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NTLk > 11) Fat, Carbohydrate, Water, Mineral, Electrolyte, and Vitamin Requirements in Infancy, Childhood, and Adolescence > Flashcards

11) Fat, Carbohydrate, Water, Mineral, Electrolyte, and Vitamin Requirements in Infancy, Childhood, and Adolescence Flashcards

1
Q

What must the energy balance during childhood and adolescence balance?

A
  • Energy expenditure
  • A level of physical activity that is consistent with good health
  • Must include energy associated with tissue deposition
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2
Q

The energy requirements for growth are (low/high) in comparison to maintenance.

A

low

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3
Q

The energy requirements for growth are low in comparison to maintenance, apart from which period? Why?

A

The first few months of life, in which growth is substantial

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4
Q

What are the two components for the energy needs for growth? (2)

A

1) Energy used to synthesize growing tissues

2) Energy deposited in those tissues

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5
Q

The energy cost of growth in children is largely derived from which children?

A

Pre-term infants and children recovering from malnutrition

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6
Q

In practicality, when is the energy cost of growth particularly an issue in infancy?

A

Only during the first half of infancy, in which energy deposition contributes significantly to energy requirements

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7
Q

What equation is used to predict the TEE for individuals aged 0 to 2 years old? How does it vary between boys and girls?

A
  • EER = TEE + Energy Deposition

- It does not vary between sexes

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8
Q

The number of calories required for energy deposition (decreases/increases) as infancy progresses.

A

decreases

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9
Q

How is the energy content of tissue deposition computed?

A

From rates of protein and fat deposition

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10
Q

Why isn’t the PAL included in the calculation to determine the EER of individuals aged 0 to 2 years old?

A

Because there is very little physical activity

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11
Q

What allows for the determination of whether a child is acquiring a sufficient quantity of calories?

A

Growth velocity

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12
Q

How does the determination of energy status compare between growth velocity and growth charts?

A
  • Growth velocity is a sensitive indicator of energy status

- Indicates whether growth faltering is occurring earlier than growth charts

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13
Q

What does weight velocity indicate? What does length velocity indicate?

A
  • Weight velocity indicates acute episodes of dietary intake

- Length velocity indicates chronic factors

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14
Q

When are nutrient requirements on a per-weight basis highest in the life cycle? Why?

A
  • During the first six months of life

- Characterized by the most rapid growth rates

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15
Q

Pre-mature infants possess an energy requirement around __% higher than term infants.

A

20

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16
Q

Why do pre-mature infants possess a greater energy requirement than term infants?

A

1) They have a higher basal metabolic rate

2) They have a lower coefficient of absorption of fats and carbohydrates

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17
Q

On a per-kilogram basis, energy expenditure is two times (smaller/greater) in infants than in adults.

A

greater

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18
Q

What are the primary organs contributing to the infant’s basal metabolism?

A
  • Brain
  • Liver
  • Heart
  • Kidney
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19
Q

What does the transition from an intrauterine to an extrauterine environment alter in the infant?

A

Causes an increase in oxygen consumption in the infant

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20
Q

Why do infants have a proportionally high BMR for their size?

A

Increased oxygen consumption of vital organs in proportion to their weight

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21
Q

How does the energy cost of growth vary throughout the first month of life?

A
  • 35% during the first month
  • 3% at 12 months
  • 1% at 5 years old
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22
Q

What are the periods associated a greater energy cost of growth?

A
  • Infancy (0 to 2 months)

- Adolescent growth spurt

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23
Q

What does the exposure of a newborn to mild cold result in? What does the exposure of a newborn to even lower temperature result in?

A
  • Non-shivering thermogenesis (cold)

- Shivering thermogenesis (colder)

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24
Q

What is the most important contribution to non-shivering thermogenesis?

A

An increase in fatty acid oxidation in BAT

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25
Q

How does the quantity of BAT vary between infants and adults?

A

Infants possess a greater quantity of BAT than adults

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26
Q

How does the function of WAT compare to BAT?

A
  • WAT is primarily used as a site for energy storage

- BAT is used to burn fat to produce heat and regulate body temperature

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27
Q

What are structural characteristics of BAT that contribute to its function? (4)

A
  • Highly vascularized
  • Innervated by the CNS
  • Multilocular (multiple lipid droplets)
  • Greater proportion of mitochondria
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28
Q

What structure is responsible for the production of energy dissipated as heat in BAT?

