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308 Cards in this Set
- Front
- Back
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What is Health Literacy?
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The capacity of individuals to obtain, process and understand basic health information and services need to make appropriate health decisions
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Health Literacy is a stronger predictor of health than:
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Educational level
Household Income Race Gender Age |
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What age range is considered elderly?
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65+ years old
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What age range is considered old?
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65-70 years old
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What age range is considered aged?
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75-84 years old
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What age range is considered oldest old?
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85+ years old
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What is the most rapidly growing population segment?
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The oldest old age range
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Why are Nutritional Requirements different in "old age"?
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Physiological changes
Polypharmacy - the use of multiple medications by a person |
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What are the goals involved with "aging well"?
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Independence
Being in good health Mobility Quality of life self esteem |
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What is the average US life expectancy?
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High rate of infant mortality compared to other countries, BUT once adulthood is reach % living to old age is increasing
Female - 80.4 years Male- 75.2 years |
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What are two physiological changes that occur with aging?
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Reduced blood vessel elasticity
Increased blood pressure |
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How does aging affect the body's endocrine system?
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Reduced levels of estrogen, testosterone
Decreased secretion of growth hormone Reduced glucose tolerance |
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How does aging affect the body's Vitamin D absorption?
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Decreased ability to convert 7 hydrocholesterol into previtamin D3 and then into vitamin D3 in the skin through sunlight exposure --- 4 fold decrease of aged skin to synthesize vitamin D, needed fortified foods or supplements
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How does aging affect the gastrointestinal system?
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-Reduce secretion of saliva and mucus ---dry mouth may affect intake, increase risk of cavities, decreased nutrient absorption
-Missing or poorly fitting teeth, chewing, pain -Dysphagia - difficulty swallowing -Decrease secretion of hydrochloric acid (HCL) and digestive enzymes, 30-50% decrease in HCL and pepsin |
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How does aging affect the musculoskeletal system?
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-Increased risk of fractures
-Increased fat mass -Decrease resting metabolic rate -Reduced work capacity -ALL best reduced through increased PA |
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How does aging affect the nervous system?
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-blunted appetite regulation
-blunted thirst regulation -reduced nerve conduction -changed sleep as wake cycle becomes shorter |
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How does aging affect the renal system?
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-reduced number of nephrons
-less blood flow -slow glomerular filtration rate -things that stress kidney -- too much protein, diabetes, HT, drug metabolites, waste products |
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How does aging affect the respiratory system?
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Reduced breathing capacity
-decreased exercise tolerance -decreased calorie expenditure Reduced work capacity (endurance) -decreased ADLs |
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Should people gain weight as they age?
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Pros - more reserves for illness, increased bone density, enjoyment of eating
Cons - increased risk of chronic disease |
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Nutrient Recommendation/DRIs for Elderly
TRENDS ONLY |
As we get older we need a diet that is increased in nutrient density, nutrient needs are at least he same, decreased calorie needs for most people, women over 60 often eat less than 1500 kcal/day
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Energy requirement for the elderly
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Requirements vary widely based on lean body mass, PA and exercise, and body weight
Generally decrease by 20% since middle adulthood Energy requirement formulas include age in their calculations (Harris Benedict: only a few subjects up to age 70 --- Mifflin St. Jeor: used more older subjects up to age 80 so better than HB but not perfect) |
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Why do people tend to eat less as they get older?
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Decreased appetite, sense of smell and taste, and decreased activities of daily living
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Why do some people eat more as they age?
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Bored
Lonely Used to cooking for more than one person Don't want to waste any "left over" food |
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Recommended Energy intake for Elderly
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Female
-decrease from 2000kcal/day to 1600kcal/day for 60+ Male -decrease from 2400kcal/day to 2000kcal/day for 60+ |
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Recommended Protein intake for Elderly
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At risk for protein deficiency
RDA is 0.8 g/kg but newest eveidence suggests that 1.0-1.3 g/kg may be better for older adults in order to maintain lean mass |
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For what condition would an increased amount of protein be inappropriate?
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Decreased renal function (kidneys)
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Recommended Carbohydrate intake for Elderly
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Same recommendation for younger adults
focus on complex whole grains fiber --- 14g/100kcals |
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Why is fiber intake especially important for older adults?
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decreased peristalsis - movement of the muscles in your intestines that aid digestion
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Recommended Fat intake for Elederly
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Same recommendation as younger adults
20-35% kcals/day |
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Recommended Fluid intake for Elderly
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Fluid intake becomes more important for older people
decreased reserves as body is less percent water more easily dehydrated since thirst mechanism is less active |
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IRON DRI Elderly
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Only changes in females
adults --- 18mg/d older adults/post menopause --- 8mg/d |
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CALCIUM DRI Elderly
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31-50 ---- 1000mg/day female & male
51-70 ---- 1200mg/day female -----1000mg/day male >70 -----1200mg/day female and male increase in DRI because of decrease in Ca+ absorption due to decrease in secretion of gastric acids |
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VITAMIN D DRI ELDERLY
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31-50 ---- 15µg/day female & male
51-70 ---- 15µg/day female >70 -----20µg/day female and male increase due to a decrease in cholecalciferol (vitamin D3) formation in skin, and very susceptible to drug-nutrient interactions |
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What are good sources of Vitamin D?
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fortified cereals, mushrooms, milk, eggs, liver, salmon, tuna, catfish, herring, NOT cheese (unless specifically labeled as such)
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SODIUM DRI Elderly
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31-50 ---- 1500/2300 mg/day female & male
51-70 ---- 1300/2000 mg/day female & male >70 -----1200/1800 mg/day female & male Decrease due to decreased renal function and increased blood pressure |
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CHROMIUM DRI Elderly
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31-50 ---- 25µg/day female
35µg/day male 51-70 ---- 20µg/day female 30µg/day male >70 ---- 20µg/day female 30µg/day male possible reason for decrease is a decrease in energy (glucose & fat) metabolism |
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VITAMIN B12 DRI Elderly
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2.4 mbc/day at all three age ranges for BOTH genders
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What factors decrease absorption of B12 in older people?
