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FSHN 459- Unit 2

weight just after birth (1st week) 6-10% 1st day, 1st week get back to BW
4-6 months growth 2x BW
6-12 months growth rate slows
12 months growth 3x BW
12 months length increase by 50%
when use WHO growth charts? 0-2 years
when use CDC growth charts? >2 years
growth charts are based on (4) weight for age, weight for length, length for age, head circumference
0-2 percentile weight for length underweight
2-5 percentile weight for length at risk of underweight
5-98 percentile weight for length healthy weight for length
98+ percentile weight for length overweight
feeding as a developmental opportunity mealtime stimulates language development
infant reflexes controlled by CNS; root/suckle/suck
suckle tongue movements
root touch baby's cheek, it turns head and opens mouth
infant motor skill development order top down, central to peripheral
infant motor skills influence what? ability to feed, amount of calories expended
infant sensorimotor development example putting things in mouth
cognitive development infancy- why important? need social and emotional stimulation to maximize brain maturation
holding/physical contact with babies important for cognitive development
digestive system development newborns swallowed amniotic fluid stimulates intestine, levels of enzymes increase with time
fats infancy short and medium chain more readily utilized than long chain, but limited conversion PUFA (should be provided)
why essential fats are important for infants EPA: substates, DHA: immunologic/phospolipids in retina and brain, energy
iron in infants supplemental for exclusively BF infants
lead infants interferes with calcium and iron absorption, slowed growth
thrifty hypothesis perinatal food deprivation and adult incidence of obesity, TIIDM, HT, CVD
predictive adaptive response LBW show catch-up during 1st year- exacerbates diseases later in life
weaning from BM/HMS 12-24 months, introduce water via cup at 6-8 months
food allergies and intolerances infancy don't avoid foods (except under 1 year)
organic failure to thrive inadequate wt or ht from a health problem
inorganic failure to thrive environmental cause
Inappropriate early nutrition leads to abnormal adipose tissue distribution, insulin resistance, glucose intolerance, high BP
Preterm infants are at risk for suboptimal neurodevelopment etc
Correction for gestational age substract gestational age at birth from 40
Born at 28 weeks corrected age 3 months preterm (12 wks), so subtract 3 months form actual age
VLBW/ELBW infants need respiratory support/GI tract problems
Enteral feeding intestinal
Parenteral feeding IV etc
Gavage feeding tube from mouth or nose into stomach (ideal b/c want to use as much of GI tract as possible)
Gastrostomy feeding directly into stomach
Jejunostomy feeding directly into jejunum
Elevated preterm nutrient requirements (what stores are low)? fat/glycogen, Ca, P, Fe, fat soluble vitamins
Forms of protein for preterm infants may need hydrolyzed or single AAs
Fats preterm 55% of kcal, supplement w/ MCT oil (don’t need bile)
Supplemental fats preterm essential and MCT
Vitamins/minerals preterm need >DRI (not provided in BM)
Preterm infant formulas extra vitamins/minerals and extra calories
Preterm/bone mass most rapid bone growth in 3rd trimester (at risk for low bone mass)
Non-nutritive effect of BM on bone development maybe immunologic benefits
Why iron not in human milk fortifier creates ROS
Measuring height of toddlers <2 recumbent; >2 standing
When do growth charts change 24 months (WHO==>CDC)
STRONG kids program 1st 6 months associated w/ picky eating in early childhood
No picky eaters parents enable picky eating behavior
Parent provides (5) regular schedule, child-size portions, variety of food, limited distractions, family mealtime
Child decides what to eat, how much to eat, whether or not to eat
Recommended toddler food intake 1TBSP per year of age; regular but flexible
Food jags focus/fixation on one food item
What types of food to toddlers prefer? sweet and slightly salty
Special events (toddler) special associated w/ fatty food
Context (toddler) bad if meals are argumentative or hurried
What 2 things not to do w/ toddlers? restricting/bribing with food
What considered for toddler nutrition? gender, height, weight, physical activity
What 5 nutrients aren't met in toddlers? Fe, Ca, D, Zn, N3
Fiber infants too much is bad, but only getting ½ recommended
Lead poisoning infants brain/blood/kidneys (IQ , behavior)
Physical activity pre-school getting basic motor skills, “active play”
Active play pre-school enjoyment (intrinstically), often appears purposeless
Active play curve upside down U/peaks in early childhood
Causes of toddler obesity (4) marketing/convenience of foods, inactivity, parental obesity, screen time
