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Community health > Nutrition for Infants, Children and Adolescents > Flashcards

Nutrition for Infants, Children and Adolescents Flashcards

1
Q

Why is Nutrition Important?

A
  • Provides energy for daily living
  • For maintenance of all body functions
  • Vital to growth and development
  • Therapeutic benefits
  • Healing
  • Prevention of illness
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2
Q

How do infants grow during the first year with respect to their body and brain?

A
  • Weight increases 200%
  • Body length increases 55%
  • Head circumference increases 40%
  • Brain weight doubles
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3
Q

What are the options in feeding the newborn?

A
  • Breastfeeding - Exclusive is recommended for 6 months
  • Formula feeding
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4
Q

What are the breastfeeding advantages to Infants

A
  • Immunologic benefits
  • Decreased incidence of ear infections, UTI, gastroenteritis, respiratory illnesses and bacteremia
  • Convenient and ready to eat
  • Reduced chance of overfeeding
  • Fosters mother- infant bonding
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5
Q

Breast feeding advantages to Mothers

A
  • May delay return of ovulation
  • Loss of pregnancy- associated adipose tissue and weight gain
  • Suppresses post-partum bleeding
  • Decreased breast cancer rate
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6
Q

Effects of poor nutrition on cognitive function

A
  • Decreased brain growth and or CNS development
  • Poor performance on measures of cognitive ability
  • Malnourished children are unprepared to benefit from age-appropriated educational experiences.
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7
Q

Give the definitions of complementary foods

A
  1. Any energy-containing foods that displace breastfeeding and reduce intake of breast milk.
  2. Any nutrient containing foods or liquids other than breastmilk given to young children during the periods of complementary feeding…[when] other foods or liquids are provided along with breastmilk. (WHO)
  3. Any foods or liquids other than human milk or formula that are fed during the first 12 months of life.
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8
Q

What forms the basis of feeding transitions and complimentary foods?

A

Growth, nutritional and developmental factors form the basis.

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9
Q

What are the assumptions associated with introducing complementary foods?
What are the key factors?

A

It presupposes the ability of the infant to be nourished by, safely ingest and accept such foods.

The key factors - Digestion and absorption, neuromuscular development, taste and texture acceptance.

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10
Q

When is growth faltering observed?
When does the WHO/CDC deceleration in weight/length occur?

A

Growth faltering - Between 3-6 months

WHO/CDC deceleration in weight/length 3-12 months in breast fed infants.

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11
Q

What should complementary foods contain?

A

They should contain energy, iron and zinc.

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12
Q

What is the weaning dilemma and when was it first described?

A

It was described in 1970-80 in developing countries.

Risk of infection with introduction of contaminated complementary food vs. suboptimal growth with exclusive breast feeding.

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13
Q

What percentage of children/adolescents are overweight?

How has this increased over the last 20-30 years and why?

A

> 20%

This has increased by 50-100% over the last 20-30 years due to more sedentary lifestyle and behavior (TV/Video games)

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14
Q

Which race is seeing more obese adolescents and children?

A

Prevalence increasing rapidly among African American race.

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15
Q

How are obesity and diabetes related statistically?

A

Reports indicate 8-45% of newly diagnosed pediatric patients with diabetes are diagnosed with type 2.

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16
Q

What are the health consequences associated with obesity?

A
  • Cardiovascular disease risk
  • Type 2 diabetes (epidemic)
  • Hypertension
  • Orthopedic problems
  • Sleep apnea
  • Gall Bladder disease/ steatohepatitis
  • Psychosocial problems
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17
Q

Etiology of Pediatric Obesity

A
  • Genetic predisposition: 80% risk if both parents obese
  • Environment
  • Dietary intake
  • Physical activity / Sedentary activity
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18
Q

Treatment of Pediatric Obesity

A
  • Multidisciplinary and Comprehensive
  • Formal behavior modification
  • Family based
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19
Q

Prevention of Cardiovascular disease

A
  • Cholesterol levels track ( Childhood cholesterol levels associated with degree of early atherosclerotic changes)
  • Behavior tracking
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20
Q

What are the clinical signs in the hair of nutritional deficiency - what nutrients are deficient?

A
  • Spare &thin - Protein, Zinc, Biotin Deficiency
  • Easy to pull out - Protein deficiency
  • Corkscrew coiled hair - Vit C & Vit A deficiency
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21
Q

What are the clinical signs in the mouth of nutritional deficiency - what nutrients are deficient?

A
  • Glossitis - Riboflavin, Niacin, Folic acid, B12, Protein
  • Bleeding & Spongy gums - Vit. C, A, K Folic acid & Niacin
  • Angular stomatitis, Cheilosis & Fissured tongue - B2, 6 & Niacin
  • Leukoplakia - Vit A, B12, B-complex, Folic acid & Niacin
  • Sore moth and tongue - Vit B12, 6, C, Niacin, Folic acid & Iron
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22
Q

What are the clinical signs in the eye of nutritional deficiency - what nutrients are deficient?

A
  • Night blindness, Exophthalmos - Vit. A deficiency
  • Photophobia - blurring, conjunctival inflammation - Vit. B2 & Vit A deficiencies.
23
Q

What are the clinical signs in the nails of nutritional deficiency - what nutrients are deficient?

A

_ Spooning - Iron deficiency

  • Transverse lines - Protein deficiency
24
Q

What are the clinical signs in the skin of nutritional deficiency - what nutrients are deficient?

