Final Flashcards
Infancy
First year of life (birth-12 months)
Early infancy
0-6 months
Later infancy
6-12 months
Newborn development
- hear and move in response to familiar sounds (exposed to mothers voice in utero)
- subtle cues for hunger and satiety
- strong reflexes, especially suckle and root, within hrs. after birth
- reflexes replaced by purposeful movement
CNS development in newborns
- begins in utero
- CNS immature when first born
- evolves in complexity in first year
Reflex
automatic response triggered by specific stimulus
Rooting reflex
infant turns head toward the cheek that is touched
Suckle
reflex causing tongue to move forward and backward
- sometimes triggered by smell of breast milk
5 domains of development
- Motor
- Sensory
- Cognitive/mental
- Language and communication
- Social, adaptive, emotional
Motor development
refers to ability to control voluntary muscle movement
- influenced by sensory system
- gross and fine
- crawl/turn over
- ability to focus
Sensory development
refers to responding to information from environment
Cognitive/mental development
refers to development of brain through interaction with environment
Language and communication
refers to development of ability to communicate
- can’t express but can communicate very early
Social, adaptive, and emotional development
refers to development of responding to other people, gaining a sense of their own abilities and relationships
Development occurs…
in a predictable sequence like building blocks
- stages are interrelatable
Intrinsic influence
refers to development of things you can’t necessarily see
- child’s health (nutrition)
- brain function
- temperament
Extrinsic influence
factors such as family, environment, cultural norms
The development of motor control starts with?
Head and trunk control then lower legs
- top down
- central to extremities
Motor control development influences?
Ability to be fed, feed self and amount of energy expended
Sensorimotor
refers to knowledge of world limited to sensory perception and motor activity
For infants, the _____ is an important source of stimulation and pleasure
mouth
- allows development of cognitive skill
- sensorimotor skills
- develop ability to speak
- move tongue properly
- say words
Feeding tubes in early infancy can interrupt…
Development and have long term negative consequences
Digestive system development
- gut functional at birth (can digest fat, protein, simple sugars)
- 6 months required for GI tract maturation
- as infant ages levels of digestive enzymes expand
- speed of stomach emptying increases
- peristalsis becomes more consistent
Feeding skills development
- infants born with reflexes and food intake regulatory mechanism
- inherent preference for sweet taste
Reflexes fade and infant begins to purposely signal wants and needs at?
4-6 weeks
Tongue moves side to side, teeth arrive, and can swallow pureed foods and hold bottle at?
4-6 months
Self feeding with hands or spoon, munching and biting skills, lumpy and chopped foods, drinking from open cup at?
9-12 months
Energy needs from birth to 6 months
108 kcal/kg/day
Energy needs from 6 to 12 months
98 kcal/kg/day
Energy needs for babies born prematurely
120 kcal/kg/day
Energy needs in first 6 months of life are…
higher per pound than any other time of life
- supports so much growth and development
Factors that influence caloric needs for infant
- weight
- growth rate
- sleep/wake cycle
- temperature and climate
- metabolic response to food
- health status
Warmer climates nurse…
more
Growth spurts typically happen at
3 weeks and 3 months
Growth spurts does NOT signal…
a need for solid foods or formula if breastfeeding
Protein needs from birth to 6 months
2.2g/kg/day
Protein needs from 6 to 12 months
1.6g/kg/day
Premie protein needs if growth or digestion are not affected
1.52 g/kg
Premie protein needs required for preterm or recovery from illness
3.0 - 3.5 g/kg
Premie protein needs for extremely low birth weight
4.0 g/kg
Hydrolyzed protein or single amino acid formulas may be used for
preemies or sick infants
Fat needs from birth to 12 months
AI about 30 g/day
Infants need ____ for _____ development
cholesterol; brain
Breastmilk contains about ___% calories from fat
55
CHO needs from birth to 6 months
60 g/day
CHO needs from 6-12 months
95 g/day
Metabolic rate of infants is…
highest of any time after birth
- related to rapid growth and high proportion of muscle
Fluoride for infants
supplement at 6 months unless provided with fluoridated water
Vitamin D for infants
breastfed babies need supplement of 400IU from birth until 1 year of age
Iron requirements for birth to 6 months
0.27 mg/day
Iron requirements for 6 months to 12 months
11 mg/day
Anemia is uncommon in infants because of:
- prenatal iron stores of mother
- high bioavailability in breastmilk
Whole, reduced fat or skim cow’s milk should not be used before…WHY?