Treatment of toddler obesity maintain weight, set expectations
Sleep and obesity preschool <9.5 hours; maybe low leptin or high ghrelin
Celiac disease preschool/highest populations usually symptoms develop by 2 years (highest middle eastern or Irish)
Possible causes of ADHD genetics, harmful exposures (alcohol, tobacco, lead)
Feeding habits ADHD rigid/self-restricted; drink calories; more likely to have deficiencies
Autism food habits rigid food choices; gluten or casein free may work
Pulmonary problems preschool hunger and fullness cues harder to interpret b/c of fatigue
Why nutrition is important preadolescent sports, academic, health problems
5 pillars of Let’s Move! healthy start, empowering parents, healthy foods in schools, access to healthy foods, physical activity
CDC BMI growth charts <5 underweight; 85-95 overweight; >95 obese
When does BMI increase in childhood? around age 6
Restrictive intake childhood more influence over hunger and satiety; influenced by parental restrictive intake
Excess nutrients childhood fat, sat fat, sugar, salt
Low nutrient childhood omega 3*
Fiber childhood half recommended amount
Dental caries childhood 50% have decay (soda)
Obesity children trend/paradox increasing w/out increase in energy intake
Obesity different countries more obese in developing than developed
Obesity and school significant amount of time, 35% of food, 50% of energy
School lunch cash and commodity foods provided, direct link b/w food policy and what kids eat at school
Consequence of childhood obesity physically developed sooner (others)
Target areas for childhood obesity (4) breakfast, child involvement, positive environment, communication
Treatment of childhood obesity weight maintenance and height increases; behavior change/not numbers
Optimal defaults make environment safer, people are healthier as a consequence
Unit bias people tend to consume the portion they’re given
Proposed legislation Kelly Brownell 1 penny per ounce of soda
Food intolerance non-immune mediated reaction to food (may take days)
Food allergies response of immune system to certain foods (symptoms appear rapidly)
Sensitization (allergies) GI tract, consequence of prior exposure
Allergy prevalence increasing (small %)
What allergies resolve by school age? milk, eggs, soy
What allergies are “permanent”? peanut, tree nut, seafood
Vitamin D and allergies if vitamin D deficient, more likely to have allergic sensitization to allergens
Cow’s milk allergy accidental exposure very likely, negative quality of life
SOTI cows milk may lessen allergy through incremental administration of cow’s milk
Egg allergy egg white proteins, heavily glycolsylated, cooking may reduce allergenic activity
Egg allergy childhood vaccines, limitations
Peanut allergy prevalence are increasing, anaphylactic reactions
Prevalence of peanut allergy hygiene hypothesis, timing of introduction, additives (cause unknown)
Obesity and allergies may increase prevalence (systemic inflammation)
Parental allergy sex dependent association
US food labeling (allergies) must state if has allergen or derived protein
Anxiety and food allergies anxiety about possible exposure; discomfort associated w/ eating
factors influencing needs of childhood chronic conditions (2) energy output, protein needs
other nutrients chronic conditions begin with DRI; varies widely (medications may increase turnover rate of nutrients)
growth assessment chronic conditions special charts (e.g. Down's Syndrome); age and secondary conditions affect growth
meeting nutritional needs of chronic conditions 1st choice: food and beverage orally
eating and feeding problems chronic conditions most children with developmental delays have feeding difficulties
TIDM 10-14 years onset; peak incidence is becoming earlier
why increase in type 1 diabetes? increased exposure to triggers of autoimmunity
hygiene hypothesis decreased exposure to infections agents (type 1 diabetes)
hygiene hypothesis most common populations low population density, first born, fewer siblings **higher in more educated/richer people
which vitamin is correlated with type 1 diabetes and allergies? vitamin D (mediates immune effects)
risk factors for T2DM in youth small for gestational age or large for gestational age
cystic fibrosis thick mucus clogs lungs and lack pancreatic enzymes (higher energy needs)
cystic fibrosis nutritional interventions pancreatic enzyme supplements
cerebral palsy nutrition related secondary effects (2) GERD, constipation
cerebral palsy feeding problems spilling, longer mealtimes
cerebral palsy problem nutrients bone density (no weight bearing movement)-> calcium and vitamin D
caloric needs cerebral palsy depends if involuntary/voluntary muscle movement occurs
ADHD nutrition interventions (3) antioxidants, omega 3s, avoid additives
cause of autism genetic, environmental, or both?
