Nutrition/GI Flashcards
What is a prebiotic
Fermentable fibre that stimulates growth and activity of beneficial intestinal microbiota
Inulin, fructo-oligosaccharide (FOS), galacto-oligosaccharide (GOS)
Physiological effects of fibre?
Laxative
- increased fecal bulk
- stool softening
Metabolic
- Lower total and LDL cholesterol levels
- Attenuating postprandial glycemia/insulinemia
- Satiety
Fermentation
- Colonic carbohydrate energy salvage
- Positive microbiota modulation
- Improved intestinal barrier function
- Anti-inflammatory/anti-carcinogenic properties
- Increased colonic Ca absoprtion
- Stimulates colonic Na-dependent fluid absorption
Low fibre diet associated with?
Chronic constipation (but no evidence for treating constipation with fibre)
Energy-dense dietary choices, increased levels of body fat, metabolic syndrome
Risks associated with increasing dietary fibre intake?
Decreased intestinal mineral bioavailability (but NOT supported in vivo studies)
?could impact growth if not taking other nutrients
How to counsel families around dietary fibre
- eating fibre-rich foods ensures a nutrient-rich diet
- eating a varied, high fibre diet confers broad physiological benefits (healthy microbiome, bowel regularity, lower postprandial glycemia, displaces high energy low nutrient foods)
- fresh/frozen fruits/veggies and fresh/dried/canned legumes and whole grains > regined/manufactured foods
- increase fibre gradually to facilitate adaptation
- emphasize importance of fluid intake, water first choice
Recommended fibre intake
Age 1-3: 19g
Age 4-9: 25g
Age 9-13: M 31g, F 26g
Age 14-18: M 38g, F 25g
What is the best way to measure children with neurological impairment?
- weight
- height/length is best but may not be possible to obtain (spasticity, contractures, limited cooperation)
- body segment measurements correlate strongly with height/length but require special skills
Pros/cons of condition-specific growth charts
- result in fewer kids being flagged, but assumes that altered growth is constitutional
- standard growth charts may over-identify kids for further evaluation but reduce risk of missing individuals with potentially modifiable growth impairment
FOR MOST CONDITIONS, USE OF CONDITION-SPECIFIC GROWTH CHARTS DO NOT IMPROVE THE ABILITY TO IDENTIFY KIDS AT RISK (CP is an exception)
CP-specific growth charts - who has increased comorbidities?
GMFCS I-IV and V w/o feeding tubes: wt below 20th centile
GMFCS I/II: wt <5th centile had comorbidity hazard ratio of 2.2
GMFCS III-V: Wt <20th centile had MORTALITY hazard ratio 1.5
Questions to ask around feeding for children with neurological impairment?
- Duration of feeds
- Feeding aversion
- coughing/choking with feeds
- recurrent pneumonia
- chronic chest symptoms
How do nutritional requirements differ in children with neurological impairment?
Infancy - similar requirements
Micronutrient requirements comparable to TD children
Energy requirement differential WIDENS WITH AGE
- 2/2 diff in physical activity
- 2/2 diff in body composition (muscle/bone mass)
May be 16-31% lower than for typically developing kids
No clinically relevant formulae, have to use clinical judgment, monitor intake, adjust PRN
Nutritional risks for children on AEDs
Nutritional monitoring for children on AEDs
Folate deficiency
B12 deficiency
Hyperhomocysteinemia
Impaired bone health (with prolonged AED use)
Vitamin, mineral, and trace element levels should be monitored and supplemented - but no standard recommendation
How can we define growth?
Sum of increases in fat mass and lean mass consisting of bone, muscle, and organs
How does neurological impairment affect growth?
Non-nutritional factors (ie genetics and altered weightbearing status impact acquisition of lean mass
What is the best indicator of lean tissue and organ growth?
LINEAR GROWTH