9 months of age
- iron deficiency anemia linked to early introduction of cow’s milk
Health Canada infant recommendations
- support breastfeed up to 2 years and beyond
- no cow’s milk before 9 months (unless whole milk)
- complementary feeding to start at 6 months
- gradually increase frequency of complementary feedings
- no honey before 1 year
- progress in textures gradually
- allergens
- consider food safety and choking hazards
Progress in textures
pureed –> lumpy –>mashed –> diced
- lumpy foods offered no later than 9 months
No evidence that introducing any allergen has an increased risk of developing an allergy after
6 months
- offer no more than 1 potential allergen at time and wait at least 2 days before introducing another
Foods that could choke infants
- popcorn
- peanuts
- raisins
- stringy meats
- gum and gummy textured candies
- hot dogs
- hard fruits or vegetables
Recommendations for 6 to 9 months
- increasing textured foods
- slowly increase amount based on infant’s appetite
- should be eating 3 meals with breast/formula feeds
Recommendations for 9 to 12 months
- move towards diced soft foods
- increase texture to encourage chewing
- encourage self feeding and eating family foods
Expectations for 12 months
- general pattern of 3 meals and 3 snacks
- slow self weaning as increase solid food intake (about 2 milk feedings/day)
- solids increase in amount progressing towards table foods with some modification
Hungry feedings cues
- watches food being prepared
- reaches for food, spoon
- tight fists
- irritation if pace too slow or stops
Full feedings cues
- plays with food, utensils
- slows pace of eating
- turns away from spoon
- tries to get out of high chair
- stops eating
- spits out food
Why assess physical growth in infants?
Reflects:
- nutritional adequacy
- health status
- economic and environmental adequacy
How do we assess physical growth in infants?
- weight
- height/length
- head circumference
Infant/child weight and height must be interpreted in context of
age and gender
How do we interpret growth in infants?
percentile rankings
- child weighs the same or more than 95% of reference population
- child weighs less than 5% of reference population
Who is reference population when referring to percentiles?
WHO studied children from 6 countries:
Brazil, Ghana, India, Norway, Oman, USA
- based on standard measurements of babies
- based on an exclusively breastfed population
Difference between infant growth charts used in CA (WHO) and USA (CDC)
- CDC based charts describe how children have grown in past
- WHO describe how children should grow
Interpretation of growth data
Measures over time identify change in growth progress and whether there is a need for an intervention
Warning signs for infant intervention
- loss of weight or length gain
- plateau in weight or length for > 1 month
- drop in weight without regain in a few weeks
- fast gain in weight
concern for underweight in infants
less than 3rd percentile for weight for age
concern of stunting in infant
less than 3rd percentile for height for age
concern of wasting in infant
less than 3rd percentile for weight for length
risk of overweight in infant
weight for length greater than 85th percentile
overweight infant
weight for length greater than 97th percentile
obese infant
weight for length greater than 99.9th percentile
small or large head for infant
head circumference less than 3rd or greater than 97th percentile
WHO charts can be used as growth indicator for premies only if…
infant’s body weight is greater than 2500 g
For premies, catch up growth can take…
1-3 years
Using growth chart for premies need to correct
for gestational age
Correcting for gestational age
- subtract gestational age from 40 weeks
- divide by 4 to get months
- subtract that amount from current age
What is the gestational adjusted age for a 9 month old infant born at 32 weeks of age
7 months
Low birth weight is…
- an indicator of general health of newborns
- a key determinant of growth, health and development
Low birth weight infants are at…
greater risk of dying during the first year of life, and of developing chronic health problems
What percentage children less than 4 years of age have a food allergy?
6-8%
Common allergy symptoms in infants
respiratory or skin rashes
Treating allergies in infants
may consist of baby formula with hydrolyzed proteins
Food avoidance/postponement may lead to…
decreased nutritional adequacy and limit variety
___________ for infants at risk of allergies
Breastmilk
Oral tolerance induction
The idea of slow sensitization especially for milk, soy, egg and wheat
- overcome risk of allergy by consuming tiny but increasing portions of the food
- train immature immune system
- shown to help prevent certain allergies
Between the ages of 1 to 3 years
toddlers
Between the ages of 3 to 5
preschoolers
Toddler stage characterized by
rapid increase in gross and fine motor skills
Preschool stage characterized by
- increasing autonomy
- broader social circumstances
- increasing language skills
- expanding self control
Health Canada recommendations for young children
- serve small nutritious meals and snacks each day
- do not restrict nutritious foods because of allergen potential
- offer variety form all 4 food groups
- satisfy thirst with water
- respect children’s ability to determine how much food to eat
- be patient
- be a good role model
- organize fun physical activities
Toddlers and preschoolers have small stomachs so
they need to eat small amounts of food more often throughout the day
Children need a total of ___ of milk every day to help meet their requirement of vit. D
2 cups
Equation for estimating energy requirements for 13 to 36 months
89 x (child weight in kg) - 100 + 20 kcal - account for age, gender, height, weight, physical activity level
Most Canadian toddlers/preschoolers _______ recommendations
Meet or exceed
RDA for protein for children 1 to 3 years
1.1 g/kg/day
RDA for protein for children 4 to 8 years
0.9 g/kg/day
Most toddlers and preschool-age children have adequate vitamin and mineral consumption except for
- iron
- calcium
- vit. D
What nutritional factors put preschoolers at risk for iron deficiency
- high milk consumption
- low iron diet
RDA for iron for children 1 to 3 years
7 mg/day
RDA for iron for children 4 to 8 years
10 mg/day
Approximately ____% of children aged 1 to 5 years have iron deficiency anemia in Canada
3.5 to 10.5%
Much higher iron deficiency anemia where in Canada and why?
