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nutrition thru life > Infancy, Childhood, Adolescence Nutr. req > Flashcards

Infancy, Childhood, Adolescence Nutr. req Flashcards

1
Q

For infants, children, and adolescents, the energy requirement is based on:

A

energy expenditure + energy for growth/deposition

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2
Q

The energy needed for growth is (more/less) than the energy expenditure (TEE). What is used as an indicator if energy is sufficient?

A

less

growth is good indicator

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3
Q

the energy for growth is needed to: (2)

A

energy DEPOSITED in tissue

energy needed to SYNTHESIZE tissue

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4
Q

How is energy needs calculated for infants 0-2? What does not need to be considered?

A

EER equation
EER = TEE + energy deposition
no difference in gender, no PAL (inactive)

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5
Q

the studies on energy cost of growth for infants were mostly conducted on:

A

preterm recovering babies

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6
Q

What happens to deposition energy needs as age increases in children?

A

DECREASES
only significant in 1st year; decrease to 3%
*until puberty

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7
Q

Why are the first 6 months crucial in terms of nutrition?

A

highest nutrient req per weight!

period of RAPID ORGAN GROWTH - detrimental effects magnified

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8
Q

What is a better detector of faltering growth than growth charts? What does it indicate?

A

growth RATES (height or weight gain per month)

indicate insufficient energy
weight = ACUTE
length = CHRONIC (long term)

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9
Q

How does energy expenditure differ in a newborn vs 1 yr old?

A

same % BMR

newborn: higher GROWTH, thermal stress
1 yr old: higher activity

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10
Q

The BMR of a newborn is primarily for what parts of the body?

A

brain (70%!), heart, liver, kidney

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11
Q

How does energy expenditure compare in a newborn vs adult?

A

newborn have 2x higher expenditure (per body wt)

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12
Q

How does metabolism of organs change after birth?

A

higher O2 consumption, increases as mass of organs increases

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13
Q

Apart from growth needs, what is another major contributor to newborn energy needs?

A

cold exposure -> thermal stress

NON-SHIVERING THERMOGENESIS -> increased metabolic rate!

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14
Q

How is fat composition in newborns different, and what implications does this have?

A

have BROWN ADIPOSE: metabolically active fat capable of thermogenesis -> oxidize fat for energy/heat

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15
Q

How is BAT different from WAT?

A

BAT: highly vascularized, can oxidize fat, present in newborns, innervated, small lipid droplets and lot of mitochondria

WAT: spherical, filled with fat, storage tissue, produce inflammatory cytokines (THFa, mcp1, etc)

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16
Q

How is BAT produced, and how does it function in the body?

A

cold exposure -> symp. NS stimulate more BAT production

NON SHIVERING THERMOGENESIS
mitochondria will make UCP1 (uncoupling protein) -> uncouple e transport chain from ATP -> so instead of making ATP, generated energy dissipate as HEAT

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17
Q

why is nonshivering thermogenesis important in infants?

A

no physical activity, need other method to generate heat and stay warm

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18
Q

How do energy requirements change once kids reach 3-8 years?

A

still EER for TEE + growth;
need to account for PAL
boys need more energy (bigger wt/ht)

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19
Q

The most important contributor to energy needs, _____, depends on what 3 factors?

A

BMR

  1. mass of each metabolically active tissue
  2. % of each metabolically active tissue
  3. contribution of each tissue to energy metabolism
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20
Q

For 3-8 yr olds, the TEE is based on ____ while the energy for growth is based on ____.

A

doubly labelled water studies

rate of weight/protein/fat increase

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21
Q

How is energy needs determined for a faltering child?

A

based on weight/height of NORMAL child

use 50th percentile, or multiply by 1.2-1.5, or 1.5-2

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22
Q

How do energy deposition needs change again in adolescence?

A

increased, due to development of primary + secondary sex characteristics (puberty), heart/muscle/resp systems

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23
Q

What contributes to differences in energy req among adolescents?

