1、1Nutrition and Feeding Prof.Cheng Qian Dept.of Child Health Care CMUC 2 Low nutritional storesThe nutritional vulnerability of infants and children High nutritional demands for growth Rapid neuronal developmentcontribution to basal metabolic rate4ContentsNutrient needs of the normal infant and child
2、The nutrition-related characteristics of gastrointestinal tract in infant Diet of the normal InfantDiet of the normal child and adolescentNutritional assessment5 to acquainted with the energy requirement at different age group,especially in infancy to acquainted with the ideal proportion of energy p
3、roduced by macronutrients to list the RNI or AI of some micronutrients(VitA,B,C,D,iron,calcium,zinc,iodine)OBJECTIVES 16ContentsNutrient needs of the normal infant and childThe nutrition-related characteristics of gastrointestinal tract in infant Diet of the normal InfantDiet of the normal child and
4、 adolescentNutritional assessment7Dietary reference intakes,DRIs营养素参考摄入量营养素参考摄入量Estimated Average Requirement,EAR平均需要量平均需要量 Recommended Nutrient Intake(Recommended Dietary Allowances),RNI(RDA)推荐摄入量推荐摄入量Adequate Intake,AI适宜摄入量适宜摄入量 Tolerable Upper Limit,UL可耐受可耐受最高摄入量最高摄入量 RNI=EAR+2SDAMDR 宏量营养素素接受范围宏量
5、营养素素接受范围PI-NCD 建议摄入量建议摄入量SPI 特定建议量特定建议量Prevention for Chronic illness 8Relationship of Dietary Reference Intakes to RNI,EAR and UL9Nutrient needs of the normal infant and child10 Category of nutrientsEnergyMacronutrients Pro,Fat,CHOMicronutrients minerals trace elements vitaminsOther diet elements c
6、ellulose(纤维素纤维素）water *Chinese nutrition society 2000,201311Energygrowth and synthesis of new tissue,metabolic processes,physiological functions and activitythe energy intake is used forThe EAR is the average dietary energy intake predicted to maintain energy balance in a healthy individual of defin
7、ed group.The EAR account for age,gender,weight,stature,and physical activity level.The RNIs of energy are the same as the estimated average requirement(EAR).12Energy requirements of infants(from Hanley&Belfus 1988.)mo13 0 12m 95 kcal/kg.d 1y 1100 kcal/d 2y 1200 kcal/d 3y 1350 kcal/d 5y 1600 kcal/d 7
8、y 1800 kcal/d 10y 2100 kcal/d Requirements of Total Energy(2000 Chinese Dietary Reference Intakes)14MacronutrientsProteinFatCarbohydrateare energy sources and are essential for cellular homeostasis.15 ProteinProtein intake is required to supply for the synthesis of constituent protein and other nitr
9、ogen-containing compounds such as polypeptide hormons.16EEA can not be synthesized by human.These amino acids are essential or indispensable to the diet.Infants require all of the indispensable amino acids that adults require,as well as cysteine(半胱氨酸）半胱氨酸）and tyrosine（酪氨（酪氨酸）酸）(and perhaps arginine精
10、氨酸精氨酸)early in life;these additional amino acids are indispensable for this stage,due to the immaturity of hepatic cystathionase（胱硫（胱硫醚酶）醚酶）in early infancy.17Protein qualitythe distribution of amino acidsthe proportion of amino acidsA protein of high quality contains a large propotion of essential
11、amino asids.*Human milksoy-based infant formula+methionine(蛋氨酸蛋氨酸)18RNI for Protein Age Protein 0-12m 1.53g/kg.d 1y-35g/d2y-40g/d 3y-45g/d4y-50g/d 5y-55g/d 6y-55g/d7y-60g/d 19FATFat is the most calorically dense macronutrient.The main dietary sources of fat include animal products,vegetable oils,mar
12、garine,baked goods,and fried foods.Fats paly significant structural and function roles.The AMDR for fats is 30-40%of the total energy intake for children 1-3yr of age and 25-35%for children 4-18yr(USA).20linolenic acid（ALA,亚麻酸亚麻酸）and linoleic acid（LA,亚油酸）亚油酸）are the most important unsaturated fats,a
