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HUNT 243 exam > Toddlers & children & adolescents > Flashcards

Toddlers & children & adolescents Flashcards

1
Q

What are the 3 main changes that occur in toddlers (what characterises them)?

A
  1. growth velocity plateaus (= reduction in appetite)
  2. Rapid increase in gross & fine motor skills
  3. Dramtic development in language
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2
Q

What characterises preschool age children?

A

+ Increasing autonomy
+ broader social circumstances
+ increasing language skills & expanding ability to control behaviour

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3
Q

Why is Nutrient adequacy for under 5s important?

A

+ adequate energy & nutrients to achieve full growth & development protentional
+ undernutrition during these years will lead to impairment in cognitive development
+ growth occurs in spurts & appetite variable
+ innate ability to self-regulate calorie intake

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4
Q

What is the recommended period for continuing BF?

A

12m (MOH) – 2y (WHO)

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5
Q

What feeding skills do toddlers have between 12-18 months?

A

move tongue side-to-side and can chew food with rotary movement

refined pincer grasp; pick up small objects & put them in their mouth

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6
Q

What feeding skills do toddlers have between 18-24 months?

A

well-developed chewing = handle all food textures

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7
Q

What feeding skills are developed in toddlers?

A

Increasing fine motor & visual coordination

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8
Q

What precautions should be taken when feeding toddlers?

A
  1. high chair
  2. supervision
  3. no eating on the run
  4. avoid hard foods or food can be shaped to plug airways (hard lollies, popcorn, nuts, whole grapes & hot dogs
  5. offer walk/ milk with meals
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9
Q

What is typical toddler behaviour?

A
  1. Strong independence
  2. emergence of “no”
  3. EASILY DISTRACTED
  4. Learning to self-regulate
  5. Overstimulation (= overtired)
  6. Shyness & fear of strangers
  7. Biting, pinching & hair pulling
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10
Q

Toddlers typically experience food jags what are these?

A

strong food preference vs dislikes (refuse foods previously like)

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11
Q

What are some recommendations to deal with food jags?

A

serve new foods along with familiar foods
Model healthy eating behaviour
Don’t force a toddler to eat

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12
Q

What are 3 characteristics of a toddlers appetite?

A

+Decrease in food & appetite (slowing growth & distractions)
+ toddler needs small portion sizes (1 TBS per year of life)
+ routine & regular meals are important (should not “graze”)

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13
Q

What feeding skills develop in pre-schoolers?

A

+ refinement of utensil use
+ choking less of a concern
+ better fine motor skills

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14
Q

When is the optimal time to get children involved in food preparation & cooking?

A

Pre-school years

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15
Q

What physical changes occur is preschool years?

A
  1. growth Rate slows
  2. body becomes slimmer
  3. straighter
  4. protruding stomach flattens
  5. limb lengthen
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16
Q

How is appetite regulated in preschoolers?

A

+ food environment; parental behaviour & SES
+ food preference development, appetite & satiety (prefer sweet, salty is learned; prefer energy-dense food; preferences = unlearned)
+ Kids able to adjust calorie intake based on needs
+ external cues override hunger & satiety signals
+ no effect of portion size on calorie intake

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17
Q

What is the division of responsible (who decides what during feeding?)

A
  1. parents decide:
    What, where & when
  2. Children decide
    whether & how much
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18
Q

What is the impact of restrictive feeding?

A

girls of restrictive parents ate too much & reported negative emotions about eating when given free access to treats

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19
Q

What are evidence-based portion sizes for toddlers?

A
  1. Meet EAR & not exceed energy requirements

2. Broke into food groups

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20
Q

What is the issue with portion size estimates for toddlers?

A

a lot of misinformation ( overestimates)

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21
Q

How many kcal per kg do children need compared to adults

A

72 kcal/ kg vs 30-35 kcal per kg

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22
Q

Young children have smaller stomach volumes; what is the key to meeting nutrient needs?

A

Nutrient density & high frequency (don’t graze)

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23
Q

What is the protein sparing effect?

A

Used for growth & tissue repair rather than energy

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24
Q

What are the protein recommendation for children?

A 
2-3y 14g/day
4-8y 20 g/day 
or
2-3y 1.08g/kg
4-8y 0.91g/kg
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25
Q

What are the role of fats?

