Nutrition Considerations

AMINKHAH, SOHEIL AFSHAR, SAMIRA DMD-3D

Objectives
Identify nutritional needs of children aged 1 to 12 and of adolescents

State the effects of inadequate nutrition during the growing years Describe eating disorders that can occur during adolescence.

The Dietary Guidelines of 2010

Aim For Fitness
Aim for a healthy weight Be physically active each day

Build a Healthy Base

Let the pyramids guide your food choices Choose a variety of fruits and veggies daily Choose a variety of grains daily, especially whole grains Keep food safe to eat

The USDA Food Guide Pyramid

To translate science into practical terms To help people meet the nutritional needs for carbohydrate, protein, fat, vitamins, & minerals

USDA Food Guide Pyramid

Special Considerations with The Food Guide Pyramid

Not for children under the age of 2 since they still need half their Calories from fat cautions kept in mind teens, young adult, pregnant and women concerned about osteoporosis prevention need at least 3-4 daily serving milk and milk products.

Daily servings for children and adolescents

MALNUTRITION

Malnutrition is:
poor nutrition due to an insufficient, poorly balanced diet, faulty digestion or poor utilization of foods. Malnutrition also occurs when there is an imbalance of energy and protein in an individuals diet. The body may become unable to absorb the nutrients it requires to function properly.
*For example, if a child is suffering from energy and protein malnutrition,

they will most likely have deficiencies in iron, calcium, and other vitamins and minerals.

Problem of underconsumption
iron deficiency :
Iron deficiency anemia occurs when your body doesn't have enough iron.

Iron is important because it helps you get enough oxygen throughout your body. Your body uses iron to make hemoglobin. Hemoglobin carries oxygen
through your body. If you do not have enough iron, your body makes fewer.

Iron deficiency early in life appears related to behavioral problems

and motor function.

iron deficiency
What are the symptoms?
- weackness -fatigue - Pallor and numbness - Common oral manifestation are: glossitis and fissures at corner of mouth ( angular cheilitis)

- How is it treated?
Iron found in : meat, poultry and fish and also in beans, lentils,

Calcium inadequacy
Osteoporosis a pediatric disease with geriatric consequences 1.5 million fractures each year 25 million women at risk
This problem alleviated by: 1- educating used more calcium 2- supplements

Osteoporosis

Vitamin D deficiency
Also known as calciferol due to its role in calcium absorption It is the only fat soluble vitamin that we can make- in the presence of sunlight Important mediator of efficient recycling of calcium and phosphorus so they are available for bone growth and remodeling Elderly and shut ins are at risk- not enough sunlight We get vitamin D form fortified milk and cereal Function Calcium absorption, regulate bone metabolism, healthy immune system Deficiency Rickets in children, Osteomalacia in adults

Rickets
General term refers to
abnormal bone growth and development due to pervasive lack of calcium and phosphorus substrate

Failure to attain or
regression of motor milestones (notably walking or other weightbearing activities)

Bowed legs, flared wrists,

pain on major motor activity, growth failure

Vitamin D deficient rickets

results in disorganized cartilage in long bone growth plates

History of lack of sun

exposure and dietary risk factors

Presents between 6 and

18 months

Cobalamine (Vitamin B12) Deficiency

Vitamin B12 is a complex organo-metallic compound with a cobalt atom. Vitamin B 12 cooperates with foliate in the synthesis of DNA.

Vitamin B 12 has a separate biochemical role, unrelated to folate, in synthesis of fatty acids in myelin Vitamin B12 deficiency is associated with megaloblastic anaemia (per nicous anaemia), demyelinating neurological lesions in the spinal cord. Dietary deficiency of B12 may arise the subjects who are strict vegetarians and eat no animal product.

Cobalamine (Vitamin B12) Deficiency

Treatment: 1. Prompt hematological response w/ parenteral vitamin B12 1-5mcg/24hrs 2. If there is neurological involvement 1mg IM daily for at least 2wks 3. Pernicious Anemia: Monthly vitamin B12 1mg IM necessary throughout patients life

Problems of over consumption

Obesity

Obesity
1. Definition: Generalized, excessive accumulation of fat in subcutaneous & other tissues 25% of children are considered obese today. 85% of obese children over the age of ten will become obese adults. The American Obesity Association uses: The 85th percentile of BMI for overweight because ~ BMI of 25, overweight for adults and the 95th percentile of BMI for obesity because ~ BMI of 30, the marker for obesity in adults

2.

