15: Nutrition in Infancy and Adolesence

Question 0

What is a sensitive indicator of whether or not energy needs are being met?

Answer 0

Growth.

Question 1

How does the energy for growth compare to energy for growth through infancy and childhood?

Answer 1

Energy requirement for growth are much lower, except for the first few months of life.

Question 2

What will detect growth faltering earlier than growth charts?

Answer 2

Growth velocity (cm/mth or g/mth)

Question 3

What accounts for a huge portion of newborns BMR?

Answer 3

Brain (70%), liver, kidney, heart. Very metabolically active tissues.

Question 4

What accounts for a large portion of energy expenditure only in the first two months?

Answer 4

Thermal stress. Brown adipose tissue developed in utero and supported by milk maintains temperature without shivering, and stimulates muscle and bone development.

Question 5

How are energy equations derived?

Answer 5

Label H, O, C with stable radioisotopes, see expenditure and derive equations.

Question 6

What accounts for a large amount of variability from ages 3-10?

Answer 6

Variable growth rates and activity levels.

Question 7

When do sex differences start being seen in requirements?

Answer 7

3 yrs

Question 8

EER=

Answer 8

TEE + energy deposition

Question 9

Are there any conditions EER will greatly underestimate requirements?

Answer 9

If there has been previous energy deprivation and catch up growth is required.

Question 10

What accounts for the bulk of the metabolically active tissue?

Answer 10

Fat free mass

Question 11

What are dietary carbohydrate recommendations based on for the first 6 mths?

Answer 11

Breast milk. Assumed to be ideal.

Question 12

At what age do we assume the regular brain requirement for glucose had been reached?

Answer 12

12 mths

Question 13

What recommendations are made for sugar and children?

Answer 13

Limit intake. High GI is related to poor cognitive function, especially for short term memory. Also low nutrient density.

Question 14

What risks are associated with underconsumption of fibre? Over consumption?

Answer 14

Poor micro biome and higher risk for obesity. Zinc and other micronutrient deficiencies due to high Phytates and oxalates.

Question 15

What is the basis of fibre recommendations?

Answer 15

CVD health, use AI.

Question 16

What is the basis of carbohydrate recommendations?

Answer 16

Adequate brain glucose. RDA.

Question 17

What is the protein recommendation based on after exclusive breast feeding?

Answer 17

Nitrogen equilibrium (factorial method) and protein deposition. RDA

Question 18

What are three aspects included in the factorial method?

Answer 18

1. Estimated maintenance requirements.
2. Measures rates of protein deposition.
3. Estimated the efficiency of protein utilization for growth.

Question 19

How does the protein RDA compare to the AI?

Answer 19

RDA is slightly lower than AI.

Question 20

What are some possible risk factors for the higher protein content of formula?

Answer 20

High protein may increase IGF1 which could be a risk factor for obesity. May contribute to less self regulation.

Question 21

What is the only life stage that has an AI for fat?

Answer 21

Infancy (up to 12 months).

Question 22

Is the omega 6 content of breast milk always consistent?

Answer 22

Much higher in vegetarians typically.

Question 23

Is there a difference between omega 3 and omega 6 intake between boys and girls?

Answer 23

Boys have higher energy expenditure which means higher fat oxidation, so AI is greater for boys than for girls.

Question 24

What are recommendations for children and adolescence eater intakes based on?

Answer 24

Just the AI for the median total intake. See normal hydration status from very wide range of intakes.

Question 25

What are sodium requirements for children based on?

Answer 25

Kidney is mature by 12 months, so AI is based on meeting nutrient needs for other essential nutrients. Proportionally no different from adults. Extrapolate down.

Question 26

What are recommendations for potassium in children taken from?

Answer 26

Extrapolated from adults. Adjusted based on energy intake, not weight (which may underestimate).

Question 27

What are some conditions that result from potassium deficiency?

Answer 27

Higher blood pressure, bone demineralization, kidney stones. See from inadequate intake over an extended period of time.

Question 28

EAR (child)=

Answer 28

EAR(adult)(weight child/ weight adult)^0.75(1+ growth factor)

Question 29

Why is extrapolation from adults used so often?

Answer 29

Unethical to do dose/response relationship during growth.

Question 30

What is the vit D requirement based on?

Answer 30

Only bone density.

Question 31

Why is vitamin K important?

Answer 31

Prothrombin synthesis, bone health, brain health, and anti cancer properties.

Question 32

What is the vitamin K index?

Answer 32

AI (median intake)

Question 33

What contributes to the risk for hemorrhagic disease of the newborn?

Answer 33

Vitamin k is transferred poorly across the placenta, plasma clotting factors are low at birth, breast milk is low in vitamin K, PCBs and other toxins cause excessive breakdown of vitamin K

Question 34

When does an infant receive a vitamin K injection?

Answer 34

Within 6 hrs of birth.

Question 35

How are the requirements for vitamin K for older infants calculated?

Answer 35

Extrapolate from younger infants rather than adults, because otherwise unrealistically high.

Question 36

How is the calcium RDA calculated?

Answer 36

Can directly measure with DEXA so don't have to extrapolate.

Question 37

What are the threes lines of evidence for Ca needs in the 9-18 yrs group?

Answer 37

The factorial approach Ca retention to meet peak none mineral accretion Clinical trials in response to variable Ca intake.

Question 38

When are iron reserves used during infancy?

Answer 38

Within the first 6 mths

Question 39

What are the major components for Fe needs of older infants?

Answer 39

Basal losses, increased hemoglobin mass, increased tissue Fe, increased storage Fe

Question 40

What are the major components for Fe needs age 9-18?

Answer 40

Basal losses, increase in hemoglobin mass, increase in tissue, menstrual losses starting. No provision for storage after early childhood.

Question 41

When is menstruation assumed for increased iron requirements?

Answer 41

14

Question 42

Which gender has a higher risk of being zinc deficient in childhood?

Answer 42

Boys. Switches in adolescence.

Question 43

What is the iodine recommendation based on?

Answer 43

Creation of positive iodine balance (adult extrapolation is too low)

Question 44

What risk is there of consuming above the UL for fluoride?

Answer 44

Enamel fluorosis.