A

+ provides energy
+ membranes of all cells
+ omega-3 & omega-6 are essential for brain, nerve function & healthy skin
+ transport fat soluble vitamins

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26
Q

What fats is it most important to maximise?

A

maximise omega-3, DHA & EPA

Ratio between omega-3s and omega-6s

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27
Q

What is the AMDR for fat & sat/trans fat for children under 14?

A

20-35% tot energy (sat/ trans fat 10% or less)

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28
Q

Are children meeting guidelines for fat?

A

No they are consuming too much saturated fat

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29
Q

What do children get most of their carbohydrates from?

A

Mostly from refined cereals & free sugars (monosaccharides & disaccharides added to food)

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30
Q

What is the AMDR for carbohydrates?

A

45-65%

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31
Q

Do childen consume to many free sugars?

A

Yes.
5-18 years 13% of tot energy
Free sugars should be less than 10% of total energy

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32
Q

What is fibre and the recommendations for 2-8 year olds?

A
  1. non digestible carb that helps with GI & prebiotics

2-3 years 14g/day
4-8years 18 g/day

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33
Q

What are the fluid recommendations for children?

A

+ 70% water
+ maintain normal hydration, BP & fluid balance
+ sources water, milk, diluted fruit juices, soups, sauces, F& V
+ milk between meals; water with meals (500ml of milk per day)
+ consume fruit juice with meals
+ not tea/ coffee before 13 years

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34
Q

What are the 4 nutrients of concern in children?

A

Iron
zinc
Ca2+
Vit D

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35
Q

What is the role of calcium?

A
  1. essential for teeth & healthy bones
  2. regulates muscle contraction
  3. nerve conductivity
  4. blood clotting
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36
Q

What is the role of Vitamin D?

A

Vit D plays a role in Ca2+ absorption & bone health (direct & indirect)

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37
Q

What is the role of iron?

A
  1. carrying oxygen in haemoglobin & myoglobin
  2. energy metabolism
  3. immune system
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38
Q

What is the role of zinc?

A

structural role in growth hormone & insulin & enzyme functions

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39
Q

What are the sources of zinc?

A

Best:
meat, fish, shellfish & eggs (good sources in wheat & cereals)
Low bioavailability:
lentils, beans, leafy veges, potatoes

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40
Q

What are some Anti- inhibitors of iron & zinc absorption?

A

+ phytate is found cereals, legumes, nuts & seeds

+ tannins found in tea + coffee

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41
Q

What % of 1-2 year olds have been reported as iron deficient & what % are not meeting requirements?

A

16%

18%

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42
Q

Why is iron deficiency high in infants/toddlers?

A

increased deficiency as less fortified cerals & cows milk introduced too early

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43
Q

What is the top contributor to energy, sat fat, calcium, Vit D & A & zinc in 2-4 year olds?

A

Milk

+ 84% consumed milk (27% whole; 57% reduced fat; 15% flavoured)

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44
Q

What % of toddlers consume veggies (excluding potato)

A

60%

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45
Q

What % of toddlers consume sugar sweetened beverages?

A

30%

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46
Q

Why should children below 5 not consume sugar sweetened beverages?

A
  1. Increase dental carriers
  2. increase calories
  3. reduce appetite
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47
Q

When should a toddler move from highchair to table?

A

+ between 18m-3y
+ When they can sit up right (for long periods)  if they try & climb out
+ accelerated by older siblings
+ right height to use intensils etc (booster pad)

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48
Q

What % of children have dental carriers?

A

41%

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49
Q

What populations have a higher prevalence of dental carries?

A

+ more in other ethnicities + less in communities with fluoridation

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50
Q

Why do we have a high prevalence of dental carries in NZ children?

A
  1. lack of fluoridation
  2. Plunket education,
  3. shortage of dentist
  4. poorer beverage choice in northland
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51
Q

What are some interventions for dental carries in NZ?

A

+ banned sweetened beverages advertisement
+ sugar tax
+ Increase dental resources in high risk area
+ free tooth brushes
+ water fluoridation
+ culturally relevant & entertaining health messages
+ supervised tooth brushing programme in schools
+ health warning on sugar

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52
Q

What are the MOH interventions for dental carries in NZ?

