Nutrition, Growth and Development Week 1- Nutrition

WEEK OBJECTIVES 1. Describe the nutritional, energy, and fluid requirements for infancy and childhood for normal growth and development. Source: Texas Heart Institute Heart Information Center a. Fibre: Describe the role of fibre in health and prevention of disease. Identify the major sources of fibre in the diet of children. o Fiber is a form of complex carbohydrate o A diet high in fiber has been shown to reduce cholesterol levels, protect against heart disease, cancer, stomach/bowel problems o 2 forms of fiber: soluble and insoluble soluble fiber is found in oatmeal, dried beans, peas, fruits, apples, strawberries, citrus insoluble fiber is found in cereals, whole grains, rice and vegetables b. Carbohydrates: Explain the role of carbohydrates as a source of energy. Identify the sources of carbohydrates. (lectures) o Carbohydrates are the main source of fuel in a balanced diet. The body converts carbohydrates to glucose, which can be used right away or can be stored in glycogen in muscle and liver. Glycogen can be quickly changed back to glucose as needed. Once your body has made enough glycogen, the leftover glucose is stored as fat. Sugars are simple carbohydrates: glucose, sucrose, galactose. Milk, fruit and sugar added to foods are sources of simple carbs, and are an immediate source of energy. Fruit, soda, refined and brown sugar, honey, syrup Starches and fiber are complex carbohydrates. Bread, cereal, corn, peas, potatoes, pasta and rice c. Proteins: Outline the differences between dispensable and indispensable amino acids. Explain the major roles of proteins in the body. (lectures) Indispensible (or essential AA) are necessary in the diet as they cannot be made in the body o Histidine, isoleucine, leucine, lysine, methionine, valine, phenylalanine, threonine, tryptophan Dispensible (or non essential AA) are not necessary in the diet as the body can make them o All the others Function: immune function, enzymes, transport nutrients throughout the body, hormone, fluid balance (albumin), transporting O2, source of energy (4kcal/gm) d. Lipids: Describe the different types of dietary fats and how they are metabolized; explain the role of fat in the diet. Explain the role that essential fatty acids play in the diet, in health and in disease. o Saturated fat
Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

Raises cholesterol, increases heart disease risk Butter, fat from red meat, tropical oils (coconut oil) Trans fats

Unsaturated fat Omega 3 fatty acids: linolenic acid Can be converted to DHA and EPA in the body Found in fish oil, flaxseed oil, canola and soybean oil o Marine fish oils also provide other omega 3 fatty acids in large amounts Omega 6 fatty acids: linoleic acid Can be converted to ARA in the body Found in plant oils, vegetable oils (safflower, sunflower, corn, soya)

Partial hydrogenation of unsaturated fatty acids (as occurs during food manufacturing) produces trans fatty acids, which are solid or semisolid at room temperature. Main source of trans fatty acids is partially hydrogenated vegetable oils, used in manufacturing certain foods (eg, cookies, crackers, chips) to prolong shelf-life. Trans fatty acids may elevate LDL cholesterol and lower HDL; they may also independently increase the risk of coronary artery disease.

e. Energy: Describe the fluid and calorie requirements for infants, children, and youth. Explain how and why energy requirements vary throughout the lifespan.

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

f. Explain the importance of breastfeeding and discuss the advantages of breast milk in infant health. Nutritional benefits of breastfeeding include o Better protein quality and digestibility o fat quality and digestibility o energy/intake regulation o decreased infection o decreased eczema risk o may have benefits to intelligence o may or may not decrease obesity rates 3. Describe the role that nutrition and healthy, active living play in child development

Long term impacts of inactivity and poor nutrition in children: Chronic disease o Cardiovascular disease, type II diabetes, osteoporosis, dental carries, cancer

Overweight and obesity o Respiratory difficulties, chronic MSK problems, skin disease, infertility

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

Academic difficulties Mental health problems Reduced quality of life

Nutrition Eating breakfast leads to improved academic performance o Kids who skip breakfast show slower memory recall and increased errors

Undernourished kids tend to have lower scores on tests and are more likely to repeat a grade Severe malnutrition in early life negatively affects intellectual development o o Kids with malnutrition or current under-nutrition did even more poorly Decreased diet quality is a predictor of poor test scores