Northern Ontario First Nation communities
- due to high consumption of evaporated milk and cow’s milk at 6 months of age an prolonged breastfeeding without sufficient supplementation
- don’t necessarily have access to good dietary sources
Iron deficiency anemia in children may cause
delays in cognitive development and behavioural disturbances
Preventing iron deficiency anemia in children
- limit milk consumption to 2 cups per day
- provide iron rich foods
- Canadian Task Force on Periodic Health Examination recommends that all high risk infants be screened at 6 and up to 12 months
Treating iron deficiency anemia
- iron supplements
- counselling with parents
- repeat screening
- micronutrient powders (sprinkles)
RDA for calcium for children 1 to 3 years
700 mg/day
RDA for calcium for children 4 to 8 years
1000 mg/day
Ensure adequate calcium intake in children through:
- milk and milk alternatives
- dark green vegetables
- fish with soft bones that are eaten
RDA for vitamin D for 1 to 8 years
600 IU
Approximately ___% of Canadian children deficient in vit. D
20
Feeding behaviours of toddlers
- rituals are common
- may have strong preferences and dislikes
- food jags are common
- imitate parents and siblings
May take up to how many exposures before toddler accepts food?
8 to 10
What is not a good way to get kids to eat vegetables?
- clean your plate
- using food as reward
- heavy restriction of less healthy
Development of feedings skills of preschool aged children
- can use fork, spoon, and cup
- temper tantrums occur less frequently
- foods should be cut into bite sized pieces
- adult supervision required
Beginning at age 3, DRI equations for estimating a child’s energy requirements are based on child’s:
- age
- height
- weight
- activity level
- gender
On average toddlers gain?
8 oz. per month
What percentage of children aged 2-5 are overweight/obese?
13%
On average preschoolers gain?
4 lbs. per year
WHO definition of obese children aged 2 to 5
BMI greater than 97th percentile for age and gender
WHO definition of overweight children aged 2 to 5
BMI greater than 85th percentile for age and gender
Toddlers and preschoolers should obtain ___ minutes of any intensity physical activity per day
180
Interpersonal and environmental considerations for toddlers and preschoolers
- child care
- neighbourhood environment
- family influence
- peers
- parenting style
- media
Parenting and feeding styles
- authoritarian
- indulgent
- neglectful
- authoritative
Authoritarian
control child eating, restricting food, forcing other food
Indulgent
minimal guidance/structure, child eats whenever and whatever
Neglectful
parenting is absent, foods available may be inadequate/inappropriate
Authoritative
balanced approach
- parent determines what is offered
- child determines what is eaten
Low warmth and high demandingness
Authoritarian
High warmth and low demandingness
Indulgent
Low warmth and demandingness
Neglectful
High warmth and demandingness
Authoritative
Authoritarian style parenting ___ times more likely to obese compared to authoritative
4
Indulgent and neglectful style parenting __ times more likely to be obese compared to authoritative
2
Canadian guidelines for screen time for children 0 to 2 years
No screen time
Canadian guidelines for screen time for children 2 to 4 years
under 1 hour per day
Each 1 hour increment in TV viewing associated with
- higher intakes of sugar-sweetened beverages, fast food, red and processed meat, total energy intake, and percent energy intake from trans fat
- lower intakes of fruit, vegetables, calcium, and dietary fiber
Marketing influence on child nutrition
- commercials during child programming
- fast food predominates sponsorship, even for ad free television
- characters, give aways
- child oriented food products
Goal for overweight and obesity in toddlers and preschoolers
maintain weight while increasing height
- weight loss typically not recommended (don’t exceed 1 pound per month)
- not time to restrict food
Treatment guidelines for overweight and obesity in toddlers and preschoolers
Stage 1: prevention plus
- behaviour change and more frequent follow up
Stage 2: structured weight management
- planned diet/eating, logs to monitor behaviour, monthly follow up
Stage 3: comprehensive multidisciplinary intervention
- more intensive intervention, multiple health professionals, weekly follow up visits
What is nutrition screening?
- process of identifying characteristics known to be associated with nutrition problem
- completed by dietitians OR health care professionals in various settings
- determines the need for further nutritional assessment
Why nutrition screen?
- early identification of problems
- to prevent serious consequences in future
- to provide treatment when needed
- to identify who needs services, treatment and referrals
- to promote awareness and behaviour change
Nutrition screening tools
- contain measures/questions focusing on known risk factors
- usually short check lists
- nutritional risk increases with increased presence of risk factors
- categorizes individuals based on needs for further assessment
- MUST be followed up appropriately
What is NutriSTEP?
