nutrition in children

INTRODUCTION

Dr Nicola Flynn• Research Associate Under Dr Dilip Mahalanabis Society

for applied studies, Salt Lake Kolkata.• Consultant Pediatrician & Neonatologist, Ruby General

Hospital, Kolkata.

Nutrition In

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• Children, our future, form one third of our population.

• Growth is the best global indicator of children’s well-being.

• Adequate food intake is essential for proper growth.

• Low food intake can affect their physical and mental growth.

Impaired growth and development in children can affect the rest of their lives

Child’s Health and Future

Malnutrition and Child

• Asia has largest number of malnourished children

• India accounts for 40% of malnourished children in the world

• UNICEF estimates that malnutrition affects physical and mental function of 2 billion children.

According to WHO and UNICEF estimates, 60% of child deaths are malnutrition associated.

1 in 3 of the world's malnourished children lives in India1

Child and Physical Development

• Rapid growth happens between infancy and adolescence

• Nutrition is vital during the growth phase

• Inadequate nutrition affects growth and muscle development

Boys

Girls

Child and Mental Development

0% of Brain d

evelopmen

t

2 04 06 08 01 0 0

T i m e p e r i o d2 5 w k s 3 0 w k s 3 5 w k s 4 0 w k s 1 y r 5 y r s

0% of Brain d

evelopmen

t

2 04 06 08 01 0 0

T i m e p e r i o d2 5 w k s 3 0 w k s 3 5 w k s 4 0 w k s 1 y r 5 y r s

Critical Periods for Brain Growth

Brain Growth Across the Years

Factors that Affect Child Growth

Nutrition and Child Development

Outcomes of inadequate diet

• Poor growth• Poor cognition • Poor muscle development• Reduced work capacity• Poor social development• High rates of illness • Difficulty in school

Nutritional status of children during the critical period is of paramount importance

for later physical, mental & social development.

Reference: Nutrient requirement and RDA for Indians , ICMR , 1990

Nutritional requirement of preschoolers

Nutrient Requirements of Young Children is Manifolds of Adult

Requirements

Gaps in Mean Intake of Nutrients amongst Children in India

Micronutrient deficiencies represent a hidden form of hunger with severe consequences on physical growth, immune functions,

cognition and productivity

Graph depicting the micronutrient intake of Indian children (Boys and girls) in the age group of 7–15 years as compared to 100% RDA as per NNMB 1996 Data. (RDA

marked as dotted line)

30

Nutrients

Macronutrients

Micronutrients

carbohydrates Proteins Fats VitaminsMinerals

Fat soluble

vitamins

Water Soluble

Vitamins

Saturated

Unsaturated

Monosaccharide

Disaccharide

Polysaccharide

Complete proteins

Incomplete

proteins

Poly Unsaturated

Mono Unsaturated

Deficiency of Nutrients and Physical Development

Micronutrient Deficiency

Effects

Vitamin D and calcium

Deficiency affects bone development

Potassium, zinc, magnesium and copper

Deficiency disturbs the growth hormones and affect growth

Manganese Deficiency leads to skeletal abnormalities including retarded growth

Vitamin E Deficiency affects muscle development

Deficiency of Nutrients and Mental Development

Micronutrient

Deficiency manifestations

Vitamin B1

• Reduction of the brain content of neurotransmitters.

• Reduced levels of brain GABA, glutamate and aspartate

Vitamin B2

• Impaired performance on psychomotor tests, neuromotor incoordination and personality changes

Vitamin B3

• Loss of memory, nervousness, easy distractibility and schizophrenia

Vitamin B6

• Depression, irritability, loss of memory, inability to concentrate, peripheral neuritis

Vitamin B12

• Loss of memory, disorientation and emotional instability

Folic acid• Memory loss, forgetfulness, depression, irritability,

introversion, lack of confidence

Vitamin C• Reduced score for IQ, memory, abstract thinking

and non-verbal intelligence, altered behavior

Vitamin E • Poor memory and attention span

Deficiency of Nutrients and Mental Development

Micronutrient Deficiency manifestations

Iodine

• Poor somatic and central nervous system growth, sluggishness, inactivity, lethargy, poor concentration, impaired cognition and incoordination.