A

+ brush teeth 2x a day
+ regular checkups
+ water or milk
+ healthy snacks
+ lift the lip to check for signs of tooth decay
+ parents brush until 8 years
+ spit out toothbaste; don’t rinse with water
+ avoid sugar sweetened beverages
+ only serve juice at mealtimes & dilute 1:10; no more than ½ cup; 100% fruit juice

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53
Q

What are two parental feeding strategies & there impacts?

A

+Parent modelling of health eating behaviours
(positive impact on F & V intake & less unhealthy snack intake)
+ restrictive parenting practices (limit/ eliminate palatable foods = poorer child eating outcomes (neg feelings & unhealthy foods)

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54
Q

What are parenting styles measures off?

A

measures of attitudes; beliefs & behaviours

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55
Q

What are parenting styles a spectrum of?

A

Spectrum of responsiveness (degree of acceptance & sensitive) & demandingness (extent of control + expectations

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56
Q

What are the 4 parenting styles?

A
  1. Authoritarian
  2. permissive
  3. authorities -> good (warm; militariant)
  4. neglectful
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57
Q

What is responsiveness (parenting styles)?

A

how the parents encourage child eating in a responsive child-centred way

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58
Q

What are two examples of responsiveness?

A

+ arranging food to make it interesting & complimenting the child
+ showing disapproval for child not eating or physical struggle

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59
Q

What is demandingness?

A

how much the parent encourages the child to eat

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60
Q

What are some parental feeding practices?

A 
\+ prompt to eat
\+ pressure to eat certain foods/ quantities
\+ restriction of food/ portion sizes
\+ reasoning
\+ punishing
\+ making food available & accessible
\+ rewards (instrumental feeding)
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61
Q

Should food rewards be used?

A

No. decrease preference food kids like & increase preference for reward food

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62
Q

Should non-food rewards be used?

A

benefits:
+ extrinsic motivation to taste novel foods (stickers)
+ Large significant differences in exposure

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63
Q

What are the overall recommendations for encouraging food exposure?

A

+ provide a variety of healthy foods for meal time = choice
+ recognise emotional aspect of eating
+ use authoritative feeding practices
+ neutralise palatable foods

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64
Q

What % of NZ population is school aged?

A

73%

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65
Q

What are UNICEF’s 4 children’s rights?

A
  1. Non discrimination
  2. Ensure the best interests of child
  3. Right to life, survival & development
  4. Respect for the views of the child
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66
Q

What are the 3 crucial phases to health in school aged children?

A
  1. 5-9 Years (middle childhood growth):
    vulnerable to infection & malnutrition which could adversely affect development
  2. 10-14 (adolescent spurt):
    BMI increases rapidly; need to get sufficient nutrition
  3. 15-19(Adolescent growth phase)
    Further brain reconstruction, increased exploration & experimentation
    initiation of life-long behaviours that determine health
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67
Q

What are 11 ways that cognitive development occurs in school aged children?

A
  1. self-efficacy: gaining knowledge of what to do
  2. Change to concrete operations from egocentrism & magical thinking (more rational reasoning)
  3. develop sense of self
  4. peer relationships more important
  5. Involved in food prep (improve self-esteem & confidence)
  6. Masters utensil use
  7. Parents major influences on child’s likes + dislikes
  8. Parental modelling is important for healthy eating patterns
  9. Outside influence more important (media)
  10. Snacking significant sources of calories
  11. Parental responsive feeding style (when & what; child chooses how much)
  12. More aware of body image (dieting occurs (esp if mother projects)
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68
Q

How does growth change in school aged children?

A
  1. velocity slows down
  2. steady increase in height
  3. growth spurt coincides with increased appetite
  4. growth remains plastic (changes according to environment )
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69
Q

How changes occur in school aged children in regards to physiological development?

A
  1. Muscular strength, motor coordination & stamina increase
  2. More complex pattern movements
  3. Boys have more lean body mass
  4. Body fat reduces a minimum (around 6y) before increasing for adolescent (BMI/ Adiposity rebound)
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70
Q

What does a BMI rebound before 5 indicate?

A

risk for overweight/ obesity

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71
Q

Why is it important to monitor growth in school-aged children?