Nutrition Screening Tool for Every Preschooler
- 17 question screening tool for both toddlers and preschoolers
- each answer associated with a Risk Level
- parent administered
- determines 3 levels of risk
NutriSTEP provides:
- early identification of potential nutrition problems
- parent referral to community resources
- parental nutrition education
- support in evaluating preschool nutrition interventions
- means of monitoring community nutrition programs
Target behaviours in the prevention of overweight or obesity from birth would include:
- limiting sugary beverages
- encouraging consumption of fruits and vegetables
- limiting portion sizes
- eating a fibre-rich diet
Middle childhood
children between the ages of 5 to 10
Preadolescence for girls
ages 9 to 11
Preadolescence for boys
ages 10 to 12
Unique characteristics for school-aged life stage
- preparation for physical and emotional demands of adolescent growth spurt
- adequate nutrition associated with improved growth and performance
- girls develop earlier than boys
Cognitive development of school-aged life stage
- achievement of self efficacy
- developing sense of self
- more independent, learning role in family
- peer relationships become more important
- adequate nutrition associated with improved academic performance
Self-efficacy
knowledge of what to do and ability to do it
Physiological development of school aged life stage
- increases in muscular strength, motor coordination, and increased overall stamina
Boys general have more ______ ______ than girls
lean tissue
Adiposity rebound
In early childhood when body fat reaches a minimum then increases in relation to the body’s preparation for adolescent growth spurt
When does adiposity rebound occur?
At about 6 years of age
Percent body fat reaches a minimum of __% in females
16
Percent body fat reaches a minimum of __% in males
13
Early adiposity rebound is associated with
increased obesity risk
Adiposity rebound tends to be ___ in females than males
earlier and greater
BMI considerations for school aged children
- BMI is not consistent because there is so much growth (weight and height) during this time
- plotting BMI for age intervals is really the only way to know where children stand
- goal is not to strive for certain BMI but to be in reasonable percentile based on age and gender
Protein DRI for children 4 to 13 years old
0.95 g/kg/day
AMDR
Acceptable Macronutrient Distribution Range
- the range of intake for a particular macronutrient source, expressed as a percent of total energy, that is associated with reduced risk of chronic diseases while providing sufficient amounts of essential nutrients
Wiggle room
AMDRs for children aged 4 to 18 years is not static there is 20% of wiggle room
Benefits of fibre
- provides fuel for beneficial bacteria within lower GI tract
- aids with waste removal
- slows digestion
- makes you feel fuller longer
Fibre is indigestible
- we cannot breakdown plant components ourselves
- cannot obtain energy
- no AMDR
Fibre recommendations for children aged 4 to 13
Between 25 and 31 based on age and gender
Canadian health survey for children aged 9-13 suggests…
- fat consumption is too high
- fibre intake is too low which is related to low fruit and veg intake
- calcium levels are low
- sodium is way too high
During childhood dietary iron and iron status are usually _______
adequate
Children at risk for iron deficiency
- limited access to iron-rich foods
- low iron or specialized diet (vegetarian)
- medical conditions that affect iron status
A child with a BMI equal to or greater than the 85th percentile but less than the 95th percentile is…
overweight
Toxic media environment
Kids these days are exposed to way too much screen time
Influences as you get into school age
- self esteem and body image in media
- more peer influences
- friends telling the truth
- anatomic toys
Weight based stigmatization exhibits as
- biased attitudes, prejudice and behavioural intentions
- various forms of discrimination
- social marginalization, weight-related teasing
Normal increase in body fat during school aged children may be interpreted as…
beginning of obesity before girls have growth spurt
Parental controls and restriction of forbidden foods may…
increase intake of these foods
Weight-related teasing associated with:
- increased frequent dieting
- increased extreme weight control behaviours
- increased binge eating
- increased depressive symptoms
- decreased self esteem
- decreased body satisfaction
Measures to prevent childhood obesity
- limit sugar sweetened beverages
- limit TV
- limit fast foods
- limit portions
- limit energy dense foods
- have daily breakfasts
- encourage fruits and veg
- promote calcium rich diets
- promotes diets high in fiber
- promote physical activity
What works for preventing childhood obesity?
Combination of clinical and school based multi-component programs
- physical activity
- parent training/modelling
- behavioural counselling
- nutrition education
Physical activity guide for children aged 5 to 17
- 60+ mins/day of moderate to intense exercise
- 3+ days/week, intense exercise
- 3+ days/week, muscle building exercise
Approximately what percent of Canadian children achieve 60+ minutes 6+ days/week
7%
_____ level of activity in school aged children compared to preadolescents
HIGHER
Schools are in a unique position to support healthy eating…why?
