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.
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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
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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.
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Fats(Lipids): |
- 35% of daily caloric requirements of lipids.
- Essential fatty acids (poly unsaturated FA)
- Source - corn oil, sunflower oil.
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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
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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.
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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
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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.
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Zinc: |
- Essential part of several enzymes.
- Deficiency causes growth failure,hypogonadism,anemia,liver dysfunction.
- Source – meat, fish, wheat.
- Requirement – 22 mgs./ day.
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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.
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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.
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Miscellaneous: |
- Chromium,Selenium,Cobalt,Molybdenum,Folate.
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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.
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Vitamin B1(Thiamine): |
- Deficiency – beri beri,cardiac,swelling,vomiting,convulsions etc.
- Requirement = 1 mg/day
- Source – wheat,lentils,dal,nuts,meat,eggs.
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Vitamin B2(Riboflavine): |
- Deficiency – Glossitis,Dermetitis,Eyes–Keratitis
- Requirement - 1.5 mgs/day
- Source – leafy vegetables,methi,sag,soyabenas,wheat,eggs.
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Niacin: |
- Deficiency – Diarrhea,Muscle Weakness,Memory Loss,Dermatitis etc.
- Requirement -5 - 15 mgs/day
- Source – Nuts,rice,liver,Leafy vegetables,wheat.
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Vitamin B6(Pyridoxine): |
- Deficiency – Failure to thrive irritability anemia vomiting.
- Requirement – 1 – 2 mgs/day
- Source – mixed diet
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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)
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Vitamin B12(Cyancobalamin): |
- Deficiency – Anemia,Spinal Cord problems.
- Requirement – 1.5 micro gms / day
- Source – Liver,leafy veg,milk.
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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.
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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.
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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.
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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*
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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.
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Investigations: |
- ECG, ECHO, Fundus
- X-ray Chest, USG Abdomen & KUB, Doppler.
- Vit. And mineral levels in blood
- Bone marrow
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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.
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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.
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Nutrition Rx : Contraindications |
- Renal Stones, Eyes, Skin, Brain, Teeth etc.
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