CHILD AND ADOLESCENT NUTRITION. Definition: Nutrition = modifications of food`s components in the body to maintain life. The processes of growth, maintenance.

CHILD AND ADOLESCENT CHILD AND ADOLESCENT

NUTRITIONNUTRITION

CHILD AND ADOLESCENT NUTRITIONCHILD AND ADOLESCENT NUTRITION

Definition:Definition:

Nutrition = modifications of food`s components in the Nutrition = modifications of food`s components in the body to maintain life.body to maintain life.

The processes of growth, maintenance of organs and The processes of growth, maintenance of organs and systems are due to dietary nutrients, plastics, energy and systems are due to dietary nutrients, plastics, energy and biocatalyst.biocatalyst.

CHILD AND ADOLESCENT NUTRITIONCHILD AND ADOLESCENT NUTRITION

Nutritional needs:Nutritional needs: - quantity (energy, calorific value); - quantity (energy, calorific value); - quality. - quality.

Quantitative nutritional needs (energy)Quantitative nutritional needs (energy)

Life processes in the body are made of energy Life processes in the body are made of energy expenditure.expenditure.The main energy sources are carbohydrates and lipids.The main energy sources are carbohydrates and lipids.

Energy needsEnergy needs:: - maintenance needs - maintenance needs - needs for thermoregulation - needs for thermoregulation - physical activity or muscle activity - physical activity or muscle activity

- needs for growth - needs for growth

ENERGY NEEDSENERGY NEEDS

1. 1. Maintenance needs for basal metabolism = needs and Maintenance needs for basal metabolism = needs and the needs of operation:the needs of operation:

a) basal metabolism (MB) a) basal metabolism (MB) = total body energy = total body energy expenditure for breathing, heart contractions, secretions, expenditure for breathing, heart contractions, secretions, etc..etc.. M.B. MB 2 x baby = adult. M.B. MB 2 x baby = adult. M.B. lower in premature and dystrophic. M.B. lower in premature and dystrophic. M.B. increase in feverish. M.B. increase in feverish.

Maintenance needsMaintenance needs

b) b) Operational needs Operational needs = needs for food specific dynamic = needs for food specific dynamic action (SDA) and losses through excretion.action (SDA) and losses through excretion.

SDA = calories expended in food digestion and SDA = calories expended in food digestion and utilization.utilization.

higher energy expenditure after ingestion of protein higher energy expenditure after ingestion of protein and lower fat and carbohydrate intake after small and lower fat and carbohydrate intake after small increase in weight → high protein regimens.increase in weight → high protein regimens.

Maintenance needsMaintenance needs

similar diets meals → consuming lower calorie when similar diets meals → consuming lower calorie when the number is higher.the number is higher.

Losses increased excretion:Losses increased excretion:- artificial nutrition (hyperosmolar formulas)- artificial nutrition (hyperosmolar formulas)- diarrhea.- diarrhea.


2.2. The needs for thermoregulation depends on:The needs for thermoregulation depends on: - large body size in relation to weight; - large body size in relation to weight; - skin thinness; - skin thinness; - ambient temperature. - ambient temperature.

3.3. Physical activity and muscle activity requires energy Physical activity and muscle activity requires energy to the intensity and duration of effort. to the intensity and duration of effort.


4. 4. Growth needs vary with:Growth needs vary with: - age (the higher the more the child is less) - age (the higher the more the child is less) - child health, - child health, - individual peculiarities. - individual peculiarities.

The caloric needs are covered by the body by burning The caloric needs are covered by the body by burning food that provides on average:food that provides on average:4 kcal per 1 gram of protein;4 kcal per 1 gram of protein;4 kcal per 1 gram carbohydrates;4 kcal per 1 gram carbohydrates;9 kcal per 1 gram fat.9 kcal per 1 gram fat.

Growth NeedsGrowth Needs Child's overall Child's overall energy ratio energy ratio diminishes with age:diminishes with age:

- in the first trimester of life: 110-120 kcal / kg / day;- in the first trimester of life: 110-120 kcal / kg / day; - in the second quarter: 100-110 kcal / kg / day; - in the second quarter: 100-110 kcal / kg / day; - third and fourth quarter: 90-100 kcal / kg / day; - third and fourth quarter: 90-100 kcal / kg / day; - child 1-3 years: 90 kcal / kg / day; - child 1-3 years: 90 kcal / kg / day; - preschool: 80 kcal / kg / day; - preschool: 80 kcal / kg / day; - school: 50-60 kcal / kg / day. - school: 50-60 kcal / kg / day.

Before puberty, growth is accelerating the need to Before puberty, growth is accelerating the need to increase caloric intake.increase caloric intake.

Growth NeedsGrowth Needs

Hiperglucidic scheme and / or infant hiperlipidicHiperglucidic scheme and / or infant hiperlipidic↓↓

stimulates lipidogenesisstimulates lipidogenesis↓↓

± hyperplasia, hypertrophy of adipose cells± hyperplasia, hypertrophy of adipose cells↓↓

early obesity early obesity

Growth NeedsGrowth Needs

Hypocaloric diets:Hypocaloric diets:→ malnutrition→ malnutrition→ depressants sympathetic nervous system → saving → depressants sympathetic nervous system → saving operating needs and thermogenesis.operating needs and thermogenesis.

Optimal caloric intakeOptimal caloric intake:: carbohydrates 45% of total calories, carbohydrates 45% of total calories, 33-40% lipids, 33-40% lipids, 12-15% protein. 12-15% protein.

QUALITATIVE NUTRITIONAL NEEDSQUALITATIVE NUTRITIONAL NEEDS

Plastic factorsPlastic factors: protein and some minerals;: protein and some minerals;Factors energyFactors energy: carbohydrates and lipids;: carbohydrates and lipids;Biocatalyst factorsBiocatalyst factors: vitamins, minerals, water.: vitamins, minerals, water.