- reach nearly all children
- captive audience
- venue for both nutrition and education
- role modelling/social norms
- may have positive influences on parents
4 aspects of school nutrition environment
- School food and beverage policy
- Breakfast/snack programs
- Access to off campus vendors
- Health Curriculum
Ontario School food and beverage policy
- Nutrition standards for food and beverages sold in elementary and secondary schools
- Took effect in September 2011
- Applies to all venues and events on school property
- 10 “event” days per year where any food is limited
- 20 minutes of daily physical activity
Ontario School food and beverage policy nutrition standards
3 categories
- green
- yellow
- red
Green category
Sell most (at least 80%):
- healthier options
- higher levels of essential nutrients and lower amounts of fat, sugar and sodium
Yellow category
Sell less (less than 20%) - may have slightly higher amounts of fat, sugar and sodium than food in green category
Red category
Not permitted
- foods contain few or no essential nutrients
- contain high amounts of fat, sugar and sodium
Green food examples
- extra lean ground meat
- whole grain bread
Yellow food examples
- white bagels
- cheese
Red food examples
- candy
- energy drinks
- fried foods
Chocolate milk controversy
- 250 mL has approximately 26 g of sugar and policy states that schools are not allowed to sell milk-based drinks with more than 28 g
- children like it!
- good source of calcium, vitamin D, protein
- 2 x the sugar of white milk
- no added health benefits
- normalization of sugary foods
How is the policy doing?
Not very well
Food breakfast programs
- Canada has no national breakfast program; education is the jurisdiction of provincial governments
- district school/level programs may provide “universal” breakfast, lunch, or snacks to children
Breakfast programs in Guelph
- Food and Friends
- Breakfast for Learning
- Breakfast clubs of Canada
Number of breakfast programs are _______
increasing
Canadian Children’s food and beverage advertising initiative
- voluntary industry driven program
- core principles include not advertising food or beverage products in elementary schools
Ontario Health Curriculum
Incorporates healthy eating component
- grade 1: Food groups, hunger
- grade 2: food choices, food guide
- grade 3: nutrition value, local and cultural foods, environmental impact
- grade 4: nutrients, healthy eating
- grade 5: food labels, media effect on choices
- grade 6: benefits of healthy food
- grade 7: health issues form food choices
- grade 8: macro/micro nutrient functions
How many minutes of physical activity per day are recommended for school aged children?
60 minutes
Early adolescence
11 to 14 years old
Middle adolescence
15 to 17 years
Late adolescence
18 to 21 years
- crosses over with early adulthood
Adolescent nutritional needs
- substantial physical, emotional and cognitive maturation
- rapid physical growth affects nutrient needs
- strong desire for independence can influence food choices
Puberty begins during…
early adolescence
Biological changes of puberty include
- increases in height and weight
- sexual maturation
- changes in body composition
- accumulation of skeletal mass
___ of changes is consistent but ___ of changes is not
Order; timing
Sexual maturation
Biological age not chronological age
Sexual maturation should be used to
assess nutritional needs
Sexual maturation rating
scale to assess degree of sexual maturation
SMR stage 1
pre puburtal growth and development
SMR stages 2-5
occurrences of puberty
SMR stage 5
sexual maturation has concluded
Sexual maturation in boys
genital development and pubic hair growth
Sexual maturation in girls
breast development and pubic hair growth
Menarche
onset of first menstrual period
Menarche in girls occurs
2-4 years after initial development of breasts
- SMR 4
Age of menarche in girls
ranges from 10 to 17 years
- earlier now than in previous generations
Peak velocity of linear growth in girls occurs
approximately 6 to 12 months prior to menarche
- SMR 3
Slow or delayed growth occurs
- in highly competitive athletes
- severely restricted diets
___ tend to develop earlier than ___
Girls; boys
Peak weight gain in girls follows
linear growth spurt by 3 to 6 months
Girls decrease in lean body mass from __% to __% of body weight
80; 74
Girls gain approximately __ cm and stop growing around __ years of age
8; 16
Females experience a __% increase in body fat during puberty
120
Body fat levels in females
low: less than 20%
medium: 28%
high/obesity: greater than 35%
__% body fat is required for menarche to occur
17
__% body fat is needed to maintain normal menstrual cycles
25
In males there is a ______ variation in chronological age at which sexual maturation takes place
large
Peak velocity of linear growth in males occurs ____ and ends ___
during SMR 4; with the appearance of facial hair
- can be as early as 10 years and as late as 14
Boys can gain between ____ cm/year in height
7 and 12
In males linear growth continues throughout adolescence at a slower rate until about
21 years
In males peak weight gain occurs
at the same time as peak linear growth
Peak weight gain for males is approximately ___ lbs. per year
20
In males body fat decreases to approximately __%
12
___ of bone mass is accrued in adolescence
Half
By 18 __% of skeletal mass is formed
90
Given growth and development during adolescence, what are the key nutrients?
