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Nutrition > Nutrition in Infants/Children > Flashcards

Nutrition in Infants/Children Flashcards

1
Q

How is growth regulated?

A

Growth and body composition is controlled mainly at the level of long bone growth.

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2
Q

Bone growth

A

Long bone length growth- primary driver of whole body growth.
Genetic determination of rate/time course (canalization)
Adequate nutrition required for genotypic height attainment

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3
Q

Skeletal muscle growth

A

Growth rate/target weight controlled by bone length growth.
Passive stretch= pyshiological stimulus for growth
Muscle activity and adequate nutrition are required for maximum phenotypic mass

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4
Q

Visceral organ growth

A

Driven by functional demand: food intake and metabolic work.

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5
Q

Infant growth

A

IGF-1 mediated

Insulin is main driver of IGF-1 production at this stage

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6
Q

Childhood growth

A

IGF-1 mediated

Growth Hormone main driver of IGF-1 at this stage

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7
Q

Puberty growth

A

Primarily driven by sex-steroid

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8
Q

Activators of endochondral ossification

A 
IGFs, 
IGFBPs, 
T3, 
25OH2 VitD, 
FGFs, 
IHH, 
PtHrP, 
BMPs, 
WNTs, 
VEGFs
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9
Q

Growth Faltering

A

Primary and Secondary malnutrition and weight loss due to:
Primary insults- Inadequate diet, or disease. That cause:
Interactions: anorexia, malabs, decr immunity, mucosal damage, nutrient loss

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10
Q

Stunting and wasting

A

Wasting: low weight for height
Stunting: low height for age.
Stunting more common, and is a cyclical syndrome w serious co-morbidities. It decreases the psychosocial development

Both caused by:

  • Poor diet after weaning, lacking specific nutrients
  • Infection/Inflammation: major inhibitory influence.
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11
Q

Where is long bone growth regulated?

A

at the level of endochondral ossification in the growth-plate

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12
Q

When does stunting begin?

A

In childhood- breast feeding protects the infant, so occurs after weaning.
Considered an inflammatory disease assoc w poor sanitation and hygiene: Environmental enteric dysfxn.

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13
Q

Environmental Enteric Dysfunction

A

Caused by intestinal inflammation–> innate and acquired immune activation:
Chronic villous atrophy
Crypt hyperplasia
Inflammatory cell infiltrate

EED then leads to:
-increased intestinal permeability –> inflammation (increased TNFa, IL1, IL6, corticosteroids, insulin resistance, and decreased IGF1/IGFBP3)
- malabs and malnutrition –> increased susceptibility to infection.
These all cause inhibition of bone growth and STUNTING

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14
Q

Vegan Children

A

Can have near-normal growth but need some supplementation (lacks in developing countries)

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15
Q

Milk and growth

A

Milk intake is the main determinant of serum IGF-1 and height. Those who have high intake of milk become taller and achieve their growth potentials better than those who don’t.

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16
Q

Main nutrient deficiencies assoc w stunting

A

Iodine, Protein and Zinc

17
Q

Type I nutrient deficiencies

A

VitA def: blindness, but no effect on growth.
Fe def: anemia, but no effect on growth
Iodine def: goiter/cretinism, and depressed growth.

18
Q

Type II nutrient deficiencies

A

Prot def: depressed growth.
Zinc def: depressed growth
- happens with nutritionally poor staples (starchy root-crops) and foods with high phytate content (cereals and legumes), and low intake of animal foods.

19
Q

Foods assoc with Zinc deficiency

A

Starchy root-crops as diet staples
High phytate content foods: cereals and legumes
Low intake of animal source foods.

20
Q

Iodine and bone length growth

A

Iodine–> T4/T3 –> promotes GH secretion and modulated IGF-1 activity
Directly regulates chondrocyte maturation.

Severe Iodine def: Impaired mental fxn, delayed physical development

21
Q

Zinc and bone length growth

A

Needed for the anabolic effect of IGF-1 in the growth plate, when deficient–> stunting.

22
Q

EED and linear growth

A 
Causes release of inflammatory inhibitors of endochondral ossification:
Cortisol
FGF21
IL1, IL6, IL8
TNF
IFNy
23
Q

Nutritional components that stimulate chondrocyte proliferation

A 
Milk
AAs
Zn
Iodine
These increase linear bone growth
24
Q

Major reason of global stunting problem

A

Inflammation through EED- reflecting poor sanitation and hygiene

25
Q

Kwashiorkor

A

Multiple pathologies:

  • Edema: may mask weight-loss
  • Dermatosis: lighter hair color
  • Hypoalbuminemia: fatty liver
  • K+ def: apathy and anorexia
  • Infection
  • Abnormal plasma AAs (reduced EAAs)
26
Q

Severe childhood malnutritions

A

Marasmus: no obvious pathology. Severe wasting (<70% weight for height)

Kwashiorkor: presence of edema

27
Q

Skin lesions in Kwashiorkor

A

associated with higher risk of: death, hypothermia, and predisposes to infections

28
Q

Phased Tx of Severe Malnutrition

A

Resuscitate, repair, replete.

Week 1: Initial stabilization-
-treat infection with broad-spectrum antibiotics,
-treat hypoglycemia and hypothermia.
-Dehydration w ReSoMal
- Correct w/VitA, Folic acid, Zn and Cu. NOT Fe.
- Correct K and Mg with low-protein feed.
Edema will be cured, appetite will return

Week 2-6: Rehab
-Large amounts of E-dense milk based feed with Fe.
Allows catch-up growth.

29
Q

Kwashiorkor falsies

A

Protein deficiency is main cause– protein def in children is rare. The sxs of Kwash is cured by low protein diet
Loss of edema occurs before any change in plasma albumin

30
Q

Oxidative stress in Kwashiorkor

A

Noxious insult–>
Free radical production–>
Inadequate protection (defs of: Vit E, A, C, Se, Zn, Mn, Cu, Sulphur AAs) –>
Fe-catalyzed chain rxns (Fe overload) –>
Inadequate repair (EFA defs) –>
Damage, edema, Fatty liver, skin lesions, bleached hair

31
Q

Damage from oxidative stress

A

Damage to membs and prots disrupt transport and ionic balance–> K+ loss

Kidney: Na+ and H2O retention
Glycocalyx &amp; Interstitial: edema
Liver: 
   - impaired prot synth
   - Impaired albumin, apoB100 secretion
   - damaged mito fxn: decr ATP and fatty infiltration
Skin: changes similar to sunburn (free rads from ionizing radiation in sunlight)
Hair: bleaching
32
Q

Ferritin and Kwashiorkor

A

Increased plasma ferritinin malnourished children indicate XS tissue iron stores–> v bad px.

33
Q

Whats being done about severe childhood malnutrition?

A

1- Improving micronutrient status

2- Improving water supply, sanitation and hygiene (WASH program)

34
Q

What causes the malnutrition in Kwashiorkor?

A

Deficiencies of micronutrients, especially antioxidants.
NOT protein.
Oxidative stress exacerbated by XS Fe

Nutrition (5 decks)

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