Promotion of normal growth rate, organ Promotion of normal growth rate, organ development, and body compositiondevelopment, and body composition

Prevention of later diseasePrevention of later disease— ObesityObesity— CardiacCardiac— AllergicAllergic— CancerCancer

Birth weight triples by 1 year, but does Birth weight triples by 1 year, but does not quadruple until age 2not quadruple until age 2

Birth length increases by 50% in year 1, Birth length increases by 50% in year 1, but does not double until age 4but does not double until age 4

After age 2, children average 2 -3 kg and After age 2, children average 2 -3 kg and 6 - 8 cm of growth per year6 - 8 cm of growth per year

Serve as a guide for estimating nutrient Serve as a guide for estimating nutrient needneed

DRIs recently revised for specific DRIs recently revised for specific childhood ages childhood ages (Institute of Medicine)(Institute of Medicine)

Much of the data are extrapolated from Much of the data are extrapolated from adult, but increasingly more specificadult, but increasingly more specific

Since they are group recommendations, Since they are group recommendations, they include a margin of safetythey include a margin of safety

The Two FactorsThe Two Factors

WhichWhich

Contribute to Childhood MalnutritionContribute to Childhood Malnutrition

POVERTYPOVERTY

IGNORANCEIGNORANCE

Children after the age of 1 are Children after the age of 1 are largely unprotected becauselargely unprotected because

— Programs are much less specific Programs are much less specific regarding nutrient requirements regarding nutrient requirements compared with < 1 yearcompared with < 1 year

— A child’s diet and an adult diet are A child’s diet and an adult diet are similar; thus, children can be similar; thus, children can be shortchanged in a general assistance shortchanged in a general assistance paradigmparadigm

Willful or unwitting ignorance by parents Willful or unwitting ignorance by parents may contribute to nutritional imbalances:may contribute to nutritional imbalances:

— Parent allowing child to choose foods Parent allowing child to choose foods leading to unbalanced dietleading to unbalanced diet

— Parent willfully manipulating diet without Parent willfully manipulating diet without consideration for balance and nutrient needsconsideration for balance and nutrient needs

» Imposition of adult diet on young childImposition of adult diet on young child» Fad foods/”nutriceuticals” Fad foods/”nutriceuticals”

Vary considerably among childrenVary considerably among children

Dependent on:Dependent on:— Basal metabolic rateBasal metabolic rate

— The Barker Hypothesis & Fetal “Programming”The Barker Hypothesis & Fetal “Programming”

— Growth rateGrowth rate— Physical activityPhysical activity— Body sizeBody size

Range from 1000 Kcal/d at 1 year to 2200 Range from 1000 Kcal/d at 1 year to 2200 Kcal/d at 12 yearsKcal/d at 12 years

Absorption of amino acids increases Absorption of amino acids increases protein synthesis in children (unlike adults)protein synthesis in children (unlike adults)

The body is unable to store excess dietary The body is unable to store excess dietary amino acidsamino acids

— Uses them for energy production if energy Uses them for energy production if energy intake is lowintake is low

— Or converts them to glucose or fat if energy Or converts them to glucose or fat if energy intake is adequateintake is adequate

(Continued)(Continued)

Daily protein requirement ranges from 12 grams Daily protein requirement ranges from 12 grams at 1 year to 35 grams at 12 yearsat 1 year to 35 grams at 12 years

Note that protein requirements during childhood Note that protein requirements during childhood are low compared to newborn or teenare low compared to newborn or teen

— Growth rates are slowerGrowth rates are slower

— Tissue synthetic rates are slowerTissue synthetic rates are slower

Amino acid needs for growth decrease from 56% Amino acid needs for growth decrease from 56% of total intake at birth to 5% at 5 yearsof total intake at birth to 5% at 5 years

The DRIs are largely extrapolated The DRIs are largely extrapolated from infant or adult datafrom infant or adult data

Exceptions are for energy, protein Exceptions are for energy, protein and iron where balance studies have and iron where balance studies have been performedbeen performed

(Continued)(Continued)

Minerals/elements that are likely to be Minerals/elements that are likely to be low in the diet of young childrenlow in the diet of young children— CalciumCalcium

» Crucial for Crucial for preteenpreteen girls re: future osteopenia girls re: future osteopenia