Protein:Protein:- necessary for growth,necessary for growth,- sole source of nitrogen and indispensable amino sole source of nitrogen and indispensable amino

acids.acids.Carbohydrates:Carbohydrates: - elements easily digestible energy, - elements easily digestible energy, - necessary for lipid metabolism. - necessary for lipid metabolism.


Lipids:Lipids: - important source of energy in a small footprint - important source of energy in a small footprint - soluble vitamins and unsaturated fatty acids. - soluble vitamins and unsaturated fatty acids.

Qualitative nutritional needs of infants:Qualitative nutritional needs of infants:

Breast feedingBreast feeding Bottle feedingBottle feeding

ProteinProtein 2 – 2,5 g/kg/2 – 2,5 g/kg/day day 3 – 3,5 g/kg/ 3 – 3,5 g/kg/ day day

LipidLipid 4 – 6 g/kg/ 4 – 6 g/kg/ day day 4 – 6 g/kg/ 4 – 6 g/kg/ day day

Carbohydrate Carbohydrate 10 – 12 g/kg/10 – 12 g/kg/day day 10 – 12 g/kg/10 – 12 g/kg/day day


"food balance" = optimal ratio between the principles of "food balance" = optimal ratio between the principles of food:food:

P: L: G = 1:2:4 (P: L: G = 1:2:4 (newborn and infantnewborn and infant).).

P: L: G = 1:1,2:3,5 (P: L: G = 1:1,2:3,5 (child 1-3 yearschild 1-3 years). ).

ProteinProteinss

- not stored in the body → required daily intaknot stored in the body → required daily intak

- protein diet free total → more than 48 hours in infants - protein diet free total → more than 48 hours in infants and young childrenand young children

factors that alter protein intake:factors that alter protein intake: - adaptability of the body; - adaptability of the body; - carbohydrate intervention as saving factor protein; - carbohydrate intervention as saving factor protein; - biological value and protein digestibility (90% for - biological value and protein digestibility (90% for animal and 50-80% for vegetable).animal and 50-80% for vegetable).

ProteinProteinss

Sources:Sources: meat, cheese, fish, liver, eggs meat, cheese, fish, liver, eggs pasta, vegetables, fruits (smaller amounts) pasta, vegetables, fruits (smaller amounts)

Essential amino acids Essential amino acids (9)(9) phenylalanine, lysine, leucine, isoleucine, threonine, phenylalanine, lysine, leucine, isoleucine, threonine, tryptophan, methionine, valine, histidinetryptophan, methionine, valine, histidine - body can not synthesize or manufacture them in - body can not synthesize or manufacture them in sufficient quantity;sufficient quantity; - must exist in certain proportions for protein - must exist in certain proportions for protein resynthesis health state.resynthesis health state.

ProteinProteinss

essential amino acid needs in infants = 10 x adultessential amino acid needs in infants = 10 x adult proper diet → at least 50% of the total protein are proper diet → at least 50% of the total protein are animalanimal

Amino acid semiesential: under certain conditions the Amino acid semiesential: under certain conditions the body's ability to synthesize from their precursors.body's ability to synthesize from their precursors.

ProteinProteinss

Cystine, taurine Cystine, taurine (derived from methionine) and (derived from methionine) and tyrosinetyrosine (derived from phenylalanine) should be considered (derived from phenylalanine) should be considered essential amino acids in the neonatal period and low essential amino acids in the neonatal period and low birth weight baby.birth weight baby.

Non-essential amino acidsNon-essential amino acids:: alanine, arginine, glutamine, glycine, glutamic acid, alanine, arginine, glutamine, glycine, glutamic acid, asparagine, aspartic acid, cysteine (cystine), tyrosine, asparagine, aspartic acid, cysteine (cystine), tyrosine, proline, serine →contribute to meeting the needs of the proline, serine →contribute to meeting the needs of the body nitrogenbody nitrogen

ProteinProteinss

In breast fed infants protein requirement is lower In breast fed infants protein requirement is lower than in the bottle fed (high biological value and than in the bottle fed (high biological value and digestibility of human milk proteins rapidly).digestibility of human milk proteins rapidly).

For ideal maximum use of the protein → 32-35 kcal For ideal maximum use of the protein → 32-35 kcal compared to 1 g protein.compared to 1 g protein.

ProteinProteinss

Plastic rolesPlastic roles::- constitution of cells,- constitution of cells,- composition: hormones, enzymes, factors- composition: hormones, enzymes, factorscoagulationcoagulation- renewal of cells and tissues,- renewal of cells and tissues,- physical strength and intellectual- physical strength and intellectual- processes of the body's defenses against infection - processes of the body's defenses against infection and poisoning. and poisoning.

ProteinProteinss

Functional RolesFunctional Roles:: - circulating bilirubin, metals (Fe, Cu, Zn, Co, I), - circulating bilirubin, metals (Fe, Cu, Zn, Co, I), metabolites and blood gases;metabolites and blood gases;

- fluid exchange between capillaries and cell gap,- fluid exchange between capillaries and cell gap, device is muscle contraction; device is muscle contraction;

- maintenance of colloid-osmotic pressure of plasma;- maintenance of colloid-osmotic pressure of plasma;

- acid-base balance.- acid-base balance.

ProteinProteinss

Excess proteinExcess protein - exceeds the capacity of the kidney excretory → ↑ - exceeds the capacity of the kidney excretory → ↑ glomerular filtration → kidney hypertrophy.glomerular filtration → kidney hypertrophy. - causes hypertrophy of cell → fat storage → obesity - causes hypertrophy of cell → fat storage → obesity in adults.in adults. - hyperammonemia → low IQ. - hyperammonemia → low IQ.

ProteinProteinss

Protein deficiencyProtein deficiency::

- slow growth rate;- slow growth rate;

- reduction of enzymatic synthesis, hormonal and - reduction of enzymatic synthesis, hormonal and humoral immunologic factors;humoral immunologic factors;

- clinical: swelling hypoproteinemia and protein - clinical: swelling hypoproteinemia and protein malnutrition (kwashiorkor). malnutrition (kwashiorkor).