A

+ identify problems before out of control ( obesity is very hard to reverse)
+ no Growth-standards for school-age children (references only)
+ bMI changes constantly throughout childhood (don’t have overweight cutoffs)
Under 5th = underweight
over 95th = obese
So only way to know if BMI is normal

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72
Q

What are NZ food & nutrition guidelines for young people (school-aged children)?

A
  1. Eat a variety of food groups daily (F & V; increase wholegrains with age, include milk & protein)
  2. Eat enough for activity, growth & to maintain a healthy body size (eat all meals and snacks)
  3. Choose foods that are low in fat, sugar & salt
  4. Drink plenty of water & low fat milk (limit SSB)
  5. no alcohol
  6. Eat meals with family
  7. Envolve child in cooking & prep
  8. Ensure food is safe
  9. Be Physically active (60min mod/ vigorous a day; limit sedentary behaviour)
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73
Q

What are 4 determinants of PA?

A
  1. girls less active
  2. decreases with age
  3. obese children less active
  4. less active if cold
74
Q

What meal patterns are recommended for school-age children?

A
  1. 3 meals + 2 small snacks at regular times
  2. Grazing not recommended (dental issues & non-nutritious)
  3. Nutritious breakfast, healthy lunch & family dinners
75
Q

What are shared family meals associated with?

A
  1. 12% reduction for overweight
  2. 20% reduction for eating unhealthy foods
  3. 35% reductions in odds for disordered eating
76
Q

What is breakfast associated with?

A

better nutrient intake & healthier body weight (16% energy; 1/3 of calcium, iron, thiamine, riboflavin, folate & zinc)

77
Q

What is the issue with skipping breakfast?

A

adversely effects cognitive performance (esp. attention & memory)

78
Q

What % of children don’t have breakfast at home?

A

18%

79
Q

What is associated with with high rates of breakfast consumption?

A

Higher education

80
Q

What are the most commonly eaten lunch foods (in order)?

A

+ sandwiches, + fruit + biscuits, crisps & snacks + sweetened beverages, + pies & sausage rolls, + yoghurt, + confectionary…

81
Q

What considerations should be taken into account with snacks for school aged children?

A
  1. Important for growth spurts
  2. Size & timing of snacks to be considered (shouldn’t interfere with appetite)
  3. energy dense; nutrient-poor are inappropriate (marketed as beneficial)
  4. contribute 12% to daily intake (only 8% protein, calcium, iron, vit A)
  5. this can contribute to excess energy intake
  6. high sodium
82
Q

What does Eating for healthy children (MOH revised in 2017) gives recommendation for ?

A
  1. for meal times
  2. making meals fun
  3. getting children involved etc.
83
Q

What are the determinants of dietary Choices?

A

+ Income
+ Education (education to make good choices)
+ Housing (storage, power, food prep areas, appliances)
+ Cultural
+ Availability of community services & facilities (accessibility of supermarket)

84
Q

How much of weekly budget is typically spent eating out?

A

1/3

85
Q

Are children meeting veggies, fruit, milk & MFPE guidlines?

A
  1. 40% meeting veges
  2. 69% meeting fruit
  3. ~100% eat every day (43% eat white bread)
  4. 64% drink milk once a week (21% never)
  5. 51% consume 2+ serving MFPE daily
86
Q

What is the Prevalence of inadequate micronutrient intakes in school aged children?

A 
\+ 10% low Vit A
\+ 37% low folate
\+ Little vit D naturally in food (cut-off 50 nmol/L  Maori & pacific at risk)
\+ calcium = 65% inadequate intake
\+ 48% low selenium (lower South Island)
\+ iron (1.3% inadequate  LOW)
\+ zinc 16% concerning
87
Q

What is food insecurity?

A

limited/ uncertain availability of nutritionally adequate & safe foods
or limited ability to acquire foods that meet cultural needs

88
Q

What is the cause of food insecurity?

A

Insufficient money

89
Q

What is food insecurity associated with?

A

+ obesity
+ poorer health
+ development/ behavioural problems
+ reduced school performance

90
Q

Who is at most risk of food insecurity?

A

Low SES, Maori & Pacifica (2x poverty rate)

91
Q

What % of NZ children experience poverty?

A

35%

3 out of 5 children in persistent poverty

92
Q

What is the impact of school feeding programmes?