— IronIron— ZincZinc— MagnesiumMagnesium

Healthy, growing children consuming a varied diet Healthy, growing children consuming a varied diet do not need vitamin supplementationdo not need vitamin supplementation

Children at nutritional risk who may benefit from Children at nutritional risk who may benefit from vitamin supplementationvitamin supplementation— Those from deprived, neglectful or abusive familiesThose from deprived, neglectful or abusive families

— Those consuming fad dietsThose consuming fad diets— Those with chronic disease, particularly affecting the Those with chronic disease, particularly affecting the

GI tractGI tract— Those on dietary programs for managing obesityThose on dietary programs for managing obesity— Those on vegetarian diets without adequate dairy Those on vegetarian diets without adequate dairy

productsproducts

Protein, energy and protein-energy Protein, energy and protein-energy malnutritionmalnutrition— Endemic areas include sub-Saharan AfricaEndemic areas include sub-Saharan Africa

Iron deficiencyIron deficiency— World-wide for various reasonsWorld-wide for various reasons

» Intestinal blood loss (parasitic) in developing countriesIntestinal blood loss (parasitic) in developing countries» Inadequate intake (cow’s milk) in developed countriesInadequate intake (cow’s milk) in developed countries

Vitamin A deficiencyVitamin A deficiency

ObesityObesity— Begins generally after the age of 2 - do not Begins generally after the age of 2 - do not

restrict dietary fat before this agerestrict dietary fat before this age— 30% of children are obese: rate is increasing30% of children are obese: rate is increasing

— Childhood obesity is not generally “outgrown”Childhood obesity is not generally “outgrown”

— Growth adiposity rebound between 5 and 7 years Growth adiposity rebound between 5 and 7 years is critical in predicting adult obesityis critical in predicting adult obesity

» Early rebound more predictive of later obesityEarly rebound more predictive of later obesity

GIRLS2 - 18 yrs

Obesity Obesity (continued)(continued)

— Young children will not innately choose a well-Young children will not innately choose a well-balanced diet unless appropriate foods are balanced diet unless appropriate foods are presented and models of food acceptance givenpresented and models of food acceptance given

— Parents and school lunch programs must provide Parents and school lunch programs must provide

nutritious foods at regular meals and snacks, and nutritious foods at regular meals and snacks, and

allow the children to decide how much they eatallow the children to decide how much they eat— Children do best 4-6 times a day with relatively low Children do best 4-6 times a day with relatively low

volume foodsvolume foods» Snacks should be considered normal mealsSnacks should be considered normal meals

ObesityObesity (continued)(continued)

— The influence of advertising should notThe influence of advertising should not be underestimatedbe underestimated

» 50% of television advertising is for foods (higher in 50% of television advertising is for foods (higher in children’s programs)children’s programs)

» Most foods shown on TV are high in fat, sugar and salt (e.g., Most foods shown on TV are high in fat, sugar and salt (e.g., sweetened cereal, fast foods, snack products, candy)sweetened cereal, fast foods, snack products, candy)

» TV messages have primarily emotional/psychological appealTV messages have primarily emotional/psychological appeal

— Physical inactivity likely plays the largest Physical inactivity likely plays the largest role in childhood obesityrole in childhood obesity

Iron Deficiency: 6-13%Iron Deficiency: 6-13%— Children at risk due to low iron stores at birth (up to Children at risk due to low iron stores at birth (up to

250,000 per year)250,000 per year)

» Growth-retarded infantsGrowth-retarded infants» Infants of diabetic mothersInfants of diabetic mothers

— Children at risk due to inadequate intakeChildren at risk due to inadequate intake» Early introduction of cow’s milk (before 12 months)Early introduction of cow’s milk (before 12 months)» Unsupplemented infant formula (up to 30% of sales)Unsupplemented infant formula (up to 30% of sales)» Breastfeeding without iron supplementation (20% at 9 monthsBreastfeeding without iron supplementation (20% at 9 months

— Children with increased GI blood lossChildren with increased GI blood loss

Vary significantly based on gender and ageVary significantly based on gender and age

DRIs for malesDRIs for males— 13 - 15 years old: 2000 Kcal/d13 - 15 years old: 2000 Kcal/d— 16 - 18 years old: 3200 Kcal/d16 - 18 years old: 3200 Kcal/d