autism GI disturbances most have GI symptoms; could be malabsorption or leaky gut syndrome
autism has increased incidence of what? (2) overweight/obesity and allergies/intolerances
Opioid excess theory (Austism); intolerance to casein/gluten because peptides bind to opioid receptors
What diet may help with autism? gluten, casein, and lactose free
changes of puberty (4) sexual maturation, ht/wt, skeletal mass, *body composition
patterns of growth puberty large variation (biological vs chronological age)
changes of skeletal mass adolescence 1/2 of peak is accrued during adolescence
nutritional factors contributing to accretion of bone mass during puberty caffeine, alcohol, Ca/D/minerals/protein
eating habits adolescence snacks up to 1/3 intake, skipping meals more common (BF most commonly skipped); TV during meals
role of parents in adolescent eating provide nutritious foods, model healthy choices, eat breakfast w/ kid (or at all)
frequency of family meals inversely associated w/ disordered eating, BMI, substance use, depression
SSBs adolescence 84%, 30 oz per day
zinc adolescence need/retention increases during growth spurts (sexual maturation)
calcium adolescence need and absorption higher during adolescence (more than any other time except infancy)
adolescence vit D parathyroid hormone becomes elevated if deficient; demineralization of bones ensues
bones and soda high phosphate impairs vit D activation
physical activity adolescence lifelong activity patters develop; 60 minutes per day
what puts individuals at risk for disordered eating? (3) perfectionism, genetics, early age of menarche
normal eating flexible, varies w/ hunger, feelings, schedule, proximity to food
dieting behaviors dieting and weight loss efforts predict more weight gain in adolescents
dieting consequences (4) weight gain, less nutritious foods, binge-eating, development of eating disorders
family weight talk and dieting (teasing/dieting) never produced better outcomes in girls (study)
anorexia commonly causes amenorrhea
bulimia weight is not a predictor (maintenance or fluctuations)
binge-eating disorder not followed by compensatory behavior
online media body image pro-ana, fashion, home decor; exp group= negative affect, thinking about weight afterwards
body dissatisfaction increased risk of decreased activity (clothes, scared of trying, etc)
exercise, depression, and adolescence synthesis and metabolism of serotonin; positive effect is especially strong during adolescence
disordered eating and bone mineral density cortisol will inhibit osteoblast replication (decrease BMD)
behavioral objectives for healthy wt mgmt in adolescents (3) breakfast, mindful eating, "normal eating"
preventing obesity and eating disorders (4) eat healthy, activity, positive self-talk, assume overweight teens have experiences weight mistreatment and address it with them and their families
TED talk eating disorders controversial model
emotional/symbolic dimensions of food research tends to ignore this and focus on rational barriers ("fitting in")
best predictor of adult obesity adolescent obesity
general guidelines for weight mgmt therapy (2) learner-center, accomplishments/positives
sports nutrition protein; vulnerable to special diets
hydration/adolescent sports nutrition vulnerable to heat illness
ergogenic supplements side effects many, renal function
Created by: melaniebeale