Under Nutrition in Infants and Children

Question 1

What is primary malnutrition?

Answer 1

Lack of or poor quality of food

Question 2

What is secondary malnutrition?

Answer 2

accompanies a disease which disturbs appetite or food digestion/absorption/utilization

Question 3

Consequences in developing countries, of malnutrition, include a major cause of death and stunts _______ and ________ development.

Answer 3

physical and mental development

Question 4

In developed countries, malnutrition, accompanies a wide variety of ______, _____, _______ , _______ conditions.

Answer 4

Social, psychiatric, medical and surgical conditions

Question 5

Undernutrition is due to a combination of what?

Answer 5

disease and dietary inadequacies which are mutually reinforcing

Question 6

Inadequate dietary intake or disease leads to appetite loss and malabsorption, decreased immunity, mucosal damage and nutrient loss., which leads to what?

Answer 6

Faltering of growth and weight loss

Question 7

Malnutrition can result in stunting or wasting. what is the difference between the two?

Answer 7

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)

Question 8

How is growth regulated?

Answer 8

1. Bone growth: is a genetic and nutritional component. length growth primary driver of whole body growth
2. Skeletal Muscle: Growth rate and target weight controlled by bone length growth due to passive stretch physiological stimulus for growth
3. Visceral Organ Growth: growth driven by functional demand (food intake and metabolic work)

Question 9

Continued growth in infancy and childhood is regulated by what endocrine hormones?

Answer 9

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)

Question 10

Continued growth during puberty is regulated by what?

Answer 10

primarily sex-steroid driven

Question 11

Bone lengths by endochondral ossification, what is the process?

Answer 11

recruitment of stem cells, via GH and IGF-1 and T3, which proliferate into chondrocytes

Question 12

Stunting reduces psychosocial IQ development. What is a way to help increase the child’s IQ?

Answer 12

Physical stimulation
–attention from the mother and dietary supplementation have a positive effect on improving the development of stunted growth

Question 13

Infant lengthening reflects the maternal-intrauterine status and is independent of what?

Answer 13

Protein intake

Question 14

In breast fed babies, protein intake was not associated with ______ or _____ gain during the first year of life

Answer 14

weight or length gain

Question 15

Infection and inflammation produce what hormones and cytokines?

Answer 15

Cortisol 
IL-1
IL-6
TNF
which all inhibit chondrogenesis (and lead to stunting)

Question 16

What are the activators of chondrogenesis?

Answer 16

TGFbeta and BMP

Question 17

Childhood height growth is sensitive to what?

Answer 17

1. 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
2. Environmental Stress

Question 18

Type 2 nutrients are more likely to influence length growth and have what characteristics?

Answer 18

1. Ubiquitous with fixed tissue levels and lack of storage in the body.
2. No characteristic physical signs of deficiency
3. Immediate growth response
4. Responds to daily input with high degree of interdependence (control) on each other’s balance
5. Sensitive to physiologic control (Through absorption or excretion)

Question 19

What nutrients influence height growth?

Answer 19

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

Question 20

During intervention studies in the 30s, 50s, and 70s, it was shown that giving school children, what food source, promoted what?

Answer 20

Skimmed milk supplements increased protein content in diet and height improved
–children were stunted on the low protein diet

Question 21

In Uganda it was shown that what food sources showed faster height growth?

Answer 21

Milk and meat eating children are taller and thinner than those eating mainly starchy foods.

Question 22

Therefore more milk and meat (protein) leads to what kind of school children?

Answer 22

Taller and thinner

Question 23

We know that it is milk not meat that influence serum ________ and thus the height for children

Answer 23

IGF-1

–this was shown in preschool Danish children

Question 24

For children on vegan diets, what were the results in terms of height?

Answer 24

Girls: able to maintain normal height growth
Boys: growth was slightly lower than average

Question 25

Mineral supply, ______ and ______, does not seem to affect bone length, however deficiences can lead to bone deformities such as Rickett’s.

Answer 25

Calcium and Phosphate

• –phosphate alone may be relevant to length
• –calcium does not affect long bone growth

Question 26

Zinc, in animal studies, have been shown to stimulate bone ____ ______ and bone _____.

Answer 26

bone protein synthesis and bone formation

–to enable the anabolic effect of IGF-1 in the growth plate

Question 27

Zinc augments the anabolic effects of IGF-1 on osteoblasts and inhibit _______ activity.

Answer 27

Osteoclast

Question 28

A diet that was zinc-free showed what?

Answer 28

growth cessation and body weight cycling

Question 29

Meta-anaylsis shows that zinc increases height but not _______??

Answer 29

weight in children

Question 30

Zinc supplementation increases bone length/height growth in what situations?

Answer 30

In utero
In children
-global prevalence of inadequate zinc intake is correlated with the prevalence of stunting in children under 5 years of age

Question 31

What is the major reason for stunting worldwide?

Answer 31

Inflammation through environmental enteric dysfunction reflecting poor sanitation and hygiene is major reason for the global stunting problem

Question 32

Vitamin A deficiency leads to what in children?

Answer 32

Blindness but no effect on growth

Question 33

Iron deficiency anemia shows what effect on growth?

Answer 33

no effect on growth

–affects over 50% of women of reproductive age in parts of Asia

Question 34

Iodine deficiency-goitre/cretinism, has what effect on growth?

Answer 34

depressed growth

–as well as impaired mental function

Question 35

Protein deficiency in school children showed what effect on growth?

Answer 35

Depressed growth

—difficult to detect but likely with some nutritionally poor staples

Question 36

Treatment of iodine and bone length growth is by giving children dietary iodine T4/T3 which promotes secretion of what?

Answer 36

Promotes GH secretion, modulates GH action and levels of IGF-1 and IGFBP3
–directly regulates chondrocyte maturation