Nutrition in Children and Youth Dagmar Schneidrová Department of Child and Youth Health 3rd Faculty of Medicine Charles University in Prague.

Nutrition in Children and Youth

Dagmar SchneidrováDepartment of Child and Youth Health

3rd Faculty of MedicineCharles University in Prague

Nutrition and Health

Childhood and adolescenceChildhood and adolescence = = key periods for growth and key periods for growth and developmentdevelopment

Ensure daily energy and nutrients Ensure daily energy and nutrients requirements for health, growth requirements for health, growth and development and health in and development and health in adulthoodadulthood

Inadequate intake of nutrients Inadequate intake of nutrients

(esp. (esp. 0-2 years0-2 years ) might cause ) might cause irreversible changesirreversible changes

Current Research

PhysiologyPhysiology:: - - nutrients relevant for metabolism and nutrients relevant for metabolism and

development of development of brain, intestinal flora and brain, intestinal flora and bonesbones

Epidemiology:Epidemiology: - - nutrient intake, eating habits, attitudes nutrient intake, eating habits, attitudes

in preschool, school children in preschool, school children - prevalence of nutrition related disorders - prevalence of nutrition related disorders

(obesity, eating disorders)(obesity, eating disorders) Public Health, Health Promotion Projects:Public Health, Health Promotion Projects: - - effectiveness of intervention programmes effectiveness of intervention programmes

(in preschool, school children) (in preschool, school children)

Brain and cognition

Most intensive development of NS Most intensive development of NS in prenatal period and up to 3 yearsin prenatal period and up to 3 years

Decreased intake of energy and Decreased intake of energy and essential nutrients in first years – essential nutrients in first years – important impact on structural and important impact on structural and functional development of CNSfunctional development of CNS

Relationship between the intake of Relationship between the intake of some some nutrients and cognitive nutrients and cognitive functionsfunctions studied in detail studied in detail

Iodine

Important for synthesis of thyreoid Important for synthesis of thyreoid gland hormonesgland hormones

Prenatal iodine deficiency – impact Prenatal iodine deficiency – impact on cognitive development on cognitive development ((e.g.e.g.learning disabilities)learning disabilities)

Less evidence on relationship Less evidence on relationship between deficit in children and between deficit in children and cognitive developmentcognitive development

Folic acid (vitamin B9)

B-group vitamins (B1, B2, B6, B9, B-group vitamins (B1, B2, B6, B9, B12) required for the synthesis of B12) required for the synthesis of various neurotransmittersvarious neurotransmitters

Folic acid deficiency – in early Folic acid deficiency – in early pregnancy – risk of neural tube pregnancy – risk of neural tube defectsdefects

1996 – FDA – a flour 1996 – FDA – a flour supplementation programme in the supplementation programme in the USA reduced the incidence of USA reduced the incidence of malformations by 13%malformations by 13%

Fatty acids (omega 3, 6)

Omega 3Omega 3,6,6 polyunsaturated fatty polyunsaturated fatty acids (DHA) – found in acids (DHA) – found in phospholipids in CNS (brain, phospholipids in CNS (brain, retina)retina)

Play a role in cognitive Play a role in cognitive developmentdevelopment

Deficiency rare – neurological and Deficiency rare – neurological and visual disorders (esp. in premature visual disorders (esp. in premature infants)infants)

Iron

Metabolism of neurons, cognitive Metabolism of neurons, cognitive functions and behaviourfunctions and behaviour

Iron deficiency: Iron deficiency: - - impaired brain function: impaired brain function: * * poor spatial memorypoor spatial memory in in adolescents * cognitive adolescents * cognitive performanceperformance , attention, attention

- impaired immunocompetence: - impaired immunocompetence: * * decreased resistance todecreased resistance to infections infections - anaemia - anaemia

Zinc

Key role in growth of cells and CNS Key role in growth of cells and CNS developmentdevelopment

Modulates the transmission of Modulates the transmission of nerve signalsnerve signals

Deficiency in prenatal and Deficiency in prenatal and postnatal period: – malformations postnatal period: – malformations of NSof NS

Deficiency in childhood:Deficiency in childhood: - impact on cognitive and motor - impact on cognitive and motor

functions in vulnerable childrenfunctions in vulnerable children

Breakfast – short-term impact

Breakfast – replenishes Breakfast – replenishes carbohydrate reserves after carbohydrate reserves after fasting overnight – beneficial fasting overnight – beneficial effects on brain functions:effects on brain functions:

* * learning ability (attention, learning ability (attention, memorization) memorization) * performance at school * performance at school * behaviour * behaviour

Intestinal flora (immunity)

0-5 years – development of intestinal 0-5 years – development of intestinal floraflora

BMBM – important for the development of – important for the development of immune system (L. bifidus, growth immune system (L. bifidus, growth factors, trans-oligosacharides), factors, trans-oligosacharides), protection against infections, allergiesprotection against infections, allergies