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Lower HCL/pepsin production in stomach
Lower intrinsic factor production in stomach Better absorbed in synthetic form |
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FOLATE DRI Elderly
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Absorption might be slightly less in older people, main reason for decrease is drug nutrient interactions.
Anti folate drugs or anti tumor drugs are used to treat cancer; tumor growth depends on DNA synthesis and cell division which are suppressed with folate deficiency |
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VITAMIN A DRI Elderly
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Getting enough is not usually a problem with this age group, in fact toxicity is as much or more a problem because increased stores due to less clearance of metabolites
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VITAMIN E DRI Elderly
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DRI stays the same, although need to get the DRI is greater due to enhanced immune function and maintenance of cell membranes integrity which is associated with nerve function and cognitive status
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What are the consequences of Zinc deficiency?
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Getting enough is not usually a problem BUT consequences of being deficient include:
decrease in wound healing, taste acuity, and immune response |
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What vitamins should be taken as supplements for older people?
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– vitamin B12 / folate also vitamin B6
– vitamin E – vitamin D, but be careful about possible toxicity – Calcium |
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What vitamins should be decreased for older people?
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Iron and Vitamin A
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What are Nutrition Risk Factors for older people?
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• hunger
• poverty • inadequate food and nutrient intake • functional disability • social isolation • living alone • urban and rural demographic areas • depression • dementia • poor dentition and oral health, chewing and swallowing problems • presence of diet-related acute or chronic diseases or conditions • polypharmacy • minority status • advanced age • dependency |
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What does the DETERMINE screening for nutritional status stand for?
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– D = Disease
– E = Eating poorly – T = Tooth loss / mouth pain – E = Economic Hardship – R = Reduced social contact – M = Multiple medicines – I = Involuntary weight loss or gain – N = Needs assistance in self-care – E = Elderly > 80 years old |
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What factors does the "Mini Nutritional Assessment (MNA)" screen for?
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o Changes (decrease) in Food Intake
o Weight loss during the past 3 months o Mobility o Psychological distress or acute illness o Neuropsychological problems o BMI |
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What are the benefits of maintaining physical activity throughout aging?
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– Maintain lean mass
– Maintain aerobic capacity – Increase calorie requirement – Maintain mobility (independence, ADLs) |
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What is "normal aging"?
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physiologic and biochemical changes that occur over time, they increase in rate and severity with poor lifestyle choices
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What is "successful aging"?
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the reduction or postponement of physical changes which can be achieved by making healthy lifestyle choices
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What are signs of an older person being underweight?
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• Assessing underweight as a possible nutrition risk factor:
• Percent weight loss – > 10% of body weight lost unintentionally – probably best assessment, since it accounts for usual weight • Percentile for age: < 5th percentile (have to consider usual adult weight) • BMI: < 18.5 (again, have to consider adult weight) |
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What are treatments used for underweight older people?
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gradual increase of calories and protein
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Why is dehydration especially common in older people?
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decreased reserves
decreased thirst decreased ability to concentrate urine toileting issues |
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What is dehydration?
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Decreased cellular water to the point of decrease metabolic, measured in overall decrease in body fluid
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What are signs of dehydration?
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– Dry tongue
– Speech difficulties – Sunken eyes – Upper body muscle weakness – Tongue grooves – Weakness – Confusion – Dry mucus membranes in nose/mouth |
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What are some treatments for dehydration?
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• Gradual increase in water/fluid intake;
• May use 5% glucose solution with some sodium to increase absorption rate |
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What age range is considered Adolescence?
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11/12 to 21
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In what order to boys and girls develop?
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Girls hit puberty before boys and develop physically before cognitively.
Boys develop in both at approximately the same time psychosocial development comes later for both |
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What factors influence DRIs within adolescence?
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- Sexual maturation
- Increased height - Increased weight - Increased skeletal mass - Changes in lean mass and fat mass |
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In growth spurts does height or weight grow first?
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Growth spurts are usually height followed by weight gain
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What is the peak growth rate in adolescent girls?
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3.5 inches/yr (0.3 inches/month)
18.3 pounds/yr (24 ounces/month) or 1.5 lb/month -Major growth completed by 16 years (or even earlier) |
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What is the peak growth rate in adolescent boys?
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Boys
2.8 - 4.8 inches/yr (0.31 inches/month) 20 pounds/yr (27 ounces/month) or 1.7 lb/month -Major growth completed by 21 years |
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How much of ideal body weight is gained during adolescence?
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As much as 50%
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Body (fat) composition changes in adolescent girls
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increase from about 16% fat mass to about 27% at maturity
< 17% may delay menarche < 25% may disrupt menstrual cycle < 16% may stop ovulation |
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Body (fat) composition changes in adolescent boys
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decrease from about 16% fat mass to about 12% at maturity
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When is the influence of peers typically the highest in terms of eating habits?
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Early high school years (14-16 years old). It peaks in middle adolescence
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What factors are snacks typically high and low in?
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HIGH
-total and saturated fats, sodium and sugar LOW -fiber and vitamins & minerals |
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Adolescents eating habits are high in...
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total fat, sodium, saturated fat, sugar
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Adolescents eating habits are low in ...
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fiber, fruits & veggies, calcium, iron & zinc
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Eating habits that are typical of adolescents...
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o Eat on the go
o increase in Fast Food o More snacks o Skip meals o decrease in Breakfast |
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What are some specific physiological effects of being an adolescent vegetarian?
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• Later puberty
• Leaner later • decreased risk of CVD and cancer |
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Why does calcium DRI decrease at 19-30 years?
