Nutrition Flashcards
What is the continuum of inadequacy in nutrition in children ?
Weight loss
Growth failure (failure to thrive)
Malnutrition
What are the nutritional problems in children?
Failure to thrive Malnutrition Vitamin D deficiency (Rickets) Vitamin A deficiency Obesity
What causes children to have nutritional vulnerability?
Low calorie reserves from protein and fat
High nutritional demand from rapid growth in infancy
Rapid neuronal development
Acute illness or surgery or trauma
What is the body composition of preterm, neonates and infants?
Preterm (90% water, 5% protein)
Term neonate (70% water, 10% protein, 20% fat)
Infant (60% water, 15% protein, 25% fat
What percentage of calorie expense is spent on growth in children?
Infants - up to 30%
Children - up to 5%
What percentage of BMR is spent on brain growth?
At birth - 66%
At one year 50%
What is the normal pattern of weight gain in newborns?
4 months - double BW
1 year - triple BW
What is the normal calorie need of children?
up to 6 months - 115 kcal/kg/day
up to 1 year - 95 kcal/kg/day
up to 10 years - 75 kcal/kg/day
Increase to 150-200 kcal/kg/day to get catch up growth
What is the Barker hypothesis?
FGR and LBW increases risk of CAD, CVD, T2DM, HT in later life
What are the advantages of exclusive breastfeeding?
FOR INFANT
Ideal nutrition concoction for frist 6 months
Improves survival by reducing GIT infections
Reduces necrotising enterocolitis in preterm babies
Increases mother-baby bonding
Reduces risk of NCD in later life
FOR MOTHER
Increases mother-baby bonding
Increases birth spacing
Mothers risk of BCA is reduced
What are the anti-infective properties of breastmilk?
IgA - mucosal protection
Bifidus factor - promotes Lactobacillus growth in GIT
Lysozyme - Bacteriolytic enzyme
Lactoferrin - iron binder and anti E coli
Interferon - antiviral
Macrophages
Lymphocytes
What are the nutritional properties of breast milk?
Protein quality - easily digestible 60/40 whey/casein
Lipid quality - oleic acid for easy digestion
Ca/PO4 = 2/1 - prevents hypocalcemic tetany
Iron - up to 50% bioavailability
PUFA - for retinal development
Low renal solute load (prevents hypernatremic dehydration)
What are the potential complications of breastfeeding?
Difficulty in establishing Cant measure feeds Infection transmission - CMV, HIV, Hep B Breast milk jaundice Can't continue exclusively beyond 6 months Vit K deficient - bleeding in newborn Twins Preterms can't suck Cracked nipples Mother's milk production rate Mother's career restriction and financial implications
What is colostrum?
Feed high in Ig and protein
Produced for first few days
When should breastfeeding be established?
Within 1 hour from birth
Exclusively for 6 months
With solid food for 6 months
Can go up to 18 months age
What is the physiology of breastfeeding?
Rooting, suckling and swallowing
Nipple stimulation leads to PRL from AP and OTC from PP
(Let down reflex)
Why is pure cows milk unsuitable as a formula feed?
Too much protein and electrolytes
Inadequate iron and vitamins A,C,D
Can give after 1 year age
How does Cow’s milk and Infant formula differ from breastmilk?
Same energy
More protein (but Cow’s milk protein)
Cows milk has less carb, formula has more
Cows milk has 40/60 whey/casein
Cows milk has more fat, sodium, calcium, phosphorus
Cows milk has less iron, formula has more
What is failure to thrive?
Suboptimal weight gain in infants and toddlers with weight crossing below 2nd centile that is not constitutional
(AKA growth faltering)
Mild = fall across 2 centile lines
Severe = fall across 3 centile lines
What are the causes of failure to thrive?
ORGANIC 5%
-CP, cleft lip
-CD, CKD, CF, CLD (chronic illness)
-GORD and severe vomiting
-Malabsorption (Coeliac, CF, OJ, NEC, short gut)
-Metabolic (Down, Hypothyroid, storage disorders, TORCH)
-High BMR (thyrotoxicosis, malignancy, HIV, CHD, CKD)
NON ORGANIC 95%
-poverty
-psycho-socio-economic-behaviuoral
-abuse
How is FTT managed?
