Diet and nutrition in childhood Flashcards
Babies: ideal food
Mammalian milk
-recommendation exclusive for first 6 months
Infant formula is alternative
Breast-feeding in UK
Infant Feeding Survey 2010: UK low
-only 34% at 6 months and <1% at 12 months
It is difficult, tiring, needs support; needs to be promote
Breast-feeding less likely to happen in UK if:
Breast-feeding less likely to happen if:
-white, young, routine/ manual professions, left education early
Maternal diet
Fat deposits - energy store for feeding
400-600kCal extra, 11g protein, plus fluid
Cabohydrate, fat, protein, vitamins, minerals
Anti-infective agents (e.g. immunoglobulins, lysozyme; long-lasting protection)
Contra-indications to breastfeeding
Cleft palate (indirect feeding) Inborn errors of metabolism (e.g. galactosaemia) HIV infection (WHO 2009 antiretrovirals enabled them to breast-feed babies without passing on)
Infant formula
Kineys, liver enzyme systems immature to digest cow’s milk
Is modified
Weight gain (babies)
Controversy over charts
Put on weight at different intervals if they drink infant formula
Breast-feeding reduces
- childhood obesity
- diabetes
- < infections (3mths –>year, long lasting, plus breast cancer
Babies/ infants: nutrient needs: 4-6 months
Rapid growth and development
Iron stores before birth, depleted
Breast milk or infant formula
Babies/ infants: nutrient needs: 6-12 months
Iron intake during weaning process
> protein uptake required, plus vitamins and minerals
Government help: healthy start scheme
Free milk, plain fresh and frozen fruit and vegetables plus infant formula, vitamins
Young children (birth - 4years) and pregnant mothers
Weekly, flexible voucher scheme
Early and close liaison with health professionals re:
-pregnancy, breastfeeding and healthy eating
Welfare Food Scheme
Started during WWII re: food shortages Vitamin supplements (drops)
Weaning
Expanding the diet (from 6 months)
GIT too immature to digest
Kidneys can’t regulate high solute load
Neuromuscular co-ordination to move food back in mouth and therefore swallow
Helps with developing chewing ability (teeth)
Toddlers and pre-school children
Eating is social occasion
Copy elder, enjoy
Food refusal may be for attention
Milk (1year): 500ml-litre
-Ca, riboflavin, 1/2 protein, 1/4 energy needs
-vit D: proprietary milks and fortified cereals
Variety, avoid unhealthy snacks as rewards
Teeth: fermentable carbohydrates
Water: intake encouraged, or weak cordials
Tea: tannins (+sugar?) so not main drink
Toddlers and pre-school children 1-4years: main nutrient needs
Energy requirements > as active, rapidly growing
Protein requirements slight >
Most vitamins, minerals >
2nd year need energy-dense diets (full-fat milk, watch NSP [fibre] amounts)
school children and adolescents: main nutrient needs
5 years+: semi-skimmed milk
Regular meals especially breakfast, not substitute with unhealthy snacks
Decline in family meals; 500,00 UK kids go to school hungry; 8 million families food poverty
< fat and sugar content will need and equivalent energy balance to avoid weight loss
Importance of healthy diet: ensure children understand as they gain more control over their choices
Main nutrient needs: school 4-6 years
Energy requirements still >, also protein (but vit D mainly via sunlight exposure)
Main nutrient needs: school 7-10 years
Energy requirements still >, also protein
Main nutrient needs: school 11-14 years
Energy requirements still >, also protein by ~50%
Higher iron requirement for girls
Main nutrient needs: school 15-18 years
Energy and protein requirements still >
Ca > in boys as rapid skeletal development
Higher iron requirement for girls
School meals
Set-price meal (primary schools), cafeteria (secondary)
Free hot dinner - infant 2014
Contribution to child’s nutrition, considerable impact: fat potential, e.g. chips
> fat: 5years+ should be 35% of energy intake
Children’s food trust
Eat Better Do Better
• advice, training and support to anyone
providing children`s food
• improving lunchtimes in early years
settings and schools
• helping schools with cooking skills
• providing independent, expert advice to
local and national government (and other
organisations working on children’s food)
• encouraging industry to help families make
better choices
Children’s food trust: Meet Sam
New campaign highlights how childhood food can shape health for life
-warn of how diet of today’s toddler could cripple health of tomorrow’s adults