13、lso are important essential fatty acids.Humans are incapable of synthesizing the precursor ALA and LA and dependent on dietary sources for these essential fatty acids.Saturated fats:animal fats Unsaturated fats：vegetable fats polyunsaturated:fish oil,plants （多不饱和脂肪酸多不饱和脂肪酸）21 CHO is the major resour
14、ces of the energy.CarbohydrateCarbohydrates are abundant in many foods including cereals,grains,fruits,and vegetables.Dietary carbohydrates include monosaccharides(单糖单糖),disaccharide（双糖双糖）,oligosaccharides(低低聚糖聚糖）,and polysaccharides（多糖多糖）。）。The primary function of carbohydrates is to serve as an en
15、ergy source for all cells,with the central nervous system and erythrocytes depending most on glucose as an energy substrates.22Optimal Distribution of Energy Fat contributes 50%of total energy in breast milk or standard infant formula.The average diet of older children provides 25-30%of total energy
16、 from fat.45-55%from carbohydrate and about 8-15%from protein.0-6m 45-50%7-24m 35-40%23Micronutrients（微量营养素微量营养素）mineralstrace elements（微量元素微量元素）vitamins24The major minerals are that require intakes of more than 100mg/day and contribute at least 0.1%of total body weight.Calcium(Ca),phosphorus(P),mag
17、nesium(Mg),sodium(Na),potassium(K),chloride(Cl),and sulfur(S)Minerals25Summary of clinically relevant information on minerals Biochemical Action Effects of deficiency Effects of Toxicity Dietary Sources Structure of bone and teeth;activates smooth,skeletal,cardiac muscle contraction and neural trans
18、mitter release,blood coagulationPoor mineralization of bone and teeth,osteomalacia,osteoporosis,rickets,tetany,growth impairment,possibly hypertensionDietary:excessive calcification of bone,calcification of soft tissueParenteral:heart block and renal stonescheese,milk,turnip and mustard greens,colla
19、rds,kale,broccoli,canned salmon and sardines with bones,clams,oystersMagenesiumPhosphorusCalciunConstituent of bones and teeth,Structure of cytoplasm and nucleic acids,phospholopids,coenzyme for CHO,fat,and protein metabolismRickets may develop in low-birth-weight babies;neuromuscular,renal,and skel
20、etal abnormalitiesHigh-phosphorus infant formulas(Ca:P ratio 1:1)may contribute to hypocalcemia,tetany in early infancyMilk,cheese,dairy products,egg yolk,meat,legumes,nuts,poultry,fish26Iron(Fe),Iodine(I),Copper(Cu),Zinc(Zn),Fluoride(F),Chromium(Cr),Selenium(Se)Trace elementsTrace minerals,which co
21、mprise less than 0.1%body weight,have essential physiologic roles.27Summary of clinically relevant information on Trace Elements Biochemical Action Effects of deficiency Effects of Toxicity Dietary Sources IronStructure of hemoglobin and myoglobin for O2 and CO2 transport,oxidative enzymes,cytochrom
22、e,and catalaseHypochromic(血红蛋血红蛋白低）白低）,microcytic anemia（低色素贫（低色素贫血）血）,growth failureHemochromatosis（血红素沉着症）（血红素沉着症）Liver,lean meat,egg,poultry,oysters,legumes,fortified cereals,grains,dark molassesZincCofactor or more than 90 enzymes,including erthrocyte carbonic anhydrase and superoxide dismutaseG
23、rowth failure,hypogonadism（性机能（性机能低下症）低下症）,hypogeusia（味（味觉减退症）觉减退症）,diarrhea,dermatoses（皮肤病）（皮肤病）Vomiting and diarrhea,dematoses,copper deficiencyWidely distributed,deficiency in chronic diahrrhea and parenteral nutritioniodineComponent of thyroid hormones thyroxine and triiodothyronineHypothyroid（甲
24、减）（甲减）,simple goiter（单纯性（单纯性甲状腺肿）甲状腺肿）,endemic cretinism（地方性甲低）（地方性甲低）Thyrotoxicosis（甲（甲亢）亢）,medicinally induced goiter（甲状（甲状腺肿）腺肿）Iodized salt,seafood,seaweed28RNI(or Al)Age Ca Fe I Zn mg mg ug mg(m)(AI)(AI)0-6 300 0.3 50 1.5 6-12 400 10 50 8.0 12-24 600 12 50 9.0(2000 Chinese Dietary Reference Int
25、akes)29Fat-soluble vitamins vitamin A,D,E,KWater-soluble vitamins vitaminB1,2,3,6,12 vitamin C,H,Folate Vitamins30Clinically Information on Some VitaminsBiochemical actionComponent of retinal pigments(视网膜色素）视网膜色素）and rhodopsin（视紫红质）（视紫红质）for vision in dim light,bone and tooth development;preserves i