A

Improved educational outcomes:

  1. School attendance
  2. Math achievement
  3. Decreased tardiness
  4. Mood, cognition
  • Primarily in children at nutritional risk
93
Q

What are the guiding principles of school feeding programmes?

A
  1. variety from 4 food groups
  2. min sat fat, salt 7 added sugar
  3. only water & milk for drinks
  4. standard & large portion sizes (1.5x)
  5. 75% must be green items
94
Q

What behaviours increased success with the school feeding programmes?

A
  1. encourage & praise to try new foods
  2. Talk about what’s healthy (+ why)
  3. adults eat alongside
  4. allow students to graze
  5. staff talk positively about kia
95
Q

What are 6 practical activities that help with the

A 
\+ appropriate time 
\+ Encourage to eat more
\+ Time only to eat
\+ Reward positive eating behaviour
\+ healthy eating benefits in curriculum
\+ adult role models
96
Q

What is the cost of school feeding programmes

A

Yr 1-8: $5 student a day

Yr 9+ $7 student a a day

97
Q

Who consumed most from school feeding programme?

A

The most disadvantaged learners

98
Q

What was the benefits of school feeding programme?

A

Consumed more vegetable items Fewer snacks Improved feelings of fulness Improved wellbeing

99
Q

What are the implications of childhood obesity?

A

+ Psychosocial: poor self-esteem; depression & sleep disorders
+ Pulmonary: sleep apnoea; asthma; exercise intolerance
+ GI: gallstones.
Renal: Glomerulosclerosis
+ musculoskeletal
+ endocrine issues (reproductive; type 2 diabetes)
+ cancers
+ CVD disease

100
Q

What are the characteristics of obese children?

A
  1. taller
  2. higher bone mass
  3. look older (treated differently)
  4. earlier sexual maturity
  5. High risk for predictors of adult disease (hyperlipidaemia; hypertension; poor glucose tolerance; elevated liver enzymes)
101
Q

What should be used to detect changes in adiposity?

A

Frequent monitoring of BMI

102
Q

What are the 2 main predictors of childhood obesity?

A 
BMI rebound: early before 5.5 years
Maternal obesity (strongest predictor)
103
Q

What are the 3 main contributing factors to childhood obesity?

A
  1. Energy Intake
  2. Environmental:
    + prevalence fast food outlet; marketing; physical re options
    + Economic
  3. Parental health:
    + breastfeeding & nutrition pregnancy
    + maternal smoking
    + Parental obesity
104
Q

What are some secondary contributing factors to childhood obesity?

A
  1. PA: reducing PA in low-income countries is a concern
  2. Sleep: less sleep reduces PA & appetite
  3. Other: medical; genetics
  4. Television/ screen time: not in bedroom (reduced EE; increased dietary intake & disruption of sleep)
105
Q

What is the childhood obesity plan?

A

22 Initiatives; 3 key themes:

  1. Targeted interventions for obese
  2. Increase support for those at risk
  3. Broad approaches for general population
106
Q

What are the achievements to date of the childhood obesity plan?

A

+ 95% were identified & referred to professionals
+ health star rating
+ Play sport programme in 44 schools
+ DHB’s SSB free
+ MOH; posted clinical guidelines for weight management in NZ children
+ ERO has published reports on food, nutrition & PA in NZ schools & preschools

107
Q

How can the food industry play a role in reducing childhood obesity?

A

+ reduce fat, sugar & salt content
+ ensure healthy & nutritious sources available & affordable
+ practice responsible marketing (large effects)

108
Q

how is food marketing regulated for children in NZ?

A

Self-regulatory system to restrict marketing of unhealthy food & drinks up to 14 years (duty of care to 18y)

109
Q

How does World Cancer research recommend regulating food marketing to children?

A

+ implement Gov-led mandatory restriction (self-regulatory ineffective)
+ all forms should be restricted on all media to 18 years
+ Use nutrient profile to decide what foods should be restricted
+ children must be given priority when conflicting information

110
Q

What are the 4 stages of the childhood obesity plan?

A
  1. Monitor
  2. Assess
  3. manage
  4. Maintain
111
Q

What happens in the monitor stage of the childhood obesity plan?

A
  1. regularly measure BMI
  2. extra support: provide nutrition & PA advice if trending towards
  3. potentially refer to dietitian
  4. discuss current & long-term health risks
112
Q

What are the steps of the assess stage of the childhood obesity plan?

