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1) Nutrition & Health > Childhood Nutrition, Obesity, and Undernutrition > Flashcards

Childhood Nutrition, Obesity, and Undernutrition Flashcards

1
Q

Name the 3 challenge in childhood nutrition.

A

1) To provide energy and nutrients for
- maintenance needs
- proper growth and development
- long term health
2) To establish healthy eating and activity habits
3) To develop a health body image

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2
Q

When do girls stop growing in comparison to boys?

A

2 years before

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3
Q

How do infant and adult heart rate, respiration rate and energy needs compare?

A

Infants needs are all higher

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4
Q

How many kcals/pound of body weight does an infant need? Adult?

A

Infant: 45/lb
Adult: < 18/lb

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5
Q

How do the American Academy of Pediatrics and the Canadian Pediatric Society differ in terms of their recommendations for transitional diets in childhood?

A

USA: adopt low fat diet from age 2-3 is expected to decrease CVD in adults
Canada: childhood is a transition, priority is a healthy eating patern

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6
Q

What is the composition of breast milk?

A

High in fat: 55%
Protein: 6%
CHO: 39%

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7
Q

What % of children in Canada are overweight or obese?

A

31%

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8
Q

Has there been improvement in childhood obesity?

A

In the last year, o/w + obesity in 2-5 year olds has decreased

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9
Q

How does the treatment for childhood obesity differ from adult obesity?

A
  • Grow into the weight
  • Less aggressive
  • More positive approach
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10
Q

Why do we use percentiles for children?

A

Since body shape is different and percentiles can track growth

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11
Q

How do percentiles work?

A

If you are in the 75% percentile, that means that you are bigger than 75 children and smaller than 25 children

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12
Q

What does crossing percentile lines indicate?

A

That you are gaining weight more rapidly than height

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13
Q

How likely are kids below the 85th percentile to be obese in adulthood? Above 85?

A
  • Below 85th: 10-15% chance (low)

- Above 85th: 50-85%, chances increase as you increase the age

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14
Q

We don’t use the term obese in children. What does being in the 85th percentile mean? 95?

A

85: at risk of being overweight
95: overweight

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15
Q

According to the percentiles graph, 15% of children are obese, yet statistics show that 31% of children are overweight/obese. Why?

A

It is based on a different population (old data) from a healthier time.
The data from the past 2 surveys have been ignored

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16
Q

Name the 4 medical assessments of an overweight adolescent.

A

1) Personal and family history
2) Social/Psychological history
3) Physical Exam
4) Laboratory tests

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17
Q

What does personal and family history assess?

A

BMI changes

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18
Q

What does social/psychological history assess?

A

Tabacco use, depression, family disfunction, eating disorders

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19
Q

What does physical exam assess?

A

Anthropometrics, waist circumference, skinfolds, blood pressure

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20
Q

What do laboratory tests assess?

A

Fasting glucose, cholesterol, liver enzymes

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21
Q

How do you evaluate the readiness for a change in a child?

A
  • Dietary Assessment (foods, portions,eating patterns, beverages)
  • Physical Activity Assessment
  • Assess readiness to make changes
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22
Q

What is the primary goal of therapy?

A
  • Behavioural change
  • Patient is instrumental in treatment, commitment to
    goals and change is required
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23
Q

What is the secondary goal of therapy?

A
  • Weight maintenance (decrease BMI)

- Change the behavior, the numbers will follow

24
Q

What is the tertiary goal of therapy?

A
  • Resolve/Improve Medical Complications

- Reinforcement for behavioral change

25
Q

Name skills to change current behaviour.

A
  • Develop awareness of current eating and activity patterns (and parenting behaviour)
  • Identify problem behaviors
  • Modify current behaviour
  • Small changes, gradually
  • New behaviors become permanent
  • Continued awareness of behaviour
26
Q

What is the appropriate goal for child weight loss?

A
  • BMI below 85th percentile

- Maintain baseline weight (grow into weight)

27
Q

How many pounds should you lose per unit of time?

A

1 pound/month

28
Q

How should you increase activity level?

A
  • Encourage fun social activities
  • Incorporate into usual daily routine
  • Incremental changes
  • Increase intensity gradually
  • Limit screen time
29
Q

Why are breastfed infants less likely to be overweight?

A
  • Baby is learning satiety signals, decides when to stop eating
  • Bottle: caregiver decides when the baby stops
30
Q

What are the recommendations in terms of physical activity?

A
  • Min. 60 min of moderate to vigorous activity
  • Play time
  • Physical activity (sports, activities)
  • Mostly aerobic
  • Vigorous at least 3 days a week
  • Muscle/bone strengthening 3 days/week
31
Q

Name some complications of weight-management programs.