CarbohydratesCarbohydrates

- - energy substrate for all cells,energy substrate for all cells, - plastic role in human body structure - plastic role in human body structure serve to biosynthesis of: serve to biosynthesis of:

-glycogen,-glycogen,-galactocerebrosis brain-galactocerebrosis brain-glucoproteins,-glucoproteins,-glucolipids,-glucolipids,-amino acids-amino acids-fatty acids. -fatty acids.


Food carbohydratesFood carbohydrates::- - monosaccharidesmonosaccharides (glucose, fructose and galactose) (glucose, fructose and galactose)

- - glucose polymersglucose polymers

- - disaccharidesdisaccharides (lactose, sucrose and maltose) (lactose, sucrose and maltose)

- - polysaccharidespolysaccharides (starch and glycogen). (starch and glycogen).

CarbohydratesCarbohydratesGlucose:Glucose: - in fruits, vegetables, honey, - in fruits, vegetables, honey,

- fetal transplacental transfer of glucose - dependent of - fetal transplacental transfer of glucose - dependent of mother glycemia;mother glycemia;

- control of glucose homeostasis is fully in 2-5 weeks - control of glucose homeostasis is fully in 2-5 weeks after birth, including premature;after birth, including premature;

- glucose polymers are an adequate source of - glucose polymers are an adequate source of carbohydrate for premature infants and infants with carbohydrate for premature infants and infants with malabsorption, and is easily hydrolyzed in the gut.malabsorption, and is easily hydrolyzed in the gut.


Fructose:Fructose:

in fruits, vegetables, honey or derived from hydrolysis in fruits, vegetables, honey or derived from hydrolysis of sucrose.of sucrose.

GalactoseGalactose::

- derived from hydrolysis of milk lactose,- derived from hydrolysis of milk lactose, - favorably influence brain development in newborn - favorably influence brain development in newborn and infant.and infant.


LactoseLactose:: - quantities in human milk > cow's milk only, - quantities in human milk > cow's milk only, - important role in infant brain development. - important role in infant brain development.

SucroseSucrose:: - high power sweetening - high power sweetening - child with customary sweetness, - child with customary sweetness, - promote obesity. - promote obesity.


MaltoseMaltose:: - the seeds sprouted grains - the seeds sprouted grains - produced by hydrolysis of starch - produced by hydrolysis of starch - slowly hydrolyzed by maltase → 2 glucose molecules - slowly hydrolyzed by maltase → 2 glucose molecules - is well tolerated. - is well tolerated.

StarchStarch:: - cereals, tubers, roots, bananas, - cereals, tubers, roots, bananas, - its hydrolysis is initiated by salivary and pancreatic - its hydrolysis is initiated by salivary and pancreatic amylase. amylase.


GlycogenGlycogen:: - storage form of carbohydrate in the liver and muscle - storage form of carbohydrate in the liver and muscle - starch-like structure - starch-like structure - hydrolyzed by the same enzymes. - hydrolyzed by the same enzymes.

FiberFiber:: - wall polysaccharides in plant - wall polysaccharides in plant - resist the hydrolytic action of human digestive - resist the hydrolytic action of human digestive enzymes,enzymes, - digestibility dependent chemical structure, how to - digestibility dependent chemical structure, how to prepare, while standing in the intestinal flora and colon.prepare, while standing in the intestinal flora and colon.


The main The main action of dietary fiberaction of dietary fiber::

- increases fecal volume and accelerates intestinal - increases fecal volume and accelerates intestinal transit bowl;transit bowl;

- regulates appetite - effect of satiety; - regulates appetite - effect of satiety;

- amended by binding to intestinal bacterial flora; - amended by binding to intestinal bacterial flora;

- increased excretion of fat, protein and calories in the - increased excretion of fat, protein and calories in the stool; stool;


The main action of The main action of dietary fiberdietary fiber:: - increase the removal of cations by reducing the - increase the removal of cations by reducing the absorption of Zn, Fe, Ca, Mg, Na and K;absorption of Zn, Fe, Ca, Mg, Na and K;

- binds cholesterol and bile acids in the gut; - binds cholesterol and bile acids in the gut;

- decrease the absorption of carbohydrates through the - decrease the absorption of carbohydrates through the formation of gels and modulates tissue sensitivity to formation of gels and modulates tissue sensitivity to insulin.insulin.

SourcesSources of dietary fiber: bran cereals, fruits, vegetables. of dietary fiber: bran cereals, fruits, vegetables.


The The quantity and quality of carbohydrate intake quantity and quality of carbohydrate intake during the first months of life is crucial for life and any during the first months of life is crucial for life and any error during the formation of brain cells is irreparable. error during the formation of brain cells is irreparable.


Carbohydrate Carbohydrate needsneeds:: - premature: 6 -8 g / kg / day (first week - transient - premature: 6 -8 g / kg / day (first week - transient lactase deficiency), then 12 g / kg / day;lactase deficiency), then 12 g / kg / day; - new - born IUGR: 18-25 g / kg / day in the neonatal - new - born IUGR: 18-25 g / kg / day in the neonatal period to combat hypoglycemia;period to combat hypoglycemia; - infant and young child: 12 g / kg / day; - infant and young child: 12 g / kg / day; - preschool: 10 g / kg / day; - preschool: 10 g / kg / day; - school: 8 g / kg / day. - school: 8 g / kg / day.


Deficiency of carbohydrate, in terms of adequate intake Deficiency of carbohydrate, in terms of adequate intake of protein, determined using protein for energy purposes of protein, determined using protein for energy purposes by their gluconeogenesis and avoid the structural role.by their gluconeogenesis and avoid the structural role.

Excess sugar Excess sugar leads to obesity and diabetes mellitus by leads to obesity and diabetes mellitus by insulin depletion.insulin depletion.Excess milk lactose Excess milk lactose in some formulas produce osmotic in some formulas produce osmotic diarrhea.diarrhea.Excess starch Excess starch creates imbalance of nutritional factors creates imbalance of nutritional factors with development dystrophy by hypoproteinemia.with development dystrophy by hypoproteinemia.