Children’s food trust: preschool
Eat Better, Start Better
School Fruit and Vegetable Scheme
2004
Free piece of fruit or vegetable per day in infant schools
Lunches - at least 1 portion of both fruit and veg (or salad) every school day, and menus highlight in season fruit and veg
Fruit and/ or veg at school food outlets (e.g. breakfast clubs, tuck shops, and in vending machine)
National Healthy Schools Programme
2005
Schools achieve ‘Healthy Schools Status’
Includes learning about food as well as eating
From 2014 ‘school led’ ‘healthy schools’ status
British Nutrition Foundation
Provide info on food and nutrition
Nurseries and schools
Promote healthy eating
Schools: government standards
Ofsted monitored
Minimum national standards
Nutrient- and food-based
Jamie Oliver
School dinners
‘Feed me better’ campaign, 2005
-Harder-to-reach poor communitites are suffering more
-easier for middle classes/ higher SES
Sugar campaign more recently (diabetes)-food industry
-‘Chocolate doesn’t lie’
Adolescence
Transition from childhood to adulthood
Own choices and exert independence e.g. vegetarian and vegan diets
Weight and shape influences (girls and boys)
-may lead to eating disorders
Teenage growth spurt
-e.g. insatiable appetite (3000kCal+ if active)
-encourage carbohydrate > (bread, potatoes)
-avoid fatty/ sugar snacks
Vegetarian and vegan diets for children
Lacto-or Lacto-ovovegetarian through weaning and childhood i.e. restriction in animal protein
Food stuffs can be bulky, not nutrient dense
-energy, protein and other nutrient levels<
-non-haem iron only in plants (+phytate inhibitor in nuts, legumes, wholegrain cereals)
-vit D many animal-based sources (e.g. oily fish, eggs, milk, liver)
May be smaller and lighter
Teenagers at risk:
-growth spurts, unconventional eating habits, family/ peer group isolation
-meat-eating family (cheese; non-haem iron absorption adaption takes time)
Dietary intake: baby
Energy 515-920 kCal/day
Sugars 40% (lactose)
Protein 12-15 g/day
Minerals
-Fe from milk then need to create stores
- rickets; rise in Bradford 2007 (osteomalacia in adults), Southampton 2010
Vitamins
-D: Dietary up to 4 years then sun exposure; hypocalcaemia and hypomineralised enamel in Scotland re < UV radiation
-C: scurvy, poor wound healing and Fe absorption
Pre-school dietary requirements
Energy 1200-1700 kCal/day
Sugar 25-30%
Protein 15-19 g/day
Minerals
-Fe from milk then need to create stores
- rickets; rise in Bradford 2007 (osteomalacia in adults), Southampton 2010
Vitamins
-D: Dietary up to 4 years then sun exposure; hypocalcaemia and hypomineralised enamel in Scotland re < UV radiation
-C: scurvy, poor wound healing and Fe absorption
Older children/ adolescents dietary intake
Energy 1800-2750 kCal/day
Sugars 17-25% (85g)
Protein 28-55 g/day)
Minerals
-Fe from milk then need to create stores
- rickets; rise in Bradford 2007 (osteomalacia in adults), Southampton 2010
Vitamins
-D: Dietary up to 4 years then sun exposure; hypocalcaemia and hypomineralised enamel in Scotland re < UV radiation
-C: scurvy, poor wound healing and Fe absorption
Ca/ Vit D/ Vit A and teeth
No link between diet high in Ca and Vit D improving strength of developing teeth, but adverse effects if mother poorly nourished
Vit A for enamel, Vit D for dentine
Total fat
30-35% energy intake 2-3 years
25-35% 4-8 years
Total salt
<1-6g, depending on age
Free
<5-10% energy
Food policies and capmaigns
NHS 5 a day campaign Change4Life PHE Action on Childhood Obesity, 2016 Healthy Start FSA: Saturated Fat Campaign 2009 Every Child Matters -government initiative, leading to Children Act 2004 -health and wellbeing Scotland, Wales, NI
WHO and FAO 2003
• observational and experimental studies
• compromised or excessive nutrient supply during early
foetal and infant life – later health consequences
• long-term effects, risk of chronic disease in adulthood
• concern re dietary patterns of women and children
• improving nutritional status could improve health of future generations
• early life nutrition is important
PHE
2 snack limit, Jan 2018
8-week plan with money-off vouchers
Challenge food industry <20% sugar by 2020
March 2018 - <20% in calorie content by 2024
Change4Life: sugar
“Around 30% of the sugar in kids' diets comes from sugary drinks, such as fizzy pop, juice drinks, squashes, cordials, energy drinks and juice.” 4-6 years: 5 cubes (19g) 7-10 years: 6 cubes (24 g) 11+ years: 7 cubes (30 g)