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Increase in bone mass is now pretty much complete
By age 20, 98% of skeletal muscle is accrued By age 30, peak bone mineral density |
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Why is Vitamin D important for adolescence?
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Needed for Ca+ absorption and utilization, not increased during rapid growth because not related to body mass
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What nutrient are adolescents most commonly deficient in?
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Iron, almost exclusively in females
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Why does zinc DRI increase for 14-18 year olds in both genders but more in males?
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Combo of growth/body size and sperm production
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Why does zinc DRIA decrease at 19-30 for females but stay high for males?
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No longer needed for growth in females but in males its related to fertility and sperm health
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Why does the folate DRI increase for both genders at 14-18 years old?
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needed for cell growth/division
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Why is folate important once menarche occurs in females?
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it reduces the risk of Neural Tube Defects
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Why does Vitamin C DRI increase for both genders with age?
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Collagen synthesis, more body surface for antioxidant protection
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Why is the vitamin C DRI the same for both genders at 9-13 years old and then becomes higher for males?
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Difference in body size
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What factors are primary influences on protein requirements in adolescents?
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growth rate and lean body mass
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What percentage of adolescents are overweight and obese?
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34% are overweight
18.4% are obese |
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When should weight loss be a goal for overweight adolescents?
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When growth/puberty is completed because there is less of a chance of losing that weight naturally
If there are medical complications related to wight |
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Stage 1 : Assessment and Treatment of Adolescent Overweight and Obesity
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Stage 1: Prevention Plus
- Adolescent’s BMI is ≥85th and <95th %tile; has no significant comorbidities and has not completed growth yet. - This treatment level focuses on basic nutrition and physical activity guidance to promote health and prevent disease. |
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Stage 2 : Assessment and Treatment of Adolescent Overweight and Obesity
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Stage 2: Structured Weight Management
- Same as Stage 1, but more structured! - Ex.: Screen time is limited to <1 hr/d; meal plan is introduced to encourage nutrient-dense foods. - Adolescent is encouraged to keep a food journal - Healthcare provider is trained in behavioral pediatric weight management incl. motivational counseling (possibly mental health counseling, MNT, etc.) - Monthly follow-up is strongly recommended. |
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Stage 3 : Assessment and Treatment of Adolescent Overweight and Obesity
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Stage 3: Comprehensive Multidisciplinary Intervention
- Like Stage 2 but more structured and with a multi-disciplinary approach and more frequent client contact. - Structured plan for diet and PA designed to lead to a negative energy balance. - Weekly visits for 8-12 weeks followed by bimonthly visits. - Multidisciplinary team includes MD or pediatric nurse practitioner, a RD, a mental health counselor, a RN, and an exercise physiologist or PT. |
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Stage 4 : Assessment and Treatment of Adolescent Overweight and Obesity
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Stage 4: Tertiary Care Prevention
- Only for severely obese youth or those with significant, chronic comorbidities. - Youth must be evaluated for maturity (physical and mental) - Treatment is provided by a “tertiary wt.-management center that specializes in adolescent obesity”. - Treatment may include meal replacements, a very-low energy (≤12 wks), medication and surgery (gastric bypass). - For surgery, adolescents must have a BMI of >35 with major complications or >40 with minor comorbidities |
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Adolescent athletes are more likely to…
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Take steroids
Suffer from eating disorders Be injured |
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Recommendations for sports drinks
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If using sports drinks, should contain 6% or less carbohydrate/sugar
Or use diluted juices (1:2 ratio with water) |
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How can we tell if adolescent still has potential for growth?
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• Gynecological age (age minus age of menarche)
• If less than 2 years since menarche, may still grow. |
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How often should adolescents be screened for iron deficiency?
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Every 5 years; or every year if risk factors
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Why is the cutoff for hemoglobin levels increased by 0.3 g/dL for smokers?
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Increase need for oxygen delivery O2 delivery
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What percentile is used to diagnose hypertension?
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-Stage 2 HT: >99th + 5 mmHg
-Stage 1 HT: >95th to <99th percentile + 5 mmHg Pre-hypertensive:>90th to <95th percentile Normal BP: <90th percentile |
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What are risk factors for hypertension?
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Family history
High sodium intake Overweight Inactive Tobacco Use |
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Why are adolescents at high risk for eating disorders?
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-Influence of environment, peers
-Changing body composition |
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Why are adolescents particularly vulnerable to effects of eating disorders on nutritional status?
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-increased nutrient requirements
-Potential for growth -Body establishing regular ovulation.. Sexual maturation |
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Body dissatisfaction
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approx. 60% of girls and 35% of boys are not happy with their body wt.
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Dieting Behaviors
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attempting to lose wt. by manipulating food and/or beverage intakes (range of 44-60% of adolescent females and about 15% of adolescent males)
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Disordered Eating
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estimates vary; 10-20% of adolescents
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Binge Eating Disorder
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periodic binge eating without vomiting or the use of laxatives; diagnosis if 2x/wk for 6 months (2% of general pop., but 30% of dieting pop.)
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Bulimia nervosa
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repeated episodes of fast, uncontrolled eating of large quantities of food in a very short time; often followed by purging (1-3% of adolescent females)
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Anorexia Nervosa
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eating disorder which leads to extreme wt loss, poor body image, and irrational fears of weight gain and obesity (0.2-1.0% of adolescent females and adult women)
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What sports predispose athletes to disordered eating?
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Weight class specific: Wrestling, boxing, martial arts
Others: Gymnastics, ballet, dance |
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What range is considered adulthood?
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24-64 years old
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Early adulthood
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20s and 30s
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Midlife
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40s and 50s
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Later adulthood
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60+
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Adult Nutrition focuses on reduction in risk of chronic diseases such as ....
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-heart disease
-osteoporosis -insulin resistance -cancer -arthritis -metabolic syndrome - stroke -diabetes |
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What age group has the largest percent of emergency visits in the US?
