Nutrition In Children
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Transcript of Nutrition In Children
INTRODUCTION
Dr Nicola Flynn• Research Associate Under Dr Dilip Mahalanabis Society
for applied studies, Salt Lake Kolkata.• Consultant Pediatrician & Neonatologist, Ruby General
Hospital, Kolkata.
Nutrition In
Ch
il
dre
n
• Children, our future, form one third of our population.
• Growth is the best global indicator of children’s well-being.
• Adequate food intake is essential for proper growth.
• Low food intake can affect their physical and mental growth.
Impaired growth and development in children can affect the rest of their lives
Child’s Health and Future
Malnutrition and Child
• Asia has largest number of malnourished children
• India accounts for 40% of malnourished children in the world
• UNICEF estimates that malnutrition affects physical and mental function of 2 billion children.
According to WHO and UNICEF estimates, 60% of child deaths are malnutrition associated.
1 in 3 of the world's malnourished children lives in India1
Child and Physical Development
• Rapid growth happens between infancy and adolescence
• Nutrition is vital during the growth phase
• Inadequate nutrition affects growth and muscle development
Boys
Girls
Child and Mental Development
0% of Brain d
evelopmen
t
2 04 06 08 01 0 0
T i m e p e r i o d2 5 w k s 3 0 w k s 3 5 w k s 4 0 w k s 1 y r 5 y r s
0% of Brain d
evelopmen
t
2 04 06 08 01 0 0
T i m e p e r i o d2 5 w k s 3 0 w k s 3 5 w k s 4 0 w k s 1 y r 5 y r s
Critical Periods for Brain Growth
Brain Growth Across the Years
Factors that Affect Child Growth
Nutrition and Child Development
Outcomes of inadequate diet
• Poor growth• Poor cognition • Poor muscle development• Reduced work capacity• Poor social development• High rates of illness • Difficulty in school
Nutritional status of children during the critical period is of paramount importance
for later physical, mental & social development.
Reference: Nutrient requirement and RDA for Indians , ICMR , 1990
Nutritional requirement of preschoolers
Nutrient Requirements of Young Children is Manifolds of Adult
Requirements
Gaps in Mean Intake of Nutrients amongst Children in India
Micronutrient deficiencies represent a hidden form of hunger with severe consequences on physical growth, immune functions,
cognition and productivity
Graph depicting the micronutrient intake of Indian children (Boys and girls) in the age group of 7–15 years as compared to 100% RDA as per NNMB 1996 Data. (RDA
marked as dotted line)
30
Nutrients
Macronutrients
Micronutrients
carbohydrates Proteins Fats VitaminsMinerals
Fat soluble
vitamins
Water Soluble
Vitamins
Saturated
Unsaturated
Monosaccharide
Disaccharide
Polysaccharide
Complete proteins
Incomplete
proteins
Poly Unsaturated
Mono Unsaturated
Deficiency of Nutrients and Physical Development
Micronutrient Deficiency
Effects
Vitamin D and calcium
Deficiency affects bone development
Potassium, zinc, magnesium and copper
Deficiency disturbs the growth hormones and affect growth
Manganese Deficiency leads to skeletal abnormalities including retarded growth
Vitamin E Deficiency affects muscle development
Deficiency of Nutrients and Mental Development
Micronutrient
Deficiency manifestations
Vitamin B1
• Reduction of the brain content of neurotransmitters.
• Reduced levels of brain GABA, glutamate and aspartate
Vitamin B2
• Impaired performance on psychomotor tests, neuromotor incoordination and personality changes
Vitamin B3
• Loss of memory, nervousness, easy distractibility and schizophrenia
Vitamin B6
• Depression, irritability, loss of memory, inability to concentrate, peripheral neuritis
Vitamin B12
• Loss of memory, disorientation and emotional instability
Folic acid• Memory loss, forgetfulness, depression, irritability,
introversion, lack of confidence
Vitamin C• Reduced score for IQ, memory, abstract thinking
and non-verbal intelligence, altered behavior
Vitamin E • Poor memory and attention span
Deficiency of Nutrients and Mental Development
Micronutrient Deficiency manifestations
Iodine
• Poor somatic and central nervous system growth, sluggishness, inactivity, lethargy, poor concentration, impaired cognition and incoordination.