Academy of Medical Royal Colleges
2013
- tax on sugary drinks
- less fast food outlets near schools
- TV adverts after 9pm ‘watershed’
Chief Medical Officer
2014
-sugar tax fizzy drinks and junkfood
Denmark
- saturated fat tax 2011, repealed in 2012
- sugar tak (proposed 2013 but not imposed)
Mexico
-sugar tax drinks 2013
UK 2016
- tax on soft drinks 2018
- reformulate
- strong message sugar toxicity
Food Standards Agency
- encourage and facilitate healthy eating (eatwell guide)
- improve diet and nutrition in UK
- reduce diet-related disease (“eat well, be well”)
- protect public`s health and consumer interest in relation to food
Department of Health
Standard setting
Surveillance of nutrient intake and nutritional status of general population
Shared with FSA
British Nutrition Foundation
Charity
Promote wellbeing of society - impartial interpretation/ dissemination of scientific knowledge
Advice on diet, physical activity and health
British Dietetic Assocation
Food Facts about Sugar
NHS live well
Healthy living for everyone
e.g. healthy food swaps
National Diet and Nutrition Survey
Year 1 2008/2009
• Food consumption, nutrient intakes and nutritional
status 1.5yrs+ living in private UK households
• Commissioned by the FSA in 2006 (+DH/PHE funding)
• Socio-demographics, physical measurements, age and gender
• 3,000 individuals, cross-sectional
• Intake comparisons with government recommendations (Dietary Reference Values, COMA report 1991)
and previous surveys (see next)
(yr2 ‘09/’10 …… yr4 ‘11/’12 up to yr9 ‘16/’17)
Years 1-3 published 2012, years 1-4 2014 etc.
• Currently years 5-6 (‘12-’13 and ‘13-’14 data) Sept 2016
National Diet and Nutrition Survey
Year 1 2008/2009
• Food consumption, nutrient intakes and nutritional
status 1.5yrs+ living in private UK households
• Commissioned by the FSA in 2006 (+DH/PHE funding)
• Socio-demographics, physical measurements, age and gender
• 3,000 individuals, cross-sectional
• Intake comparisons with government recommendations (Dietary Reference Values, COMA report 1991)
and previous surveys (see next)
(yr2 ‘09/’10 …… yr4 ‘11/’12 up to yr9 ‘16/’17)
Years 1-3 published 2012, years 1-4 2014 etc.
• Currently years 5-6 (‘12-’13 and ‘13-’14 data) Sept 2016
1st food survey
1986/87 Dietary and Nutritional Survey of British Adults
Stand alone food survey
1992/93 NDNS
• repeated 3 yearly until 2000/01
Rolling programme food survey
NDNS (RP)
• interviews, diet-diary, main food provider (purchase, prepare),
nurse visits, blood, urine
• different data, but can compare previously
• continuous, cross-sectional data
• new in 11/12 - blood indices of nutritional status and 24 hr urinary
sodium in children and older adults
2007
Health Survey for England
2008
Scottish Health Survey
National Diet and Nutrition Survey (yrs 1-6): results in children
• 8% children (11-18yrs) meet 5-a-day target (mean 2.8)
• Sugar-sweetened soft drinks reduced (4-10yrs);
from 130g (yrs 1+2) to 100g (yrs 5 and 6) (significantly)
(Ages 11-18yrs similar pattern but non-significant)
• Saturated fat: still exceeding recommendations
• Sugars (NMES) reduced (4-10yrs):
years 1 and 2 cf years 5 and 6
But 13.4% total food energy in 4-10yrs and 15.2% in 11-18yrs
• Vitamins and minerals: less than RNI (e.g. A, D, Fe)
National Diet and Nutrition Survey: overall diet in children
Overall diet and nutrient intakes similar to previous
assessments
Indications of trends towards healthy recommendations
e.g.
• sat fat ↓ but still too much
• NMES ↓ but still too high (~13 and 15% for 4-10 and 11-18yrs)
• some↑ in fruit, lesser extent re: vegetables
Salt – above recommendations
Diet and Nutrition Survey of Infants and Young Children key findings
• varied diet • high proportion (78%) ever been breastfed, though duration less • fruit and vegetable consumption lower in lower SEC •75% boys and 76% girls exceeded EAR for energy • protein above RNI • sodium 181% of RNI for 12 -18mth grp
Changing habits
- How? Effectiveness?
- Slowly
- Consider effect of advertising
- Knowledge, attitude, behaviour
- Environment, access
- Diet diaries
- Family, not just child
Are children eating the right things?
1. We should make sure they are (parent/carer, relative, healthcare professional) 2. So that they can grow up “big and strong” (develop and grow properly, and be healthy, including in later life) 3. And teach them about nutrition (so they are able to make healthy choices)