LipidLipidss

energy and nutrients with plastic role (the nervous energy and nutrients with plastic role (the nervous system myelination)system myelination)

dietary fatdietary fat:: - triglycerides, - triglycerides, - phospholipids - phospholipids - cholesterol - cholesterol - metabolic derivatives of fats. - metabolic derivatives of fats.

LipidLipidss

Triglycerides (TG)Triglycerides (TG) - most of the food ration; - most of the food ration; - have animal origin (milk, butter, egg yolk, meat, - have animal origin (milk, butter, egg yolk, meat, offal) and vegetable (soybean oil, corn, sunflower, offal) and vegetable (soybean oil, corn, sunflower, olive);olive); - TG animal nature prevails in saturated fats such as - TG animal nature prevails in saturated fats such as vegetable and in the predominant polyunsaturated vegetable and in the predominant polyunsaturated fatty acids.fatty acids.

LipidLipidss

Saturated fatty acidsSaturated fatty acids: increased plasma cholesterol : increased plasma cholesterol levels and promote atherosclerosis.levels and promote atherosclerosis.

Unsaturated fatty acidsUnsaturated fatty acids:: - monounsaturated: oleic acid (role in myelination) - monounsaturated: oleic acid (role in myelination) - polyunsaturated (omega-6 series - linoleic and - polyunsaturated (omega-6 series - linoleic and gamma-linoleic acid and omega 3 series - alpha gamma-linoleic acid and omega 3 series - alpha linolenic acid).linolenic acid). - considered essential, - considered essential, - structural components of membranes, - structural components of membranes, - precursors of prostaglandins, leukotryenes and - precursors of prostaglandins, leukotryenes and trombhexanilor → growth and cell function.trombhexanilor → growth and cell function.

LipidLipidss

Important role inImportant role in::

- diencefalo-pituitary hormones, the serum - diencefalo-pituitary hormones, the serum lipoproteins;lipoproteins;

- trophicity of the skin and appendages;- trophicity of the skin and appendages;

- structural and functional integrity of the arterial wall - structural and functional integrity of the arterial wall and platelets.and platelets.

LipidLipidss

Linoleic acidLinoleic acid:: - olive oil, soy, corn, sunflower, cotton, - olive oil, soy, corn, sunflower, cotton, - reduce plasma levels of LDL cholesterol. - reduce plasma levels of LDL cholesterol.

Linolenic acidLinolenic acid:: - fish oil, corn, soybean, sunflower, - fish oil, corn, soybean, sunflower, - major component of the phospholipids of brain and - major component of the phospholipids of brain and retinal cell membranes.retinal cell membranes.

LipidLipidss

CholesterolCholesterol:: - component of all cell membranes - component of all cell membranes - in myelin structure, steroid hormones, vitamin D, - in myelin structure, steroid hormones, vitamin D, - role in the formation of bile salts. - role in the formation of bile salts.

Food sourcesFood sources: milk, butter, cream cheese, offal, egg : milk, butter, cream cheese, offal, egg yolk. yolk.

LipidLipidss

Fiber increases intestinal elimination of cholesterol Fiber increases intestinal elimination of cholesterol ingested.ingested.

Cholesterol food shortage Cholesterol food shortage → nerve structures are not → nerve structures are not affected (endogenous synthesis).affected (endogenous synthesis).

Fat needsFat needs:: - infant: 4-6 g /kg /day; - infant: 4-6 g /kg /day; - child 1-3 years: 4-5 g /kg /day; - child 1-3 years: 4-5 g /kg /day; - school: 2 g /kg /day. - school: 2 g /kg /day.

LipidLipidss

Deficiency of fatDeficiency of fat:: → reduce energy intake disrupts the growth process, → reduce energy intake disrupts the growth process, decreases absorption of fat soluble vitamins. decreases absorption of fat soluble vitamins.

Linolenic acid deficiencyLinolenic acid deficiency:: - peripheral neuropathy - peripheral neuropathy - reduction of visual acuity, - reduction of visual acuity, - trophic disorders of the skin and hair, - trophic disorders of the skin and hair, - adesivity platelet growth. - adesivity platelet growth.

LipidLipidss

Linoleic acid deficiencyLinoleic acid deficiency::- dermatitis,- dermatitis,- trophic appendages disorders,- trophic appendages disorders,- hypertension,- hypertension,- hyperlipidemia and hypercholesterolemia. - hyperlipidemia and hypercholesterolemia.

LipiLipidsds

Excess fatExcess fat:: increased intake of calories obesity → often associated increased intake of calories obesity → often associated with hypertension.with hypertension.

Establishing a fair Establishing a fair ration of fat ration of fat quantity and quality is quantity and quality is the most effective prevention of adult atherosclerosis. the most effective prevention of adult atherosclerosis.

Water and Mineral Salts NeedsWater and Mineral Salts Needs

The presence of water:

- most urgent need of body - greater need as the body is younger:

newborn: 180-200 ml / kg / dayinfant: 150ml/kg/day,child 1-3 years: 100-125ml/kg/day.

Fluid balance = balance between intake and excretion of fluids.


ContributionContribution:: - fluid intake; - fluid intake; - water from food constitution; - water from food constitution; - water from combustion. - water from combustion.

LossesLosses:: - urine; - urine; - faeces; - faeces; - sweating; - sweating; - skin perspiration; - skin perspiration; - breathing. - breathing.


Distribution of body fluids in newborn and infant:Distribution of body fluids in newborn and infant: water = 75% total body weight, water = 75% total body weight, → 40% of the total water in the extracellular fluid. → 40% of the total water in the extracellular fluid.

DehydrationDehydration occurs due to extracellular water. occurs due to extracellular water.


The need for water increases in the following conditions:- ambient temperature increase;- in newborn;- phototherapy;- fever;- diarrhea / vomiting;- decrease in ambient humidity;- feeding with formula milk high calories and hyperosmolar type.