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24-44 year old adults
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What age does weight gain in both men and women begin?
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40 years old
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Why do adult men begin to gain weight?
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some effect of hormones, but mostly related to decrease in physical activity
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Why do adult women begin to gain weight?
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lower estrogen levels (increased abdominal fat) AND decreased physical activity
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Climacteric Change
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Point in life where crucial changes occur; refers to the loss of reproductive activity, marked by menopause in women and reduction in testosterone production in men
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Underweight BMI
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<18.5
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Normal weight BMI
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18.5-24.9
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Overweight BMI
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25-29.9
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Obese BMI
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>30
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What is the primary problem with BMI as a way to evaluate weight?
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It does not measure body composition - the extra weight may not be fat it could be muscle
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How is percent body fat measured?
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1) Skin fold measurements
2) Underwater (hydrostatic) weighing 3) Bod Pod air displacement, which uses the same principle as hydrostatic weighing) 4) Bioelectrical Impedance Analysis (BIA) 5) DXA |
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What is the most accurate measurement of body fat?
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DXA
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Compare women and men's percent body fat
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1) For women, the percent body fat is significantly higher than it is for men at each classification and for each age range.
- For example, a percent body fat that is defined as “obese” in males is considered to be “normal” (i.e. recommended) in females. 2) For both genders, there is a small increase in percent body fat as part of the natural aging process. |
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Why is the higher % body fat for women still considered to be healthy?
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It doesn't increase risk of disease
Natural difference due to childbirth |
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Underweight % of "desirable weight"
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<90% of desirable weight
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Normal % of "desirable weight"
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90-120% of desirable weight
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Overweight % of "desirable weight"
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>120% of desirable weight
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Obese % of "desirable weight"
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>130% of desirable weight
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How to determine "desirable" weight?
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Hamwii formula
Metropolitan Life Insurance Tables (Miller Method) |
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Hamwii formula
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a. Female: 100 pounds for first 5 feet (60 inches) + 5 pounds per inch over 5 feet
b. Male: 106 pounds for first 5 feet (60 inches) + 6 pounds per inch over 5 feet |
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Miller Method
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a. Female: 119 pounds for first 5 feet (60 inches) + 3 pounds per inch over 5 feet
b. Male: 135 pounds for first 5 feet (60 inches) + 3 pounds per inch over 5 feet |
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Why is waist circumference important?
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Because central adiposity is closely associated with increased risk of CVD
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Ideal waist circumference for women
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<35 inches
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Ideal waist circumference for men
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<40 inches
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What are energy needs based on?
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Basal Metabolic Rate
Thermic Effect of Food Activity Thermogenesis |
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The heart, liver, kidneys, brain and GI tract only make up about _____of our body weight. Yet, metabolically these organs are highly active and expend about _____ of our BMR
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5%
60% |
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Harris Benedict Equation
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-accurate (within 10% of true answer) about 69% of the time
-developed in 1919! Female: 655 + (9.6 x kg) + (1.8 x cm) – (4.7 x age) = kcals/day RMR Male: 66.5 + (13.75 x kg) + (5 x cm) – (6.8 x age) = kcals/day RMR |
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Mifflin-St. Jeor Equation
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“newer”, but not as mainstream “yet”
Female: (10 x kg) + (6.25 x cm) – (5 x age) – 161 = REE Male: (10 x kg) + (6.25 x cm) – (5 x age) + 5 = REE REE= Resting Energy Expenditure |
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How is the REE used within energy requirement formulas?
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With either equation (Harris Benedict OR Mifflin St. Jeor), you get REE. Then multiply the REE by the appropriate activity factor
-REE x activity factor = estimated total kcals needed per day |
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Sedentary Activity Factor
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1.2 -- Mostly resting with little or no activity
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Lightly Active Activity Factor
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1.3 -- Occasional unplanned activity, such as going for a stroll
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Moderately active Activity Factor
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1.5 -- daily planned activity such as brisk walks or jogs
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Moderately to heavily active Activity Factor
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1.7 --- daily planned activity that works up a sweat
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Heavily active Activity Factor
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daily workout routine that requires several hours of continuous exercise
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We typically need fewer calories as we age, why?
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decreased physical activity
decreased muscle mass |
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How does appetite and attention to hunger cues compare to the toddler period in terms of energy intake regulation?
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Regulation is not usually nearly as sensitive in toddler years -- outside influences take precedence
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Total Fat --- Adults
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20-35% of kcals
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Saturated Fat --- Adults
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<7 % of kcals
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Monosaturated Fats --- Adults
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10-15% of kcals
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Polyunsaturated Fats --- Adults
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<10% of kcals
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Cholesterol --- Adults
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<300 mg/day
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Protein --- Adults
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1 to 2x the RDA -- no more due to potential negative effects on Ca+ balance, kidney function)
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Sugar --- Adults
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<10% of kcals
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Alcohol --- Adults
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MODERATE
-2 drinks for men -1 drink for women |
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Fruit --- Adults
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2 cups (4 servings) especially citrus and brightly colored
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Vegetables --- Adults
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2.5 cups (5 servings) especially dark green, leafy, deep yellow
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Milk/Dairy/Calcium --- Adults
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3 servings/day (low fat)
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Grains --- Adults
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6 servings (at least 3, or 50% whole grain)
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Sodium ---- Adults
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DRI = 1500 mg/day; new 2010 DG = 1500 mg/day also (as the new goal for all Americans; not just those with HT)
1 tsp. of table salt =5-6 grams of salt~2300 mg of Na+ |
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Fiber --- Adults
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14 grams/1000kcals (U.S. average is about half)
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Water --- Adults
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1 ml/kcal works (science still evolving) What is the AI for total water? (INLUDES THE WATER IN OUR FOOD)
Total Water AI for men = 3.7 L and for women = 2.7 L |
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Pros of a Vegetarian Diet
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1. decreased risk of cardiovascular disease
2. decreased risk of hypertension 3. increased consumption of fruits and vegetables 4. decreased consumption of total and saturated fat 5. often lower BMI |
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Potential Cons of Vegetarian Diet
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Low dietary protein quality
Possible nutrient deficiencies possible decreased fertility |
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What nutrients do vegetarians run the risk of being deficient of?