Overweight and Obesity Classification - For Adults: Ages 21+

Body

mass index (BMI) weight (kg)/ height squared (m2).

You are considered: Underweight Healthy Weight Overweight Obese

With a BMI of: Below 18.5 18.5 - 24.9 25.0 - 29.9 30 or higher

Obesity class
Obesity is further divided into three separate classes, with Class III obesity being the most extreme of the three.

BMI (kg/m2) 30.0- 34.9 35.0-39.9 40.0

Class I Class II Class III

(Extreme Obesity)

Obesity
Appears most frequently in the 1st year, 5-6 years & adolescence Etiology: Excessive intake of food compared w/ utilization Genetic constitution Psychic disturbance Endocrine & metabolic disturbances rare Insufficient exercise or lack of activity

Obesity
Clinical Manifestations: 1. Fine facial features on a heavy-looking taller child 2. Larger upper arms & thighs 3. Relatively small hands & fingers tapering 4. Psychologic disturbances common 5. Bone age advanced Leads to many health and social problems increased severity of asthma increased blood pressure, heart rate, and cardiac output hip and knee problems Diabetes

Treatment of Obesity
1st principle: decrease energy intake 1. 3-day food recall to itemize childs diet 2. Plan the right diet a. Avoid all sweets, fried foods & fats b. Limit milk intake to not >2 glasses/day c. For 10-14 yrs, limit to 1,100-1300 cal diet for several months 3. Child must be properly motivated 2nd principle: increase energy output 1. Obtain an activity history 2. Increase physical activity

Physical Activity
Helpful for the prevention of overweight and obesity. Contributes to weight loss. Helps maintain weight loss.

Adolescent Problems Related to Nutrition

Anorexia Nervosa
A psychological disorder that causes a client to so drastically reduce kcal that the reduction disrupts metabolism. An inordinate fear of being fat. Results in hair loss, low blood pressure, weakness, amenorrhea, brain damage, and even death

Treatment
Development of a strong and trusting relationship between client and care provider. Client must accept that weight gain and a change in body contours are normal during adolescence. Fluoxeting hydrochloride

Anorexia Nervosa

Bulimia
Bulimia A syndrome in which the client alternately binges and purges by inducing vomiting and using laxatives and diuretics to get rid of ingested food. Bulimics are said to fear that they cannot stop eating. Bulimia is not usually life-threatening, but it can irritate the esophagus and cause electrolyte imbalances, malnutrition, dehydration, and dental caries.

Treatment Limit eating to mealtime Portion control Close supervision after eating Psychological counseling

Nutrition through Life Cycle

Infants, Babies and Toddlers ( 0 3 years old)

Breast-feeding is optimum feeding for first 6mnths Advantages for baby lower risk of infection, protection against allergens, provides correct mix and quantity of nutrients, baby only takes what it needs Vitamin A, C & D and calcium all important for infants Cows milk contains more protein, less fat, lactose and Vit A &C Weaning transition on to a mixed diet, advised at 6mnths Suggested introductory foods; pureed cooked vegetables and pureed fruit

Pre-School ( 3 6 years old)

Children between 3-6yrs have high energy and nutrient (calories) needs. Variable appetite relating to fluctuations in growth rate Important nutrients include; Calcium and Vit. D, Fibre, Iron and Fluoride and total fat Should avoid high fat, high salt and high sugar food

School Age Children (6 12 years old)

reduced rate of growth need food having a high ratio of nutrients to calories Children should be eat breakfast fruits are liked food in this group

Adolescents (12 18 years old)

Biological, psychosocial and cognitive changes affect nutritional status Rapid growth increases nutrient needs Need for calcium and Vitamin D to build bone density; Iron to prevent irondeficiency anaemia.

Drugs and alchohol use in adolescence

Alcohol
Affects absorption and normal metabolism of glucose, fats, proteins, and vitamins. Lack of absorption of niacin and thiamin prohibit the cells from using glucose for energy.

Tobacco
Can influence appetite, nutritional status, and weight. Smokers need more vitamin C because smoking alters the metabolism. Low intakes of vitamin C, vitamin A

Cocaine
Highly addictive and extremely harmful. Weight loss is very common; addicts substitute the drug for food. Form that can be smoked is called crack

Thanks for attention