Mineral SaltsMineral Salts

RolesRoles:: structurestructure: are used in cell cytoplasm, the skeletal : are used in cell cytoplasm, the skeletal structure, Hb, endocrine glands etc.structure, Hb, endocrine glands etc.

regulator and biocatalystsregulator and biocatalysts:: - maintain osmotic pressure, - maintain osmotic pressure, - maintaining acid-base balance, - maintaining acid-base balance, - regulating the activity of the nervous system, - regulating the activity of the nervous system, myocardium, muscle,myocardium, muscle, - activation of digestive enzymes - activation of digestive enzymes ..


ActionsActions:: synergisticsynergistic (Ca and P, Cu and Fe) = contribution of an (Ca and P, Cu and Fe) = contribution of an ion demand increases synergistically of another one;ion demand increases synergistically of another one;

antagonisticantagonistic (Na, K, Ca and Mg) = an increased intake (Na, K, Ca and Mg) = an increased intake of other ion remove it.of other ion remove it.

Nutritional sourcesNutritional sources:: - animal products - animal products - vegetable products - vegetable products - drinking water. - drinking water.


Food intake is necessary for the formation of new Food intake is necessary for the formation of new tissues and to cover loss of skin, hair, tears, urine and tissues and to cover loss of skin, hair, tears, urine and faeces.faeces.

Body needs Body needs are great:are great: - during periods of accelerated growth, - during periods of accelerated growth, - during exercise, - during exercise, - in fever. - in fever.

Mineral Salts Mineral Salts SodiumSodium

principal cation of extracellular fluidRoles: - osmotic pressure regulation, - maintaining acid-base balance, - maintain water balance in the body - neuro-muscular excitability, - cardiac contraction.Sources: milk, meat, eggs, vegetables, cooking salt.Losses: heavy sweating, severe diarrheaExcess → fluid retention, hypervolemia, hypernatremia and swelling in young infants.

Mineral Salts Mineral Salts PotassiumPotassium

cation of the fundamental cellcation of the fundamental cellRolesRoles::- muscle contraction,- muscle contraction,- conduct of neuromuscular impulse- conduct of neuromuscular impulse- cardiac rate.- cardiac rate.

K + Na + Cl K + Na + Cl contributing to the maintenance:contributing to the maintenance:- acid-base balance,- acid-base balance,- osmotic pressure- osmotic pressure- fluid balance.- fluid balance.

Mineral Salts Mineral Salts Potassium Potassium

SourcesSources: milk, meat, fruit (peaches), vegetables : milk, meat, fruit (peaches), vegetables (carrots).(carrots).

DeficitDeficit:: - in acidosis, - in acidosis, - as corticosteroids, - as corticosteroids, - -clinicalclinical: nausea, vomiting, bloating, tachycardia, : nausea, vomiting, bloating, tachycardia, neuromuscular instability.neuromuscular instability.

ExcessExcess:: - in renal failure, - in renal failure, - drug administration, - drug administration,→ atrium-ventricular block.→ atrium-ventricular block.

Mineral Salts Mineral Salts

Chlorine Chlorine extracellular anion,Roles: - osmotic pressure regulation, - acid-base balance of extracellular fluid, - hydrochloric acid in gastric juice structure.Sources: milk, meat, eggs and cooking salt.Deficit in: -vomiting, -profuse sweating, -prolonged treatment with ACTH.→ hypochloraemic alkalosis.

Mineral Salts Mineral Salts Calcium Calcium

the main constituent of the skeletonthe main constituent of the skeletonRoles:Roles: -contractibility and neuromuscular excitability; -contractibility and neuromuscular excitability; -permeability of cell membranes; -permeability of cell membranes; -blood clotting; -blood clotting; -activation of enzymes (trypsin, pancreatic lipase). -activation of enzymes (trypsin, pancreatic lipase).

Maintaining serum calcium: The balance between Maintaining serum calcium: The balance between skeletal fixation and release are regulated by skeletal fixation and release are regulated by parathyroid hormone in the presence of vitamin D and parathyroid hormone in the presence of vitamin D and tireocalcytonin (hypocalcemya hormone). tireocalcytonin (hypocalcemya hormone).

Mineral Salts Mineral Salts CalciumCalcium

SourcesSources: milk and dairy products.: milk and dairy products.

DeficitDeficit::→ tetany,→ tetany,→ rickets,→ rickets,→ osteoporosis.→ osteoporosis.

Excess dietary calcium Excess dietary calcium has no effect attributes on body, has no effect attributes on body, homeostasis is well regulated.homeostasis is well regulated.

Mineral Salts Mineral Salts IronIron

In the composition:In the composition: -hemoglobin -hemoglobin -myoglobin -myoglobin -of many enzymes and catalysts. -of many enzymes and catalysts.

Fetal iron reservesFetal iron reserves:: proportional to the duration of pregnancy: proportional to the duration of pregnancy: n.b at term → 250 mg (4-6 months are exhausted) n.b at term → 250 mg (4-6 months are exhausted) premature n.b → 125 mg (to cover 2-3 months). premature n.b → 125 mg (to cover 2-3 months).

Mineral Salts Mineral Salts Iron Iron

Iron needs Iron needs depend ondepend on:: -stocks in the body -stocks in the body -form of contribution (only 5-10% is absorbed from -form of contribution (only 5-10% is absorbed from ingested iron).ingested iron).

Fe Fe rich foodsrich foods: liver, meat, eggs, fish, cereals, beans, : liver, meat, eggs, fish, cereals, beans, spinach, tomatoes, fruit.spinach, tomatoes, fruit.

Mineral Salts Mineral Salts Iron Iron

Recommended dietary intakeRecommended dietary intake:: 0-6 months 0-6 months → 6 mg / day;→ 6 mg / day; 6 months-10 years 6 months-10 years → 10 mg / day;→ 10 mg / day; adolescentsadolescents - girls → 12-24 mg / day; - girls → 12-24 mg / day; - boys → 9-18 mg / day. - boys → 9-18 mg / day.