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Vitamin D
Vitamin B12 Iron Calcium |
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What is the recommended amount of Physical Activity?
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30 minutes most days (5-7 days per week)
For weight management: 60 minutes on most days For weight loss: 60 – 90 minutes on most days |
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What percentage of adults are obese?
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Nearly 1/3 (27.4-32%)
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Obesity is associated with increased risk of almost all nutrition related chronic diseases EXCEPT ...
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Osteoporosis
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What are the risk factors associated with Metabolic Syndrome?
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-genetic predisposition
-overweight -low physical activity |
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Characteristics/Diagnosis for Metabolic Syndrome
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At least three of the following...
-abdominal obesity (waist circum>40 in men; >30 in women) - high blood pressure (≥130/>85mmHg ) - increased blood triglycerides (>150 mg/dL) - decreased blood HDL-C (< 40mg/dL in men; <50 mg/dL in women) - increased blood LDL-C (> 130 mg/dL) - elevated fasting blood glucose (> 110 mg/dL) - Elevated fasting plasma insulin levels (WHO) |
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Treatment for metabolic syndrome
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-weight loss
-increased physical activity -spread out meals -maybe decrease carbohydrate to 45% of calories -increase complex carbohydrates to increase soluble dietary fiber |
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Why do men need more B-vitamins (thiamin, niacin, riboflavin, vitamin B12)?
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Men need more energy, B-vitamins are involved in energy metabolism so they need more B-Vitamins to metabolize that energy
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What nutrients are involved in bone health?
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calcium
vitamin D magnesium vitamin C |
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Why is vitamin A expressed in retinol equivalents?
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We can convert various carotenoids to the active form of Vitamin A - so we need a common currency.
New unit for vitamin A is called "Retinol Activity Equivalent" 1 RAE = 1 mcg or retinol or 12 mcg of beta-carotene |
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Where is retinol found?
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Animal products only
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Which vitamins are better absorbed in the synthetic form?
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The natural form (d-alpha-tocopherol) is more efficiently absorbed than the synthetic form of vitamin E.
Can you think of a vitamin where the opposite is true? Folic acid (ie the synthetic form of folate) is better absorbed than naturally occurring folate |
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Why are folate and B12 DRI the same for men and women?
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They are not involved in energy metabolism
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Why is the iron DRI first different for men and women and then later its the same?
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menstruation then menopause
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Why is chromium DRI higher for men?
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involved in glucose tolerance and men eat more calories
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Why is the zinc DRI higher for men?
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needed for sperm production and health of sperm
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Why is vitamin C DRI higher for men?
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Increased body size -- greater need for collagen synthesis
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Why is the Vitamin E DRI the same for both men and women?
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Difference in body size is not as important (antioxidant function is the primary consideration for establishing the DRI)
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Why is vitamin A DRI higher for men?
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Role in cell differentiation/epithelial cell health; mucous membranes; skin; bone --- men have more cells
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Influences on food intake for adults...
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Not as attuned to internal hunger cues
more outside influence and psychological factors |
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Define two types of growth in infants....
Hyperplasia and Hypertrophy |
Hyperplasia - increase in number of cells
Hypertrophy - increase in size of cells |
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What is the fastest period of growth after birth?
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Period in between 0-6 months
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On average, the infant's birth weight __________ by six months and ________ by one year
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On average, infant’s birth weight doubles by 6 months and it tripples by 1 year
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What is the number one tool used to ***** growth in a healthy newborn?
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Weight gain!
But height/length circumference are used too |
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Convert english system to metric
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2.2 lb = 1kg
2.54 cm = 1 in |
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Why are growth charts best for assessing long term growth?
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Growth patterns and trends from infancy through childhood are very important
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Trends in growth
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First parameter to fall on growth charts due to insufficient nutrition is weight
Second parameter to fall on growth charts is height/length Body does everything possible to preserve brain development because once that is compromised, “catch up” growth is not possible. |
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Average growth for infants...
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Infants from 0-3 months: 20-30 g/day
Infants from 3-6 months: 15-21 g/day Infants from 6-12 month: 10-13 g/day |
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Define reflexes
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an automatic response to stimulus or stimuli
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Rooting
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occurs when the infants cheek is touched; infants turn head toward that cheek and the infants opens mouth --- important for breast feeding
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Suckling
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tongue moves back and forth and allows infant to suck breast or bottle
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Do infants typically breathe through their nose or mouth?
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Newborn/infants are obligate nose breathers. They are not able to breathe through the mouth. This also allows them to feed. This reflex must disappear before baby can feed from a spoon.
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Palmar reflex
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A precursor to voluntary grasping -- infant grasps object put into his/her palm
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Voluntary Muscle Control
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Affects ability to progress from bottle/breast feeding to spoon feeding and then to self feeding with utensils
Also affects caloric requirements: Energy needs increase with increased muscle movement |
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In what order does muscle development occur?
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Top to Bottom (from head to feet) –babies first develop head control; then develop ability to sit up; last thing they develop is ability to walk
(Crawling is NOT a developmental milestone) Central to Peripheral (from middle to extremities; or shoulder and arms to hands and fingers) |
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Motor and Reflex Development
Bottle to Spoon feeding... |
Bottle to Spoon feeding:
Infant must be able to sit up; have head control Suckling reflex must disappear so that the lips clean food off of the utensil. |
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Motor and Reflex Development
Bottle to open cup... |
Tongue needs to be able to control liquid
Lips must be able to control seal on the cup |
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Motor and Reflex Development
Self feeding... |
Requires fine motor skills
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Meconium
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Black tarry substance from intestines of full-term infants (baby's first stool)
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Describe breastfed babies stool
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Breastfed babies have yellow, soft, seedy stools – this is not diarrhea! Stools are not well-formed due in part to lack of fiber in their diet.