A
  1. Full history necessary (identify clinical, social & behavioural factors)
    1. Consider co-morbidities, families history, PA, diet, sleep, psychological issue
    2. Clinical exam: anthropometry, skin infection, BP, liver enzyme, sleep apnoea
    3. Lab tests: lipid profile; sleep study (BEARS: bed time issues; daytime sleepiness; awake at night; during of sleep; snoring)
113
Q

What are the steps of the Manage stage of the childhood obesity plan?

A

Aim: slow weight gain so the child can grow into it
+ set realistic goals aimed at changes in food, activity & behaviour
+ Jointly agreed lifestyle changes (practitioner, child + whanau)
+ Plan for regular review & progress monitoring
+ Activity: opportunities in & outdoors; active transport; limit screen time; age-appropriate sleep
+ use Behavioural strategies: self-monitoring; goal setting; contracting; problem solving

114
Q

What’s the mantain stage of the childhood obesity plan?

A
  1. Maintain contact
  2. continue to monitor growth
  3. identify & monitor guidelines
115
Q

What are the general guidelines for approaching childhood obesity?

A

+ avoid making child feel stigmatized
+ avoid jargon
+ confident, caring approach
+ value child & respect parents

116
Q

What are the main characteristics of adolescence?

A

+ independent: PA and food are choices
+ social pressures: body image, alcohol, and drug use
+ increasing personal interest & misinformation (fad dieting; ed)
+ concerns: over nutrition
+ Puberty causes sexual maturation, anthropometry changes
+ sequence of puberty is consistent (but timeline not)
+ Biological age should be used instead of chronological age

117
Q

What is puberty?

A

Maturation of the reproductive system

118
Q

How do we measure biological age during puberty?

A

5 tanner stages

based on menarche, breast development, pubic hair & changes in genitals

119
Q

When does peak growth velocity occur in females?

A

12-16 years

25cm taller & 16kg

120
Q

What %BF do girls need for menarche & what % BF do girls need to maintain normal menstruation?

A

17%

25%

121
Q

When does peak growth velocity occur in males?

A

14-17.5 years

28cm taller & 20kg

122
Q

Why does Excessive exercise slow down growth spurts?

A

intensive training sessions may stop a child from meeting there energy requirements

123
Q

When does the mass of bone mass accretion occur?

A

+ 90% accreted by 18y

+ 24% gained in 4 year period of peak growth velocity

124
Q

What brain development occurs during puberty?

A

+ regions associated with movement shrink because they become more efficient

+ regions associated with memory, decision making & emotional responses develop & grow

125
Q

What psychological/ cognitive development occurs during puberty?

A

+ a sense of personal identity
+ moral & ethical value system
+ feelings of self-esteem/ self-worth
+ a vision of occupational aspirations

126
Q

What are the 3 periods of cognitive development in adolescence & their characteristics?

A

11-14 years (Early):
+ concrete black & white thinking, egocentrism & impulsive dominant

15-17 years (mid):
+ emotional & social independence
+ peer influence on food choice peaks
+ able to think abstractly but unable to apply

18-21 years (late)
+ less prevalent body image issues
+ stronger sense of individuality & values
+ more induvial autonomy

127
Q

What is the issue with the wide chronological range of biological changes that occur in adolescence?

A

+ males may use steroids
+ may develop eating issues & poor body image
+ Peer influences stronger than family

128
Q

What are influences of food choices during adolescence?

A
  1. Food availability
  2. Preference
  3. parental modelling
  4. peer attitudes
  5. behaviours
  6. convenience
  7. personal/ cultural beliefs
  8. mass media
  9. body image
  10. PA
  11. vegeterianism
129
Q

What is the effect of busy lives of food practices during adolescence?

A

snacking
meal skipping
eating away from home
fewer family meals

130
Q

What is snacking associated with?

A
  1. picky eater
  2. watching TV
  3. gain weight
  4. less F & V
  5. more Fats food
  6. more SSB
131
Q

Why is meeting energy needs crucial in adolescence?

A
  1. greatest during adolescence (except pregnancy & lactation)
  2. linear growth & sexual maturation can be delayed by Calorie deficit (can be caught up if acute)
132
Q

What is low energy availability?

