2. Nutrition is the science that interprets the interaction of
nutrients and other substances in food in relation to
maintenance, growth, reproduction, health and disease of
an organism.
Food is any substance when ingested or eaten nourishes
the body.
Nutrients are chemicals in foods that are used by the
body for growth, maintenance, and energy.
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3. WHY IS NUTRITION IMPORTANT?
Energy of daily living
Maintenance of all body functions
Vital to growth and development
Therapeutic benefits
Healing
Prevention
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4. Nutrients that cannot be synthesized by the body and
thus must be derived from the diet are considered
essential.
Nutrients that the body can synthesize from other
compounds, although they may also be derived from the
diet, are considered nonessential.
Macronutrients are required by the body in relatively
large amounts; micronutrients are needed in minute
amounts.
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5. Lack of nutrients can result in deficiency syndromes (eg,
kwashiorkor, pellagra) or other disorders .
Excess intake of macronutrients can lead to obesity and
related disorders; excess intake of micro-nutrients can be
toxic.
Also, the balance of various types of nutrients, such as
how much unsaturated vs saturated fat is consumed, can
influence the development of disorders.
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6. An optimal feeding should contain five food types
includes vegetables, fruits, grains (eg, breads, cereals,
pastas), dairy products, and protein group (e.g meat,
poultry, fish, eggs, nuts, legumes) plus oils.
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7. Nutritional requirements of infants and young children
differ from that of adults in a number of aspects due to
energy expenditure (i.e., basal metabolism, metabolic
response to food, and physical activity), rate of growth,
new growth, body composition, and physiological
changes (e.g., puberty).
The nutrient requirements of children are influenced by
(1) growth rate, (2) body composition, and (3)
composition of new growth.
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8. Recommended Dietary Allowance (RDA):
The average daily dietary nutrient intake level
sufficient to meet the nutritional requirements of
nearly all (97-98%) healthy persons.
The RDA for that nutrient usually is set at the
mean requirement (the EAR) plus 2 standard
deviations.
RDAs are useful for assessing the nutrient
intakes of individuals or groups,
But not for ascertaining the adequacy,
inadequacy, or excess.
CONT’D…
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9. ENERGY
The 3 components of energy expenditure in adults are
Basal metabolic rate
The thermal effect of food (energy required for digestion and
absorption)
Energy for physical activity
Additional energy intake and expenditure are required to
support growth and development for children
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10. Energy is measured in Joules or calorie
Kilocalorie
The amount of heat necessary to raise the
temp. of 1 kg of water from 14.5 to 15.5 C or
by 1c
1Joule= 4200 calories
1kcalorie= 1000calories
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11. The nutrients that provide energy intake in the
child's diet are
Fats contribute ∼ 9 kcal/g
Carbohydrates contribute ∼ 4 kcal/g
Proteins contribute ∼ 4 kcal/g)
=> They are referred to as macronutrients
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12. Energy expenditure in children
1- Basal metabolism 50%
2- Physical activity 25%
3- Growth 12%
3- Fecal loss 8%
4- Thermal effect of food 5%
CONT’D…
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13. Energy requirement based on age
0-6mn 108kcal/kg/day
6-12mn 98kcal/kg/day
1-3 yr 102kcal/kg/day
4-6yr 90kcal/kg/day
7-10yr 70kcal/kg/day
11-14yr male 55kcal/kg/day
female 45kcal/kg/day
15-18 male 47kcal/kg/day
female 40kcal/kg/day
CONT’D…
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14. NUTRITIONAL VALUE OF LOCALLY
AVAILABLE FOODS
Important to
estimate and
council the amount
of calories taken
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16. FAT
The main dietary sources of fat include
Animal products (meat, butter, milk, cheese, egg yolk)
Vegetable oils, margarine and fried foods
Dietary fats are composed of a various mix of
saturated fats, monounsaturated fat, PUFA, trans fat,
and cholesterol
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17. Function of fat in the body
Energy-dense macronutrients
Cholesterol moieties are precursors for cell
membranes, hormones, and bile acids
Fat intake also facilitates absorption of the fat-soluble
vitamins a, d, e, and k
Dietary intakes of mono- and polyunsaturated
fats have been associated with positive health
outcomes
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18. Humans are incapable of synthesizing the precursor ω3
(α–linolenic; ALA) and ω6 (linoleic; LA) PUFAs and are
dependent on dietary sources for these essential fatty
acids
Essential fatty acid (EFA) deficiency can be associated
with desquamating skin rashes, alopecia, and growth
deficits
Essential fatty acids are present in breast milk, are often
supplemented in infant formula, and are required for
normal growth and development
CONT’D…
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19. PROTEINS
Protein intake is required to supply nitrogen and
amino acids for the synthesis of constituent
proteins and other nitrogen-containing
compounds such as polypeptide hormones
Are major structural component of all cells in the
body
Functions as enzymes, in membranes, as
transport carriers, and as some hormones
The daily dietary protein requirement decreases
from 2.2 g/kg in 3-mo-old infants to 1.2 g/kg in
5-yr-old children and to 0.8 g/kg in adults.