A
  • UCP1 is responsible for the uncoupling of oxidative respiration from ATP production
  • Increases proton leakage across the inner membrane of the mitochondria of BAT
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29
Q

Where is UCP1 contained? What is it activated by?

A
  • Contained in the mitochondria

- Activated by free fatty acids and the sympathetic nervous system

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30
Q

What is UCP1 inhibited by in a thermoneutral state?

A

The presence of ATP in the cytoplasm

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31
Q

How may white adipocytes influence BAT cells?

A

May play an inflammatory role by producing cytokines and chemokines, which can cause a cytotoxic effect on BAT cells

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32
Q

As the child ages, physical activity becomes a (smaller/larger) component of the TEE.

A

larger

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33
Q

What equation is used to predict the TEE for individuals aged 3 to 8 years old? How does it vary between boys and girls?

A
  • EER = TEE + Energy deposition

- The EER is higher in boys than in girls

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34
Q

Why is the EER higher in boys than in girls (aged 3 to 8 years old)? (2)

A

1) Weight differences

2) Fat-free mass differences

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35
Q

What are the three factors that contribute to the BMR? (3)

A

1) Mass of metabolically active tissue
2) Proportion of each tissue
3) Contribution of each tissue to energy metabolism

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36
Q

What is the energy cost of growth based on in children aged 3 to 8 years old?

A

Weight gain, protein and fat deposition

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37
Q

What is the energy deposition in children aged 3 to 8 years old?

A

20 kilocalories per day

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38
Q

What may the calculation of energy needs in the case of catch-up growth utilize? (2)

A

1) The 50th percentile of weight or height for the age

2) Energy requirement of the actual age multiplied by 1.2 to 1.5 or 1.5 to 2.0

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39
Q

What is the energy deposition in adolescents aged 9 to 18 years old?

A

25 kilocalories per day

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40
Q

What is the energy deposition in adolescents during the peak growth spurt?

A

Increase (30 kilocalories per day)

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41
Q

What is the energy deposition in adolescents during the peak growth spurt?

A

Increase (30 kilocalories per day)

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42
Q

What may increase energy requirements during adolescence? (2)

A

1) Development of reproductive organs and secondary changes during puberty
2) Occupational and recreational physical activity

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43
Q

What forms the bulk of active metabolic tissue?

A

Fat-free mass

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44
Q

Why is there a higher energy and nutrient requirement in adolescent boys?

A

Marked gender differences in terms of the intensity and duration of the growth spurt leads to disparities in terms of the fat-free mass

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45
Q

Growth is relatively (slow/fast) during adolescence.

A
  • slow

- Apart from the adolescent growth spurt

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46
Q

There are __ grams of carbohydrates per liter of milk.

A

74

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47
Q

What volume of milk is consumed in infants from 0 to 6 months? What percentage of the milk corresponds to carbohydrates?

A
  • 0.78 liters per day

- 37% of the total intake is derived from carbohydrates

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48
Q

What is the median carbohydrate intake from weaning foods?

A

50 grams per day

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49
Q

What volume of milk is consumed in infants from 6 to 12 months?

A

0.6 liters per day (44 grams of carbohydrates per day)

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50
Q

What is the carbohydrate recommendation in infants aged 0 to 6 months?

A

60 grams per day (AI)

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51
Q

What is the carbohydrate recommendation in infants aged 6 to 12 months?

A

95 grams per day (AI)

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52
Q

What is the effect of non-milk extrinsic sugars in children?

A

Produce a dilution effect in terms of micronutrients

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53
Q

What is the carbohydrate requirement for infants above the age of 1?

A

130 grams per day (RDA)

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54
Q

Why is the carbohydrate requirement for children above the age of 1 the same as for adults?

A

Because the brain glucose consumption after age 1 is consistent, or increases modestly

55
Q

Fiber intake recommendations are set as a function of ______ intake.

A

energy

56
Q

How does the recommendation for fiber vary across age groups?

A

A decreased energy requirement (lower in younger individuals) results in a lower fiber requirement

57
Q

What is the consequence of an excess quantity of fiber?

A

May decrease the quantity of minerals absorbed (e.g. calcium and iron)

58
Q

What is the recommendation for fiber in infants below the age of 1?