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How long does it take for the GI tract to fully form and mature in infants?
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Takes approximately 6 (up to 12) months for the GI tract to fully form and mature before it is mature enough to fully digest fats, protein, and simple sugars.
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Peristalsis
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Movement of food through the intestines
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Structure of Infant GI tract
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Healthy newborns may have loose opening between intestinal cells that could allow intact proteins or other substances to pass into the bloodstream.
This is why some foods should not be introduced too early |
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Preterm or Low Birth Weight
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<2500 grams
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Very Low Birth Rate
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<1500 grams
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Extremely Low Birth Rate
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<1000 grams
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Small for gestational age
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Newborn wight is <10th percentile for gestational age
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T or F: Calorie and protein needs are higher per kg of BW for pre-term and LBW babies.
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True
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T or F: pre-term and LBW babies have an increased need for calcium and phosphorous and Vitamin A, E, iron, and fluoride.
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True
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Cystic Fibrosis
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Pancreatic enzymes are extremely viscous and may not reach intestines to aid in digestion
Genetically altered chromosome 7 leads to impaired endocrine functions in the body |
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Exocrine glands vs. Endocrine glands
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Exocrine glands, like sweat and salivary glands, secrete into ducts
Endocrine glands secrete hormones, etc., directly into the bloodstream. |
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Allergies
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Immune response to protein
Allergic reaction (skin rash, wheezing, respiratory, symptoms) due to absorption of intact protein fragments. |
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Energy requirements for Infants
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Infants require *108 kcal/kg/d… compared to adults, who require 30-35 kcal/kg/d. *this might be 15% too high based on new research
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Protein requirements for Infants
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Recommended protein intake for 0-6 mo = 1.52 g/kg/d compared to adults, who require 0.8 g/kg/d.
0.5-1 year olds is 1.6 g/kg/d |
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What is the primary reason for the difference (infants vs. adults) based on body weight?
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Rapid growth rate
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Variation in Energy Need is Due Mainly to ...
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1. Differences in growth rate
2. Differences in physical activity 3. Efficiency of digestion and absorption |
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Dietary Fat RDA for Infants
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There is no RDA/AI for dietary fat, but it should not be restricted in infants because they:
Need a concentrated source of calories for growth AND… Cholesterol is very important for new cell synthesis |
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What percentage of calories from fat is breast milk?
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55%
How does that compare to the recommendations for the average healthy adult? We recommend 20-35% kcal/d coming from fat |
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Breast milk has a high concentration of...
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short chain fatty acids and medium chain fatty acids
Why? These Fas are digested and absorbed more easily Standard Infant Formulas and food sources have longer chain fatty acids. |
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Major role of Carbohydrates
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Energy
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Major role of Flouride in Infants
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Infants must have a good source because…
Necessary for teeth formation even before they erupt |
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Vitamin D RDA for Infants
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AAP recently increased their recommendation from 200 to 400 IU/day for children.
Vitamin D is low in breast milk Other source is sunlight. |
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Sodium AI in Infants
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AI = 120 mg/d (0-6 mo) and 370 mg/d (7-12 mo)
How is AI determined for infants? Based on the level in breast milk |
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What is Sodium needed for?
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1. Fluid and electrolyte balance (recall that Na+ is the major electrolyte of extracellular fluid)
2. Cell growth |
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What is Iron needed for?
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Important for growth and cognitive development
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Iron RDA for Infants
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Infant has iron stores which adequately meet the needs of the infant up to 6 months
Then what?! Then the infant needs a good source of iron What happens at around 6 months of age? The infant is introduced to solids, specifically rice cereal which is fortified with iron Breast milk is poor source of iron. |
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T or F: Iron in formula causes constipation
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FALSE There is simply not enough iron in infant formula to cause this.
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What is Zinc needed for in infants?
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Important in growth and development
Important for appetite for growing infants |
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Infant Cues
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Watch the food being opened in anticipation of eating
Tight fists or reaching for the spoon as a sign of hunger Showing irritation if the feeding pave is too slow or if it temporarily stops Starting to play with food or spoon when getting full Slowing the pace of eating or turning head away when full Stop eating or starting spitting food out when full |
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What may affect a parents ability to read baby's cues?
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Sleep deprivation
Stress Depression Distractions (phone, older child, spouse, TV) Intellectual level of caregiver |
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What foods should be introduced after breast milk?
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1. Iron-fortified infant cereals
2. Vegetables, then fruits (pureed). Why? 3. Pureed meats 4. Introduce one new food at a time and wait 3-5 days before introducing a new food. 5. Infant should have been exposed to a variety of new foods by the end of the first year. 6. No cow’s milk during the first year. 7. No fruit juices during the first six months (or even first year and never at bedtime) |
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What is the main purpose for introducng foods on a spoon at 4-6 monthw
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Main purpose for introducing foods on a spoon at 4-6 mo is for stimulating mouth muscle development (nutritional needs are secondary, since breast milk is still adequate until 6 mo).
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How much should an infant eat?
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0-3 mo: 16-20 fl oz/day
3-4 mo: 24-32 fl oz/day 4-6 mo: 1-2 Tbs./meal (or 2-3 Tbs./meal) 6-9 mo: pureed V & F 1-2 4-oz. jar(s) and one 4-oz meat mixture 9-12 mo: mixed textured V & F 6-oz jar; meat-based dinners (6 oz) |
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How do we know that infant is eating enough?