- Calcium
- Iron
- Vit. D
- Protein
Energy requirements for adolescents are influenced by
- activity level
- BMR
- Pubertal growth and development
Level of activity ______ during adolescence
Declines
Energy ranges for male and female adolescents
Males: 2200 - 3100 kcal/day
Females: 2000 - 2400 kcal/day
Protein requirements for adolescents influenced by
amount needed to maintain existing and lean body mass and develops new muscle
DRI protein requirements for adolescents
0.85 g/kg (AMDR 10-30%)
Low protein intakes during adolescence linked to
- reductions in linear growth
- delays in sexual maturation
- reduced lean body mass
Carbohydrate intake for adolescents
130 g/day or 45-65%E
Dietary fibre recommendations for males and females age 9 to 18 are between
26 and 38
Fat required during adolescence
- required as dietary fat and essential fatty acids for growth and development
What is the AMDR for total fat and omega 3 fatty acids during adolescence?
25 to 35%, and 0.6 to 1.2%
Less than __% E from saturated fat
10
During peak weight gain, adolescent males gain an average of __ lbs. /year
20
Calcium AI during adolescence is critical why?
to ensure peak bone mass
Calcium absorption highest for females and males when?
around menarche and during early adolescence
Approximately how many times more calcium is absorbed during adolescence compared to adulthood?
4x
Adolescents who do not include dairy should consume…
Calcium fortified foods
RDA for calcium for ages 9 to 18?
1300 mg/d
Vitamin D important because?
- facilitates intestinal absorption of calcium (and phosphorus)
- essential for bone formation
Northern latitudes may require supplementation of what?
Vitamin D
- synthesized by body via skin exposure to sunlight
DRI for vitamin D during adolescence
600 IU per day
Iron critical during adolescence because
- rapid rate of linear growth and increase in blood volume
Female iron needs highest _____
after menarche
- 15 mg/day
Male iron needs highest ____
after growth spurt
- 11 mg/day
Other key nutrients during adolescence?
- zinc
- B vitamins
Why is zinc important during adolescence?
for sexual maturation and growth especially in males
Why are B vitamins important during adolescence?
for protein synthesis and cofactor properties
“teen” brain refers to
- ability to reason although rational thought may be limited
- living in the moment so limited consideration of long-term consequences
- reward benefits much more important than possible risk
Social and emotional development during early adolescence
- strong need for social acceptance from peers
- body image may change as a result of changes in body shape
- increased awareness of sexuality
- strong sense of impulsivity
Social and emotional development during middle and late adolescence
- increased opportunities for employment and outside activities
- greater autonomy from parents
- continued need for social acceptance from peers
- increased awareness of social and moral issues
About __% of adolescents report following a vegetarian diet
4
Reasons adolescents adopt a vegetarian diet include:
- cultural or religious beliefs
- moral or ethical concerns
- health beliefs
- to restrict fat/calories
- a means of independence from family
Compared to non vegetarians, vegetarians tend to have:
- higher intake of fruits and veggies
- less overweigh/obesity
- more eating disorders
- more weight controlling behaviour
Position of dieticians of Canada on vegetarian diets
- depends on level of restriction (high = concerns with adequacy)
- can be associated with eating disorders
- fortification and supplements will help vegans to achieve adequate nutrition
Teen eating challenges
- nutrition knowledge may be limited
- may be motivated by weight loss
Physical activity guide for children aged 5 to 17
- 60+ minutes/day of moderate to intense exercise
- 3+ days/week, intense exercise
- 3+ days/week muscle building exercise
Rates of physical activity tend to ______ as children get older
decrease
Association between body satisfaction and weight related behaviours in females
Lower body satisfaction associated with:
- increased extreme weight control behaviours
- increased binge eating
- decreased physical activity
- decreased fruit and veg intake
Association between body satisfaction and weight related behaviours in males
Lower body satisfaction associated with:
- increased extreme weight control behaviours
- increased binge eating
- decreased physical activity
Continuum of eating concerns and disorders
Body dissatisfaction > dieting behaviours > disordered eating > clinically significant eating disorder
Key features of anorexia nervosa include
- refusal to maintain body weight at normal weight for age
- intense fear of gaining weight
- amenorrhea
- distorted body image
Key features of bulimia nervosa include
- recurrent episodes of rapid consumption of a large amount of food in a discrete period of time
- use of laxatives or diuretics
Binge eating disorder
Binge eating not followed by compensatory behaviours caused by dietary restrictions leading to uncontrolled hunger
Why are eating disorders so common in adolescence?
- life is overwhelming
- so many changes
- struggling for independence and identity
- increased pressure
- source of control over stress
Early adulthood
Mid 20s to 30s
Characteristics of early adulthood
- involved in transitions to adulthood
- planning, buying and preparing food may be newly developing skills
- may have renewed interest in nutrition
Midlife
40 to 64 years
Characteristics of midlife
- period of active family responsibilities
- managing schedules and meals becomes a challenge
- multigenerational caregivers
- health concerns are frequently added
Older age
65+ years
Characteristics of older adult
- transition to retirement
- more leisure time
- greater attention to physical activity and nutrition
- food choices and lifestyle factors especially for those with chronic disease
Physiological changes of adulthood
- growing stops by 20s
- bone density continues until 30 yrs. of age
- dexterity and flexibility decline
- muscular strength peaks around 25 to 30 yrs.