A

gender (males need more; females are smaller, more fat, so lower BMR)

different activity levels (highly variable)

different development rates (different timing, magnitude)

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24
Q

What forms the bulk of metabolic active tissue in adolescents and adults, and what is it correlated with?

A

FFM

energy expenditure

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25
Q

growth during adolescence is generally (fast/slow), except during:

A

slow

growth spurt

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26
Q

What is the basis of carb req for babies 0-6months? What about 7-12 months?

A

amount in human milk (x amount consumed)

older babies: milk + median intake from complementary foods

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27
Q

higher intakes of sugar may result in lower intake of ____. this is known as the _____ effect.

A

micronutrients (vit, minerals)

nutrient dilution effect

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28
Q

At what age does carb requirement become the same as adults? What is this based on?

A

1 yr

based on requirement for brain (RDA)

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29
Q

What is the differences in fibre recommendations for each age group?

A

same AI calculation: 14g/1000kcal

higher energy needs -> more fibre

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30
Q

Protein req for infants is based on:

A

content and volume of human milk

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31
Q

How does protein intake of formula fed babies compare to breastfed, and what implications does this have?

A

higher protein
more protein -> more rapid wt/length gain, more adiposity
more IGF1 (Promote growth)

32
Q

What is the “early protein hypothesis?”

A

early high protein -> increase risk of later obesity & related problems

because of high amounts of insulin releasing AA; more IGF1, insulin

33
Q

What is the method for estimating protein requirement for children, and when can this start to be used?

A

RDA - use factorial method

can start in late infancy (7-12 month)

34
Q

the protein factorial method includes:

A
  1. maintenence requirement (mean)
  2. rate of protein deposition (mean)
  3. efficiency in using for growth (x1.72)
35
Q

fat requirements for infants:

A

AI based on milk

31g <6 months, 30g 7-12 month

36
Q

fat requirements for children/adults:

A

no RDA/AI - follow AMDR

less than 3 years: 30-40%
8+ years: <35%

37
Q

Do most young kids get sufficient fat in the diet?

A

yes; but 47% of 1-3 year olds consume less than 30% fat

38
Q

How does omega 6 in the diet change once weaning begins?

A

% in diet decreases slightly from 8% -> 6% (total amount increases)

39
Q

omega 3 is very important for infants for what reasons?

A

-> DHA (for dev brain, retinas)

40
Q

What is the requirement for PUFAs for children and adolescents based on?

A

median intake in areas of no defiency (AI)

41
Q

the recommended omega 6 to 3 ratio:

A

between 5:1 and 10:1

42
Q

Why do males have higher AI for PUFAs?

A

oxidized for energy; males have higher energy req

43
Q

How is the water requirement for infants determined?

A

water in milk, volume drank per day (+ foods after 6 months)

rounded up

44
Q

What is the water recommendation for kids & adolescents, and why?

A

AI
median intake
cannot establish amount for ALL, since too much variability in activity, environment, etc

45
Q

Na and Cl for infants is based on:

A

mean intake from milk (+ food after 6 months)

46
Q

When are the kidneys considered to be functioning at adult capacity?

A

12 months

47
Q

What is the AI for Na and Cl for kids based on? Do kids tend to have a high or low intake?

A

meeting OTHER nutritional needs; more food -> more Na consumed

extrapolated from adult data (Na vs total energy intake)

kids have HIGH intake; need more energy -> more Na since more food

48
Q

What is K for infants based on? What about for kids/adolescents?

A

amount in milk (+ food after 6 months)

extrapolated, same as Na

49
Q

why is it important to have sufficient K in childhood?

A

citrate for bicarb buffer
counteract effects of Na -> natriuretic, promote Na excretion

(not enough K -> Na + water enter cell -> artery pressure -> HTN; deficiency accumulate over time!)

50
Q

Why is K (or Na) req not based on weight for children?

A

risk of underestimation; kids have higher energy per weight needs than adults

51
Q

How are most vitamins and mineral requirements determined for children?

A

extrapolate from adult data
(account for faster metabolism and growth)
Adult RDA x (1+ growth factor) x (kid wt/adult wt)^0.75

52
Q

how does the “growth factor” for vitamin calculation change through childhood?

