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NUTRITION NUTRITION IN CHILDHOOD & ADOLESCENCE IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ DR RAB NAWAZ MBBS, MPH, PGD MBBS, MPH, PGD (Nutrition), Bannu (Nutrition), Bannu Medical College Bannu, Medical College Bannu, NWFP, PAKISTAN NWFP, PAKISTAN
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NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

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Page 1: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

NUTRITION NUTRITION IN CHILDHOOD & ADOLESCENCEIN CHILDHOOD & ADOLESCENCE

DR RAB NAWAZDR RAB NAWAZ

MBBS, MPH, PGD (Nutrition), MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, Bannu Medical College Bannu,

NWFP, PAKISTANNWFP, PAKISTAN

Page 2: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Food Guide PyramidFood Guide Pyramid

The Food Pyramid, developed by the US Department of The Food Pyramid, developed by the US Department of Agriculture (USDA), is an excellent tool to help you make Agriculture (USDA), is an excellent tool to help you make healthy food choices. The food pyramid can help you choose healthy food choices. The food pyramid can help you choose from a variety of foods so you get the nutrients you need, and from a variety of foods so you get the nutrients you need, and the suggested serving sizes can help you control the amount of the suggested serving sizes can help you control the amount of calories, fat, saturated fat, cholesterol, sugar or sodium in your calories, fat, saturated fat, cholesterol, sugar or sodium in your diet. diet.

Grains, Bread, Cereal and Pasta form the Base Grains, Bread, Cereal and Pasta form the Base Fruits and VegetablesFruits and Vegetables Lean Meat and Fish, Beans, Eggs Lean Meat and Fish, Beans, Eggs Dairy ProductsDairy Products Fats and SweetsFats and Sweets

Page 3: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Food Guide Pyramid (2)Food Guide Pyramid (2)

What counts as ONE servingWhat counts as ONE serving Grain group: 1 slice of bread, ½ cup of cooked rice, ½ cup of cooked Grain group: 1 slice of bread, ½ cup of cooked rice, ½ cup of cooked

cereals, 1 ounce of ready to eat cereal.cereals, 1 ounce of ready to eat cereal. Fruit/ Vegetable group: ½ cup of chopped raw or cooked vegetables, ½ Fruit/ Vegetable group: ½ cup of chopped raw or cooked vegetables, ½

cup of raw leafy vegetable, 1 cup of raw leafy vegetable, 1 piece of fruit or one melon wedge, ¾ cup of juice, ½ cup of canned fruit, piece of fruit or one melon wedge, ¾ cup of juice, ½ cup of canned fruit, ¼ cup of dried fruit¼ cup of dried fruit

Meat group: 2-3 ounce of cooked lean meat, poultry or fish, ½ cup of Meat group: 2-3 ounce of cooked lean meat, poultry or fish, ½ cup of cooked dried beans or 1 egg (counts 1 ounce of lean meat), 2 tablespoon cooked dried beans or 1 egg (counts 1 ounce of lean meat), 2 tablespoon of peanut butter (counts 1 ounce of lean meat) of peanut butter (counts 1 ounce of lean meat)

Milk group: 1 cup of milk or yogurt, 2 ounces of cheeseMilk group: 1 cup of milk or yogurt, 2 ounces of cheese Fats & Sweets group: limit calories from these.Fats & Sweets group: limit calories from these.

4-6 years old children can eat these serving sizes. For children below 4 4-6 years old children can eat these serving sizes. For children below 4 years, a total of 2 servings from the milk group each day.years, a total of 2 servings from the milk group each day.

Page 4: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.
Page 5: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

CHILDHOODCHILDHOODFrom age 1 through the beginning of adolescence.From age 1 through the beginning of adolescence.Growth in childhood slower than infancy.Growth in childhood slower than infancy.Weight gain about 5 pounds and grow 2-3 inches annually.Weight gain about 5 pounds and grow 2-3 inches annually.Three groups on the basis of age and developmentThree groups on the basis of age and development

Toddlers (Age 1-3 years)Toddlers (Age 1-3 years)Preschoolers (Age 4-5 years)Preschoolers (Age 4-5 years)School children (Age 6-10 years)School children (Age 6-10 years)

Energy & Proteins RDAs for childrenEnergy & Proteins RDAs for children Age (y)Age (y) Kcal/kg Kcal/day Proteins g/kg Proteins Kcal/kg Kcal/day Proteins g/kg Proteins g/day g/day

1-3 1-3 102 102 13001300 1.21.2 16 16

4-64-6 90 90 18001800 1.11.1 24 24

7-107-10 70 70 20002000 1.01.0 28 28

On average 1 year old child requires 1000-1300 Kcal/day. This energy requirement On average 1 year old child requires 1000-1300 Kcal/day. This energy requirement doubles by 10 years age. doubles by 10 years age.