• Sequel leading to minimal brain function to a syndrome of severe intellectual disability.
• Global loss of 10–15 intellectual quotient
Iron
• Listlessness, apathy, lack of vigor and enthusiasm, lower scores on motor development and cognitive tests and poor school grades-
• Less myelinization and altered neurotransmitter function
Zinc• Lethargy, decreased visual memory, impaired
cognitive development and neuropsychological problems
Selenium• Depression, low mood, low energy level, anxiety and
stress
Choline • Poor memory and mental functioning
DHA• Short memory span, poor ability for discrimination,
aggression, hostility, learning disability, dyslexia? attention deficit disorder
Deficiency of Nutrients and Immunity
Micronutrient deficiency
Effects
Vitamin A Impairs immuno competence, therefore it
can increase the risk of infection Vitamin E Impair several aspects of the immune
response, including B- and T-cell mediated immunity
Vitamin C Impaired inflammatory responses & function of phagocytes
Zinc Impaired lymphocyte responsiveness & T cell development
Selenium Impaired antibody production
• Frequent illness adversely affects growth & development of children1
• Growing children need the BEST nourishment with all essential nutrients in recommended quantity2 for Optimal immune function Faster recovery Healthy physical growth Mental development
1. Journal of Nutrition. 1999;129:531-533.2. Healthy Nutrition: An Essential Element of a Health-Promoting School. WHO, FAO and
Education International, 1998. WHO Information Series on School Health – Document 4. Geneva: WHO
Essential Fatty Acids
The Essential Fats are a group of fatty acids that are essential to
human health.
• Omega-3 (3) – Linolenic acid• Omega-6 (6) – Linoleic acid
Structure of EFAs
LINOLEIC ACIDS (Omega 6)Eighteen-carbon essential fatty acids that contain two double bonds.
• 18:2 (9,12)
– LINOLENIC ACIDS (Omega 3)Eighteen-carbon essential fatty acids that contain three double bonds18:3 (9,12,15)
Function of EFAs• Formation of healthy cell membranes• Proper development and functioning of the
brain and nervous system• Production of hormone-like substances called
Eicosanoids –Thromboxanes–Leukotrienes–ProstaglandinsResponsible for regulating blood pressure, blood viscosity, vasoconstriction, immune and inflammatory responses.
Omega-3s
• Sources:WalnutsWheat germ oilFlaxeed oil/canola oilFish liver oils/Fish eggsHuman MilkOrgan meatsSeafood/Fatty fish
- albacore tuna- mackerel- salmon-sardines
Benefits of Omega-3s• Lower PG2s• Anti-inflammatory• Lower triglyceride and
cholesterol levels• Cancer prevention• Renal maintenance• Increase insulin sensitivity
• Enhance thermogenesis and lipid metabolism
• Benefits vision and brain function
• Decrease Skin inflammation
• Inhibit platelet adhesion
Reports of -3 Deficiency• Holman and colleagues reported a case of peripheral
neuropathy and blurred vision in a child receiving total parenteral nutrition devoid of omega-3 fatty acids for 5 months.1
-Holman et al. AM J Clin Nutr 35:617, 1982
• Bjerve and his coworkers reported linolenic acid deficiency in nine patients fed by gastric tube for 2.5 to 12 years, who had received only 0.025% to 0.09% of their total kilocalories as omega-3 fatty acids.
-Bjerve et al. Am J Clin Nutr 45:66, 1987.
Platelet aggregation, cardiovascular diseases, and inflammation
Sources:Corn oilPeanut oilCottonseed oilSoybean oilMany plant oils
Omega-6s
Benefits of Omega-6sSpecifically, omega-6 fatty
acids with a high GLA content may help to:
• Reduce inflammation of rheumatoid arthritis
• Relieve the discomforts of PMS, endometriosis, and fibrocystic breasts.
• Reduce the symptoms of eczema and psoriasis.
• Clear up acne and rosacea.• Prevent and improve
diabetic neuropathy.