- decline in size and mass of muscle and increase in body fat
Hormonal changes in adult women
- decline in estrogen
- increase in abdominal fat
- increase in risk of CVD and accelerated loss of bone mass
Hormonal changes in adult men
- gradual decline in testosterone level and muscle mass
Body composition changes in adults
- positive energy balance
- increase in weight and adiposity
- decrease in muscle mass
- fat redistribution
- bone loss begins about age 40
Fat redistribution
- gains in central and intra-abdominal space
- decrease in subcutaneous fat
Between ages 20 and 64, health and wellness greatly influenced by:
- diet
- PA level
- body weight
- smoking
Caloric intake declines by approximately __% per decade during early adulthood…due to?
2; decreased metabolic rate and decrease in physical activity
To maintain a healthy weight into adulthood
- consume nutrient-dense/lower energy foods
- increase physical activity
It is difficult to meet vitamin and mineral needs at calorie levels below
1800
AMDR ranges for adults
Fat: 20-35%
Carb: 45-65%
Protein: 10-35%
Fibre helps:
- prevent against certain types of cancer and heart disease
- allows us to eat a lot more food
- helps rid body of cholesterol
Calcium RDA ___ to ___ mg/day for adults
increases; 1200
All adults over age 50 should take a supplement with ____ because:
400 IU of Vit. D
- limited exposure to sunlight
- institutionalization or long working hours
- certain medications
Most older adults are above adequate intake of what micronutrient?
Iron
Total body water ____ with age
decreases
____ glasses of fluid/day will prevent dehydration in most older adults
6+
Risk factors for health conditions in adults and older
- overweight/obesity
- weight pattern
- waist circumference
- Physical inactivity
Recommendations for PA in adults
- 30 to 60 minutes per day
- 150 minutes per week
- strength training twice per week
- start slowly 10 minutes at a time and build up tolerance
In adults and older adults weight bearing and resistance exercises increase
lean muscle mass and bone density
Chronic conditions with modifiable risk factors include:
- heart disease
- cancer
- stroke
- type II diabetes
What is the life expectancy in Canada?
82 years
Fastest growing population group in Canada?
Elderly
2 main causes of death
Cancer and heart disease
Lean body mass
sum of fat-free tissues, mineral as bone and water
Sarcopenia
term used for loss of LBM associated with aging
- can begin as early as 40 years old
LBM decreases ___ from age 30 to 70
2-3% per decade
3 nutritional considerations for older adults
- Sensory changes
- Physical limitations
- Cognitive factors
Taste and smell ___ with age
decline
_____ retain their sense of smell better than _____
Women; men
What affects taste and smell more than aging?
Disease and medications
Cognitive disorders
- Alzheimer’s
- Vascular dementia
- Parkinson’s disease
- Alcohol-related and AIDS-related dementia
- Dementia
Dementia
a progressive cognitive decline, characterized by forgetfulness, memory decline, difficulty with decision-making and mental ability
- ranks 5 in cause of death of older people
Effects of cognitive disorders
- confusion
- anxiety
- agitation
- loss of oral muscular control
- impairment of hunger/appetite regulation
- changes in smell and taste
- dental, chewing and swallowing problems
Nutrition interventions for cognitive disorders must:
- ensure food safety
- safe use of kitchen tools and equipment
- dietary focus
- nutrient-dense diet
- maintain hydration
- supply needed energy
Change in eating patterns that comes with aging
- meal prep
- decreased appetite
- smaller less frequent meals
Changes in sensual awareness related to appetite
hunger and satiety cues weaken
- need to be more conscious of food intake levels since appetite regulating mechanisms may be blunted
Changes in sensual awareness related to thirst
thirst regulating mechanisms decrease with age
Older adult meal intake impacts:
- weight changes
- nutrient intake
- disease management
- immunity
- risk of falls
- psychological health
Factors impacting nutritional intake of older adults:
- disease condition
- functional disability
- inadequate food intake
- swallowing difficulty
- depression or anxiety
- poly pharmacy
Poly-pharmacy
- taking too many medications
- certain medications limit absorption
Oral health depends on and determines?
Depends on: - GI secretions - Skeletal systems - mucus membrane - muscles - taste buds - olfactory nerves Determines what we can eat
Strategies to promote food intake in older adults:
- maintain focus on eating
- provide plenty of time to eat
- serve favourite foods
- encourage regular drinks between bites
As adults get older milk and alternatives ____, fruits, veggies, and grains ____ and meat and alternatives ____
increases; decreases; remains the same
Nutrition concerns for older adults
- poor intake of all four food groups
- variety of nutrients consumed at low levels (vitamin C, D, folate, B6, B12, calcium, magnesium, and zinc)
- protein and energy also low
Osteoporosis
Porous bone
- results from decreased bone mass and disruption of bone architecture
Osteoporosis ___ in women than in men
higher
- mostly due to hormonal changes
- decrease in estrogen for women
- men testosterone tapers more slowly
Osteoporosis symptoms
Osteoporosis has no symptoms
Of older people who break a hip:
- 10 to 20% die within a year
- 50% have permanent disabilities
Kyphosis
shrinking height
- results from compression or bone fracture in spine
Nutritional remedies for osteoporosis
- increase calcium and vitamin D through diet or supplements
- don’t take calcium with antacids
- consume foods rich in vitamins C, D, B6 and K
Promise of Prevention and Health Promotion:
- good nutrition habits make a greater impact when started early in life
- never too old to practice health promotion strategies
Infant mortality includes
deaths that occur within first year of life
Which of the following statements best describes motor development in infants?