A

decrease
female reach 0 by age 13
male reach 0 after 18

53
Q

Infants who are breastfed should receive supplements of _____

A

vitamin D (400 IU)

54
Q

What are the vit D recommendations for children?

A

same as adults (600IU)

to maintain normal Ca metabolism, bone health

55
Q

A newborn is very susceptible to vitamin ___ deficiency. Why, and what can this lead to?

A

vitamin K
poorly transported across placenta
low [clotting factors] -> bleeding risk (HEMORRHAGIC DISEASE OF THE NEWBORN)

56
Q

In the weeks following birth, why would a infant still be at high bleeding risk, and what can this cause?

A

almost no vit K in milk -> further deficiency

late hemorrhagic disease of the newborn (3-8 wks)

57
Q

List in order of increasing vitamin K: cow milk, formula, human milk

A

human milk < cow milk < formula

58
Q

How can we prevent hemorrhagic disease of the newborn?

A 
give vit K shot at birth
or orally (but need higher dose)
59
Q

What is the vitamin K req for infants based on?

A

amount in milk (accounting for supplement at birth!)

60
Q

How does vitamin K recommendation change once weaning starts?

A

higher amount; extrapolated from infant amount

no data on foods

61
Q

Vitamin K deficiency is very (common/rare) in kids. How does it occur?

A

malabsorption

drug interaction

62
Q

Good vitamin status is associated with good ______ in prepubertal children. Why?

A

bone mass
reduced vitamin K -> COFACTOR for gamma-glutamyl carboxylase
modify glutamate residues in vitamin K dependent proteins -> binding of OSTEOCALCIN to hydroxyapatite for bone!

63
Q

VKD proteins are essential for:

A

coagulation

bone synthesis

64
Q

A drug that affects metabolism of vit K is ____, which is a blood ____. How does it work?

A

warfarin
thinner
inhibit vit K epoxide reductase
-> cannot reduce oxidized vit K -> inactive vit K can’t be reused in cycle (no more clotting)

65
Q

The 3 ways of calculating Ca needs for adolescents:

A
  1. factorial approach
  2. retention to meet PEAK BONE ACCRETION (like infants)
  3. clinical trials (measure BMC in response to Ca intake)
66
Q

Ca for kids is based on:

A

accretion

account for retention rate of only 20%

67
Q

are current adolescents getting enough Ca?

A

NO!

girls are even lower than boys for recommendation; both well below

68
Q

The most common nutrition deficiency in the world is:

A

iron deficiency

69
Q

How are recomendations for young infants changed once they reach 7 months?

A

0-6 month: based on milk
7-12 month: factorial approach
*median total Fe deposition (Hb, storage, nonstorage)
account for losses, bioavailability (10%), intake from food

70
Q

Why is the bioavailability factor of iron lower for infants?

A

non-meat sources, lower bioavailability

71
Q

what are the factors considered for iron needs in children?

A
  1. basal losses (fecal, urinary, dermal)
  2. Hb mass increase
  3. storage Fe increase
  4. nonstorage Fe increase
    * account for bioavailability (10% nonmeat, 18% omnivore)
72
Q

What changes in the Iron factorial considerations once adolescence is reached?

A

Fe storage is full; don’t need to account for deposition in stores anymore

73
Q

What changes in adolescence cause an increase in iron needs?

A

weight gain -> more Fe needed (tissue nonstorage Fe)

menstruation begins -> girls need more!

74
Q

How was the RDA for Iodine set for kids?

A

based on median intake of REHABILITATED malnourished children

75
Q

fluoride can come from ____ or ____, and has what benefits?

A

food or water

protect against dental caries

76
Q

what are the negative effects fluoride could cause?

A

high intake before adult teeth erupt -> ENAMEL FLUOROSIS (white patches)
more severe: brown mottled teeth

extreme chronic amounts -> fluorosis -> calcification, damage bone and joints

nutrition thru life (15 decks)

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