Iron deficiency Iron deficiency - etyopathogenic mechanisms:- etyopathogenic mechanisms: -martial deficiency intake -martial deficiency intake -martial deperdition -martial deperdition -martial diversion -martial diversion

Mineral Salts – Iron DeficiencyMineral Salts – Iron Deficiency Low Iron IntakeLow Iron Intake

Low iron reserves Low iron reserves at birth:at birth: - prematurity; - prematurity; - W.b < 3 000g; - W.b < 3 000g; - twinning; - twinning; - feto-fetal transfusion enzygotic twins; - feto-fetal transfusion enzygotic twins; - feto-maternal transfusion; - feto-maternal transfusion; - martial deficiency in pregnant women (multiparous); - martial deficiency in pregnant women (multiparous);


Low iron reserves Low iron reserves at birth:at birth: - perinatal loss (placenta previa, placental detachment); - perinatal loss (placenta previa, placental detachment);

- neonatal hemorrhage (hemolytic disease of the note, - neonatal hemorrhage (hemolytic disease of the note, cord bleeding, early ligation of the umbilical cord);cord bleeding, early ligation of the umbilical cord);

- exanguino-transfusion. - exanguino-transfusion.


Low intakeLow intake:: - greater weight gain needs → ↑ Fe ↓ dissatisfied - greater weight gain needs → ↑ Fe ↓ dissatisfied reserves and intake (preterm infants with rapid growth reserves and intake (preterm infants with rapid growth rate);rate); - excessive extension of the system lactate (bottlefed - excessive extension of the system lactate (bottlefed infants cow milk / standard milk powder);infants cow milk / standard milk powder); - other food mistakes: - other food mistakes: - excess flour - excess flour - diversification of food without eggs, meat, vegetables - diversification of food without eggs, meat, vegetables rich in iron; rich in iron;


Low intakeLow intake:: - rapid growth and teen menstrual losses not covered by - rapid growth and teen menstrual losses not covered by food intake;food intake;

- cyanogen congenital heart disease (right-left shunt) - cyanogen congenital heart disease (right-left shunt) with hypochromic anemia and polycythemia;with hypochromic anemia and polycythemia;

- difficulties in food intake (severe encephalopathy).- difficulties in food intake (severe encephalopathy).


Intestinal malabsorption of ironIntestinal malabsorption of iron::-chronic digestive disorders-chronic digestive disorders-malabsorption syndromes-malabsorption syndromes-prolonged diarrhea-prolonged diarrhea-celiakie-celiakie-mucoviscidosis-mucoviscidosis-gastric resection.-gastric resection.

Mineral Salts – Iron DeficiencyMineral Salts – Iron DeficiencyIron LossesIron Losses

-- repeated small hemorrhages repeated small hemorrhages (small and repeated (small and repeated melena, recurrent nosebleeds, frequent harvesting of melena, recurrent nosebleeds, frequent harvesting of blood from small infants);blood from small infants);

- - gastrointestinal bleeding gastrointestinal bleeding (cow's milk protein allergy, (cow's milk protein allergy, parasitic infestations, digestive abnormalities).parasitic infestations, digestive abnormalities).

Other causesOther causes: bleeding after surgery or trauma, renal : bleeding after surgery or trauma, renal (hematuria, hemoglobynuria).(hematuria, hemoglobynuria).

Mineral Salts – Iron DeficiencyMineral Salts – Iron Deficiency Excessive Iron UtilisationExcessive Iron Utilisation

- chronic inflammation (Crohn's disease, rheumatoid - chronic inflammation (Crohn's disease, rheumatoid arthritis);arthritis);

- infections (tuberculosis, septicemia, osteomyelitis, - infections (tuberculosis, septicemia, osteomyelitis, urinary tract infections);urinary tract infections);

- hemosiderosis;- hemosiderosis;

- malignancies.- malignancies.

Mineral Salts – IronMineral Salts – Iron Prevention of iron deficiency anemiaPrevention of iron deficiency anemia

Antenatal (maternal) prophylaxis: - mother's diet (green vegetables and fruits, eggs, meat);

- systematic control of hemoglobin (Hb) of V-VI months of pregnancy;

- administration of iron preparations in the last trimester of pregnancy.


After birth After birth (infant) prophylaxis(infant) prophylaxis::

-late umbilical cord ligation after the cessation of its -late umbilical cord ligation after the cessation of its pulsations (ensures the transfer of 40-60 mg iron);pulsations (ensures the transfer of 40-60 mg iron); - early and prolonged breast feeding; - early and prolonged breast feeding; - diversification of food (at 4 - 4 1 / 2 months for - diversification of food (at 4 - 4 1 / 2 months for infants fed standard formula or cow's milk, from 5-6 infants fed standard formula or cow's milk, from 5-6 months for those breas/bottlefed) with vegetable soup, months for those breas/bottlefed) with vegetable soup, meat, liver, egg yolk, green vegetables, cereals fortified meat, liver, egg yolk, green vegetables, cereals fortified with Fe; with Fe;


After birth After birth (infant) prophylaxis(infant) prophylaxis::- additional 1-2 mg Fe + + / kg / day to 6-8 weeks to a - additional 1-2 mg Fe + + / kg / day to 6-8 weeks to a year to premature twins, SGA, maternal hemorrhage at year to premature twins, SGA, maternal hemorrhage at birth, digestive disorders, recurrent infections, children birth, digestive disorders, recurrent infections, children with high growth;with high growth;

- systematic prophylaxis with 10 to 25 mg Fe / day (or - systematic prophylaxis with 10 to 25 mg Fe / day (or 1-2 mg / kg) for all term infants with normal weight at 6 1-2 mg / kg) for all term infants with normal weight at 6 months (for at least 3 months). months (for at least 3 months).

