Under Nutrition in Infants and Children Flashcards
What is primary malnutrition?
Lack of or poor quality of food
What is secondary malnutrition?
accompanies a disease which disturbs appetite or food digestion/absorption/utilization
Consequences in developing countries, of malnutrition, include a major cause of death and stunts _______ and ________ development.
physical and mental development
In developed countries, malnutrition, accompanies a wide variety of ______, _____, _______ , _______ conditions.
Social, psychiatric, medical and surgical conditions
Undernutrition is due to a combination of what?
disease and dietary inadequacies which are mutually reinforcing
Inadequate dietary intake or disease leads to appetite loss and malabsorption, decreased immunity, mucosal damage and nutrient loss., which leads to what?
Faltering of growth and weight loss
Malnutrition can result in stunting or wasting. what is the difference between the two?
Wasting: low weight:height ratio
Stunting: low height:age ratio (more common than wasting) (develops post weaning; catch-up growth may or may not occur)
How is growth regulated?
- Bone growth: is a genetic and nutritional component. length growth primary driver of whole body growth
- Skeletal Muscle: Growth rate and target weight controlled by bone length growth due to passive stretch physiological stimulus for growth
- Visceral Organ Growth: growth driven by functional demand (food intake and metabolic work)
Continued growth in infancy and childhood is regulated by what endocrine hormones?
Infant: IGF-1 mediated with insulin main driver of IGF-1)
Childhood: growth hormone is main driver of IGF-1 (dwarfism can be seen here)
Continued growth during puberty is regulated by what?
primarily sex-steroid driven
Bone lengths by endochondral ossification, what is the process?
recruitment of stem cells, via GH and IGF-1 and T3, which proliferate into chondrocytes
Stunting reduces psychosocial IQ development. What is a way to help increase the child’s IQ?
Physical stimulation
–attention from the mother and dietary supplementation have a positive effect on improving the development of stunted growth
Infant lengthening reflects the maternal-intrauterine status and is independent of what?
Protein intake
In breast fed babies, protein intake was not associated with ______ or _____ gain during the first year of life
weight or length gain
Infection and inflammation produce what hormones and cytokines?
Cortisol IL-1 IL-6 TNF which all inhibit chondrogenesis (and lead to stunting)
What are the activators of chondrogenesis?
TGFbeta and BMP
Childhood height growth is sensitive to what?
- Nutrition (type 2 nutrients): protein, zinc, potassium, sodium, magnesium, phosphorus and water – you can’t take a biochemical measurements and show a child is deficient in one of these nutrients
- Environmental Stress
Type 2 nutrients are more likely to influence length growth and have what characteristics?
- Ubiquitous with fixed tissue levels and lack of storage in the body.
- No characteristic physical signs of deficiency
- Immediate growth response
- Responds to daily input with high degree of interdependence (control) on each other’s balance
- Sensitive to physiologic control (Through absorption or excretion)
What nutrients influence height growth?
Animal Source Food: milk, meat, fish, and eggs that are rick in bioavailable micronutrients and minerals
Type two nutrients: protein and zinc
Type one nutrient: iodine
During intervention studies in the 30s, 50s, and 70s, it was shown that giving school children, what food source, promoted what?
Skimmed milk supplements increased protein content in diet and height improved
–children were stunted on the low protein diet
In Uganda it was shown that what food sources showed faster height growth?
Milk and meat eating children are taller and thinner than those eating mainly starchy foods.
Therefore more milk and meat (protein) leads to what kind of school children?
Taller and thinner
We know that it is milk not meat that influence serum ________ and thus the height for children
IGF-1
–this was shown in preschool Danish children
For children on vegan diets, what were the results in terms of height?
Girls: able to maintain normal height growth
Boys: growth was slightly lower than average
Mineral supply, ______ and ______, does not seem to affect bone length, however deficiences can lead to bone deformities such as Rickett’s.
Calcium and Phosphate
- –phosphate alone may be relevant to length
- –calcium does not affect long bone growth
Zinc, in animal studies, have been shown to stimulate bone ____ ______ and bone _____.
bone protein synthesis and bone formation
–to enable the anabolic effect of IGF-1 in the growth plate
Zinc augments the anabolic effects of IGF-1 on osteoblasts and inhibit _______ activity.
Osteoclast
A diet that was zinc-free showed what?
growth cessation and body weight cycling
Meta-anaylsis shows that zinc increases height but not _______??
weight in children
Zinc supplementation increases bone length/height growth in what situations?
In utero
In children
-global prevalence of inadequate zinc intake is correlated with the prevalence of stunting in children under 5 years of age
What is the major reason for stunting worldwide?
Inflammation through environmental enteric dysfunction reflecting poor sanitation and hygiene is major reason for the global stunting problem
Vitamin A deficiency leads to what in children?
Blindness but no effect on growth
Iron deficiency anemia shows what effect on growth?
no effect on growth
–affects over 50% of women of reproductive age in parts of Asia
Iodine deficiency-goitre/cretinism, has what effect on growth?
depressed growth
–as well as impaired mental function
Protein deficiency in school children showed what effect on growth?
Depressed growth
—difficult to detect but likely with some nutritionally poor staples
Treatment of iodine and bone length growth is by giving children dietary iodine T4/T3 which promotes secretion of what?
Promotes GH secretion, modulates GH action and levels of IGF-1 and IGFBP3
–directly regulates chondrocyte maturation