• Sequel leading to minimal brain function to a syndrome of severe intellectual disability.

• Global loss of 10–15 intellectual quotient

Iron

• Listlessness, apathy, lack of vigor and enthusiasm, lower scores on motor development and cognitive tests and poor school grades-

• Less myelinization and altered neurotransmitter function

Zinc• Lethargy, decreased visual memory, impaired

cognitive development and neuropsychological problems

Selenium• Depression, low mood, low energy level, anxiety and

stress

Choline • Poor memory and mental functioning

DHA• Short memory span, poor ability for discrimination,

aggression, hostility, learning disability, dyslexia? attention deficit disorder

Deficiency of Nutrients and Immunity

Micronutrient deficiency

Effects

Vitamin A Impairs immuno competence, therefore it

can increase the risk of infection Vitamin E Impair several aspects of the immune

response, including B- and T-cell mediated immunity

Vitamin C Impaired inflammatory responses & function of phagocytes

Zinc Impaired lymphocyte responsiveness & T cell development

Selenium Impaired antibody production

• Frequent illness adversely affects growth & development of children1

• Growing children need the BEST nourishment with all essential nutrients in recommended quantity2 for Optimal immune function Faster recovery Healthy physical growth Mental development

1. Journal of Nutrition. 1999;129:531-533.2. Healthy Nutrition: An Essential Element of a Health-Promoting School. WHO, FAO and

Education International, 1998. WHO Information Series on School Health – Document 4. Geneva: WHO

Essential Fatty Acids

The Essential Fats are a group of fatty acids that are essential to

human health.

• Omega-3 (3) – Linolenic acid• Omega-6 (6) – Linoleic acid

Structure of EFAs

LINOLEIC ACIDS (Omega 6)Eighteen-carbon essential fatty acids that contain two double bonds.

• 18:2 (9,12)

– LINOLENIC ACIDS (Omega 3)Eighteen-carbon essential fatty acids that contain three double bonds18:3 (9,12,15)

Function of EFAs• Formation of healthy cell membranes• Proper development and functioning of the

brain and nervous system• Production of hormone-like substances called

Eicosanoids –Thromboxanes–Leukotrienes–ProstaglandinsResponsible for regulating blood pressure, blood viscosity, vasoconstriction, immune and inflammatory responses.

Omega-3s

• Sources:WalnutsWheat germ oilFlaxeed oil/canola oilFish liver oils/Fish eggsHuman MilkOrgan meatsSeafood/Fatty fish

- albacore tuna- mackerel- salmon-sardines

Benefits of Omega-3s• Lower PG2s• Anti-inflammatory• Lower triglyceride and

cholesterol levels• Cancer prevention• Renal maintenance• Increase insulin sensitivity

• Enhance thermogenesis and lipid metabolism

• Benefits vision and brain function

• Decrease Skin inflammation

• Inhibit platelet adhesion

Reports of -3 Deficiency• Holman and colleagues reported a case of peripheral

neuropathy and blurred vision in a child receiving total parenteral nutrition devoid of omega-3 fatty acids for 5 months.1

-Holman et al. AM J Clin Nutr 35:617, 1982

• Bjerve and his coworkers reported linolenic acid deficiency in nine patients fed by gastric tube for 2.5 to 12 years, who had received only 0.025% to 0.09% of their total kilocalories as omega-3 fatty acids.

-Bjerve et al. Am J Clin Nutr 45:66, 1987.

Platelet aggregation, cardiovascular diseases, and inflammation

Sources:Corn oilPeanut oilCottonseed oilSoybean oilMany plant oils

Omega-6s

Benefits of Omega-6sSpecifically, omega-6 fatty

acids with a high GLA content may help to:

• Reduce inflammation of rheumatoid arthritis

• Relieve the discomforts of PMS, endometriosis, and fibrocystic breasts.

• Reduce the symptoms of eczema and psoriasis.

• Clear up acne and rosacea.• Prevent and improve

diabetic neuropathy.

