Lecture 24 Flashcards
3x Nutritional Requirements that infancy is influenced by
- Growth
- Organs have a functional capacity that differs from adults
- when baby’s born most of their organ systems are immature (how and what can feed) - Metabolic activities - the ratio of surface area to weight or height decreases with age
- metabolic activities much more closely related to SA
- baby/infancy drugs prescribed more using Body SA> rather than by kg/weight
- baby’s also more at risk of dehydration
Graph of a Time of Rapid growth
- 9months - 2 years (22 gram per day) (increases significantly then starts to drop of)
- highest growth outside of utero, is in first 5 months of life
- dont grow as fast again until pre-pubertal/pubertal growth spurt
- change in rapid growth rate reflects nutritional requirements
Values re A time of rapid growth
First year:
Weight increases 300%
Length increases 55%
Head circumference increases 40%
Brain weight doubles (2x)
-80% of brain growth occurs by 2years old
-95% of brain growth occurs by 5 years old
-re Nutrition: if you dont get correct/optimal nutrition in early years, can lead to damaging and irreversible effects that can last a life time
Early growth and Nutritional status impact on later life
Nutritional status in utero and early life, can dictate growth trajectory for rest of life + risk of certain diseases
Early life programming/nutrition- premised on Barker hypothesis:
-early life programming and interaction with nutrition and interaction with genes, interact to form Epigenetics - which imprints and make a mark for your life time (how we are set up in early life dictates whether have a healthy life or we get diseases)
-found strong J shaped association with birth weights and risk of death from CDV
-smaller and large gestational age baby (as J shaped) = higher risk of dying of CVD late in life
-hypothesis: tested in animal studies and cohort studies. has been demonstrated to hold through
-Public health campaigns to ensure that maternal and early life nutrition in optimised in populations
Barker hypothesis
Early life programming/nutrition- premised on Barker hypothesis:
- early life programming and interaction with nutrition and interaction with genes, interact to form Epigenetics - which imprints and make a mark for your life time (how we are set up in early life dictates whether have a healthy life or we get diseases)
- Birth record in UK
- David parker reviewed birth records of patients who have died from CVD disease, tracking back to birth
- found strong J shaped association with birth weights and risk of death from CDV
- smaller and large gestational age baby (as J shaped) = higher risk of dying of CVD late in life
- hypothesis: tested in animal studies and cohort studies. has been demonstrated to hold through
- Public health campaigns to ensure that maternal and early life nutrition in optimised in populations
Daily Energy (estimated) and Protein RDI
av Infant: -alot more energy + double protein (growing so rapidly and organs developing so rapidly) -Energy 2000kJ. 454kJ/Kg -Protein 10.4g. 2.2g/kg av Adult: -Energy 11000kJ. 172kJ/Kg -Protein 64g. 1.0g/kg
Feeding the Newbown
- Breast feeding
- MoH NZ, WHO exclusive breast feeding for 6 months
- biological fluid that could never have mimiced functionally - Formula feeding
Percentage of Growing up babies being exclusively breast fed
Antenatally 68% of mothers described their ideal duration of breast feeding as longer than 6 months
- 96% of Nz babies when born are successfully breast fed
- good until first month 82% exclusively breast fed
- 63% at 3 months
- 6% at 6 months
Reasons for babies not being exclusively breast fed 100% until 6 months of age
- Woman have to return to work- babies go to day care. Economic constraints on woman.
Which Countries with most successful rates of best exclusive breast feeding rates for the longest duration of breast feeding?
