BMS208 Human Nutrition

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BMS208 Human Nutrition

• Topic 16 Diet and Life Cycle
• Infancy, Childhood and Adolescents
• Brian Spurrell

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Objectives

1. Describe growth patterns of infants and
   demonstrate the ability to use growth charts.
2. Identify nutritional and other health benefits of
   breast feeding.
3. Discuss the factors used in the selection of an
   infant formula.
4. Discuss the appropriate age and procedure used
   for the introduction of cows milk and solids
   into an infants diet.
5. Explain the nutritional needs of young children,
   including energy, protein, lipids, vitamins,
   minerals and water.
6. Discuss the effect of nutritional deficiency on
   behavior.
7. Discuss food allergies and intolerances in
   children and identify common allergens.

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Objectives

1. Describe the incidence of childhood obesity and
   the role of heredity and environmental factors in
   obesity development.
2. Describe the nutritional needs of adolescents.
3. Discuss the role of childhood obesity in the
   early development of type 2 diabetes and
   cardiovascular disease.

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Nutrition during Infancy

• The first year of life is a time of rapid growth
  and development.
• Breast milk or iron-fortified formula is the
  primary food the first year with gradual
  introduction of solids beginning at four to six
  months of age.
• Preterm infants have very special nutrient needs.
  
• Mealtimes with toddlers should be a pleasant and
  relaxed environment.

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Nutrition during Infancy

• Energy and Nutrient Needs
• Energy Intake and Activity
• Weight doubles the first five months, triples by
  one year.
• High basal metabolic rate
• Rapid growth
• 45 kcal/pound body weight (change this to kJ/kg)
• Energy Nutrients
• Carbohydrates at 60 of energy intake, needed for
  brain
• Fat provides most of the energy
• Protein especially important for growth and
  development

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Nutrition during Infancy

• Energy and Nutrient Needs
• Vitamins and Minerals
• More than double the needs of an adult in
  proportion to weight
• Vitamin A, vitamin C, vitamin D and iodine are
  especially high
• Water
• Higher of water compared to adults
• Found outside the cells and easily lost
• Dehydration from diarrhoea and vomiting is a
  concern.

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Nutrition during Infancy

• Breast Milk
• Frequency and Duration of Breastfeeding
• First few weeks 8-12 feedings per day on demand
• Every two to three hours
• 10-15 minutes on each breast
• What do Breastfeeding Australia think?

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Nutrition during Infancy

• Breast Milk
• Energy Nutrients
• Lactose, the form of carbohydrate in breast milk,
  enhances calcium absorption.
• Alpha-lactalbumin is the form of protein in milk
  and is easily digested and absorbed.
• Fat is generous in essential fatty acids.
• Vitamins
• Vitamin D content is low.
• In the US - Vitamin D supplementation is
  recommended by AAP for breastfed infants. Is this
  necessary in Australia?

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Infants vs Adults!
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Nutrition during Infancy

• Breast Milk
• Minerals
• Calcium is well absorbed
• High bioavailability of iron and zinc
• Low in sodium and fluoride
• Supplements
• Vitamin D, iron and fluoride during first year
• A single dose of vitamin K is given at birth.

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Nutrition during Infancy

• Breast Milk
• Immunological Protection
• Colostrum, the first secretions from the breast,
  provides antibodies and white blood cells.
• Bifidus factors allow for the growth of normal
  flora.
• Lactoferrin is a protein that binds iron so that
  bacteria cannot grow.
• Lactadherin is a protein that fights viruses that
  cause diarrhoea.
• Breast milk also contains growth factors and
  lipase enzymes.

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Nutrition during Infancy

• Breast Milk
• Allergy and Disease Protection
• Fewer allergies than formula-fed babies
• Lower blood pressure as adults
• Lower blood cholesterol as adults
• Other Potential Benefits
• Less obesity as adults
• Indications of positive effect on later
  intelligence

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Nutrition during Infancy

• Infant Formula
• Infant Formula Composition
• Infants can be weaned to formula or other
  appropriate foods when breastfeeding is ended.
• Copy breast milk if possible
• Iron-fortified
• Risks of Formula Feeding
• Be careful about lead-contaminated water.
• Contains no antibodies
• Use proper food handling techniques.

