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Nutritional Requirement (Pediatrics), contraction dietary reference…

- - - - 1-3yr=30-40% of total energy
      - 4-18yr= 25-35%of total energy
    - - FUNCTION
        
        Energy source
        When found in foods, is a source
        of ω3 and ω6 PUFAs
        Facilitates absorption of fat soluble vitamins
      - SOURCES
        
        Infants
        
        Human
        milk or infant formula
        
        Older children
        
        Butter, margarine,
        vegetable oils,whole milk,
        visible fat on meat and poultry
        products, invisible fat in fish,
        shellfish, some plant products
        such as seeds and nuts, bakery
        products
      - Effects of Excessive Consumption
        
        No UL (Upper limit)
        
        High fat intake will lead to
        obesity
        
        Low fat intake (with high carbohydrate) has been shown to increase plasma triacylglycerol concentrations and decrease HDL cholesterol
      - Life stage group
        
        Age and RDA or AI (g/ day)
        
        Infants
        
        0-6 mo - 31*
        
        7-12 mo 1-18 yr - 30*
        
        Insufficient evidence to determine AI or EAR
  - - - The body can synthesize its needs for saturated fatty acids from other sources
    - - SAT FA
        
        Animal fats (meat fats and butter fat),coconut ,palm kernel oils
      - Trans fat
        
        stick margarines, foods containing hydrogenated or partially hydrogenated vegetable shortenings
    - - increase in plasma total and LDL cholesterol
    - - Age and RDA or AI (g/ day)
        
        No dietary requirement
  - - - liver, eggs, foods that contain eggs, e.g., cheesecake, custard pie
    - - No dietary requirement
  - - - Abundant in many food
      - Provides 4 kcal/g
      - RDA :primary energy source for the brain
      - AMDR:source
        of kcal to maintain body weight
      - Glycemic index
        
        measure of the height of blood sugar levels 2 hours following ingestion against the reference standard (a slice of white bread)
    - - Major types
        
        starches and sugars Grains and vegetables (corn pasta, rice, potatoes, breads) are sources of starch
        Natural sugars are found in fruits and juices
        Sources of added sugars: soft drinks, candy, fruit drinks, desserts
    - - No defined intake level
      - Upper end of the AMDR
        
        decreasing risk of chronic disease
      - added sugars ; no more than 25% of energy requirement
    - - Age and RDA or AI (g/ day)
        
        7-12 mo - 95*
        
        Children >1 yr - 130
        
        0-6 mo - 60*
        
        Pregnancy ≤18 yr - 175
        
        19-30 yr - 175
  - - - Improves laxation,
        reduces risk of
        coronary artery (heart) disease, assists in
        maintaining normal blood glucose levels
    - - oats,
        wheat, unmilled rice
    - - A high intake of dietary fiber will not produce deleterious effects in healthy
        persons
  - - - Provides 4 kcal/g,Major structural component of all cells in the body,as enzymes, in membranes, as transport carriers, and as some hormones
    - - meat,
        poultry, fish,eggs, milk,cheese, yogurt,
    - - No defined intake level for potential adverse effects of protein is
        identified
      - Limited in some health conditions
        
        renal disease and metabolic dis ; phenylketonuria
    - - INDISPENSABLE
        
        Histidine,Isoleucine
        ,Leucine,Lysine,Methionine,Phenylalanine,Threonine,
        Tryptophan,Valine
  - - - Maintains fluid volume outside of cells
    - - sodium chloride (salt),benzoate,phosphate; salted meats, bread, nuts,cold cuts; margarine; butter;salt added to foods in cooking or at the table
      - Salt is ∼ 40% sodium by weight
    - - Hypertension Increased risk of cardiovascular disease and stroke
  - - - With sodium, maintains fluid volume outside of cells and thus normal cell function
    - - sodium chloride (salt), benzoate,phosphate; salted meats, nuts, cold cuts; margarine; butter; salt added to foods in cooking or at the table
      - Salt is ∼60% chloride by weight
    - - In concert with sodium, results in hypertension
  - - - Maintains fluid volume inside/ outsideof cells - normal cell function;
        Acts to blunt the rise of blood pressure in response to excess sodium intake, and decrease markers of bone turnover and recurrence of kidney stones
    - - Fruits and vegetables, dried peas, dairy products, meats, nuts
    - - None documented from food alone,From supplements or salt substitutes can result in hyperkalemia
        and possibly sudden death if excess is consumed by persons with chronic renal insufficiency (kidney disease) or diabetes
      - drugs for cardiovascular disease such as ACE inhibitors, ARBs, or potassium-sparing diuretics should be careful not to consume supplements containing potassium and might need to consume less than the AI
  - - - Maintains homeostasis in the body,Allows transport of nutrients to cells and removal and excretion of waste products of metabolism
    - - All beverages, including wate
      - watermelon, meats, soups,Breast milk and infant formula
    - - No UL because normally functioning kidneys can handle >0.7 L (24 oz)
        of fluid per hour hyponatremia, which can result
        in heart failure, and rhabdomyolysis (skeletal muscle tissue injury),
- - - - exclusively breastfed or given breast milk for 6 mo
        
        complementary foods for 1 yr or longer
      - Beneficial
        
        GROWTH FACTORS
        
        Transforming growth factor (TGF)
        
