Nutrition in Var Life Stages

FEEDING SKILLS DEVELOPMENT

Age | Feeding skills | Nutrition | 4-6 months | Fading root/bite reflex | the CHILD experience new tastes. Give rice cereal with iron [remember IDA] | 6-7 months | Sits with minimal support. Holds bottle alone | Add fruits and vegetables | 8-9 months | Improved pincer grasp, puts random things in their mouth | Add protein foods and finger foods[stage wherein a lot of contamination could actually be going on] | 10-12 months | pulls to stand, reaches for food | Add soft table food.Allow to self-feed. | 12-18 months | increased independence | Stop bottle feeding, practice eating from a spoon, drinking from a glass/cup | 18 months to 2 yrs | GROWTH GAP -Growth slows. Less interest in eating | important role of mother or caregiver to encourage self-feeding with utensils | 2-3 years | Intake varies | Mother/caregiver to exert control on feeding. [picky with the food. ex want chocolate, junk foods] |
PRE-SCHOOL (1 TO 6 YEARS)

Growth is one of the anthropometric measurement to see the nutritional development of the child.

1 to 2 years old: on average, grows 12 cm, gains 3.5 kg.
4 years old: rate of growth slows down * 6-8 cm/year * 2-4 kg/year * nutritional intervention for possible malnutrition and other nut deficiencies when the child is growing around 4 cm or less.
6 years old: Brain growth triples

* Head circumference * physical index of both past nutrition and brain development * most sensitive anthropometric measurement of prolonged undernutrition(4 mos onward) during childhood and associated intellectual impairment * a Growth chart is available

Developing Healthy Habits 1) Offer a variety of healthy foods and snacks. 2) Encourage fruit and vegetable intake. 3) No junk food snacking. 4) Limit intake of juices ( 4 oz per day). 5) Increase intake of water (no soda). 6) Encourage low fat dairy products (3-4 servings/ day). 7) Make fun physical activity a habit. 8) Limit TV to no more than 1 to 2 hours per day. 9) Track growth and development carefully. 10) Be a good role model.

Notes: The problem with babies is that caregivers would give sweets to them which is wrong. At an early age, they should be given fruits and vegetables so they will grow with taste preferences towards this.
If a child is obese at younger age, there is a tendency to carry it to adulthood. consequence: medical problems.
Tracking of growth and development should be continuous even baby is apparently healthy. Children sometimes do not survive until 5y/o because of the malnutrition problems.

Nutritional Concerns in Adults and Adolescents 1) Malnutrition and poverty. 2) Growth spurt-onset of menses for girls-changes in body size/image. 3) Food fads, vitamins, athletes. 4) Eating disorders: anorexia and bulimia nervosa. 5) Overweight and obesity. 6) Hyperlipidemia and heart disease. 7) Bone mineralization and osteoporosis

Notes: Food fads like Splenda(Sucralose) sugars (also in milk teas). All sugars are not really good especially when you have diabetic history. Brown sugar has higher sucrose index than white sugar.
Protein shakes: adolescent athletes tend to overdrink protein which when metabolized produces different byproducts that is also not good in excess.
Osteoporosis results from reduced calcium absorption bec Filipinos don’t usually drink milk but coffee instead. Calcium supplementation will be lower.

POVERTY AND MALNUTRITION

* Iron-Deficiency Anemia (IDA) – most common childhood nutritional problem worldwide. Iti s common in lower socioeconomic status communities where food is a problem. Also, by parasitic worms. * Low vitamin C intake. * Exposure to lead. * Very important cause of malnutrition

* Lead Poisoning is more harmful in children as it affects developing nerves and brains so they are more prone to develop toxicity.
Sources: from paints, soil, soldered cans, highways, airborne lead, pottery etc

* Loss of developmental skills * Behavior, Attention problems * Hearing loss * Kidney damage * Reduced IQ * Slowed Body Growth

* Poor nutrition and cognitive function: * Decreased brain growth and or CNS development. * Poor performance on measures of cognitive ability. * Malnourished children are unprepared to benefit from age-appropriate educational experiences.

I. Adolescence

Adolescent Growth Spurt * Physiological growth stage (Tanner staging) rather than chronological age, is the best indicator for establishing requirements or evaluating intake. * Greatest growth spurt. Greatest height.