A

Inadequate energy to support the functions required by the body to support optimal health & performance

133
Q

What are the facts of the female athlete triad ?

A 
\+ altered menstrual cycle
\+ fatigue, low energy
\+ altered mood, poor concentration
\+ under-performance; failing to improve
\+ injuries 
\+ loss of enjoyment from sport
134
Q

Who are most at risk of female athlete triad?

A
  1. participants of sports that emphasis thinness (associated with body image) -> take extreme measures to control body fat
135
Q

What is Relevant energy deficiency in sport (RED-S)?

A

+ includes the triad but also includes effects on other functions:
immunological, GI, CVD, psych, growth/ development, metabolic, endocrine…
+ also highlights males can experience as well
+ to conserve energy expenditure functions that are not needed for life shut down (to maintain cellular maintenance, locomotion, thermoregulation… etc

136
Q

What may prolonged Relevant energy deficiency in sport (RED-S) cause?

A

+ disability
+ osteoporosis (loss of quality of life)
+ sport performance will decrease
+ decreased CV function

137
Q

Who is most at risk of Relevant energy deficiency in sport (RED-S)?

A

+ people with personality traits such as perfectionism
+ social pressure & from coaches & parents
+ recreational (45/47% non-elite at risk) because have less support
= endurance & sports with emphasis on fitness

138
Q

How do we prevent Relevant energy deficiency in sport (RED-S)?

A

+ ensure they are aware how to meet their nutrient requirements
+ peak season energy intake should be higher
+ avoid large periods without eating…

139
Q

What are protein requirements associated with in adolescents?

A

Requirements closely linked to body size & age (males accumulate lean body mass)

140
Q

Who have higher iron during adolescence?

A 
\+ follow restricted diets
\+ young women with high menstrual losses
\+ pregnant teens
\+ some athletes
\+ 80% higher for vegeterians
141
Q

When should iron intake be the highest?

A

During periods of rapid growth

142
Q

What is the prevalence of iron deficiency in females?

A

11% (12.4% in least deprived)

5% deficient with anaemia (11% maori)

143
Q

When is calcium requirements the highest?

A

Highest in people aged 12-18 years – 1300 mg

144
Q

How much does calcium absorption increase during peak growth?

A

30%-50-60% (peaks early adolescent in males; menarche in females)

145
Q

What increases calcium excretion & reduces deformation?

A

High sodium & protein increases calcium excretion

vit D reduces iron absorption

146
Q

What are the 4 stages of the bone remodelling cycle?

A
  1. Initiation: osteoclast precursors are called to the bone by osteocytes in bones through chemical messengers  they attach to the bone & mature
  2. Mature Osteoclasts break down bone to release calcium into the bloodstream (occurs when blood calcium is low as essential for cardiac transactility & nerve transmission) -> take precedence over skeletal needs
  3. Osteoblasts reform bone (takes longer so lose bone for most of adult life)
  4. Osteocytes mineralise bone
147
Q

What is the mechanism behind osteoporosis

A
  1. Bone is broken down until it becomes brittle & weak (higher turnover -> becomes very porus)
148
Q

How many men & women suffer from osteoporosis?

A

1 in 3 women

1 in 5 women will suffer in their lifetime

149
Q

How much does the risk of a second fracture increase after the first?

A

80%

150
Q

Why do the risk factors for osteoporosis occur in adolescence?

A

over 90% adult bone mass has accrued

151
Q

Why is there a sharp decline in bone mass at menopause?

A

Loss of oestrogen

152
Q

Why are females 2x more likely to have a bone fracture?

A

Lower peak bone mass

153
Q

How much can 10% increase in bone mass delay osteoporosis?

A

13 years

154
Q

When does bone velocity peak in boys & girls respectively?

A

(precedes peak bone growth 6months after)
Boys: 14.05
Girls: 12.5

155
Q

How much of bone is accumulated during peak bone velocity?

A

1/4

156
Q

Why is there more fractures in adolescence?

A

Rate of accretion surpasses rate of mineralisation so higher risk of fractures for a transient period

157
Q

How does physical activity affect bone mass (loss & accretion)?