A
  • There is no functional criterion for fiber status

- There is NO dietary fiber in breastmilk

59
Q

What is the AI for protein based on in infants from 0 to 6 months?

A

The average milk volume and the average protein content

60
Q

What is the average milk volume from 0 to 6 months?

A

0.78 liters per day

61
Q

What is the average milk volume from 6 to 12 months?

A

0.6 liters per day

62
Q

How does the protein intake vary between breastfed and formula-fed infants?

A

Protein intakes are higher in formula-fed infants

63
Q

______-fed infants gain more weight and lean-body mass. Is it related to protein intake?

A

Formula

- A greater protein intake from formula is NOT associated with these effects

64
Q

What does the Early Protein Hypothesis state?

A

A high protein consumption early in life increases plasma concentrations of insulin-releasing amino acids

65
Q

What is the consequence of a high concentration of insulin-releasing amino acids early in life?

A
  • Increase in IGF-1
  • Enhances weight gain and body weight deposition
  • Increases the risk of adiposity and obesity later in life
66
Q

A study analyzed the effects of reducing the protein contents of formula to a level that is similar in breast milk. What were the results?

A
  • Decreased plasma concentrations of essential amino acids, insulin and IGF-1
  • Increased fat oxidation
  • Reduced the prevalence of obesity
67
Q

What is utilized to estimate the protein EAR for children aged 7 months to 18 years of age?

A

Factorial method

68
Q

What are the three components of the factorial method used to estimate the protein EAR for children aged 7 months to 18 years of age?

A

1) Estimates of maintenance requirement
2) Measurement of rates of protein deposition
3) Estimates of the efficiency of protein utilization for growth

69
Q

How does the EAR for older infants aged 7 to 12 months, determined via the factorial method, compare to the AI?

A

The EAR is slightly lower than the AI based on the mean protein content of human milk and complementary foods

70
Q

Which nutrient requirement is used to assess protein content in infants aged 0 to 6 months, and in older infants aged 7 to 12 months?

A
  • Young infants (0 to 6 months): AI

- Older infants (6 to 12 months): EAR determined by the factorial method

71
Q

How does the protein requirement (on a body-weight basis) compare between children aged 1 to 18 years old and adults?

A

The protein requirement is similar

72
Q

How is the fat requirement in infancy determined?

A
  • Young infants (0 to 6 months): AI based on fat content of breast milk
  • Older infants (6 to 12 months): AI based on fat content of breast milk and complementary foods
73
Q

How is the fat requirement determined for children and adolescents?

A

There is NO AI, EAR or RDA for total fat intake in these age groups

74
Q

How does the AMDR for fat vary as childhood progresses?

A

The AMDR for fat decreases as childhood progresses

75
Q

What are the risks of consuming a low-fat diet during childhood?

A

Inadequate intakes of essential fatty acids and fat-soluble vitamins

76
Q

How are the omega-3 and omega-6 requirements in infancy determined?

A
  • Young infants (0 to 6 months): AI based on fatty acid content of breast milk
  • Older infants (6 to 12 months): AI based on fatty acid content of breast milk and complementary foods
77
Q

How are the omega-3 and omega-6 requirements determined for children and adolescents?

A
  • The AI is based on the median intake in US and Canadian populations, demonstrating a lack of deficiency symptoms
  • The IOM recommends an omega-6 to omega-3 ratio between 5:1 and 10:1
78
Q

Why are the AIs for omega-6 and omega-3 fatty acids higher in boys than in girls?

A
  • Energy expenditure increases fat oxidation

- Omega-6 and omega-3 fatty acids are readily used for energy

79
Q

How is the requirement for water in infancy determined?

A
  • Young infants (0 to 6 months): AI based on water content of breast milk
  • Older infants (6 to 12 months): AI based on water content of breast milk and complementary foods
80
Q

How are water requirements determined for children and adolescents?

A
  • There is no single water intake level that can be recommended
  • Normal hydration status may be achieved over a wide range of total water intakes
  • The AI is based on the median total water intake of healthy populations
81
Q

How are sodium and chloride requirements in infancy determined?

A
  • Young infants (0 to 6 months): AI based on sodium and chloride content of breast milk
  • Older infants (6 to 12 months): AI based on sodium and chloride content of breast milk and complementary foods
82
Q

How do sodium and chloride requirements differ between children, adolescents and adults?