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Nutrition during Infancy

• Infant Formula
• Infant Formula Standards (in Australia??)
• American Association of Pediatricians (AAP)
  guidelines
• FDA mandates safety and nutritional qualities
• Special Formulas
• For premature infants or those with inherited
  diseases
• Hypoallergenic formulas or soy formulas for
  infants with allergies
• Soy formulas for lactose intolerance and vegans

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Nutrition during Infancy

• Infant Formula
• Inappropriate Formulas
• Soy beverages are nutritionally incomplete and
  inappropriate.
• Goats milk is deficient in folate.
• Nursing Bottle Tooth Decay
• Can be caused by formula, milk, or juice
• Prolonged exposure to formula when sleeping
• Upper and lower teeth may be affected by decay.

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Dont give a bottle to go to sleep!
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Nutrition during Infancy

• Special Needs of Preterm Infants
• Limited nutrient stores
• Physical and metabolic immaturity
• Long-chain fatty acids are important for the
  healthy growth of blood vessels and bones.
• Preterm breast milk fortified with preterm formula

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Nutrition during Infancy

• Introducing Cows Milk
• No cows milk the first year
• Contains the protein casein and may cause
  intestinal bleeding and anaemia in the first year
  of life
• Whole cows milk from 1-2 years of age
• Reduced-fat cows milk gradually introduced
  between 2-5 years of age

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Nutrition during Infancy

• Introducing Solid Foods
• When to Begin
• 4-6 months
• Timing varies from infant to infant depending on
  growth rates, activities, and environmental
  conditions.
• Beikost is any non-milk foods given to an infant.

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Nutrition during Infancy

• Introducing Solid Foods
• Food Allergies
• Introduce single-ingredient foods, one at a time.
• Period of 4 to 5 days between new foods
• Rice cereal, then oat and barley, and lastly
  wheat
• Allergic reactions include skin rash, digestive
  upset, or respiratory discomfort.

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Nutrition during Infancy

• Introducing Solid Foods
• Choice of Infant Foods
• Should be provided with variety, balance, and
  moderation
• Palatable and nutritious
• No added salt, sugar, or seasonings
• Safe and convenient
• Fat information is not provided on food labels

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Nutrition during Infancy

• Introducing Solid Foods
• Foods to Provide Iron
• Iron-fortified cereals with vitamin C-rich foods
  and juices
• Meat or meat alternatives such as legumes
• Foods to Provide Vitamin C
• Vegetables first, then fruits
• Set limits on fruit juice consumption at 4-6
  ounces per day.

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Nutrition during Infancy

• Introducing Solid Foods
• Foods to Omit
• Concentrated sweets
• Products with sugar alcohols (sorbitol) that may
  cause diarrhoea
• Canned vegetables contain too much sodium.
• There is a botulism risk with honey and corn
  syrup.
• Choking hazards from carrots, cherries, gum, hard
  or gel-like candies, hot dogs, marshmallows,
  nuts, peanut butter, popcorn, raw celery, whole
  beans, and whole grapes

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Nutrition during Infancy

• Introducing Solid Foods
• Vegetarian Diets during Infancy
• Rice milk is inappropriate for infants and
  toddlers.
• Iron-fortified cereals needed until the second
  year of life
• Milk products and variety are important to proper
  nutrition.
• Deficiencies of vitamin D, vitamin B12, iron, and
  calcium may develop.
• Energy-dense foods are required.

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Nutrition during Infancy

• Introducing Solid Foods
• Foods at One Year
• 2-3 cups cows milk
• Be careful of milk anaemia when milk is consumed
  excessively.
• Balance and variety from all food groups
• Drink liquids from a cup, not a bottle

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Nutrition during Infancy

• Mealtimes with Toddlers
• Discourage unacceptable behavior.
• Let toddlers explore and enjoy food.
• Dont force foods.
• Let children choose nutritious foods.
• Limit sweets.
• Make mealtimes pleasant.

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Nutrition during Childhood

• Energy needs, nutrient needs, and appetites
  during childhood vary because of growth and
  physical activity.
• Hunger and nutrient deficiencies affect
  behaviour.
• Nutrition concerns at this age include
• lead poisoning, high energy, sugar and fat
  intakes, iron deficiency, caffeine consumption,
  food allergies, and food intolerances.
• Adults and schools need to provide children with
  nutrient-dense foods.