        Nerve growth factor
        
        Epidermal growth factor
        
        ENZYMES
        
        Platelet-activating factor (PAF)- acetylhydrolase
        
        Glutathione peroxidase
        
        Nucleotides
        
        ANTIBACTERIAL FACTORS
        
        κ-Casein
        
        Oligosaccharides
        
        Lactoferrin
        
        Secretory IgA
        
        Cytokines
      - Contraindications to Breastfeeding :no_entry:
        
        CMV
        
        Hepatitis B
        
        Herpes simplex
        
        Hepatitis C
        
        Breastfeeding is not contraindicated
        
        Varicella-zoster
        
        Alcohol intake
        
        Tuberculosis
        
        Cigarette smoking
        
        HIV & HTLV
        
        hemotherapy, adiopharmaceuticals
      - Conditions for Which Human Milk May Have
        a Protective Effect
        
        Diarrhea,Otitis media,Urinary tract infection,Necrotizing enterocolitis,Septicemia,Infant botulism,Insulin-dependent diabetes mellitus,Celiac disease,Crohn disease,Childhood cancer,Lymphoma,Leukemia,Recurrent otitis media,Allergy,Hospitalizations,Infant mortality
      - Problems
        
        Mastitis
        
        2-3% of lactating women
        
        warmth, tenderness,edema, & erythema
        
        Staphylococcus aureus, Escherichia coli, group A streptococcus,Haemophilus influenza, Klebsiella pneumoniae, and Bacteroides spp.
        
        Breast abscess -less common complication
        
        Inadequate Intake
        
        Insufficient milk intake, dehydration, and jaundice>>>1st week
        
        Signs
        
        lethargy, delayed stooling, decreased urine output, weight loss >7% of birth weight, hypernatremic dehydration, inconsolable crying and increased hunger
        
        Feeding 8-12 times a day
        
        Jaundice
        
        Breastfeeding jaundice
        
        related to insufficient fluid intake >>> 1st week
        
        associated with>>> dehydration & hypernatremia
        
        Breast milk jaundice
        
        persistently high serum indirect bilirubin
        
        2nd to 3rd wk of life
        
        Persistently high bilirubin levels
        
        :check:changing from breast milk >>>infant formula for 24-48 hr
        
        :check:phototherapy
      - Collecting Breast Milk
        
        Good hand washing and hygiene
        
        Refrigerated - used within 48 hr.
        
        Frozen - used for up to 6 mo
        
        Milk should be thawed rapidly by holding under running tepid water - used completely within 24 hr after thawing.
        
        Milk should never be microwaved.
      - Growth of the Breastfed Infant ; 1st yr of life
      - Recommendations
        
        Exclusive breastfeeding for about 6 months
        
        Peripartum policies and practices that optimize
        breastfeeding
        
        skin-to-skin contact
        
        Ensure 8-12 feedings at the breast every 24 hr
        
        Begin daily oral vitamin D drops (400 IU)
        
        All breastfeeding infants should be seen by a pediatrician within
        48 to 72 hr after discharge from the hospital
        
        Mother and infant should sleep in proximity to each other to
        facilitate breastfeeding
        
        back-to-sleep position n, no earlier than 3 to 4 weeks of age and after breastfeeding has been established
    - - Parental preference>>>most common reason for using infant formula
      - Ready-to-feed products generally provide 20 kcal/30 mL (1oz) and approximately 67 kcal/dL
      - Once opened - used within 4 weeks.
      - Once prepared- used within 24 hours.
      - Formula should be used within 2 hours of removal from the refrigerator
      - Once a feeding has started- used within an hour or be discarded.
      - Stored in refrigerator - warmed by placing the container in warm water for ~5 min.
      - Formula should not be heated in a microwave
      - Weight
        
        weight gain of 25-30 g/day
        
        140-200 mL/kg/ day in the first 3 months of life
        
        weight gain declines from 3-12 months of age.
    - - Protein content: 1.8 to 3 g/100 kcal or (1.45-1.6 g/dL)
      - higher than in mature breast milk (1.5 g/100 kcal).
      - β-globulin & α lactalbumin in human milk
      - Fat provides 40-50% of the energy
    - - lactose and use sucrose, corn syrup solids, maltodextrin to provide 67 kcal/dL.
      - provide a protein content of 2.45-2.8 g per 100 kcal or 1.7-1.8 g/dL.
      - DHA and ARA
      - INDICATIONS
        
        Galactosemia & Hereditary lactase deficiency
    - - oligopeptides>>>molecular weight =of <5000 Da
      - peptides>>>molecular weight <3000 Da
    - - peptide-free formulas
    - - Whole cow milk should not be introduced until 12 mo
      - Reduced-fat milk @ 12 and 24 mo of age
    - - low folic acid concentrations>>>electrolyte disturbances,anemia
      - NOT RECOMMENDED
    - - Important Principles for Weaning
        
        Begin at 6 mo of age
        
        encourage a cup
        
        Introduce 1 food at a time
        
        Iron-containing foods
        
        Zinc intake
        
        Phytate intake
        
        Breast milk should continue to 12 mo
        
        Give no more than 24 oz/day of cow milk
        
        Fluids other = discouraged
        
        Give no more than 4-6 oz/day of fruit juices
- - - - 6 mo until 15 mo
        
        self-feeding skills
      - 12-15 mo
        
        Bottle weaning
        
        bedtime bottles>>>discouraged
      - avoided
        
        Hard candies, nuts, and raw carrots
      - sliced length wise.
        
        Hot dogs, sausages, and grapes
      - need to eat 3 healthy meals
        
        2 snacks daily
      - daily vitamin D intake of 600 IU/ day