A
  • There is no reason to expect that the sodium requirement of children and adolescents are different than adults
  • The maturation of the kidneys is similar
83
Q

How are sodium and chloride requirements determined for children and adolescents?

A

The AI is extrapolated from the adult AI, using the average of median energy intake levels of age groups

84
Q

How is the requirement for potassium in infancy determined?

A
  • Young infants (0 to 6 months): AI based on potassium content of breast milk
  • Older infants (6 to 12 months): AI based on potassium content of breast milk and complementary foods
85
Q

What are possible consequences of potassium deficiency?

A
  • Increase in blood pressure
  • Bone demineralization
  • Kidney stones
86
Q

How does a deficiency in potassium affect sodium?

A
  • Increases sodium re-entry to maintain cellular volume
  • Increases water retention
  • Results in an increase in blood pressure (stiffness and hypertension)
87
Q

How is potassium citrate related to kidney disease?

A
  • Potassium citrate is a precursor for bicarbonate

- Acts to counteract the calcium-carbonate release, which retards kidney disease or calcium-containing kidney stones

88
Q

How is the requirement for potassium determined for children and adolescents?

A

Extrapolated from recommended intakes of potassium from adults to children on the basis of the average of median energy intake levels

89
Q

Why is the requirement for potassium in children and adolescents based on energy intake and not weight?

A

Because basing the requirement on weight may lead to relatively low and potentially inadequate intake of potassium

90
Q

How are maintenance requirements for micronutrients extrapolated from adults to infants and children?

A

EARchild = EARadult (F) where F = (Weightchild/Weightadult)^0.75

91
Q

Why can’t the ratio of a child over an adult be used as a method to extrapolate data?

A

Because it would result in a higher percentage than represented by the actual weight

92
Q

How does the BMR vary based on body weight (allometric)?

A

As the body weight of an organism increases, the BMR decreases

93
Q

How are growth requirements for micronutrients extrapolated from adults to infants and children?

A

EARchild = EARadult (F) where F = (Weightchild/Weightadult)^0.75 (1 + Growth Factor)

94
Q

How are growth factors determined?

A

By a study that produced an approximate proportional increase in protein requirements for growth, which is used as an estimate for the growth factor

95
Q

What is the growth factor of females beyond 13 years of age?

A

Assumed to represent a negligible increased requirement

96
Q

Which type of infants are recommended to be given a daily 400 IU vitamin D supplement?

A
  • Breastfed infants
  • Infants consuming formula that are not fortified with vitamin D
  • Infants that consume less than 1 liter of fortified milk
97
Q

Which type of child is recommended to be given a daily 400 IU vitamin D supplement?

A

Children above a year of age, consuming an insufficient quantity of cow’s milk (below 2 cups per day)

98
Q

Why is there a rapid increase in the AI of vitamin K from infancy to childhood?

A

Older children consume a greater quantity of fiber-rich foods, allowing for a greater intake of vitamin K

99
Q

Why are infants at an increased risk of vitamin K deficiency at birth?

A
  • Vitamin K is not efficiently transported across the placenta
  • Infants lack intestinal flora
100
Q

What increases the risk of hemorrhagic disease of a newborn?

A

The low concentration of clotting factors

101
Q

Differentiate hemorrhagic disease of the newborn and late hemorrhagic disease of the newborn.

A
  • Hemorrhagic disease of the newborn has an early onset (birth to 3 weeks)
  • Late hemorrhagic disease of the newborn has a late onset (3 to 8 weeks)
102
Q

What is late hemorrhagic disease of the newborn associated with?

A

Breastfeeding, as there is a low quantity of vitamin K in breastmilk, compared to cow’s milk and formula

103
Q

How may hemorrhagic disease of the newborn be effectively prevented?

A

By the administration of vitamin K

104
Q

How is the requirement for vitamin K determined infants (0 to 6 months)?

A

Based on the vitamin K intake of infants principally fed breast milk and provided vitamin K prophylaxis

105
Q

From 6 to 12 months, the vitamin K intake is expected to be (above/below) the AI based on human milk consumption. Why?

A

above

- Due to the increase in consumption of complementary foods

106
Q

How is the AI of vitamin K for infants aged 6 to 12 months determined?

A

It is extrapolated up from the AI of infants aged 0 to 6 months

107
Q

Why is the AI of vitamin K for infants aged 6 to 12 months not extrapolated down from adults?