• Excessive amounts of omega-6 (PUFA) and a very high omega-6/omega-3 ratio has been shown to promote the pathogenesis of many diseases:-cardiovascular disease

-cancer-Inflammatory and autoimmune diseases

Essential Fatty Acid Deficiency Side Effects

• hemorrhagic dermatitis

• skin atrophy• scaly dermatitis• dry skin• weakness• impaired vision• tingling sensations• mood swings• edema

• high blood pressure• high triglycerides• hemorrhagic folliculitis• hemotologic

disturbances (ex: sticky platelets)

• immune and mental deficiencies

• impaired growth

Dermatitis, Atopic in an Infant and on a Young Girl's Face

Differing characteristics -3 and -6 Essential Fatty Acid Deficiencies

Omega-3 (-Linolenic Acid) Omega-6 (Linoleic Acid)

Clinical Features

Normal skin, growth, reproductionReduced learningAbnormal electroretinogramImpaired visionPolydipsia

Growth retardationSkin lesionsReproductive failureFatty liverPolydipsia

Biochemical markers

Decreased 18:3 -3 and 22:6 -3Increased 22:4 -6 and 22:5 7Increased 20:3 -9(only if -6 also low)

Decreased 18:2 -6 and 20:4 -6Increased 20:3 -9 (only if -3 also low)

Guthrie H, Picciano, Mary. Human Nutrition. Lipids p128 1995

Who are at risk for deficiency?

• Long-term TPN patients without adequate lipid

• Cystic Fibrosis • Low Birth Weight

Infants• Premature infants• Severely malnourished

patients• Patients on Long-term

MCT as fat source• Patients with fat

malabsorption

• Acrodermatitis Enteropathica

• Hepatorenal Syndrome• Sjogren-Larsson

Syndrome• Multisystem neuronal

degradation• Crohn’s disease• Cirrhosis and alcoholism• Reye’s Syndrome• Short bowel syndrome

Recommendations: Infants & Children

• The American Academy of Pediatrics recommends that infant milk formula should provide at least 2.7% of total kilocalories in the form of linoleic acid.

• Of note, human milk provides 3.5% to as high as 12% of total kilocalories in the form of linoleic acid depending on the fat composition of the maternal diet.

AI for Infants and Children

0-6 mos 0.5 g/day of n-3 PUFA

7-12 mos 0.5 g/day of n-3 PUFA

1-3 yrs 0.7 g/day of -linolenic acid


Boys


14-18 yrs 1.6 g/day o -linolenic acid

Girls



Food and Nutrition Board, Institute of Medicine (FNBIOM,2001)

DHA

DHA is one of the primary structural component of brain tissue and retina

Docosahexaenoic acid (DHA) is an omega-3 essential fatty acid

DHA and Brain DHA and Retina

DHA Aids Brain Cell Maturation

A - Less astrocytes maturation when cultured in serum deficient conditions.B, C, D - Improved maturation of astrocytes as DHA is supplemented inincreasing concentrations.

Improved maturation of astrocytes with higherconcentrations / levels of DHA

Animal studies have indicated a causal connection between DHA availability & cognitive or behavioral

performance

DHA and Neurotransmission

DHA is an important constituent of the brain cell membrane, which have a role in

neurotransmission

G-proteins are structures that are present on the cell membrane & assist in movement of nutrients

Human Beings are Poor DHA Synthesizers

Less than 0.2% of ALA is converted to DHA in the hepatocyte

Hence, it becomes important to directly consume DHA during crucial periods of

brain growth

DHA in ActiGrow

DHA from fish oil

Significance

Free of high levels of mercury, oceanic pollutant and toxins

High mercury levels

Undesirable levels of mercury and oceanic pollutant have the potential to damage the tissues

More stable Less stable The oxidative stability of long chain polysaturated fatty acids (PUFA) and DHA containing fish and algae oils varies widely according to their fatty acid composition. DHA from algal sources is found to be ten times more stable than fatty acids derived from fish oils.

Desirable EPA content

Higher EPA content

Not desirable during growing phase

from a vegetarian source

Thank You

nutrition in children

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