Please enable JavaScript.
Coggle requires JavaScript to display documents.
Nutritional Disorders (Pediatrics), Greatest risk in the first 1000 days…
Nutritional Disorders
(Pediatrics)
Overweight and Obesity
Prenatal factors
high preconceptual weight
maternal smoking
gestational weight gain
high birth weight
Breastfeeding>>>only modestly protective
measurement
BMI
Formula
= weight in kg/(height in meters)
Adults
BMI ≥30
obesity
BMI 25-30
overweight
Children >2 yr old
BMI ≥95th
obesity
BMI 85th - 95th
overweight
Causes
ENVIRONMENTAL CHANGES
GENETICS
Genetic determinants - FTO gene at 16q12
melanocortin-4 receptor (MC4R) deficiency
ENDOCRINE
GH deficiency
Hyperinsulinism
Cushing syndrome
Hypothyroidism
Pseudohypoparathyroidism
Comorbidities
type 2 diabetes, hypertension, hyperlipidemia,
nonalcoholic fatty liver disease (NAFLD)
metabolic syndrome
(central obesity, hypertension, glucose
intolerance, and hyperlipidemia)
increases risk for CV morbidity and mortality
Identification and Evaluation
Exam: growth chart for weight, height, and BMI trajectories
Laboratory Evaluation
fasting plasma glucose, triglycerides, low- density lipoprotein&high-density lipoprotein,cholesterol, and liver function tests
Intervention
Based on behavior change theories
Drinking lower quantities of sugar
Working with a dietitian
Meals should be based on fruits, vegetables, whole grains, lean meat, fish, and poultry.
Pharmacotherapy
children <16 yr old
Orlistat
Bariatric surgery
BMI ≥40
after failing 6 mo of program
Prevention
PREGNANCY
Do not smoke.
Maintain moderate exercise as tolerated.
Normalize body mass index before pregnancy
POSTPARTUM AND INFANCY
BF 4-6 mo,other foods 12 mo
FAMILIES
Eat meals as a family in a fixed place and time.
Do not skip meals, especially breakfast.
SCHOOLS
Education
COMMUNITIES
exercise and safe play facilities
HEALTHCARE PROVIDERS
Explain the biologic and genetic contributions to obesity.
INDUSTRY
Mandate age-appropriate nutrition labeling for products aimed
GOVERNMENT AND REGULATORY AGENCIES
Classify childhood obesity as a legitimate disease.
Undernutrition
factors
Child-caring practices
Access to health and water/ sanitation services
Household food supply
FOOD SECURITY
4 Dimensions
availability
supply of food
Access
household level
Utilization
Stability
Measurement of Undernutrition
Malnutrition
LBW, <2,500 g
2 main causes
Preterm delivery
Fetal growth restriction
Height-for-age
children <2 yr
LOW
reflects socioeconomic disadvantage
Weight-for-height
LOW
acute malnutrition.
HIGH
overweight
Weight-for-age
most commonly used index
mid-upper arm circumference
Body mass index (BMI)
overweight
+1 SD & +2 SD
obesity
More +2 SD
thinness
<−2 SD
Micronutrient deficiencies
public health significance
vitamin A, iodine, iron,& zinc.
Vitamin A
Xerophthalmia
Night blindness & Bitot spots
Iodine deficiency
goiter
pregnancy
cretinism
<100 μg/L indicates insufficient intake
Iron-deficiency
anemia
Zinc deficiency
Consequences of Undernutrition
Fetal programming
associated with an increased risk of hypertension, stroke,type 2 diabetes in adults
Economic consequences
Increased costs of healthcare Productivity losses,
Productivity losses from reduced cognitive ability
Increased costs of chronic diseases
Consequences of maternal undernutrition
Interventions
Promotion breastfeeding for 6 mo , and continued breastfeeding for at least 2 yr
Micronutirient supplements
most cost-effective investment
Vitamin A, Iron,Zinc, salt iodization
Zinc
10-20 mg/day for 2 wk
Severe Acute Malnutrition
6-59 mo, a mid-upper arm circumference <115 mm
Reductive Adaptation
Changes lead to
hypoglycemia
amino acid imbalances
hypothermia
fluid overload
excess body sodium,fluid retention,and edema
GI Infection
Treatment
Rehabilitation phase
restore wasted tissues
Stabilization phase
repair cellular function,
correct fluid and electrolyte imbalance
restore homeostasis
REFEEDING SYNDROME
complicate the acute nutritional rehabilitation of undernourished child
HALLMARK
development of severe hypophosphatemia
2 Common mistakes
Focusing on the illness and treat as for a
well-nourished child.
Treating edema with a diuretic
Giving a high-protein diet in the early
phase of treatment.
Community-based Therapeutic
Care
RUTF is usually provided
Steps
Emergency Treatment
Stabilization
Rehabilitation
Greatest risk in the
first 1000
days
,from conception to 24 mo of age