A

The AI produced would be too high, which would be impossible to reach without a supplement

108
Q

How is the requirement for vitamin K determined for children and adolescents?

A

Based on the highest median intake for an age group for which there are no signs of deficiency

109
Q

Clinically significant vitamin K deficiencies are extremely rare in children and adolescents. In which scenarios would they be observed?

A
  • Individuals with malabsorption syndromes (e.g. Celiac’s disease)
  • Individuals consuming drugs interfering with vitamin K metabolism
110
Q

What is reduced vitamin K a cofactor for?

A

y-glutamylcarboxylase

111
Q

What is the mechanism of action of y-glutamylcarboxylase?

A

Catalyzes post-translational modifications of certain glutamic acid residues in vitamin K-dependent proteins

112
Q

What is y-glutamylcarboxylase required for? (2)

A

1) Activity of coagulation

2) Binding of osteocalcin to hydroxyapatite in bone (bone deposition)

113
Q

Describe the vitamin K cycle.

A
  • The reduced form of vitamin K is oxidized to an epoxide after it is utilized as a cofactor
  • The epoxide is reduced by vitamin K epoxide reductase to regenerate the active reduced form of vitamin K
114
Q

How does Warfarin interfere with the vitamin K cycle?

A
  • Inhibits vitamin K epoxide reductase

- The reduced form of vitamin K is utilized and may not be regenerated, causing anti-coagulant effects

115
Q

What is the calcium recommendation based on for children aged 1 to 8 years old?

A

Calcium accretion

116
Q

What are the three major lines of evidence concerning calcium requirements for children and adolescents aged 9 to 18 years old?

A

1) Factorial approach
2) Calcium retention to meet peak bone mineral accretion
3) Clinical trials, where bone mineral content is measured in response to variable calcium intake

117
Q

What functional criteria is used for the determination of iron status in infants aged 0 to 6 months?

A
  • There is no functional criteria

- The AI is based on the intake from breast milk

118
Q

What are the major components of iron requirements for infants aged 6 to 12 months? (4)

A

1) Obligatory basal losses
2) Increased hemoglobin mass
3) Increased tissue (non-storage) iron
4) Increased storage iron

119
Q

How does the bioavailability of iron differ in infants aged 6 to 12 months? Why?

A
  • Bioavailability is lower (10%, as opposed to 18%)

- Because the diet is low in meat

120
Q

What is the most common nutritional disorder in the world?

A

Iron deficiency

121
Q

What are the major components of iron requirements for children aged 1 to 8 years of age?

A

1) Basal losses

2) Median total iron deposition

122
Q

What are the major components of iron requirements for adolescents aged 9 to 18 years of age?

A

1) Obligatory basal losses
2) increased hemoglobin mass
3) Increased tissue (non-storage) iron
4) Menstrual iron losses in adolescent girls

123
Q

When are iron stores assumed to be filled, and are no longer a component of iron requirements?

A

By 9 years of age

124
Q

What are the needs for absorbed iron associated with in adolescence?

A
  • Growth
  • Increase in body weight
  • For example, 0.035 mg of iron is required for every gram of weight gained in boys
125
Q

How is the additional weight gain during the peak growth spurt determined?

A

The difference between the maximum and average growth rate

126
Q

By the age of __, girls are assumed to almost all have started to menstruate.

A

14

127
Q

What is the iodine requirement for children aged 1 to 8 years old based on?

A

A study concerning children that were previously malnourished and subsequently rehabilitated

128
Q

How does the AI for fluoride vary with age?

A
  • There is no AI associated with infants aged 0 to 6 months

- The AI is 0.05 mg/kg/day in all age groups, and varies based on body weight

129
Q

Why is the AI intake range of fluoride recommended for all ages? (2)

A

1) It confers a high level of protection against dental caries
2) It is associated with no known unwanted health effects

130
Q

What is the cause of enamel fluorosis?

A

Fluoride ingested during the pre-eruptive development of teeth

131
Q

At what point are children no longer susceptible to enamel fluorosis? Why?

A
  • 8 years of age

- Because the enamel has completed pre-eruptive maturation

132
Q

What is the UL for fluoride in children aged 0 to 8 years old based on?

A

The threshold beyond which moderate enamel fluorosis appears

133
Q

What is associated with the development and severity of enamel fluorosis?

A

The level and duration of exposure

NTLk (20 decks)

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