Nordic countries - Sweden
-Mothers paid parental leave for 12 months
(Nz has 17-19 weeks paid parental leave - less support for woman)
Breast Milk Energy macronutrient content
1. Breast milk: Protein 6% -allows sustained (brain) growth (long time as a baby> vs puppy) Fat 55% -baby stomach smaller than fist, small volume able to consume, therefore milk needs to be high in fat to have optimal energy density Carb 39% 2. Recommended adult diets: Protein 15-25% Fat 20-35% Carb 45-65%
Breast milk features
- Variable composition throughout lactation and during a single feed (biological fluid)
-formilk: high in water (quenches thirst). hind milk: high in fat (to satisfy hunger)
-first born: baby is colostrum sticky yellow substance, high in immunoglobulins (provides baby with immunity)
-mature milk: high in protein - Protein content- Whey:casein ratio
- Early 20:80
-Mature 50:50 (equal)
a-lactoalbumin (predominantly) - Fat content: Provides 50% of energy
-LCPUFA Long chain poly-unsaturated Fatty Acids
-arachiodonic acid
-docosohexaenoic
-adults can convert essential fatty acids to these LCPUFA, but infants have immature enzyme systems, so can convert essential fatty acids as efficiently - Higher bioavailability (iron, calcium, protein)
- Biologically active proteins: Ig Immunoglobulins, enzymes, cytokines and growth factors
-help to mature GI tract - Low risk of infection (breast milk confers passive immunity)
Infant Formula features
- Constant composition (static fluid)
- Protein content- whey:casein ratio
- 18:82 - 60:40
- a-lactoglobulin
- 50% more protein - Fat content: mixture of fatty acids different
- Lower Bioavailability (iron, calcium, protein)
- Biologically active components cannot be reproduced
- Increased risk of contamination of infection
Comparing composition of breast milk and instant formula
- Breast milk:
Variable composition throughout lactation and during a single feed (biological fluid)
-foremilk: high in water (quenches thirst). hind milk: high in fat (to satisfy hunger)
-first born: baby is colostrum sticky yellow substance, high in immunoglobulins (provides baby with immunity)
-mature milk: high in protein - Infant formula: Constant composition (static fluid)
Comparing protein content of breast milk and instant formula
- Breast milk:
- Whey:casein ratio
- Early 20:80
-Mature 50:50 (equal)
a-lactoalbumin (predominantly) - Instant formula:
whey:casein ratio
-18:82 - 60:40
-a-lactoglobulin
-50% more protein
Comparing fat content of breast milk and instant formula
1. Breast milk: Provides 50% of energy -LCPUFA Long chain poly-unsaturated Fatty Acids -arachiodonic acid -docosohexaenoic -adults can convert essential fatty acids to these LCPUFA, but infants have immature enzyme systems, so can convert essential fatty acids as efficiently 2. Instant formula: mixture of fatty acids different
Comparing bioavailability of breast milk and instant formula
- Breast milk: Higher bioavailability (iron, calcium, protein)
- Instant formula: Lower bioavailability (iron, calcium, protein)
Comparing biologically active components of breast milk and instant formula
- Breast milk: Biologically active proteins: Ig Immunoglobulins, enzymes, cytokines and growth factors
- Instant formula:Biologically active proteins cannot be reproduced
Comparing infection risk of breast milk and instant formula
- Breast milk: Low risk of infection (breast milk confers passive immunity)
- Instant formula: Increased risk of contamination
Fluid requirements of Infants
Amounts of Water ml/kg/day 1 week old: 80-100 2 weeks old: 125-150 3 months: 140-160 6 months: 130-155 9 months: 125-145 1 year: 120-135 -when babies are born, have immature kidneys, unable to concentrate urine, therefore: 1. high fluid requirement 2. risk of dehydrations (need to be careful if baby's get temperature need to be monitored and must be given alot of water) (as can get dehydrated quickly)
Renal Solute load
Average Renal Solute Load mOsm/litre
Human milk: 93
-low osmolarity/renal solute load
Milk based formula: 135
Isolated Soy protein based formula: 165
Evaporated milk formula: 260
Whole cow milk: 308
-if baby’s kidneys immature, high requirement for water, feeding baby whole cows milk could cause considerable problems
-hyperneutremic (high Blood Sodium Na) and become dehydrated –> death (high renal solute load conferred on infant)
-began diluting cows milk and adding sugar = infant formula development
-“wet nurse” = breast feed other people’s babies
Digestive factor in Early infancy of Protein compared with adult levels
Protein:
Gastric acid -Lower Production: rapid fall in pH after a meal
-protein in breast milk is very bioavailable (easy to digest and absorb)
Digestive factor in Early infancy of Trypsin compared with adult levels
Low pancreatic enzyme secretion
- Trypsin: Reduced activity
- Chymotrypsin: Low levels
- Intestinal mucosal Peptidases: Adequate
- Pancreatic proteases: Low levels
Digestive factor in Early infancy of Fats compared with adult levels
Fats:
1. Pancreatic lipase: Very low levels
2. Bile acids: low levels
Compensating mechanism: Lingual, gastric and breast milk - BSSL (bile salts stimulated lipase)
-allows lipase in breast milk to be activated and allowed to digest fat of breast milk
Digestive factor in Early infancy of Carbohydrates compared with adult levels
Carbs:
- Salivary amylase: Low levels
- stays active in stomach - Pancreatic amylase: Very low levels
- Breast milk amylase - Disaccharidases: Adequate levels
- fermentation and absorption in large intestine
- alot of carb is malabsorbed in infants and gets into large bowel. here bacteria ferment the carb, and is absorbed (another source of energy)
- infants tend to have loose stools, gasey: because fermenting carb in breast milk
- could also become constipated
Reasons why breast fed babies often have loose stools and are gasey
Breast milk have Disaccharidases in Adequate levels
- fermentation and absorption in large intestine
- alot of carb is malabsorbed in infants and gets into large bowel. here bacteria ferment the carb, and is absorbed (another source of energy)
- infants tend to have loose stools, gasey: because fermenting carb in breast milk
- could also become constipated
Why do we need to eat solid food?
