change noted from just introducing an activity-based program

5. Academic Performanceo Maintain or improve academic performance (improved planning, short

term memory and behaviour control in the classroom)

5. Plot childrens growth parameters and BMI on growth charts (both WHO



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and CDC) and use the plots to assess against normal growth velocitiesSource: Journal of Nutrition 2007, lectures

In Canada, use WHO. Only use CDC in specialized situations, i.e. eatingdisorders.

CDC vs WHOo WHO: The WHO charts are based for the first time on a prescriptive, prospective,international sample of infants selected to represent optimum growth. Compared

to CDC reflects a lighter, taller samplepopulation-based study conducted between 1997 and 2003 in Brazil, Ghana,India, Norway, Oman, and the United States.Lived in socioeconomic conditions favorable to growth .no known health or environmental constraints to growth ,mothers willing to follow MGRS feeding recommendations (i.e., exclusiveor predominant breast-feeding for at least 4 mo, introduction of complementary foods by 6 mo of age, and continued breast-feeding to at least12 mo of age),no maternal smoking before and after delivery, single term birthabsence of significant morbidity

o CDC: based on national data collected in a series of 5 surveys between 1963 and1994. Reflects a shorter, heavier sample

Whereas WHO standards are based solely on breast fed infants,the CDC sample based on relatively few infants who were breastfed for more than a few months (e.g. in one survey sample only1/5 exclusively breast fed for 4 months)Includes obese childrenIncludes children with chronic diseaseSample size and study design not as rigorous as WHO.

When analyzing growth charts, important to look at trends, as opposed to asingle point on the chart

o As long as infant stays on the same growth curve, there should be no

alarm (except in cases listed below). Also take into considerationheight/weight of parents when assessing children. Causes for concern

o When cross over different growth curves, sharp decline, sharp increaseo WHO: when under 3 rd percentile or over 85 th percentile.

85-97% overweight97.1-99.9 obese class I (mild)>99.9% obese class II (moderate)


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CASE OBJECTIVES

6. Use a growth chart to identify whether current weights is withinnormal range



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7. Describe consequences of anemia on developmentSource: Nelsons

Iron deficiency has nonhematologic systemic effects. The most concerning effects ininfants and adolescents are impaired intellectual and motor functions that canoccur early in iron deficiency before anemia develops. There is evidence that thesechanges might not be completely reversible after treatment with iron,increasing the importance of prevention. Pica , the desire to ingest non-nutritivesubstances, and pagophagia , the desire to ingest ice, are other systemicsymptoms of iron deficiency. The pica can result in the ingestion of lead-containing substances and result in concomitant plumbism (chronic leadpoisoning)

12. Explain how nutritional deficiencies can exist in the face of obesity.Describe appropriate interventions in the child/youth with obesity.

Overweight and obese patients may develop paradoxical nutritionaldeficiency from eating high-energy foods with a poor nutrient content.

The concept the nutrient density of food assists not only in identifyingand treating nutritional deficiencies, but also in preventing them.

Naturally nutrient rich foods are those providing the highest amounts of nutrients for the least amount of kilojoules.

o E.g. dark-coloured fruits and vegetables, whole grains, lean meats,seafood, eggs, beans, nuts and low-fat dairy products

Appropriate Interventions:

It is important for people deciding to reduce their kilojoule intake to maintain anutritionally sound diet, providing adequate vitamins, minerals and macronutrients.



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Provide nutritional guidanceo Establish set meal plans: remove foodstuffs with empty calories and

encourage consumption of nutrient dense foods. Increase physical activity. Counseling and support to enhance behaviour modification. She began a

regular


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