IF IF ferments non-digestable ferments non-digestable carbohydrates (fiber), results in carbohydrates (fiber), results in formation of short-chain fatty acids formation of short-chain fatty acids (SCFA) which provide colonocytes with (SCFA) which provide colonocytes with energy energy

Bone growth

0-2 years0-2 years – very fast growth (esp.in – very fast growth (esp.in length)length)

11-13 years11-13 years (prepuberty) – intensive (prepuberty) – intensive bone mineralization - half the mass of bone mineralization - half the mass of calcium of the adult is laid downcalcium of the adult is laid down

9-14 years9-14 years – the period of peak bone – the period of peak bone growth – adolescents acquire 25% of their growth – adolescents acquire 25% of their final bone massfinal bone mass

Intense bone turnoverIntense bone turnover in children, who in children, who replace replace 50 to 100% of their skeleton50 to 100% of their skeleton in in a yeara year, compared to 10% in adults, compared to 10% in adults

Bone growth

The construction of bone outweighs The construction of bone outweighs its destruction – allows the bones to its destruction – allows the bones to increase in length and get strongerincrease in length and get stronger

Calcium requirement of children (3-8 Calcium requirement of children (3-8 years) per unit bodyweight are years) per unit bodyweight are 2 to 4 2 to 4 times greater times greater than that of adultsthan that of adults

Intake of calcium and phosphorus – Intake of calcium and phosphorus – Ca/P > 1 Ca/P > 1 (cola beverages – P>Ca)(cola beverages – P>Ca)

Calcium deficiency

Has no immediate direct impact on Has no immediate direct impact on growth (cannot be identified by growth growth (cannot be identified by growth curves)curves)

Main effect - reduces mineralization and Main effect - reduces mineralization and results in a lower peak bone massresults in a lower peak bone mass

US study – children who were deprived US study – children who were deprived of cow´s milk over a long period were of cow´s milk over a long period were more liable to experience fracturesmore liable to experience fractures

Spanish study – a significant inverse Spanish study – a significant inverse relationship between the prevalence of relationship between the prevalence of fractures amongst school children and fractures amongst school children and the calcium content in tapwaterthe calcium content in tapwater

Bone growth

CalciumCalcium PhosphorusPhosphorus FluorideFluoride ProteinProtein

Vitamin DVitamin D Vitamin AVitamin A Vitamin KVitamin K Vitamin CVitamin C

Osteoporosis prevention

Nutritional status of mother Nutritional status of mother in last in last trimester of pregnancy (highest trimester of pregnancy (highest accumulation of calcium)accumulation of calcium)

Genetic factors (60-80 %)Genetic factors (60-80 %) Hormonal factors (puberty)Hormonal factors (puberty) Nutritional factorsNutritional factors (esp. (esp.

consumption of dairy productsconsumption of dairy products and and other food rich in calcium – other food rich in calcium – see next see next

slideslide)) Physical exercisePhysical exercise (increases bone (increases bone

density)density)

Food rich in calcium

Milk, dairy products (cheese, Milk, dairy products (cheese, yoghurt)yoghurt)

Sardines, herrings, sea-weedSardines, herrings, sea-weed Poppy, sesame seedsPoppy, sesame seeds MolassesMolasses Appricots, figsAppricots, figs Cabbage, savoy cabbage, Brussels Cabbage, savoy cabbage, Brussels

sprouts, broccoli, pulsessprouts, broccoli, pulses

Multiple deficiencies (Fe, Ca, Zn, Mg, I, vit. B6, vit. C, folic

acid) Delayed growth and development Delayed growth and development Rachitis (infants)Rachitis (infants) Anaemia (6-24 months, puberty)Anaemia (6-24 months, puberty) Delayed menarché in girls (eating Delayed menarché in girls (eating

disorders)disorders) Decreased resistance to infectionsDecreased resistance to infections Fatigue, low mental performanceFatigue, low mental performance Emotional disordersEmotional disorders

Nutrient intake in preschool children (Maříková et al., 2005)

Evaluation of average daily energy and Evaluation of average daily energy and nutrient intake in 91 preschool children nutrient intake in 91 preschool children from kindergartens in Teplice, German from kindergartens in Teplice, German RDI usedRDI used

Adequate intakeAdequate intake of Ca, Fe, vit. B1, B2, of Ca, Fe, vit. B1, B2, energy, fat (29.5% - energy, fat (29.5% - increased increased saturated fatty acids)saturated fatty acids)

Sign. increased intakeSign. increased intake of of proteins proteins (2.45 g/kg (2.45 g/kg compared to RDI 0.9 g/kg )compared to RDI 0.9 g/kg )

Sign. decreased intake Sign. decreased intake of of vit. C (67% vit. C (67% of RDI)of RDI)

