Nutrition Flashcards
What are various requirements for protein, fat, and carbohydrates?
What are various requirements for protein, fat, and carbohydrates?
Why should whole cow milk not be introduced until 1 year of age?
It is associated with iron deficiency anemia because of its low iron content and occult intestinal blood loss, which occurs in 40% of normal young infants being fed cow milk. Early use of whole milk may contribute to weight acceleration and the development of overweight/obesity
Why is honey not recommended for infants during the first year of life?
Honey has been associated with infantile botulism as have some commercial corn syrups. Clostridium botulinum spores contaminate the honey and are ingested. In infants, intestinal colonization and multiplication of the organism may result in toxin production and lead to symptoms of constipation, listlessness, and weakness
How is nutritional status objectively assessed in children?
- Growth chart: Anthropometric data give an estimate of the height, weight, and head circumference of a child compared with a population standard. A change in the child’s percentile months may signify the presence of a nutritional problem or systemic disease.
- Compare actual with ideal body weight (average weight for height age): The ideal body weight is determined by plotting the child’s height on the 50th percentile and recording the corresponding age. The 50th percentile weight for that age is obtained, and this ideal body weight is divided by the actual weight. The result is expressed as a percentage—the percent ideal body weight—that gives a better stratification of patients with significant malnutrition. An ideal body weight percentage of more than 120% is obese, 110% to 120% is overweight, 90% to 110% is normal, 80% to 90% is mild wasting, 70% to 80% is moderate wasting, and less than 70% is severe wasting.
- Measurement of midarm circumference: This provides information about the subcutaneous fat stores, and the midarm-muscle circumference (calculated from the triceps skinfold thickness) estimates the somatic protein or muscle mass.
- Laboratory assessment: Vitamin and mineral status can be directly assayed. Measurements of albumin (half-life, 14 to 20 days), transferrin (half-life, 8 to 10 days), and prealbumin (half-life, 2 to 3 days) can provide information about protein synthesis, but each may be affected by certain diseases. The ratio of albumin to globulin may decrease in patients with protein malnutrition.
How do marasmus and kwashiorkor differ clinically?
- Kwashiorkor is edematous malnutrition as a result of low serum oncotic pressure. The low serum proteins result from a disproportionately low protein intake compared with the overall caloric intake. These children appear replete or fat, but they have dependent edema, hyperkeratosis, and atrophic hair and skin. They generally have severe anorexia, diarrhea, and frequent infections, and they may have cardiac failure.
- Marasmus is severe nonedematous malnutrition caused by a mixed deficiency of both protein and calories. Serum protein and albumin levels are usually normal, but there is a marked decrease in muscle mass and adipose tissue. Signs are similar to those noted in hypothyroid children, with cold intolerance, listlessness, thin sparse hair, dry skin with decreased turgor, and hypotonia. Diarrhea, anorexia, vomiting, and recurrent infections may be noted.
What vitamins and minerals are often deficient in strict vegans and some vegetarians?
Vitamin B 12 , iron, calcium, and zinc . The groups most at risk are infants, children, and pregnant and lactating women. Semivegetarian diets rarely lead to such deficiencies.
What two factors make vitamin D deficiency such a common problem?
Changes in sun exposure/use of sunscreen and increases in obesity. Very few foods naturally contain vitamin D or are fortified with vitamin D. Exceptions are cod liver, tuna, fortified milk, and orange juice. The major source of vitamin D has been exposure to natural sunlight. If an individual wears a sunscreen with a protection factor of 30 or more, vitamin synthesis in the skin is reduced by > 95%. If an individual has darker skin, which provides more natural sun protection, he or she requires 3 to 5 times longer exposure to make the same amount of vitamin D as a person with a white skin tone. Obesity is also a risk factor, because fat sequesters vitamin D. As sun exposure is reduced because of concerns about potential future malignancies and as obesity rates remain high, vitamin D deficiency is likely to remain a problem.
How much vitamin D should children receive on a daily basis?
Infants (
What are the weight status categories for children in terms of body mass index (BMI) percentile?
• Underweight:
What screening laboratory tests should be done for obese children?
- Liver function tests (AST and ALT): to assess possible NAFLD
- Fasting lipid profile : elevated triglycerides and reduced HDL is highly suggestive of significant insulin resistance
- CBC : iron deficiency and iron deficiency anemia are common in obese children
- Fasting glucose : sensitivity, however, is low to detect glucose intolerance. A standard oral glucose tolerance test should be considered for severe obesity, positive family history of type 2 diabetes or when acanthosis nigricans is present.
- Vitamin D level : deficiency is common in obese children.
- Thyroid function tests
What are the different types of cholesterol?
Triglycerides: the major form of fat in the body
LDL: low density lipoprotein; the “bad” cholesterol; formed from VLDL or chylomicrons; saturated and trans fats increase LDL; major carrier of cholesterol into the body tissues
HDL: high density lipoprotein; “good” cholesterol; synthesized in the liver and gut; major carrier of cholesterol away from the body tissues
VLDL: very low density lipoprotein; made by the liver; high in triglycerides
Chylomicrons: transports dietary fat from intestines to liver and adipose tissues; high in triglycerides
Non-HDL (total cholesterol – HDL): can be used if a nonfasting lipid profile is obtained or if triglycerides are > 400
Why is the promotion of cardiovascular health and the identification of specific risk factors important in pediatric medicine?
- Atherosclerotic changes originate in childhood.
- Risk factors for the development of atherosclerosis can be identified in childhood.
- The progression of atherosclerosis relates to the number and intensity of these risk factors.
- Risk factors track from childhood to adult years.
- Interventions exist for the management of identified risk factors.
What is the most common hyperlipidemia in childhood?
Familial hypercholesterolemia, type IIA, with elevated cholesterol and LDL. This condition results from a lack of functional LDL receptors on cell membranes as a result of various mutations. When LDL cannot attach and release cholesterol to the cell, feedback suppression of hydroxymethylglutaryl coenzyme A reductase (the rate-limiting enzyme of cholesterol synthesis) does not occur, and cholesterol synthesis continues excessively. In the homozygous form of type IIa, xanthomas may appear before the age of 10 years and vascular disease before the age of 20 years. However, the homozygous form is very rare, with an incidence of 1 in 1,000,000 births. The heterozygous variety has a much higher incidence of 1 in 500, but it is less likely to produce clinical manifestations in children.