Page 6: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Vitamins and mineralsVitamins and minerals With cooperation of healthy child a well planned diet provide most nutrients except With cooperation of healthy child a well planned diet provide most nutrients except

iron.iron. RDA for iron during childhood (1-3 years) is 7 mg.RDA for iron during childhood (1-3 years) is 7 mg. RDA for iron during childhood (4-8 years) is 10 mg.RDA for iron during childhood (4-8 years) is 10 mg. As iron is low source of iron, so much consumption of milk contribute to low iron As iron is low source of iron, so much consumption of milk contribute to low iron

intake. Milk should be limited to 3-4 cups which allows room for diet rich in iron like intake. Milk should be limited to 3-4 cups which allows room for diet rich in iron like lean meats, legumes, fish, poultry and cereals etc.lean meats, legumes, fish, poultry and cereals etc.

A child diet may also be deficient in other micronutrients like zinc, vitamin D & E. A child diet may also be deficient in other micronutrients like zinc, vitamin D & E. Those children who are on low fat diets i.e. low fat dairy products suffer more. Those children who are on low fat diets i.e. low fat dairy products suffer more.

Outside influences such as TV viewing, affect children preferences for low nutrient Outside influences such as TV viewing, affect children preferences for low nutrient density foods.density foods.

Nutritional concerns of childhoodNutritional concerns of childhood HungerHunger Malnutrition, Micronutrients and PEM. Malnutrition, Micronutrients and PEM. Deficiencies of vitamins A, D, Zinc, Iron and proteins.Deficiencies of vitamins A, D, Zinc, Iron and proteins. These result in illnesses, stunted growth, limited development and in case of vitamin These result in illnesses, stunted growth, limited development and in case of vitamin

A deficiency possibly permanent blindness. A deficiency possibly permanent blindness.

Page 7: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

ADOLESCENCEADOLESCENCE It is the time between the onset of puberty and adulthood.It is the time between the onset of puberty and adulthood.

Boys grow about 8 inches, gain about 45 pounds and increase their lean body mass.Boys grow about 8 inches, gain about 45 pounds and increase their lean body mass. Girls grow about 6 inches, gain about 35 pounds and increase their body fat.Girls grow about 6 inches, gain about 35 pounds and increase their body fat.

Growth through adolescence is hormone driven. Growth spurts for girls begin Growth through adolescence is hormone driven. Growth spurts for girls begin between ages 10.5 and 11 years with a peak in the rate of growth at around age 12.between ages 10.5 and 11 years with a peak in the rate of growth at around age 12.For boys growth spurts usually begin between ages 12.5 and 13 and peak at around For boys growth spurts usually begin between ages 12.5 and 13 and peak at around age 14. This period of maximal growth lasts about 2 years.age 14. This period of maximal growth lasts about 2 years.

Adolescence is an uncomfortable time for the teen who is concerned with body Adolescence is an uncomfortable time for the teen who is concerned with body imageimageor body changes or athletic activities.or body changes or athletic activities.

Low nutrient snacks are a large part of the diet and adequate amounts of fruits and Low nutrient snacks are a large part of the diet and adequate amounts of fruits and vegetables are missing.vegetables are missing.

Factors that determine food selection and consumption include the desire to beFactors that determine food selection and consumption include the desire to behealthy, fitness goals, amount of discretionary income, social practices and peers.healthy, fitness goals, amount of discretionary income, social practices and peers.

Page 8: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Nutrient needs of adolescentsNutrient needs of adolescents Growth not age should be ultimate indicator of nutrient needs.Growth not age should be ultimate indicator of nutrient needs. Energy needs are greater during adolescence than at any other time of life with exception Energy needs are greater during adolescence than at any other time of life with exception

of pregnancy & lactation.of pregnancy & lactation. Energy & Proteins RDAsEnergy & Proteins RDAsMales Males

Age (yrs) Kcal/kg Kcal/day Proteins g/kg Proteins gm/day Age (yrs) Kcal/kg Kcal/day Proteins g/kg Proteins gm/day

11-14 55 2500 1.0 4511-14 55 2500 1.0 45

15-18 45 3000 0.9 5915-18 45 3000 0.9 59

FemalesFemales

Age (yrs) Kcal/kg Kcal/day Proteins g/kg Proteins gm/day Age (yrs) Kcal/kg Kcal/day Proteins g/kg Proteins gm/day

11-14 47 2200 1.0 4611-14 47 2200 1.0 46

15-18 40 2200 0.9 4415-18 40 2200 0.9 44 Vitamins & MineralsVitamins & Minerals Higher vitamins and minerals needs.Higher vitamins and minerals needs. Three nutrients of importance i.e. vitamin A, iron and calcium.Three nutrients of importance i.e. vitamin A, iron and calcium. AI for calcium 1300 mg/day, for iron is 11 mg/day (boys) and 15 mg/day (girls).AI for calcium 1300 mg/day, for iron is 11 mg/day (boys) and 15 mg/day (girls). Improving fruit & vegetable intake will help in obtaining adequate vitamin A. Improving fruit & vegetable intake will help in obtaining adequate vitamin A.