Mineral Salts Mineral Salts MagnesiumMagnesium

intracellular cation,Roles: - decreases the excitability of the neuro-muscular - reduces myocardial excitability and conduction - vascular trophic action - the elements of the blood physiology - to bone - favoring the action of vitamin D and bone matrix formation, ossification stimulates collagen - stimulates the formation of Ig, serum complement and phagocytosis.

Mineral Salts Mineral Salts MagnesiumMagnesium

SourcesSources: meat, milk, nuts, peas.: meat, milk, nuts, peas. Deficit → hypomagnesemia:Deficit → hypomagnesemia: - convulsions, - convulsions, - osteoporosis - osteoporosis - diarrhea, - diarrhea, - E.K.G. changes, - E.K.G. changes, - resistance to the action of vitamin D. - resistance to the action of vitamin D.

ExcessExcess: increased drug intake - rarely (compensatory : increased drug intake - rarely (compensatory mechanisms occur: diarrhea and magnesiuria). mechanisms occur: diarrhea and magnesiuria).

Trace - elements Trace - elements

Zinc Zinc Roles: - synthesis of amino acids, lecithin and surfactant;

- promotes membrane glucose transport, adipocytes, and its use by the cellular response to insulin;

- prolongs the action of insulin;

- stimulates pituitary gonadotropin, GH hormone, androgen.

Trace - elements Trace - elements ZincZinc

RolesRoles:: - surgical wound healing and burns stimulating - surgical wound healing and burns stimulating collagen synthesis and fibroblast proliferation;collagen synthesis and fibroblast proliferation;

- adjusting the sense of smell and taste;- adjusting the sense of smell and taste;

- night vision (maintain plasma vit. A).- night vision (maintain plasma vit. A).

SourcesSources: meat, liver, fish, milk, egg yolk, cereals, water.: meat, liver, fish, milk, egg yolk, cereals, water.

Trace elements Trace elements ZincZinc

DeficitDeficit:: - hypogonadal dwarfism - hypogonadal dwarfism - anorexia, - anorexia, - hipoosmie - hipoosmie - alopecia, keratitis, skin ulceration - alopecia, keratitis, skin ulceration - delayed skeletal ossification - delayed skeletal ossification - mental slowness, - mental slowness, - iron deficiency anemia. - iron deficiency anemia.

ExcessExcess:: - keeping food in galvanized vases - keeping food in galvanized vases - drinking water consumption of zinc pots. - drinking water consumption of zinc pots.

Trace - elementsTrace - elementsIodineIodine

essential in the synthesis of thyroid hormones.essential in the synthesis of thyroid hormones.

SourcesSources: fish, vegetables, nuts, iodized salt.: fish, vegetables, nuts, iodized salt.

The recommended intake of iodine The recommended intake of iodine supplementationsupplementation:: - during pregnancy - during pregnancy - lactating women. - lactating women.

Trace - elements Trace - elements Fluorine Fluorine

Roles: - the skeletal structure, enamel - in preventing tooth decay.

Supplementing the diet of pregnant women in the fetus increases its content.

Sources: foods of plant origin, animal, water.Deficit → cavities.Excess → fluorosis (damage to tooth enamel).

Trace - elements Trace - elements Selenium Selenium

Roles: - the structure of cell membranes, mitochondria, microsomes and lisosomes - stimulates growth - promotes IgM synthesis - absorption of vitamin E - the Krebs cycle - in heme catabolism.

Sources: meat, kidney, saltwater fish, milk, cereals and mushrooms.

Trace - elements Trace - elements Selenium Selenium

Deficit: - hemolysis - cardiomyopathy - ↑ incidence of breast cancer and digestive tract.

Chronic excess: - photodermatosis - alopecia - trophic nail disorders - respiratory and liver chronic disorders

VITAMINSVITAMINS

essential cofactors in a variety of metabolic pathwaysessential cofactors in a variety of metabolic pathways

ClassificationClassification:: - fat soluble - fat soluble - water soluble. - water soluble.

Needs vary with age and / or existence of disease.Needs vary with age and / or existence of disease.

Additional CompulsoryAdditional Compulsory vitamin Dvitamin D early in life; early in life; vitamin Kvitamin K (K (K11) in the newborn, 1 mg IM. ) in the newborn, 1 mg IM.

VITAMINSVITAMINS

Dietary sources of fat-soluble vitamins:Dietary sources of fat-soluble vitamins:

Vit. A Vit. A (retinol): fortified milk, eggs, liver, butter, (retinol): fortified milk, eggs, liver, butter, carrots, cabbagecarrots, cabbage

Vit. DVit. D: fortified milk, fish, egg yolk: fortified milk, fish, egg yolk

Vit. EVit. E: oil seeds / grains, nuts, beans, soybeans, green : oil seeds / grains, nuts, beans, soybeans, green leafy vegetablesleafy vegetables

Vit. KVit. K: cow's milk, green leafy vegetables, liver, : cow's milk, green leafy vegetables, liver, vegetable oils vegetable oils

VITAMINSVITAMINS

Food sources of water soluble vitamins:Food sources of water soluble vitamins: Vit. BVit. B11 (thiamin): milk, meat, cereals, legumes(thiamin): milk, meat, cereals, legumes

Vit. BVit. B2 2 (riboflavin): milk, meat, eggs, green vegetables, (riboflavin): milk, meat, eggs, green vegetables, cerealscereals

Vit. BVit. B3 3 (niacin, nicotinamide, PP): meat, fish, milk, (niacin, nicotinamide, PP): meat, fish, milk, green vegetables, whole grainsgreen vegetables, whole grains

Vit. BVit. B55 (pantothenic acid): meat, milk, eggs, (pantothenic acid): meat, milk, eggs, vegetables, whole grains vegetables, whole grains

VITAMINSVITAMINSFood sources of water soluble vitamins:Food sources of water soluble vitamins: Vit. BVit. B66 (pyridoxine): meat, liver, milk, whole grains, (pyridoxine): meat, liver, milk, whole grains, soybeanssoybeans