A
  • Pallor - Folic Acid, Iron, B12
  • Follicular hyperkeratosis – Vitamin B & Vitamin C
  • Flaking dermatitis - PEM, Vit B2, Vit A, Zinc & Niacin
  • Pigmentation, Desquamation - Niacin & PEM
  • Bruising & Purpura - Vit K, Vit C & Folic Acid
25
Q

What is the Clinical sign of iodine deficiency in mountainous areas and far from sea places?

A

Goiter

26
Q

What do signs in the joint and bones help detect?

A

They help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (scurvy).

27
Q

What is anthropometry?

A

It is the measurement of body height, weight and proportions.

28
Q

What is anthropometry essential for and used for?

A

It is an essential component of clinical examination of infants, children & pregnant women.

Used to evaluate both under & over nutrition. Measured values reflect the current nutritional status & don’t differentiate between acute and chronic stages.

29
Q

What are the other anthropometric measurements?

A
  • MUAC
  • Skin fold thickness
  • Head circumference
  • Head/chest ratio
  • Hip/waist ratio
30
Q

What is the importance of anthropometric measurement in children?

A

Accurate measurement of weight and height can be used to evaluate the physical growth of the child.

31
Q

How is growth monitoring carried out?

A

The data are plotted on growth charts over a period of time that is enough to calculate growth velocity, which can be compared to international standards.

32
Q

How is height measured in adults?

A

The subject stands erect & bare footed on a stadiometer with movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5cm.

33
Q

How is weight measured?

A
  • A regularly calibrated electronic or balanced-beam scale should be used - spring scales are less reliable.
  • eight measured in light clothes, no shoes and read to the nearest 100 g(0.1kg)
34
Q

International standard for assessing body size in adults?

A

Body mass index (BMI)

35
Q

How is BMI computed?

A

Weight (kg) / Height (m2)

36
Q

What is a high BMI (obesity level) associated with?

A

It is associated with type 2 diabetes and high risk for cardiovascular morbidity and mortality.

37
Q

Give the WHO classification for BMI

A
  • <18.5 - Under weight
  • 18.5 - 24.5 - Healthy weight range
  • 25-30 - Overweight (Grade 1 obesity)
  • > 30-40 - Obese (Grade 2 obesity)
    40 - Very obese (Morbid or Grade 3 obesity)
38
Q

How is the waist/hip ratio calculated?

A

Waist circumference measured at the level of the umbilicus to the nearest 0.5cm

  • Subject stands erect with relaxed abdominal muscles, arms at the side, and feet together.
  • Measurement should be taken at the end of normal expiration.
39
Q

What is the use of waist circumference?

A
  • It predicts mortality better than any other anthropometric measurement.
  • It’s been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified.
40
Q

Give the two levels of risk associated with waist circumference and obesity.

A

Level 1 - Male: >94cm, Female >80cm

Level 2 - Male: >102cm, Female >88cm

41
Q

What do the levels in Waist circumference/2 signify?

A
  • Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain.
  • Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes and CVS complications.
42
Q

How is hip circumference measured?

A

It is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5cm.

  • The subject should be standing and the measurer should squat beside him.
  • Both measurement should be taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue.
43
Q

How to interpret the Waist/Hip ratio

A
  • High risk WHR= > 0.80 for females & >0.95 for males
  • i.e. waist measurement >80% of hip measurement for women and >95% for men.
  • indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders.
  • A Waist/Hip ratio below these cut off levels is considered low risk.
44
Q

Advantages of anthropometry

A
  • Objective with high specificity and sensitivity
  • Measures many variables of nutritional significance (Ht, Wt, MUAC, HC, Skin fold thickness, waist & hip ratio, BMI).
  • Readings are numerical & gradable on standard growth charts
  • Readings are reproducible
  • Non-expensive and need minimal training.
45
Q

Limitations of anthropometry

A
  • Inter-observers errors in measurement
  • Limited nutritional diagnosis
  • Problems with reference standards, i.e. local versus international standards
  • Arbitrary statistical cut-off levels for what considered as abnormal values.
46
Q

How is dietary assessment carried out (methods)?

A
  1. 24 hour dietary recall
  2. Food frequency questionnaire
  3. Dietary history since early life
  4. Food diary technique
  5. Observed food consumption
47
Q

How is 24hour dietary recall carried out?

A
  • A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours.
  • It is quick, easy & depends on short term memory, but may not be truly representative of the person’s usual intake.
48
Q

How is the food questionnaire method carried out? Advantages?

A
  • The subject is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, week & per month.
    Adv - Inexpensive, more representative & easy to use.
49
Q

What are the limitations of the food questionnaire?

A
  1. Long questionnaire
  2. Errors with estimating serving size
  3. Needs updating with new commercial food products to keep pace with changing dietary habits
50
Q

What is dietary history, how should it be collected and what details are important?

(Note that it’s important to cross check data)

A
  • It is an accurate method for assessing the nutritional status.
  • Information should be collected by a trained interviewer, and should include details about usual intake, types, amount, frequency & timing.
51
Q

What should be recorded in a food diary?
What is the length of collection period?
Disadvantage?

A
  1. Food intake (types & amounts) recorded by the subject at the time of consumption.
  2. Length of collection period - 1-7 days
  3. Reliable but difficult to maintain
52
Q

How does observed food consumption compare to the other methods of dietary assessment?

A

It is the most unused method in clinical practice, but recommended for research purposes.

53
Q

How is observed food consumption method carried out?
Advantages and disadvantages?

A

The meal eaten by the individual is weighed and contents are exactly calculated.

Adv - High degree of accuracy
Disadv. Expensive, needs time and effort

Community health (19 decks)

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