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Nutrition during Childhood

• Energy and Nutrient Needs
• Energy Intake and Activity
• Needs vary widely because of growth and physical
  activity.
• Energy requirements (convert to SI)
• 1 year 800 kcalories
• 6 years 1,600 kcalories
• 10 years 2,000 kcalories
• Inactivity can lead to obesity.
• Vegans may have difficulty in meeting energy
  needs.

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Nutrition during Childhood

• Energy and Nutrient Needs
• Carbohydrate and Fibre
• Carbohydrate recommendations are the same as
  those for adults.
• Fibre intakes change with age.
• Fat and Fatty Acids
• Children 1-3 years should have 30-40 of energy
  from fat.
• Children 4-18 years should have 25-35 of energy
  from fat.
• Low-fat diets may have low vitamin and mineral
  content.

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Nutrition during Childhood

• Energy and Nutrient Needs
• Protein
• Needs increase slightly with age
• Requirement considers nitrogen balance, the
  quality of protein consumed, and the added needs
  of growth
• Vitamins and Minerals
• Needs increase with age.
• Balanced diet meets all needs except iron
• Iron-fortified foods are important.

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Nutrition during Childhood

• Energy and Nutrient Needs
• Supplements
• Rely on foods
• Supplements not needed
• Planning Childrens Meals
• Variety of foods from each food group
• Proper portion sizes

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Nutrition during Childhood

• Hunger and Malnutrition in Children
• Hunger and Behaviour
• Missing meals, especially breakfast,
• Affects behaviour and academic performance.
• gt Low blood glucose,
• gt smaller glycogen stores

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Nutrition during Childhood

• Hunger and Malnutrition in Children
• Iron Deficiency and Behaviour
• Affects behaviour and intellectual performance
• Affects attention span and learning ability
• Brain is affected by low iron before the blood is
  affected.
• Other Nutrient Deficiencies and Behaviour
• Marginal malnutrition may affect behaviour.
• Affects personal appearance also

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Nutrition during Childhood

• The Malnutrition-Lead Connection
• Malnourished children are more vulnerable to lead
  poisoning.
• Anaemia caused by lead may be mistaken for an
  iron problem.
• Can develop learning disabilities and behavioural
  problems
• Ban on lead in food and the environment has helped

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Nutrition during Childhood

• Hyperactivity and Hyper Behaviour
• Hyperactivity, also called attention-deficit/hyper
  activity disorder (ADHD)
• Interferes with social development and academic
  behaviour
• Dietary changes and alternative therapies do not
  solve true hyperactivity.
• No evidence that sugar causes hyperactivity

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Nutrition during Childhood

• Hyperactivity and Hyper Behaviour
• Misbehaving children need consistent care.
• Regular hours of sleep
• Regular mealtimes
• Regular outdoor activity

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Nutrition during Childhood

• Food Allergy
• also called food-hypersensitivity reactions
• and Intolerance
• Detecting Food Allergy
• Immunologic response with the production of
  antibodies, histamines, and other defensive
  agents
• 3-5 of children are diagnosed
• Asymptomatic allergy produces antibodies without
  symptoms
• Symptomatic allergy produces antibodies and
  symptoms

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Nutrition during Childhood

• Food Allergy and Intolerance
• Anaphylactic Shock
• Life-threatening food allergy reaction
• Foods may include eggs, milk, soy, peanuts, tree
  nuts, wheat, fish, and shellfish
• Often outgrow allergies to eggs, milk, and soy
• Recognize symptoms
• Epinephrine injections (adrenalin) can be used to
  counteract anaphylactic shock.
• Food labelling to identify common allergens and
  additives

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Nutrition during Childhood

• Food Allergy and Intolerance
• Food Labelling
• Eight common allergens must appear on a food
  label.
• If cross-contamination is possible, this must be
  stated on the label.
• Food Intolerances
• Adverse reactions to foods like stomach aches,
  headaches, rapid pulse rate, nausea, wheezing,
  hives, bronchial irritation, coughs, and other
  discomforts are not all food allergies.
• Symptoms without antibody production
• A tolerance level for pesticides has been set
  based on the effects on development.