26、ntegrity of epithelial cell;promotes wound healing,and growth.Effects of deficiencynight blindness,xerophthalmia(干眼症）干眼症）,photophobia（畏光）（畏光）,conjunctivitis（结膜炎）（结膜炎）,poor growth,impaired resistance to infectionEffects of toxicityCarotenemia（葫萝卜素血症）（葫萝卜素血症）with xanthosis cuitis（黄肤症）（黄肤症）,night sweat
27、s,dry and cracking（皲裂）（皲裂）Dietary sourcesliver,fish-liver oils,milk fat,egg yolk,butter,green and deep yellowVitamin A31Vitamin DBiochemical actionRegulates absorption and deposition of calcium and phosphorus,formation of calcium transport protein in duodenal（十二指肠）（十二指肠）mucosa,synthesis of calcium-b
28、inding protein in epithelial cell,othersEffects of deficiencyIn infants and children:ricketsEffects of toxicityIn infants and children:hypercalcemia（高血钙）（高血钙）,anorexia,poor growthDietary sourcesForified milk,egg yolk,liver,salmon,butter,sardines,mackere*The body can synthesize when the skin is expos
29、ed to sunshine.32Vitamin B1(Thiamin,硫胺素硫胺素)Biochemical actionCombines with phosphorus to form thiamin pyrophosphate,which acts in various oxidative decarboxylations,including pyruvic acidEffects of deficiencyWet beriberi（脚气病）（脚气病）:congestive heart failure,tachycardia（心动过速）（心动过速）,peripheral edemaDry
30、beriberi:neuritis,paresthesia,irritability,anorexiaEffects of toxicityunknownDietary sourcesLiver,meat,milk,pork,whole grains,legumes,nuts33Vitamin CBiochemical actionIntegrity maintenance of all intercellular materials,collagen biosynthesis,iron absorption and transport,metabolism of tyrosine,synth
31、esis of corticosteroids(皮质类固醇）皮质类固醇）Effects of deficiencyScurvy（坏血病）（坏血病）:diffuse tissue bleeding,pinpoint peripheral hemorrhages,easy bone fracture,poor wound healing,friable bleeding gums with loose teethEffects of toxicityNausea(恶心）恶心）,diarrhea,cramps（腹痛）（腹痛）;massive doses may predispose to kidne
32、y stonesDietary sourcesCitrus fruits（柑橘类）（柑橘类）,tomatoes,berries,green vegetables,cabbage,human milk34Vitamins RNIs for infant Vit A 400 gRE/d Vit D 10 g/d Vit C 40-50 mg/d Vit B1 0.2-0.3 mg/d Vit A 1 gRE=3.3IU Vit D 1 g=40IU35Other Diet Elements water cellulose 36 Water 1 yearbreast milkand/orformul
33、acomplementaryfoods(modified)adult dietformulaAnd/orhuman milkformula*Complementary foods usually accounts for 20%total caloric intake at 6 months of age,and increase to 50%by 1 year of age.93ContentsNutrient needs of the normal infant and childThe nutrition-related characteristics of gastrointestin
34、al tract in infant Diet of the normal InfantDiet of the normal child and adolescentNutritional assessment94Diet of the Normal Child and Adolescent95Reduced food intakeSelf-selection of dietSelf-feedingEating habitNutritional issues:toddlers 96Skipping meals Consumption of a limited variety of foods
35、Frequent consumption of high-fat,high-sugar,low-protein foods,a lack of fibre Dieting Nutritional issues:adolescent 97ContentsNutrient needs of the normal infant and childThe characteristics of GI which relates nutrition in infant Diet of the normal InfantDiet of the normal child and adolescentNutri
36、tional assessment98 Anthropometrics Clinical data Dietary data Biochemical dataComprehensive nutritional assessment includes:99Nutritional disorders in pediatrics ObesityFailure to thriveMalnutritionVitamin deficienciesMineral deficienciesothers100uIllustrated textbook of paediatrics 3rd edition,2005 uNelson textbook of pediatrics 19th edition,2011uRudolphs Pediatrics 22nd edition,2010uPediatric Nutrition 3rd edition,2005uAmerican Academy of Pediatrics Nutrition Handbook,7th edition.2014儿科学儿科学(五年制五年制)第第8 8版版 人民卫生出版社人民卫生出版社References