A
  • Too severe restriction of calories, lean body mass may be lost and linear growth may slow
  • Preoccupation with weight may translate to self-esteem issues
  • Conflict between adolescent and family should be referred to therapist
32
Q

Name some additional treatment options for high risk morbid obesity.

A
  • Bariatric surgery and pharmacotherapy
33
Q

Can children use pharmacotherapy?

A

Trials underway but currently not approved for pediatric use (<16 y.o.)

34
Q

Can children undergo bariatric surgery?

A
  • Minimal criteria: BMI>40 with co-morbidities, conservative treatments failed, psychosocial evaluation
  • Behavioural commitment
35
Q

How could you decrease the risk of childhood obesity?

A
  • Promote breastfeeding
  • Parents to provide, child to decide
  • Limit TV time
36
Q

How many kids under the age of 5 have died in 2011? In 1990?

A
  • 2011: 7 million

- 1990: 12 million

37
Q

What are the main causes of death for young children?

A
  • Neonatal
  • Pneumonia
  • Diarrhea
  • Malaria
  • Measles
  • HIV/AIDS
  • Injuries
38
Q

What is acute protein energy undernutrition characterized by?

A
  • short term
  • wasting
  • low weight for height
39
Q

What is chronic protein energy undernutrition characterized by?

A
  • long term
  • stunting
  • low weight + height for age
40
Q

Define primary energy malnutrition. What is it due to?

A
  • Inadquate intake
  • poverty
  • low food supply
  • poor quality of food
  • Armed conflicts
  • Political turbulence
  • Natural disasters
41
Q

Define secondary energy malnutrition. What is it due to?

A
  • Disease state
  • decreased intake
  • decreased absorption/utilization
  • increased losses
  • increased requirement
42
Q

What is the successful adaptation to PEM? Unsuccessful?

A

Successful: Marasmus
Unsuccessful: Kwashiorkor

43
Q

How old are children with marasmus? Kwashiorkor?

A

Marasmus: infancy < 2 years
Kwashiorkor: 1-3 year olds

44
Q

What is marasmus? Does it develop slowly? What are the physical symptoms? What percentage of weight for age? Do they have a good appetite?

A
  • Severe deprivation or impaired absorption of protein, energy, vitamins and minerals
  • Develops slowly
  • Severe weight loss and muscle
    wasting, including the heart
  • < 60% weight-for-age
  • Good appetite is possible
45
Q

What is Kwashiorkor? Does it develop slowly? What are the physical symptoms? What percentage of weight for age? Do they have a good appetite?

A
  • Inadequate protein intake or infection
  • Rapid onset
  • Some muscle wasting, some fat retention, edema and fatty liver
  • 60-80% weight-for age
  • Loss of appetite
46
Q

Define edema. What causes it?

A
  • Plasma proteins leave leaky blood vessels and move into tissues
  • Proteins attract water, causing swelling
  • When pressure is applied to the swollen tissue, it leaves an indentation
47
Q

Name some long term consequences of PEM.

A

Decreased:
 Development (physical, social, cognitive)  Adult productivity
 Reproduction
 Potential of the society as a whole

48
Q

Describe a successful adaptation to PEM malnutrition.

A

 integrated metabolic response to a change in environmental conditions
 maintains steady state within ‘preferred range”
 fully reversible
 no loss in overall function
 Eg Marasmus

49
Q

Describe an unsuccessful adaptation to PEM malnutrition.

A

 more severe metabolic adjustment
 changes are outside “preferred range”
 may not be reversible
 loss of physiological function  Eg Kwashiorkor

50
Q

What do infections cause?

A 
 Lack of antibodies
   Hb no longer synthesized
 Anemia
 Dysentery – infection of the GI tract
 Fever
 Fluid imbalances
 Heart failure, possible death
51
Q

How do you rehabilitate a patient with Kwashiorkor?

A

1) Restore fluid and electrolyte imbalances
2) Treat infections
3) Nutrition intervention must be cautious, slowly increasing protein

52
Q

Name some common infections with PEM.

A

 Diarrhea
 Pneumonia and other respiratory tract infections
 Urinary tract infections
 Measles
 Tuberculosis
 Parasitic infections
 Also parasitic infections are associated with Fe and Vitamin A deficiencies

53
Q

What is cholera? What are the signs and symptoms? How many people does it affect? How many deaths? Which country has it started in recently?

A

 Bacterial infection of small intestine producing toxin
 Vomiting, diarrhea, electrolyte imbalance, dehydration
 3-5 million people per year
 100,000 - 130,000 deaths
per year
- Haiti

54
Q

What is the double burden of malnutrition?

A
  • Undernutrition (child mortality)

- Overnutrition (chronic disease)

55
Q

What percentage of health care is malnutrition?

A

34%

1) Nutrition & Health (21 decks)

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