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Percentage of children classified as overweight
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Nutrition during Childhood

• Childhood Obesity
• Genetic and Environmental Factors
• Parental obesity is a risk factor. Parents act as
  role models.
• Poor diet and physical inactivity are risk
  factors.
• Convenience foods and meals eaten away from home
• Non-nutritious choices at school
• Sedentary activities, e.g. watching television
• Energy-dense soft drinks

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Nutrition during Childhood

• Childhood Obesity
• Growth
• Grow taller at first, then stop growing at a
  shorter height
• Greater bone and muscle mass to support weight,
  thus stocky appearance
• Physical Health
• Abnormal blood lipid profile
• Increases the risk for high blood pressure, type
  2 diabetes, and respiratory disease

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Nutrition during Childhood

• Childhood Obesity
• Psychological Development
• Emotional and social problems
• Stereotypes and discrimination
• Prevention and Treatment of Obesity
• Integrated approach with diet, physical activity,
  psychological support, and behavioural changes
• Begin early treatment before adolescence

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Nutrition during Childhood

• Childhood Obesity
• Diet
• Reduce rate of weight gain, rather than attempt
  weight loss
• Strategies
• Serve kjoule-controlled family meals.
• Involve children in shopping and preparing meals.
• Encourage children to eat when hungry, eat
  slowly, enjoy food, and stop eating when full.
• Teach them to select nutrient-dense foods.
• Limit high-fat and high-sugar foods.
• Never force children to clean plates.
• Plan for nutritious snacks.
• Discourage eating while watching television.

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Nutrition during Childhood

• Childhood Obesity
• Physical Activity
• Limit sedentary activities.
• Encourage regular vigorous activity.
• Parents need to set good examples.

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Nutrition during Childhood

• Childhood Obesity
• Psychological Support
• Weight-loss programs with parental involvement
• Positive influence on eating behaviours
• Behavioural Changes
• Focus on how to eat
• Parental and media influence
• Teaching consumer skills

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Nutrition during Childhood

• Mealtimes at Home
• Parents as gatekeepers
• Honoring Childrens Preferences
• Offer variety of foods
• Fun mealtimes
• Learning through Participation
• Help plan meals
• Assist with food preparation

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Nutrition during Childhood

• Mealtimes at Home
• Avoiding Power Struggles
• Children need to regulate their own food intakes.
• Can determine their own likes and dislikes
• Offer new foods at the beginning of meals and in
  small quantities.
• Choking Prevention
• Be alert to foods that are common causes of
  choking.
• Make sure children are sitting, not running or in
  danger of falling when eating.

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Nutrition during Childhood

• Mealtimes at Home
• Playing First
• Schedule outdoor play before meals.
• Relax and take time while eating.
• Snacking
• Teach how to snack
• Limit access to concentrated sweets.

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Nutrition during Childhood

• Mealtimes at Home
• Preventing Dental Caries
• Brush and floss after meals.
• Brush or rinse after snacks.
• Avoid sticky foods.
• Select crisp and fibrous foods.
• Serving as Role Models
• Children learn through imitation of parents,
  older siblings, and care givers.
• Help children to develop positive attitudes
  toward food and eating.

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Nutrition during Childhood

• Nutrition at School
• Meals at School not govt funded (AUS)
• Voluntary programs
• Breakfast in schools
• School Canteens Healthy Foods Program
• Seeking to reduce childhood obesity and behaviour
  problems

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Nutrition during Adolescence

• Another rapid state of growth occurs during
  adolescence.
• Nutrient needs rise, and iron and calcium are
  especially important.
• Busy lifestyles make it challenging to meet
  nutrient needs and develop healthy habits.
• Peer pressure is significant among adolescents.

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Nutrition during Adolescence

• Growth and Development
• Growth speeds up and continues for about 2½
  years.
• Gender differences
• Females begin puberty at 10-11 years of age, grow
  15cm taller, add fat, and gain about 16kg.
• Males begin puberty at 12-13 years of age, grow
  20cm taller, add lean body mass, and gain 20kg.