DRIs for femalesDRIs for females**

— 13 - 15 years old: 2200 Kcal/d13 - 15 years old: 2200 Kcal/d— 16 - 18 years old: 2100 Kcal/d16 - 18 years old: 2100 Kcal/d

**add 300 Kcal for pregnancy; 450 Kcal for lactationadd 300 Kcal for pregnancy; 450 Kcal for lactation

Second peak of protein accretion during Second peak of protein accretion during childhoodchildhood— Associated with significant growth spurtAssociated with significant growth spurt

DRIs for malesDRIs for males— 11 - 14 years (pre-growth spurt): 45 g/d11 - 14 years (pre-growth spurt): 45 g/d

— 15 - 18 years (growth spurt): 59 g/d15 - 18 years (growth spurt): 59 g/d

NutrientNutrient Gender Increment IncrementGender Increment Increment Suggested Suggested

(average) (peak of growth spurt)(average) (peak of growth spurt)

CalciumCalcium M 210 400 1100 M 210 400 1100

F 110 240 1200F 110 240 1200**

Iron M 0.57 1.1 10 Iron M 0.57 1.1 10

F 0.23 0.9 13F 0.23 0.9 13****

Zinc M 0.27 0.50 12Zinc M 0.27 0.50 12

F 0.18 0.31 9F 0.18 0.31 9

All values are mg/dAll values are mg/d** to increase bone mineral stores to increase bone mineral stores* * increased iron turnover due to mensesincreased iron turnover due to menses

Onset of puberty in both sexes increases:Onset of puberty in both sexes increases:— Energy needs for increased physical activityEnergy needs for increased physical activity— Protein needs for rapid skeletal growthProtein needs for rapid skeletal growth— Calcium needs for bone mineralizationCalcium needs for bone mineralization

Onset of menstruation in girls increases:Onset of menstruation in girls increases:— Iron demand to replace blood loss and match Iron demand to replace blood loss and match

expanding blood volumeexpanding blood volume— Calcium need to protect against later Calcium need to protect against later

osteopeniaosteopenia

Low energy intake (dieting) creates difficulties in Low energy intake (dieting) creates difficulties in obtaining adequate levels of micronutrientsobtaining adequate levels of micronutrients

Replacement of milk (or other high-calcium foods) with Replacement of milk (or other high-calcium foods) with soft drinks, coffee, etc., results in a low calcium intake soft drinks, coffee, etc., results in a low calcium intake associated with a high protein intake — leads to associated with a high protein intake — leads to negative calcium balance and increased risk of negative calcium balance and increased risk of osteoporosisosteoporosis

High iron requirements to sustain rapidly expanding High iron requirements to sustain rapidly expanding blood volume and lean body mass and to offset blood volume and lean body mass and to offset menstrual losses in females are frequently not met; iron menstrual losses in females are frequently not met; iron deficiency is particularly prevalent in female athletesdeficiency is particularly prevalent in female athletes

Positive zinc balance is essential for adolescent Positive zinc balance is essential for adolescent growth; zinc deficiency is characterized by growth growth; zinc deficiency is characterized by growth failure, hypogonadism, decreased taste acuity; failure, hypogonadism, decreased taste acuity; increased prevalence in Middle Eastincreased prevalence in Middle East

Vegetarian diets without eggs and milk lead to vitamin Vegetarian diets without eggs and milk lead to vitamin D and B12, riboflavin, protein, calcium, iron and zinc D and B12, riboflavin, protein, calcium, iron and zinc deficiency; adolescents on vegan diets must learn to deficiency; adolescents on vegan diets must learn to assess protein quality and balanceassess protein quality and balance

Obesity, often carried over from preteen years, Obesity, often carried over from preteen years, becomes worse with poor quality snacks, limited food becomes worse with poor quality snacks, limited food choice and frequent eating away from homechoice and frequent eating away from home

Nutritional issues in childhood and Nutritional issues in childhood and adolescence differ in developing and adolescence differ in developing and developed countriesdeveloped countries

The antecedents of adult diseases are The antecedents of adult diseases are found in childhood nutritional disordersfound in childhood nutritional disorders ObesityObesity AllergyAllergy ?Cancer?Cancer