a. Voluntary control of muscles starts from head and moves down legs
b. Voluntary control of muscles starts from being able to fan toes out at birth to blinking eyes in response to loud noise or light
c. Voluntary muscle control develops with central muscles first and then moves out to hand muscles
d. Voluntary muscle control develops with rooting reflex and then moves out to hand muscles
e. a and c
e. a and c
Which of the following is a warning sign indicating growth problems in infants
a. Plateau in head circumference gain for more than one month
b. Lack of height gain
c. Plateau in gain for more than one month
d. Drop in weight without regain within a few weeks
e. All of the above
e. All of the above
Infants need a high fat diet compared to older people; therefore up to _____ of calories from fat may be recommended?
a. 25%
b. 32%
c. 40%
d. 55%
e. 60%
d. 55%
The 2006 WHO growth charts are based on longitudinal and cross sectional data of ________________.
a. Preterm and full term infants
b. Low birth weight and normal birth weight infants
c. Exclusively or predominantly breastfed infants
d. Formula fed infants
e. Infants fed equal amounts of formula and breast milk
c. Exclusively or predominantly breastfed infants
BMI in the 90th percentile would indicate that a 3 year old was:
a. Underweight
b. Normal weight
c. Overweight
d. At risk of overweight
e. Obese
c. overweight
Potential consequences of a weight loss program in childhood are slowed linear growth and the beginnings of an eating disorder
a. True
b. False
True
At daycare a small chocolate candy bar was given only to three year olds who ate everything at mealtime. Choose the best description of the feeding relationship problem between daycare center staff and 3 year olds:
a. Inappropriate portion sizes for toddlers
b. Served severely restricted junk foods
c. Inappropriately used coercion to control food intake
d. Taught children to like sweets
c. Inappropriately used coercion to control food intake
Preadolescence is generally defined as ages:
a. 5-10 for girls/7-9 for boys
b. 7 to 9 for girls/9 to 11 for boys
c. 9 to 11 for girls/10-12 for boys
d. 10-12 for girls/11 to 13 for boys
e. 11 to 13 for girls/12 to 14 for boys
c. 9 to 11 for girls/10-12 for boys
What are the proposed mechanisms by which television viewing contributes to obesity?
a. Reduced energy expenditure
b. More commercials advertising appropriate foods
c. Increased intake while watching television
d. All of the above
e. a and c only
e. a and c only
The most significant predictor of childhood obesity has been found to be:
a. Low family income
b. Food insecurity
c. Parental obesity
d. Lower cognitive simulation
e. Use of formula instead of breastfeeding
c. Parental obesity
The struggle for independence that characterizes adolescent psychosocial development may lead to development of health compromising eating behaviours, including:
a. Excessive dieting
b. Meal skipping
c. Use of unconventional nutritional supplements
d. Adoption of fad diets
e. All of the above
e. All of the above
Health advantages for an adolescent consuming a vegetarian diet include:
a. High intake of fiber
b. High intakes of B vitamins, especially B12
c. High intakes of vitamins and minerals found in plant foods
d. All of the above
e. a and c only
e. a and c only
During peak weight gain, adolescent males gain an average of ___ lb./year.
a. 10
b. 20
c. 30
d. 40
b. 20
Susan is a 15 year old who likes fruits some vegetables and breads but refuses to consume milk, seafood and eggs. A recent doctor visit revealed normal hemoglobin and plasma ferritin levels…what would you advise?
a. A folate supplement (400mg/day)
b. A vitamin D supplement (400 IU/day)
c. An iron supplement (10mg/day)
d. No changes in nutrient intake
b. A vitamin D supplement (400 IU/day)
Men and women continue to develop bone density until 40 years of age
a. True
b. False
b. False
Among adults, the AMDR for total fat intake is ____ of calories.
a. 10-15%
b. 15-20%
c. 20-35%
d. 35-40%
e. 40-50%
c. 20 to 35%
Which type of fiber is helpful in decreasing absorption of cholesterol?
a. Oatmeal
b. Viscous fiber
i. Soluble
c. Fermentable fiber
i. Insoluble
d. Potato skin
e. a and b
e. a and b
In older adults, BMI is an adequate indicator of excess body fat associated with morbidity and mortality.
a. True
b. False
b. False