Nutrient intake in school children (Brázdová et al., 2000)

Survey in Survey in a a representative sample of 980 representative sample of 980 children (junior and senior school age) from children (junior and senior school age) from CR - 24 hour recall and food frequency CR - 24 hour recall and food frequency ques. (focused on dietary sources of ques. (focused on dietary sources of vitamins and Ca)vitamins and Ca)

Inadequate intake of vit. C Inadequate intake of vit. C (80 and 50% (80 and 50% of RDI in junior and senior school age), of RDI in junior and senior school age), vit. vit. E E (69, 60%), (69, 60%), Ca Ca (66, 54%)(66, 54%)

Recommended : -Recommended : - increaseincrease consumptionconsumption of of vegetable, fruitvegetable, fruit and and milk products milk products

- - focus on focus on nutrition education (food nutrition education (food pyramid)pyramid)

Health promotion projects (methods

recommended by MoH)• Children:Children:• A little pyramid („Pyramidáček“) A little pyramid („Pyramidáček“) – Health Institute – Health Institute

BrnoBrno• Fruits and vegetables 5 times a dayFruits and vegetables 5 times a day – MF MU Brno– MF MU Brno • Complex system of intervention in school cateringComplex system of intervention in school catering – –

National Institute of Public Health PragueNational Institute of Public Health Prague• Let´s slim with Bumbrlínek Let´s slim with Bumbrlínek – Health Institute Brno– Health Institute Brno• Let´s eat and live healthy – Health Institute PlzeńLet´s eat and live healthy – Health Institute Plzeń• What is wrong and good for us – HI PlzeńWhat is wrong and good for us – HI Plzeń• We´ll be healthy in the 21We´ll be healthy in the 21stst century – MF MU Brno century – MF MU Brno• Optimalization of physical activity in school children – Optimalization of physical activity in school children –

Pedagogical FacultyLiberec Pedagogical FacultyLiberec

A little pyramid („Pyramidáček“) – Health

Institute Brno

Educational programmme for Educational programmme for kindergartens - basics on healthy kindergartens - basics on healthy nutrition and promotion of physical nutrition and promotion of physical activityactivity

Curricula – teaching methods - Curricula – teaching methods - play, competitions, fairy tales, play, competitions, fairy tales, stories, arts (e.g. food pyramid)stories, arts (e.g. food pyramid)

http://www.pyramidacek.czhttp://www.pyramidacek.cz

Interactive Interactive Programmes Programmes in Nutrition in Nutrition EducationEducation

Skálová L., Komárek L., Kernová V., Skálová L., Komárek L., Kernová V., Rážová J.Rážová J.

National Institute of Public Health National Institute of Public Health Centre of Health and Living ConditionsCentre of Health and Living Conditions

Pyramid of Healthy Pyramid of Healthy NutritionNutrition

Programme for ChildrenProgramme for Children

Education programme for food Education programme for food choicechoice

Set up a food pyramidSet up a food pyramid Set up a dietSet up a diet

www.www.szuszu..czcz zdraví/pro děti zdraví/pro děti

Websites(education of parents,

teachers, children, physicians, nurses)

www.vyzivadeti.cz

Manual for teachers on nutrition

(Health promotion in schools)

„Best school lunch“ (General Health Insurance Comp. Competition,

CR)

Obesity and overweight in children and youth

EU Community projects

Children, Obesity and Children, Obesity and Associated Avoidable Chronic Associated Avoidable Chronic DiseasesDiseases

• coordinator: European Heart Network, Brusselcoordinator: European Heart Network, Brussel

(CZ: Czech Heart Association srdce) (CZ: Czech Heart Association srdce) • 2004 - 2007 2004 - 2007 •

Prevalence of overweight children

in 31 countries grouped by region

Source: HBSC

Ove

rwei

gh

t P

reva

len

ce (

%) North America

Scandinavia

United Kingdom

(South) Western Europe

(Central) Western Europe(Northwest) Eastern Europe

(Southwest) Eastern Europe

0

5

10

15

20

25

United S

tate

s

Canad

a

Mal

ta

Spain

Portugal

Italy

Greec

e

Wal

es

England

Scotla

nd

Slove

nia

Hungary

The fo

rmer

Yugosl

av R

epublic

of M

aced

onia

Croat

ia

Finla

nd

Norway

Denm

ark

Sweden

Austria

Belgiu

m (F

rench

)

France

Germ

any

Belgiu

m (F

lem

ish)

Switzer

land

Nether

lands

Czech

Rep

ublic

Poland

Estonia

Ukrai

ne

Russia

n Fed

erat

ion

Latvi

a

Lithuan

ia

Ove

rwei

gh

t P

reva

len

ce (

%) North America

Scandinavia

United Kingdom

(South) Western Europe

(Central) Western Europe(Northwest) Eastern Europe

(Southwest) Eastern Europe

PERCENTAGE OF OVERWEIGHT AND OBESE CHILDREN Reference data: WHO and IOTF recommendations

Age 7 – 11 years

0

5

10

15

20

25

30

35

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

%

USAEuropeCzech Rep.

