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NUTRITION

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Issue of immense national importance

  • Children have high maintenance needs, high metabolic and nutrient turn over rates.
  • Children have marked organ development and functional changes.
  • Requirements vary with respect to age,weight,sex,disease status etc.

Nutrition : Lets begin……..

  • Children achieve 80% of their growth potential in the first 3 to 5 yrs. of life.
  • Nutrition, illness etc. play and important in physical growth, mental development, psychosocial Dev., bone growth, dentition, sexual maturation etc.
Nutrition Plans
Calories:measured as energy requirement
for physical activity and growth.
  • 1 gm of protein gives 4 kilo Calories.
  • 1 gm fat gives 9 kilo Calories
  • Caloric requirement –

  • 1 yr = 115 Kcal / Kg
  • 1 – 3 yrs. = 1350 Avg.
  • 4 – 6 yrs. = 1850 Avg.
  • 7 – 9 yrs. = 1200 Avg.
  • 10 – 19 yrs. = 2600 – 3000 Avg.
Protein:
  • Polypeptides containing aminoacids
  • Essential Amino Acids –Leucine,Isoleucine,Lysine Methionine,Valine etc.
  • Non essential amino acids
  • Class A or biological complete protein – animal proteins
  • Requirement –

  • 1 year old = 1.5gms/kg/day
  • 4 – 6 yrs = 20gms/day
  • 7 – 9 yrs = 25gms/day
  • 10 – 18 yrs = 30 to 40 gms/day
Obesity:
  • 17 – 23% increased risk of hypertension,leptin receptors(Chr. 7),insulin resistance,hyper insulinemia, increased leptin levels, diet, Na intake,Na sensitivity(50% ass.), life style,parental education,family history,computers and sedentary lifestyle.
Fats(Lipids):
  • 35% of daily caloric requirements of lipids.
  • Essential fatty acids (poly unsaturated FA)
  • Source - corn oil, sunflower oil.
Calcium:

    Essential for bone development, dentition, muscle activity, over all growth.

    Requirement = 1 yr - 500 mg/day

  • older child - 700 mg / day
  • adult - 500 mg/ day
  • Source – milk, millets, nonveg food.