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Overall health (monitored via growth charts using ht, wt, head circumference at various ages)
Growth slows in second six months by about 50%. |
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Two types of reasons to be concerned about infant’s growth pattern/trend:
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Drop (or gain) in 2 or more percentile curves
Infant falls below 5th – 25th percentile or gains above the 75th – 95th percentile. |
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Tips for weaning from breast/bottle to cup
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This process can begin at or after 6-8 months
Ability to elevate the tongue and control the liquid does not occur until about 12 months of age Therefore, breast milk or infant formula should still be the main feeding method |
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What is a toddler?
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1 year (12 months) to 3 years (36 months)
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What is a preschooler?
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3 years to 5 years
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Dramatic increase in vocabulary from average of…
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10-15 words at 18 mos to
100+ words at 24 mos 3 word sentences by 36 mos Increase in language skills help toddler express needs and wants |
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Gross and Fine Motor Skills Toddler
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Gross Motor Skills:
Sitting up on a small chair Walking by ca. 12 mos, crawling upstairs by 15 mos, running with “stiff legs” by 18 mos, riding tricycle by 36 mos Fine Motor Skills: Required for self feeding Refined pincer grasp at 12 mos; Using spoon more skillfully by 1 to 2 years |
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Psychological Aspects of Feeding Relationship and Eating Behavior
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Balance/moderation
Healthy Eating attitudes Healthy Eating habits |
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How to Establish Healthy Attitudes For Food
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Nourishment, not comfort
Importance, for nutrition and health Allow toddler to self-feed and try (and reject) new foods Serve as a role model |
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Special Nutrition Concerns for Toddlers and Preschoolers
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Energy: avoid too little or too much
Protein: adequate amount for growth, immune function, etc. Iron: growth and cognitive development Zinc: growth and appetite Calcium: optimal skeletal mass Vitamin D: calcium absorption and utilization Fluoride: strong teeth Fiber: regularity/laxation (How many bowel movements a day?) |
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On average, how many exposures for acceptance of new food by toddler?
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Approximately 8-15 times
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Childhood Monitoring of Health Related Nutrition
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Height/weight: growth
Head circumference: growth and brain development Hemoglobin/hematocrit: iron status Feeding skills: fine and gross motor skills Food variety: psychological, fine motor skills, future health Gross motor development: walking, running, stairs, kicking, etc. Fine motor development: pick up small objects, feed self (hold utensil) Cognitive development: colors, numbers, object permanence, etc. Speech development: words, sentences, understand commands |
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Average growth for infants and toddlers
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0-6 mos: 30 oz/month
6-12 mos: 15 oz/month 12-36 mos: 8 oz/month 3-5 years: 3-4 oz/month |
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Vegetarian diets for young children may be low in...
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Energy
Vitamin D Zinc Iron B12 Protein Omega-3’s |
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Why are snacks important for toddlers?
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- small stomachs
Should be nutrient-dense Variety, balance, and moderation should all be considered when offering snacks too (not just for meals) |
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What is the effect of too much fiber?
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*Too much fiber can cause GI upset, diarrhea, and decreased nutrient absorption (of which two minerals in particular=
1. Iron 2. Calcium |
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Food Sources of Fiber
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Laxation (19-25 g/day)
Food sources Whole grains Nuts/seeds Legumes Fruits and veggies |
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Food Sources of Calcium
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Dairy
Fortified foods and beverages Dark leafy greens * Vitamin D should also be present…. Why? (Vitamin D helps calcium be absorbed) -Calcium is needed to achieve peak bone mass. Yet about 21% of children 2-8 yo do NOT meet the DRIs for calcium! |
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Food Sources of Zinc
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Growth, taste acuity, appetite
Food sources: Meat/poultry Beans/legumes Milk nuts Whole grains/cereals * Protein sources are best, so vegetarians might be at risk for zinc deficiency |
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Food Sources of Iron
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Cognitive development
-low hemoglobin/hematocrit are signs of iron deficiency stores are depleted need iron supplements Food sources Meat, especially red (heme-iron is best absorbed) Bread with fortified flour Pasta? Cereals |
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Why should toddlers limit certain drinks?
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-milk to less than 24 oz/day
May exclude foods high in other nutrients Juice, even 100%, to 4-6 oz High in calories, not nutrients Soda Empty calories; too much sugar |
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Energy Intake for Toddlers
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1742 kcal/day for boys
1642 kcal/day for girls |
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When is BMI lowest?
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4-6 years --- after that BMI slowly increases --- This increase is called BMI rebound or adiposity rebound
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BMI Below 5th Percentile
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Underweight
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BMI 85th - 94th %tile
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Overweight
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BMI ≥95th %tile
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Obesity
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The CDC recommends that health care providers use which growth charts?
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use the WHO growth charts to monitor growth for infants and children 0-2 years in the U.S.
use the CDC growth charts to monitor growth for children 3 years and older in the U.S. |
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Child
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5-10 YEARS OLD
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Preadolescent
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Girl: 9-11 years old
Boy: 10-12 years old |
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If about 20% of kcal/d for 6-11 yo are being consumed from liquids, how does that impact the following?
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Iron, Zinc, Vitamin B12, Calcium, Fiber, and Dietary Fat
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Babinski reflext
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a baby’s toes fan out when the sole of the foot is stroked, perhaps a remnant of evolution from heel to toe
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Blink reflex
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a baby’s eyes close in response to bright light or loud noise to protect their eyes
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Moro Reflex
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a baby throws its arms out and then inward (as if embracing) to help a baby cling to its mother in response to loud noise or when its head falls
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Palmar Reflex
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a baby grasps an object placed in the palm of its hand, as a precursor to voluntary grasping
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Rooting Reflex
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When a baby’s cheek is stroked it turns its head toward the cheek that was stroked and opens its mouth to help the baby find the nipple
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Stepping Reflex
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a baby who is held upright by an adult and is then moved as a precursor to voluntary walking forward; begins to step rhythmically
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Sucking Reflex
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a baby sucks when an object is placed in its mouth to permit feeding
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Withdrawal Reflex
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a baby withdraws it foot when the sole is pricked with a pin to protect it from unpleasant stimulation
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what micronutrients might need to supplement for breastfed infants?