Page 9: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

PREGNANCYPREGNANCY Time of tremendous changes, guided by changing levels of hormones. Uterine, breast and Time of tremendous changes, guided by changing levels of hormones. Uterine, breast and

adipose tissues grow, blood volume expands and gastrointestinal motility slows. All these adipose tissues grow, blood volume expands and gastrointestinal motility slows. All these changes have nutritional and dietary implications for pregnant women.changes have nutritional and dietary implications for pregnant women.

Weight gained during pregnancy is a combination of fetal and maternal tissues and fluids. Weight gained during pregnancy is a combination of fetal and maternal tissues and fluids. Weight gain recommendations are based on BMI prior to pregnancy. Women of normal Weight gain recommendations are based on BMI prior to pregnancy. Women of normal weight (BMI=19.8-26) should gain 25-35 pounds over the course of pregnancy Most of this weight (BMI=19.8-26) should gain 25-35 pounds over the course of pregnancy Most of this weight gain occurs during the second & third trimester.weight gain occurs during the second & third trimester.

Nutrition related components of preconception careNutrition related components of preconception care Risk assessment: Age, Diet, Substance use, existing medical condition, Barriers to prenatal Risk assessment: Age, Diet, Substance use, existing medical condition, Barriers to prenatal

care and PHC.care and PHC. Health Promotion: Healthful diet and refraining from substance use. Compliance with Health Promotion: Healthful diet and refraining from substance use. Compliance with

prenatal care.prenatal care. Interventions: Referral to hospitals with highly equipped and trained staff. Nutrition Interventions: Referral to hospitals with highly equipped and trained staff. Nutrition

counseling, supplementation or referral to improve diet as needed.counseling, supplementation or referral to improve diet as needed.Nutrient needs of PregnancyNutrient needs of Pregnancy A pregnant woman requires added calories to grow and maintain not just her developing A pregnant woman requires added calories to grow and maintain not just her developing

fetus but also the placenta, increased breast tissue and fat stores.fetus but also the placenta, increased breast tissue and fat stores. Growth & development of the fetus also requires nutrients—carbohydrates, and fat as a Growth & development of the fetus also requires nutrients—carbohydrates, and fat as a

source of energy while proteins, vitamins and minerals to support growth and cell source of energy while proteins, vitamins and minerals to support growth and cell differentiation.differentiation.

Page 10: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Nutritional Recommendations for PregnancyNutritional Recommendations for PregnancyNon-pregnantNon-pregnant PregnantPregnant % Increase % Increase

Energy (Kcal)Energy (Kcal) 22002200 25002500 1414

ProteinsProteins 4646 6060 3030

Vit A (ug)Vit A (ug) 700700 770770 1010

Vit D (ug)Vit D (ug) 55 55 00

Vit E (mg)Vit E (mg) 1515 1515 00

Vit (K (ug)Vit (K (ug) 9090 9090 00

Thiamine (mg)Thiamine (mg) 1.11.1 1.41.4 2727

Riboflavin (mg)Riboflavin (mg) 1.11.1 1.41.4 2727

Niacin (mg)Niacin (mg) 1414 1818 2929

Vit B6 Vit B6 1.31.3 1.91.9 4646

Folate (ug)Folate (ug) 400400 600600 5050

Vit B12 (ug)Vit B12 (ug) 2.42.4 2.62.6 88

Choline (mg)Choline (mg) 425425 450450 66

Vit C (mg)Vit C (mg) 7575 8585 1313

Calcium (mg)Calcium (mg) 10001000 10001000 00

Phosphorus (mg)Phosphorus (mg) 700700 700700 00

Magnesium (mg)Magnesium (mg) 310310 350350 1313

Iron (mg)Iron (mg) 1818 2727 5050

Zinc (mg)Zinc (mg) 88 1111 3838

Iodine (ug)Iodine (ug) 150150 220220 4747

Copper (ug)Copper (ug) 900900 10001000 1111

Page 11: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Folic acid supplementation before pregnancy reduces the risk of Folic acid supplementation before pregnancy reduces the risk of neural tube defects such as spina bifida.neural tube defects such as spina bifida.

Excessive intake of some vitamins (A) and use of drugs increase Excessive intake of some vitamins (A) and use of drugs increase the risk of poor pregnancy outcome.the risk of poor pregnancy outcome.