Vit. BVit. B88 (biotin): liver, egg yolk, peanuts(biotin): liver, egg yolk, peanuts

Vit. BVit. B99 (folic acid / folate): green leafy vegetables, (folic acid / folate): green leafy vegetables, cereals, liver, nutscereals, liver, nuts

Vit. BVit. B1212 (cobalamin): milk, meat, eggs(cobalamin): milk, meat, eggs

Vit. C Vit. C (ascorbic acid): citrus, tomatoes, cabbage (ascorbic acid): citrus, tomatoes, cabbage

VITAMIN DVITAMIN D

SourcesSources:: exogenousexogenous, provided by food:, provided by food:- animal (vitamin D- animal (vitamin D33 - cholecalciferol) - cholecalciferol)- vegetable (vitamin D- vegetable (vitamin D22 - ergocalciferol) - ergocalciferol)

endogenousendogenous: cutaneous precursor of vitamin D (7-: cutaneous precursor of vitamin D (7-dehydrocholesterol) + UV → cholecalciferol (vitamin dehydrocholesterol) + UV → cholecalciferol (vitamin DD33), metabolized in the liver. ), metabolized in the liver.

VITAMIN DVITAMIN D

In the first two years of life requires daily administration of vitamin D is rickets prevention.

The main causes of increased prevalence of rickets:

- incorrect or incomplete implementation of prevention with vitamin D; - waiver of prophylaxis with vitamin D after age 1 year; - sufficient sunshine; - high degree of pollution; - unbalanced diet, especially excess flour;

Prevention of ricketsPrevention of rickets Antenatal prophylaxis Antenatal prophylaxis - in the last trimester of - in the last trimester of pregnancy:pregnancy: Vitamin DVitamin D:: 1000 - 2000 IU daily orally or 1000 - 2000 IU daily orally or 4000 - 5 000 IU per week per os or 4000 - 5 000 IU per week per os or 200 000 IU orally at the beginning of the seventh 200 000 IU orally at the beginning of the seventh month of pregnancy.month of pregnancy.

calcium 1-2 g / day, 10 days per month, per os.calcium 1-2 g / day, 10 days per month, per os.

Vit D not be administered parenteral (may cause fetal Vit D not be administered parenteral (may cause fetal aortic stenosis).aortic stenosis).

Prevention of ricketsPrevention of rickets

Postnatal preventionPostnatal prevention(fractional, physiological, modern)(fractional, physiological, modern) from the 7th-10th day of life by 18 - 24 monthsfrom the 7th-10th day of life by 18 - 24 months daily vitamin D, 400-800 IU / day (~ 500 IU / day) per daily vitamin D, 400-800 IU / day (~ 500 IU / day) per os.os.

After the age of two years - from September to late After the age of two years - from September to late April:April:

Vitamin D - 500 IU / day, dailyVitamin D - 500 IU / day, daily Vit.A + D Vit.A + D22 - 4000 - 5 000 IU, orally, at 7-10 days. - 4000 - 5 000 IU, orally, at 7-10 days.


Only fractional administration of vitamin D is Only fractional administration of vitamin D is physiological because:physiological because:

- it ensures a good, especially if taken with a meal;- it ensures a good, especially if taken with a meal; - transport system is not required nor the activation of - transport system is not required nor the activation of vit. D;vit. D; - target organs are not subject to adjustment jumps; - target organs are not subject to adjustment jumps; - there is no danger of intoxication. - there is no danger of intoxication.


Higher doses of vitamin D (2000 IU / day):

- children with low birth weight / premature - children with pigmented skin - children receiving chronic anticonvulsant / with corticosteroids. There is no need to take calcium when feeding baby milk contains less than 500 ml / day.


Supplementation with calcium intake: - pregnant in last trimester of pregnancy - premature - children receiving < 500 ml milk per day.

Dose: 50mg/kg/day elemental calcium.

Recommended dietary vitamins intakeRecommended dietary vitamins intake

VITAMINVITAMINSS InfantInfant ToddlerToddler

Vitamin AVitamin A 1000 UI/1000 UI/dayday 2000 UI/ 2000 UI/ dayday

Vitamin DVitamin D 400-800 UI/ 400-800 UI/ dayday 400-500 UI/ 400-500 UI/ dayday

Vitamin EVitamin E 3-5 mg/ 3-5 mg/ dayday 5-10 mg/ 5-10 mg/ dayday

Vitamin KVitamin K 5 µg/ 5 µg/ dayday 5-65 µg/ 5-65 µg/ dayday

Vitamin BVitamin B11 0.30-0,50 mg/ 0.30-0,50 mg/ dayday

1-2 mg/ 1-2 mg/ dayday

Vitamin BVitamin B22 0,40-0,60 mg/ 0,40-0,60 mg/ dayday

1 mg/ 1 mg/ dayday

Vitamin BVitamin B33 6-8 mg/ 6-8 mg/ dayday 10-20 mg/ 10-20 mg/ dayday

Recommended dietary vitamins intakeRecommended dietary vitamins intake

VITAMINVITAMINSS InfantInfant ToddlerToddler

Vitamin BVitamin B55 2-3 mg/2-3 mg/dayday 5-7 mg/5-7 mg/dayday

Vitamin BVitamin B66 0,30-0,50 mg/0,30-0,50 mg/dayday 1-2 mg/1-2 mg/dayday

Vitamin BVitamin B88 1 mg/1 mg/dayday 2 mg/2 mg/dayday

Vitamin BVitamin B99 20-50 µg/20-50 µg/dayday 75-200 µg/75-200 µg/dayday

Vitamin BVitamin B1212 0,50-2 µg/0,50-2 µg/dayday 2 µg/2 µg/dayday

Vitamin CVitamin C 30-50 mg/30-50 mg/dayday 50-60 mg/50-60 mg/dayday

CHILD AND ADOLESCENT NUTRITION. Definition: Nutrition = modifications of food`s components in the body to maintain life. The processes of growth, maintenance.

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growth energy needs

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operating needs

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