- Nutrient requirements
- breast food nutrients alone insufficient and providing all nutrients - Physical development
- oral motor development (delayed introduction to solid food –> delayed language attainment)
- gastrointestinal maturation (pancreas: increasing pancreatic secreiton) - Social development
- become part of family and start eating with everyone - Antigen exposure
- baby’s born with immature immune system
- breast milk proteins dont tend to give baby and allergic reaction. but when introduced to solid foods and other proteins in diet, can get food allergy, some fatal
- e.g. protein in peanut very allergenic, -need to be aware, especially if allergy within family
- lower risk of becoming allergic to additional proteins, if baby is continued to be breast fed as proteins are being introduced into diet
General requirement to change food sources and forms
Baby grows: begin to hold head up, be able to grab things with hand and bring towards mouth.
-able to move fluid/thicker food around mouth with tongue, form bolus and swallow.
-develops gag reflex, which is important for attainment of good feeding skills
when born baby has good sucking and swallowing skills, but lack gag reflex, therefore unable to form bolus of food)
Progress onto thicker fluid –> pureed food –> soft lumps –> finger foods –> independant feeder
Baby’s and food allergies
- Antigen exposure
- baby’s born with immature immune system
- breast milk proteins dont tend to give baby and allergic reaction. but when introduced to solid foods and other proteins in diet, can get food allergy, some fatal
- e.g. protein in peanut very allergenic, -need to be aware, especially if allergy within family
- lower risk of becoming allergic to additional proteins, if baby is continued to be breast fed as proteins are being introduced into diet
Food and Nutrition Guidlines
0-6 months: Breast Milk (formula) exclusively
12-24 months: Cows Milk/Toddler milk (breast)
6-24 months: Introduce new foods sequentially within first year
Fluid –> thickened fluid (mixed infant formula/baby rice –> pureed apple/pears –> thicker textures/softer lumps –> finger foods
a) changed in last 5 years- previously solids introduction 4-6 months. not soy milk, peanuts, cow milk until 1 year
b) Now: exclusively breast milk until 6 months. Solids in common sense. everything can be introduced by 1 year.
Monitoring Growth and Development
- Growth charts (way of montioring nutritional status by ensuring growth appropriately)
- A number of different growth charts are available
- WHO growth charts/growth standards for NA (centile charts)
What do Centile charts show?
Measuring and Plotting
Weights and lengths of children
-plotted on charts to get distribution of population
-data from 6 countries where infants were exclusively breastfed for 6 months
-tells “how babies grow”/normal distribution of growth across populations
-tragectory of growth over time
91st centile: only 9% of children would be expected be heavier
50th centile: half of all children should be above and half below this line
-some degree of weight loss is common after birth. calculating the percentage weight loss is a useful way to identify babies who need extra support
(acute loss= bug/diarrhoea and vomiting/gone off food. Then regain quickly)
-Compare with height (if height is still 50th percentile, but weight dropped off and not very well, can see that dietary intake has decreased temporarily
-If height also comes down, concerned -something is occurring that is decreasing weight (weight loss) and decreasing height gain
What physically changes markedly over time in children?
The body shape of a one-year-old changes dramatically by age two
-born: dont move much. higher % of body fat: lean body mass. 1/3 head, 1/3 abdomen, 1/3 legs
The two year old has lost much of the baby fat
-the muscles (especially in the back, buttocks and legs) have firmed and strengthened
-and the leg bones have lengthened
-once start moving, increased lean body mass, fat mass decreases
-face hasnt shrunk, just proportionately not so big
Lifetime growth graph
Infancy: 1-2 years; on average, grows 12cm, gains 3.5 kg
Childhood: 4 years. 6-8cm/year. 2-4 kg/year.
-eating is important during preschool years, as growing but is time of developming healthy eating habits and behaviours around food
Pubertal growth spurt - individuals start at different ages. Girls start before boys.