• Excessive amounts of omega-6 (PUFA) and a very high omega-6/omega-3 ratio has been shown to promote the pathogenesis of many diseases:-cardiovascular disease
-cancer-Inflammatory and autoimmune diseases
Essential Fatty Acid Deficiency Side Effects
• hemorrhagic dermatitis
• skin atrophy• scaly dermatitis• dry skin• weakness• impaired vision• tingling sensations• mood swings• edema
• high blood pressure• high triglycerides• hemorrhagic folliculitis• hemotologic
disturbances (ex: sticky platelets)
• immune and mental deficiencies
• impaired growth
Dermatitis, Atopic in an Infant and on a Young Girl's Face
Differing characteristics -3 and -6 Essential Fatty Acid Deficiencies
Omega-3 (-Linolenic Acid) Omega-6 (Linoleic Acid)
Clinical Features
Normal skin, growth, reproductionReduced learningAbnormal electroretinogramImpaired visionPolydipsia
Growth retardationSkin lesionsReproductive failureFatty liverPolydipsia
Biochemical markers
Decreased 18:3 -3 and 22:6 -3Increased 22:4 -6 and 22:5 7Increased 20:3 -9(only if -6 also low)
Decreased 18:2 -6 and 20:4 -6Increased 20:3 -9 (only if -3 also low)
Guthrie H, Picciano, Mary. Human Nutrition. Lipids p128 1995
Who are at risk for deficiency?
• Long-term TPN patients without adequate lipid
• Cystic Fibrosis • Low Birth Weight
Infants• Premature infants• Severely malnourished
patients• Patients on Long-term
MCT as fat source• Patients with fat
malabsorption
• Acrodermatitis Enteropathica
• Hepatorenal Syndrome• Sjogren-Larsson
Syndrome• Multisystem neuronal
degradation• Crohn’s disease• Cirrhosis and alcoholism• Reye’s Syndrome• Short bowel syndrome
Recommendations: Infants & Children
• The American Academy of Pediatrics recommends that infant milk formula should provide at least 2.7% of total kilocalories in the form of linoleic acid.
• Of note, human milk provides 3.5% to as high as 12% of total kilocalories in the form of linoleic acid depending on the fat composition of the maternal diet.
AI for Infants and Children
0-6 mos 0.5 g/day of n-3 PUFA
7-12 mos 0.5 g/day of n-3 PUFA
1-3 yrs 0.7 g/day of -linolenic acid
4-8 yrs 0.9 g/day of -linolenic acid
Boys
9-13 yrs 1.2 g/day of -linolenic acid
14-18 yrs 1.6 g/day o -linolenic acid
Girls
9-13 yrs 1.0 g/day of -linolenic acid
14-18 yrs 1.1 g/day of -linolenic acid
Food and Nutrition Board, Institute of Medicine (FNBIOM,2001)
DHA
DHA is one of the primary structural component of brain tissue and retina
Docosahexaenoic acid (DHA) is an omega-3 essential fatty acid
DHA and Brain DHA and Retina
DHA Aids Brain Cell Maturation
A - Less astrocytes maturation when cultured in serum deficient conditions.B, C, D - Improved maturation of astrocytes as DHA is supplemented inincreasing concentrations.
Improved maturation of astrocytes with higherconcentrations / levels of DHA
Animal studies have indicated a causal connection between DHA availability & cognitive or behavioral
performance
DHA and Neurotransmission
DHA is an important constituent of the brain cell membrane, which have a role in
neurotransmission
G-proteins are structures that are present on the cell membrane & assist in movement of nutrients
Human Beings are Poor DHA Synthesizers
Less than 0.2% of ALA is converted to DHA in the hepatocyte
Hence, it becomes important to directly consume DHA during crucial periods of
brain growth
DHA in ActiGrow
DHA from fish oil
Significance
Free of high levels of mercury, oceanic pollutant and toxins
High mercury levels
Undesirable levels of mercury and oceanic pollutant have the potential to damage the tissues
More stable Less stable The oxidative stability of long chain polysaturated fatty acids (PUFA) and DHA containing fish and algae oils varies widely according to their fatty acid composition. DHA from algal sources is found to be ten times more stable than fatty acids derived from fish oils.
Desirable EPA content
Higher EPA content
Not desirable during growing phase
from a vegetarian source
Thank You