Report of the International Obesity Task Force, 2004

Overweight and obesity in adolescents (13 – 17 years)

The International Obesity Task Force (www.iaso.org)

0 10 20 30 40

CZ

H

GR

I

UK

obezitanadváha+obezita

Overweight and obesity in Czech adult population

International Obesity Task-Force, 2005 www.iaso.org

BMI = weight (kg)BMI = weight (kg)/ / heightheight22(m)(m)

1 .Norm 1 .Norm 18,5 - 24,918,5 - 24,9

2. Overweight 25 - 29,92. Overweight 25 - 29,9

3. Obesity I3. Obesity I 30 - 34,9 30 - 34,9

4. Obesity II4. Obesity II 35 - 39,9 35 - 39,9

5. Obesity III 40 and 5. Obesity III 40 and more more

0

10

20

30

40

50

60

70

80

BMI 2 BMI 3 BMI2+3

mužiženy

Obesity - etiology

• Genetic factors

• Metabolic factors• Socioeconomic

factors • Nutritional habits• Physical activity

Multifactorial disease

Obesity

Genetic factors Genetic factors Hormonal factorsHormonal factors Socioeconomic,Socioeconomic,

psychological psychological factorsfactors

Eating habits Eating habits (increased (increased energy intake)energy intake)

Physical activity Physical activity (decreased – low (decreased – low energy output)energy output)

High blood High blood pressurepressure

High cholesterolHigh cholesterol Diabetes (II type)Diabetes (II type) CVDCVD tumorstumors Risk of Risk of

preliminary death preliminary death in adulthood in adulthood higher by 50-80% higher by 50-80%

Prevention of obesity

Excl.Excl. breastfeeding breastfeeding for 6 months and for 6 months and sustained BF until 2 yearssustained BF until 2 years

MonitoringMonitoring of growth and nutritional of growth and nutritional status (preventive pediatric status (preventive pediatric examinations –examinations – early detectionearly detection))

EducationEducation of parents and children on: of parents and children on: -- healthy nutrition and eating habitshealthy nutrition and eating habits (regular eating regimen in smaller (regular eating regimen in smaller portions, healthy composition of a portions, healthy composition of a diet - food pyramid), warning about diet - food pyramid), warning about dietingdieting - - regular physical activityregular physical activity (balance between energy input and (balance between energy input and output)output)

Nutritional Counselling (HPH – Health Promoting Hospitals/WHO)

Evaluation of history data, incl. Evaluation of history data, incl. weight (questionnaires) weight (questionnaires)

Assessment ofAssessment of eating habits eating habits andand food consumptionfood consumption (24 hours recall)(24 hours recall)

Assessment ofAssessment of physical activityphysical activity (questionnaires)(questionnaires)

Analysis of data (PC programme – Analysis of data (PC programme – energy, nutrient intake)energy, nutrient intake)

Individual counselling based on Individual counselling based on current guidelines on healthy current guidelines on healthy nutrition (food pyramid) nutrition (food pyramid)

Treatment of obesity

Group weight reduction courses Group weight reduction courses for children and parents, for children and parents, adolescents (STOB – adolescents (STOB – www.stob.cz)www.stob.cz)

Health promotion projects of MoH Health promotion projects of MoH (e.g. „Let´s slim with (e.g. „Let´s slim with Bumbrlínek“)Bumbrlínek“)

Spa treatment Spa treatment

Group weight reduction courses (www.stob.cz)

3 months 3 months courses for children and courses for children and parents/grandparents, adolescentsparents/grandparents, adolescents

Cognitive behavioural approach Cognitive behavioural approach – – modified for children (plays, contests)modified for children (plays, contests)

Elaboration of individual Elaboration of individual regimen of regimen of healthy eating and physical healthy eating and physical activity activity

Evaluation of questionnaires before Evaluation of questionnaires before and after treatment (effectiveness)and after treatment (effectiveness)

Follow-up, controlsFollow-up, controls

www.hravezijzdrave.cz

References

WHO/Nutrition – School-age children WHO/Nutrition – School-age children and adolescents: and adolescents: http://www.http://www.whowho..intint//nutritionnutrition//publicationspublications//schoolagechildrenschoolagechildren/en/en//

WHO/Global Strategy on Diet, WHO/Global Strategy on Diet, Physical Activity and Physical Activity and Health/Childhood overweight and Health/Childhood overweight and obesity: obesity: http://www.who.int/dietphysicalactivithttp://www.who.int/dietphysicalactivity/childhood/en/y/childhood/en/