A
  1. non-weight bearing individuals rapidly lose bone mass (shows the important of skeletal loading)
  2. Bone mineral acquisition require varying forces of intensity & dynamic
  3. Bone mass is positively correlated with childhood PA & nutrition (site-specific)
  4. Effect of exercise most obvious during pubertal growth
158
Q

What is the relationship between obesity & bone mass density?

A

Increases the risk of LOWER EXTREMITY fractures

159
Q

Why does oestrogen inhibit bone remodelling?

A

Effects:

  1. osteocytes
  2. osteoblasts
  3. t-cells
  4. osteoclasts
160
Q

What does oestrogen deficiency/ ovarian insufficiency cause?

A

Lower bone mineral density

161
Q

What is the effect of amenorrhea on bone mass density

A

+ 6 months due to weight loss, ED & stress cause BMD > 2 SD
+ affects vertebral BMD most
+ osteopenia more severye if ED during adolescence

162
Q

What is the relationship between rat contraception & bone health?

A

+ oral estrogen pills are not protective (lower in oral contraceptive users)
+ inhibit bone remodelling if already have enough estrogen

163
Q

What is the calcium EAR based on?

A

Skeletal accretion -> need to absorb 440mg so EAR set at 1050 mg/ day; RDI = 1300 mg to account for bioavailability

164
Q

What enhances & inhibits calcium excretion?

A

Vit D enhances absorption
Iron inhibits absorption (don’t consume together)

Sodium & protein increase calcium excretion

165
Q

What are some secondary factors that decrease bone mass?

A

caffeine, alcohol, cigarette smoking, SSB

166
Q

What are some secondary factors that increase bone mass?

A

Energy & protein intake; diets high in V & F

167
Q

What are the 5 types of vegetarian diets?

A
  1. Pescatarian
  2. Lacto-vegetarian
  3. Ovo-vegetarian
  4. Lacto-ovo vegetarian
  5. Vegan
168
Q

What are the primary reasons for being vegetarian?

A 
\+ health beliefs
\+ religious beliefs
\+ animal rights
\+ dislike meat
\+ exert independence
169
Q

What are the eating for healthy vegetarians guidelines?

A 
3 serves veges; 2 servings fruit
6 servings fruit/ veges a day
2-3 serving milk/ alternatives
2 servings legumes, eggs, nuts & seeds
* OUTDATED
170
Q

Why are the eating for healthy vegetarians guidelines outdated?

A

+ Latest recommendations recommend more veges
+ Match nutrient recommendations better
+ Servings sizes have been adjusted
+ children & vegetarian recommendations haven’t been updated

171
Q

What can we replace protein with (plant sources)?

A

legumes, nuts, seeds, breads & cerals, soy foods & wholegrains

172
Q

What is the bioavailability of non-harm iron & some sources?

A

Bioavailability for non-haem iron is 5-12%

Non Haem sources: fortified cerals, legumes, veges, cashew nuts & eggs

173
Q

How can we reduce physic acid from inhibiting zinc absorption?

A
  1. Fermenting, heating, soaking & sprouting seeds & legumes reduce amount of phytic acids
  2. Yeast based/ leavened breads
  3. Take iron away from zinc to help absorption
174
Q

What are some zinc sources?

A

Pumpkin seeds

Cheese

175
Q

What is the role of zinc?

A

Important for growth, development, lean muscle mass & sexual maturation (males requirements are higher)

176
Q

What is the association between veganism & fractures?

A
  1. Vegans had a greater risk of fractures (43% increase in number)
  2. 231% higher risk of hip fractures (independent of calcium intake??)
177
Q

What are some deficiency symptoms of low B12?

A 
Fatigue
Pale
Neurological changes
Weight loss
Loss of appetite
Anaemia
178
Q

What fatty acids are an issue for vegans & how can this be remedied?

A
  1. EPA & DHA lower/absent in vege/ vegan diets
  2. ALA can be converted to EPA & DHA but very inefficient
  3. Vegetarians should double ALA to promote conversion
  4. Sat & trans-fat, alcohol should be limited as they reduce the conversion of ALA
179
Q

How s vegetainsim associated with disordered eating?

A

more likely to report frequent:
chronic dieting
purging
laxative use

180
Q

What are some sources of ALA?

A

soybean oil, rapeseed oil, walnut oil etc.

HUNT 243 exam (3 decks)

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