Healthy active living Results of increasing physical activity in school aged children: 1. Heart Health o o Lower levels of triglycerides, fibrinogen, homocystine, C-reactive protein Higher aerobic fitness levels and increased arterial compliance

2. Healthy Weight Reduction in BMI 3. Healthy Bones Increased bone density 4. Healthy Self No significant change noted from just introducing an activitybased program 5. Academic Performance o Maintain or improve academic performance (improved planning, short term memory and behaviour control in the classroom)

5. Plot childrens growth parameters and BMI on growth charts (both WHO
Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

and CDC) and use the plots to assess against normal growth velocities Source: Journal of Nutrition 2007, lectures In Canada, use WHO. Only use CDC in specialized situations, i.e. eating disorders. CDC vs WHO o WHO: The WHO charts are based for the first time on a prescriptive, prospective,
international sample of infants selected to represent optimum growth. Compared to CDC reflects a lighter, taller sample population-based study conducted between 1997 and 2003 in Brazil, Ghana, India, Norway, Oman, and the United States. Lived in socioeconomic conditions favorable to growth. no known health or environmental constraints to growth , mothers willing to follow MGRS feeding recommendations (i.e., exclusive or predominant breast-feeding for at least 4 mo, introduction of complementary foods by 6 mo of age, and continued breast-feeding to at least 12 mo of age), no maternal smoking before and after delivery, single term birth absence of significant morbidity CDC: based on national data collected in a series of 5 surveys between 1963 and 1994. Reflects a shorter, heavier sample

Whereas WHO standards are based solely on breast fed infants, the CDC sample based on relatively few infants who were breast fed for more than a few months (e.g. in one survey sample only 1/5 exclusively breast fed for 4 months) Includes obese children Includes children with chronic disease Sample size and study design not as rigorous as WHO. When analyzing growth charts, important to look at trends, as opposed to a single point on the chart o As long as infant stays on the same growth curve, there should be no alarm (except in cases listed below). Also take into consideration height/weight of parents when assessing children. Causes for concern o When cross over different growth curves, sharp decline, sharp increase o WHO: when under 3rd percentile or over 85th percentile. 85-97% overweight 97.1-99.9 obese class I (mild) >99.9% obese class II (moderate) <3%: wasting <0.1% severe wasting. o CDC: 85-95% is at risk of over weight. >95% is overweight

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

CASE OBJECTIVES 6. Use a growth chart to identify whether current weights is within normal range

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

7. Describe consequences of anemia on development Source: Nelsons Iron deficiency has nonhematologic systemic effects. The most concerning effects in infants and adolescents are impaired intellectual and motor functions that can occur early in iron deficiency before anemia develops. There is evidence that these changes might not be completely reversible after treatment with iron, increasing the importance of prevention. Pica, the desire to ingest non-nutritive substances, and pagophagia, the desire to ingest ice, are other systemic symptoms of iron deficiency. The pica can result in the ingestion of leadcontaining substances and result in concomitant plumbism (chronic lead poisoning) 12. Explain how nutritional deficiencies can exist in the face of obesity. Describe appropriate interventions in the child/youth with obesity. Overweight and obese patients may develop paradoxical nutritional deficiency from eating high-energy foods with a poor nutrient content. The concept the nutrient density of food assists not only in identifying and treating nutritional deficiencies, but also in preventing them. Naturally nutrient rich foods are those providing the highest amounts of nutrients for the least amount of kilojoules. o E.g. dark-coloured fruits and vegetables, whole grains, lean meats, seafood, eggs, beans, nuts and low-fat dairy products

Appropriate Interventions: It is important for people deciding to reduce their kilojoule intake to maintain a nutritionally sound diet, providing adequate vitamins, minerals and macronutrients.
Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014

Nutrition, Growth and Development Week 1- Nutrition

Provide nutritional guidance o Establish set meal plans: remove foodstuffs with empty calories and encourage consumption of nutrient dense foods. Increase physical activity. Counseling and support to enhance behaviour modification. She began a regular

Peter Chen, Alia Dharamsi, Sebastian Ko, Justin Mui, Kulveer Parhar, Aalia Sachedina, Indeep Sehkon MD 2014