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Nutrition during Adolescence

• Energy and Nutrient Needs
• Energy Intake and Activity
• Needs vary depending on rate of growth, gender,
  body composition, and physical activity.
• Energy needs can range
• from 7560kJ per day for an inactive female
• to 14700 kJ per day for a highly active male.
• Problems with overweight and obesity

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Nutrition during Adolescence

• Energy and Nutrient Needs
• Vitamins
• Needs for all vitamins increase
• Vitamin D needs special attention because it
  allows for calcium absorption.
• Iron
• Females needs increase because of menstruation.
• Males needs increase because of developing lean
  body mass.
• Iron deficiency is a concern.

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Nutrition during Adolescence

• Energy and Nutrient Needs
• Calcium
• Crucial time for peak bone mass
• Increase milk and milk products
• Low calcium intakes and physical inactivity may
  cause problems with osteoporosis in later life.

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Nutrition during Adolescence

• Food Choices and Health Habits
• Snacks
• Provide ¼ of daily energy intake
• Favorite snacks are often high in fat and sodium
  and low in fibre.
• Beverages
• Soft drinks replace fruit juices and milk.
• Caffeine may be an issue.

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Nutrition during Adolescence

• Food Choices and Health Habits
• Eating Away from Home
• 1/3 of meals are consumed away from home.
• Influence of fast-food restaurants
• Peer influence
• is strong when making nutritional choices.

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Nutrition during Adolescence

• Problems Adolescents Face
• Marijuana
• Enhances enjoyment of sweets
• Affects appetite, pain and memory
• Cocaine
• Stimulates nervous system
• Elicits the stress response
• Weight loss is common.

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Nutrition during Adolescence

• Problems Adolescents Face
• Ecstasy
• Serotonin flooding alters mood may also damage
  nerve cells and impair memory
• Tend to lose weight
• Drug Abuse, in General
• Use money to buy drugs, not food
• Lose interest in foods
• Use drugs that suppress appetite
• Lifestyles fail to promote good eating
• Infectious disease affects nutrition.
• Medications to treat drug abuse alter nutrition
  status.

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Nutrition during Adolescence

• Problems Adolescents Face
• Alcohol Abuse
• Provides energy, no nutrients
• Displaces nutritious foods from the diet
• Alters nutrient absorption and metabolism
• Smoking
• Eases feelings of hunger
• Lower vitamin and fiber intakes
• Increases needs for vitamin C
• Need antioxidant fruits and vegetables to reduce
  cancer risk
• Smokeless tobacco (chewing)
• has many drawbacks including cancer of the mouth.

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Childhood Obesity and the Early Development of
Chronic Diseases

• Highlight 16

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Childhood Obesity and the Early Development of
Chronic Diseases

• Nutrition and health education programs during
  childhood and adolescence are effective when
  combined with heart-healthy meals at home and
  school, fitness activities and parental
  involvement.
• Cardiovascular disease (CVD) damages the heart.

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Early Development of Type 2 Diabetes

• On the increase in recent years
• Risk factors include obesity, sedentary
  lifestyle, and family history.
• Insulin resistance
• Increased blood cholesterol and blood pressure
  leading to atherosclerosis and CVD
• Many complications leading to a shorter life span

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Early Development of Heart Disease

• Atherosclerosis
• Is often a part of cardiovascular disease
• Artery walls thicken with plaque
• Fatty streaks begin to accumulate in fibrous
  connective tissue
• Lesions in the arteries

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Early Development of Heart Disease

• Blood Cholesterol
• Tends to rise as dietary saturated fat increases
• Correlation with childhood obesity
• Family relationship
• Screening and education are key.
• Blood Pressure
• May be a sign of underlying disease
• More common in obese children

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To convert these to SI values - mmol/L,multiply
by 10 and then divide by 386.
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Physical Activity

• Active children have better lipid profiles.
• Habits developed at this age are carried into
  later life.

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Dietary Recommendations for Children

• Moderation, Not Deprivation
• Less saturated fat
• More fruits and vegetables
• Nuts, vegetable oils, and some fish provide
  essential fatty acids.
• Treat problems with diet first, then drugs.

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Smoking

• Increases risk for heart disease
• Half of teens who continue to smoke will die of
  smoking-related causes.