Females: 11-14 years:
Grow 8.4 - 9.0 cm/year. * Girls deposit more total body fat. (eg 1/6 body fat becomes ¼ of the total wieght) *
Males: 13-16 years:
Grow 9.5 - 10.3 cm/year. * Boys deposit more muscle mass. * Boys tend to gain more weight at a faster rate and skeletal growth continues longer than girls.

ANOREXIA NERVOSA
-a psychological disorder manifested by self-starvation, weight loss, intense fear of weight gain, body image distortion

Diagnostic Criteria for Anorexia Nervosa (DSMIV) * Refusal to maintain body weight over a minimal normal weight. * Intense fear of gaining weight or becoming fat, even though underweight. * Denial of low body weight. * In females, absence of at least 3 consecutive menstrual cycles (because of deficit of hormones already)

BULIMIA NERVOSA
- a psychological disorder manifested by binge eating and purging * Recurrent episodes of binge eating characterized by: * Eating a larger amount of food than most people would eat in a specific period of time. * A sense of lack of control over eating at this time. * Recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, laxatives, exercise). * Binge eating and other behaviors occur, on average, at least twice a week for three mos. * Self-evaluation is unduly influenced by body shape / weight. They do not have the right perception of weight

PEDIATRIC OBESITY
Etiology and Treatment

* Etiology: * Genetic predisposition: 80% risk if both parents obese * Environment * Dietary intake * Physical activity / sedentary activity * Treatment: * Multidisciplinary and comprehensive * Formal behavior modification * Family-based

Health Consequences * Cardiovascular disease risk * Type 2 diabetes (epidemic) * Hypertension * Orthopedic * Sleep apnea – stoppage of breathing during sleep * Gall bladder disease/steatohepatitis - imbalance of bile salt and cholesterol. * Psychosocial problems - difficulty in the society

II. Adulthood * Broadly divided into three periods: young, middle, and late adulthood.
18-40 years Young Adulthood
40-65 years Middle Adulthood (busy, career oriented individuals, or settled with family)

65 up late adulthood * Growth is usually complete by age 25.

Nutrient Requirements * Nutrient requirements change very little.
IRON REQUIREMENT: for women is higher than men until after menopause
PROTEIN REQUIREMENT: 0.8 g per kilogram of body weight.
CALCIUM REQUIREMENT: * from 19-50 years old is 1,000 mg. after 35 yrs of age, absorption of Calcium is decreasing already.
VITAMIN D REQUIREMENT: 5 g per day.
Both Calcium and Vitamin D are essential for strong bones, and both are found in milk * Begins to diminish after the age of 25. * Basal metabolic rates are reduced by 2 to 3% a decade. * Determined primarily by activity and amount of lean muscle mass.

Kilocalories Requirements * Begins to diminish after the age of 25 * Basal metabolic rates(BMR) are reduced by 2 to 3% a decade. * Determined primarily by activity and amount of lean muscle mass

Eating Habits * Food selection is often made based on concerns about WEIGHT, COST OF FOOD, or TIME. * These habits may lead to nutrient deficiencies. * Selection of food, however, is often based on convenience and flavor rather than nutritional content of food. * Consequently, many people ingest more fat, sugar, salt, and high-calorie foods and less fiber and other nutrients. *
Notes: If you eat at around 4 to 5-hour intervals to prevent the onset of gastritis that would predispose you to peptic ulcer. Where there would be a breach in the mucosa of stomach.
Employed people in call centers especially in the age group of 20-35 usually eat in fast foods and do not get nutrient value of food. It is convenience over nutritional content.

Weight Control * Being overweight can lead to an increased incidence of DIABETES MELLITUS and HYPERTENSION. * Overweight people are poor risks for surgery, live shorter lives, and are prone to social and emotional problems. * Most common cause of being overweight is ENERGY IMBALANCE (more calories have been taken in than were needed for energy). * GENETICS and a HYPOTHYROID CONDITION can also contribute to overweight condition. * The best solution is INCREASED EXERCISE combined with REDUCED KCAL.

Notes: Diabetes Mellitus, from 2010 to 2013 is expected to increase more. Hypertension is a risk factor for DM.