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20. Amino acids are categorized in to 3
Indispensable/essential AA humans depend on dietary
sources to meet adequacy and prevent deficiency
Threonine,
valine,
leucine
isoleucine,
lysine,
tryptpophan,
phenylalanine, methionine, and histidine
CONT’D…
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21. Conditional essential/indispensable AA are
essential only at certain life stages
e.g. in infants cysteine, tyrosine perhaps arginine
Dispensable/ nonessential AA available in
foods
Alanine
Aspartic acid
Asparagine
Glutamic acid
Serine
CONT’D…
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22. CARBOHYDRATES
Dietary carbohydrates include
Monosaccharides (glucose, fructose)
Disaccharides (sucrose, lactose)
Oligosaccharides and polysaccharides (starch)
The primary function of carbohydrates is to
serve as an energy source for all cells, with the
central nervous system and erythrocytes
depending most on glucose as an energy
substrate.
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23. WATER
Water is essential for existence
Water comprises ~ 50 to 60% of body weight in
young adults and 70 to 75% of body weight in
infants
Total body water, expressed as a percentage of
body weight, is a function of age, sex, and body
composition
Water is taken as food and fluid and also
produced in the body during metabolism of
nutrients
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24. Human needs for water are related to caloric
consumption, to insensible loss and to specific
gravity of urine
The daily consumption of fluid by the healthy
infant is equivalent to 10-15% of body weight
compared with 2-4% in the adult
Evaporation from the lung and skin accounts for
40-50% of intake and renal excretion for 40-50%
of intake
CONT’D…
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25. FEEDING IN INFANCY
Breast milk is the best food for the newborn
It should be started immediately after birth with in one
hour of life
It should be given exclusively for the first 6 month of
life even water need not to be added
It contains all the nutrients required by the infant
Sunlight exposure should be advised.
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26. The suckling newborn stimulates the mother's
pituitary to release prolactin and oxytocin, which
in turn stimulate the production and let-down of
breast milk (milk ejection reflex), respectively
Composition of breast milk varies at different
stages after birth
Colostrum is milk produced during the 1st week
after birth, yellow & thick and contains more
antibodies and WBC , secreted in small amount,
contains more protein than mature milk.
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27. Mature milk is secreted after the colostrums, thinner &
watery but contains all the nutrients required by the baby
Foremilk is milk secreted at the start of feeding it is
watery ,rich in proteins, vitamins, minerals and water.
Hind milk thicker and richer in fat content
CONT’D…
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28. For effective breast feeding, there should proper
attachment and positioning with effective suckling
Good Positioning
Supporting babies whole body
Neck and back on same plane with neck
slightly extended
Babies entire body facing mother
Babies abdomen touching mothers abdomen
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29. Good Attachment
Babies mouth wide open
Lower lip turned outwards
Chin touching nipple
More areola visible on above than below
Effective suckling
Slow, deep suckling with pause in between
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30. Causes of poor attachment
Use of feeding bottles
Inexperienced mother
Lack of skilled support
Inverted nipples
Consequences of poor attachment
Pain to nipple or sore nipple
Breast engorgement
Poor milk supply hence the baby is not satisfied after
sucking.
Baby refuse to suck and poor weight gain
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33. Indicators of adequate breast feeding
Baby passes urine 6-8 times per day.
Sleep for 2-3 hours after feeds.
Gains weight around 20-30 gm/day
Crosses birth weight by 2 weeks.