-dont use chronological ages for puberty, instead stage puberty in Tanner stages
Eating for healthy children
4 core food groups used for education
serving sizes different
Preschoolers: from 2 years until 5th birthday
-at least 2 servings of veges and 2 servings of fruit daily
School children: (5-12 years). Atleast 3 servings of vegetables and 2 servings of fruit each da
Childhood nutritional concerns
Childhood obesity
- children being born into environment of excess of energy
- parents are role models
- if you’re over weight as a child, and both parents overweight = 90% likely to be obese as an adult
- if your obese in childhood you’re likely to be obese as an adult
2014/15 NZ Health survey results
Children 2-14 years
Obese:
2014/15 -11
2006/07- 8.5
*significance of difference between years 200607 and 2014/15 P=0.00
-about 25% of Nz children are overweight (or obese)
*significance of difference between years 2006/07 and 2014/15 Maori P=0.003. Pacific P=0.04.
-disparity for specific children - their obesity has increased has risen alarmingly for specific children, (2006-07) 22-23% and 12 % for Maori –> (2014-15) 29-30% and 15% for Maori
-Huge health disparity in health outcome for maori and pacifica in NZ
Body mass index for age oercentiles
Boys and girls 2-20years Overweight= ->95th percentile At risk of overweight= >85th percentile Normal 10th-85th percentile Underweight
Contributing factors to childhood obestiy
Energy density large
Bigger portion sizes
More fast food (consume more food out of home than at home)
Junk food
Sweetened drinks
-try to ban TV ads of unhelathy foods during children TV time
-computer media fast food advertising - hard for govt to regulate
-Large sedentary behaviour (listening, or useing technology)
-less physical activity
–physical environment we live in is not conducive to involuntary activity (walking to school, non-safe playgrounds, streets not safe)
-have to make more deliberate opportunities to play and be physically acitve
Childhood obesity action plan
Pyramid: Peak: Targeted initiatives (govt initiatives: before school checks people are screened for obesity. those children and their families will then be targeted for interventions. GP worried as dont feel like they have the nescesary resources to help/support them) Increased support (support families and children who have risk factors for obesity) Broad population approaches (marketing and advertising to children, public health awareness, small physical activity, school guidelines)
Adolescent growth spurt
nutrition in childhood in prepubertal growth spurt
-difficult to manage puberty nutrition
-children more independant re what they eat/have more purchasing power
-yet nutrition demands/key nutrients in this stage/age that are very important
1. Increased Protein requirement - to increase lean body mass (esp boys)
2. Increased Iron requirements - esp girls esp once starting menstruation
3. Increase Folate requirement - due to increased cell production due to increased growth
4. Increased Calcium requirement- huge amount of bone growth during pre-pubertal and pubertal growth spurt
When growing: Need to maximise Calcium and mineral deposits in bone.
-but adolescence is difficult stage for people to eat healthy (more interested in other activities)
+ other minerals associated with bone growth : Boron and Manganese + activity( which is vitally important for adequate bone growth and bone mineralisation)
-adolescence need to plenty amount of sport and particularly weight bearing activity
-diary products good source of calcium, but dairy product intake decreases significantly during adolescence (fizzy drinks take over)
-important age for nutrition, difficult age to ensure optimal nutrition and health
Bone gain and bone loss
Active growth(0-20 yrs) - peak bone mass (13-30 yrs) - bone loss (35-82 yrs)
-as bone grows during early childhood and adolescence, amount of minerals deposited is like bank saving account. If can continually deposit significant amount of calcium and keep it in there= will ensure good retirement/bones are healthy when go the=rough middle age/retirement
-if dont get enough minerals during this time, and dont attain peak bone mass, then wont have enough calcium to age and retire on = higher risk of Osteoporosis later in life = more likely to fracture/breaks hips when older
-peak bone mass attained 16-18 years
-maximal bone mass formation:
–Girls: 12 years
–Boys: 13 years
Attainment of PBM influenced by dietary calcium intake and weight bearing exercise
Summary
Nutrient requirements are at their greatest in early childhood and adolesence
Types of food need to be appropriate for physiological and physical development - very important in infancy
Dietary requirements need to meet the demands of Growth and development
Children are at risk of developing malnutrition (can have irreversible effects for the rest of their lives)
Food is provided by caregivers/parents (cannot really intervene with a child without involving their family)
Dietary patterns and behaviours are formed in childhood (-therefore important to devleop good food patterns and dietary behaviours early on is really important)
Nutritional status in childhood can impact on health and disease in adulthood
Childhood obesity
Genetic and environmental factors
Growth
Physical health
Psychological development
Obesity and Chronic disease
Early development of Type 2 diabetes Early development of heart disease Atherosclerosis -plaque -fatty streaks