III. Older Adult Years
Basic Nutritional Requirements for the OLDER PATIENT * CARBOHYDRATES should comprise 45-65% OF TOTAL CALORIES * FAT should comprise 20-35% of total calories * PROTEIN should comprise 10-35% of total calories * Fluid : 30ml/kg/day or 1ml per kcal intake * Intake of elderly increased with interaction with family. :’)

* Estimation of PROTEIN: (0.8 to 1.5) gm/kg/day Restriction of these amounts may be indicated in renal or hepatic insufficiency * Estimation of FIBER: (complex carbohydrates are the preferred fiber source) Men: 30 gm/day Women: 21 gm/day

Basic Nutritional Requirement for Older Patient * Carbohydrates should comprise 45-65% OF TOTAL CALORIES * Fat should comprise 20-35% of total calories * Protein should comprise 10-35% of total calories * Fluid: 30ml/kg or 1 ml per kcal intake * Intake of elderly increased with interaction with family. :’) * Estimation of protein: (0.8 to 1.5) gm/kg/day * Restriction of these amounts may be indicated in renal or hepatic insufficiency * Estimation of fiber (complex carbohydrates are the preferred fiber source) * Men: 30 gm/day
Women 21 gm/day

Potential contributors to nutritional problems in elderly * Reduced total energy needs * Poor dentition, reduced salivary flow * Declining absorptive and metabolic capacities * Chronic diseases,restrictive diets * Loss of appetite, anorexia * Changes in taste or odour perception * Side effects of drugs (nausea, aftertaste) * Depression * Mental disorders( senile dementia , Alzheimer’s)
Notes: Alzheimers- there are diminished levels of neurotransmitters in the brain. With senile dementia, it just goes with aging.

Potential Contributors to Nutritional Problems of the Elderly * Reduced total energy needs * Poor dentition, reduced salivary flow * Declining absorptive and metabolic capacities * Chronic diseases,restrictive diets * Loss of appetite, anorexia * Changes in taste or odour perception * Side effects of drugs (nausea, aftertaste) * Depression * Mental disorders(senile dementia , Alzheimer’s)

RESTING ENERGY EXPENDITURE (REE) * Resting energy expenditure represents the amount of calories required for a 24-hour period by the body during a non-active period.

Harris-Benedict Equations (calories/day):

Male: (66.5 + 13.8 X weight) + (5.0 X height) - (6.8 X age)
Female: (665.1 + 9.6 X weight) + (1.8 X height) - (4.7 X age)

RESPIRATORY QUOTIENT (RQ) * The RQ represents the ratio of carbon dioxide exhaled to the amount of oxygen consumed by the individual. RQ is useful in interpreting the results of the REE. * The physiological range of RQ is 0.67 to 1.3.

This value represents the combination of carbohydrate, fat and protein being used for energy.

If RQ > 1.0, decrease the total calorie intake and adjust the carbohydrate to fat ratio.
If RQ < .81, increase the total calorie intake, dependent on the goal for the nutrition therapy.

NUTRITIONAL SYNDROMES .

Undernutrition: it is often clinically difficult to physically distinguish “cachexia” from “wasting”

Cachexia – (REE is increased)
“okay ang caloric intake but the energy expenditure will exceed the normal”

Wasting – (REE is decreased)
“the patient does not eat and the calories are not in the normal range.” In either cachexia or wasting, energy expenditure exceeds caloric intake

Obesity – prevalence extends to the 60-70 age group

* Adverse outcomes associated with obesity include impaired functional status (esp. BMI>35), increased health care resource use and increased mortality * Poor diet quality and micronutrient deficiencies are COMMON in obese elderly pts., especially women who live alone * In the older obese patient, the focus should be on attaining a healthy weight to promote improved function, overall health, and quality of life * A combination of dietary change, behavior modification and increasing activity or exercise are appropriate for most elderly obese patients. Notes: For those with frailty and obesity, the emphasis may be better placed on preservation of strength and flexibility rather than on weight reduction.

The prevalence of obesity is increased in the 60-70 age grp. Up to 24.9 BMI is normal, around 30 is obese. Obese people may still have may micronutrient deficiencies.
In older obese individuals it is important to look at the whole picture. Eg if they have proper strength, or are in bed most of the time.
The Karnofsky Performance Scale Index - allows patients to be classified as to their functional impairment. This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. The lower the Karnofsky