CONT’D…
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34. OPTIMAL BREAST FEEDING PRACTICES
Have written breast feeding policy that is
routinely communicated to all health care staff
Counsel mother and discuss about feeding of the
newborn during pregnancy
Start breast feeding with in 1 hr of birth
Teach mother on breast feeding practices
Exclusive breast feeding for the first 4-6mns
Breast feeding should be given 8-12 times per
day including night feeds
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35. It should be on demand and frequent
Empty one breast before switching to the other
Increase breast feeding during illness
Continue breast feeding for a total of 24 months
Start complementary feeding at 6months
Don’t give artificial teats or pacifiers
No supply or advertizing of breast milk substitutes to
mothers always tell about priority of breast milk
CONT’D…
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36. ADVANTAGES OF BREAST FEEDING
Increases mother to infant bonding
Protects infants from infection
Lactational amenorrhea for the mother means of family
planning
If started immediately after birth facilitates uterine
contraction expulsion of placenta and prevent PPH
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37. Natural food for full-term infants and is the appropriate
milk for the 1st year of life
Always available at the proper temperature and requires
no preparation time
Fresh and free of contaminating bacteria
Associated with fewer feeding difficulties incident to
allergy and/or intolerance to bovine milk which include
diarrhea, intestinal bleeding, occult melena, colic, and
atopic eczema
CONT’D…
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38. Human milk contains bacterial and viral
antibodies, including relatively high
concentrations of secretory immunoglobulin A,
that prevent microorganisms from adhering to
the intestinal mucosa
Macrophages in human milk may synthesize
complement, lysozyme, and lactoferrin
Lactoferrin is an iron-binding whey protein has
an inhibitory effect on the growth of E. coli in
the intestine
= lower incidence of diarrheal disease, otitis
media, pneumonia, bacteremia and meningitis
than formula fed infants
CONT’D…
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39. Supply all the necessary nutrients except
fluoride, vitamin K & vitamin D
Iron content is low, but most normal term infants
have sufficient iron stores for the 1st 4–6 mo of
life. Human milk iron is well absorbed
The vitamin K content also is low and may
contribute to hemorrhagic disease of the
newborn
CONT’D…
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40. The only disadvantage of breast feeding is transmission
of maternal infection to the newborn
HIV in case of maternal HIV infection follow
countries policy for breast feeding
HTLV infection is a contraindiation for breast feeding
HBV maternal infection baby should receive Ig and
HBV vaccination immeditely after birth
CMV May be found in milk of mothers who are
CMV seropositive causing symptomatic illness in
term infants is uncommon
HSV If active lesion on breast don’t feed
CONT’D…
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41. COW’S MILK
Associated with milk protein allergy
Occult blood lose in the stool
3 times higher in protein , 2 times in Na, iron
and linoliec acid are lower
High ratio of casein to whey protein
Calorie is comparable 67 calories/dl
Higher calcium and phosphorus in cows milk
=> Should be avoided in the 1st yr of life
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42. Complementary feeding should be started at 6 mn
Initially with semi solid foods
One food at a time
Include all the five nutrition components
Weaning cessation of breast feeding should be at
24 months
If not possible it can be as early as 12mns
CONT’D…
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43. COMPOSITION OF BREAST MILK VS
COWS MILK
Each 100ml of breast and cow’s milk contain the
following
Human milk cows milk
calories 67 67
water 87% 87%
carbohydrate 7.4% 4.4%
fat 3.5% 3.5%
protein 1.5% 3.5%
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45. ASSESSMENT OF NUTRITIONAL STATUS
Nutritional assessment is the tool by which
the nutritionist evaluates the patient for
Maintenance of normal growth and health,
Risk factors contributing to disease, and
Early detection and treatment of nutritional
deficiencies and excesses.
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46. Four types
Anthropometric
Biochemical
Clinical
Dietary
Various tests monitor different aspects of
nutritional status in each category.
Standards that are relevant to a specific
population are important.
CONT’D…
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47. 1. DIETARY ASSESSMENT
Dietary insufficiency or excess generally precedes signs
of biochemical ,anthropometric, or clinical deficiency
Quality and quantity of food intake and the macro and
micronutrients provided can be measured.
A number of methods are available for the collection of
information about food consumption.
The most common dietary assessment tools in clinical
practice are the
24hour recall,
3- to 7-day food records or
“Usual patterns" described by the patient or caregiver.
• It is helpful to use a combination of methods!
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48. 2. ANTHROPOMETRICS EVALUATION
Anthropometry is the measurement of physical
dimensions of the human body at different ages.
Comparison with standard references for age and sex
helps determine abnormalities in growth and
development.
Reference standards are derived from measurements of a
normal population.
Repeated measurements of an individual over time
provide objective data on nutrition, health, and well-
being.
Simple safe non invasive, less skill
Errors can be caused by poor technique and equipment.
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50. 3. CLINICAL EVALUATION
Severe nutritional deprivation is easily detectable in most
instances.
More subtle physical signs, which suggest less severe
chronic or sub acute deficiencies, are often nonspecific
for individual nutrients.
Thorough medical and dental histories and physical
examinations that show signs suggestive of nutrient
deficiency or excess should be recorded and described as
precisely as possible.
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51. 4. LABORATORY ASSESSMENT
Confirmation by biochemical means is crucial to
Diagnose subclinical deficiencies
Substantiate clinically evident over or under
nutrition.
Provide baseline data for monitoring response .
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52. 1. Hemoglobin and Red blood cell indices
2. Serum proteins
3. Cellular immunity
4. Vitamin concentration
5. Minerals
6. Nitrogen balance
7. Radiologic evaluation
8. Histopathology
CONT’D…
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