Non-organic
-Primary care with correction of eating behaviour and nutrition
Organic or severe non-organic (early infancy)
-Admission with active refeeding
-Correct eating behaviour, feeding technique and nutrition
How to clinically evaluate FTT?
Hx -diet with food diary -feeding pattern and technique -symptoms of organic causes -birth and delivery, breastfeeding -family patterns -developmental domains -social issues Ex for organic causes and abuse, anthropometry Ix -FBC with S Ferritin -SCr, BUN, E, ABG, Ca, Po4, S Albumin -LFT, TFT, CRP, UFR, SFR -Karyotype, CXR, sweat test for CF
Which anthropometric measurement allows screening for malnutrition in the community?
MUAC
What are the complications of malnutrition?
Delayed wound healing
Permanent intellectual delays
Worsens prognosis of intercurrent illnesses
What are the methods of supplying nutrition?
Enteral (NG, PEG, FJ)
Parenteral (TPN)
What are the strategies for increasing energy intake?
Diet -3 meals and 2 snacks per day -increase variety -increase energy density -decrease fluid food Behavioural -Meal punctuality -Praise and support good eating habits -Never force feed -Encourage eating
What are the anthropometric measurements for assessing nutrition?
Weight for height - acute malnutrition -3SD
MUAC - <115 mm is severe
Height for age - chronic malnutrition
What are the features of Marasmus?
Severe protein energy malnutrition Weight for height -3SD Wasted and wizened Withdrawn and apathetic No edema
What are the features of Kwashiorkor?
Severe protein energy malnutrition
Late weaning followed by high starch low calorie diet
Triggered by infection
Severe wasting and generalized edema
Almost normal weight from edema
Flaky skin with hyperkeratosis and desquamation
Hepatomegaly
Angular stomatitis
Sparse depigmented hair
Diarhea, hypothermia, bradycardia, hypotension
Low albumin, potassium, glucose, magnesium
How is SAM managed?
Correct hypoglycemia Prevent hypothermia Correct dehydration cautiously Correct electrolytes Treat infections Supply micronutrients Refeeding with small frequent meals low in protein Start with F75 until above -3SD then F100 until above -2SD then BP100 until normal then thriposha
What is the physiology of Vit D?
Low serum calcium PTH Cholecalciferol in skin 25 hydroxy in liver 1,25 hydroxy in kidneys Increases serum calcium (GIT absorbs, urine bone resorbs)
What are the effects of vit D deficiency?
Rickets - failed mineralization of osteoid growing bone
Hypocalcemia (tetany, seizures, stridor)
What are the causes of rickets?
Nutritional (No sunlight, exclusive BF, vegan diet)
Malabsorption (Coeliac, CF, OJ)
Metabolism (CKD, CLD)
Drugs (phenytoin, phenobarbital)
What are the features of rickets?
Craniotabes ping pong skull Rachitic rosary at costochondral junctions Wide wrists and ankles (metaphysis expansion) Harrison sulcus Bow legs FTT short stature Frontal bossing Delayed teeth Hypotonia
How to manage rickets?
Ix - calcium, phosphorous, ALP high, PTH high
Wrist Xray
Mx
Diet change, treat cause, give daily vit D3
Monitor ALP fall
What are the features of Vit A deficiency ?
Fat malabsorption
Night blindness, corneal ulceration, bitot spots, scarring
Risk of measles
What is childhood obesity?
Overweight >91 centile
Obese >98 centile
>3SD
High in developed countries, less active kids
risk higher in low socioeconomic groups
Not relate to food intake compared to normal kids
What are the effective options for maintaining weight?
Diet, exercise, behaviour, drugs, surgery Reduce screen time Increase activity Reduce fat Increase fruits and veggies No sugar Reduce portion size Good food habits Orlistat lipase inhibitor Metformin
What are the complications of obesity?
MSK - SCFE, bow legs, pes planus Neuro - idiopathic high ICP OSA PCOS T2DM HT DL Psychological