The energy RDA increases by 300 Kcal/day for the 2The energy RDA increases by 300 Kcal/day for the 2ndnd & 3 & 3rdrd trimesters.trimesters.

Protein needs increases by about 10 gm/day while CHO & fats Protein needs increases by about 10 gm/day while CHO & fats as for non pregnant women.as for non pregnant women.

The diet should contain CHO & fats in the same proportion as The diet should contain CHO & fats in the same proportion as recommended for non pregnant women.recommended for non pregnant women.

Using the FGP pregnant women who consume enough energy Using the FGP pregnant women who consume enough energy should be able to meet all their nutrients needs except iron & should be able to meet all their nutrients needs except iron & folate. They should get extra calories mainly from grains, fruits folate. They should get extra calories mainly from grains, fruits and vegetables.and vegetables.

Page 12: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

LACTATIONLACTATION Breast feeding mother must choose a varied, healthful and nutrient dense diet.Breast feeding mother must choose a varied, healthful and nutrient dense diet. Need for energy and many nutrients is higher during lactation than during Need for energy and many nutrients is higher during lactation than during

pregnancy.pregnancy. RDA values suggest an additional 500 Kcal and 12-15 grams of proteins each day.RDA values suggest an additional 500 Kcal and 12-15 grams of proteins each day. RI levels for minerals are generally higher during lactation than during pregnancy.RI levels for minerals are generally higher during lactation than during pregnancy. Fluids are also important for adequate milk production.Fluids are also important for adequate milk production. Food choices during lactation should follow the USDA Food Guide Pyramid and Food choices during lactation should follow the USDA Food Guide Pyramid and

emphasize nutrient dense foods.emphasize nutrient dense foods. With good choices and adequate intake a lactating mother may not need vitamin or With good choices and adequate intake a lactating mother may not need vitamin or

mineral supplementations.mineral supplementations. The main CHO in breast milk is lactose while triglycerides are the main source of The main CHO in breast milk is lactose while triglycerides are the main source of

energy in breast milk.energy in breast milk.Benefits of BreastfeedingBenefits of Breastfeeding For infantsFor infants For mothersFor mothers For countryFor countryAdvantages of human milk over cows milkAdvantages of human milk over cows milkProteins: more whey less casein, less phenylalanine, more peptidasesProteins: more whey less casein, less phenylalanine, more peptidasesLipids:Lipids: more lipase enzymes, more Linoleic acid, higher polyunsaturated to more lipase enzymes, more Linoleic acid, higher polyunsaturated to

saturated fatty acid ratio, more cholesterol.saturated fatty acid ratio, more cholesterol.Minerals:Minerals: Less calcium, less sodium, higher calcium to phosphorus ratio, iron and Less calcium, less sodium, higher calcium to phosphorus ratio, iron and

zinc in more available formzinc in more available form

Page 13: NUTRITION IN CHILDHOOD & ADOLESCENCE DR RAB NAWAZ MBBS, MPH, PGD (Nutrition), Bannu Medical College Bannu, NWFP, PAKISTAN.

Unless the lactating mother reduce their physical activity, breastfeeding Unless the lactating mother reduce their physical activity, breastfeeding women need about 500 more Kcal/day than they did when they were not women need about 500 more Kcal/day than they did when they were not pregnant. Obtaining adequate energy and using the Food Guide Pyramid to pregnant. Obtaining adequate energy and using the Food Guide Pyramid to balance choices most lactating women can obtain all the nutrients they need balance choices most lactating women can obtain all the nutrients they need from their diet. Alcohol, cigarettes and drugs should not be used while breast from their diet. Alcohol, cigarettes and drugs should not be used while breast feeding. feeding.

Nursing mothers should eat plenty of vegetables (source of many Nursing mothers should eat plenty of vegetables (source of many micronutrients)micronutrients)

Vegetables of cabbage family causes colic symptoms in breastfed children. Vegetables of cabbage family causes colic symptoms in breastfed children. Other foods with bad reputation include peanut butter, chocolate, egg whites Other foods with bad reputation include peanut butter, chocolate, egg whites and nuts. But removal of these foods from the diet should be done only under and nuts. But removal of these foods from the diet should be done only under the supervision of a registered dietitian.the supervision of a registered dietitian.

Vegan women and who do not follow diet guidelines, should take vitamin Vegan women and who do not follow diet guidelines, should take vitamin B12 supplement.B12 supplement.

Those women who do not get regular sun exposure or do not drink milk or Those women who do not get regular sun exposure or do not drink milk or other fortified foods should get vitamin D supplementation.other fortified foods should get vitamin D supplementation.

For most nursing mothers dietary counseling is the preferred way to address For most nursing mothers dietary counseling is the preferred way to address nutrient imbalances. nutrient imbalances.