    Regulation with Vit. D

Phosphorus:
  • Normal requirement = 400 – 500 mg / day in childhood.
  • Works in conjunction in calcium levels.
  • Normal ratio of Ca x P = < 50.
  • If ratio more – e.g. Chronic Kidney Disease etc.
Iodine:
  • Normal secretions of thyroid gland.
  • Deficiency Causes Hypothyroidism.
  • Excess causes - Hyperthyroidism.
  • Source –sea food, non veg and veg diet,salt
  • Requirement – 0.1 – 0.15 mgs/ day
Fluorine:
  • Prevents Dental caries.
  • Source -sea food and tea,drinking water.
  • Excess causes – flouorosis.
  • Requirement = 0.2 mgs/ day.
  • Water contains 2 parts per million normally.
Zinc:
  • Essential part of several enzymes.
  • Deficiency causes growth failure,hypogonadism,anemia,liver dysfunction.
  • Source – meat, fish, wheat.
  • Requirement – 22 mgs./ day.
Magnesium:
  • Essential part of several enzymes.
  • Deficiency causes growth failure,Malnutrition,CRF, Diarrhea,Irritability,anemia,liver dysfunction,muscle cramps.
  • Source – meat,plant food (milk is a poor source).
  • Requirement – 200 - 300 mgs/day.
Copper:
  • Essential part of several enzymes,helps in iron absorption.
  • Deficiency causes growth failure,Malnutrition,Diarrhea, Irritability,anemia,liver dysfunction.
  • Source – meat,liver,Sea food,nuts,raisins(milk is a poor source).
  • Requirement – 80 – 40 mgs/day.
Miscellaneous:
  • Chromium,Selenium,Cobalt,Molybdenum,Folate.
A paradox:
  • Inspite of protein Calorie Malnutrition decreasing in the upper strata of society, obesity has become more prominent in almost 40% of school going children.
  • Inspite of children being of adequate weight or,over weight,they still show nutritional deficiencies.
  • Fast food, colas, unhealthy fried items etc.
  • Grow charts and normograms of height,weight,BP,BMI charting.
Vitamin B1(Thiamine):
  • Deficiency – beri beri,cardiac,swelling,vomiting,convulsions etc.
  • Requirement = 1 mg/day
  • Source – wheat,lentils,dal,nuts,meat,eggs.
Vitamin B2(Riboflavine):
  • Deficiency – Glossitis,Dermetitis,Eyes–Keratitis
  • Requirement - 1.5 mgs/day
  • Source – leafy vegetables,methi,sag,soyabenas,wheat,eggs.
Niacin:
  • Deficiency – Diarrhea,Muscle Weakness,Memory Loss,Dermatitis etc.
  • Requirement -5 - 15 mgs/day
  • Source – Nuts,rice,liver,Leafy vegetables,wheat.
Vitamin B6(Pyridoxine):
  • Deficiency – Failure to thrive irritability anemia vomiting.
  • Requirement – 1 – 2 mgs/day
  • Source – mixed diet
Folic Acid:
  • Deficiency – Megaloblastic Anemia .
  • Requirement – 1 – 2 mgs / day
  • Source – leafy veg,dates,liver, milk.(95% of folic acid is lost by over cooking)
Vitamin B12(Cyancobalamin):
  • Deficiency – Anemia,Spinal Cord problems.
  • Requirement – 1.5 micro gms / day
  • Source – Liver,leafy veg,milk.
Vitamin C(Ascorbic Acid):
  • Deficiency – lethargy,fretful,tender bones,muscle weakness, gum and skin bleeding,rash.
  • Requirement – 20 mgs / day
  • Source – citrus fruits,veg,papaya,tomato etc.
Vitamin A:
  • Deficiency – Night blindness,skin changes,respiratory infections,failure to thrive.
  • Requirement – 400 micro mgs / day
  • Source – butter,ghee,veg,mango,carrot,spinach etc.
Vitamin D:
  • Deficiency – Bone changes with rickets,failure to thrive,weakness,fractures.
  • Requirement – 400 micro mgs / day
  • Source – butter,ghee,veg,mango,carrot,spinach etc.
Iron:
  • Deficiency – lethargy,fretful,tender bones,muscle weakness, gum and skin bleeding,rash.
  • Requirement – 20 mgs / day
  • Source – citrus fruits,veg,papaya,tomato etc.
  • Neonatal screening crucial*
  • School health programmes crucial*
Investigations:
  • Haemogram, Electrolytes , RFT, LFT, ABG.
  • Uric Acid, Ca, P, ionic gap.
  • Urine R/M, C/S, E/U/C (Fe Na.)
  • PRA, Aldosterone, LH, FSH, GH, insulin, Testosterone, T3, T4, TSH.
  • C3, C4, ANA, DNA Ds, ANCA, Anti GBM Ab.
  • Genetic investigations.
Investigations:
  • ECG, ECHO, Fundus
  • X-ray Chest, USG Abdomen & KUB, Doppler.
  • Vit. And mineral levels in blood
  • Bone marrow
Examination:
  • BP & Pulses in all four limbs *.
  • Cutaneous – skin lesions, rash.
  • CNS – bell’s palsy,encephalopathy,retinopathy
  • CVS – CCF,PP & BP diff in UL & LL.
  • RS – pulmonary infections
  • P/A – bruits, masses, palpable kidney
  • Endo – thyromegaly,virilization,cushingoid
  • Genetic – turner’s,william’s,neuromas, etc.
Treatment:
  • Non Pharmological:Weight control, diet, exercise, no smoking or drug abused.
  • Pharmological:Supplementation of vitamins,minerals,iron etc.
  • Choice of treatment: Rational approach,doses with regards weight and age, no over use, chemists can be devils, no self treatment,avoid myths,food pyramid,wrong promotion in market of protein supplements.

Nutrition Rx : Contraindications
  • Renal Stones, Eyes, Skin, Brain, Teeth etc.