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• Fluoride supplements are recommenced if the family lives in a place that does not provide fluoridated water
• If breast milk is the only form of nutrition after six months, fluoride is recommended • If breast milk is the only form of nutrition, term infants at age four months are recommended to have supplemental iron at 1 mg/kg per day, until iron containing complementary foods provide this same level of iron to prevent iron deficiency • If breast milk is the only form of nutrition, preterm infants are recommended to have supplemental iron at 2 mg/kg per day starting at age 1 month until 12 months to prevent iron deficiency • Vitamin B12 may be prescribed if the mother is vegan • If breast milk is the only form of nutrition, vitamin D supplements are recommended at 400 international units per day. The 2010 institute of medicine dietary reference intakes for vitamin D and Calcium did not change their recommendations for infants. |
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WHAT conditions DECREASES ENERGY NEEDS?
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DOWN SYNDROME
DECREASED AMBULATION SPINA BIFIDA |
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WHAT conditions INCREASES ENERGY NEEDS?
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LUNG PROBLEMS
CYSTIC FIBROSIS |
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what type of nutritional assessment is used for CEREBRAL PALSY
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body composition assessment to determine muscle mass and fat stores
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when does growth rate decline? when does weight gain plateau?
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12 MONTHS
1-2 YEARS OLD |
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What does Protein, IRON, ZINC, Calcium, VIT. D do?
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ADEQUATE AMOUNT FOR GROWTH/IMMUNE FUNCTION
GROWTH/COGNITIVE DEVELOPMENT GROWTH/APPETITE OPTIMAL SKELETAL MASS CALCIUM ABSORPTION/UTILIZATION |
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UNINVOLVED
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LOW DEMANDINGNESS/RESPONSIVENESS
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AUTHORITARIAN
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HIGH DEMANDINGNESS, LOW RESPONSIVENESS
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INDULGENT
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HIGH RESPONSIVENESS, LOW DEMANDIGNESS
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AUTHORITATIVE
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HIGH RESPONSIVENESS AND HIGH DEMANDINGNESS
***MOST POSITIVE PARENTING STYLE IN TERMS OF FEEDING |
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RESPONSIVENESS
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EXTENT TO WHICH PARENTS SHOW AFFECTIVE WARMTH, ACCEPTANCE, and INVOLVEMENT
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DEMANDINGNESS
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EXTEND TO WHICH PARENTS SHOW CONTROL, MATURITY DEMANDSm and SUPERVISION IN THEIR PARENTING
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children's familiarity with food accounts for ____ of variability of food preference
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25-30%
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children do not like ____flavors
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BITTER
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how much should you limit media?
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1-2 hours a day
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SGA
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SMALL FOR GESTATIONAL AGE
less than 10th percentile for gestational age |
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NUTRITIONAL NEEDS IN SPINA BIFADA
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energy needs are LOWER
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how does cerebral palsy develop?
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may be due to perinatal traumatic injury resulting in anoxic event to the brain
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PREDICTORS OF CHILD BEING OVERWEIGHT
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earlier increased BMI after age 4
gestational diabetes in mother (w/ high blood glucose in preg.) maternal obesity decreased income decreased cognitive stimulation |
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WHAT CLASSIFIES A CHILD WITH SPECIAL NEEDS?
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having a condition lasting longer than a year
need for medical services limitation in function, activites, or social role having a biological, psychological, or cognitive based needs |
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what are the common nutrient deficiencies?
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MOSTLY IRON, ZINC, CALCIUM
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ABCD method
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A: anthropometric
B: biochemical C: clinical/physical D: Diet |
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what must disappear before baby can be spoon fed?
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SUCKLING REFLEX
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WHY is ZINC important for infants?
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GROWTH AND DEVELOPMENT
AND FOR APPETITE |
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what are the main reasons for not giving cows milk to infants before 12 months?
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IRON DEFICIENCY ANEMIA
HIGH RENAL SOLUTE LOAD MICRONUTRIENTS ARE LOW |
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what age is infant introduced to solids?
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4-6 months -- pureed soupy foods
6-8 months --- foods with lumpy but soft textre 8-10 months---soft, mashed foods |
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Pre-eclampsia/what may help prevent?
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usually after 20 weeks, preg. specific HTN
this is the most dangerous an increase in calcium, Vitamin C and E |
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Hormones needed to sustain milk production
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PROLACTIN: for production
OXYTOCIN: for the "let down" |
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What components are produced by cells in the mammary tissues?
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LACTOSE
OLIGOSACCHARIDES CASEIN WHEY: aids in digestion/protect at bacteria LACTAL BUMIN SAT. FAT (medium chain for easy absorption/digestion) MUFA DHA/EPA: omega 3 ARA: omega 6 |
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what determines how much breast milk is produced?
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breast size-->affects amount of storage/frequency of feeding
frequency of feeding amount of emptying of breast --> indicates demand |
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LACTOGENSIS I II III
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first few days postpartum
2-5 days postpartum; "engorgement" 10 days postpartum; milk becomes stable and production stimulated based on demand |
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which 2 vitamins may need to be supplemented during breastfeeding for mother?
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CALCIUM
VITAMIN D |
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how long does baby have stores or iron?
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up to 6 months
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feeding: Beginning/END ; which is higher in fat?
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beginning: FOREMILK
END: HIND MILK the HIND MILK is higher in fat |
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difference of breast milk v. milk from other mammals
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electrolyte content (osmolarity)
protein content lower -->easier for kidneys mineral content lower bioavailibity of nutrients is higher immune properties are higher |
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what releases due to suckling/psychological factors/friction?
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OXYTOCIN
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